The Place of Bioethics in Philosophy: Toward a Mutually Constructive Integration.

The critique to which Blumenthal-Barby et al. (2022), respond—that philosophy has little left to do in bioethics—reflects a common assumption that normative theorizing first generates general moral principles that are then applied to particular cases. On this view, moral philosophy is often assumed to be an ahistorical intellectual activity (AHIA) sufficient for generating principles and foundational arguments that will determine how we understand human morality and make moral progress. Once the philosophical foundations are laid, so the assumption goes, the philosophical work ends, and the practical work begins. However, it is striking that much of the target article’s response to the skeptics appears to be framed in a manner consistent with the assumption that philosophy is an AHIA. The many examples the authors use to argue for the role of philosophy in bioethics focus on philosophy’s one-way contributions to bioethics. But this tendency persists also in their discussions about integrating and connecting the two fields. Their suggestions focus on the application and translation of “general principles, concepts, and theories” and “technical concepts from metaphysics and epistemology” (1). Although the authors note that a philosopher’s work in bioethics can enrich their philosophical work (13), little is made of this point. Though we agree with the authors that descriptive ethics should not be conflated with normative ethics (1), it does not follow that sources of ethical judgment reside entirely in the domain of philosophical ethics as they risk implying. In this OPC, we will show that philosophy’s entry into medicine in the 1960s and ’70s, was the beginning of a dialectical process that has allowed philosophy to reconstitute itself, as an evolving reflective activity in applied problematic situations. We conclude that appreciating this dialectic is critical to the possibility of a mutually constructive integration of philosophy and bioethics. In our view, philosophical ethical theorizing, understood as an AHIA, should not be assumed to be a sufficient starting point for normative ethics in an applied field such as bioethics. Such an assumption can, on the one hand, overstate the self-sufficiency of philosophical arguments and, on the other, understate the interdisciplinary nature of bioethics as a field. In response to skepticism about philosophy’s impact on bioethics, the authors claim that it was arguments, not data, that “birthed the field of bioethics and moved the field forward ... and changed the way medicine was practiced and how people behaved” (9). This claim belies the historical roots of modern bioethics in revelations about the many abuses in human subjects research, both in Nazi Germany and in the United States, that eventually had a profound impact on medicine (Jonsen 2003). For example, from 1960–79, the practice habits of oncologists went from very often withholding the diagnosis of cancer from patients to almost always disclosing (Gordon and Daugherty 2003). This change coincided with a deeper paradigm shift in societal assumptions about the rights of human subjects and patients. This broader historical understanding of moral change in medical practice makes us wary of the authors’ claim that “philosophy should retain a central role in bioethics because ... bioethics originated predominantly from philosophy/philosophers ... and bioethics cannot expect to understand itself without the presence of philosophers” (11). While philosophy and philosophers were important in constituting bioethics, the field was interdisciplinary from its origins, engaging philosophers, theologians, scientists, social