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Navel-gazing

Questions to which the Answer is Yes

28 Nov, 14 | by Iain Brassington

Over at Practical Ethics, Charles Camosy asks a question: Can bioethics be done without theology?

Yep.  It can.

Well, that was quick and simple.

But – oh, all right: I probably ought to say a bit more.  Now, Camosy’s post is quite long, and that means that if I want to scrutinise it in any detail, I’d have to generate something at least as long.  I’m not sure if I – or any reader – has the patience for that, so what follows is probably not going to be without the odd gap.  All the same, this post has turned out to be something of a monster in its own right – so it might be worth going to make a cup of tea first if you intend to read it.

The tl;dr version is that I think that Camosy’s argument is fallacious in several places.  And though I’m arguing from a position of godlessness, I think that the problems ought to be apparent to those who do have faith as well.  With that caveat issued, here we go… more…

Paternalism up a Mountain

12 Aug, 14 | by Iain Brassington

“Paternalism” is one of those words that has a hell of a lot of power.  On several occasions, I’ve seen it used as a trump to shut down an argument: saying “But that’s paternalism” is, at least sometimes, treated as a way of showing that anyone arguing in favour of the allegedly paternalistic action is an imbecile, and has therefore lost the argument by default.  I suspect that this is due to a bastardisation of the (already iffy) “Georgetown Mantra”; but it does seem to be a position horribly common in medical schools.  It’s also very unsophisticated.  Whether or not something is paternalistic seems to me to be less important than whether it’s justified.  Something might be unjustified, and the reason for that might be because it’s paternalistic; but it doesn’t follow from that that no paternalism could be justified.  In just the same way, too much bleach or bleach in the wrong place is something you’d want to avoid; but it doesn’t follow that you should avoid bleach at all times and at all costs.

I want here to tell you a story based on something that happened just over a week ago. more…

Testing, testing…

24 Mar, 14 | by Iain Brassington

So, yeah.

It’s been a bit quiet here, hasn’t it?

There’s been a range of reasons.  Mainly, it’s had to do with David and I both having to do (whisper it) real w*rk, and that’s got in the way.

And then WordPress went a bit odd, which made it impossible to post anything.  (Part of the reason for this post is to confirm that I can publish something.)

And something else, too, from my personal perspective: I’ve been blogging here since 2008, and it’s hard to stay grumpy for that long.  Even for me.  So think of recent quietness as a sabbatical.  I think my grumpiness is recharged now, though.  So there’ll be a guest post going up soon, and then – I hope – back to something like normal from me.

Hello, hello; it’s good to be back.  I’d post a link to a vid for that, too, except for the unfortunate associations with Gary Gli…  Wait: what?  The Glitter Band is still touring?  Good grief.  Well, if they can keep going, I have no excuse, do I?

Still can’t embed videos, though…

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

17 May, 13 | by David Hunter

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.

Kelly Hills, Data Miner

7 Nov, 12 | by Iain Brassington

Kelly Hills has been data-mining – collecting and collating information about the frequency with which certain terms appear in paper titles in three journals: the JME, Bioethics, and the AJoB.

I was going to say that the charts are not much use, but that they are pretty and quite cool; and I was going to add that their lack of utility doesn’t matter at all because prettiness and coolness is sufficient to make them worth looking at.  Not everything worthwhile is worthwhile because it’s useful, after all.  Being a philosopher, I have to believe that.

But then it occurred to me that there probably is some utility to them.  Taken with some care, they help us to see what is held to be important by people publishing work – and, I suppose, they might also help decide which journals are more receptive to certain topics (or, conversely, which journals are saturated with them).

Here’s what the JME‘s chart looks like:

The image isn’t perfect, of course: because size is a mark of brute numbers and the algorithm that generates the image isn’t sensitive to context, “ethics”, and “ethical” get separated, when the reality might not indicate that they merit separate consideration.  “Euthanasia” gets only a small amount of attention – which tells us something about the heat-to-light ratios in debates on the topic.  It also gives some support to John Coggon’s idea that it’s getting hard to find anything new worth saying in that particular field – though I’d’ve thought the same, and more, would apply in respect of consent, and that seems to generate a heck of a lot of attention.

Stacey Swimme reports that: Ethicist Reports: Prostitution is Not Harmful

4 Sep, 12 | by David Hunter

Stacey Swimme a political advocate for sex workers in the US has written a rather nice response piece to a paper recently published in the JME: Is prostitution harmful?

You can read her response here: ethicist-reports-prostitution-is-not-harmful

Hat Tip to Christian Munthe for picking up on this.

Philosophy, Bioethics and Otherworldliness

31 Aug, 12 | by Iain Brassington

Hmmmm.

So Brian L picked up on Catarina’s post that picked up on Brian E’s post that picked up on the ever-simmering stuff about male circumcision – and the American Academy of Pediatrics’ latest policy position in particular – with the comment “Philosophers are a bit unworldly, but this is still quite something”.  I take the implication of that to be that, even by the standards of philosophers, this debate is abstract and abstruse and perhaps even a little omphalosceptic.

The comment reminds me of a conversation that Muireann Quigley and I had with someone – I can’t remember who – a couple of IAB’s ago: this unknown person – whom I think was a medic rather than a philosopher – was wondering aloud about the number of papers on things like enhancement, and IVF, and so on, and whether there weren’t more important things for bioethicists to think about – notably what to do about the various things that actually do directly threaten the life and welfare of real people right now. more…

Bioethics – a discipline without a natural home?

18 Apr, 12 | by David Hunter

This post is inspired by this excellent and challenging article by Carl Elliot where he asks why should students study bioethics at scandal plagued institutions such as his own University of Minnesota (I said it was challenging).

One of the problem he notes is that bioethicists in scandal plagued departments such as medical schools rarely speak out publicly or critically about the scandals and suggests in this lovely paragraph that there might just be a conflict of interest at play:

“Many university administrators seem to think that leaving a stack of cash on the table for the bioethicists is a good way to make amends for wrongdoing. Bioethicists don’t usually complain.  When the Presidential Commission for the Study of Bioethical Issues looked at the issue of making reparations to victims of unethical research, it suggested that reparations do not necessarily have to mean monetary compensation to victims. Instead, they may mean more funding for bioethics. For example, when the Clinton administration apologized on behalf of the federal government for the Tuskegee syphilis study in 1997, it also announced a grant initiative to establish a bioethics center at Tuskegee University.  Whether the victims of unethical research see a bioethics program as fitting compensation is not for me to say.”

Relatively recently we have seen an explosion of new bioethics centres in the UK, fuelled in part by funding bodies desires to establish Centres of excellence, which saw much funding in bioethics consolidated into very large amorphous grants. I wondered at the time whether this was good for the discipline – since it effectively left isolated ethicists out in the cold in regards to seeking funding.

With no disrespect intended for those in Centres funded in this way it doesn’t seem to me that this has worked as a strategy – those who were doing good work continued to do good work, those who weren’t… So it seems the idea of an Ethics Centre is in twilight, after what happened at Keele, and in other places the idea itself seems to be going out of fashion. I doubt we will see the end of ethics centres altogether, no doubt Oxford will keep inventing new ones to get even more pots of money, and some of the strongly established ones will survive, but will we see new ones? Or more posts at existing ones?

Outside of centres there seem to be three main places where work in bioethics is located in UK universities (I’ve excluded sociology since with rare exceptions most of the work carried out in bioethics by sociologists is either non-normative in nature or at least ought to be non-normative in nature):
1. Medical Schools
2. Law Schools
3. Philosophy departments

And while each of these has strengths they also have significant weaknesses. The first challenge bioethics faces is that it lacks an obvious home in regards to the REF – without a specific category people will tend to be submitted under whichever department they are associated and there are legitimate concerns about whether bioethics will be fairly evaluated under any of these categories.

Medical Schools offer the advantage of being at the coalface – however as Elliot notes this face can be pretty ugly. I know in my times at the coalface I was asked (and refused) to do some fairly questionable things – including trying to bias the outcome of a supposedly independent audit. They can also be academically isolating – unless you are in a centre that is part of a medical school you are unlikely to have colleagues who are directly interested in your research. Even in such a centre you can expect to be a small part of the overall school – the sort of money, respect and influence a bioethics centre can bring in pales in comparison to other units in a medical school typically.

Law Schools are where many of the existing centres are based and can be fruitful homes for bioethics since they facilitate a particular approach to bioethics – namely a case driven legal analysis approach. There can be some strong synergies here between lawyers and philosophers and good collaborative work. However there is also the risk that bioethics is not typically central to the concerns of a law school or more importantly its undergraduate students, so without a strong postgraduate offering it is unlikely that law will be a comfortable home for a bioethicist.

Philosophy departments are where historically most bioethics was based, and given that many approach bioethics from this perspective it provides a natural home for bioethics. Except of course there are worries about how well applied ethics will do in a philosophy REF submission, a risk of being too “philosophical” ie losing touch with the coalface and perhaps a certain amount of snobbishness about the topic area – I’ve heard it suggested by colleagues that the courses I teach mustn’t be as hard as their courses since three times as many students take mine.

So it seems like there isn’t an easy natural home for bioethics – perhaps unsurprising given the inter-Disciplinary nature of the topic area. I have some sympathy for the idea of a virtual centre – where individuals in the institution in different schools or departments form an alliance and come together regularly to discuss papers, apply for grants and work together, but that typically requires some institutional support to make it work.

So what do you think? Where should bioethics be based?

The Status of Bioethics

24 Feb, 12 | by Iain Brassington

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?

more…

Henrietta Lacks and “Enchanting Rhetoric”

7 Feb, 12 | by Iain Brassington

Note: There’s a couple of errors of interpretation in this post.  I’m not going to re-write it, because I wrote what I wrote, and it’s in the public domain, and I don’t think it’s all that dignified to pretend that one never makes blunders; it’s better to acknowledge them, take the hit, and move on.  But please do have a look at Rebecca Skloot’s response in the comments, and at my answer to her. – IB, 8.ii.12

*     *     *     *     *

Since I read it in the autumn, there’s been a few things nagging at the back of my mind about Rebecca Skloot’s The Immortal Life of Henrietta Lacks.  A few things that don’t seem quite right somehow; and prompted by Pär Segerdahl’s post on The Ethics Blog, I’m tempted to see if I can put them into words.

For those who haven’t read the book, it deals with the story of how it was that an apparently immortal cell culture line, HeLa, was obtained.  The cells were taken from a cervical tumour that went on to kill one Henrietta Lacks, a poor black woman who lived near Baltimore.  During the course of her treatment, a sample of cancerous cells was taken for testing, as was a sample of healthy cells.  (“HeLa” gets its name from the convention of naming culture lines by contracting the name of the person from whom they’re derived.)  These biopsies were apparently unconsented.  But what’s important about them is that, whereas most cell lines at the time died fairly quickly, the cancer sample kept on dividing and dividing.  The HeLa strain proved to be important in all kinds of areas of research.  Doubtless, some of this research has made some people very wealthy.  Yet Henrietta’s descendents have seen none of this profit.  Indeed, many of them are not much more enfranchised today than a black woman would have been 60 years ago; they weren’t even aware that there was such a thing as HeLa.

So what’s the problem?

One of them is definitely stylistic.  I have problems with something that Skloot thinks is a virtue, which is that “dialogue appears in native dialects” (xi).  I don’t share the notion that it’s in any way dishonest to polish out people’s linguistic infelicities, just as one would polish out all the ums and ahs and placeholders in everyday speech.  And I can’t shake the feeling that the professionals who get speaking parts in the book have had their speech tidied; though it’s probably true that the higher your social status, the less susceptible you are to malapropisms, I don’t believe that the educated people directly quoted in the book were always grammatically perfect and never used colloquialisms.  But this is a minor quibble.

What’s more nagging – and potentially more interesting from an ethicist’s point of view – is a question about why any of this is particularly important. more…

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