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02/15/2016

Does Bioethics Tell Us What to Do?

by J.S. Blumenthal-Barby, Ph.D.

 Applied ethicists—including bioethicists—are in the business of making normative claims. Unlike, say, claims in meta-ethics, these are meant to guide action. Yet, when one examines the literature and discourse in applied ethics, there are three common barriers to these claims being action-guiding. First, they often lack precision and accuracy when examined under the lens of deontic logic. Second, even when accurately articulated in deontic language, they often fall into the category of claims about “permissibility,” a category that yields low utility with respect to action guidance. Third, they are often spectrum based rather than binary normative claims, which also yield low utility with respect to action guidance.

First, consider the concern about lack of precision under the lens of deontic logic. Deontic logic is a branch of logic that is concerned with the meaning of certain normative terms such as “permissible” (permitted), “impermissible” (forbidden, prohibited), “obligatory” (duty, required), “omissible” (non-obligatory), or “optional” (even “supererogatory”—beyond the call of duty). The traditional schema is as follows:

  • Something is permissible if and only if its negation is not obligatory.
  • Something is impermissible if and only if its negation is obligatory.
  • Something is omissible if and only if it is not obligatory.
  • Something is optional if and only if neither it nor its negation is obligatory.
  • Something is obligatory if and only if it is necessary for all normative demands to be met.

Yet, often claims made in the applied ethics literature do not map directly onto these deontic terms. For example, commonly used terms are “ethically acceptable,” “ethically problematic,” “ethically admirable,” “ethically justifiable,” “has a duty,” etc. Thus, one initial challenge is to translate commonly used terms into the relevant deontic terms to figure out their normative status. For example, a claim that pre-implantation genetic diagnosis (PGD) to prevent disability is ethically acceptable might be read as a claim that it is optional, meaning that neither PGD nor not-PGD is obligatory. On the other hand, a claim that PGD to prevent disability is a duty of a parent might be read as a claim that it is obligatory, meaning that it is necessary [for all normative demands to be met]. To say that PGD to prevent disability is “ethically problematic” is less clear (e.g., does that mean it is impermissible, or permissible despite its problems), as is saying it is “ethically admirable” (e.g., does that mean it is supererogatory—beyond the call of duty, or obligatory)? So, bioethicists must choose their terms carefully.

The second concern is that even when accurately articulated in deontic language, claims in applied ethics often fall into the categories of “permissible” or “optional,” which yield low utility with respect to action guidance. To make a claim that X is permissible says nothing about whether one ought to do X. Perhaps this is a problem as much with the deontic logic or morality itself as much with bioethics. Yet, if bioethics is in large part concerned with figuring out and articulating what to do (in policy, in clinical practice), then perhaps there should be more focus on arguing for what is impermissible (ought not to do) or obligatory (must do). It would be interesting to examine bioethics scholarship historically to see if there has been a transition from scholars making more direct arguments about what we ought or ought not to do (e.g., we ought to allow people to have active euthanasia, we ought to allow kidney sales) in the earlier years of bioethics when it was trying to establish itself as a valuable field—compared to more recent literature being “softer” whereby scholars construct arguments to arrive at conclusions about permissibility, leaving more “on the table” so to speak. It would also be interesting to see if there are any differences between the more theoretical bioethics literature and the clinically situated literature in this regard.

The third and final concern is that normative claims in bioethics are often spectrum based rather than binary, also yielding low utility with respect to action guidance. Consider three examples: some have argued that advance directives should be followed to the extent that the person when they are activated is “the same person” as when they were filled out (something that might arguably interfere with this is advanced dementia). But how would this work in terms of action guidance? If this person is 70% the same person (having 70% of the same memories, beliefs, dispositions, etc.), do we follow 70% of the advance directive? Another example is the argument that researchers have obligations to provide ancillary care to their subjects to the extent that they are morally entangled with them and to the extent that they are vulnerable. But this does little to answer the question of what exactly a researcher must provide. Another example is the argument that removal of a life-sustaining technology (e.g., a total artificial heart) is morally wrong to the extent that it becomes part of the self or is more “integrated” with the person. If the technology is 70% part of the self, is turning it off 70% morally wrong? What does this mean (i.e., can we do it)? Enough examples.

Now, it is a legitimate question whether bioethics should tell us what to do. Or to put it another way, how action guiding it should be. I leave this question for another post!

References:

McNamara, Paul, “Deontic Logic”, The Stanford Encyclopedia of Philosophy (Winter 2014 Edition), Edward N. Zalta (ed.), URL = <http://plato.stanford.edu/archives/win2014/entries/logic-deontic/>.

 

 

 

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