The Status of Bioethics

There’s been a couple of things that’ve appeared on the net over the last few days that have revivified something that’s been niggling away at the back of my mind for quite a long time now: the status of bioethics as an academic discipline.

First there was Brian Leiter’s blog post.  Commenting on the oddness that has been overtaking the American Journal of Bioethics for the last couple of weeks (Not been keeping up?  Christian Munthe and Carl’s posts on the Fear and Loathing in Bioethics give a pretty good account), he points out that “[b]ioethics already has a fairly dim reputation in academic philosophy” – and he’s right: it does, even without the alleged strangeness at the AJoB.

And then there’s this interview with Hilde Lindemann in 3:AM Magazine, with this eye-catching passage:

A few years ago I was at a metaethics workshop, and over breakfast a male colleague and I made a game of ranking the different specialties in philosophy according to how prestigious they were – a ranking with a precise inverse correlation to gender. Here’s the list we came up with:

Philosophy of Mind, Philosophy of Language, and Metaphysics: The alpha-dominant philosophy, done by Real Men

Epistemology and Philosophy of Science: Done by manly enough men

Metaethics: Done by men who aren’t entirely secure in their masculinity

Ethics, Social and Political Philosophy: Done by girls

Bioethics: Done by stupid girls

Feminist philosophy, of course, is not philosophy at all.

The status of bioethics isn’t the primary concern of the interview, but it’s what jumped out at me; and – speaking as someone whose PhD was in metaethics in a very mind-and-language department, and who subsequently got work in bioethics – the ranking seems to be about right.  (I was warned at the start of my career that setting out down a bioethics path would make it hard to get a job in a “proper” philosophy department in future – a prediction that I think has something to it.  David Hunter’s recent move to a proper philosophy department is the exception that proves the rule, notwithstanding that his previous job was with a very good bioethics place.)

Bioethics employs philosophers, and makes use of philosophy; but it’s not enormously highly regarded as a discipline by philosophers.  Why should that be?  Does it matter?

Off the top of my head, I can think of a range of possible reasons of varying plausibility.

It might be because bioethics is “contaminated” by the real world.  Maybe the real world is for policymakers, not philosophers; they should follow in philosophers’ wake, but it’d be a mistake for philosophers to think that they have to get their hands dirty.  And maybe the suspicion is that being contaminated by the real world means making intellectual compromises – pure lines of thought can’t be followed, but have to be tempered by what’s politically acceptable.

There might be a degree of professional jealousy: bioethicists pop up on Radio 4 much more frequently than do meta-ethicists or logicians.  (This is the least powerful explanation, though there might be a grain of truth in it for some.  Incidentally: I’m still open to invitations…)

But there’s another possibility, and that’s that philosophy-department philosophers look down on bioethics because the standard of philosophy just isn’t very high.  And this possibility might be associated with a fourth: that bioethics is just too weighed-down with all kinds of other stuff.

I wouldn’t want to say which of these – if any – is the best explanation.  But there’s a part of me that wonders whether there might be something to the third and fourth points.  There are some very good philosophers working in the discipline; and some very good applied philosophy gets done under its banner.  But, every so often, there is some utter dreck that surfaces.  (I’m not going to identify anything: but we’ve probably all read papers that we think to be terrible, or seen conference papers that were just embarrassing for all present; we might even have reviewed and rejected papers for one journal and then see them pop up in another.)  And there’s quite a lot that, though it deals with matters of moral concern, isn’t really ethics as a philosopher would understand it.

In this light, while bioethicists’ openness to survey papers might be useful inasmuch as it throws a light on the context in which moral debates happen, it’s easy to see why non-bioethicists might struggle to see the point.  And these papers do, at least sometimes, go beyond their remit: it’s a bit of a parody to say that they go from a finding about what most medics think about a subject to policy recommendations in the space of a sentence – but we’ve all seen papers that come closer to matching that parody than we might like to admit.  Finally, though principlism might have its place, it does also pop up where it probably shouldn’t, and can be treated rather dogmatically.  (To nod towards, and subvert, Raa Gillon in the JME a few years ago: ethics doesn’t need principles.  It generates them, tests them, analyses them, criticises them, modifies them, worries about them… but it doesn’t need them.)

Oh, there’s one other possible explanation, which I’ve noted on these pages before (see here and here) – and that’s that anybody at all can call himself a bioethicist.  And while it’s true that the same applies to philosophers, or chemists, or whatever, there is a quality-control problem inasmuch as that bioethicists are frequently employed by medical or health institutions, and de facto are scrutinised by people whose expertise is not in ethics.  This gives shelter to incompetence.  Not – of course – to say that bioethicists employed by medical schools are incompetent: the majority is fine, and a substantial number is great.  But if an incompetent person happened to blag their way into a job (as sometimes does happen) it’s possible that they might take longer to ferret out than they would if they’d been in a department with different expertise.

Does it matter?  Some people working within bioethics might deny that it does.  They might point, for example, to the fact that bioethics is proudly interdisciplinary – perhaps even a non-discipline.  It welcomes philosophers, but also lawyers, sociologists, theologians, medics, and just about anyone else.  Having a low reputation among philosophers doesn’t matter because bioethics isn’t philosophy.  That’s not what we’re about, the thought might go.

Except that this doesn’t work.  Chemistry isn’t philosophy, either; but it doesn’t have a low reputation.  And the defence really doesn’t cover work in bioethics that is, inescapably, philosophy but philosophy of a low quality.

As to the question of whether it matters: I think it does.  I’m not blind to the possibility that that’s just because I still think of myself as a philosopher, and so would like to think that I stand a chance of having the respect of my peers.  And if they’re going to have a low opinion of me, I’d like that to be because they think I’m not very good at what I do, rather than because I do it at all.

But I also think that there’s more to it than that.  Even if – for the sake of the argument – we accept that bioethics isn’t reducible to philosophy, it doesn’t follow that philosophy is just one tool in the bioethical box.  Rather – for reasons that I’m hoping to publish in the near-ish future – it is central to bioethics, and vitally important.  You could have bioethics without at least some of the other disciplines that fit into the tent at the moment; but you couldn’t have it without philosophy.  Philosophy is uniquely capable of making sense of what we think, why we think it, and whether we should continue thinking it.  Bioethics is, obviously, a kind of ethics; and while ethics may be scrutinised as a discipline by other disciplines, and while moral behaviour might be scrutinised by other disciplines, ethics’ home – qua ethics – is within philosophy.

That’s why it matters if bioethics is poorly regarded by other philosophers.  Philosophers are the people best able to assess the standard of philosophical endeavour; and if the standard of philosophy within bioethics is low, and granted the importance of philosophy, then we’ll be faced with a danger that the general intellectual standard of bioethics is low, too.

OK – so I’ve sort of given away the gist of what I think I’ll be saying at the IAB in the symposium that David Hunter has put together with James Wilson and me (and Tom Beauchamp’ll be joining us!  And Mikey Dunn!  It’ll be the highlight of the conference…).  But Leiter is, I fear, kind of right.  Bioethics has allowed itself to be caught in the shallows.

  • Ben

    As far as I knew, bioethics doesn't have a low reputation. But then I'm no philosopher. Also, I think you missed the point, which is to highlight that 
    Hilde Lindemann is a rude, sexist bigot.

  • Samia Hurst

    I agree, and would add that this is true of (again some not all of) its empirical rigor as well.

  • Ooooooh-kaaaaaaayyyyyy… I think you may have misunderstood the game she was playing, but just in case…
    *heads to the bunker*

  • Stuart Oultram

    Hi Iain
    I agree (ish) with what your saying

    I, like you, have a philosophy background and like you chose to go down the bioethics route. For me it was the grounded nature of bioethics which attracted me to the subject (probably explains why I always liked moral and political philosophy as well [especially in the applied form]). Also as a lecturer in bioethics what I enjoy is its interdisciplinary nature, the fact that when I go to bioethics conferences I can have conversations with scientists, lawyers, healthcare practitioners ect. 
    That said I’ve encountered a bit of prejudice from philosophers and I’m willing to bet that there’s plenty of philosophers out there who would not consider me a philosopher or what I do as having anything to do with philosophy (although as someone who did duel honours I’ve encountered philosophers who think that because I didn’t do single honours philosophy not only am I not a philosopher but I can’t claim to have a philosophical background either ).

    I dare say being a bioethics person was a problem in the jobs market when it came to applying for jobs in philosophy departments (although there were occasions when I did get interviews). However, conversely I did find that in the academic world beyond the philosophy department being a bioethicist was pretty good in terms of the jobs I could, and have, applied for (I’m now a lecturer in bioethics in a medical school).
    Sadly in terms of how it’s regarded (esp. amongst philosophers) I think it is the interdisciplinary nature of Bioethics that is its greatest problem, although to my mind you can’t do it properly without being willing to talk to other interested parties so to speak (I also wonder if this has something to do with RAE and what will be REF placement as bioethics is tricky). Although as you say I’m sure there is also a perception that Bioethics is somehow easy or less intellectually challenging than other areas of philosophy but the idea that somehow bioethics only produces bad work while philosophers in other areas only produce good work is laughable in the extreme.

    Also, I have always had a suspicion that because bioethics tends to be more accessible to people (you don’t have to be an academic to have a conversation about abortion) than say the philosophy of language philosophers are likely to look down on it – “my god you talk in a way that’s understandable for non-academics!”

    On a related issue what saddens me the most about bioethics at the moment is (although I acknowledge this is based on my own perception)  that it’s greatest strength (it’s openness to interdisciplinarity) is being eroded by academic disciplines attempting to claim it as their exclusive territory with (I’m sorry to say) sociology and philosophy being the worst offenders.  

    Although finally like you I think it is important that philosophy has a central role to play in bioethics – but then again I would say that wouldn’t I

  • Ben

    In hindsight, Hilde does sound more like a girls name.

  • Ben

    *turns on sarcasm detector*

  • Neil Levy

    Ignoring Ben's odd claim (is he a bioethicist? That would explain a lot!), my two cents. I think there are two things going on here. One is philosopher's disdain for the popular, which is sometimes unmotivated by anything more than snobbery. But the disdain is also motivated by the fact that a lot of popular work isn't very good and some is embarrassing. And (this is the second thing going on) some of this public philosophy is done by people calling themselves bioethicists. This not only contaminates people's impression of bioethics, it lowers the standard generally. No matter how smart you are, you will not do your best work if you are not stimulated by smart arguments from others. As a consequence, I think the best bioethics is done by people who do something else as well (eg, Allen Buchanan).

    Oh, one point of disagreement. Philosophy of mind has an increasing proportion of women. It's (no longer) a good example of high status philosophy done by alpha males alone.

  • Hmmm…  You've not actually read the interview, have you?  Or even seen the big photo that's at the top?

  • I completely agree – and I think that you and Stu are saying very similar things.  I hadn't realised that women are getting a higher profile in the PofM – I have to admit that I'm still a bit raw after my last incursion into that field, and haven't been keeping up…

  • Neil Levy

    Here is an incomplete list of women working in Phil Mind:

    My impression is down the naturalist end, the proportion of women is higher than in the more a prioristic end. But that may reflect my patchy knowledge.

  • Stuart Oultram

    re your IAB symposium I should add that this debate (status / future of Bioethics) is also the central theme for this year’s EACME conference which is being hosted by the Centre for Ethics in Medicine at Bristol University.
    As for the issue of non-philosophers calling themselves bioethicists I'm genuinely conflicted about this.
    On the one hand as someone with a philosophy background I'm instinctively wedded to the idea that Bioethics is strongly grounded in philosophy and I agree(ish) with what you and Neil say.

    Yet on the other hand Bioethics is also inherently interdisciplinary (indeed it's what I love about it) but because of that it makes it hard to complain when people from academic backgrounds other than philosophy get involved in the conversation (it would be like telling Doctors that they can't talk about medical ethics because they didn't do a philosophy degree).

    As I've said in my other post the interdisciplinary nature of bioethics is something that should be celebrated and protected. 

    still I think i'll stop there as I'm starting to sound like a charcter from one of those heart warming TV movies you get on Sunday afternoons. 

  • Interesting… thanks!  I can only assume that I saw “Philosophy of Mind” in the title when that was posted, got scared, and closed the window without reading further…

  • Yup.  Ta.

  • Alan Regenberg

    Great post, and important terrain – i'm sorry i'll miss your iab talk.

    I think your post points towards this – but to be explicit. I think one of the problems is in bioethics being viewed as a discipline rather than something more like a 'field of study'/focal point/topic/etc/. ie, it isn't particularly helpful to confer the professional title 'bioethicist' – when bioethics is inherently interdisciplinary. It's hard to know what sort of expertise to expect from a 'bioethicist' and thus, how to appropriately evaluate the quality of their scholarship. 

    If the field, such as it is, were more explicitly committed to not being a discipline, but interdisciplinary – then the finer grained focus on these origins might discourage bad philosophy, weak empirical rigor, etc.Another point of clarity that i think consistent with your post – philosophy may be necessary for good bioethics, but i dont think it's sufficient.  you need philosophy plus…  with the 'plus' expertise(s) perhaps being more context dependent, yet just as essential.

    Finally – to risk sounding defensive – i do also think there's also room in the field for  bioethicists (such as myself) – who are not rooted in any other field, but serve as translators/bridges/the glue for the participants from different disciplines.

  • The doctors point is interesting, and does prompt a range of other questions.  For the record, I have met doctors who think that ONLY doctors should talk about medical ethics, because only they're sufficiently medical.

    There is a sense in which everyone's an ethicist – everyone makes judgements about proper behaviour.  So, to that extent, there's no reason in principle why any ethical discipline can't be opened out.  And there're likely to be times when we'd all be better off for that having happened.

    However, there're still likely to be some who're clearer thinkers than others, and whose judgement is therefore in some sense better.  It strikes me that philosophy is likely to be one of the disciplines that gives people an edge.  And it might be the best at giving people an edge.  That's not to say that others aren't doing ethics – just that being philosophically competent might well make you better at it.

    And in that sense, why shouldn't people accept the expertise of experts?  A lung doctor would defer to a stomach doctor on matters of the stomach; he might know the broad terrain, but ought to admit that he won't be as incisive a diagnostician than his colleague.  Another doctor would defer to the builder when it comes to the construction of her new porchway.  Why should bioethics not exhibit a comparable hierarchy?

  • adam Hedgecoe

    Iain, thanks for a great post. I agree with your point that bioethics has, at its core, an unavoidable link to philosophy. Of course, for some us, that’s part of the problem.

    Way back in time when Tom Wilkie was setting up the Wellcome Trust’s biomedical ethics programme, he had an explanation for why the funding focus was going to be on the social sciences: because good philosophical bioethics is hard to do well, while social scientists find it easier to say original things in this area (we look at a new disease group/clinical population for example).

    My own movement from philosophical bioethics (I have an MA from Hull) to sociology was driven in part because SO MUCH bioethics at the time was repetative and ignored what everyone else had already written. The assumption seemd to be that if you said something as a bioethicist, even if loads of other peopele had already said much the same thing, you were still being original.

    I think this is still a strong theme in a lot of bioethics writing: I’ve written about the problem of nonoriginal reasoning in bioethical debates around pharmacogenetics, but of course, ‘proper’ philosophers may have quite a different set of complaints about the rigour of bioethics.


    adam hedgecoe

  • Keith Tayler

    Stephen Toulmin famously believed that medical ethics saved the life of ethics. It is, I believe, a pity that medical ethics has been subsumed into the weirdness that is bioethics. I do not think bioethics will kill off ethics, but it is not surprising that many philosophers wish to keep their distance from many of the debates in bioethics. Rehashed arguments for eugenics, demands for research into immortality, claims that humanity can be saved if we quickly achieve a 2% increase in IQ or “moral enhancement “, predictions that we will upload our minds into computers by the end of the century, and all manner of other wacky sci-fi claptrap cannot be counted as being “proper” philosophy. For sure there are many serious debates within bioethics but most of them would answer to the name of medical ethics, research ethics, or just plain old practical ethics. So I welcome the thought that some are having that the days of bioethics might be numbered (given the amount of money that is thrown at it I have my doubts). Not sure about your “contamination” of the real world problem. As we have discussed before, armchair thinking is as prominent in bioethics as it is in proper philosophy. One of the reasons why bioethics should be dumped is that it has never made a proper philosophical attempt to understand “practical” philosophy. The relation between theory and practice, the doxa, the problem of description, interpretation, context, etc., have received little attention. This might take some hands-on experience which is of course an anathema to some proper philosophers. However, professional philosophers that have only been academic philosophers are seldom any good (far too political). Who knows, practical ethics could save the life of philosophy by dragging it out of the armchair.

  • Keith Tayler

    I do not intend to get involved in the furore that is raging under Savulescu’s post, but it does illustrate why bioethics is pretty much intellectually bankrupt. Rehashing the very poorly argued thesis that supports “after-birth abortion” is scrapping the barrel. I object to Savulescu defence of this “cut and paste” paper and am amazed that he thinks'More than ever, proper academic discussion and freedom are under threat from fanatics opposed to the very values of a liberal society.’ More than ever! Surely he cannot be so insulated from the world to have missed the serious assaults on the values of a liberal society. All very silly. 'More than ever, proper academic discussion and freedom are under threat from fanatics opposed to the very values of a liberal society.’ More than ever! Surely he cannot be so insulated from the world to have missed the serious assaults on the values of a liberal society. All very silly.