If Bioethics doesn’t exist, what am I doing here?

OK – I admit it: some rhetorical questions are too easily answered.  Still, I’ve been reading Leigh Turner’s paper in the latest JME, and mulling it over.  The title of the paper – “Does Bioethics Exist?” is a bit more radical than the content, wich considers the question of whether bioethics exists as a “widely shared method, theory, normative framework or mode of moral reasoning”.  But still, the question the paper poses is interesting.

The underlying thought – or worry – is encapsulated like this:

[A]n increasing number of individuals make their living as bioethicists, [but] there is no recognizable, widely shared, common moral philosophy that bioethicists draw upon to resolve moral disputes. There is no common creed, widely accepted method of moral reasoning or normative theory, or practical body of wisdom that binds together bioethicists. Within the halls of academe, it is just as possible to establish a successful academic career as a utilitarian or libertarian as it is publishing and teaching as a neo-Kantian, Rawlsian, virtue theorist, casuist or proponent of natural law. We are well past the time when the “principles of biomedical ethics” provided a common reference point for addressing ethical concerns.

My initial response to this was to wonder whether there really ever was a time when there were principles that provided a common reference point, and whether it really has passed.  And I think that the answer to these questions is “yes” and “no”.  I think that bioethics has been, and still is, in thrall to Principlism, and that it’s hard to see how it could not be.  Correspondingly, there’s been, and still is, a long-running dispute between those who accept Principlism and those who don’t – my guess from the gist of the paper is that Turner is among the former group (or at least sympathetic to it), and (for the record) I’m one of those who think that Principlism is incoherent and has done little but damage the discipline qua academic pursuit.  (Pace Turner, Principlism doesn’t synthesise utilitarianism and deontology; it simply ignores their incompatibility, which ain’t the same.)

Still, the Principles are still a common reference point… would that they weren’t.

And the reason for this is that I think there’s another way to cut the bioethical pack, and it’s roughly along a division between those who’re philosophers and those who’re medics.  (The division is rough-and-ready, but it’ll do for now.*)  Principlism is, I think, much more popular among the latter group, and I can see why those actually working at the coalface would be attracted to its rubric, and so how Priniciplism might get carried over into ethical analysis.  Moreover, because bioethics is, perhaps, a much broader church than many other disciplines, it means that there’s plenty of Principlists to keep Prinicplism popular.

I’ve touched before on the question of whether bioethics is too expansive in its definition of what makes a bioethicist; I mentioned in August that there’s a difficulty in establishing a professional standard for bioethicists.  To some extent, a person can become a bioethicist by fiat.  I’m not entirely happy with this: I think that there are some people who claim to speak authoritatively on bioethical matters who, frankly, don’t have the first clue, and that there are some established and big-name bioethicists whom I think aren’t up to much.  But it’s hard to see what could be done to sift the good from the not so good, what the guage should be, or whether any sifting would be really what we want.  That is: the cure might be worse than the illness.

But back to the paper.  Turner makes the point that

[i]f bioethics is capacious enough to include libertarians, communitarians, deontologists, neo-Kantians, utilitarians, neo-Aristotelians, virtue theorists, feminists, Rawslians, Habermasians, narrative theorists, interpretivists, principlists, casuists, civic republicans, liberal egalitarians and religious ethicists of every persuasion, does bioethics exist as something other than a loosely connected assemblage of conflicts over norms, principles, practices and policies?

To which I tend to shrug and say, “So what?”  Consider an analogy with “proper” Philosophy.  Along the corridors of a Philosophy department, you might find Wittgenstinians or Anti-Wittgentinians, Dummettians, Dennettians, Kripkeans, internalists, externalists, Churchlandians, Quineans, Tarskians… and that’s just a sample of the range of approaches to the philosophy of mind and language; you might find metaphysicians who aren’t all that interested in mind and language; you might find “analytics” and “Continentals”; and you might find all kinds of other stuff.  This bewindering taxonomy is made all the more bewildering by the fact that we can’t even take it as read that philosophy means subscribing to a given set of norms about reasoning or procedure – a Wittgenstinian, an Austinian and a Derridean may share some characteristics but differ markedly in others, and disagree about what counts as proof or truth.  Does that mean that there’s no such thing as metaphysics, no such thing as philosophy?  Not at all.  The range of styles of argument doens’t mean that there’s no such thing; the discipline doesn’t need agreement on rules or procedures to be recognisable as a discipline.  Maybe it is a loose assembledge, and maybe the edges are tattered, with a tendency to shade into politics, neuroscience, sociology, mathematics, or whatever; philosophy doesn’t suffer for it.

The same, I think, applies to bioethics; maybe it doesn’t exist as a disciplined discipline.  It certainly has no doctrine (although Principlists think it does…).  It has better or worse practitioners, and there are those whom I don’t regard as contributing much (*cough*religious bioethics*cough*), but… meh.  So it goes.

If there is anything that unifies bioethicists, it’s that we’re interested in ethics as applied to the biosciences or biomedicine.  That’s pretty minimal, though, and I’m not sure we need much more to be sufficiently clearly defined as a discipline.  My hunch is that we should stop worrying, learn to love our insubstantiality, and get on with the serious business of demonstrating why our opponents in any given argument are wrong, dammit, wrong.

*  Obviously, there are exceptions to this rule: I can think of some excellent bioethicists who started life as medics, but crossed to the dark side and became philosophers – hello, Søren!  Nevertheless, I think that they are the exception, and even the mediaevals knew that the presence of exceptions proves the presence of a rule…)

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