BIOETHICS

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© 2006 The Author. Journal compilation © 2006 Blackwell Publishing Ltd., 9600 Garsington Road, Oxford, OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA

Philosophical Books Vol. 47 No. 3 June 2006 pp. 245–254

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RECENT WORK

XXXX

BIOETHICS

The University of York

The amount of recent work in bioethics is dauntingly large. To survey such asizeable body of work requires homing in on a specific theme. Preparing thisarticle, I was most struck by the lack of consensus on, and variety of sourcesof anxiety about, bioethics’s methodology. On the one hand, an enormousand increasingly varied body of work is published under the rubric, bioethics.On the other hand, we seem ever further from methodological consensus.The situation seems analogous to that of an imperialist or coloniser who isincreasingly unsure as to how to manage their ever-expanding territories.

Philosophical Bioethics

I’ll begin with philosophical or traditional bioethics. There’s a contrastbetween direct and indirect work. Two recent books illustrate direct philo-sophical bioethics. The first is my own, the subject matter of which is corebioethical topics such as stem cell research, defining death, prenatal geneticintervention, and genetic enhancement.

1

I was concerned to avoid simplyapplying some familiar or preferred normative theory to bioethical problems.After all, the fact that a utilitarian, say, would endorse a biomedical procedureis inconclusive in the absence of proof that utilitarianism is the right moraltheory (at least, right for the problem in hand). Nonetheless, my book is informedby theoretical insights from philosophy, such as theories of personal identity.So, bioethical problems are situated within four philosophical themes: moralstatus; life, death and killing; personal identity; and the argument from nature.

I wanted to stress in the book that it is all too easy to take a consequentialistapproach in bioethics—such that the response to bioethical problems becomesthe kind of cost-benefit analysis anyone can do—when some of the most importantconsiderations in bioethics are non-consequentialist. The idea was to takedeontological considerations seriously without simple-mindedly and incon-clusively applying a deontological moral theory such as Kantianism. For example,I think it is worth thinking hard about the argument from nature precisely

1. Stephen Holland,

Bioethics: A Philosophical Introduction

(Polity Press, 2003).

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© 2006 The Author. Journal compilation © 2006 Blackwell Publishing Ltd.

because it remains popular and influential in bioethics despite seemingly havingnothing going for it. Part IV of my book reports, develops and applies Rich-ard Norman’s account of the argument, according to which it is a reasonable,but ultimately flawed, response to bioethical challenges.

2

One reviewer mis-construed this as revealing the book’s implicit conservative agenda.

3

Althoughthis is understandable—after all, the main role of the argument from natureis “to resist current and feasible biomedical innovations”

4

—it is mistaken. It shouldbe possible to examine a prominent aspect of bioethical discourse that is usuallyused restrictively, such as the argument from nature, and inquire into whatsense can be made of it and its influence, without incurring the distasteful chargeof conservatism.

5

Otherwise, the discipline would be seriously impoverishedas bioethicists are warned off discussing other restrictive considerations (thepotentiality principle, the sanctity of life doctrine, etc.).

Another recent work of ‘direct philosophical bioethics’ is David DeGrazia’s

Human Identity and Bioethics

.

6

Like mine, DeGrazia’s book discusses somestandard bioethical problems, specifically the definition of death, the authorityof advance directives, enhancement technologies, prenatal genetic interventionsand other reproductive choices. But he approaches these topics by defining andapplying a single philosophical concept, namely identity. DeGrazia claims thathis “book distinguishes itself by developing accounts of both senses of identityand maintaining that both are normatively important” (p. 8). The two sensesof identity referred to here are ‘numerical’ and ‘narrative’. Numerical identityis a traditional topic in analytic philosophy: the criteria for our continuedexistence over time and, relatedly, the nature of our essence. Narrative identityinvolves one’s self-conception, what one considers as most important to whoone is, and related notions such as self-creation, autonomy, and authenticity.

Clarifying this distinction is an important corrective to the tendency to employone of these senses of identity at the expense of the other. It helps to clarify realbioethical worries that are poorly articulated. Specifically, it is often the case thata worry about narrative identity is lurking behind a biomedical innovation but,because narrative identity is “largely neglected by analytic philosophers” (p. 8),that worry is misunderstood or under-represented, which precludes a properdiscussion. A good example is enhancement technologies. It is implausible thatenhancements alter numerical identity (the individual is clearly one and the samebefore and after the enhancing intervention). But concerns about such technologies

2. Richard Norman, ‘Interfering with Nature’,

Journal of Applied Philosophy

, 13 (1996), pp. 1–11.3. Cynthia Townley,

Philosophical Books

, 46 (2005), pp. 174–5.4.

Bioethics

, p. 151.5. Townley claims that I am “honest about finding [that arguments from nature will be conser-

vative] appealing”. But I don’t find this aspect of arguments from nature appealing and,consequently, don’t anywhere say that I do. She cites p. 151 of my book, where I do allude anumber of times to appeals to the argument from nature; I suspect this is a case of misreading ‘theappeal to . . .’ as ‘the appeal of . . .’. This misperception of the book as conservative resultedin other unfair claims, such as that “Holland’s presentation is also less than inclusive when adiscussion of ‘parents’ inexplicably becomes discussion of a ‘wife’ and ‘husband’ (pp. 165–6)”; far from being “inexplicable”, I explained on p. 160 that “[i]n this text, ‘husband’ and‘wife’ are used to refer to people intending to parent a child, simply for the sake of brevity”.

6. David DeGrazia,

Human Identity and Bioethics

(Cambridge University Press, 2005).

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are clarified by employing the notion of narrative identity. Another great pleasureof DeGrazia’s book is the way he persuasively presents, and consistently applies,distinctive views about both kinds of identity. For example, concerning numericalidentity he writes: “Against the philosophical majority, I will argue that we areessentially human animals, not minds or persons, and that our persistence conditionsare biological, not psychological” (p. 8). This engenders interesting though con-troversial positions on such matters as the definition of death and the effect ofan author’s dementia on the moral authority of their advance directives.

Indirect philosophical bioethics includes recent work that advocates usingphilosophical periods or movements as a kind of prism or lens through whichto view contemporary bioethical problems. For example, Kuczewski and Polansky’s“compilation of essays reflects a new and burgeoning dialogue between con-temporary bioethicists and scholars of ancient Greek philosophy”.

7

The bur-geoning of this dialogue is a predictable consequence of the (relatively) recentupsurge of interest in classical themes in moral philosophy which has resultedin the now familiar appeal to virtue ethics by bioethicists. It is also grounded incertain features of medicine and bioethics that point towards classical ideas. Forexample, both medicine and bioethics seem to advance in ways which suggestthat there is knowledge to be had in these areas, but only by attending flexiblyto the idiosyncratic saliencies in particular (medical, ethical) cases. This kindof particularist thinking inevitably puts one in mind of classical notions such as

phronesis

, or ‘practical wisdom’. The first part of Kuczewski and Polansky’s bookis reflexive: ancient themes and concepts are employed to elucidate “the char-acter of medical and ethical knowledge”. The second, entitled ‘The Heuristic Valueof Classical Approaches’, is practical: contemporary bioethical problems (abor-tion, euthanasia, etc.) are viewed via the insights of the Ancients (Socrates andThrasymachus, Aristotle on potentiality, Epictetus on death, for example).

Glen McGee’s new edition of

Pragmatic Bioethics

is another example of indirectphilosophical bioethics.

8

The assumption behind McGee’s collection is that wewould benefit from looking at bioethics via American Pragmatism, and specificbioethical issues might be addressed by reference to American pragmatist writings.In his thoughtful and insightful Introduction to the Second Edition, McGee iscareful to explain that “Pragmatism is not a simple ethics machine or a bucket ofsolutions that can be dumped on any emergent fire” (p. xv). On the contrary,“[t]he task of the authors . . . is to make manifest the outlines and dimensionsof pragmatic philosophy so that elements of a pragmatic method for inquiryin bioethics can be ascertained and discussed” (p. xvi). The book falls into threeparts: papers in Part One look at the ‘pragmatic method’ and bioethics in general;papers in Part Two are intended to suggest that bioethical debates can be informedby parts of the canon of classical American Pragmatism; those in Part Threeapply aspects of Pragmatism to specific bioethical issues more overtly.

9

Books such as Kuczewski and Polansky’s, and McGee’s, are valuable for numer-ous reasons. With one or two exceptions, the contributions are at least interesting,

7. Mark G. Kuczewski and Ronald Polansky (eds.),

Bioethics: Ancient Themes in Contemporary Issues

(MIT press, 2000), p. ix.8. Glen McGee (ed.),

Pragmatic Bioethics

(MIT Press, 2nd edn. 2003).9. For my review of the book, see

Journal of Medical Ethics

, 30 (2004), p. e9.

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and at best stimulating and informative. The quality of the contributors andediting results in a publication that raises the intellectual ante in bioethics, animportant consideration in a philosophical climate that tends to denigratepractical ethics. And such books help to integrate students’ experience of abstractand applied philosophy. On the other hand, their point, expressly, is not toproselytize but to provide a perspective on bioethical problems. No-one issaying that a bioethicist has to be an expert in ancient Greek or Americanpragmatist philosophy—or any equivalent—nor that one should adhere to suchpoints of view to the exclusion of others. Quite rightly, no-one is saying thatindirect philosophical bioethics of this kind amounts to

the

bioethical methodology.

Expansion

Alongside recent works of philosophical bioethics is evidence of the expansionof bioethics beyond the traditional. I’ll focus on expansion along two dimen-sions. First, bioethicists continue to occupy new terrain within the wider fieldof ethics, health and medicine. The recent upsurge of interest in public healthis a case in point. There have always been occasional pieces by bioethicistsand medical ethicists on the ethical dimension to public health interventionssuch as immunisation and health education. But the more concerted andconsolidated interest in public health matters in mainstream bioethical litera-ture is new. A very recent volume of

Bioethics

, for instance, includes papers on“a wide spectrum of issues canvassed including those of public health ethics,feminist approaches to bioethics, and the more usual fare of bioethics includ-ing research on human beings and concerns about new medical technolo-gies”.

10

The preceding volume begins with: “Though the ethical issues raisedby infectious disease are every bit as interesting, important, and difficult as thoseraised by standard topics in bioethics—i.e. abortion, euthanasia, genetics,cloning, stem cell research, and so on—the general topic of infectious diseasehas thus far been neglected by the discipline of bioethics”.

11

In fact, the wholeof one recent volume of

Bioethics

is devoted to public health ethics.

12

Evidently,Wikler’s prediction of “a bioethics of population health” has been realized.

13

The second dimension of expansion of bioethics is outside the Westernmilieu in which bioethics originated. There has been a spate of recent worksadvocating addressing contemporary bioethical problems philosophically, butwithin non-Western philosophical traditions as opposed to the traditionalanalytic school. An example is Ren-Zong Qiu’s

Bioethics: Asian Perspectives

.

14

Qiu’s book is notable for the breadth and quality of the collected essays, the

10. Paul M. McNeill, ‘Guest Editorial: Deep Listening: Bridging Divides in Local and GlobalEthics’,

Bioethics

, 19 (2005), p. iii.11. Michael J. Selgelid and Margaret P. Battin, ‘From the Guest Editors: Ethical Issues in

Infectious Diseases’,

Bioethics

, 19 (2005), p. iii.12.

Bioethics

, 18 (2004).13. Daniel Wikler, ‘Presidential Address: Bioethics and Social Responsibility’,

Bioethics

, 11 (1997),p. 186.

14. Ren-Zong Qiu (ed.),

Bioethics: Asian Perspectives

(Kluwer, 2004).

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authors of which are all non-Western though many were trained in Westernacademia. Qiu’s collection powerfully expresses the diversity of perspectiveson contemporary bioethical problems that emerge once the philosophy inphilosophical bioethics is expanded to include non-Western traditions: “Theintellectual foundation of bioethics is entrenched in or closely related toparticular cultures. In Asia there are Confucian, Taoist, Buddhist, Hindu,Islamic, Christian and many native cultures. For example, in East Asia Con-fucianism is still very influential, and some bioethicists are trying to developa Confucian approach to bioethics or to integrate this approach withapproaches other than Western liberalism” (p. 2).

The Social Science Critique

I want to go on to suggest that this expansion of bioethics along the dimen-sions briefly described above increases anxiety about the discipline’s meth-odology. But, first, there is a related theme to discuss, namely the sophisticatedcritique of philosophical bioethics from non-philosophical disciplines withinthe Western intellectual milieu to which traditional bioethics belongs. A goodstarting point is the insistence on the relevance of non-philosophical styles ofreflection to bioethics, as in the recent upsurge of interest in applying literarymaterial and techniques to bioethical problems. Correctives to over-relianceon traditional philosophical approaches are more and less benign. A benignexample is Stripling’s

Bioethics and Medical Issues in Literature

, which situatescontemporary bioethical problems in literary works.

15

This is an interestingsubgenre, but I won’t dwell on it because it is a relatively unchallenging cor-rective to philosophical bioethics: looking at bioethical problems from theperspectives of two such closely related Humanities disciplines as philosophyand literature ought to be perfectly feasible.

There is a more challenging aspect of the literary approach to bioethics. Somewriters have provided literary analyses of bioethics itself, revealing bioethicalwritings as, at least in part, literary constructions employing techniques familiarfrom overtly fictional writings, such as metaphor and rhetoric.

16

The resultantscepticism about the claims of philosophical bioethics to presumed virtues suchas value-neutrality and objectivity immediately puts one in mind of the socialscience critique familiar from writers such as Renée Fox, Barry Hoffmasterand Charles Bosk.

17

The connecting thought is that of bioethics as (literary, social)construction. The basic tenet of the social science critique is that, because ofits origins in philosophy, bioethics presents itself as an ahistorical, rational arbiterof normative judgements. The emphasis is on dispassionate, un-embeddedargumentation and the universal application of principles or theories to indi-vidual cases, in ignorance of empirical evidence in general, and the social sciences

15. M.Y. Stripling,

Bioethics and Medical Issues in Literature

(Greenwood, 2005).16. E.g., Todd Chambers,

The Fiction of Bioethics: Cases as Literary Texts

(Routledge, 1999).17. See, e.g., Raymond DeVries and Janardan Subedi (eds.),

Bioethics and Society: Constructing theEthical Enterprise

(Prentice Hall, 1998); Barry Hoffmaster (ed.),

Bioethics in Social Context

(TempleUniversity Press, 2001).

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in particular. According to the critique, this philosophical approach is in-appropriate both in principle—it advocates a ‘top-down’ style of normativeanalysis that ignores ground-level social realities—and practice (it threatens toleave bioethics side-lined from real world policy-making processes).

18

How has the social science critique been handled recently? Adam Hedgecoe’sis a thoughtful recent attempt to make compatible philosophical and socialscientific perspectives in bioethics.

19

On his preferred version of ‘criticalbioethics’, “social science seems less of a threat to traditional bioethics andmore like an opportunity to improve the way ethical work is done, and expandthe range of topics open to ethical scrutiny” (p. 135). He suggests character-istics needed for a piece of work to be called ‘critical bioethics’, includingbeing informed by empirical research, being prepared to allow empirical datato challenge cherished ethical theory, reflexivity, and what he calls ‘politescepticism’ about relevant empirical claims. Hedgecoe’s is an admirable attemptto avoid a damaging stand-off between philosophy and social scientificapproaches in bioethics. And no doubt there are lots of things the two ‘camps’can learn from one another. But I am much less optimistic than Hedgecoeabout the prospects of making the two cohere in ‘critical bioethics’.

The worry is that analytic philosophers and social scientists adhere tosignificantly different value systems. Hedgecoe quotes an illustrative example,namely Rayna Rapp’s study of women contemplating prenatal testing for Down’sSyndrome and/or abortion.

20

Two considerations relevant to the topic thatemerged from Rapp’s study are (a) the impact of the birth of a disabled childon existing people and relationships and (b) the moral status of the embryo.Which of these is most important in determining the normative status of thesemedical procedures? Rapp reports that (a) is salient for her informants whilstthe moral status of the embryo is one of the least important issues for womencontemplating prenatal testing and/or abortion. Typically, for a social scientist,this would be decisive. After all, the fundamental value in the social sciencesis deep regard for the felt and lived experiences of informants. But by contrast,whilst traditional bioethicists would fully recognise that (a) is important bothin itself and to the normative status of the procedures in question, for them (b)would be the

more important

consideration. Again, this is because of fundamentalvalues: the fundamental value in analytic philosophy is dispassionate reasoning.

This putative stand-off between social scientific and analytic philosophicalapproaches in bioethics needs clarifying. Neither camp is being provocative.Each appreciates that both considerations, (a) and (b), are normatively import-ant. Neither is insensitive to, nor ignorant or disparaging of, an importantvalue. Neither camp is occupying an untenable position (such as vulgarrelativism or a-contextualism). It is just that the two sets of thinkers typicallyweigh important considerations differently because of the different emphasisthey place on the lived and felt experience of informants. So, Hedgecoe is

18. See Mätti Hayry, Tuija Takala and Peter Herissone-Kelly (eds.),

Bioethics and Social Reality

(Rodopi, 2005).19. Adam M. Hedgecoe, ‘Critical Bioethics: Beyond the Social Science Critique of Applied

Ethics’,

Bioethics

, 18 (2004), pp. 120–43.20. R. Rapp,

Testing Women, Testing the Fetus: The Social Impact of Amniocentesis in America

(Routledge, 2000).

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quite right to insist that the view of Rapp’s informants “requires more engage-ment than simple dismissal [by bioethicists]” (p. 137). But engagement mightwell result in a stand-off. For the social scientist, the fact that the women’s“reasoning about what is important is different to that presented in bioethicstexts . . . implies that bioethicists . . . would be better employed turningtheir attention towards the rights and duties (or principles, or utilitarian cal-culations) that are involved in relationships with other people, and how theseare affected by the arrival of a Down’s baby, rather than the moral statusof the embryo” (p. 136). But what Hedgecoe pejoratively describes as “thedie-hard philosophical bioethicist”, whilst respecting the emotional responsesof the women to a deeply disturbing situation, might demur because, forthem, (b) is normatively more important then (a).

Methodological Anxiety

The themes from recent work discussed so far in this review are sources ofanxiety about bioethics’s methodology. First, there is an irony in the fact thatso much is published as bioethics, given the lack of consensus on how to goabout addressing and solving bioethical problems. Philosophical bioethics mightseem like safe ground: surely we can be reassured of the methodological coher-ence within mainstream Western analytic philosophy. But how much reassur-ance is there here? Even from the very brief overview of recent philosophicalbioethics above, it is clear that philosophy informs bioethics in various ways.Some writers apply standard normative theory (principlism, utilitarianism, etc.).Others, like myself and DeGrazia, eschew normative theory. The latter mighttake a thematic approach, enquiring into how moral status, for example, or theargument from nature, inform bioethical discourse. Or they might wrestle withjust one philosophical concept, applying it to a range of diverse bioethicalproblems. This might take them out of mainstream analytic philosophy—inthe way DeGrazia’s insistence on the normative significance of narrative identitydoes—raising a question as to how far can one leave familiar philosophicalterritory and still be doing philosophical bioethics. Or one might apply thoughtsand perspectives from some philosophical era or movement, in the mannerof the indirect philosophical bioethics reported above. But then, which ones:if Greece, why not Rome; if Pragmatism, why not Positivism?

Secondly, and much more importantly, both dimensions of expansion ofbioethics described above make reliance on Western philosophy seem not somuch traditional as parochial. Referring back to Wikler’s ‘bioethics of popu-lation health’, it is widely acknowledged that public health ethics would notbe well served by simply applying the paradigms and principles of bioethicsto public health dilemmas.

21

Advances in bioethics are due in large part to anincreased awareness of, and concern to protect, individual rights grounded inthe principle of respect for autonomy. By contrast, the distinctive feature of

21. James C. Thomas, ‘Teaching Ethics in Schools of Public Health’,

Public Health Reports

, 118(2003), pp. 279–86.

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public health ethics is the dilemma that arises

between

individual rights andcommunity benefit. Simply to apply the guiding principles of bioethics to thefield of public health would be question-begging: it would be tantamount toassuming the priority of individual rights over communal benefits, when it isprecisely the relative values of these that is the core ethical question in publichealth. So, even if we were convinced that traditional bioethics has a coherentmethodology, the expansion into public health necessitates a new approach.

That the second dimension of expansion—into non-Western contexts—creates methodological anxiety is even more obvious. Bioethical problems areglobal. But the philosophy in philosophical bioethics is in the analytic tradition.This is hopelessly ethnocentric. It might be quite inappropriate to prioritizeWestern philosophy over sophisticated alternative philosophical traditions devel-oped in the non-Western cultures in which, increasingly, bioethicists work. Buthow is bioethics to avoid both ethnocentric reliance on analytic philosophy, onthe one hand, and the collapse into an ever-expanding set of cultural perspec-tives that have nothing in common but bioethical problems, on the other?Take one example from Qiu’s book: quite what are we to do with the factthat the concept of personhood is defined differently in Western and Confu-cian philosophical cultures? Reduce the one to the other? Choose one andeschew the other? Operate both? Or are we to relativize bioethics, so that oneconcept of personhood is employed in one context, the other in the other?

Relatedly, the upshot of the social science critique of traditional or philo-sophical bioethics is a kind of perspectivalism. Increasingly, bioethical issuesare considered from the various perspectives, or through the various lenses,of the protagonists in the relevant medical scenarios. There is space here onlyto allude to important cases in point that figure prominently in recent work.First, feminist bioethicists have continued their impressive development of adistinctively feminist perspective on bioethical problems by insisting on thereconstruction of the experiences of women caught up in the kinds of scenariosthat create bioethical problems.

22

Second, there has been increased interest inreconstructing the values, attitudes, beliefs, etc., of protagonists working insuch fields as reproductive medicine.

23

The spate of books in which bioethicalproblems are discussed from one of a variety of religious traditions is a clearindication of the perspectival fragmentation of bioethics.

24

For all their differ-ences, all such work shares an idea grounded in the social science critique:the refusal to privilege traditional philosophical (i.e., analytic) approaches overother, often conflicting, perspectives on bioethical problems.

22. Rosemarie Tong, Anne Donchin and Susan Dodds (eds.),

Linking Visions: Feminist Bioethics,Human Rights, and the Developing World

(Rowman and Littlefield, 2004), and Rosemarie Tong,Gwen Anderson and Aida Santos (eds.),

Globalizing Feminist Bioethics: Crosscultural Perspectives

(Westview Press, 2000), are important in marrying the themes of feminist and developingworld bioethics. See, also, Rosemarie Tong,

Feminist Approaches to Bioethics: Theoretical Reflectionsand Practical Applications

(Westview Press, 1996).23. See, e.g., Anne Kerr,

Genetics and Society: A Sociology of Disease

(Routledge, 2004).24. See, e.g., M.J. Iozzio (ed.),

Considering Religious Traditions in Bioethics: Christian and Jewish Voices

(University of Scranton Press, 2001); Benjamin Freedman,

Duty and Healing: Foundations of aJewish Bioethic

(Routledge, 1999); Lisa Sowle Cahill,

Theological Bioethics: Participation, Justice, andChange

(Georgetown University Press, 2005).

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Responses

Concerns about methodology have been discussed for most of the short his-tory of bioethics, and contemporary bioethicists are aware of the issue.

25

Howhas it been tackled in recent work? The pluralism in bioethical methodologyis mirrored by the variety of responses to it. To illustrate, there is a distinctionbetween what might be called methodological pluralism versus methodolo-gical monism: that is, between writers who work with a plurality of bioethicalmethods versus those who endorse a single preferred methodology for bio-ethics. An example of the former is Kevin Wildes’s

Moral Acquaintances

.

26

Wildesdescribes his book as being “about methodology in a practice inspired bymoral controversy and seminal experience”, focusing on “a careful examinationof the different methods used in contemporary secular bioethics” (p. 2). It isa work of methodological pluralism because, “this book is not about findinga single method for bioethics” (p. 6). In fact, it is easy to discern in Wildes’sbook a kind of celebration of methodological pluralism: anything other thana plurality of methods would amount to a failure to do justice to the complex-ity of bioethical problems and contemporary society.

Wildes is attempting to avoid a dilemma between ignoring plurality inbioethics and what he calls ‘unqualified relativism’. He presents his projectby metaphorical reference to “moral friends, strangers and acquaintances”.As I understand it, the idea is that we should begin by reflecting on the kindsand occasions of agreement and disagreement discernible in bioethics; thatway we can discover rather than assume common ground. Again, Wildesresorts to metaphor to express the point: we need to study the genealogy,spectrum, geography, etc., of agreement and disagreement. Wildes suggeststhat his approach can provide substantive achievements at various levels. Atthe very least, we can get clearer about bioethics’s numerous methods ofanalysis. More ambitiously, we might discern hitherto unsuspected types ofagreement and consensus, and that some disagreement is less entrenchedthan first thought.

Notwithstanding Wildes’s admirable reasonableness, his is a dangerous game.After all, bioethics is a practical discipline, its

raison d’être

being to provide—or at least contribute substantially to the development of—solutions to dilem-mas in health care and medicine. So, methodological pluralism is a source ofscepticism: how can bioethics succeed in the absence of a tried and trustedmethod? The upshot of what Wildes calls his ‘methodological exploration’might be that pluralism is reinforced and scepticism encouraged. Consider asmall but, I think, telling detail. Repeatedly, Wildes restricts methodologicalexploration to ‘secular society’. This is odd for a number of reasons. For onething, the variety of contemporary religious perspectives on bioethical prob-lems is a major source of the methodological diversity Wildes is discussing.

25. Famously, Daniel Wikler, in ‘Federal Bioethics: Methodology, Expertise, and Evaluation’,

Politics and the Life Sciences

, 13 (1994), pp. 100–1, referred to the methodology of bioethics as“anarchic”.

26. Kevin Wm. Wildes, S.J.,

Moral Acquaintances: Methodology in Bioethics

(University of Notre DamePress, 2000).

254


For another, Wildes himself is clearly aware of this: he reports that, histor-ically, theology is one of the disciplines out of which bioethics grew, thatcurrent practitioners include theologians, and that contemporary bioethicsembraces theology (p. 3).

27

The point is telling because the restriction to thesecular creates the impression that the outcome of methodological explorationwill be more favourable than I think we have the right to expect.

This brings us to methodological monism. I’ll illustrate this by reference toa text about to be published by Jonathan Baron.

28

Like Wildes’s, Baron’sstarting point is methodological pluralism in bioethics. But, in contrast toWildes’s methodological exploration, Baron endorses a particular methodo-logy, namely “utilitarian decision analysis”, in order to help establish bioethics’sauthority. So, the sense in which Baron is ‘against bioethics’ is very specific.First, his target is ‘applied bioethics’ as opposed to scholarship in bioethics.In other words, he is concerned about practical judgements and actions(endorsing this medical intervention, rejecting that research protocol ) asopposed to scholarly bioethical literature (he agrees that bioethical scholarsprobably endorse his preferred methodology). Second, he is ‘against’ appliedbioethics because “[i]t has become a kind of secular priesthood to whichgovernments and other institutions look for guidance, but it lacks the author-ity that comes from a single, coherent guiding theory in which practitionersare trained” (p. 4). Baron’s thought is that this methodological vacuum isunnecessary: bioethical issues “can be illuminated by applied utilitarianism,in the form of decision analysis. Thus, what I have to say is ‘against bioethics’but it is also ‘for’ an alternative” (p. 5).

The nice thing about Baron’s book is that he is advocating a perspectiverather than a dauntingly detailed methodology: “Decision analysis is also dif-ficult and time consuming. I shall not be recommending, though, that it bedone very often. Rather, I shall argue that our thinking about issues shouldbe informed by its perspective” (p. 6). Relatedly, he is concerned to keep a lighttouch when it comes to actual analysis. For example, employing his preferredmethodology is less about presenting precise statistical values for goods andrisks, than about taking the right attitude to the bioethical problem in hand:quantitative, future-oriented, overridable comparisons of outcomes. There areplenty of pleasures to be got from Baron’s sophisticated text, which containsinteresting theoretical and practical claims about the grounds, subtleties andimplications of utilitarian decision analysis. But my worry about Baron’sapproach will be obvious from its juxtaposition with Wildes’s. It is highly unlikelythat any one methodology will be endorsed by bioethicists to the extent heenvisages, a point that brings us full circle: that I would hesitate to endorseutilitarian decision analysis as applied bioethics’s basic methodology will bepredictable given the deontological approach in my book briefly alluded to atthe start of this review.

27. Wildes’s book includes innumerable religious references but they tend to be serving historicalpoints.

28. Jonathan Baron,

Against Bioethics

(MIT Press, forthcoming). Thanks to the author for forward-ing me a final draft of the MS.

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BIOETHICS