Health Care Analysis

, Volume 21, Issue 1, pp 6–19

The Troubled Identity of the Bioethicist

Authors

    • Cardiff Law SchoolCardiff University
Original Article

DOI: 10.1007/s10728-012-0229-9

Cite this article as:
Priaulx, N. Health Care Anal (2013) 21: 6. doi:10.1007/s10728-012-0229-9

Abstract

This paper raises questions about bioethical knowledge and the bioethical ‘expert’ in the context of contestation over methods. Illustrating that from the perspective of the development of bioethics, the lack of unity over methods is highly desirable for the field in bringing together a wealth of perspectives to bear on bioethical problems, that same lack of unity also raises questions as to the expert capacity of the ‘bioethicist’ to speak to contemporary bioethics and represent the field. Focusing in particular on public bioethics, the author argues that we need to rethink the concept of bioethicist, if not reject it. The concept of the bioethicist connotes a disciplinary or theoretical unity that is simply not present and from the perspective of public policy, it is incredibly misleading. Instead, bioethical expertise would be a capacity of a broader community, and not an individual. Such a conception of bioethics as an expert community rather than as an individual capacity, focuses our attention on the more functional question of what knowledge and skill set any individual possesses.

Keywords

BioethicsSociologyEmpirical insightsInterdisciplinaryExpertisePublic bioethicsMethods

What are philosophical ethicists good for when real-life moral problems need to be solved? Two views present themselves. The first is that with their superior wisdom they can tell decisionmakers what to do. The second is that with their analytical skills they can explicate alternative views for decisionmakers to choose from… The first view is prevalent among philosophical bioethicists, who almost invariably think that they have a rational method by which they can tell right from wrong. Nonphilosophers often disagree with this and say that they themselves have alternative and better methods of arriving at good moral and political judgments. Despite the disagreement, both philosophical and nonphilosophical biethicsts seem to agree that the purpose of their work is to change the world for the better, not just to describe people’s opinions and arguments [13: 468].

Introduction

Deciding how to feed into a conversation about methods in bioethics has been a bedevilling task. How can one talk of methods in the face of conflicting conceptions of what bioethics ‘is’—whether a discipline, sub-discipline, field, or just a loose cluster of bioethical things? According to Adler and Zlotnik Shaul, such debates in bioethics are symptomatic of a more fundamental disagreement over its ‘methods and standard of rigor’ given that these things play a role in characterizing an academic discipline [1: 188]. In very broad terms, two dominant representations of bioethics seem to arise. The first is what might be described as the “interdisciplinary conception” where the field encompasses a wide range of disciplinary actors and in which a broad range of methods are simply flourishing; as such bioethics is envisaged as a welcoming home for anyone who wishes to contemplate dilemmas that are in some way describable as bioethical ones. The second conception of bioethics, notably philosophical bioethics, stands in stark contrast to this. According to some critics, the interdisciplinary conception of bioethics is largely a fiction. Ives and Dunn, for example, argue that despite bioethics being more than a ‘sub-discipline of moral philosophy’, it nevertheless continues to be ‘generally characterized by analytic methods rooted in philosophical argument’ [22: 257, see also 15].

These two conceptions of bioethics and the method(s) they embrace, sit at the heart of this paper. Of course, the extent to which either can actually be said to represent what bioethics ‘is’, is moot. These are very crude representations of a far more complex intellectual terrain where most aspects of what bioethics is, are hotly debated. From questions as to the identity of bioethics, the identity of the bioethicist, as well as the kinds of method(s) appropriate for bioethical investigation, one will not find consensus. The answers one receives to these questions is contingent upon who you ask, the particular literature consumed, the remit and cultural tradition of particular journals, and even then it can be tricky to assess whether the authors in question are ‘bioethicists’ reflecting upon the problems or promise of the field, or simply ‘gadflies’ [17: 137] from the cottage industry of bioethical scepticism. This is not a negative appraisal; rather it may well be the kind of debate and disagreement that typifies a maturing field populated by different generations with distinctive intellectual leanings. Nevertheless, the point is that to talk about methods in bioethics is hard. As such, these representations of bioethics provide a vehicle for thinking about on-going debate around methods and in particular, to assess the significance of this in the context of a fast moving and important field.

Critically for this paper, bioethics, of course, is more than an academic enterprise. Whatever bioethics ‘is’, its success extends far beyond the institution of university programmes with many so-called bioethicists now performing advisory and ‘expert’ roles. It is the development of this practical and social function that makes the concept of ‘public bioethics’ [22, 27] meaningful and in turn, opens up ‘bioethics’ to (sometimes harsh) scrutiny,

Bioethicists have some form of academic training, usually in philosophy. However, the field of applied bioethics has to some extent taken on a life of its own with its own degree programs, local consultants and committees. It is this applied field that I am “against”. It has become a kind of secular priesthood to which governments and other institutions look for guidance, but it lacks the authority that comes from a single, coherent guiding theory in which practitioners are trained [4: 4].

Baron’s (arguably flawed) aspiration for a single, coherent guiding theory aside, the concern as to the disciplinary identity of actors involved in public bioethics is worth taking seriously. Because bioethics constitutes a resource for the formation of public policy which impacts upon the social world, how bioethics filters into policy channels itself becomes a public issue. In this sense we should probably be less concerned with what ‘bioethics is’, in favour of thinking about who holds themselves out as being a ‘public bioethicist’ and the utility of that concept as a representation of bioethical knowledge. This argument becomes more compelling on view of the kinds of arguments currently in motion around what bioethics is, and in particular, the kinds of questions being raised about methods in bioethics. As I explore in this piece, given the contestation over method arguably there is little unity in bio-ethics beyond some nebulous idea of what a bioethical problem might consist of.

While regarded as being fruitful for creating a bioethical community and an environment where bioethical issues are broadly investigated, that lack of unity becomes problematic when it comes to the question of what the ‘bioethicist’ can bring to policy-makers who seek guidance on matters of bioethical import. Given the significant questions arising within bioethics over the validity of particular perspectives and knowledge claims one needs to be attentive to how in the midst of this, bioethics is left without any real standards by which to govern how bioethicists represent the field in the public sphere. Insofar as policy-makers calling upon the service of bioethicists may currently raise few questions about the substance of ‘ethical expertise’, and merely accept that ethical deliberation around issues of social, political and medical import is both desirable and necessary, these questions are nevertheless being raised elsewhere [see 29].

Given the breadth of subject-matter captured by bioethics (with calls for the field to reach broader concerns, see Sherwin [30]), and the plurality of methods and approaches that different actors bring, it would seem that a public bioethicist can only capture a one-dimensional perspective of bioethical knowledge. Insofar as a ‘bioethicist’ might be a moral philosopher, a sociologist, a lawyer, a clinician or a scientist, the idea of ‘being a bioethicist’ (beyond someone interested in bioethical things), seems to have so little specificity or reference point (beyond an interest in bioethical things) as to render the entire notion of ‘bioethicist’ meaningless in practice. As a capacity of an individual, the concept of the bioethicist is an invitation to over-reach one’s expertise. In the face of contestation over method in particular, which underpins competing approaches to what ‘ethics’ is, it would also seem to be an incredibly misleading title. It may imply that an actor’s expertise lies in philosophical method where one may in fact have none; or it may connote a far broader conception of ethics where empiricism and fact-gathering matters more than philosophical ethics. Either way, both these perspectives have a role to play in public bioethics. As such, while this paper argues that bioethics will be best served by the widest disciplinary engagement possible, and by embracing the broadest range of tools and methods, in the context of public bioethics, it is time to reject the label of bioethicist in favour of a more transparent approach which is fit for purpose.

Addressing Bioethical Things

The Big Bioethical Family?

I trained under philosophers, sociologists, religious studies scholars, physicians, attorneys, historians, and genetic counselors. Being exposed to this wide variety of perspectives and approaches inculcated in me a marked skepticism about the labels of bioethics and bioethicist. …I have never heard any of my professors or colleagues call themselves a bioethicist, nor do I ever recall us discussing bioethics [11: 123].

Is bioethics an interdisciplinary enterprise? According to some accounts, bioethics is, or at least has the capacity to be, a broad field. Nearly a decade ago, [14] explored this question in drawing together a range of conversations around the fundamental nature of bioethics, from the identity of those involved in bioethical work, to the question of what tools and methods best advance our understanding of bioethical problems. What Häyry and Takala illustrated was that rather than being some fixed entity with a definitive meaning, the bioethical project is a developing, ever-changing and multi-faceted one,

Is it only about medicine, nursing and healthcare? No. Is it only about law and regulation? No. Is it only about philosophy and philosophical ethics? No. Is it only about social phenomena and their interpretation? No. Bioethics embraces all these and more [14: 1].

While this points to a rich plurality of meanings where bioethics provides a home capable of accommodating a wide range of disciplinary actors, methods and problems, it is also true to say that the “bioethical residents” (if they really are that) do not always happily co-exist or share a unified understanding about what the bioethical project entails. At the heart of this sometimes troubled co-existence are two concerns. The first is the issue of scope—notably whether bioethics is pursuing the right questions1; the second is the issue of method, with some coming to question whether those problems are being addressed in the right way. Insofar as these issues intersect and overlap, and certainly both suggest that bioethics needs to evolve in some way, the question of bioethical method might be seen as by far the more fundamental challenge to the bioethical identity and the integrity of the field. It is in this respect that some have claimed that bioethics falls short of being an interdisciplinary home by virtue of being dominated by philosophical bioethics and as such lacks the tools needed for it to have purchase for addressing real life moral problems.

Philosophical Bioethics

By virtue of a purported failure to engage with the social sciences and empirical method, bioethics became an extremely popular target for critique [see for example, 2, 4, 9, 19]. This particular criticism typically came, though not exclusively, from social scientists who conceptualised ‘mainstream bioethics’ as being largely dominated by moral philosophy [see 15: 124–126, 24]. The claim that bioethics needs to become more ‘social scientific’ or ‘critical’, concerns the legitimacy of moral philosophical method for addressing and resolving bioethical problems. Debates around how moral philosophy stands to benefit from engagement with other fields, or more strongly put, why it needs to, have been well-rehearsed, but the basic thrust of the questions being raised concerned the extent to which bioethics is a ‘realist discipline’. The alleged dominance of philosophical bioethics has been argued as being problematic for being ‘yoked to abstracts of reason and theory’ so that ‘judgments about matters of bioethics frequently outstrip the contexts that generate and shape those matters and ignore the agonizing experiences of the people who grapple with them’ [19: 1]. Social scientists pointed out that while moral philosophers draw distinctions between the descriptive and the normative, fact and value, “is” and “ought”, that these merely constitute artefacts ‘of the theoretical project of justification, [rather than] an intrinsic feature of moral experience’ [19: 1–2]. Attention to context and subjective realities, some claimed, illustrates how philosophical bioethics fails to resemble ethical reasoning as it presents itself in clinical settings [15]. As a result, it has been claimed that the distance which philosophical bioethics maintains from real social settings and social actors leads to very serious theory–practice gaps which undermine the ability of bioethics to have any purchase for addressing problems in the real world. Some have asserted this more strongly still; as Verkerk and Lindemann [31: 247] argued,

The idea of abstract impartiality that has characterized traditional ethics must be abandoned as not only unattainable but dangerous… it is all too easy for those who aspire to that ideal to import the prejudices and preoccupations of their own social group into their theorizing under the guise of false universality. …If, from her perspective, she sees morally important considerations that others have missed, the others could very likely return the compliment. In this sense, morality is genuinely democratic: there is no humanly accessible vantage point that assures the authority of anyone’s moral judgments, including the professional ethicist’s. This means that the bioethicist, like everyone else, can only speak from her own knowledge and experience [31: 247].

As such, scholars of this ilk have argued that bioethics faces a difficult gap that must be bridged if it is to remain a relevant and serious discipline’ [15: 126].

The problems that philosophical bioethics has with sociological empirical bioethics (or sociology of bioethics) and vice versa are claimed to be underpinned by very distinctive disciplinary approaches and methods. Insofar as Mairi [24] has argued that philosophical and sociological bioethics could work together to ‘widen the bioethical perspective’, and the different approaches of each could be complementary in ‘asking different questions and using different methods derived from their respective theoretical cores’, one of the most prominent features of these debates as they manifest themselves in published form at least, is that they seem intractable. As Hedgecoe reflects, while the response of some bioethicists to such social scientific critiques has been ‘indifference or over-defensive irritation’, he also notes that at points the social science critique has been presented in an ‘overly antagonistic’ way, where ‘the benefits of engaging seriously with the social sciences have not always been clear’ [15: 121]. As such, when the question as to how empirical research can be of purchase to bioethics, the debate has been represented as being marred by ‘confusion, and a shifting back and forth’ between two identities or ‘models’ of bioethics, one where moral philosophy sits at the centre, and the other where bioethics is genuinely a multidisciplinary activity. In this latter respect, bioethics is seen as encompassing healthcare professionals, lawyers, life scientists, theologians, economists, lawyers etc., who ‘deploy the methodology from their discipline to tackle “ethically” problematic social and public policy consequences of advances in biomedicine and biotechnology’ [5: 10–11].

The debates around bioethics are essentially about method and different ways of approaching a particular problem domain. Some philosophers have claimed that bioethical problems cannot be resolved by ‘appeal to or use of empirical evidence’. Empirical research work, such as public consultation, may be interesting, but cannot provide the answers as to the morality of the problem in hand’ [5: 11]. To be apprised of subjective preferences is wholly at odds with the project of moral philosophy which is normative in nature; as Harris [12: 10] has argued, ‘discovering what the public thinks about issues of ethical significance is not the same as discovering the ethical values of the public. And finding out what the public thinks it acceptable to do about issues of ethical importance is not the same as finding out what the public finds ethically acceptable.’

That’s not Bioethics!

On review of this paper, the author was invited to explore the manner by which she represented bioethics. There is no doubt that the foregoing presents far too neat an account of antagonism between philosophical bioethics and sociology of bioethics and indeed, too tidy a representation of methods in bioethics. But for reasons that I explore, even if the review exercise has been instructive, one still needs to be hesitant before suggesting that the social scientific accounts of bioethics are invalid, or that (as one referee claimed) empirical work in bioethics is flourishing. The opportunity to rethink the field, in terms of assessing what bioethics is, to identifying the deployment of broader methods and the extent of interdisciplinary interaction, has not been straightforward. By far the most significant obstacle has been the question of what litmus or measures one might deploy for such an analysis. Ironically my exploration of these questions suggests the desirability of a far broader research study than can be undertaken here.

So where does one look in order to present a ‘fair’ account of bioethical activity? According to [17] some critics, most notably Hedgecoe and Hoffmaster, have presented harsh criticisms of ‘a discipline that few bioethicists would recognize or bother defending’ [17: 141]. Accusing both of making sweeping assertions about bioethics, Herrera argues that because those critiques fail to be supported by evidence with, ‘no apparent effort to connect the criticisms to specific debates in that literature, such generalizations do no justice to the variety of traditions and philosophical orientations that one finds in bioethics’ [17: 140]. Arguing that the harshest judgments of bioethics seem to be largely directed at what clinical and medical ethicists have to say, Herrera speculates that such critics may be most bothered by one particular expression of bioethics, notably the bioethics which emerges from ‘the loudest, and most influential, voices heard in bioethics … from commentators who take their ideas to the mass-media, and who weigh-in on each medical controversy that develops’ [17: 140]. Yet these voices, Herrera complains, are not the summation of what bioethics is; rather, he argues that many bioethicists work out of the way of the media, in a wide range of academic departments, including those affiliated with the social sciences’ [17: 140]. As such, the argument is clear—there is a broad and rich variety of work being undertaken in bioethics, and this complexity will be missed if one takes the most influential bioethical commentators and/or clinical and medical ethicists as a representation of what bioethics is.

Of course, in many respects, Herrera must be right and many of us working in fields such as law, economics or philosophy will at some time have confronted horribly boiled down accounts of what people ‘think we all do’. At the same time, such simplified conceptions of our work afford us an opportunity to consider how ‘we’ present ourselves to the outside world. Insofar as Herrera is anxious to note that the real bioethics is best represented as being home to a far broader range of activities, constituents and perspectives so that, for example, Hedgecoe’s description of bioethics ironically looks sociologically uninformed, it is also important to note that a great deal of that broader bioethical activity will be largely invisible to a great many. For those not socially interacting with these broader activities and engaging in workshops and conferences around bioethics, what bioethics ‘is’ will be largely the summation of how it is represented in mainstream journals, by the ‘loudest’ and ‘most influential’ on the television, radio and in the broad sheets. In the absence of a visible challenge, these voices will be taken to represent the views of many within the bioethical community. That seems reasonable enough. Moreover, even if medical ethics constitutes a small part of what ‘bioethics’ is, the range of mainstream books and journals purporting to be about bioethics give quite a different impression, leading one bioethical commentator to recently complain that ‘medical ethics dominates bioethics’ [6: 219]. As such, there is a communication problem here. If the field of bioethics is being misrepresented, members of the bioethical community will need to evaluate how to render more visible the kinds of projects currently being undertaken in the field which problematize the flawed conception of bioethics that some social scientists have been working with.

Notwithstanding Herrera’s concerns, it is difficult to see that the social scientific critique is completely flawed or indeed that bioethics is significantly different from the way that Hedgecoe, for example, has represented it. And some, seemingly within the bioethical community, have taken Hedgecoe’s calls for a ‘critical bioethics’ very seriously [see 10, 22] suggesting that there is at least some substance to his critique of bioethics. Moreover, Hedgecoe did not seek to critique all bioethical activity (which would be a tall order for anyone); rather, his claim was that philosophical method dominated bioethics. And it was in respect that he argued that contemporary bioethics suffers a serious theory–practice gap where the ethical issues that philosophical bioethicists imagine to be central to real world problems can actually turn out to be fairly irrelevant on closer investigation of the real world. As such, central to [15] critique was a call for the development of a ‘critical bioethics’ that was rooted in empirical research and a ‘bottom-up’ approach which investigates how real people experience moral dilemmas. This, he argued could point to a range of quite different considerations from those seen as central in bioethical texts [15: 136] and would demand that all ethical theories were subject to revision. Hedgecoe anticipated resistance to an empirically informed bioethics insofar as this would undermine,

[E]lements of the universalist stance adopted by traditional philosophical bioethics, a high, perhaps unacceptable price for the philosopher to pay to engage with critical bioethics. But it is hard to see how one can take social science seriously and at the same time insist on one’s ethical conclusions having an absolute and universal application, without evidence to support such a claim [15: 138].

Though the present author was pointed towards a blossoming of empirical work in bioethics which some have called the ‘empirical turn’—a development which if significant would certainly defeat the allegation of philosophical dominance—the extent of this blossoming, what it really means for bioethics, and the question of who is doing empirical work, have proved hard to discern. As Hurst [20: 444] comments, ‘the empirical turn in bioethics can be understood in different ways, and these models sometimes cloud discussion on the need or relevance of empirical research in bioethics’. The extent to which empirical research really informs bioethics, is contested; [23] for example have argued that ‘empirical bioethics’ is simply a cosmetic exercise, finding that,

As a relative newcomer to bioethics, empirical research provides just the facts while normative ethics does the difficult and important work of resolving value questions by defining concepts, building valid arguments and reaching practical conclusions [23: 228].

The claim that empirical research consists of providing information for the application of norms, rather than confronting or challenging them has been echoed elsewhere [18]. Insofar as there is an element of ‘empiricism’ inherent in such an exercise, this would fall far short of what is required for an empirical turn. For Firth, ‘empirical findings contribute more than just descriptive information to which the ethicist applies ... theories’. Echoing Hedgecoe, she argues that these findings should ‘contribute to our very understanding of the principles themselves’ [10: 202]. Given that philosophical bioethics is Hedgecoe’s target for analysis (as opposed to social scientists, clinicians and others like social workers, who have long been engaged in social scientific work), one is left wondering to what extent philosophical bioethics is empirically turning and to what extent it can—or should. It is not evident that philosophical bioethics is really convinced. While [25: 970] concedes that ‘it would be bizarre to claim that knowing what people actually think about moral controversies has no place in the discussion of ethics, or that a properly philosophical approach to decision making requires no understanding of …people’, he notes that there are nevertheless ‘serious questions about how to use empirical data to ‘contribute’ to important debates’ [25: 970].

As such, to the outsider at least, many within the field of philosophical bioethics appear to be deeply concerned about the implications of empirical research for the normative project—a subject which has attracted extensive debate in mainstream journals [see for example, 7, 10, 20, 21, 23, 26]. For Louhlin, to avoid deteriorating into the ‘sort of vacuous discussion that characterises so much speculative bioethics, management theory and a range of other putatively ‘practical academic specialisms’ [25: 970] an empirically informed philosophy demands first gaining clarity about methodology. Yet as Louhlin notes, for many philosophers empirical approaches to questions of applied ethics commits a ‘rudimentary error’: ‘psychologism’—which destroys the distinction between the ‘normative’ and the ‘empirical’. One cannot, as this argument goes, logically settle the normative by appeal to the empirical [25: 970]. Similarly, Herrera, despite his misgivings about the social scientific commentary on bioethics, holds serious reservations around empirical bioethics, commenting that, even ‘some bioethicists who rely on social science methods express their own doubts about a straightforward integration of fieldwork and bioethics’ [17: 145]. For straight-talking McMillan, ‘bioethics is better when it addresses genuine moral issues’ [26: 194] and if empirical work lacks a normative enquiry, ‘then it is reasonable to wonder whether it is bioethics at all’.

Bioethics in Public Bioethics

In many respects, the lack of unity over methods is highly desirable. For one, these debates reveal much more clearly that amongst the constitution of people who purport to speak to a bioethical agenda (and self-identify as bioethicists), we are dealing with more than moral philosophers. Insofar as there is clear disagreement around the extent to which bioethics should embrace the social sciences, it is perhaps to be expected that the so-called empirical turn will be ‘incomplete’ [20: 444]. At this stage, philosophical bioethics at least, would appear to be at the exploratory stage, rather than actually turning. There is now an extensive literature which takes empiricism seriously in exploring practical research methodologies where ethical deliberation can be enriched by meaningfully incorporating empirical findings [see 10] and assessing how normative analysis can survive empiricism [20]. Moreover, this is not merely a question as to how or whether philosophical bioethics should incorporate the social sciences; it is a far broader dialogue about methods in a more general sense (even if fractious at times). Herrera’s concern that social scientists are not adverse to ‘smuggling in’ normative considerations [17: 144] raises as many questions about the nature of social scientific knowledge as are being raised about philosophical bioethics.

In terms of how we typify these debates, quite critically, contemporary literature around an empirical bioethics far from presents a general picture of antagonism over methods, or ‘turf wars’ in bioethics. Nor indeed do these debates seem to present questions about whether bioethics is a discipline. Rather, these debates are illustrative of a broad mix of people within the bioethical community who not only believe strongly in the purchase of the field and their methods to real life bioethical problems but to cite Häyry, also harbour a desire to ‘change the world for the better’ [13: 468]. As such, it should perhaps not matter too much that one is left with a rather confused picture of what ‘bioethics is’. It is perhaps inevitable that the bigger a field becomes the more difficult it will be to define given a splintering of interests, methods and activities. What perhaps should trouble us more, particularly in the context of a debate which raises questions about ‘bioethical knowledge’, and the increased willingness of a variety of different disciplinary actors to engage with it, is the confused identity of the ‘bioethicist’ that has emerged; it is in this respect that we need to question what precisely she or he can really bring to public bioethics.

The powerful role that philosophical bioethicists play in the public sphere very typically, even if not always explicitly, underpins many of the social scientific critiques of bioethics. In the face of an alleged shift away from technical models of scientific governance towards what Moore has described as an ‘ethical model’ [27], public ethics is represented as having transformed into an industry where ethicists, ‘give advice to governments, make ‘expert’ statements for parliament and formulate recommendations for many fields of practice’ [29: 130]. These kinds of activities, some claim extend far beyond ethical ‘horizon-scanning’ and advice, to the exercise of non-legal regulatory power [16] over matters of scientific research, technology, medicine and medical services. As Ives and Dunn comment, public bioethics ‘aims to have practical and public consequences—i.e. to motivate people to change their behaviour in particular ways’ [22: 257] and the kinds of activities in which bioethicists are engaged place them ‘in a position of power and influence’ [22: 260]. Insofar as Hedgecoe notes that many bioethicists may be reluctant to explicitly adopt ‘the mantle of regulators’, research studies illustrate how bioethicists have proved pivotal as a form of social control over the medical profession, and how bioethics has ‘become a form of political legitimation for decision-making around controversial technologies’ [22: 166]. Insofar as this representation of public bioethics is typically founded upon the claim that philosophy has monopolised bioethics, the kind of unity assumed to be typical of public bioethics in terms of discipline and method is not assumed here; nor is that kind of unity seen as desirable for bioethics. In the context of debates around method, there is good reason for thinking that the dominance of one discipline or disciplinary perspective in bioethics should be seen as deeply problematic given (1) the relevance of a wide range of theoretical and empirical approaches; (2) the kinds of questions being raised about those theoretical approaches. Therefore, while some have questioned the standing of philosophical bioethics by virtue of questions over ‘ethics expertise’ or the extent to which it reflects the ‘real world’ [29], concerns over the epistemic foundation of bioethics and indeed expertise, remain just as alive in the context of a public bioethics composed of a far broader range of disciplinary actors utilising a range of methods and tools.

Given the debates we have explored, of central concern here must be the question of consistency and standards in public bioethics. What does it mean to be a ‘public bioethicist’ or ‘bioethical expert’ in the sense of ‘knowing what you’re talking about’ given the plurality of reasonably held views, methods and disciplinary perspectives that are constitutive of bioethics? How, for example, ought a bioethicist approach live bioethical problems when ‘doing bio-ethics’ or being an ethical expert is regarded by some as meaning only philosophical bioethics see further, [3], but for others can summon up an ‘ethics’ which is informed by ‘a whole field of social roles and practical functions which are not necessarily occupied by academic ethicists’ [29: 129–130] It would seem to me that while bioethicists are expected to provide ‘a governance solution, an instrument for the regulation of new social and technological trends’, that absent of some basic common guidelines for the practice of public bioethics, the claim to bioethical expertise rests on shaky foundations.

This concern is further amplified when we also consider current debates around methods in bioethics which illustrate no consensus as to how to bring together very different traditions of investigation together. Empirical turn or not, methodological questions loom hard here. This is a new game for bioethics. Hurst for example has articulated the concern that bioethics has been importing ‘methodological tools from empirical disciplines but too often it has not imported the standards to which researchers in these disciplines are held’ [20: 444]. As such, where bioethicists are being called upon to optimize ‘decision making processes on different political levels and in various areas of professional practice’ it is worth questioning the kind of contribution that individual bioethicists can really make, and indeed what we should expect of a ‘bioethicist’ in the policy arena.

There is a need to rethink the concept of ‘bioethicist’ if not reject it. My preference is for the latter in favour of a more transparent approach. Insofar as the debates around methods in bioethics are constructive for the development of the field, these also alert us to some serious concerns about the nature of bioethical knowledge emerging from various disciplinary traditions. Bioethics has not represented itself as a field where ‘anything goes’, yet the concept of ‘the bioethicist’ (or bioethical expert) in the midst of these debates implies a kind of disciplinary or theoretical unity that is simply not present. Though bioethics is enriched by a broader constitution of actors who bring their own insights to the field, the very same development also heralds our declining individual capacity to act as genuine representatives of bioethics. Few of us can claim to be bioethical generalists in the sense of capturing the broad complexity of the field in terms of the range of methods and disciplines which may be said to define it. While one can point to examples of research by authors who come from different disciplinary backgrounds and manage to combine methods in such a way as to do service to both philosophical method and empirical research [see 26 citing Dunn et al. 8], such work will still fall short of representing the multiplicity of perspectives from the bioethical community that can contribute to meaningful policy discussion. As such, if the aim of public bioethics is ‘to connect policy making with ethical considerations and ethical deliberations, in order to improve political decision-making’ [27: 198], from the perspective of knowledge, rigorous and robust research, and our shared commitment to making the world better, we would do well to retreat from the label of bioethicist to strengthen bioethics and bioethical discussion.

Conclusion

So, what does this mean for the fate of bioethics? None of this constitutes an argument against bioethics or indeed, expertise; rather it is merely an argument against the labels of “bioethicist” and ‘bioethical expert’. Bioethics would stand for nothing more than a community of actors who collectively are capable of bringing a plurality of methods to the table; as such individuals who act in a bioethical capacity constitute merely one school of that broader community where there is reasonable disagreement over methods. Ideally any individual claiming to have expertise germane to bioethical issues will limit her participation and her identity by reference to what skills, insights and disciplinary perspective (whether moral philosophy, law, STS etc.) she can bring to the public policy table, whilst noting the perceived limitations of her approach in the context of the broader debate going on within bioethics. No matter how diverse one’s approach to bioethical issues might be, one cannot hold expertise in everything. None of this is to suggest that there is no such thing as bioethical expertise, but rather than this would be an attribute of the broader community, not of the individual. Arguably that expertise arises through “social interdisciplinary interaction” and it would be in that context that bioethical issues can be more comprehensively addressed. Such a conception of bioethics—as an expert community rather than as an individual capacity, focuses our attention much more keenly on the more functional question of what knowledge and skill set any individual possesses.

For the internal dynamics of the bioethical community, this seems like a critical step. Rather than being prescriptive about the kind of method or theory that best serves bioethics, bioethics stands for a broad and diverse community of actors interested in bioethical matters, allowing the widest range of approaches including more traditional ones like philosophical bioethics to flourish. This argument works in two directions. It operates to ensure that bioethics develops and is recognised as a field represented by the broadest range of individuals; moreover, it helps to ensure that no single disciplinary perspective or method becomes dominant in representing bioethical issues—something which the concept of the ‘bioethicist’ risks. Fostering a conception of bioethics as an interdisciplinary venture is perhaps the most critical for bioethics, even if the ‘bioethicist’ fails to survive it. While bioethics has been represented here as a clash between social scientific techniques and philosophical methods, the questions raised of both in relation to how they contribute to bioethical enquiry are serious enough to think that neither will individually serve bioethics well. Nevertheless, bioethics, and public bioethics needs both [21: 251]. Though social scientific critiques of bioethics have come down hard on philosophical method, the basic thrust of such critiques do not point to its demise. As Adam Hedgecoe comments, while bioethical philosophers need to ‘accept that there are some questions that they cannot answer, and that trying to answer them through adopting certain philosophical methods may be counter-productive’, he also argues that ‘the policy arena with [philosophical] bioethics removed would be sadly impoverished, lacking the benefits that philosophical analysis can bring to such discussions’ [15: 142]. As such, Hedgecoe’s analysis which is echoed elsewhere [see 24] points to a rather more moderate conclusion—that bioethics would be of better service to the public by being the multidisciplinary home that some have envisaged or believe bioethics to be.

Ideally, policy-makers would have some appreciation of the epistemic limits of any given theoretical or disciplinary perspective, whether that comes from law, economics, philosophy, social sciences or psychology (arguably this is where philosophical and social epistemology is needed). All of them have weaknesses and suffer from theoretical blind-spots. Irrespective of the sometimes difficult debates between social scientists and moral philosophers, from a public policy perspective, the interaction between different disciplines is critical. No single discipline can claim epistemic authority on bioethics. From this perspective, when our work is situated in the public sphere and has the capacity to affect the lives of real people, we should do our utmost to bring the widest range of perspectives, methods and approaches—or at a minimum, to represent what we know, as capturing only one aspect of what bioethics is all about. Real people live (at least some of) the questions we ask, so we should try to address those questions as honestly as we can.

Footnotes
1

Some note that bioethics has been far too selective, conservative, popularist, grant-led or plain fanciful in the 'problems' it analyses. Such conservatism, complainers argue, has led to the neglect of problems which are serious and need bioethical attention, including matters of public health, the environment and other issues of broader global import [6]. There are also those, of which the present author can be implicated, who indulge in the blood sport of 'bioethics bashing' in picking out a few 'bioethical' authors who demonstrate sci-fi tendencies and an unhealthy pre-occupation with future technologies which can often be presented in an overly favourable light [28]. Nevertheless, importantly, the question of which problems bioethics picks up can be pursued by those who self-identify as insiders or outsiders to bioethics.

 

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© Springer Science+Business Media New York 2012