Relevance

Bioethics done by philosophers and by those who call themselves ethicists is predominantly action guiding.^{Footnote 4} Philosophical contributions are thought to be relevant when they address practical matters and pass judgments on policies and practices. Hundreds or perhaps thousands of potential practical solutions to real-life issues are being presented in bioethics journals every month.^{Footnote 5} I say “potential” because all of the solutions offered are only directly applicable within their own theoretical frameworks and with the normative presuppositions chosen by the authors. This is not often made explicit, because authors tend to believe that their theories and presuppositions are right. That is why they are using them. Despite their limited applicability, these practice-oriented studies are preferred to open-ended knowledge-for-its-own-sake studies.

Interestingly, a lesser degree of such direct relevance is expected of social science contributions. Qualitative studies that are not meant to yield generalizable results have their legitimate place in bioethics and need not justify themselves. Their value is seen to be in enhancing our understanding of ethical issues and of their complexity and diversity. I would think that much basic research in philosophy could do the same; however, I am less convinced that the directly-to-applications approach does. It bypasses the most profound philosophical questions, and thereby also the most valuable contributions that philosophers could make to deepening our understanding of ethical issues. It seems that relevance in bioethics simply means that the contribution is about practice.

Common Morality

To gain further relevance, many philosophers believe, rightly or wrongly, that their basic normative premises are derived from common morality^{Footnote 6} and that, as such, they should be generally acceptable, as should their conclusions—provided, of course, that the arguments used are valid. Unfortunately this is not so straightforward. For one thing, arguments do not really address the ethical concerns people have,^{Footnote 7} and moral beliefs do not necessarily follow logic. So even if the premises are shared, valid arguments might not be enough.

I am very doubtful as to whether there is any common morality when it comes to the sort of ethical questions we are dealing with in bioethics. If we look at the classical issues of bioethics—the beginning and end of life—it becomes clear that there is very little agreement. The question of when a human being with full moral worth comes into being continues to divide us, although the answers assumed have far-reaching implications for views concerning diverse practices from contraception to stem cell research. We are similarly parted when it comes to end-of-life decisions. Some of us firmly believe that a person has a right to voluntary euthanasia, whereas others think that life is an inalienable right. And if we expand the considerations to issues of justice, we find that some of us are egalitarian and some libertarian; and these stances have a profound impact on how we think healthcare services should be organized and how scarce resources should be allocated.

Perhaps, however, “common morality” means something else, and perhaps only some of the competing ethical views rightfully belong to common morality. Some philosophers seem to believe that, as a result of their long studies and extended research into pertinent matters, their reflective intuitions will tell us which these are. Then again, it has also been argued that due to “the intense training and selection that undergraduate and graduate students of philosophy go through, there is good reason to suspect that the alleged reflected intuitions are reinforced intuitions.”^{Footnote 8} Bioethicists clearly deal with bioethical problems more than anyone else, but whether that desensitizes or sensitizes us to the ethical nuances of the matters at hand is another question. Are we hardened by the exposure, or does it allow us to look at the matters in a cool, composed, and unbiased way? And should ethical matters be looked at in this way?

Then again, if by referring to common morality we are referring to some sort of empirical fact, perhaps we should seek the help of empirical sciences.^{Footnote 9} There are two main problems here. First, although empirical sciences could indeed shed some light on what common morality entails, most empirical scientists are quick to remind us that they are not simply in the business of “scooping up facts,” but that “those ‘facts’ are inherently tied to theories of knowing the world and to a repertoire of techniques and skills for accessing the world (or indeed constructing that world through an ongoing set of social processes).”^{Footnote 10} In short, empirical social sciences do not produce pure facts. However, they do tell us something about the world, even if the view is colored by the theoretical and methodological choices of the researcher. Second, it is unclear what we should conclude from empirical findings, even when they are on some level generalizable. We know that we are divided on many key issues in bioethics, so simply assuming that the majority view sums up common morality would be accepting the tyranny of the majority. It would also disregard another fairly commonly held idea—that ethics should be there to protect minorities. It is exactly with notions like common morality and appeals to them that philosophy has an important role—not in constructing guidelines based on what is believed to be common morality but by studying the notion itself and the justifiability of appeals to it.

Interdisciplinarity

To be relevant, in the sense of direct applications, philosophers need the help of other sciences, and the method of reflective equilibrium, in one form or another, is still among the favored ones to bring together the input from different disciplines.^{Footnote 11} The idea of reflective equilibrium is roughly to “articulate a process by which ethical theory, the concerns and views of the stakeholders, the needs and priorities of policy and the views of the ‘thinker’ are considered, resulting in a coherent, and therefore justifiable, ‘equilibrium.’”^{Footnote 12} The reflective equilibrium method is celebrated for its egalitarianism and flexibility, and its nondogmatic and nonfoundationalist nature, while being criticized for these same features. The critics argue that, without any privileged principles, the views of the thinker, which might be prejudiced, have too strong an effect on the “results.”^{Footnote 13} It is also, quite rightly, pointed out that, as a method, reflective equilibrium turns out to be very cumbersome.

Jonathan Ives has recently suggested a method of “reflexive balancing,”^{Footnote 14} which, he claims, will overcome some of the problems of reflective equilibrium while retaining its most valuable elements. His model starts with identifying the relevant “boundary principles” through robust and reflexive empirical research. These arise from the perspective of the stakeholders and might not coincide with the views of the researcher. With this, he hopes to eliminate any personal prejudices. It does not, however, eliminate prejudices from the views of the stakeholders. And because empirical research does not produce pure facts, the initial theoretical (positivism, antipositivism, structuralism, functionalism, social constructionism, conflict theory, critical theory, etc.) and methodological (qualitative or quantitative analysis, ethnographic approaches, participant observation, conversation analysis, computational methods, in-depth interviews, etc.) choices will have a significant effect on the results. Therefore, it does not fully eliminate the possible prejudices of the researcher either. However, when summarizing the method, Ives says that, when searching for the boundary principles, we should be willing to question all of our methodological and theoretical commitments and aim to fully understand the micro and macro context of the problem. If this were to be taken seriously, the search for the boundary principles would be an endless task.

For Ives, the boundary principles work as a starting point for the ethical analysis. They are not privileged principles but are initially treated as if they were to make ethical inquiry possible. From there on, his model works very much like reflective equilibrium, with a few specifications. Ives believes that achieving coherence sometimes requires compromise, and sometimes there could be more than one possible solution to a given ethical problem. His method is practically oriented, and with it he hopes to be able to “suggest a coherent compromise that will provide a temporary ‘fix’ [to the ethical issue at hand] until it either becomes redundant or something better comes along.”^{Footnote 15}

Similarly to the reflective equilibrium method, reflexive balancing becomes very cumbersome in the weighing stages. Each new problem presents a challenge to the whole system. And each problem, Ives says, “requires the researcher to explore anything and everything that might have an impact on the problem at hand.”^{Footnote 16} Furthermore, because there is a requirement of coherence, with any changes in the system, the coherence with every single part of the system should be checked.

What Is the Point?

I have used reflective equilibrium and reflexive balancing as examples of some of the problems that interdisciplinary bioethics, in the search for practical solutions, faces and creates. What I hope to have shown is that either the work is endless or the solutions will be in one way or another biased.

Therefore, I do not think that looking for practical solutions is what academic bioethics should predominantly be doing. Philosophers, like many social scientists, should be more interested in increasing our understanding of phenomena themselves. I would go as far as to say that studies in which the purpose is to search for “a solution that we can live with, and which goes some way towards resolving the problem we currently have”^{Footnote 17} belong not in academic journals but in reports from whoever has commissioned the study.

For the commissioned studies, I would suggest a reverse methodology. In most cases, the policymakers already have an idea of what they would like the solution to be. Social scientists could study the acceptability of the suggested policy and try to identify the minimal alterations or other causes of action needed to make it tolerable to people. Legal scholars could study the legal boundary conditions, philosophers could provide the normative justifications, and reflective and reflexive balancing could then be used to fine-tune the policy. This is actually where interdisciplinarity is at its strongest; when you already know what you want to achieve, different disciplines striving toward a shared goal would make for a well-justified and received policy decision.

I am very aware that many philosophers would prefer to do more philosophy and less policy, but due to the fact that research grants often expect policy recommendations, we end up publishing papers that lean toward practical suggestions.^{Footnote 18} In the bigger picture, this is all a part of a paradigm change in academic research more generally. In research funding, the expected utility plays a huge role whatever the discipline, and although mere increased understanding would arguably be useful in the long run, the modern world wants more immediate results. Perhaps those of us in editorial positions could do our part in encouraging pure research papers and, by doing so, could help to keep knowledge-interest-driven research alive.