This Is Bioethics. Udo Schüklenk
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1.3 What are the fundamental purposes of ethics then? Unsurprisingly, one of the purposes of ethics is to offer us clear action guidance when we are faced with a particular ethical problem. Of course, action guidance alone is not sufficient, or else an ethicist telling us what we ought to do is not much different to what a preacher or a taxi driver, engineer or medical doctor could tell us. Anyone can admonish us to do this or do that when faced with an ethically challenging situation. All of us almost certainly would have a view on what the NGO chief should be doing. In fact, most of us would probably happily add our two cents worth of opinion when asked what we think the NGO chief should do, policy wise. Thinking about what she ought to do engages with ethics. That takes us to the second objective of ethics. It is to do with the normative justification for the advice given. The preacher’s advice would derive its authority from the claim that she knows what a higher authority (say a God) wants us to do. Of course, many people today are atheists2 or agnostics3, and many of those who are not atheists hold a large number of different deities dear to their hearts, all with competing action guidance derived from their respective sources of godly wisdom. For all we know, the taxi driver and engineer might just reply that that is how they feel, or possibly even think, about the problem at hand. Let us leave aside, for a moment, that in ancient Greece there were no taxi drivers or engineers as we understand them today. During those times their approach to ethics would have led to them being labeled as Sophists4, that is a group of philosophers who subscribe to the view that there are no objectively right or wrong answers to ethical questions, and that answers to ethical questions are at best reflective of someone’s subjective, strongly held beliefs or feelings. What gave way to the birth of modern ethics were philosophers like Plato5 and his teacher Socrates who both believed that we can actually give right or wrong answers to questions about what is ethically good or bad. We will return to their take on ethics in a moment. How might the medical doctor in our example respond to the ratings agency’s ethical challenge? Trying to do better than the Sophists of the world, she could refer to guidance documents issued, for instance by her national medical association’s ethics people6, or those issued by the World Medical Association7, a worldwide umbrella organization of national medical associations, or possibly the World Health Organization8. But what if these organizations have actually omitted to address the problem at hand in their guidance documents? And, even if they haven’t, quotes from a document don’t constitute an ethical justification. What if the document quoted got it wrong? It turns out, we have good reason to be skeptical about famous historical medical guidance documents such as the Hippocratic Oath9. Robert M. Veatch explains why the Hippocratic Oath isn’t a document medical professionals ought to aspire to. According to Veatch just about everything is wrong about it, from its pledge to questionable Greek deities to a cultish understanding of medicine as a secretive practice to practical guidance that prioritizes individual patient interest always over the greater good of the society (Veatch 2012a, 10–29). To put it in Veatch’s own words, ‘the Oath is so controversial and so offensive that it can no longer stand alongside religious and secular alternatives. […] The Hippocratic Oath is unacceptable to any thinking person. It should offend the patient and challenge the health care professional to look elsewhere for moral authority’ (Veatch 2012a, 1). Veatch tells us, somewhat reassuringly, that the Oath today is used in so many variations in the world’s medical schools that sometimes only fragments of the original document seem to remain (Veatch 2012b).
1.4 Be mindful that even if we agreed with the content of the Hippocratic Oath or a modern version of it, and even if they actually provided us with guidance for the problem under consideration, we would again have to take it on authority that we should go about the NGO’s problem in one particular way and not in another, unless there is an ethical justification provided why we should do what it admonishes us to do. Given that in our scenario almost certainly a lot of people would disagree with whatever it is that is being proposed, policy wise, it is important that we get our justification right. Here is where ethics’ second purpose comes in: In addition to providing us with action guidance, it must also provide us with a reasoned justification for the guidance given.
1.5 As we will discover, there exist a fair amount of competing ethical theories, some more influential than others, that succeed with varying degrees of success both on the action guidance as well as on the action justification fronts. How should we decide then, which one, or which set of them to adopt for our own purposes? Is it ok to use one set of theories for one type of problem and another set of theories for another type of problem? Couldn’t we choose virtue ethics for decision‐making at the hospital bedside, but decide to go with utilitarianism for matters of resource allocation decision‐making? But why should we do that, as opposed to just the opposite? Could there be a meta‐theory telling us which theoretical approach to deploy under what circumstances? Or must we determine which theory is the right one and try to abide by its guidance as best as we can, even if some of that guidance is turning out to be deeply counter‐intuitive? Well, these are questions about the nature of ethics; they ask whether there can be a true ethics, whether ethical statements must be of a particular kind, whether they can be objectively true or false, or whether they ultimately boil down to statements expressing our feelings. These and other questions are typically analyzed by meta‐ethicists. They don’t create ethical theories, rather they create theories about ethics. There are also legitimate questions about the extent to which ethical theories truly lend themselves to be ‘applied’ in some sense or another to problems such as the one mentioned at the beginning of this chapter. We will not engage in this sort of theorizing about ethics in this chapter, with the exception of a few paragraphs on ethical relativism. The reason for this is that the discussions driving meta‐ethics are quite technical in nature, and by and large there is no obviously correct solution to many of its controversies. Even in the absence of final answers to many of these questions, however, it is still quite possible to undertake ethical analyses. As we will see throughout this book, some arguments are more plausible than others; certain types of argument, such as for instance slippery‐slope based arguments, are almost always flawed, and so on and so forth. However, you can easily read up on meta‐ethical theories elsewhere. (McMillan 2018) A wonderful source of superb on‐line Open Access content, written usually by the some of the best philosophers around, is the Stanford Encyclopedia of Philosophy. Check, for instance its entry on Theory and Bioethics10 (or Singer 1991, Part VI: The Nature of Ethics).
1.6 Bioethics is specifically concerned with normative issues in the biomedical and life sciences. Bioethicists hail these days from many different disciplines, including theology, law, medicine, sociology and many others. Think of typical problems bioethicists analyze in their research: Should we permit editing of the human genome? Is it acceptable to use sentient animals in clinical research? Is abortion wrong? Should