Abstract
Using a case-study involving bioethics and LGBTQ+ family-making, I demonstrate the appeal of a pragmatist ethics approach to bioethics. On the specific pragmatist view I offer, ethical progress is a matter of overcoming ethical problems. Ethical problems are here understood as conflicts that arise as we attempt to live out our values in the natural and social world and which prompt us to reflect upon and sometimes reinterpret or revise our values or practices. Pragmatism is inherently nonideal in its theoretical approach, since it holds that the relevant conflicts that prompt moral inquiry are not conflicts among abstract ideals, but practical conflicts that arise from our interaction with the world. Ideals alone, then, cannot be a proper guide to bioethical progress. After laying out this approach to moral theorizing in more detail, I take up a case study, focusing on the value of genetic relations within families and the use of reproductive technologies to allow LGBTQ+ people to produce biologically related children. I use this case to show the value of nonideal approaches to bioethics. More specifically, I argue that pragmatism—as a nonideal theory—instructs us to evaluate these issues and family-making practices by considering the situatedness of LGBTQ+ people in a heteronormative society, and the ways in which that particular context produces practical conflicts as LGBTQ+ people and families attempt to live out their values in the social world.
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Notes
- 1.
Importantly, Mills (170) himself points to previous feminist, antiracist, and anti-capitalist work that has eschewed ideal theory, pointing to Alison Jaggar, Marx, and Frederick Douglass.
- 2.
For anyone who is not familiar with this analogy, Thomson puts forth a thought-experiment in which the reader is asked to imagine themselves waking up in a hospital bed, attached through their kidney to the kidney of a famous violinist. Because the violinist will die without this form of human dialysis, and because the reader is the only tissue match, the Society of Music Lovers has kidnapped the reader and forcibly hooked them up to the violinist to save his life. Unhooking, the doctor explains, will kill the violinist since he can live only through the use of the reader’s body.
- 3.
I will return to this point in Sect. 17.2.3.
- 4.
In previous work, I have referred to this aspect of ideal theory while making the case for a pragmatist account of ethical progress using the term “utopian” and “end-state” largely interchangeably, but here I will stick with Valentini’s terminology of “end-state” in order to avoid confusion (Roth 2012, 388).
- 5.
Here we might note that the problem is not merely that the focus on ideal weight does not help solve the patient’s here-and-now medical complaint, but also that the very idea that weight itself has much to do with health can be questioned empirically. See Alison Reiheld’s contribution to this volume “Thin or thick, real or ideal: How thinking through fatness can help us see the dangers of idealized conceptions of patients, providers, health, and disease.”
- 6.
Though as I believe the case study in Sect. 17.3 will illuminate, I do not think there is such a neat correspondence between queer, feminist, and antiracist value commitments and commitment to anything like the problem-resolving method I have described above.
- 7.
The idea here is to look for “partial” ideal theory, such that we would not necessarily look for a complete picture of the ideal in all aspects of morality and justice, but might think only about one slice of morality and justice, what we can call “family/reproductive ethics.” See Robeyns 344.
- 8.
Actually, I doubt this latter claim. For instance, even if we assume for the sake of argument that Velleman is correct in his moral assessment of donor conception, this would not explain nor justify the history of discrimination against LGBTQ+ people in other areas of family-making. Consider cases in which LGBTQ+ people who came out in the process of divorce from a different-sex partner lost custody of their children. Alternatively, consider anti-LGBTQ+ discrimination in adoption placements. In neither case does the traditionalist view of the value of genetic relations have any clear connection to anti-LGBTQ+ policy. Thus, it seems to me that there remains significant room to recognize historical injustice against LGBTQ+ people when it comes to parental rights and family-making even on a view like Velleman’s. (This raises an interesting question as to why traditionalist views on genetic relations so often go hand in hand with a blanket opposition to all aspects of LGBTQ+ family equality, when the former does not entail or imply the latter.)
- 9.
In reciprocal IVF, one woman provides the oocytes, which are fertilized in vitro using sperm from a donor, and the resulting embryo is transferred to the other partner who then, if pregnancy occurs, gestates. By “elective,” I mean uses in which the more conventional (and also less risky, less physically burdensome, and less costly) donor insemination could in all probability successfully lead to a pregnancy for the partner who prefers to gestate; in other words, in an elective use of reciprocal IVF, additional technological intervention is employed, though the use of that technology does not make a successful pregnancy significantly more likely than it would have been using donor insemination alone.
- 10.
In contrast, those focused on paradise island might do just fine at envisioning a world without structural inequalities in the first place.
- 11.
I think that proponents of the radical approach like Haslanger and myself do pay some attention to this kind of consideration. However, taking on a pragmatist nonideal approach to theorizing about these issues makes the need to pay attention here much more explicit.
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Roth, A. (2021). Nonideal Theory and Ethical Pragmatism in Bioethics: Value Conflicts in LGBTQ+ Family-Making. In: Victor, E., Guidry-Grimes, L.K. (eds) Applying Nonideal Theory to Bioethics. Philosophy and Medicine, vol 139. Springer, Cham. https://doi.org/10.1007/978-3-030-72503-7_17
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