Pragmatic Bioethics

Pragmatism is an approach to philosophy that has experienced a revival in recent years, after a long time of comparative disrespect in the philosophical community. It is no surprise that the philosophical potential of pragmatism is now tested, among many others, in relation to bioethics, another burgeoning field of philosophical inquiry.

Pragmatic Bioethics, edited by Glenn McGee, is a collection of eighteen articles that appears in the series "Vanderbilt Library of American Philosophy", a series that, according to the publisher, is dedicated both to exploring the historical roots and innovative developments in American Philosophy. Nevertheless, Pragmatic Bioethics is intended to be not only of interest to scholars in American Philosophy. As McGee has already made clear in his The Perfect Baby (1997), he assumes that pragmatism has something valuable to offer to anybody interested in bioethics. Just how valuable, becomes clear in his introduction, where he promises that Pragmatic Bioethics will address nothing less than the question "How should the field of bioethics think and act in a time of social crisis?", and advance answers to "questions about the emphases of the field, its identity, and its method" (xii). It will "make manifest the outlines and dimensions of pragmatic philosophy" and "speak to the coherence of a single pragmatic core of methodical emphases and theoretical claims" (xv). However, at the same time, the authors will "represent a plurality of perspectives, identifying both different approaches to pragmatism per se and different ways in which pragmatic philosophy is expressed in the worlds of science and medicine" (xv).

These are high stakes, if taken seriously. So what does the volume deliver? In the first part, "The Pragmatic Method in Bioethics", the authors focus on Dewey as main proponent of pragmatism. The topics of their articles range from general reflection on naturalism and pragmatism in contemporary bioethics (Moreno) over descriptions of pragmatic reasoning in bioethics (McGee; Fins, Bacchetta and Miller, Hester) to the role of bioethics committees (Parker). In both the second and the third part, specific issues in bioethics are discussed; they only seem to differ in the degree to which the authors refer to traditional pragmatists: in the former, Peirce, Royce and James play an important role; in the latter such references largely disappear. The second part, "Current Debates and American Philosophers", deals with two different topics, namely the collaborative character of medical practice (Mahowald, Trotter) and the experience of deep significance in medical treatment, especially in the treatment of the severely ill or dying (Gavin, Hester, Wilshire). The third part, "Pragmatism and Specific Issues in Bioethics", takes up common bioethical issues like mental illness (Singer), genetics (Saatkamp, McGee), death (Benjamin, Lachs) or the health care system and its ethics institutions (Kegley, Lysaker and Sullivan, Secundy) and is meant to illustrate how a pragmatic approach to these issues might look like.

The articles in the volume are of very uneven philosophical quality, and many conform somewhat to the stereotype according to which pragmatists have a rather impressionistic style of writing and do not give much importance to strict arguments. Personally, I found those articles most interesting that in some way, explicitly or implicitly, relate pragmatism to other approaches in bioethics.

Moreno, for example, argues in "Bioethics Is a Naturalism" that much of current bioethical writings is already latently naturalist and pragmatist - and orientation that he describes as "prevalent but unrecognized" (15). He describes the kind of naturalism that pragmatism (especially Deweyan pragmatism) proposes as a naturalism in which an emphasis on the scientific method is coupled with acknowledgement of the importance of context, personal experience and interpersonal interaction. He points out how bioethics currently, especially in its institutional realizations, can be described as naturalist in this sense.

Mahowald's "Collaboration and Casuistry" uses Peircean concepts to analyze the collaborative practice of medicine and its casuist methodology in pragmatic terms. She argues succinctly that Peirce fares better than Jonsen and Toulmin in their The Abuse of Casuistry (1988) in explaining and guiding medical practice, and especially in avoiding the charge of anti-intellectualism and relativism.

Finally, Trotter's "The Medical Covenant: A Roycean Perspective" aims at developing a Roycean understanding of the nature of the doctor-patient relationship. Instead of the usual accounts of the doctor-patient relationship that are largely framed in terms of autonomy vs. paternalism (with a tendency toward the legalistic), he uses the concept of loyalty to characterize this special relationship. Loyalty, according to Trotter, is not only important for the doctor-patient relationship, but also within the broader community. He claims that such loyalty provides the missing link that makes it possible to consistently realize autonomy as well as beneficence.

As these examples show, pragmatism in Pragmatic Bioethics is indeed understood pluralistically, as McGee claims in his introduction. What about also establishing a coherent "single pragmatic core" within such pluralism? It is less clear whether the volume is successful in this respect. Above all, there seems to be a core of concepts that appear again and again throughout the essays: experience and flexibility, context and consensus, community and loyalty. These play an important role in pragmatic thinking, and given that at least some of them have been underrepresented in much of traditional ethical theorizing, it is probably justified to present them as pragmatist contribution to bioethical thinking. Nevertheless, it is not entirely clear how distinctly pragmatist they are, given that e.g. virtue ethics, care ethics, communitarianism and casuistry focus on these or related concepts, too. Unfortunately, there is no general reflection on the relation of pragmatism to these other approaches.

The volume delivers, I think, the least with respect to the promise of "method". One somehow gets the impression that thinking as a good pragmatic bioethicist will not require any method at all, but be self-evident for any respectful and attentive democratic citizen. To be fair, perhaps something of this kind is, after all, an adequate general understanding of pragmatic bioethics; perhaps the pragmatic method in ethics can really only be conveyed through some general concepts and a series of examples (as done in this volume), given the role that apparently pertains to personal experience. Nevertheless, given the pragmatic conviction that pragmatic thinking has the same structure in theory and practice alike, it is at least surprising that the possible relevance of pragmatic methodological reflections on e.g. truth and inquiry for ethics is hardly mentioned, let alone explored in any depth, not even in the part of the book that is explicitly dedicated to method.

However, for those who are not predominantly interested in moral theory, but look for alternatives to traditional bioethical reasoning, this volume may be of greater interest. All in all, it is definitely interesting to see the use of pragmatic thought and concepts in the realm of bioethics. On the whole, the uneven philosophical quality and at times impressionistic arguments are not too surprising for a collection of bioethical writings, be they pragmatist or not. However, given the title and the claims in the introduction, the reader may be expecting too much - Pragmatic Bioethics offers some pragmatically inspired new (or at least less clearly traditional) ideas for bioethics, but not yet enough to recognize a self-standing approach to bioethics.

© 2001 Heike Schmidt-Felzmann. First serial rights