Theory and Bioethics

Bioethics are defined in different ways according to the subject one is applying it to. A definition that suits that view is Battin’s who sees bioethics as a hybrid consisting of philosophy, medicine and law BATTIN, M. P. 2003. Bioethics. In: WELLMAN, R. G. F. C. H. (ed.) A Companion to Applied Ethics. Blackwell Publishing Ltd.. That definition is now 13 years old and it still fits if there is added a long list of subjects to go with it. Bioethics are ethics about flora and fauna – and the hard questions that emerge in the humane world. Questions e.g. when - or if - a fetus is a person or whether it is wrong to use the nature – bacteria for example – to help the human race thrive.

Theories in normative ethics

One of the interesting aspects of bioethics, as a field, is that there is no dominating strain of normative ethics. The arguments are both deontological in nature as well as utilitarian. When an argument is deontological it focuses on duties. Deon comes from the ancient Greek word for duty or obligation. Simply put: There are some things that one just has to do and things one never does. In deontology there is a principle called Universalizability Principle which states, that for an action to be morally acceptable the maxim which the action is based on has to be universalizable NIELSEN, C. F. 2014. Deontologi In: CHRISTENSEN, A.-M. S. (ed.) Filosofisk Etik. Århus: Århus Universitetsforlag..

An example of a deontological argument would be “it is wrong to play God”, that falls under the category with religious arguments. Some group those arguments with teleological-, religious - and nature arguments KAPPEL, K. 2011. Bioetik. In: CHRISTENSEN, A.-M. S. (ed.) Filosofisk Etik. Århus: Århus Universitetsforlag. Aarhus Universitetsforlag..

The utilitarian arguments are focused on the consequences of our actions. The consequences are all that matters when it comes to the decision of whether something is morally just. The consequences which utilitarianism focuses on are utility and it’s often the most positive arguments in bioethics. The arguments are simple in outline: if the action that is discussed produces, or results in, more utility then one is morally obliged to apply or accept that action HOLTUG, N. 2014. Konsekventialisme. In: CHRISTENSEN, A.-M. S. (ed.) Filosofisk Etik. Århus: Århus Universitetsforlag..

Sometimes the arguments are based on virtue ethics. Where deontology and utilitarianism are based on rules independent of individuals, meaning that the rules apply no matter what, virtue ethics are based on the individuals. The perfect virtuous person is what determines the morally just action. In natural science virtues like integrity, curiosity and intelligence are often highly praised and the idea behind virtue ethics are that the virtuous person’s actions are the morally praiseworthy actions CHRISTENSEN, A.-M. S. 2014. Dydsetik. In: CHRISTENSEN, A.-M. S. (ed.) Filosofisk Etik. Århus: Århus Universitetsforlag.. In relation to bioethics most arguments focus on; that for an action or technology to be morally acceptable it should be so that a virtuous person would accept it. Problems arise when it comes to determine the perfect virtuous person.

Precautionary vs. proactionary

In the discussions of different emerging technologies or therapeutics one can either assume a precautionary or a proactionary stand. The precautionary point of view tends to be a more sceptical view, where one takes a stand against just accepting and embracing new technologies or therapeutics: their motto is better safe than sorry, based on the fear of unknown consequences or that the technology in question has the possibility of changing our life as we know it.

As a proactionist the fear is not unforeseen consequences, but that the public skepticism will hold evolution and progress back. There is a tendency to see an emerging technology or therapeutics as safe, unless there is evidence that suggests otherwise KAPPEL, K. 2011. Bioetik. In: CHRISTENSEN, A.-M. S. (ed.) Filosofisk Etik. Århus: Århus Universitetsforlag. Aarhus Universitetsforlag..

Arguments in Bioethics

There are different arguments in the discussions. The subject of discussion changes depending on what technology or therapeutics is in question. But behind the different-sounding arguments there is a structure or a system. Most of the arguments falls under different categories:

1. Autonomy and utility
2. Dignity and integrity
3. Teleological, natural and religious
4. Slippery Slope

An argument in category A is an argument that appeals to either the autonomy of an individual or that it will promote utility in the society. It’s a type of argument that one often hears from a proactionist, who normally will focus on the good aspects of an emerging technology or therapeutics. Appeal to autonomy is often motivated from a deontological point of view, but the appeal to utility is often utilitarian in nature KAPPEL, K. 2011. Bioetik. In: CHRISTENSEN, A.-M. S. (ed.) Filosofisk Etik. Århus: Århus Universitetsforlag. Aarhus Universitetsforlag..

Dignity and integrity is mostly seen as a reply to an argument from category A. It’s therefore often used by a precautionist, as their way of saying “slow down - somethings are more important than utility”. The core idea is that living matter has a dignity and integrity that we as a society should respect, but living matter can be defined in many ways allowing room for a versatile argument KAPPEL, K. 2011. Bioetik. In: CHRISTENSEN, A.-M. S. (ed.) Filosofisk Etik. Århus: Århus Universitetsforlag. Aarhus Universitetsforlag..

The teleological, natural and religious arguments are grouped together, due to their habit of being intertwined in an argument. Teleos is the ancient greek word for ‘goal’ or ‘striving’, meaning that all things have a form of ‘striving’ in their essence - the world included. So the argument normally goes: “There is a bigger purpose with the world, that we shouldn’t try to change or interfere with”. Sometimes it’s intertwined with religion, stating that one shouldn’t try to “create”, because that is only meant for the divine KAPPEL, K. 2011. Bioetik. In: CHRISTENSEN, A.-M. S. (ed.) Filosofisk Etik. Århus: Århus Universitetsforlag. Aarhus Universitetsforlag..

The different types of arguments aren’t always neatly sorted out as they have been presented, but often work in relation to each other or consists of different appeals, all to make a stronger argument.

Principles in bioethics

To guide the appliance and decision-making process there are some principles that apply in all arguments:

1. The No-Harm principle
2. The principle of Personhood
3. The Precautionary Principle

The No-Harm principle is perhaps the oldest principle in applied ethics and dates back to Hippocrates and his thoughts about practicing medicine. It simply states that one should not cause harm to another person. It’s intuitively simple in outline but lacks better definition of what ‘harm’ is - is it only physical harm or does mental harm count as well? The answer to that question normally depends on whom one is asking. For our purpose and understanding we’ll consider it to be intuitive that one shouldn’t cause physical harm or severe mental harm KAPPEL, K. 2011. Bioetik. In: CHRISTENSEN, A.-M. S. (ed.) Filosofisk Etik. Århus: Århus Universitetsforlag. Aarhus Universitetsforlag..

The principle of Personhood tries to state what defines a person. Some believe a person to be someone who is able to have a reflective view over one’s past, future and present. But this definition is far too narrow, excluding babies and people suffering from dementia. Other definitions are based on a contra factual understanding: a person is someone, who under normal circumstances can be expected to reflect over one’s past, future and present. This seems broad and lacks a good definition on what counts as normal circumstances KAPPEL, K. 2011. Bioetik. In: CHRISTENSEN, A.-M. S. (ed.) Filosofisk Etik. Århus: Århus Universitetsforlag. Aarhus Universitetsforlag..

The Precautionary Principle has many different definitions, outlines and functions. It is said to be: “[...] the most innovative, pervasive, and significant new concept in environmental policy over the past quarter century [...]” MARCHANT, G. E. & MOSSMAN, K. L. 2004. Arbitrary and capricious: The precautionary principle in the European Union courts, American Enterprise Institute.. It is meant to be a principle which can help to determine which actions must be taken or which technologies that must be accepted. But as the quote continues one sees a different side of the principle: “[...] It may also be the most reckless, arbitrary, and ill-advised” MARCHANT, G. E. & MOSSMAN, K. L. 2004. Arbitrary and capricious: The precautionary principle in the European Union courts, American Enterprise Institute..

True to the quote the Precautionary Principle seems to have many roles in the discussion about bioethics - it’s both the motto for the precautionary point of view as well as an epistemic principle that is used to explain why it’s sometimes more rational not to act, instead of acting STEEL, D. 2014. Philosophy and the precautionary principle, Cambridge University Press.. It also functions as a rhetorical tool when politicians discuss policies.

The Precautionary Principle’s complexity warrants a more detailed account and discussion, which are both found in the Parts & Procedures chapter, on the safety page.