Dissecting Bioethics

There's a sign on the wall, but she wants to be sure,

'cause you know sometimes words have two meanings.

Jimmy Page and Robert Plant, Stairway to Heaven

Many bioethical disputes are conceptual. This means that people quarrel about the use of words that they see as important. The underlying idea is that whoever wins the verbal argument will also be ethically right.

Some people can say, for instance, that “justice” denotes formal equality, whereas others hold that it should be defined as universal well-being. When representatives of these groups come together to discuss justice in healthcare, the result is often a futile lexical dispute. Even if “formal equality” and “universal well-being” could be given clear operational definitions, and even if the degree to which they prevail could be reliably measured, defenders of different concepts of justice would not be interested. It would still be more important to them that the word “justice” is used in a proper manner.

Conceptual disputes are created when well-educated individuals try to argue, against all linguistic evidence, that words can have only one meaning. In bioethics, this can lead to local or global monoculturalization with regard to generally employed moral concepts. People start to believe that there is only one way, “our way,” to express their concerns in terms of philosophical notions and ethical principles.

Our disagreement with this idea provided us with a motive to edit this special section. In the following contributions, six philosophers explore different facets of “dignity,” “naturalness,” “public interest,” “community,” “disability,” and “autonomy.” Some of them describe many equally acceptable uses of a particular concept; others attack predominant notions that threaten to suppress all others.

Matti Häyry proceeds from the observation that the concept of dignity has become a discussion stopper in bioethics. Violations of dignity are so obviously wrong that it is virtually impossible to respond to charges invoking them. This has presented politicians with an irresistible temptation to employ the notion in biomedical legislation when they want to ban activities they do not like.

Different people attach, however, different meanings to the word “dignity,” and Häyry sketches five of them. According to popular views, human dignity can be based on our divine origin, rational faculties, genome, well-being, or distinctive features and achievements. In each case, the practical implications are different. Häyry concludes that, if all these uses of the term are legitimate, as he suggests, then those who try to monopolize the concept thwart bioethical discussion needlessly, instead of furthering it.

Tuija Takala examines the connection often made between the notions of morality and naturalness, as well as immorality and unnaturalness. She distinguishes several meanings of the term “unnatural,” starting from the artificial, the miraculous, and the rare, and argues that these do not justify a link between what is moral and what is natural. Going against the laws of nature is not a good candidate of immorality, either, mainly because it is not possible.

Takala then discusses the Aristotelian idea of natural law, where a good human life is defined in terms of self-preservation, procreation, and piety. She finds the line of argument feasible, but difficult to apply to real life. Her conclusion is that, although allegations of unnaturalness should, as a signal of people's anxieties, always be carefully investigated, the tie between morality and naturalness remains shattered.

Richard Ashcroft studies the various ways in which the concept of public interest has been used in bioethical decisionmaking. He begins by describing six types of appeal to public interest under the headings personal harm prevention, group harm prevention, personal welfare, social welfare, intrinsic public interest vested in public bodies, and juridical theories of public policy. He goes on to discuss the use of health data without the express consent of particular individuals and notes that at least three different public-interest claims can be evoked in this context.

Ashcroft argues that public interest is a contested concept whose meaning is inevitably influenced by the ethical and social commitments of those who employ it. He infers from this that the validity of public-interest claims should be tested by political discussion and decisionmaking.

Michael Gross explores the reintroduction of community thinking into liberal Western thought. According to him, traditional liberal policies ignore ethnic, racial, religious, and other communities that do, however, have a legitimate voice in public discussion.

Gross sketches the history of Western political philosophy from the Enlightenment to the present day and observes that the life, liberty, happiness, dignity, and autonomy of individuals, advocated by liberalism, have in more traditional societies been replaced by the life, liberty, happiness, dignity, and autonomy of communities. This, he argues, is especially visible in decisionmaking concerning (individual and communal) life and death—for instance, in debates regarding abortion and the force feeding of prisoners.

Simo Vehmas looks into notions of disability, which abound in bioethical and sociological literature. He first identifies three individual-centered approaches to disability—namely, the moral, medical, and intersubjective models. These share the assumption that disabilities are primarily personal misfortunes, which Vehmas sees as fundamentally mistaken.

He proceeds to portray three social definitions of disability: the social creationist, social constructionist, and postmodern views. Although Vehmas agrees with some of the tenets of the social approaches, he also regards their dominant position as a threat to conceptual honesty and open communication. He concludes by suggesting that an ethical view on disability should include answers to questions concerning the criteria of a good human life and who can be expected to fulfill them.

Heta Gylling addresses the issues of autonomy, or personal self-determination, and contrasts the views of those who hold “perfectionist” and “imperfectionist” views on ethics and political philosophy. She champions the view that individual autonomy at its best ought to be linked with the ideals of a person's well-being and happiness in a just society.

Gylling challenges freedom-based doctrines that do not generate legal and social duties to help those in need and argues that radical and conservative libertarians alike fail to respect autonomy in its more important forms. She also contests communitarian ways of thinking and contends that reliance on traditions, religion, and culturally determined values are rendered ethically unconvincing by their inherent relativism.

This special section was produced as a part of the project Genes, Information, and Business, financed in 2000–2003 by the Academy of Finland. The editors wish to thank the Academy, as well as the Universities of Central Lancashire, Helsinki, Kuopio, and Manchester, and the Editors of the Cambridge Quarterly of Healthcare Ethics, for this opportunity to advocate the cause of conceptual clarity and leniency in bioethics.

The editors wish to dedicate this Special Section to an extraordinary man whose academic open-mindedness, industriousness, and skill knew no limits and whose warm-heartedness elevated everyone's spirits. Dave, this is for you.

Dissection, Lithograph, Illustration in Puck, 1879, Courtesy of the National Library of Medicine.