Empirical bioethics and moral craft

Abstract

This study discusses Michael Parker’s concepts of empirical bioethics and moral craft. Bioethics grounded only on theoretical principles cannot properly resolve ethical conflicts, and morals can only be understood in the real contexts in which people live. Both axioms, among others, have led to the development of empirical bioethics, based on ethnography, demography, social sciences and empirical data. It aims to explore and resolve ethical dilemmas by using facts, daily practice, success and failure, and solutions acquired and validated in practice. Moral craft is a set of moral and theoretical principles and values, individually or collectively built, for the analysis, study or research of a case or problem. Moral craft, according to Michael Parker, reveals the character that perfects empiricist ethics.

Ethics; Bioethics; Empiricism

Resumo

Neste ensaio são examinados os conceitos de bioética empírica e moral craft segundo Michael Parker. A bioética fundamentada em princípios puramente teóricos mostra-se incapaz de resolver adequadamente conflitos de cunho ético, e a moral só pode ser compreendida no contexto real em que as pessoas vivem. Ambos os axiomas motivam, entre outros, o surgimento da bioética empírica, fundamentada em dados etnográficos, demográficos, de ciências sociais e empíricos. Trata-se de aprender e de resolver conflitos por meio do exercício diário, dos êxitos e erros, de soluções que foram adquiridas e validadas na prática. Moral craft é o conjunto de princípios e valores morais elaborado de forma individual ou coletiva, imprescindíveis para a análise, o estudo e a pesquisa de um caso ou problema. O moral craft como apresentado por Parker revela o caráter que aperfeiçoa a ética empirista.

Ética; Bioética; Empirismo

Resumen

En este ensayo se examinan los conceptos de bioética empírica y moral craft según Michael Parker. La bioética fundamentada tan solo en principios teóricos es incapaz de resolver adecuadamente conflictos de carácter ético, y la moral únicamente puede ser comprendida en el contexto real de las personas. Ambos axiomas motivan, entre otros, el surgimiento de la bioética empírica, basada en datos de las ciencias etnográficas, demográficas, sociales y empíricas. Se trata de aprender y resolver conflictos a través del ejercicio diario, aciertos y errores, soluciones adquiridas y validadas en la práctica. Moral craft es el conjunto de principios y valores morales elaborado de forma individual o colectiva, imprescindibles para el análisis, estudio e investigación de un caso o problema. El moral craft , tal como presentado por Parker, manifiesta el carácter que perfecciona la ética empirista.

Ética; Bioética; Empirismo

Ethics and applied ethics

The concept of empirical bioethics caught my attention after reading the book Ethical problems and genetics practice ¹and talking to its author, professor Michael Parker. The book, although written mainly for genetics professionals, presented ideas and interpretations that, for me, were uncommon in a text about ethics and bioethics. Thus I consider it relevant to begin this essay by briefly describing the concepts of ethics, applied ethics, and bioethics, which precede and introduce that of empirical bioethics.

Trying to define ethics is a difficult task. However, Cortina and Martínez define it in a general manner with clarity and brevity: ethics understood as the part of philosophy that is dedicated to reflections on morality ². Its relevance is not a new topic, as it is deeply rooted in human beings, in their lives, aspirations, and individual and collective decisions about family, professional, political, sport or environmental aspects.

The wide range of philosophical conceptions – mediated by culture, economy, politics, religion, media, the environment, science and technology – is a polymorphic conglomerate of concepts, attitudes and values susceptible to different interpretations and conducts. There exists, however, an essential element or neural axis that structures and dynamizes it: the human being, the subject, the self, a man or a woman, male or female. But confusing statements hinder understanding these concepts, such as that of Stephen Hawking: we, who are ourselves mere stardust ³.

In the gradual physical and psychic progress of the human being, several questions arise. One of them, manifested explicitly or implicitly, exponent of rational and emotional development, is the question about What is good? ⁴, and primarily from metaethics to the question of definition⁵. Going beyond the issue of meaning, Wittgenstein⁶, aware of the various interpretations of ethics throughout the history of philosophy, of its relationship with the humanities, and the lack of objective and numerical data, describes it as human beings’ tendency or inclination towards well-being, justice, friendship, respect, peace, etc., which they would never disrespect.

When delving deeper into the same topic, certain questions clearly raise doubts and distrust. Is there a single answer to ethical questions? Are the principles of ethics conditioned to the person, culture or education? Then, is skepticism or relativism the best position in relation to human values? Similar questions, related to descriptive ethics and prescriptive ethics, have been analyzed by numerous philosophers over the centuries. Such reflection, compounded, remains until today.

Immersed in the anthropological, epistemic and metaethical topics of the history of philosophy, and more specifically of ethics, applied ethics, also called practical ethics⁷, progressively emerged. It refers to specific concepts of normative ethics regarding singular actions of individual or collective life (such as the option for permanent sedative status), professional life (for instance, business ethics), social life (such as gender discrimination), and international life (such as the refugee issue)⁸. In short, Peter Singer defines it as the application of ethics or morality to practical issues ⁹. More recently, McMillan introduced it as an emphasis upon attempting to provide answers to practical moral questions ¹⁰. This is nothing new, for philosophers have always addressed relevant, and sometimes urgent problems of practical life, as Seneca¹¹and Hume¹²did regarding suicide, and Russell¹³on more broader issues.

Ethics, and particularly applied ethics, has extended its projection and content from early 20th century to science, society, and the universe. It is evident that scientific, technological and social development needed a locus to harmonize life sciences – with special emphasis on ecology, technological sciences, and progress – with individual, social and global values, considering them inseparable, almost aiming at utopia.

Technology should progress in line with social welfare, including, nowadays, the environment and mitigation of the threatening global warming. As environmental activists have been warning us for decades, we have to stop our emissions of greenhouse gases ¹⁴; and the bigger your carbon footprint, the bigger your moral duty ¹⁵. Otherwise, a universal failure would be expected, which would regrettably also affect human flourishing¹⁶. It must be recognized that, since the beginning of the Industrial Revolution, humanity has had an economic and moral debt that has only increased over the centuries¹⁷.

Bioethics

In view of those issues and challenges, Paul Max Fritz Jahr created the term bio-ethik in 1927¹⁸, and Van Rensselaer Potter coined “bioethics” in 1971¹⁹. This field has spread internationally and remains fertile and indispensable for society’s development, given the unpredictable challenges in the near future²⁰.

There is no consensus among authors on considering bioethics as an applied ethics²¹: some subordinate it to this field, and others report it as an independent segment²². However, both positions confirm the interdisciplinarity and plurality of perspectives and methods, so it can be considered a macroethics ²³, comprised of several bioethics²⁴, representing a hybridized discipline ²⁵. These differences are partly justified by the fact that since its inception, bioethics has amassed scientists and philosophers, with the subsequent marked presence of health professionals, finally opening up to global society, which has been a concern since its early stages.

Empirical bioethics

The definitions of bioethics have also evolved²⁶. Sociology, law, the sciences, ethnography and an interest in objectivity have gained more relevance in these concepts, expanding the horizon for a more focused, accurate, and comprehensive bioethics. Quantitative data and singular information from past experience became a priority in studies, research and decision-making process. Epistemology, without forgetting theory, also considered indispensable a closer connection to experimental or sensitive aspects.

Politics, public affairs, conflicts between disciplinary traditions, diversity, and the singular or different aspects of people (patients, family members, or professionals, where they come from, what country they live in, etc.) helped differentiate that first bioethics from bioethics focused on information about each issue or problem – the so-called “empirical bioethics.”

Parker’s works¹have dedicated special attention to comments and definitions that outline an original and differentiated view of ethics and bioethics. These are some statements that I consider relevant concerning morality, ethics, bioethics, empirical bioethics, ethnography, and moral craft:

Morality only makes sense in the context of some shared established practices and values²⁷.

I have observed and attempted to track ethical problems as they have emerged and changed (…) my role is deeply implicated in the enactment of ethics in this setting²⁸.

Bioethics fails to take sufficiently seriously the moral significance of the realities within which people, including patients, families and doctors live and work²⁹.

For almost long as there has been bioethics, there have been demands for it to be more empirically informed and for a greater emphasis to be placed on the role of the empirical in bioethical deliberation³⁰.

Ethnography offers the possibility of a bioethics better informed about the meaning and intersubjective significance of the situation under consideration²⁹.

The experienced genetics professional committed to the moral craft of genetics sees an important and vital rule in his practice for the continuation of an active and productive interplay between morals and ethics³¹.

These statements are, in my perspective, the core of an enlightening and constructive view of bioethics, and the expression empirical turn in bioethics ³²confirms this position. They can be summarized as follows: morality can only be understood in the real context in which people live; ethics and bioethics need to be instructed by morals; the ethics of a given act, process or case inexorably needs individual data, ethnographic information and moral assessment outside previously established standards, which does not necessarily imply ignoring or excluding them.

Based on these ideas, we can see a concentrated empirical statement of bioethics that allows defining some axioms for its understanding and development. It is evident that empirical bioethics transcends the disciplinary limits of ethics and bioethics, prioritizing facts over theories. Most cases and debates about bioethics involve unquestionable empirical data³².

Bioethics based only on theoretical principles cannot adequately resolve ethical conflicts. Likewise, to be efficient bioethics has to cover reality in its multiple forms – individual, collective, family, professional, sociological, legal, academic, etc.³³It must integrate methods from the humanities, social sciences and life sciences, including ecology. The synergy between these fields generates a new perspective, expanding bioethics.

Sociology has also a relevant role among the social sciences: empirical bioethics must know how to associate arguments and values with the reality of social or family context through properly designed and conducted research. This interrelation is also called “democratic deliberation or deliberative democracy” in studies or discussions in which researchers, professionals and representatives of society participate³⁴.

As already discussed, empirical bioethics subordinates knowledge to experience ( empeiria ), according to British empiricism, which considers data provided by the senses as indispensable. Thus, experiences and objective information enable and improve the understanding of topics, questions or problems presented.

Connecting with reality expands and enriches the meaning and development of bioethics. In this respect, ethnography is considered an irreplaceable method for identifying and understanding the unique characteristics³⁵that condition and influence actions, decisions and values³³. Therefore, the social environment or context where problems, cases or conflicts take place deserves special attention. Ethnography becomes then the sine qua non condition for the case to be assessed and resolved.

Thus, bioethics does not remain at the margins of experience, as traditionally seen in philosophical ethics. Its development is gradual, monitored and challenged by new cases or problems that may contribute, given their empirical character, to the progress and improvement of knowledge in subsequent cases³⁶. Recognizing the value of empiricism in the development of bioethics implies a connection with people’s daily lives, an interaction between citizens and experts from various fields – which significantly differentiates it from the first bioethics¹.

Ethnography as a field that seeks and gathers specific data of social life in different situations becomes an improved research tool that contributes to interactions between social sciences and ethics, cooperating for a new dimension of bioethics. In this way, empirical bioethics surpasses previous but no less relevant views to expand knowledge, practice and global responsibility.

Moral craft

Leaving aside a more detailed discussion of the main concepts of empirical bioethics, I will focus here on the expression “moral craft” used by Parker³⁷, which attracted my interest due to its unusual character in the scope of ethics.

The first immersion focused on semantic aspects. “Craft” primarily refers to a work or object made by an author, technician or artist³⁸. Parker³⁷uses this concept based on Richard Sennett’s perspective in The craftsman ³⁹. For this author, “craftsmanship” is the art or the skill to build or develop things, the skill to make things (…) by themselves ⁴⁰. On the other hand, the craftsman constantly faces conflicting objective standards of excellence ⁴⁰. In addition, every good craftsman conducts a dialogue between concrete practice and thinking ⁴⁰.

Parker³⁷lacks a concise and objective definition of moral craft, which hinders understanding the term accurately. Due to this omission, based on the concept of ethics in this context, I will discuss five other terms that express some of its characteristics and, therefore, the attributes that differentiate it.

Practical wisdom

Practical wisdom of the experienced genetics professional committed to the moral craft in genetics³¹.

Parker compares practical wisdom to “ phronesis ”⁴¹, a dianoetic virtue of practical wisdom, unlike theoretical wisdom ( sophia ) and technique ( techne ), art or craft. Techne , in this case craft , refers to a number of procedures that aim to produce a certain result. It is the virtue of poetic or constructive intelligence ( episteme poietike ), which differs from the science of theoretical intelligence ( episteme dianoetike ) and episteme praktike , which considers human acts⁴².

Parker also highlights that good practice requires not only that attention be paid to the clinical or medical aspects of their day-to-day work with patients and families, but also to what might be thought of as the moral craft of genetics ⁴³. With this statement, the author recognizes the composition of moral craft, episteme poietike and episteme praktike , which operates after the election ( proairesis ), whose result will be judging the action as good or bad.

Living morality or lived morality

A mode of engagement with practice which makes it possible for both ethics and morals to be taken seriously³¹.

The interest in improving morals and in empirical bioethics also emerges from the desire to ensure a new life and new drive to traditional bioethics. It involves learning and solving dilemmas through facts, daily practice, successes and errors, solutions acquired and validated in practice, and not in a theoretical class or in a recently published work. It is experienced bioethics, ensured in the real world by responsibility and individual and corporate efficiency.

Commitment

Commitment to the moral work (…). The genetics professionals who attend the Genethics Club share a deep commitment to doing their job well for its own sake and they recognize that it requires a commitment not only to good practice in the medical aspects of their day-to-day practice but also in what I have referred to as “moral craft” of genetics⁴⁴.

Directly or indirectly, commitment is related to ethics and the so-called “everyday ethics” or “quotidian ethics,” understood as applied ethics⁴⁵. The commitment of the genetics professional to moral craft can also be understood as acting according to the code of ethics, professional commitment to the moral craft of genetics ⁴⁶.

Skills

Recognize the value of developing skills such as moral deliberation, critical reflection, and skills or moral judgment associated with moral craftsmanship, and seek out opportunities for those skills to be tested and challenged⁴⁶.

The ideal space for learning these moral skills and continuing education is the Genethics Club, or the forum for genetics (researchers, clinicians, nurses, technicians, students) and bioethics professionals. The colloquium is its method of work. One of its priorities is to discover methods to approach the case or problem under study, from different optics to positions, highlighting data and details that identify and differentiate it.

The dialogue between professionals and multidisciplinarity, with various responsibilities, constitutes incomparable conditions for the exercise and continuous learning of the necessary skills for proper practice of the profession. This is an example of the so-called dialogical empirical bioethics ⁴⁷. Lickona⁴⁸states that theory and practice are inseparable for adequate and ever-developing training.

Problem seeking

Commitment to the moral work of problem-seeking³¹.

Empirical bioethics researchers are engaged in the moral craft of undertaking novel forms of bioethics research, managing emerging difficulties and uncertainties as they traverse stable disciplinary standards in their research endeavors, striving to craft ethical arguments that have practical force in new and creative ways⁴⁹.

This is a characteristic that differentiates empirical bioethics from the activities of the Genethics Club, to which is given particular importance or consideration. Problem seeking is at the heart of the moral craft of genetics ⁴⁶. It consists in searching for new research methods for cases deemed singular, special or difficult to identify and resolve.

Common cases, presented for analysis or diagnosis, are conducted with their own methods. The interlocutors of the Genethics Club, supporters of empirical bioethics, strive to seek and build new, combined research methods, reevaluating ethical and epistemological problems and solutions to obtain more efficient results, thus contributing to the progress and improvement of empirical bioethics.

In this sense, moral craft can be understood as the one’s own or individual construct and moral repository; but it can also be understood as collective, conducted by professionals engaged and skilled in deliberation and dialogue for discovering new methods, solutions and values concerning professional practice. However, Parker’s explanation³⁷throughout his work is somewhat vague regarding this double meaning. These values should be referred to the praxis, as it is a living morality that accompanies and is decisive in everyday activities or in the correct exercise of a profession³⁷.

The considerable cooperation of the Genethics Club for constructing moral craft is thus evident. This modus operandi also shows the relevance of empirical bioethics, since doubts and conflicts arising from the daily practice of medicine support and fuel studies and discussions¹. The detailed description of data, irreplaceable for developing moral craft, is similar to situation ethics, which roughly considers the real context of a fact, problem or decision; moral craft, in turn, gathers as much data as possible to be examined and understood using different criteria.

Situation ethics, focused on the person, analyzes the particular context of an act and prioritizes love⁵⁰as the principle of choice, understood as an absolute good to which all values are subordinated⁵¹– only one thing is intrinsically good, namely love, a universal love: nothing else at all ⁵². It is impossible, in the construction of moral craft, to adopt a single model of ethics, principles or universal rules to analyze or resolve a case or problem, as would be with recognizing utilitarian ethics as a single conduct criterion.

Despite their differences, moral craft and situation ethics have in common a thesis, or principle, that is controversial for ethicists and jurists. For Fletcher⁵¹, acts commonly considered reprehensible can be judged as morally correct, depending on the circumstances, intention, will and emotion of the players: there are times when a man has to push his principles aside and do the right thing ⁵³. (…) Every man must decide for himself according to his own estimate of conditions and consequences ⁵⁴. This attractive but controversial model of ethics has been discussed by some authors of existentialist philosophy, and, particularly, in moral medicine by Joseph Fletcher.

In empirical ethics, a case or an action can only be morally and equitably evaluated by examining the characteristics, data or details that reveal, clarify, and justify it. Results from the judgment or assessment may be temporary, given the possible change or deviation due to the empiricism of the data, objects or information evaluated. According to Parker³⁷, moral craft reveals thus the character that enriches and improves ethics shaped by empiricism, of remarkable presence in research and the development of science and technology.

Final considerations

As discussed by Michael Parker¹, the empirical turn in bioethics is incontestable. Empirical bioethics presents in the examined work characteristics of a plural ethics in development, with an emphasis on data singularity and relevance, and on epistemology. It is applied bioethics, since it deals with attitudes and decisions to be made in research and in the exercise of the profession, and, in this case, in the health area; normative bioethics, since it answers the questions “What should we do?” and “Who should we be?”; descriptive bioethics, for it examines or analyzes deliberations and actions based on different criteria; and metaethics, as it deals with epistemological and linguistic issues.

Empirical bioethics handles qualitative research and develops ideas and hypotheses for quantitative research, prioritizing objective and numerical data, and aims to understand specific individual aspects, instead of generalizing or universalizing them. The progressive and recognized performance of empirical bioethics is opposed to paralysis and sterility.

But some restrictions are observed in this concept. The principle, reason or justification of a given alternative or action related to a scale or hierarchy of values is not sufficiently explicit without previously pointing a reference excellence value for merit judgment. Such positioning can easily induce subjectivism and relativism, a deviation that, according to Parker¹, can be measured, discussed, evaluated and corrected by the Genethics Club, to which, however, no responsibility is transferred, as this must be assumed by the author of the proposal or decision.

Moral craft, construct and individual or collective moral repository, subject to different interpretations, lacks a clear and objective definition that prevents inaccuracies or mistakes in understanding and using this term. An inevitable question then emerges: who performs the role of reflection that differentiates the approved from the disapproved, of the inner court or of what is prior or subsequent to a moral conviction, that is, of moral conscience? We should recognized that this concept is absent or omitted. This is, in my opinion, a moral vacuum that is difficult to justify, which could be interpreted as an implied concept, but not mentioned in the various descriptions or comments made throughout the work. The epistemological aspect, relevant to the author, is not assessed in this article, since it would require future studies.

The book has a significant characteristic: it is an experienced and genuine treatise of empirical ethics, already clear in its title Ethical problems and genetics practice , written by a renowned scientist. But given the necessary and inseparable link between ethics and genetics, the collaboration or even co-authorship of a moral philosopher would have been more appropriate. Its relevance, however, is unquestionable.

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Publication Dates

• Publication in this collection
  21 May 2021
• Date of issue
  Jan-Mar 2021

History

• Received
  13 Feb 2020
• Reviewed
  12 Jan 2021
• Accepted
  14 Jan 2021