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Critical Realism and Empirical Bioethics: A Methodological Exposition

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Abstract

This paper shows how critical realism can be used to integrate empirical data and philosophical analysis within ‘empirical bioethics’. The term empirical bioethics, whilst appearing oxymoronic, simply refers to an interdisciplinary approach to the resolution of practical ethical issues within the biological and life sciences, integrating social scientific, empirical data with philosophical analysis. It seeks to achieve a balanced form of ethical deliberation that is both logically rigorous and sensitive to context, to generate normative conclusions that are practically applicable to the problem, challenge, or dilemma. Since it incorporates both philosophical and social scientific components, empirical bioethics is a field that is consistent with the use of critical realism as a research methodology. The integration of philosophical and social scientific approaches to ethics has been beset with difficulties, not least because of the irreducibly normative, rather than descriptive, nature of ethical analysis and the contested relation between fact and value. However, given that facts about states of affairs inform potential courses of action and their consequences, there is a need to overcome these difficulties and successfully integrate data with theory. Previous approaches have been formulated to overcome obstacles in combining philosophical and social scientific perspectives in bioethical analysis; however each has shortcomings. As a mature interdisciplinary approach critical realism is well suited to empirical bioethics, although it has hitherto not been widely used. Here I show how it can be applied to this kind of research and explain how it represents an improvement on previous approaches.

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Notes

  1. Permission granted by the University of Bristol Faculty of Medicine and Dentistry Committee for Ethics on 20th December, 2011, ref: 111208.

  2. http://www.bbc.co.uk/news/world-europe-20026838.

  3. http://news.bbc.co.uk/1/hi/programmes/hardtalk/9571648.stm.

  4. This term originates from John Locke (1690) and his conception of the role of philosophical thinking as: ‘underlabourer in clearing the ground a little, and removing some of the rubbish that lies in the way to knowledge’.

  5. This is the case in Bhaskar’s first ‘basic’ phase of CR. The later stages—his ‘dialectical’ CR and philosophy of meta-reality—advance a more complex model with further stratifications, however these are not necessary for the work at hand.

  6. http://www.wada-ama.org/Documents/World_Anti-Doping_Program/WADP-Prohibited-list/2013/WADA-Prohibited-List-2013-EN.pdf.

  7. The code specifies the participant in the study, e.g. C = clinician, 4 = the fourth interview carried out.

  8. http://www.aranesp.com/.

References

  1. Alvarez, A. A. (2001). How rational should bioethics be? The value of empirical approaches. Bioethics, 15(5–6), 501–519.

    Article  CAS  PubMed  Google Scholar 

  2. Archer, M., Bhaskar, R., Collier, A., Lawson, T., & Norrie, A. (Eds.). (1998). Critical realism: Essential readings. London: Routledge.

  3. Ashcroft, R. E. (2004). Bioethics and conflicts of interest. Studies in History and Philosophy of Science Part C: Studies in History and Philosophy of Biological and Biomedical Sciences, 35(1), 155–165.

    Article  Google Scholar 

  4. Bacon, F., & Sargent, R. M. (1999). Selected philosophical works. Indianapolis: Hackett Publishing.

  5. Barilan, Y. M., & Weintraub, M. (2001). The naturalness of the artificial and our concepts of health, disease and medicine. Medicine, Health Care and Philosophy, 4, 311–325.

    Article  CAS  Google Scholar 

  6. Barkin, J. S. (2003). Realist constructivism. International Studies Review, 5(3), 325–342.

    Article  Google Scholar 

  7. Berger, P. L., & Luckmann, T. (1966). The social construction of reality: A treatise in the sociology of knowledge. UK: Penguin.

  8. Bhaskar, R. (1974). A realist theory of science. London: Verso.

  9. Bhaskar, R. (1979). The possibility of naturalism: A philosophical critique of the contemporary human sciences. London: Routledge.

  10. Bhaskar, R. (1998). Facts and values: Theory and practice/reason and the dialectic of human emancipation/depth, rationality and change. In M. Archer, R. Bhaskar, A. Collier, T. Lawson, & A. Norrie (Eds.), Critical realism: Essential readings (pp. 409–443). London: Routledge.

    Google Scholar 

  11. Bhaskar, R., & Danermark, B. (2006). Metatheory, interdisciplinarity and disability research: A critical realist perspective. Scandinavian Journal of Disability Research, 8(4), 278–297.

    Article  Google Scholar 

  12. Bhaskar, R., & Norrie, A. (1998). Introduction: Dialectic and dialectical critical realism. In M. Archer, R. Bhaskar, A. Collier, T. Lawson, & A. Norrie (Eds.), Critical realism: Essential readings (pp. 561–574). London: Routledge.

    Google Scholar 

  13. Borry, P., Schotsmans, P., & Dierickx, K. (2005). The birth of the empirical turn in bioethics. Bioethics, 19(1), 49–71.

    Article  PubMed  Google Scholar 

  14. Brassington, I. (2012). What’s the point of philosophical bioethics? Health Care Analysis, 21(1), 20–30.

    Article  Google Scholar 

  15. De Vries, M., & Van Leeuwen, E. (2009). Reflective equilibrium and empirical data: Third person moral experience in empirical medical ethics. Bioethics, 24(9), 490–498.

    Article  Google Scholar 

  16. De Vries, R., Turner, L., Orfali, K., & Bosk, C. (2006). Social science and bioethics: The way forward. Sociology of Health & Illness, 28(6), 665–677.

    Article  Google Scholar 

  17. De Vries, R. O. B., & Gordijn, B. (2009). Empirical ethics and its alleged meta-ethical fallacies. Bioethics, 23(4), 193–201.

    Article  PubMed  Google Scholar 

  18. De Wachter, M. A. M. (1982). Interdisciplinary bioethics: But where do we start? A reflection on epoche as method. Journal of Medicine and Philosophy, 7(3), 275–288.

    Article  PubMed  Google Scholar 

  19. Denzin, N. K., & Lincoln, Y. S. (2005). The SAGE handbook of qualitative research. Thousand Oaks: SAGE.

  20. Dobson, P. J. (2001). The philosophy of critical realism—An opportunity for information systems research. Information Systems Frontiers, 3(2), 199–210.

    Article  Google Scholar 

  21. Dummett, M. (1982). Realism. Synthese, 52(1), 55–112.

    Article  Google Scholar 

  22. Easton, G. (2010). One case study is enough. Lancaster University Management School Working Paper 2010/034.

  23. Easton, G. (2010). Critical realism in case study research. Industrial Marketing Management, 39(1), 118–128.

    Article  Google Scholar 

  24. Emmerich, N. (2011). Literature, history and the humanization of bioethics. Bioethics, 25(2), 112–118.

    Article  PubMed  Google Scholar 

  25. Fisher, J. W. (2010). Landmark advances in the development of erythropoietin. Experimental Biology and Medicine, 235, 1398–1411.

    Article  CAS  PubMed  Google Scholar 

  26. Fopp, R. (2007). Can social constructionism go too far? In A refereed paper presented at the second Australasian housing researchers conference, chambers house, University of Queensland, pp. 20–22.

  27. Frith, L. (2010). Empirical ethics: A growing area of bioethics. Clinical Ethics, 5(2), 51–53.

    Article  Google Scholar 

  28. Guba, E. G., & Lincoln, Y. S. (1994). Competing paradigms in qualitative research. Handbook of Qualitative Research, 2, 163–194.

    Google Scholar 

  29. Hacking, I. (1999). The social construction of what?. Cambridge, MA: Harvard University Press.

    Google Scholar 

  30. Haimes, E. (2002). What can the social sciences contribute to the study of ethics? Theoretical, empirical and substantive considerations. Bioethics, 16(2), 89–113.

    Article  PubMed  Google Scholar 

  31. Hedgecoe, A. M. (2004). Critical bioethics: Beyond the social science critique of applied ethics. Bioethics, 18(2), 120–143.

    Article  PubMed  Google Scholar 

  32. Herrera, C. (2008). Is it time for bioethics to go empirical? Bioethics, 22(3), 137–146.

    Article  PubMed  Google Scholar 

  33. Hoffmaster, B., & Hooker, C. (2009). How experience confronts ethics. Bioethics, 23(4), 214–225.

    Article  PubMed  Google Scholar 

  34. Hurst, S. (2010). What ‘empirical turn in bioethics’? Bioethics, 24(8), 439–444.

    Article  PubMed  Google Scholar 

  35. Ives, J., & Draper, H. (2009). Appropriate methodologies for empirical bioethics: It’s all relative. Bioethics, 23(4), 249–258.

    Article  PubMed  Google Scholar 

  36. Ives, J., & Dunn, M. (2010). Who’s arguing? A call for reflexivity in bioethics. Bioethics, 24(5), 256–265.

    Article  PubMed  Google Scholar 

  37. Jackson, P. T. (2004). Bridging the gap: Toward a realist-constructivist dialogue. International Studies Review, 6(2), 337.

    Google Scholar 

  38. Järvensivu, T., & Törnroos, J. (2010). Case study research with moderate constructionism: Conceptualization and practical illustration. Industrial Marketing Management, 39(1), 100–108.

    Article  Google Scholar 

  39. Joyner, M. J. (2003). o2max, Blood doping, and erythropoietin. British Journal of Sports Medicine, 37(3), 190–191.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Kamm, F. M. (2005). Is there a problem with enhancement? The American Journal of Bioethics, 5(3), 5–14.

    Article  PubMed  Google Scholar 

  41. Kass, L. (2001). Preventing a brave new world. The New Republic, 5(01), 1–17.

    Google Scholar 

  42. Kleinman, A. (1999). Moral experience and ethical reflection: Can ethnography reconcile them? A quandary for “The new bioethics”. Daedalus, 28(4), 69–97.

    Google Scholar 

  43. Koch, T. (2010). Enhancing who? Enhancing what? Ethics, bioethics, and transhumanism. Journal of Medicine and Philosophy, 35, 685–699.

    Article  PubMed  Google Scholar 

  44. Lawson, T. (1998). Economic science without experimentation. In M. Archer, R. Bhaskar, A. Collier, T. Lawson, & A. Norrie (Eds.), Critical realism: Essential readings (pp. 144–169). London: Routledge.

    Google Scholar 

  45. Leget, C., Borry, P., & De Vries, R. (2009). ‘Nobody tosses a dwarf!’ The relation between the empirical and the normative re-examined. Bioethics, 23(4), 226–235.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Levine, B. D. (2006). Should “artificial” high altitude environments be considered doping? Scandinavian Journal of Medicine & Science in Sports, 16(5), 297–301.

    Article  Google Scholar 

  47. Longhofer, J., & Floersch, J. (2012). The coming crisis in social work: Some thoughts on social work and science. Research on Social Work Practice, 22(5), 499–519.

    Article  Google Scholar 

  48. MacDougall, I. C., Hutton, R. D., Cavill, I., Coles, G. A., & Williams, J. D. (1990). Treating renal anaemia with recombinant human erythropoietin: Practical guidelines and a clinical algorithm. British Medical Journal, 300(6725), 655–659.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Marshall, P. A. (1992). Anthropology and bioethics. Medical Anthropology Quarterly, 6(1), 49–73.

    Article  PubMed  Google Scholar 

  50. Mayes, R. (2010). The modern Olympics and post-modern athletics: A clash in values. The Journal of Philosophy, Science & Law, 10, 1–17.

    Article  Google Scholar 

  51. McEvoy, P., & Richards, D. (2003). Critical realism: A way forward for evaluation research in nursing? Journal of Advanced Nursing, 43(4), 411–420.

    Article  PubMed  Google Scholar 

  52. McKeown, A. (2014). Re-thinking the distinction between therapy and enhancement: A study in empirical ethics. UK: University of Bristol. Unpublished thesis.

  53. Meyer, W. (1906). Hume Versus Kant. The Monist, 16(3), 461–468.

    Article  Google Scholar 

  54. Miah, A. (2006). Rethinking enhancement in sport. Annals of the New York Academy of Sciences, 1093(1), 301–320.

  55. Mignon, P. (2003). The Tour de France and the doping issue. The International Journal of the History of Sport, 20, 227–245.

    Article  Google Scholar 

  56. Molewijk, B., Stiggelbout, A. M., Otten, W., Dupuis, H. M., & Kievit, J. (2004). Scientific contribution. Empirical data and moral theory. A plea for integrated empirical ethics. Medicine, Health Care and Philosophy, 7(1), 55–69.

    Article  Google Scholar 

  57. Muller, J. H. (1994). Anthropology, bioethics, and medicine: A provocative trilogy. Medical Anthropology Quarterly, 8(4), 448–467.

    Article  Google Scholar 

  58. Murphy, N. (1990). Scientific realism and postmodern philosophy. The British Journal for the Philosophy of Science, 41(3), 291–303.

    Article  Google Scholar 

  59. Nichols, P. (2012). Wide reflective equilibrium as a method of justification in bioethics. Theoretical Medicine and Bioethics, 33(5), 325–341.

    Article  PubMed  Google Scholar 

  60. Niiniluoto, I. (1991). Realism, relativism, and constructivism. Synthese, 89, 135–162.

    Article  Google Scholar 

  61. Oltmann, C., & Boughey, C. (2012). Using critical realism as a framework in pharmacy education and social pharmacy research. Research in Social and Administrative Pharmacy, 8(4), 333–337.

    Article  PubMed  Google Scholar 

  62. Owens, J., & Cribb, A. (2011). Conflict in medical co-production: Can a stratified conception of health help? Health Care Analysis, 20(3), 268–280.

    Article  Google Scholar 

  63. Parens, E. (1995). The goodness of fragility: On the prospect of genetic technologies aimed at the enhancement of human capacities. Kennedy Institute of Ethics Journal, 5, 141–153.

    Article  CAS  PubMed  Google Scholar 

  64. Pellegrino, E. D. (1999). The origins and evolution of bioethics: Some personal reflections. Kennedy Institute of Ethics Journal, 9(1), 73–88.

    Article  PubMed  Google Scholar 

  65. Proctor, J. D. (1998). The social construction of nature: Relativist accusations, pragmatist and critical realist responses. Annals of the Association of American Geographers, 88(3), 352–376.

    Article  Google Scholar 

  66. Putnam, H. (1975). What is ‘Realism’? Proceedings of the Aristotelian Society, 76, 177–194.

    Article  Google Scholar 

  67. Railton, P. (1986). Moral realism. The Philosophical Review, 95(2), 163–207.

    Article  Google Scholar 

  68. Rawls, J. (1971). A theory of justice. Cambridge, MA: Harvard University.

    Google Scholar 

  69. Sandel, M. (2004). The case against perfection. The Atlantic Monthly, 293, 51–62.

    Google Scholar 

  70. Santayana, G. (1983). Reason in science. New York: Dover.

    Google Scholar 

  71. Savulescu, J., & Foddy, B. (2011). Le tour and failure of zero tolerance. In J. Savulescu, R. ter Meulen, & G. Kahane (Eds.), Enhancing human capacities (pp. 304–312). Oxford: Blackwell Publishing Ltd.

    Chapter  Google Scholar 

  72. Savulescu, J., Foddy, B., & Clayton, M. (2004). Why we should allow performance enhancing drugs in sport. British Journal of Sports Medicine, 38, 666–670.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  73. Sayer, A. (1997). Critical realism and the limits to critical social science. Journal for the Theory of Social Behaviour, 27(4), 473–488.

    Article  Google Scholar 

  74. Sayer, A. (2000). Realism and social science. London: SAGE.

    Book  Google Scholar 

  75. Scott, D. (2005). Critical realism and empirical research methods in education. Journal of Philosophy of Education, 39(4), 633–646.

    Article  Google Scholar 

  76. Soper, K. (2009). Unnatural times? The social imaginary and the future of nature. The Sociological Review, 57, 222–235.

    Article  Google Scholar 

  77. Speed, B. (1991). ‘Reality Exists OK?’ An argument against constructivism and social constructionism. Journal of Family Therapy, 13(4), 395–409.

    Article  Google Scholar 

  78. Spriggs, M. (2005). Hypoxic air machines: Performance enhancement through effective training—or cheating? Journal of Medical Ethics, 31(2), 112–113.

    Article  Google Scholar 

  79. Tallis, R. (2008). Medical ethics in the real mess of the real world. Medico-Legal Journal, 76(3), 95–112.

    Article  Google Scholar 

  80. Turner, L. (2009). Anthropological and sociological critiques of bioethics. Journal of Bioethical Inquiry, 6(1), 83–98.

    Article  Google Scholar 

  81. Van der Scheer, L., & Widdershoven, G. (2004). Integrated empirical ethics: Loss of normativity? Medicine, Health Care and Philosophy, 7(1), 71–79.

    Article  Google Scholar 

  82. Von Glasersfeld, E. (1991). An exposition of constructivism: Why some like it radical (pp. 229–238). New York: Springer.

    Google Scholar 

  83. Warnock, M. (2003). What is natural? And should we care? Philosophy, 78(04), 445–459.

    Article  Google Scholar 

  84. Widdershoven, G., Abma, T., & Molewijk, B. (2009). Empirical ethics as dialogical practice. Bioethics, 23(4), 236–248.

    Article  PubMed  Google Scholar 

  85. Wight, C. (2012). Critical realism: Some responses. Review of International Studies, 38(01), 267–274.

    Article  Google Scholar 

  86. Worrall, J. (2009). Underdetermination. Realism and Empirical Equivalence. Synthese, 180(2), 157–172.

    Google Scholar 

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Acknowledgments

I would like to thank the two anonymous reviewers for their helpful comments following the initial submission of this paper. I must also thank the clinicians and scientists who took part in the empirical study for the valuable insights that they provided. Finally, I dedicate the paper to the late Roy Bhaskar, to whom I am especially grateful for giving so generously of his time in helping me develop this work.

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  1. Centre for Ethics in Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK

    Alex McKeown

  2. Institute for Health and Human Development, University of East London, UH250, Stratford Campus, Water Lane, London, E15 4LZ, UK

    Alex McKeown

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McKeown, A. Critical Realism and Empirical Bioethics: A Methodological Exposition. Health Care Anal 25, 191–211 (2017). https://doi.org/10.1007/s10728-015-0290-2

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