Bioethics Down Under—Medical Ethics Engages with Political Philosophy

EDITORIAL 1

Medical ethics and political philosophy counterarguments claimed to be deci- ...... sive are marshalled against all but one J Med Ethics: first published as 10.1136/jme.2004.011221 on 5 January 2005. Downloaded from of them (or in some cases against all of them); 4) positive arguments in support Bioethics down under—medical ethics of the remaining solution (or a new solution brought in at this stage) are engages with political philosophy presented, and 5) a definitive conclusion is reached. Søren Holm Implicit in the standard model are a number of assumptions about the aims ...... of philosophical analysis and the rela- tionship between the view that is argued Philosophers should be wary of using the methods they use in for, and the competing views. Most philosophy when engaging in discussions about policy making importantly in the present context is the assumption that most opposing views are he beginning of November last year contentious issues should mirror the not only wrong in some sense, but that was a busy time in the bioethics best ethical analysis, or at least not be this can also be shown decisively to be the calendar with four conferences tak- in conflict with the best ethical analysis, case, because they are irrational, or at T least unreasonable. When the ethicist ing place in New Zealand and Australia. but this naı¨ve view is rather proble- The Fifth International Conference on matic. It will come as no surprise to the using the standard model enters the Priorities in Health Care took place in readers of the Journal of Medical Ethics public debate it is therefore with the firm Wellington; the Fifth Feminist App- that there is great ethical and public conviction that most of the views being roaches to Bioethics congress, the disagreement on issues such as stem cell put forward by others have already been Seventh World Congress of Bioethics, research and therapeutic cloning, a fact shown to be unreasonable. There is no and the meeting of the Australasian that was also evident in the presenta- reason to take account of them or to let Bioethics Association were all in Sydney. tions on stem cell issues at the confer- them influence decision making. Dis- cussing them is only worthwhile as a One of the interesting features of ences in Sydney. In the face of such tactical manoeuvre to get your own these meetings was a move to a deeper disagreement, whose ethical analysis arguments on the table, or in order to exploration of the relations between should influence the policy making? show them to be unreasonable. ethics and political theory and political This is a central issue in the long- The standard model, and to an even philosophy. The factors that drive this standing discussions of deliberative greater extent the rhetoric of ethics, exploration are manifold but the four democracy in multicultural societies. often imply that there is only one right most important seem to be: 1) that This means that there is no reason for solution to each policy making decision, ethicists often comment on, or propose the ethics community to try to reinvent and that it is possible to find this political action and regulation; 2) that the wheel. There is a basic wheel blue- solution, and to know that it is the there is a growing awareness that the print out there. It may have to be right decision. ‘‘Knowing that you are basic national and international societal tweaked somewhat to fit the ethics right’’ is in general a bar to a positive and legal structures profoundly influ- wagon, but it does not have to be re- engagement with the views of others, ences ethical issues; 3) the growing engineered from scratch. but ‘‘Knowing that you are right after interest in global and third world issues, A second implication of an engage- http://jme.bmj.com/ proper philosophical reflection’’ can be and 4) the move in many countries ment with political philosophy is that it even more problematic. toward greater public participation in makes it clear that much of medical In contrast, theorising about delibera- decision making concerning ethically ethics activity is actually political activ- tive democracy proceeds from the contentious issues. All of these develop- ity, not party political, but political assumption that whereas there might be ments move the focus from the tradi- anyway because it tries to influence a right solution, it is often impos- tional subject matter of medical ethics— the direction in which society develops. sible to find this solution or to know that that is, the individual ethically charged The identification of the ethicist as a

it is the right solution in any absolute on October 2, 2021 by guest. Protected copyright. action, to the question of how ethics political actor has profound implications sense. The best we can do is to outline the should influence political action and both for the role obligations of the area of acceptable policies, and then regulation. ethicist, and for the skills needed by the choose a policy within this area through To claim that this is a totally new ethicist. In order to be an effective poli- a deliberative, democratic process. development is obviously false. There tical actor the skills of philosophical If philosophers participate in the public has for a long time been great interest in analysis and the knowledge of the ethical discourse about contentious issues in the public health ethics, the ethics of health literature clearly have to be complemen- same way as they engage in philosophical systems, research ethics regulation, and ted with a much wider range of skills. discourse they are very likely to breach many other systemic and regulatory This raises an interesting question. Is many of the requirements for an engage- issues, and some of these debates have the standard model of medical ethics ment in public reason. They will also, drawn upon political philosophy. What analysis compatible with public decision however, have engaged in a social cate- is new, however, is the realisation that making in a deliberative democracy? gory mistake. Attempting to reach a an engagement with political philoso- By the standard model of bioethics legitimate public policy in a morally phy may be necessary across the whole analysis I mean the following process pluralistic liberal democracy is not a social field of medical ethics. (this is clearly a simplification, but not activity of the same kind as trying to win a What are the implications of an excessively so): 1) A putative moral philosophical argument. engagement with political philosophy? problem is identified; 2) it is analysed The first implication is that is becomes and sharpened in various ways, often to J Med Ethics 2005;31:1. problematic to what extent and exactly the point where it is stated that ‘‘… we doi: 10.1136/jme.2004.011221 how ethical analysis should influence can now see that the problem is essen- Correspondence to: Søren Holm, Cardiff Law policy making. A naı¨ve view would tially …’’; 3) a number of solutions to School, Cardiff University, Museum Avenue, claim that public policy on ethically this refined problem are canvassed, and Cardiff CF10 3XJ, UK; [email protected]