Bioethics as a Discipline

Author(s): Daniel Callahan

Reviewed work(s):
Source: The Hastings Center Studies, Vol. 1, No. 1 (1973), pp. 66-73
Published by: The Hastings Center
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THEORETICAL ANALYSIS AND PRACTICAL CASES
Bioethics
a s a
discipline
DANIEL CALLAHAN
NE of the
beguil-
ing phra ses
I ha ve
picked up
from
rea ding
scientific a nd medica l
journa ls
is "a necdota l
evidence." The ca reful resea rcher does not
cla im too much for evidence of tha t
kind;
he knows its scientific limita tions. I must
confess to the
perversity
of often
finding
evi-
dence of tha t sort more
suggestive
tha n the
solid,
well-confirmed kind. It is
surely
fa r
more
interesting
to collect. The
topic
of
"bioethics a s a
discipline"
invites a
good
dea l
of a necdota l
evidence,
a nd I intend to in-
dulge fully
in the
plea sures
of
reta iling my
own
experiences.
For the sa ke of
decency,
I will ma inta in the
confidentia lity
of
my
clinica l
records, shielding
the na mes of the
innocent a nd the
guilty.
The
topic
a lso invites reflection on wha t
I like to think of a s "the
politics
of ethics."
By
tha t I mea n the
problem
of
ta king
the
probings
of
professiona l philosophers
a nd
theologia ns
a nd
getting
someone other tha n
our
lodge
brothers a nd sisters to think tha t
a nything
is
being
sa id a t a ll.
Or,
in some
richer sense of the word
"politics," showing
tha t serious ethica l
thinking
ha s its
pla ce
in
the
body politic
of medicine a nd
biology.
Fina lly,
the
topic
invites a t lea st some
a llusion to the
concept
of a
"discipline,"
a nd
pa rticula rly
the
pla ce
of
disciplines
in the
a ca demic world. The
gra dua te
school ca ta -
logue
sense of the word denotes
specific
tra ining,
refined
methodologies,
distinctive
a pproa ches
a nd
commitments,
a
long a p-
prenticeship, professiona l expertise.
Tha t is
a
fla ttering picture. My
own
connota tion,
ha ving
seen a ca demic
disciplines
in
a ction,
is
too often
a rroga nce, insula tion,
neurosis a nd
na rrowness. Ca n bioethics a s a
discipline
a void tha t ha za rd?
I will
begin
with three a necdotes. The first
wa s a criticism leveled a t a book I ha d writ-
ten on the ethics of a bortion. It ca me from
a
pa ssiona te feminist, strongly pro-a bortion,
who on the whole liked the book a nd its con-
clusions. "But wha t
right
ha ve
you,"
she
shouted a t
me,
"to
press
a ll of
your hea vy
philosophica l questions
on
people
who a ren't
tra ined
philosophers?
Wha t
a rroga nce
a nd
cruelty!
You should be
trying
to
help women,
not
loa ding
them down with a lot of ha rd
intellectua l
problems
which will
just
ma ke
them suffer a ll the more. You cla im to be
interested in ethics.
Why
don't
you pra ctice
it!"
The second a necdote comes out of a
semina r I once led on ethics a nd
popula tion
control. The semina r members were
profes-
siona l
sociologists
a nd
demogra phers.
On
one
occa sion,
a fter some weeks of discus-
sion,
I wa s
upbra ided by
a
demogra pher
for
not
ma king
a
precise enough
distinction be-
tween
"birthra tes,"
"crude
birthra tes,"
a nd
BIOETHICS AS A DISCIPLINE 67
"fertility
ra tes." "You
philosophers,"
he
gently
chided
me,
"ha ve
just got
to ma ster
the
demogra phic
litera ture a nd the technica l
distinctions if
you're going
to be
a ny help
to us."
Cha stened,
I continued
my lecture,
which tha t
da y ha ppened
to be on the va rious
philosophica l
distinctions between a ct- a nd
rule-utilita ria nism. After I ha d
gone
on a bit
a bout
tha t, my
critic ca me ba ck a t me: "I'm
a fra id I'm
finding
this a ll
very boring.
You
philosophers
do
nothing
but ma ke technica l
distinctions a nd
split
verba l
ha irs;
a nd a ll
tha t stuff a bout the different kinds of utili-
ta ria nism is too a bstra ct to be of
a ny
use."
As a footnote to tha t
story,
I
might
a lso note
tha t the semina r
pa rticipa nts diligently
rea d
a ll of the
a ssigned rea dings
on
demogra phy.
But,
with the
exception
of one
young,
un-
wa shed resea rch
a ssista nt,
they ha rdly
rea d
a ny
of the
a ssigned rea ding
in
philosophica l
ethics;
too tedious a nd
irreleva nt, they
sa id.
Even
so,
a t the end of the
semina r,
one
criticism I received wa s tha t I did not
give
enough
time to ethics. "I wish we ha d been
a ble to
get
more
deeply
into the
problems,"
two or three
people
commented.
My
third a necdote is this. Some
collea gues
a nd I ha d
spent
some months
trying
to con-
vince a
group
of
physicia ns
tha t a
good
tra ining
in medicine did not
necessa rily
qua lify
them to ma ke
good
ethica l decisions.
They eventua lly
conceded the
point.
But
they
conceded it with a twist of the knife. One
da y they
ca me to us with a
pa rticula rly
a gonizing
ca se in
ha nd,
requiring
a
quick
bla ck-a nd-white decision. "Wha t should we
do?"
they
a sked. "You're the
philosopher,
you
tell us." The ca se wa s
a ppa lling,
a nd I
mumbled
something
a bout not
being rea lly
qua lified
to tell them wha t to do. "But
you've
been
telling
us
tha t,
a s
physicia ns,
we ha ve no
specia l qua lifica tions
for
ma king
ethica l decisions. And now
you're sa ying
you
don't either-even
though you
ha ve a
Ph.D. in
philosophy
a nd
spend
a ll of
your
time
studying
medica l ethics. Just who is
qua lified
to decide?"
I ha ve
pa infully
remembered ea ch of these
incidents beca use
they
well illustra te some
of the funda menta l
problems
of bioethics;
a nd ea ch of them illustra tes more tha n one
problem.
The first
a necdote, involving my
feminist
critic, suggests
three issues to me. The most
obvious involves the ha za rds of
pushing
diffi-
cult
questions
on
people
who would
prefer
not to think of them; Socra tes found out
wha t tha t lea ds to. Another issue is the
ima ge
of the ethicist a s someone a ddicted
to
ra ising
the
philosophica l a nte, spinning
out from one
problem
ten
more,
a nd then
ten from ea ch of those
ten,
the whole
process
pushing
forwa rd into
every
ba sic
question
a bout the
mea ning
of life a nd existence; this
ca n be ca lled
philosophica l
overkill. Still
a nother issue is the
exa spera tion
ethicists
a rouse in those
a lrea dy
committed to a n a n-
swer to a
specific
mora l
problem,
those for
whom the intellectua l
probing
is over a nd
dedica tion to
propa ga ting
the ca use is the
only
item left on the
a genda .
The
profes-
siona l diffidence of the ethicist a bout
seeing
himself in the role of the a dvoca te
(I
a m less
resisted,
with
utter
pa nic,
the idea of
pa rticipa ting
with the
physicia ns
in their a ctua l
decision. Who me? I much
preferred
the
sa fety
of the
profound questions
I
pushed
on them.
certa in a bout the
theologia n)
ca n
only
seem
a n eva sion or a fa ilure to ta ke ethics seri-
ously enough.
The second
a necdote-my experience
with the
demogra phers-ra ises
a nother series
of issues. One is the
very
low tolera nce level
of most
people,
however
highly educa ted,
for
philosophica l
theories a nd
niceties;
their
eyes quickly gla ze
over. "If I ha d wa nted to
be a
philosopher,"
one
biologist
once told
me,
"I would ha ve
gone
to
gra dua te
school
in
philosophy."
This
a ttitude, however,
is
quite a pt
to co-exist with wha t
certa inly
a ppea rs
to be a desire on the
pa rt
of these
sa me critics to wrestle
very
ha rd with the
issues. It's
just
tha t
they
don't find the cha r-
a cteristic
wa y philosophers
a nd
theologia ns
a pproa ch
them
very mea ningful;
which is a
68 HASTINGS CENTER STUDIES
nice
wa y
of
sa ying they rea lly
think it is
ma inly
hot a ir. There is a nother
wa y
of
put-
ting
this
point.
While
everyone
will
a gree
in
principle
tha t there should be
reciprocity
in
the
interdisciplina ry
work of
bioethics,
it is
utterly
na ive for the
philosopher
or theo-
logia n
to think tha t
ma ny
scientists a nd
phy-
sicia ns will rush ba ck to
Pla to,
much less
G. E. Moore.
The third a necdote
pushes
us into wha t
is the
underlying
issue in a ll three of the
stories. Just wha t is the role of the ethicist in
trying
to ma ke a contribution to the ethica l
problems
of
medicine, biology,
or
popula -
tion? I
resisted,
with utter
pa nic,
the idea of
pa rticipa ting
with the
physicia ns
in their
a ctua l decision. Who me? I much
preferred
the
sa fety
of the
profound questions
I
pushed
on them. But I a lso rea lized when fa ced with
a n a ctua l ca se-a nd this is
my
excuse-tha t
there wa s
nothing
wha tever in
my philo-
sophica l tra ining
which ha d
prepa red
me to
ma ke a
fla t,
clea r-cut ethica l decision a t a
given
hour on a
given
a fternoon. I ha d been
duly
tra ined in tha t
splendid
tra dition of
good schola rship
a nd ca reful
thinking
which
a llows a t lea st a
couple
thousa nd
yea rs
to
work
through a ny problem.
The Review
of
Meta physics
ra n a contest some
yea rs a go,
offering
a
prize
to the
person coming up
with
the best a nswer to the
question: "Why
ca n't
philosophers
ma ke
up
their minds?" It is
still a
good question,
a nd of course I ha ven't
been a ble to ma ke
up my
mind a bout the
right
a nswer. The
propensity
of
physicia ns
a nd
la wyers
to
prefer
the
ca se-method,
a nd
for
philosophers
a nd
theologia ns
to offer no
more tha n one concrete
exa mple every forty
pa ges
or so is
just
a nother side of the sa me
coin.
Pla ce of the Ethicist
Let me ta ke
up
the
question
which I sa id
wa s
underlying my
three a necdotes: wha t is
the
pla ce
of the ethicist in medicine a nd
biology?
Does he ha ve
a nthing
to contribute
a nd, if so, wha t? The a nswer a t this
point
is tha t we
just
do not
exa ctly
know. But the
fa ct tha t we
ma y
not know
yet
with
a ny
precision
wha t the contribution ca n be, pro-
vides a
splendid opportunity
to
sha pe
the
discipline
in a
wa y
which
might-just might
-ma ke a n
importa nt difference in the
long
run.
Bioethics is not
yet
a full
discipline.
Most
of its
pra ctitioners
ha ve wa ndered into the
field from somewhere
else,
more or less in-
venting
it a s
they go.
Its
va gue
a nd
prob-
lema tic sta tus in
philosophy
a nd
theology
is
ma tched
by
its even more
sha ky sta nding
in
the life sciences. The la ck of
genera l a ccept-
a nce, disciplina ry
sta nda rds,
criteria of ex-
cellence a nd clea r
peda gogica l
a nd eva lua tive
norms
provides, however,
some
unpa ra lleled
opportunities.
It is a
discipline
not
yet
bur-
dened
by
encrusted tra ditions a nd domineer-
ing figures.
Its
sa ving gra ce
is tha t it is not
yet
a
genuine discipline
a s tha t
concept
is
usua lly
understood in the a ca demic a nd
scientific communities. One ha s
a lwa ys
to
expla in oneself,
a nd tha t lea ves room for
crea tivity
a nd consta nt
re-definition;
there
a re
ma ny a dva nta ges
in
being
a
moving
ta rget.
When we a sk wha t the
pla ce
of bioethics
might be,
we of course need to know
just
wha t the
problems
a re in medicine a nd
biology
which ra ise ethica l
questions
a nd
need ethica l a nswers. I will not reta il the
whole
ca ta logue
of issues
here;
suffice it to
sa y
tha t
they begin
with "A"
(a bortion
a nd
a mniocentesis)
a nd run a ll the
wa y
to "Z"
(the
mora l
significa nce
of
zygotes).
One
evident a nd first ta sk for the ethicist is sim-
ply
tha t of
trying
to
point
out a nd define
which
problems
ra ise mora l issues. A second
a nd no less evident ta sk is
providing
some
systema tic
mea ns of
thinking a bout,
a nd
thinking through,
the mora l issues which
ha ve been discerned. A
third,
a nd
by
fa r the
most
difficult,
ta sk is tha t of
helping
scien-
tists a nd
physicia ns
to ma ke the
right
deci-
sions;
a nd tha t
requires
a
willingness
to
a ccept
the rea lities of most medica l a nd
much scientific
life,
tha t
is,
tha t a t some dis-
crete
point
in time a ll the ta lk ha s to end
a nd a choice must be
ma de,
a choice which
ha d best be
right
ra ther tha n
wrong.
Not one of these ta sks is
ea sy,
a nd one
soon lea rns tha t a ll of the sma rt cra cks one
ca n direct a t the dea r innocent scientist who
still thinks there is such a bea st a s a "va lue-
free
methodology" a pply equa lly
well to
the
methodologies
of
theology
a nd
philoso-
phy.
Feet will be wet before feet a re even
in the wa ter. Moreover, one a lso soon dis-
covers tha t well over ha lf the
in-fighting,
a nd
three-qua rters
of a ll
punches
to the
groin,
stem from
a rguments
a bout whether
BIOETHICS AS A DISCIPLINE 69
such-a nd-such a n issue
a ctua lly poses a ny
ethica l
dilemma ;
or whether wha t is
thought
to be the dilemma is
a ctua lly
the dilemma .
In the ba ttle of
ethics,
no less tha n in other
forms of huma n
wa rfa re,
the
high ground
goes
to those who succeed in
esta blishing
their definitions of the issues-a t-sta ke a nd
their
stipula tions
a bout wha t will count a s a
sound
methodology;
the rest is
ma inly
a
mopping-up opera tion.
I used a bove the
phra se
"the rea lities of
life." Another one of these rea lities is tha t
the ethica l issues of medicine a nd
biology
ra rely present
themselves in a
wa y nicely
designed
to fit the kinds of
ca tegories
a nd
processes
of
thought
which
philosophers
a nd
theologia ns tra ditiona lly
feel secure a bout.
They
a lmost
a lwa ys
sta rt off on the
wrong
foot
by coming
encumbered with the techni-
ca l
ja rgon
of some other
discipline.
And
only
in text books is one
likely
to encounter ca ses
which
present
a clea r
occa sion, sa y,
for de-
ciding
on the
va lidity
of a
deontologica l
or
utilita ria n ethica l solution. The issues
come,
tha t
is,
in a
messy, jumbled form, cutting
through ma ny disciplines, gumming up
a ll
our clea n theoretica l
engines,
festooned with
odd strea mers a nd
complica ted
knots.
The fa ct tha t this is the ca se
immedia tely
invites the
tempta tion
of wha t ca n be ca lled
"disciplina ry
reductionism."
By
tha t I mea n
a
pencha nt
for
distilling
out of a n
essentia lly
complex
ethica l
problem
one tra nscendent
issue which is
promptly
la beled the issue.
Not
coincidenta lly,
this issue
usua lly
turns
out to be a
cla ssic,
fa milia r
a rgument
in
philosophy
or
theology. By
mea ns of this
kind of
reductionism,
the
philosopher
or
theologia n
is thus ena bled to do wha t he ha s
been tra ined to
do,
dea l with those cla ssic
disputes
in a
la ngua ge
a nd a
wa y
he is com-
forta ble with-in a
wa y
which a llows him
to feel he is
being
a
good "professiona l."
The results of this
tendency
a re doleful. It
is one rea son
why
most
biologists
a nd
phy-
sicia ns find the contributions of the
profes-
siona l ethicist of
only slight
va lue. Their
problems, very
rea l to them in their
la ngua ge
a nd their fra me of
reference, a re
promptly
ma de unrea l
by being tra nsmuted into some-
one else's
la ngua ge
a nd reference
system,
in
the
process usua lly stripping
the
origina l ca se
of a ll the
complex fa cticity
with which it
a ctua lly presented itself. The whole business
becomes
positively pitia ble
when the
phi-
losopher
or
theologia n,
rebuffed or
ignored
beca use of this
reductionism,
ca n
only
re-
spond by cha rging
tha t his critics a re obvious-
ly
"not
serious" a bout
ethics,
not interested
in "rea l" ethica l
thinking.
I stress the
problem
of
"disciplina ry
re-
ductionism" out of a conviction tha t if a
discipline
of bioethics is to be crea ted, it
must be crea ted in a
wa y
which does not
a llow this form of
eva ding responsibility, of
bla ming
the students for the fa ults of the
tea cher,
of
cha nging
the na ture of the
prob-
lems to suit the
methodologies
of
profes-
siona l ethicists.
Towa rd this
end,
no
subject
would seem
to me more
worthy
of
investiga tion
tha n
wha t I will ca ll the
"ordina ry la ngua ge
of
mora l
thinking
a nd discourse." Most
people
do not ta lk a bout their ethica l
problems
in
the
la ngua ge
of
philosophers.
And I ha ve
yet
to meet one
professiona l
ethicist
who,
when
dea ling
with his own
persona l
mora l
dilemma s,
ta lks the
la ngua ge
of his
profes-
siona l
writings;
he ta lks like
everyone
else,
a nd
presuma bly
he is
thinking through
his
own
problems
in ba na l
everyda y la ngua ge
like
everyone
else. Now of course it
might
be sa id tha t this misses the whole
point
of
a serious
professiona l discipline.
Is it not
like
cla iming
tha t there must be
nothing
to
theoretica l
physics simply
beca use the
physi-
cist does not ta lk a bout the furniture in his
house in terms of molecules a nd electrons?
But the
a na logy
does not
work,
for it is of
the essence of mora l
decision-ma king
to be
ha ve
yet
to
meet one
professiona l
ethicist
who,
when
dea ling
with his own
persona l
mora l
dilemma s,
ta lks the
la ngua ge
of
his
professiona l writings;
he ta lks like
everyone else,
a nd
presuma bly
he is
thinking through
his own
problems
in
ba na l
everyda y la ngua ge....
70 HASTINGS CENTER STUDIES
couched in
ordina ry la ngua ge
a nd dea lt with
by ordina ry, non-professiona l
modes of
thinking.
The rea son for this is
a ppa rent.
An ethica l decision will not be
sa tisfa ctory
to the
person
whose decision it is unless it
is
compa tible
with the
wa y
in which the
per-
son
ordina rily
thinks a bout himself a nd wha t
he ta kes his life to be.
My point
here is
by
no mea ns to
deny
the
va lidity
of ethica l
theory,
the va lue of
technica l ethica l
la ngua ge,
or the need for
disciplined rigor.
Nor a m I
prepa red
to
gra nt
a na rrow scientist or
physicia n
the slothful
luxury
of
dema nding
tha t the ethicist ma ster
his technica l distinctions while he himself is
dispensed
from
ma stering
the ethicist's. The
ethicist ca n ma ke no useful contribution a t
a ll unless he is
ca pa ble,
on
occa sion,
of mov-
ing
more
deeply
into the issues tha n others
do,
of
giving
them a coherence a nd
cla rity
which
they ma y
la ck in the formula tions of
ordina ry la ngua ge,
a nd of
bringing
to them
a nua nced
methodology.
I a m
only trying
to
ma ke the
point
tha t
unless,
in the
process
of
doing so,
he ca n rema in in conta ct with
ordina ry la ngua ge
a nd
ordina ry thought
processes-consta ntly esta blishing
the con-
nections-both his
theory
a nd his
peda gogy
will fa il. His
theory
will fa il beca use it will
not bea r on
psychologica l rea lity,
a nd his
peda gogy
will fa il beca use it will ha ve noth-
ing
to do with the
wa y
in which the ethica l
problems a ctua lly present
themselves. The
physicia n who,
in
trying
to dea l with a ha rd
ethica l
ca se, keeps
in mind his own
feelings
a nd
thoughts, hospita l policy
a nd
public
policy,
the emotions of his
pa tient
a nd his
pa tient's fa mily, trying
to be
responsible
a nd
yet
fa ced with
multiple
a nd often
conflicting
responsibilities-tha t physicia n
will not be
responsive (nor
should
he)
to the ethicist
who tells him
tha t,
in the
end,
the rea l a nd
only
issue
is,
sa y,
utilita ria nism.
If I
ma y put
the ma tter in the form of a
pa ra dox,
the ethicist
ma y
be
quite
correct
in his theoretica l
a na lysis-perha ps
utilita r-
ia nism is, sa y,
the
la rgest philosophica l
issue
a t sta ke in
ma ny
ethica l dilemma s. Yet he
will be
quite clea rly wrong
if he does not
recognize
tha t the issue in
pa rticula r ca ses-
Mrs. Jones in Wa rd 5 a t 4:10 in the a fter-
noon-must a nd will involve fa r more tha n
the sta tus of utilita ria n
theory.
I wa nt to a dd a n
a ncilla ry point.
I once
knew a
distinguished philosopher
who sa id
he ha d little interest in
meeting
a nd
ta lking
with other
philosophers.
After a ll, he could
rea d their
writings
a nd
get
a fa r more
rigor-
ous,
honed version of their views from tha t
source tha n he could from conversa tion with
them.
Perha ps
there is
something
to this
when it is a
question
of one
professiona l try-
ing
to understa nd the views of a nother
pro-
fessiona l.
But I believe it a n
a bsolutely
disa strous
a pproa ch
in the ca se of the ethicist
trying
to understa nd the mora l
thinking
of
the
non-ethicist, pa rticula rly
tha t of the
scientist or
physicia n.
There is often no
gua ra ntee
wha tever tha t the ethica l
la ngua ge
used
by
the
physicia n
or scientist ha s
a ny
bea ring
wha tever on the
wa y
in which he
a ctua lly
ma kes ethica l decisions. Too often
it is
perfectly clea r,
in
fa ct,
tha t the a ctua l
principles
which a re
coming
into
pla y
a re
quite
a t va ria nce with the
expressed prin-
ciples.
I a m not
ta lking
a bout
hypocrisy
here,
nor a bout
ga rden-va riety logica l
inconsis-
tency,
but a bout the fa r more subtle
phe-
nomenon of someone
who,
beca use tha t is
the
only la ngua ge
he ha s been
equipped
with
for
public discourse,
ta lks one kind of ethica l
terminology
a nd
yet
a cts in
wa ys
which a re
fa r more consistent with
quite
a nother kind
of
terminology,
which no one ha s
supplied
him with. The existence of this
phenomenon
pla ces
a
grea t premium
on a
good
dea l of
ora l
excha nge
a nd
probing,
a s well a s a
premium
on a certa in
skepticism
towa rd
thinking
tha t wha t non-ethicists
sa y
is a ctu-
a lly
wha t
they necessa rily
mea n a nd do.
The
Mea ning
of
'Rigorous'
In
trying
to crea te the
discipline
of bio-
ethics,
the
underlying question
ra ised
by
the
foregoing
rema rks bea rs on wha t it should
mea n to be
"rigorous"
a nd "serious" a bout
bioethics. I
recently
ta lked with a
very good
philosopher
who ha d
spent
a
yea r
tea m-
tea ching
a course in ethica l
problems
of
biology
with a
biology professor.
He did not
wa nt to
repea t
the
experience.
He found it
impossible,
he sa id, to introduce
a ny
rea l
philosophica l
a nd ethica l
rigor
into the
course, not
only
beca use he neither could
nor would ever ha ve the time to
properly
ma ster
biology
but a lso beca use the
very
process
of
trying
to ta lk a cross
disciplina ry
lines seemed
inherently
inimica l to
rigorous,
methodologica lly-sound thinking;
it wa s like
BIOETHICS AS A DISCIPLINE 71
mixing a pples
a nd
a voca dos,
with a n inedi-
ble result. One ca n
sympa thize
with his feel-
ings,
a nd it is common
enough
for ethicists
to
ga ther a mong
themselves a fter some frus-
tra ting interdisciplina ry
session to mutter
a bout the denseness a nd
ina nity
of their
scientific a nd medica l
collea gues.
There a re two
options open
here. One is
to continue the
muttering, being quite
cer-
ta in tha t the
muttering
is
being reciproca ted
ba ck in the scientific la b. Tha t
is,
one ca n
stick to tra ditiona l notions of
philosophica l
a nd
theologica l rigor,
in which ca se one will
ra rely
if ever encounter it in the interdis-
ciplina ry
work of bioethics.
Or,
more
wisely,
the
thought ma y
occur tha t it is definitions
of
"rigor"
which need
a da pta tion.
Not the
a da pta tion
of
expediency
or
pa ssivity
in the
fa ce of ca reless
thinking,
but ra ther a
per-
ception
tha t the kind of
rigor required
for
bioethics
ma y
be of a different sort tha n tha t
norma lly required
for the tra ditiona l
philo-
sophica l
or scientific
disciplines.
This is to
sa y
no more tha n tha t the
methodologica l rigor
should be
a ppropria te
to the
subject
ma tter. I
spoke
a bove of three
ta sks for the bioethicist: definition of
issues,
methodologica l stra tegies,
a nd
procedures
for
decision-ma king.
Ea ch of these ta sks
requires
a different kind of
rigor.
The first
requires
wha t I will
pa ra doxica lly
ca ll the
rigor
of a n
unfettered
ima gina tion,
a n
a bility
to see
in,
through
a nd under the surfa ce
a ppea ra nce
of
things,
to envision
a lterna tives,
to
get
under the skin of
people's
ethica l
a gonies
or
ethica l
insensitivities,
to look a t
things
from
ma ny perspectives
simulta neously.
A different kind of
rigor
is needed for the
development
of
methodologica l stra tegies.
Here the tra ditiona l
methodologies
of
phi-
losophy
a nd
theology
a re
indispensa ble;
there a re sta nda rds of
rigor
which ca n a nd
should come into
pla y, bea ring
on
logic,
consistency,
ca reful
a na lysis
of
terms,
a nd
the like. Yet a t the sa me time
they
ha ve to
be
a da pted
to the
subject
ma tter a t
ha nd,
a nd tha t
subject
ma tter is not
norma lly,
in
concrete ethica l ca ses of medicine a nd biol-
ogy,
one which ca n be stuffed into a too-
rigidly structured
methodologica l mold.
I a m not a bout to
a ttempt
here a full dis-
course on wha t should be the
proper
a nd
specific methodology
of bioethics. Some
sketchy, genera l comments will ha ve to
do,
ma inly
in the
wa y
of a ssertions. Tra dition-
a lly,
the
methodology
of ethics ha s concerned
itself with ethica l
thinking;
how to think
stra ight
a bout ethica l
problems.
However, I
believe tha t the
province
of the bioethicist
ca n
legitima tely encompa ss
a concern with
three a rea s of ethica l
a ctivity: thinking,
feel-
ing (a ttitudes),
a nd beha vior. The ca se for
including feelings
a nd beha vior
a long with
thinking
rests on the
a ssumptions (1) tha t in
life both
feelings
a nd beha vior
sha pe
think-
ing,
often
helping
to
expla in why
defective
a rguments
a re nonetheless, for a ll tha t, per-
sua sive a nd
perva sive;
a nd
(2)
tha t it is
legitima te
for a n ethicist to
worry
a bout
wha t
people
do a nd not
just
wha t
they
think
a nd
sa y;
a
pa ssion
for the
good
is not
ina p-
propria te
for ethicists.
If ethics wa s
nothing
other tha n
seeing
to
it tha t no
logica l
fa lla cies were committed
in the
process
of ethica l
a rgumenta tion,
it
would
ha rdly
be
worthy
of
a nyone's
a tten-
tion. It is the
premises
of ethica l
a rguments,
the visions behind ethica l
systems,
the feel-
ings
which fuel ethica l
(or non-ethica l)
be-
ha vior,
which ma ke the rea l difference for
huma n life. Verba l formula tions a nd
a rgu-
ments a re
only
the
tip
of the
iceberg.
An
ethicist ca n restrict himself to tha t
tip;
he
will be on sa fe
enough professiona l grounds
if he does so. But I see no rea son
why
he
ca n't da re more tha n
tha t,
out of a
recogni-
tion tha t the source a nd
importa nce
of his
field lie not in the
a ca demy
but in
priva te
a nd
public
huma n
life,
where wha t
people
think, feel,
a nd do ma ke a ll the difference
there is.
Even in individua l
decision-ma king,
the
purely
ra tiona l
pa rt ma y quite legitima tely
pla y only
a subordina te role in some ca ses.
Persona l or
group experience,
for one
thing,
ma y provide rea sona ble, though
non-a rticu-
la ta ble,
principles
for conduct.
Tra ditions,
for
a nother, ma y provide
still other
princi-
ples,
even
though they
lie buried well below
the surfa ce of consciousness.
To be
sure,
there will
a lwa ys
be the criti-
ca l ta sk for ethics of
a sking
tha t rea sons a nd
justifica tions be
given
for
principles
derived
from
experience a nd tra ditions.
Nonetheless,
in the na ture of the ca se, these
justifica tions
ma y
not be
forthcoming,
if
only
beca use
they
ma y
be fa lsified if
pressed
into a
verba lly
a rticula ted form.
Occa siona lly, too, we see
situa tions in which beha vior is
clea rly
"good,"
but the rea sons
given
for tha t be-
72 HASTINGS CENTER STUDIES
ha vior a re wea k or non-existent.
Only
a
ma nia c would wa nt to subvert
good
beha vior
on the
grounds
of the defective
a rguments
used to ra tiona lize the beha vior.
Criteria for
Methodology
I will
only
offer one
nega tive
a nd one
positive
criterion for ethica l
methodology.
The
wrong methodology
will be used if it is
not a
methodology
which ha s been
specifi-
ca lly developed
for ethica l
problems
of medi-
cine a nd
biology.
This does not mea n it
ca nnot or should not bea r
ma ny
of the tra its
of
genera l philosophica l
or
theologica l
meth-
odology.
But if it bea rs
only
those tra its
one ca n be a ssured tha t it will not dea l
a dequa tely
with
specific
issues which a rise
in the life sciences.
My positive
criterion for
a
good methodology
is this: it must
displa y
the fa ct tha t bioethics is a n
interdisciplina ry
field in which the
purely
"ethica l" dimen-
sions neither ca n nor should be fa ctored out
without rema inder from the
lega l, politica l,
psychologica l
a nd socia l dimensions. The
critica l
question,
for
exa mple,
of who should
ma ke the ethica l decisions in medicine a nd
biology
is fa lsified a t the outset if too
sha rp
a distinction is dra wn between
wha t,
ethica l-
ly,
needs to be decided a nd
who,
politica lly,
should be a llowed to decide. It is
surely
im-
porta nt
to ethica l
theory
to ma ke this kind
of
distinction;
unfortuna tely,
if
pressed
too
doggedly
it
ma y
well
fa lsify
the
rea lity
of the
wa y
decisions a re a nd will continue to be
ma de.
The
problem
of
decision-ma king,
which
I include a s the third ta sk of the
bioethicist,
ca nnot be divorced from the
methodologica l
question. Actua lly
it ma kes me rea lize tha t
I ha ve a second
positive
criterion to offer a s
a test of a
good
bioethica l
methodology.
The
methodology ought
to be such tha t it ena bles
those who
employ
it to rea ch
rea sona bly
specific,
clea r decisions in those insta nces
which
require
them-in the ca se of wha t is
to be done a bout Mrs. Jones
by
four o'clock
tomorrow
a fternoon, a fter which she will
either live or die
depending upon the deci-
sion ma de.
I
ha ve
a lrea dy suggested tha t
philosophers a re not
very good
a t tha t sort
of
thing,
a nd tha t their wea kness in this
respect is
likely
to be
a ltogether vexing
to
the
physicia n who neither ha s the
right
a tmosphere nor the time to think
through
everything
the
philosopher usua lly a rgues
needs to be
thought through.
In
proposing
tha t a
good methodology
should ma ke it
possible
to rea ch
specific
conclusions a t
specific times,
I a m
proposing
a utopia n goa l. The
only
kinds of ethica l
systems
I know of which ma ke tha t
possible
a re those of a n
essentia lly
deductive kind,
with well-esta blished
prima ry
a nd
seconda ry
principles
a nd a
long history
of
highly
refined
ca suistica l
thinking.
The Roma n Ca tholic
schola stic tra dition a nd the Jewish
responsa
tra dition a re ca ses in
point. Unfortuna tely,
systems
of tha t kind
presuppose
a whole
va riety
of cultura l conditions a nd sha red
world-views which
simply
do not exist in
society
a t
la rge.
In their a bsence, it ha s be-
come
a bsolutely urgent
tha t the sea rch for a
philosophica lly
via ble norma tive
ethic, which
ca n
presuppose
some
commonly
sha red
prin-
ciples, go
forwa rd with a ll ha ste. Short of
finding tha t,
I do not see how ethica l method-
ologies
ca n be
developed
which will include
he
discipline
of
bioethics should be so
designed,
a nd
its
pra ctitioners
so
tra ined,
tha t it
will
directly-a t
wha tever cost to
disciplina ry elega nce-serve
those
physicia ns
a nd
biologists
whose
position dema nds
tha t
they
ma ke the
pra ctica l
decisions.
methods for
rea ching quick
a nd via ble solu-
tions in
specific
ca ses.
Instea d,
we a re
likely
to
get only
wha t we now
ha ve,
a lot of
very
broa d a nd
genera l thinking,
full of
va gra nt
insights,
but on the whole of limited use to
the
pra cticing physicia n
a nd scientist.
Much of wha t I ha ve been
sa ying pre-
supposes
tha t a distinction ca n be dra wn
between "ethics" understood
broa dly
a nd
ethics understood
na rrowly.
In its na rrow
sense, to do "ethics" is to be
good
a t
doing
wha t well-tra ined
philosophers
a nd theolo-
BIOETHICS AS A DISCIPLINE 73
gia ns
do:
a na lyze concepts, cla rify princi-
ples,
see
logica l enta ilments, spot underlying
a ssumptions,
a nd build theoretica l
systems.
There a re better a nd worse
wa ys
of
doing
this kind of
thing
a nd tha t is
why philoso-
phers
a nd
theologia ns
ca n
spend
much of
their time
a rguing
with ea ch other. But even
the better
wa ys will,
I
think,
not be
good
enough
for the dema nds of bioethics. Tha t
requires understa nding
"ethics" in a
very
broa d, well-nigh unma na gea ble
sense of the
term.
Impossible
a nd
Sca nda lous
My
contention is tha t the
discipline
of
bioethics should be so
designed,
a nd its
pra ctitioners
so
tra ined,
tha t it will
directly
-a t wha tever cost to
disciplina ry
elega nce--
serve those
physicia ns
a nd
biologists
whose
position
dema nds tha t
they
ma ke the
pra c-
tica l decisions. This
requires, idea lly,
a
number of
ingredients
a s
pa rt
of the tra in-
ing-which
ca n
only
be
life-long--of
the
bioethicist:
sociologica l understa nding
of the
medica l a nd
biologica l communities; psy-
chologica l understa nding
of the kinds of
needs felt
by
resea rchers a nd
clinicia ns, pa -
tients a nd
physicia ns,
a nd the va rieties
of
pressures
to which
they
a re
subject;
histori-
ca l
understa nding
of the sources of
regna nt
va lue theories a nd common
pra ctices; requi-
site scientific
tra ining;
a wa reness of a nd
fa cility
with the usua l methods of ethica l
a na lysis
a s understood in the
philosophica l
a nd
theologica l
communities-a nd no less a
full a wa reness of the limita tions of those
methods when
a pplied
to a ctua l
ca ses; a nd,
fina lly, persona l exposure
to the kinds of
ethica l
problems
which a rise in medicine
a nd
biology.
This is a n
impossible
list of
dema nds,
gua ra nteed
in a dva nce to sca nda lize a ll of
those
professiona ls
in whose field one must
trespa ss.
The scientist will
point
out tha t
you
a re not a tra ined
scientist,
the
physicia n
tha t
you
a re
la cking
both a medica l
degree
a nd
the clinica l
experience
of
trea ting pa tients,
the
sociologist
tha t
your
a necdota l evidence
is worth
nothing,
the
philosopher
tha t
you
a re
stra ying
from solid
philosophica l
work.
Well,
so wha t? Tha t is wha t the
discipline
of bioethics
requires.
One
importa nt
test of the
a ccepta nce
of
bioethics a s a
discipline
will be the extent
to which it is ca lled
upon by
scientists a nd
physicia ns.
This mea ns tha t it should be
developed inductively, working
a t lea st ini-
tia lly
from the kinds of
problems
scientists
a nd
physicia ns
believe
they
fa ce a nd need
a ssista nce on. As often a s
not, they
will be
wrong
a bout the rea l na ture of the issues
with which
they
ha ve to wrestle. But no less
often the
person
tra ined in
philosophy
a nd
theology
will be
equa lly wrong
in his under-
sta nding
of the rea l issues.
Only
a continu-
ing, proba bly
tension-ridden dia lectic will
suffice to
bridge
the
ga p,
a dia lectic which
ca n
only
be
kept
a live
by
a continued ex-
posure
to
specific
ca ses in a ll their huma n
dimensions.
Ma ny
of them will be
very
un-
plea sa nt
ca ses,
the kind which ma ke one
long
for the
security
of
writing elega nt
a rticles for
professiona l journa ls
on such
ma na gea ble
issues a s recent distinctions between "rules"
a nd "ma xims."