Say twenty hail Autonomy’s and reflect on what you have done – bioethicists as having some, but not priestly authority.

Nathan Emmerich, occasional commentator here at the JME blog has recently published an interesting piece in the Guardian which argues against us taking bioethicists as having a particular type of expertise. While I enjoyed and agree with much of what he argues I do have a couple of quibbles – in particular I worry that the emphasis on inclusiveness and democracy could in effect lead to the exclusion of the bioethicist, which I think would be a mistake.

The type of expertise he argues against bioethicists having is basically what I will refer to as authoritative expertise – someone who has authoritative expertise in a particular field ought to be deferred to when there is a disagreement – their opinion is “better” than ours as lay decision makers. So for example when deciding how long an object is, and whether it will fit in the boot of our car, we ought to defer to the chap with the tape measure, since their measured judgement is better than ours.

I use this example for a reason – Emmerich focuses on knowledge based expertise (no doubt because it is easier to explain to the lay public…) but this isn’t the only form of expertise that warrants some deference there is also expertise which is performative (in this case the act of measuring well). I’m inclined to think that if bioethicists deserve any deference it will be due to their performative expertise, rather than their knowledge.

Emmerich suggests however that bioethicists should not be taken as having authoratative expertise because he thinks knowledge about morality is more like knowledge about aesthetics than knowledge about facts. Hence we ought to give no more weight to the bioethicists opinion about an ethical issue, than we do someone heavily steeped in the Art’s worlds opinion about a piece of modern art – they have a “sophisticated” view but that doesn’t tell me what I should think about the piece.

He thinks bioethicists should conceive of themselves as thinking alongside, working with people to work out what to do rather than telling them what to do. He argues that commenting on the biosciences is particularly dangerous for bioethicists because it is different from medical practice in that its practice isn’t inherently involving ethical decisions – hence he claims bioethicists are tempted to make pronouncements and decide about ethical issues in the biosciences rather than work with bioscientists. As an aside I think this is exactly wrong – I doubt the empirical claim is true (ie that bioethicists proclaim and make decisions more about issues in bioscience than medicine) and I think the process of conducting bioscience does involve constant ongoing ethical decision making – it’s just a different sort of decision making, about the responsible conduct of science and dissemination rather than the treatment of patients. Nonetheless lets leave that aside.

So far so good – I don’t think bioethicists ought to be taken as overwhelmingly authoritative – the most uncomfortable experience I’ve had sitting on an ethics committee was when the committee treated me as a moral expert and simply deferred to my opinion in each case – it took awhile to break them of that. But I disagree with Emmerich about why this is the case. This is in part because I object to the metaethics he is assuming – the reason we find the expert in Art uncompelling is that the general opinion is that there is no truth of the matter when it comes to aesthetic judgements. And presumably Emmerich thinks the same about morality.

I broadly take the same view as Hobbes does here:

Of Man, Being the First Part of Leviathan. The Harvard Classics. 1909–14. Chapter V.

Of Reason and Science
And, as in arithmetic, unpractised men must, and professors themselves may often, err, and cast up false; so also in any other subject of reasoning the ablest, most attentive, and most practised men may deceive themselves, and infer false conclusions; not but that reason itself is always right reason, as well as arithmetic is a certain and infallible art; but no one man’s reason, nor the reason of any one number of men, makes the certainty; no more than an account is therefore well cast up, because a great many men have unanimously approved it. And therefore, as when there is a controversy in an account the parties must by their own accord set up for right reason the reason of some arbitrator, or judge, to whose sentence they will both stand, or their controversy must either come to blows, or be undecided, for want of a right reason constituted by Nature; so is it also in all debates of what kind soever. And when men that think themselves wiser than all others clamour and demand right reason for judge, yet seek no more but that things should be determined by no other men’s reason but their own, it is as intolerable in the society of men as it is in play after trump is turned, to use for trump on every occasion that suit whereof they have most in their hand. For they do nothing else that will have every of their passions, as it comes to bear sway in them, to be taken for right reason, and that in their own controversies, bewraying their want of right reason, by the claim they lay to it.

The point here is that when there is moral disagreement claiming to have the right judgement – the right reason – is like cheating at cards by claiming whenever it is your turn that the trump suit is whichever suit you have the most of in your hand. In other words the dispute is about which reason is right, hence simply saying “mine” does nothing to resolve this. But this view of morality is a bit more complex – I’m inclined to think there is a truth of the matter, it just isn’t easy to access, nor is it easy to show to others. Hobbes solution to the problem of irresolvable disputes is to establish an absolute sovereign who we both agree to defer to, and then we go with whatever they say. I roughly think that is right, with the conditional (that I suspect Hobbes would agree with) that we try to ensure that our absolute sovereign comes out with an answer that is as close to being right as possible. And given the complexity and the difficulty of divining moral truths that deliberation, debate and argument has a better chance of getting the “right” answer than having someone sit by themselves in a room and ponder it.

I think the bioethicist is in a position to contribute something useful to such deliberation, debate and discussion in two ways, both of which require some expertise – even if it is not totally authorative expertise. The first way is this, the bioethicist I assume will have access to more knowledge both about what has been argued in regards to ethical theory and in regards to moves in applied ethics. Knowing these moves can short-cut some discussion and debate by showing paths that will lead nowhere – the implications and consequences of particular arguments. This I think is as useful an input as that of someone who – trained in an empirical discipline – contributes their knowledge of their discipline and its findings to the debate about a particular issue. Secondly, and perhaps more importantly, a bioethicist ought I think to have a certain sort of performative expertise. This is an expertise at argument and debate, at critical thinking, questioning assumptions and being aware just how arguments go wrong, in effect this is philosophical expertise.* Is this authoritative? I think at best only partially – largely it gives the bioethicist the authority to suggest that particular lines of pursuit won’t be fruitful. In any case I think philosophical reasoning is inherently democraticising – because of its origins and use in debate and discussion it ought to aim to up skill and inform everyone in the discussion, rather than claim special status – to go back to my man with a measuring tape analogy the good bioethicist tries to provide everyone in the discussion of whether object x will fit in the car boot with a tape measure for themselves.

There is a more general line of argument which can be drawn from Emmerich’s argument against expertise in regards to bioethicists which is an argument against involving “experts” in making bioethical decisions – in effect Emmerich implies that these being decisions by experts, even committees of multiple types of experts is anti-democratic – because it involves having others making moral decisions for “us” when that is actually our responsibility. Now of course a good bioethicist would question the assumption that being anti-democratic is bad, but I’m going instead to suggest that having others decide for you can be, and in this case is, perfectly democratic. Direct democracy is well known to have certain limitations, not the least that the electorate often wants contradictory things for example that given the option people will opt for lower taxes and higher social spending… I suspect that bioethical issues are an area where direct democracy will be unsatisfying – either because of intractable disagreements within the population (think abortion) or because the technical nature of the decision means that predictably decisions will be made that lead to outcomes that few in the population would endorse. In these cases it would seem sensible to agree to establish a group of decision makers (in Hobbesian terms a sovereign) to delegate this decision to. We do this in regards to most political decisions and hence it seems that establishing a public decision making body such as the HFEA can be a perfectly democratic response, as long as it is established in the right way (in this case in a process where it occurs as a result of legislation passed by a duly elected government). Such a body may not have the moral authority of the expertise of knowing the right answer but they are our best bet at getting somewhere close to it, and hence we ought to accept their decision making. Of course Emmerich is right to think that this needs to be a public facing process which should take into consideration public opinion and input from individual members of the public, but these should be taken as no more authoritative than individual expert’s opinions. Otherwise we are in effect allowing the public (or more accurately a tiny unrepresentative vocal bit of the public) claim “right reason”, when this isn’t warranted.

Emmerich identifies a real temptation and danger for bioethicists, it is tempting to act as moral authorities, and broadly speaking illegitimate to do so. But there are dangers in the other direction as well which we need to be wary of as well I’m inclined to think direct democracy worship is no better than the autonomy worship than many current bioethicists practice.

* I am in this piece using a less than inclusive definition of bioethicist – meaning someone who has at least some training in thinking philosophically about ethical issues – this doesn’t have to be formal education of course,and could be self taught,  but the argument I am making depends on bioethicists as having this – those who work simply empirically on issues in bioethics but have no normative engagement (if such a person actually exists) would at least by the standards of this piece not count as a bioethicist. Sorry.