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Galileo’s Middle Finger: Book Review

5 Aug, 15 | by David Hunter

I recently finished reading Galileo’s Middle Finger by Alice Dreger a medical historian and ethicist (although she may deny the title) and since I found it both thought provoking, terrifying and inspiring I thought I would share a few thoughts and hopefully convince you to read it, since I think some of its content is a must read for bioethicists and people who view themselves as in some way trying to make the world a better place.


Brocher Foundation – a review

28 Jul, 15 | by David Hunter

For the last month I have been staying with 14 other academics on the shores of lake Geneva in Switzerland, free of charge thanks to the Brocher Foundation. I thought a review of the stay would potentially be of interest to others working in the field of medical ethics generally as it is an interesting opportunity that is available.

How to be a good (consequentialist) bioethicist…

6 Jul, 15 | by David Hunter

There has recently been a pattern of papers (and I am not going to identify which ones) which I take as being slightly embarrassing to academic bioethicists because they portray us in a less than flattering light because of the naive mistakes they seem to make, or the outlandish poorly argued claims they make. I have noted a trend for these to have come from relatively new, consequentialist bioethicists and being the helpful sort that I am, the aim of this blog post therefore is to help consequentialist bioethicists from falling into these pitfalls.


On Being a Hypocrite

1 Jul, 15 | by Iain Brassington

A piece appeared in The Atlantic a few days ago that aims to prick the perceived bubble of professional ethicists.  In fact, the headline is pretty hostile: THE HYPOCRISY OF PROFESSIONAL ETHICISTS.  Blimey.  The sub-headline doesn’t pull its punches either: “Even people who decide what’s right and wrong for a living don’t always behave well.”

I know that headlines are frequently not written by the person whose article they head, and so these won’t tell us much about the article – but, even so, I’m beginning to twitch.  Do I decide what’s right and wrong for a living?  I don’t think I do.  I possibly thought that that’s what an ethicist does when I was a fresher, or at school – but I’m not certain I did even then.  And even if I did, I discovered pretty quickly that it’s quite a bit more complicated than that.  For sure, I think about what’s right and wrong, and about what “right” and “wrong” mean; and I might even aspire to make the occasional discovery about right and wrong (or at least about how best to think about right and wrong).*  But as for deciding what is right and wrong?  Naaaah.

Anyway: to the substance of the piece, which – to be fair – is more moderate in tone, pointing out that “those who ponder big questions for a living don’t necessarily behave better, or think more clearly, than regular people do”.  That’s probably accurate enough, at least a good amount of the time.  I’d like to think that I’m thinking better about a particular problem than most people when I’m working on it; but I’m also thinking better about in that context than I would be at other times.  (Ask me about – say –  genetic privacy while I’m drafting a section of a paper on genetic privacy, and I’m your man.  Ask me while I’m making pastry… not so much.)  If we allow that I’m better at dealing with (a) specific moral question(s) while “on duty”, that won’t mean I’m not susceptible to the same intellectual shortcuts and fallacies as everyone else at least most of the rest of the time.  I’m probably almost as susceptible to them even when I am on duty.  I’d assume that the same applies to others in the profession, too.

The article does make great play of the apparent inconsistencies between what ethicists say and what they/ we do.  So there’s the finding about how many more say that eating meat is morally problematic than actually avoid it, and the chestnut about how ethics books are the ones most frequently stolen from libraries.**  At least there are decent sources cited – peer-reviewed papers like this one that are philosophically informed, to boot.

So: ethicists aren’t reliably better behaved than others.  I don’t think that should surprise us, though.  But, there’s a couple of questions into which we might still want to dig more deeply. more…

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.

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