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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?


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…

I Met a Relativist, and I’m Baffled

28 Oct, 11 | by Iain Brassington

Until fairly recently, I thought I’d met people who could be described as moral relativists.  But I recently met someone who’s made me wonder whether they were the real deal.

The “relativists” I’d met previously were, broadly, people who make the claim that moral statements do not have the same universal applicability as statements that we might make in respect of, say, maths or chemistry.  Thus an appeal to something like fundamental human rights may not be an appeal to anything all that fundamental after all.  This is a view with which I have a certain amount of sympathy, to be honest: the part of me that’s read too much Marx and Nietzsche is open to the idea that what we take as basic morality may be simply a trick of the historical light.  On the other hand, I do think that there’re bits of moral philosophy that do have a passing resemblance to some aspects of mathematical reasoning, inasmuch as I think that there’re certain rules concerning validity in deduction, analogy, and so on that do not depend on the particularities of a particular culture.  The fact that these rules, when applied to the natural sciences, allow us to make (a) predictions about the world that are true, and (b) machines that work is evidence that there’s something to them; and if there’s something to them, their application in philosophy seems plausibly to be reliable.  On this model, there’re at least some elements of Western philosophy that have come to be dominant not just because of Western political hegemony, but because they’re right – or at worst less wrong than our unexamined intuitions.  That’s why they stayed as part of Western philosophy, and we might expect that any coherent philosophy would settle on them sooner or later.  And so there might – no more than might, admittedly, but might all the same – be moral “quasi-facts”: moral statements that have a universal validity not because of any realist appeals, but for the much more idealist reason that there’re certain conclusions that follow inevitably from clear thinking.  Again, we might be much better at the negative whittling away of false claims than the positive assertion of true ones, but even that counts for something, and it’s at least truth-tracking.

One can accept this kind of relativism while still wholly endorsing the statements made by one’s culture.  So, for example, you might think that human rights aren’t fundamental, but still be willing to campaign for their extension.  By analogy, a football fan may admit that he’s devoted to his team only because it represents the town where he grew up; but that won’t stop him cheering for it.  And you might even be able to produce not just reasons why you believe this or that, but also reasons to believe it – or, again, at least reasons to reject its negation.  After all, even if there’s no actual universal standard, it doesn’t follow that neither is there buffoonery.

And this brings me to the relativist with whom I was speaking the other day. more…

Assisted Suicide and the Courts: Lather, Rinse, Repeat.

22 Aug, 11 | by Iain Brassington

“Martin”‘s story has been generating a reasonable amount of media and blog attention over the lat few days.  (Udo Schuklenk considers some of the Telegraph‘s coverage, for example, and finds it severely wanting.)  Paralysed after a stroke, “Martin” wants help to end his life; but his wife doesn’t want to be the one to help him.  The next best person would be one of his medical attendants.  According to the DPP’s guidance on assisted suicide, though (which I examined here), prosecution is more likely  if

[t]he suspect was acting in his or her capacity as a medical doctor, nurse, other healthcare professional, a professional carer (whether for payment or not), or as a person in authority, such as a prison officer, and the victim was in his or her care.

“Martin” claims that this is unfair discrimination, and has launched a legal bid to ensure that medics wouldn’t face prosecution for assisting his suicide.  You’d have to have a heart of stone not to sympathise with his plight.  Cast in a certain light, I think he’s got a moral case (though perhaps on slightly more slender grounds than might appear at first: as far as I can tell, he’s got noone lined up who would be willing to help; and absent a willing assistant, the bid looks empty, since it’s one thing for Smith to be entitled to assist Jones’ suicide, but another entirely for Jones to be entitled to Smith’s help).  Whether he’s got a legal one… I’m really not so sure.  And so I think I know how this is going to go.

The judges will hear his case.  They’ll look at the law.  They might acknowledge that they can see “Martin”‘s legal point.  They’ll express heartfelt sympathy.  Then they’ll tell him that there’s nevertheless nothing they can do without a change in the law.  And they’ll tell him to go home.

There’ll be a bit of a media flurry; but the law on assisted suicide won’t change, and the ethical arguments won’t change, and the minds of the people making the arguments won’t change, and “Martin” will still be in his bed.  And in a couple of years, someone whose case is similar but different enough will emerge asking the same sort of thing, and we’ll go through it all again.

Lather, rinse, repeat.

Is it OK to Laugh?

15 Dec, 10 | by Iain Brassington

Guy Francis has a website and a YouTube channel.  Some of the stuff on his YouTube channel is him singing along to pop songs.  What’s noteworthy is that Francis also has quite severe Tourette’s syndrome.  This makes his karaoke somewhat unique.  (For a sample, take a look at this.  It’s almost certainly Not Safe for Work.)

Now, Francis’ attitude to his Tourette’s is pretty plain: you don’t name your website if you think that there’s no levity to be had from it.  From the short communication I’ve had with him, he seems to see his situation as simply being at one point in a big picture of general human oddness – which I think is absolutely right.  (“My point is no one escapes, everyone is ‘comedy gold’ within their group. It’s not cruelty, it’s life.”  Damn straight.)

But there’s something slightly disconcerting about watching the vids. more…

On Nailing one’s Colours to the Mast

13 Sep, 10 | by Iain Brassington

“You’re a Kantian,” people in my department tell me.  At least, I think that’s what they say – I’m assuming that there’s no comma before the final syllable, and that I’ve got all the vowels right.  I don’t think I am, actually (a Kantian, that is – I couldn’t comment on the other option).  I’m fascinated by Kant, and think his moral system is magnificent, but I’m not sure it’s correct: I don’t buy the stuff about the nature of the will, I think he occludes the difference between reason and reasonability, and so on.  Rather, my hunch is that it’s like a magnificently-crafted carriage clock in which some of the more important cogs have the wrong number of teeth.  The mechanism may work smoothly and be a wonder of engineering, but the piece itself is deeply unreliable.

I’m not sure what my theoretical starting point is – I suspect it’s a kind of weirdly mutated Aristotelianism, laced with a bit of Kant (whom I think has more in common with Aristotle than he’d ever have admitted anyway).  Having said this, I’m reasonably sure that I’m a non-consequentialist, and quite possibly an anti-consequentialist to boot.

At least, that’s what I’d say if you asked me.  In practice, though? more…

Concord in Ethics and Bioethics

24 Mar, 10 | by Iain Brassington

Over at Pea Soup, Ralph Wedgwood makes an interesting claim:

I suspect that on several issues that are the focus of fierce moral controversies today – such as homosexuality and the death penalty – there is significantly less disagreement among contemporary philosophers than in the population as a whole. Indeed, I tentatively suggest, the historical record indicates that philosophers have been pushed towards the liberal view on these issues by some fundamental features of philosophy itself.

To what extent is this true?  more…

Questions, questions…

25 Jan, 10 | by Iain Brassington

In response to the post below about circumcision, “IntactByDefault” asked a number of questions.  I think that they merit a thread of their own, although I’ve touched on some of the issues before.

Is it not the case that, short of legislation, the role of bioethicists is to put a check on the potentially unethical behaviors of those who practice medicine on humans?

Why have the rights of male children been subordinated to such issues as cultural habit and medically superfluous parental preference or belief?

Why aren’t bioethicists, including yourself, relentlessly shaming and using any other tool at your disposal to correct the behavior of medical practitioners who modify the genitals of children without meeting the ethical standards developed to protect the rights of minors?


When the Witch Asks a Question, I Can’t Resist

4 Nov, 09 | by Iain Brassington

In the replies to this thread, The Witch Doctor asks this:

A Scenario:

Apparently there are some sites on the web just now claiming that the world is going to end in 2012. Some teenagers are becoming agitated.

I don’t want to be around when the world ends, so I’m going to drink some poison and present to my local A and E department on Halloween 2011. If conscious I will refuse treatment but ask to be kept pain free and as comfortable as possible while I make a “dignified exit” anticipating the end of the world.

I will also carry an AD in case I become unconscious before arriving at A and E.

If conscious, I will be assumed to be competent until proven otherwise. I will pass the competency test. I do not have a mental health problem. I have just been spending too much time surfing the web.

Should the medical staff allow me to die when the time comes and if not, why not?

It’s a good question – though I’d rephrase it slightly to “if so, why; and if not, why not?” at the end.

I’m curious to know what the readership here thinks.  Since I’ve posted my reply in the old thread, I’ll keep out of it as much as possible.

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