Estructura de la Bioética como disciplina normativa. David Alvargonzález

20100331013503-bioeticalogo

ON THE STRUCTURE OF BIOETHICS AS A PRAGMATIC

DISCIPLINE

DAVID ALVARGONZALEZ

Abstract: This article analyzes certain aspects of the structure of bioethics as a

discipline. It begins by arguing that bioethics is an academic discipline of a pragmatic

nature and then puts forward a classification of the main problems, issues,

and concerns in bioethics, using this classification as a way to outline the limits

and framework of the field. Pushing further, it contends that comprehensive treatment

of any topic in bioethics requires that three normative dimensions (the ethical,

the moral, and the political) be taken into account. It concludes that the classification

of the issues and analysis of each issues normative dimensions can

provide valuable contributions toward understanding the sui generis structure of

bioethics as a pragmatic discipline.

Keywords: bioethics structure, bioethics problems, bioethics disciplines, norms

types.

1. Bioethics as a Pragmatic Discipline

A discipline is a body of knowledge or skills that can be taught and

learned. Techniques, technologies, sports, hobbies, arts, rhetoric, theology,

law, and philosophy, among many others, can be taught and

learned and, therefore, can be formed into disciplines. In the context of

human praxis and norms, disciplines imply a certain institutionalization,

whereas nonhuman animals in the wild have no structured disciplines,

although they may take part in a wide range of learning

processes. Even further, any educational institution can invent any discipline

it considers useful to be taught according to the demands of the

society it serves.

In this article, I start from the assumption that bioethics is a discipline

consolidated in the academy, where the diverse origins of its practitioners

(philosophers, historians, lawyers, social scientists, biomedical

researchers, clinicians, nurses, theologians, journalists, policy analysts,

insurance brokers, and businessmen, among others) reveal its interdisciplinary

nature. The interdisciplinary nature of bioethics has been

defended, among others, by Callahan (1982), ONeill (2002), Kopelman

(2009), and Wilson (2013). Complementing this interdisciplinary nature,

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METAPHILOSOPHY

Vol. 48, No. 4, July 2017

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the relative stability of bioethics as an academic discipline has proven

to be compatible with the varied backgrounds of its practitioners. Notwithstanding,

neither the fact that addressing issues in bioethics does

not require any specific license nor the fact that no expert can lay claim

to exclusive competence precludes the existence of an institutionalized

discipline. As happens with certain professionals, such as journalists,

politicians, and entrepreneurs, there is no single academic path to

becoming a bioethicist; and as happens with so many issues concerning

the public sphere, any citizen can publicly discuss disputed issues without

being excluded a priori from the debate. In any event, with bioethics

assumed to be a field of an interdisciplinary nature, it is worth

recognizing that, for better or worse, this interdisciplinary activity has

been academically institutionalized and, hence, turned into a discipline,

into a body of knowledge that is taught and can be taught and learned,

one that is assumed to be endowed with a certain inner structure.

Nevertheless, recognizing bioethics as an academic discipline does not

entail recognizing the discipline as a science stricto sensu, since there is

a lack of consensus in the field of bioethics regarding general principles

and theories, and the ongoing confrontation of differing, competing

doctrines seems unavoidable.

Since its origins, bioethics has dealt with a wide spectrum of practical

issues concerning the ethics of biological organisms. In any event,

the ethical approach implies, as Callahan points out, that “an academic

research project in bioethics, or a bioethicist working in the public

sphere, must primarily be concerned to address a practical ought question”

(1973, 73). Callahan, among others, has stressed the practical

nature of bioethics: “The discipline of bioethics should be so designed,

and its practitioners so trained, that it will directly—at whatever cost

to disciplinary elegance—serve those physicians and biologists whose

position demands that they make the practical decisions” (Callahan

1973, 73). Based on the foregoing requirements, I shall contend that,

due to the absence of theoretical consensus and to the practical character

of issues in bioethics, the unity of the discipline is mainly pragmatic

in nature. I shall argue too that one effective way to reveal the structure

of its field is by pointing out and classifying the practical problems and

concerns that themselves raise bioethical issues.

Although ethics, morality, and politics have been part of the most

important philosophical academic systems since the time of Platos

Republic and Aristotles Nicomachean Ethics, the constitution of bioethics,

as a discipline that groups together the current practical issues

posed by biological sciences and technologies, took place in the last

third of the twentieth century (Jonsen 1998). In this article, I hold that

the rise of bioethics as a discipline resulted from the advent of a cluster

of new problems and concerns related to biological organisms. These

issues were characterized in relation to two different kinds of processes

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that, although closely related, can be analytically distinguished. There

is, on the one hand, the development of certain sciences and technologies,

such as modern medicine, biotechnology, genetic engineering, ecology,

ethology, atomic physics, information technologies, computation,

and the like, which triggered a raft of new realities, including human

embryo research, cloning, organ transplantation, enhanced prosthesis,

radioactive contamination, and species extinction. On the other hand,

wide-ranging socioeconomic changes posed certain practical issues

soliciting inquiry. A nonexhaustive list of these changes includes the

Green Revolution, world demographic growth, the fall of Soviet-style

socialism and overall triumph of consumer capitalism, the widespread

application of this capitalism to medical assistance and care, and, in

the Western countries where bioethics arose, the rise of the feminist

movement and relative decline of the social influence of Christianitys

theological anthropology and ethical codes (Bueno 1999 and 2001;

Baker and McCullough 2008).

2. Venturing to Classify the Main Problems, Concerns, and

Issues in Bioethics

As stated above, bioethics, unlike geometry, physics, or biology, is not a

strict science, and its inner unity is that of a discipline with a practical

character. Consequently, one would suspect that the only thing we can

hope for is to draw up a purely empirical inventory of the issues in bioethics,

a sort of laundry list. Librarianship specialists have proposed

certain classifications of bioethical topics, such as the one created and

maintained by the Kennedy Institute for Ethics at Georgetown University,

the Bioethics Research Library Classificatory Scheme. Although

those classifications prove to be very useful for their practical purposes,

they lack a theoretical inner structure. Jorge Luis Borges refers to the

Chinese encyclopedia entitled Celestial Empire of Benevolent Knowledge,

in which “it is written that the animals are divided into: (a) belonging

to the emperor, (b) embalmed, (c) tame, (d) sucking pigs, (e) sirens, (f)

fabulous, (g) stray dogs, (h) included in the present classification, (i)

frenzied, (j) innumerable, (k) drawn with a very fine camelhair brush,

(l) et cetera, (m) having just broken the water pitcher, (n) that from a

long way off look like flies” (Borges 1984, 103).

When we compare this classification with the phylogenetic taxonomies

based on the theory of evolution, we can see the difference

between a laundry list, like that of the Borgean Chinese encyclopedia,

and a coherent essential classification stemming from a scientific

theory. The same could be said if we compare the heterogeneous lists

of substances of the early alchemists with the current periodic table of

elements. Although laundry lists can be useful for certain practical

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purposes, they are not the kind of classification one is searching for

when elucidating the structure of a given field. Rather, one is seeking

the completeness, coherence, and order we recognize in the classification

of triangles by the relative lengths of their sides (equilateral, isosceles,

and scalene) or in the categorization of the three classes of levers.

The lack of a scientific structure of bioethics does not force retreat

from an attempt to design a coherent categorization based on a suitable

set of assumptions. Rather, the main challenge lies in finding the

appropriate philosophical criteria to account for such a classification.

While philosophical foundations are not scientific in nature, they must

still be grounded in arguments and are evaluated by being put into

action and judged by their results.

In the literature, the term “bioethics” has been used in two different

senses: in a narrow sense, bioethics is understood as biomedical ethics;

in its broader sense, bioethics includes a wide spectrum of issues concerning

biological organisms. Although Warren T. Reich contends that

nonclinical bioethics is merely a word and never flourished as a discipline

(Reich 1994 and 1995), in this article I shall follow the proposals

of Angus Dawson and Ruth Macklin and also refer to the more widereaching

sense (Dawson 2010; Macklin 2010). This choice has the

advantage that it allows treating the structure of bioethics in both the

broad and narrow senses while also requiring that one take into consideration

the nature of the relations between them. Accordingly, I shall

assume that the problems and concerns articulated by bioethics in its

broader sense make either direct or indirect reference to human and

nonhuman biological organisms and shall also contend that bioethics

in this sense is a discipline of human etiology. Based on the foregoing,

I shall divide the set of relationships and operations affecting humans

into two main groups: the first contains the relationships and operations

between humans and other intelligent and willing beings, while

the second contains the relationships and operations between humans

and entities lacking will and knowledge. This dichotomy takes on

immediate meaning in bioethics, since norms and issues concerning

intelligent and willing animals (whether human or not) usually require

treatment different from those concerning other entities. The former

group, containing the relationships and operations between human

beings and other intelligent and willing beings, can in turn be broken

down into another dichotomy. Cognizant that this proposal will be

criticized by the supporters of antispeciesism, I shall argue that the

relationships and operations among humans should be differentiated

from the relationships and operations between humans and other intelligent

and willing animals. The relationships between humans and

entities lacking will and knowledge could also be dichotomized, since

some of the latter are living beings (for instance, the nonanimal

archaea, bacteria, and eukaryota), while others are inert bodies (stones,

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rivers, clouds, stars, and so on). Nevertheless, I shall assume that, in a

bioethical context, this latter difference between living and nonliving

entities does not play a significant role (I am also aware of the controversial

nature of this assumption).

Where “H” refers to humans, “I” to entities other than animals

(whether living or not), and “A” to intelligent and willing nonhuman

animals, the criteria to classify the practical, anthropic sphere of bioethics

can be summarized as follows:

(1) Issues concerning the relationships and operations between

humans (H–H).

(2) Issues concerning the relationships and operations between

humans and nonhuman intelligent and willing animals (H–A).

(3) Issues concerning the relationships and operations of humans

with entities other than the animals included under (2) above

(H–I).

Ethology and animal psychology have unequivocally shown that the

Cartesian automatism of beasts is misguided, as no one today dares

deny that certain animals are endowed with intelligence, feelings, and

desires. Accordingly, our treatment of those animals cannot be equated

with treatment of other living beings or the inert environment. Of

course, the latter relationships (H–I) still pose bioethical issues, but

those issues require treatment other than that received by the relationships

between humans and nonhuman intelligent and willing animals

(H–A), since most living beings, and inert bodies, do not perform operations

similar to those of humans, nor do they suffer, desire, or behave

in an intelligent way. It is more difficult to justify the expediency of

affording different treatment to the issues involving the relationships

among humans (H–H) and to the issues involving the relationships

between humans and certain nonhuman animals endowed with intelligence,

feelings, and will (H–A). Advocating this difference implies confronting

the arguments of antispeciesism (Singer 1975; 1979; 2009).

Space constraints here limit any attempt to deal with this complex issue

in depth, but, for the purposes of this article, the arguments in favor of

human speciesism can be outlined as follows.

a. Comparing nonhuman intelligent animals in the wild with healthy

adult humans enculturated in complex societies reveals remarkable

differences between the two groups. Humans have a set of

very complex interrelationships between them, which include phonetic

language and the ability to deploy and reciprocate ethical

conduct. In addition, humans have much greater learning capabilities.

This is all linked to an objective culture, which includes the

most elaborate of techniques, arts, sciences, and technologies.

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b. The differences between nonhuman intelligent animals and

humans, when humans are in the early stages of development (as

infants or children) or in transient states of disability, can be justified

by means of a teleological argument that looks to the inherent

final stage of development of members of the human group

who will become healthy, enculturated adults. As no person has

ever been born as an adult, the period from birth to adulthood

(or the period of transient disability) requires an ethical protection

that, unlike the case with animals, accounts for a persons

future status as a healthy, enculturated adult.

c. Antispeciesism arguments acquire special force when comparing

certain chimpanzees that have been bred in captivity and share a

significant portion of human culture (including the rudiments of

American Sign Language) to certain human individuals who have

severe, incurable, and irreversible disabilities, such as profound

mental retardation. While comparing these two highly specific

groups, which have been selected ad hoc, may shed some light on

the charitable treatment to be accorded to the chimpanzees upon

integration into a human community, I am afraid it cannot be

put forward as an argument against distinguishing between

humans and other animals when articulating the structure of bioethics.

Any attempt to draw distinctions in any field inevitably

uncovers certain situations and examples that prove difficult to

classify, as seen in the current discussion about whether viruses

are indeed living organisms (Hegde et al. 2009; Moreira and

Lopez-Garcıa 2009). Analyzing such borderline cases, however,

does not remove the difference between living organisms and

stones. Notwithstanding certain particular borderline cases, I contend

that ethical issues adopt a varying degree of significance

depending on whether they affect the relationships among

humans (H–H) or the relationships between human and nonhuman

intelligent and willing animals (H–A). This structure is

highly indebted to Gustavo Buenos theory of anthropological

space (1978).

The most significant issues addressed by bioethics (though admittedly

not an exhaustive list) can be classified on the basis of the three

domains of anthropological relationships offered in table 1.

The second and third domains may be matched to what are called

“animal bioethics” (Singer 1975; Beauchamp and Frey 2011) and

“environmental bioethics” (Naess 1973; Taylor 1986). However, the

first group, which accounts for the relationships and operations among

human subjects (H–H), should not be reduced to so-called medical (or

clinical) bioethics. There are issues, such as capital punishment, racism,

sexism, gender discrimination, sexual orientation, and infanticide that

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are not regarded as being primarily medical or clinical concerns; there

is also an ongoing, lively debate regarding the extent to which certain

other issues, such as abortion and assisted suicide, ought to be eliminated

from medical practice (Rachels 1986; Pellegrino 1992; Baumrin

1998).

This, though, is not the end of the matter, since the core value of

the proposed classification (H–H; H–A; H–I) in accounting for the

structure of bioethics can be further demonstrated when observing the

radical consequences arising from an alteration of that structure. Such

is the case in what I term “divergent transhumanism,” which foresees

that the relationship among humans (H–H) will soon be split as a

result of the impending materialization of a group of enhanced humans

benefiting from certain biotechnological advances: genetic engineering,

TABLE 1. Classification of certain significant issues in bioethics

First domain: Relationships between humans (H–H)

Contraception, abortion, infanticide, sterilization, sexuality, sexual orientation

Surrogate motherhood, assisted reproductive technologies, adoption, ectogenesis

Embryo manipulation, stem cell research, cloning, gene therapy, eugenics, conjoined

twins

Informed consent, confidentiality, privacy, conflict of interests

Health care

Drug abuse, sport ethics, neuroethics

Mutilation, ablation, circumcision, body deformation, food bioethics

Brain death, reanimation, transplantation, donation

Pathologization, medicalization, iatrogenesis

Terminally ill patients, suffering, clinical euthanasia, assisted suicide

Capital punishment (procedural euthanasia)

Health politics and insurance, health regulation and law, resource allocation, inequalities

Migration, racism, sexism, access to health care and human research in the Third World,

epidemic control

Second domain: Relationships between humans and nonhuman, intelligent, and willing

animals (H–A)

Animal research and experimentation

Animal rights, animal liberation, Great Ape Project

Animal euthanasia, limits of animal maleficence, animal patents

Endangered animal species

Legislation concerning animals

Third domain: Relationships between humans and other entities (whether living or not)

(H–I)

Limits of biological maleficence, endangered species

Artificial life, genetic modification

Demography, aging society

Ecology, sustainability, climate change, global warming, pollution

Bio-risks, bio-terrorism, biological warfare, nuclear warfare

Space ethics, astroethics

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physical modification, bionics, information technology, and nanotechnology,

among others. These enhanced humans will give rise to superhumans

(SH), who will diverge from current, standard humans, thus

giving rise to new relationships among themselves (SH–SH), with nonenhanced

humans (SH–H), with nonhuman animals (SH–A), and with

the inanimate environment (SH–I). Regardless of whether this divergent

transhumanism reaches fruition, it must be admitted that the very formulation

of these issues has already raised bioethical questions concerning

the limits of new technologies when applied to divergent

human enhancement (Savulescu 2001 and 2002; Naam 2005; Agar

2010). The eventual admission of divergent transhumanism, such as it

affects the highly central issue of distributive equality among humans,

would imply a radical change in the structure of philosophical anthropology

(and hence in the structure of bioethics).

To end this section, I shall briefly touch on certain varieties of feminist

bioethics according to which the relationships between humans

(anthropos) (H–H) conceal two radically different situations depending

on whether they relate to females (F–F) (gyne) or to males (M–M)

(andros). Consequently, the three domains of relationships I have put

forward (H–H, H–A, H–I) might unfold as follows: men–animals (M–

A); women–animals (F–A); men–inanimate entities (M–I); women–inanimate

entities (F–I); and, of course, the relationships among women (F–

F), among men (M–M), and between the two groups (M–F). As certain

feminist bioethicists view it, women have a special sensitivity in dealing

with animals (Donovan and Adams 2007), with other living beings,

and even with inert bodies (Plumwood 1986), not to mention with

other humans, particularly with other women. Consequently, drawing

on these feminists tenets, the map of bioethical concerns should be

“enriched” and “enlarged” in all those directions. Notwithstanding any

possible gender discrimination in this approach, it is worth stressing

that the majority of feminist bioethics is directly committed to combating

sexism and gender inequality (Macklin 2001).

3. The Three Normative Dimensions of Any Bioethical Issue

Human persons, as they go about their daily lives, must observe three

different sets of norms in place to serve three different purposes.1 The

first group of rules looks to preserve the integrity of each human subject,

the second looks to maintain certain groups (professions, associations,

ethnicities, religions, and so forth), and the third looks to ensure

the smooth governance of the political state. Taking cues from Bueno,

1 This section draws on an argument that I have already developed elsewhere when

discussing certain bioethical problems raised by Alzheimers disease (Alvargonzalez

2013).

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I shall refer to these three kinds of rules as “ethics,” “moralities,” and

“politics,” respectively (Bueno 1996 and 2003).

Following Bueno, ethical norms and rules are aimed at preserving

the integrity of each human subject, as both an individual biological

body and a human person endowed with self-determination. In his

Ethics, Spinoza put forward “strength of character” as the core ethical

virtue, adding that this virtue is understood as both firmness toward

oneself and generosity toward others. Accordingly, ethical behaviors

contribute to peoples proper development and to the improvement of

their bodily health and firmness. Educational activities and medical

professions serve as prime illustrations of inherently ethical practices.

Conversely, behaviors that threaten personal integrity are regarded as

unethical. Homicide, slavery, mutilation, abuse, torture, injury, defamation,

denigration, and derision are just some examples of behaviors

geared toward undermining another persons strength. Moreover, people

unnecessarily endanger their own integrity, thereby behaving unethically

toward themselves. Suicide, drug abuse, and other reckless health

habits illustrate this point. From its very beginning, the discipline of

bioethics has been committed to protecting the integrity of individuals,

to respecting their self-determination, and to contributing to every person

s firmness.

The second set of norms and rules serves the purpose of preserving

and maintaining certain groups. All people belong to certain collectives

by virtue of their ethnicity, family, gender, age, language, religion, profession,

social class, educational level, residence, and the like. Each

group has different interests, aims, and purposes and follows its own

particular customs, mores, and rules. As proposed by Bueno,

“morality” deals with group norms and rules. This proposal is

grounded in the uses of the word “morality” in certain modern languages,

as, inter alia, in the expressions “Victorian morality,”

“Christian morality,” and “bourgeois morality,” since Victorians, the

bourgeoisie, and Christians are groups with particular customs and

norms. Moral codes, the cardinal virtue of which is loyalty to other

group members, have also been drawn up in this connection, such as

the Pirates Creed of Ethics or Custom of the Brothers of the Coast

(1640). Accordingly, many bioethicists have advocated the need to take

into account, in a wide variety of contexts, the rules affecting individuals

as members of certain collectives (ethnicities, religions, ages, sexes,

professions, and so on), since no man is an island. Hence, bioethics is

concerned not only with abstract ethical principles regarding the individual

but also with a wide variety of moralities: Jewish (Freedman

1999), Muslim (Sachedina 2009), medical (Pellegrino and Tomasma

2003), patient, military (Cook and Syse 2010), and others (Thompson

2012).

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The third normative dimension that inevitably affects human practices

deals with the rules contributing to the smooth running of a political

state. In the current world, every individual is a citizen of or lives

in a particular political state and, consequently, stands within a states

legal reach. Many bioethicists have convincingly argued that issues of

policy and political concerns have constituted the inviolable content of

bioethics from its very origins (Callahan 1973; Downie 1983; Sheehan

and Dunn 2013).

Ethical norms are universal and distributive insofar as they affect

any human individual, regardless of race, language, religion, sex, age,

class, profession, and so forth; however, this abstract ethical universality

and the related abstract human individual are not reached until all

the concrete contents that characterize them have been emptied. Individual

persons are always enculturated in a wide variety of groups and

are brought up as citizens of a particular political state. These groups

follow their own moral norms, while every state imposes its own legal

order. Although ethical rules do not in many cases come into conflict

with the morality of a given group, they sometimes do, and the prescripts

of a given community prove incompatible with individuals

rights. For instance, a Jehovahs Witness refusing a blood transfusion is

following a religious norm that clashes with the ethical imperative of

preserving life. Destructive cults serve as another illustration of groups

that support moral yet unethical norms. Furthermore, the members of

a professional association, in protecting one another, may engage in

unethical behavior, as when the 1847 American Medical Association

Code of Ethics urged physicians not to criticize colleagues who had previously

been treating a particular case (Fox and Swazey 1984). And

much has been said about the Nazis unethical medical morality. Group

moralities frequently contravene ethical imperatives, as in gender abuse,

sexism, racism, and social discrimination.

At any rate, ethical norms may be directed by ulterior moral

motives, as when the collective decisions (moral commands) taken by

certain ethnic groups implicitly override self-determination (an ethical

commitment) in respect of certain issues affecting an individuals

health. In such cases, the person is not habituated to taking certain

decisions alone, feels sheltered by the group, and looks to it for decisions

(Johnstone 2012). In other cases, ethical dictates clash with group

interests, as when the preservation of confidentiality concerning genetic

information has been challenged by the interest of blood relatives to

ascertain that information (Chadwick 2009). In addition, the moral

prescripts of different collectives may come into conflict with each

other, the code of Jehovahs Witnesses concerning blood transfusions

conflicting with the physicians code of ethics being just one example.

Further examples of incompatible moral codes include Muslims and

Christians, pacifists and the military, and police and street gangs.

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Many conflicts of interest may themselves be conflicts between the individual

and the group and between different groups (Schunklenk 2004).

Political norms are usually compatible with ethical norms, and a

substantial portion of a states legislation contributes to fostering personal

ethical virtues. Nonetheless, political and ethical norms do occasionally

come into conflict. Abstract ethical norms make no distinction

between people from different countries, whereas the policies of a given

nation require the existence of borders, policing, and deportation as a

means to preserve the states well-being, even if such policies condemn

a person to squalor and hunger, thus running counter to an individual

s well-being. Lisa Eckenwiler, Christine Straehle, and Ryoa Chung

(2012) have stressed the dialectic between ethical and political requirements

regarding health inequity, although their proposal of “global solidarity”

remains internally problematic, since solidarity is always

solidarity of a given group against others.

Ethics and politics also enter into conflict with respect to any

persons reproductive rights enjoyed as a part of the persons family

planning. Reproductive freedom includes the power to decide how

many children one will have, but this right sometimes proves incompatible

with the political need to control overpopulation. As it has sometimes

been argued, some of the costs of having children are borne by

people other than parents, and therefore these people should have a say

in birth control (Buchanan et al. 2000, 210). In parallel, Mary Warnock

has advocated the primacy of political expediency over the individual

s life in her defense of demented, terminally ill patients “duty to

die” as a means to economize state resources (2008). Capital punishment,

war, and political intelligence further serve as illustrations of the

conflict between political requirements and ethical values and virtues,

while the tension between privacy and political security is another hotbutton

issue in bioethics.

The relationship between political and moral rules may also be

marked by conflict. As is well known, Western countries that follow

certain ethical standards oppose elected female infanticide, arranged

marriage, sexual mutilation, racism, and sexism as promoted by certain

groups. Terrorism provides another illustration of the conflict between

a groups moral norms and the smooth running of the state. Of course,

there are also a large number of situations in which an individual case

may take on ethical or moral significance while lacking political relevance.

Sexual promiscuity and the legal consumption of tobacco or

alcohol may be unethical, if they threaten a subjects firmness, and

may be morally harmful, if they adversely affect certain groups, such as

families or companies, while still being legally permissible in many

countries.

The proposed distinction between ethics, morality, and politics as

three different normative dimensions of human praxis is not offered up

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as a mere dictionary definition of certain words as they are used in

modern languages; it is in fact the very foundation upon which three

different domains of rules are positioned. As Callahan stated, in bioethics

“the purely ethical dimensions neither can nor should be factored

out without remainder from the legal, political, psychological

and social dimensions” (1973, 72). In this early text, one can already

find the distinction between the ethical, the social, and the political

dimensions of any bioethical issue (the social dimension may be linked

to what I have been calling “morality”).

Many of the additions to later editions of Principles of Biomedical

Ethics introduced by Tom L. Beauchamp and James F. Childress to

respond to their critics can be better understood if the principles of

autonomy, beneficence, nonmaleficence, and justice are construed on

the basis of the conflict between ethics, moralities, and politics (Beauchamp

and Childress 2009; Gert and Clouser 1990). Itself an ethical

principle insofar as it affects the individual and his or her firmness,

self-determination finds itself curtailed as it runs into a groups moral

norms or a states political norms. The conflicts among and balancing

of the foregoing three principles and the principle of justice can be

seen as variations of the trade-offs made between ethical and political

norms as the result of the contextualization of abstract ethical norms

in the reality of political contingencies and institutional moral constraints.

As Mark Sheenan and Michael Dunn (2013) recently noted,

any ethical requirement should be discussed in the context of what is

politically practicable and actually implementable.

Robert Baker (2002) contends that a revolution of the “historicizing”

sort advanced by Kuhn in the abstract philosophy of science

must be carried out in bioethics to put an end to its ahistorical and

rationalist methodology and address its issues in historical context.

Backing Bakers contention, James H. Joness 1981 book on the Tuskegee

experiment is often quoted to illustrate the fertility of the historical

approach, and Duncan Wilson (2013) has insightfully advocated the

relevance of history in bioethical analysis. In my view, Bakers analysis

would be better understood under the assumption that bioethics entails

not only the ethical approach but also the aforementioned moral and

political dimensions. Due to its abstract nature, the ethical standpoint

may in certain respects advance in an ahistorical fashion, as does

geometry, but not physics. Nevertheless, morality and politics cannot

move forward in such a way, for they are historically determined. As

bioethics cannot be reduced to the abstract ethical analysis of certain

issues and has also included from its very beginning their moral and

political dimensions, it requires a historical and comparative methodology.

Indeed, the dichotomy between rationalism and historicism proposed

by Baker may be the result of focusing only on the ethical

dimension of bioethics (leaving aside politics and moralities) and on

478 DAVID ALVARGONZALEZ

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the work of a particular group of bioethicists (certain strict analytic

philosophers) who assume as their exclusive methodology the Cartesian

rationalism critiqued by Baker. This may also help us to understand

Roger Cooters negative statement that bioethicists usually exhibit

“shallowness (or absence) of socio-economic and political understanding”

(1995, 259).

In their ordinary praxis, people are immersed in this space of heterogeneous

norms, and, consequently, a comprehensive discussion of any

bioethical issue would benefit from an accounting of its related ethical

dimension (the perspective of the distributive individual), the moral

dimension (considering the groups involved), and the political dimension

(to the extent it affects the state and legislation), while bearing in

mind that these three different kinds of rules may frequently come into

conflict with each other.

4. On the Structure of Bioethics as a Pragmatic Discipline

As stated above, bioethics is a discipline of a pragmatic nature.

Despite the lack of consensus regarding bioethical doctrines and principles,

the field of bioethics is neither chaotic nor amorphous, and a

certain inner structure can be noted. On the one hand, bioethical

issues can be classified based on the three different kinds of relationship

involved in human praxis: relationships between humans, relationships

between humans and nonhuman, intelligent, and willing

animals, and relationships between humans and entities lacking intelligence

and will. The primary rationale sustaining this classification is

that the norms governing each of these domains require specific treatment

and imply different responsibilities. On the other hand, humans

are inevitably submerged in a three-dimensional normative space

affecting their praxis: ethical norms, which look to fortify human

individuals; moral norms, which pursue the maintenance of certain

social groups; and political norms, which safeguard the smooth running

of the state.

Regarding the three domains of human relationships, the most radical

concerns have been raised by antispeciesist animalism, which seeks

to remove the borders between humans and certain animals, and divergent

transhumanism, which looks to divide humankind into groups as

a result of the effects of divergent human enhancement (once it has

definitively shed any nuances of nineteenth-century “scientific” racism).

Even setting aside antispeciesist contentions, the degree of ethical commitment

toward certain intelligent and willing animals is still under

discussion.

Regarding the three dimensions of human norms, the main issue can

be articulated as follows: in the case of conflict between ethical, moral,

THE STRUCTURE OF BIOETHICS AS A PRAGMATIC DISCIPLINE 479

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and political norms, is there any rule in place to establish priorities

between them? This question lies at the heart of the ongoing discussions

between universalism and relativism, between liberalism and

communitarianism, between patients autonomy and physicians paternalism,

and between advocates of individual autonomy and supporters

of group or state power. Recognizing those three normative

dimensions may also shed some light on the problem of the priorities

between certain competing values affecting the individual, the group,

and the state, as well as on the balancing of and conflict among certain

bioethical principles, and may be of some help to account for the place

of the historical approach in bioethics.

Department of Philosophy

University of Oviedo

Teniente Alfonso Martınez, s/n

33011 Oviedo

Spain

dalvar@uniovi.es

Acknowledgments

I want to honor philosopher Gustavo Bueno (1924–2016), whose ideas

are the main source of inspiration for this work, and I wish to thank

Brendan Burke for his help in improving my English and style.

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