{"id":3036,"date":"2016-06-04T09:24:06","date_gmt":"2016-06-04T08:24:06","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=3036"},"modified":"2016-06-04T09:24:06","modified_gmt":"2016-06-04T08:24:06","slug":"writers-whose-expertise-is-deplorably-low","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2016\/06\/04\/writers-whose-expertise-is-deplorably-low\/","title":{"rendered":"Writers Whose Expertise is Deplorably Low"},"content":{"rendered":"

Something popped up on my twitter feed the other day: this document<\/a><\/span> from Oxford\u2019s philosophy department.\u00a0 (I\u2019m not sure quite what it is. \u00a0Brochure?\u00a0 In-house magazine?\u00a0 Dunno. \u00a0It doesn\u2019t really matter, though.)\u00a0 In it, there\u2019s a striking passage\u00a0from Jeff McMahan\u2019s piece on practical ethics:<\/p>\n

Even though what is variously referred to as \u2018practical ethics\u2019 or \u2018applied ethics\u2019 is now universally recognized as a legitimate area of philosophy, it is still regarded by some philosophers as a ghetto within the broader \u2028area of moral philosophy. \u00a0This 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<\/strong>\u2028are deplorably low<\/strong>. \u00a0These writers also tend\u2028 to have only a superficial understanding of normative ethics. \u00a0Yet reasoning in practical ethics cannot be competently done without sustained engagement with theoretical issues\u2028in normative ethics. \u00a0Indeed, Derek Parfit believes that normative and practical ethics are so closely interconnected that it is potentially misleading even to distinguish between them. \u00a0In his view, the only significant distinction is between ethics and metaethics, and even that distinction is not sharp. \u00a0[emphasis mine]<\/p><\/blockquote>\n

It\u2019s 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.\u00a0 All right: there\u2019s an element of hyperbole in my description of that complaint, but the general picture is probably recognisable.\u00a0 And I don\u2019t doubt that there\u2019ll be philosophers grumbling along those lines at the IAB in Edinburgh in a couple of weeks.\u00a0 There\u2019s a good chance that I\u2019ll be among them.<\/p>\n

There\u2019s a lot going on in McMahan\u2019s piece, and his basic claim is, I suppose, open to a\u00a0claim that, being a philosopher, he would say that, wouldn’t he?\u00a0 But even if that claim is warranted, it doesn\u2019t follow that it\u2019s false.\u00a0 And it probably isn\u2019t false.\u00a0 There is some very low-quality argument throughout bioethics (and, from what I remember from my time teaching it, business ethics) \u2013 more particularly, in the medical ethics branch of bioethics, and more particularly still, in the clinical ethics sub-branch. \u00a0Obviously, I\u2019m 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.\u00a0 Often, these are papers we\u2019ve peer-reviewed, and that haven\u2019t seen the light of day.\u00a0 But sometimes they do get published, and sometimes they get given at conferences. \u00a0I’ve known people who make a point of trying to find the worst papers on offer at a given conference, just for the devilry.<\/p>\n

It doesn\u2019t 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 \u2013 at best \u2013 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. \u00a0Within our field, my guess is that appeals to professional or legal guidelines as the solutions to moral problems is a common fallacy. \u00a0Not so long\u00a0ago, Julian noted that<\/a><\/span><\/p>\n

[t]he moralists appear to be winning.\u00a0 They slavishly appeal to codes, such as the Declaration of Helsinki.\u00a0 Such documents are useful and represent the distillation of the views of reasonable people.\u00a0 Still, they do not represent the final word and in many cases are philosophically na\u00efve.<\/p><\/blockquote>\n

Bluntly: yes, the WMA or the BMA or the law or whatever might say that you ought to do x<\/em>; and that gives a<\/em> reason<\/em> to to x<\/em> inasmuch as that one has a reason to obey the law and so on.\u00a0 But it\u2019s unlikely that it\u2019s a sufficient reason; it remains open to us always to ask what those institutions should<\/em> say.\u00a0 Suppose they changed their minds and insisted tomorrow that we should do the opposite of x<\/em>: would we just shrug and get on with the business of undoing what we did today?<\/p>\n

And yet\u2026 \u00a0The complaint about poor argument is not straightforward, for a couple of reasons.<\/p>\n

First, clinical ethics in particular is directed at clinicians; and it\u2019s reasonable to assume that clinicians have other things on their mind than the finer points of The Doctrine of Virtue<\/em>. \u00a0More, 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. \u00a0So 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.\u00a0\u00a0Something 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? \u00a0We oughtn’t to be in the business of sacrificing the good enough on the altar of the perfect.* \u00a0So an argument in a journal that takes Principlism as a given may not always be philosophically sophisticated, but it probably has a place. \u00a0Second, applied ethics that lacks empirical input, and that isn\u2019t directed towards making a real-world difference, risks becoming what parodists would have philosophy to be.<\/p>\n