A Rejection of "Applied Ethics": Philosophy's Real Contributions to Bioethics Found Elsewhere.

Abstract

This month’s Target Article by Blumenthal-Barby et al. (2022) offers a defense of the importance of philosophy to bioethics. The authors cite the crucial role of philosophers in the development and application of theories, principles, and concepts, such as the Doctrine of Double Effect (DDE) to concrete problems in bioethics. We are skeptical of these claims for reasons articulated by both Banja (2022) and Fedyk (2022) in their commentaries and that were well articulated by Art Caplan many years ago (Caplan 1980). Principles and theories aren’t “applied” in any straightforward sense, in either the sciences or in moral problem solving. Take as an example our experiences of theoretical under-determination of theories of justice in the context of COVID resource allocation committees. We were asked to assist in applying theories of justice and principles of bioethics to concrete problems of allocation of scarce vaccines and drugs, but we soon discovered that any attempt to apply a theory required us to move so far away from the theory itself that we weren’t so much “applying” a theory as we were simply offering a morally-flavored answer to the allocation questions. Although there is a sense in which bioethicists can introduce some ethical flavor to conversations like that, it is not an application of a principle or theory in any obvious sense. Or, more directly, the authors believe that DDE and its distinction between intentional harms and non-intentional, yet foreseeable harms can aid in answering important questions surrounding medical aid in dying. Even if it is true that attempts to apply DDE cannot overlook the rich philosophical literature on that topic, it is not clear that any version of DDE that is sophisticated enough to withstand scrutiny according to the standards of analytic philosophy would be simple enough to be wielded by non-specialists without having its content watered down. Alternatively, any version of DDE simple enough to be used in that context would not require the input of philosophers. In other words, even granting that theories are applied, it is not clear that applied philosophical ethics in this sense will be able to strike the right balance between theoretical correctness and parsimony. Hence, underdetermination is likely to remain in this realm despite philosopher’s best efforts. We particularly appreciate Fedyk’s appeal to philosophy of science and philosophy of biology for a potentially more fruitful model of philosophical contributions to bioethical problem solving. At the same time, this approach highlights some of the limitations of bioethics being done by scholars in philosophy departments. As a journal editor, one of us often sees work that is well argued, but misguided, because it is based upon false assumptions as a result of ignorance of the real world of medicine or science (e.g., conflating two very different technologies so that the arguments being made don’t apply to either). Just as it is not possible to do good philosophy of science without knowing something about the relevant content area, it is not possible to do good clinical ethics without knowing some clinical medicine or research ethics without knowing the relevant medical or technological details. We are in far greater agreement with BlumenthalBarby et al. about the contributions of other areas of philosophy to bioethics, such as epistemology, metaphysics, philosophy of mind, and philosophy of science. To this list should be added philosophy of language, especially pragmatic theories of communication. In the mid20th century, philosophers like H .P. Grice (1991), J. L. Austin (1975), and John Searle (1969) developed a framework for understanding language and communication that ditched the idea of linguistic communication as the mere transmission of ideas from a speaker to a hearer, replacing it with a more nuanced, multifaceted understanding of the aims of communication. On their view, we actually do things with words. In the appropriate context, saying “I now pronounce you husband and wife,” constitutes the performance of a marriage. When one asks someone, “Do you know what time it is?” they do not just answer “yes” or “no,” which would constitute a literal answer to the question. Instead, they offer an answer such as “11:58 AM” or “about noon,” thereby evincing recognition of a request for information that underlies the literal words. This is sometimes referred to as an indirect speech act.