Something popped up on my twitter feed the other day: this document from Oxford’s philosophy department. (I’m not sure quite what it is. Brochure? In-house magazine? Dunno. It doesn’t really matter, though.) In it, there’s a striking passage from Jeff McMahan’s piece on practical ethics:
Even though what is variously referred to as ‘practical ethics’ or ‘applied ethics’ is now universally recognized as a legitimate area of philosophy, it is still regarded by some philosophers as a ghetto within the broader area of moral philosophy. This view is in one way warranted, as there is much work in such sub-domains of practical ethics as bioethics and business ethics that is done by writers whose expertise is in medicine, health policy, business, or some area other than moral philosophy, and whose standards of rigour in moral argument are deplorably low. These writers also tend to have only a superficial understanding of normative ethics. Yet reasoning in practical ethics cannot be competently done without sustained engagement with theoretical issues in normative ethics. Indeed, Derek Parfit believes that normative and practical ethics are so closely interconnected that it is potentially misleading even to distinguish between them. In his view, the only significant distinction is between ethics and metaethics, and even that distinction is not sharp. [emphasis mine]
It’s a common complaint among medical ethicists who come from a philosophical background that non-philosophers are (a) not as good at philosophy, (b) doing medical ethics wrong, (c) taking over. All right: there’s an element of hyperbole in my description of that complaint, but the general picture is probably recognisable. And I don’t doubt that there’ll be philosophers grumbling along those lines at the IAB in Edinburgh in a couple of weeks. There’s a good chance that I’ll be among them.
There’s a lot going on in McMahan’s piece, and his basic claim is, I suppose, open to a claim that, being a philosopher, he would say that, wouldn’t he? But even if that claim is warranted, it doesn’t follow that it’s false. And it probably isn’t false. There is some very low-quality argument throughout bioethics (and, from what I remember from my time teaching it, business ethics) – more particularly, in the medical ethics branch of bioethics, and more particularly still, in the clinical ethics sub-branch. Obviously, I’m not going to pick out any examples here, but many of us could point to papers that have been simply not very good, because the standard of philosophy was low, without too much difficulty. Often, these are papers we’ve peer-reviewed, and that haven’t seen the light of day. But sometimes they do get published, and sometimes they get given at conferences. I’ve known people who make a point of trying to find the worst papers on offer at a given conference, just for the devilry.
It doesn’t take too much work to come up with the common problems: a tendency to leap to normative conclusions based on the findings of surveys, or empirical or sociological work; value-laden language allowing conclusions to be smuggled into the premises of arguments; appeals to vague and – at best – contentious terms like dignity or professionalism; appeals to nostrums about informed consent; cultural difference used as an ill-fitting mask for special pleading; moral theories being chosen according to whether they generate the desired conclusion; and so on. Within our field, my guess is that appeals to professional or legal guidelines as the solutions to moral problems is a common fallacy. Not so long ago, Julian noted that
[t]he moralists appear to be winning. They slavishly appeal to codes, such as the Declaration of Helsinki. Such documents are useful and represent the distillation of the views of reasonable people. Still, they do not represent the final word and in many cases are philosophically naïve.
Bluntly: yes, the WMA or the BMA or the law or whatever might say that you ought to do x; and that gives a reason to to x inasmuch as that one has a reason to obey the law and so on. But it’s unlikely that it’s a sufficient reason; it remains open to us always to ask what those institutions should say. Suppose they changed their minds and insisted tomorrow that we should do the opposite of x: would we just shrug and get on with the business of undoing what we did today?
And yet… The complaint about poor argument is not straightforward, for a couple of reasons.
First, clinical ethics in particular is directed at clinicians; and it’s reasonable to assume that clinicians have other things on their mind than the finer points of The Doctrine of Virtue. More, it’s entirely possible to be a perfectly decent clinician without ever having thought in any particular depth about the pros and cons of, say, organ harvesting. So that means that, if an ethicist is writing something that is intended to have an impact on how clinicians work, it make sense to keep things simple, and not to worry too much about the finer points of argument. Something like Principlism is a perfectly good approach on the ward: it’s rough and ready, and it’s probably not all that philosophically robust – but, frankly, who cares? We oughtn’t to be in the business of sacrificing the good enough on the altar of the perfect.* So an argument in a journal that takes Principlism as a given may not always be philosophically sophisticated, but it probably has a place. Second, applied ethics that lacks empirical input, and that isn’t directed towards making a real-world difference, risks becoming what parodists would have philosophy to be.
Put another way, a mill needs grain as well as millstones if it is to serve any purpose; bioethics can’t do without philosophy, I’d wager, but it’s a bit pointless without reality. This doesn’t mean that there’s no room for purely theoretical papers – there is, and there must be, and some of us will concentrate on writing them; but even the theoreticians ought to admit that they’re doing the theory for some tangible purpose. Again, that might well mean having to quiet appeals for theoretical purity.
All the same, even if the theory isn’t always the standard of the stuff that comes out of All Souls, it does matter if, and that, the standards of argument are deplorably low, not least because if we’re in the business of informing persons or policymakers about what to do, we need to be reliable. I take McMahan him to mean that philosophy is something important that would help the standards of argument improve. And that seems to me to be right. What counts as valid argument isn’t confined within disciplinary boundaries; what makes an inference reasonable in physiology and in sociology and in metaphysics is likely to be the same. With the possible exception of quantum physics, the rule of the excluded middle and the principle of non-contradiction are pretty universal; and since quantum physics doesn’t try to solve policy problems or dilemmas of conduct, we needn’t worry too much about that. But this is one of the reasons why philosophy is important: to the extent that we’re worried about valid argument, we’re doing philosophy. We shouldn’t insist on philosophy qua philosophy, nice though that’d be, but on high standards of argument, which requires – I would hold – a set of skills that are properly described as philosophical. Hence the better the philosophy, the better the standard of argument is likely to be. More, juggling the descriptive and the normative has been the bread and butter of ethics for centuries; there’s a sense in which we call “philosophy” whatever it is that has been grappling with these puzzles and helps us to deal with them (as I’ve argued elsewhere).
Bioethics, I’m increasingly coming to think, ought to be inclusive. Yet inclusivity in that sense is compatible with exclusivity in another; we should be prepared to take on board anything that’s interesting or useful, while still being prepared to spot when, and to say that, a particular argument is garbage.
Because some of them are.
*Long term readers of this blog may be surprised to see me say that. I can offer two things in response. The first is that there’s a huge difference between the ward and the seminar room; what’s good for one mayn’t be good for the other. The other is that I drafted this while sitting outside on a warm day with the sun beating down on me – so it might be heatstroke. Take your pick. Given that I’m being fairly charitable to sociologists as well, I think I know which is the more important consideration.