What is Bioethics? Towards a scientific understanding of a controversial discipline
IMEW Briefing, No. 1, June 2002
The term "Bioethics" is used in a number of ways. On the one hand it denotes the research area of applied ethics, and on the other a highly controversial domain of politics in which issues such as the signing of the Ethics Convention, preimplantation diagnosis and embryonic stem-cell research are debated. Here Bioethics in its role as a scientific discipline is often accused of canvasing support for these and other issues. In a recent issue of a nursing magazine Bioethics was accused of "accepting the self-policing of science and technology", that "it never seriously questioned this right", and that in actual fact Bioethics" often provided ethical arguments belatedly to support technological breakthroughs". (Pflege 4/2002)
The following does not concern itself with such political criticism, but rather deals with the history and scientific assumptions of Bioethics as a discipline.
Bioethics as an applied ethics
The specialized disciplines under the banner of ethics can be divided into ethical theories such as Utilitarianism, Kantian Ethics, Discourse Ethics and Virtue Ethics, but they can also be catagorised as different branches of applied ethics such as Medical, Environmental and Economic Ethics. Bioethics sees itself in this regard as an applied ethics that utilises many different theoretical approaches. The impression however that Bioethics doesn't always clearly define its focus of interest lies in the history of the term: "Bioethics" as a concept was developed in the USA more than 30 years ago. The term was first used in 1970 in an essay promoting the idea of a new scientific discipline encompassing both the science of biology and an ethical interest in human values. Its aim being no less than to secure a viable future for mankind, it focussed its attention first and foremost on the global destruction of the environment.
Independently from these developments the physician and development physiologist Andre Hellegers and collegues coined the term when they founded the "Kennedy Institute for Human Reproduction and Bioethics" in 1971, understanding the term as a biomedical ethics. Their initiative articulated the concern that issues of modern biomedicine were not adaquately addressed by a traditional medical ethics which restricted itself to rules and codes of conduct in general medical practice.They saw it as vitally important that the new oppertunities opened up by biomedical research and practice be handled in a responsible manner. (Callahan 1993)
What both approaches have in common is the belief that the ever increasing availability of knowledge in the sphere of biomedical science must necessarily be accompanied by ethical reflexion and debate. The former group understand Bioethics as an applied ethics of biomedicine (Honnefelder 1996), while the latter view the term as applying to the biosciences in a more generalised sense; the two positions also embrace both animal as well as environmental ethics. (Gillon 1998)
The methods of bioethics
In the field of Bioethics there are three recognisable approaches:
1) Casuistry: Casuistry operates on the basis of precedence, gathering its evidence from common moral beliefs and established patterns of behaviour. By comparing and contrasting other similar cases with their own, they then try to establish a basis on which plausible ethical judgements can be made ( Jonsen/Toulmin 1988).
A good example would be the case of the terminally ill british woman Diane Pretty who lost an appeal to the European Court of Justice to allow her husband to assist in her own death. The decision, presented in some quarters as incompassionate and even inhuman, focussed attention on the issue and led many interested observers to the conclusion that the general right to to an assisted death in certain circumstances was in fact justified. However ethical judgements achieved on this basis often don't stand up to closer scrutiny for the simple reason that rhetorical presentations of events may sometimes mask contentious moral arguments. Particular points of view and relevant details may be coloured by subjective considerations without their being declared or identified. There is also the additional danger of considering the problem in isolation - here again the Diane Pretty case springs to mind - and thereby losing sight of the wider implications were assisted death to become a real option.
2) The Theoretical Approach: In contrast to 1) this approach eschews the case by case basis of forming judgements in favour of a "stubborn" application of an ethical theory to relevant questions. The good example of this would be the Preference Utilitarianism of Peter Singer. His guiding principle for making judgements, and something which he doesn't explain further, is the maximisation of happiness. According to the theory the amount of happiness would then be greatest when the combined interests and preferences of the person involved are as far as possible fully realised. Singer's theory can indeed accomodate rational judgements but these judgements are themselves questionable: The main reason for this is that the only 'living creature' he recognises are humans, and by way of explanation maintains that only they can have preferences or at least articulate them. On this understanding Singer must exclude newly born babies and the severely mentally handicapped from his definition of 'living creatures'. (Singer 1994)
While Singer is the most well known writer in the field of Bioethics in the German public, he is nevertheless not the representative of Bioethics. Apart from "Bioethics" there are many more ethical theories that come under the heading of Applied Ethics. There are of course many differences between the various approaches but every theory leaves itself open to criticism if it does not take account of the individual case as well as the conditions in society in which it is played out.
3) The 4 Principles Model: The most common approach in the english speaking world is that of Beauchamp and Childers, which sees itself as striking a middle path between the 'bottom up' and 'top down' theories already described. This approach believes that the four principles of Autonomy, Charity, Non-violence and Justice provide a consensus based and practicable model with which to form ethical judgements because of its compatability with the basic tenets of different ethical theories. (Beauchamp/Childress 1994)
This model is also not without its critics. It is not clear, they say, how these four princlples are related to each other. In addition it is pointed out that the meaning of each of them is open to different interpretations and that in certain situations they can come into conflict with one another. Finally it has been shown that a non-flexible application of these principles can lead to arbitrary and simplified results.
On evaluation of the pros and cons of these three models it becomes clear that no one model alone can deliver the critical objectivity desired. The ethical justification for both rules of action and the assessment of judgements are indespensible. This holds both for the observation of case by case situations where the particular context is all important but also while considering wider issues where many people are equally affected. By ignoring these provisions an ethical theory can leave itself open to accusations of one-sidedness and arbitrariness. Ethics can of course do no more than create the conditions favourable for an acceptance of a particular position, especially when the general course of events gives the impression of seemingly unassailable legitimacy. Critique is only then possible when actual conditions are understood as changeable.
Finally, whether in fact the undertaking as described above should carry the name "Bioethics" at all, is something that can indeed be called into question.
(Translation by Marcus Martin)
Beauchamp, Tom /Childress, James (1994): Principles of Biomedical Ethics. New York: Oxford University Press.
Birnbacher, Dieter (1993): Welche Ethik ist als Bioethik tauglich? In: Ach, Johann S./Gaidt, Andreas (eds.): Herausforderung der Bioethik. Stuttgart: Fromann-Holzboog, pp. 45-67.
Braun, Kathrin (2000): Menschenwürde und Biomedizin. Frankfurt: Campus.
Callahan, Daniel (1995): Bioethics. In: Reich, Warren (ed.). Encyclopedia of Bioethics. New York: McMillan.
Clouser, K. Denner/Gert, Bernart (1990): A Critique of Principlism. Journal of Medicine and Philosophy 15, pp. 219-236.
Engelhardt, Tristam (1986): The Foundations of Bioethics. New York: Oxford University Press.
Gillon, Raanan (1998): Bioethics, Overview. In: Chadwick, Ruth (ed.): Encyclopedia of Applied Ethics. San Diego: Academic Press.
Honnefelder, Ludger (1996): Bioethik im Streit. In: Jahrbuch für Wissenschaft und Ethik 1, Berlin: De Gruyter, pp. 73-86.
Jonsen, Albert/Toulmin, Stephen (1988): The Abuse of Casuistry: A History of Moral Reasoning. Berkeley: University Press.
Korff, Wilhelm (1998): Einführung in das Projekt der Bioethik. In: Korff, W. (ed.): Lexikon der Bioethik. Gütersloh: Gütersloher Verlagshaus.
Potter, Van Rensselaer (1971): Bioethics. Bridge to the Future. Engle Wood Cliffs N.J.
Rehmann-Sutter, Christoph (2002): Bioethik. In: Düwell, Marcus/Hübenthal, Christoph/Werner, Michael (eds.): Handbuch der Bioethik. Stuttgart: Metzler.
Singer, Peter (1994). Praktische Ethik. Stuttgart: Reclam.
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