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The different versions of bioethics are founded on very specific underlying philosophical and ethical elements. Every philosophical doctrine or current of thought is the source of a particular set of ethics and every set of ethics supports a distinct version of bioethics that is dependent on the wisdom or shortsightedness of both the philosophy and the ethics on which it is based.
This paper is an attempt to explain how the relationship between philosophy, ethics and bioethics comes about and to identify the main consequences of the “kinship” determined by that affinity. A hypothetical situation is used to show the various solutions that are possible with five different triads that can be established, at present, as part of that relationship.
The bioethical consequences of the “kinship” between philosophy, ethics and bioethics are illustrated on the basis of the foregoing explanation. The limited scope of opinions and their contrast with rational discourse founded on reality leads to several conclusions: solving bioethical problems implies that we start with thinking that is properly supported by a philosophical anthropology that offers the best guarantee of accuracy, rationality, internal consistency and possibility for practice, which subsequently provides the basis for objective ethical thinking that is capable of unmasking any relativism, reductionism or ideologizing. In this way, it will be possible to provide answers to the problems associated with life in general and human life in particular.
Keywords: Philosophy; Ethics; Bioethics; Opinion; Rationality; Relativism; Truth; Reality
In his book My Ideas and Opinions , Albert Einstein shows he clearly knew how to distinguish between ideas and opinions. The first usually are founded on a scientific basis and thinking that depends essentially on philosophy. Opinions, in contrast, generally lack that solid support and are related more to common sense, feelings, commitments or ideologies.
Interestingly, in that book, Einstein explicitly emphasizes more than thirty times that he will express an opinion on a particular subject, be it the cult of the individual, the economic anarchy found in society, the security of propositions in mathematics, the causes of the manifestations of the cultural decadence in his time, the presence of women in wars, etc.
The following paragraph aptly illustrates this: “Any corporeal object situated arbitrarily can be placed in contact with the quasi-rigid continuation of a given Bo (body of reference). In my opinion, this fact is the empirical basis of our notion of space.”
Einstein, like other authors, scientists or philosophers, seeks to clarify the anthropological and linguistic discourse, without excessive rhetoric, so that it’s application in political discourse and, in general, in ordinary life, can be free of ambiguity and therefore avoid its manipulation .
The Greeks, several centuries before our time, made the distinction between episteme and doxa , the first to designate knowledge derived from truth and the latter to refer to common belief or mere opinion. And, so it is that some issues, which are regarded as opinable precisely for that reason, can be understood or appreciated in several or numerous ways, each with its own interpretation, without the reality to which they refer being seen as immutable because of it. But, when trying to assess a reality based on what is essential in it, the matter ceases to be “opinable” and will be mutable depending only on the capacity of the person who observes and evaluates, so there is an agreement between what it thought and the reality that is observed. In other words, it is possible to have opinions about reality that are not necessarily related to the truth and reflections that desirably should rest on it. The ability of human beings to discover the truth enables them to reflect on reality in terms of the truth as opposed to limiting their appreciation of reality to mere opinions .
Philosophy in the contemporary world navigates troubled waters, those unsettled by postmodernism . This turbulence results in instances where opinions, some “politically correct” and flattering to the mass media, are afforded more consideration than reasoning solidly supported by thinking based on reality .
The ethics Aristotle bequeathed to humanity constitute a practical branch of philosophy that aims to seek the good and to act in accordance with it; as part of the philosophy, including its formal object: reason. Each philosophical doctrine or current of thought is the source in a specific set of ethics configured according to the criterion of the ethical judgment used. And, each set of ethics supports a different version of bioethics that is dependent on the wisdom or shortsightedness of both the philosophy and the ethics on which it is based.
The different versions of bioethics (it is possible to describe several, depending on the authors) are based on philosophical elements and specific ethics . that determine their nature and lead them to resolve old legal, rational and procedural antinomies, as well as the new problems being created in today’s hyper-technified world, doing so in an asymmetric way, without serving the common good and not always with respect for the dignity of each human being.
Positive science advances only when we follow evidence rather than opinion in seeking unravel how things work. However, this is not the only knowledge we can have of reality: when looking for the reason, the purpose and the why of things, that insight is the legacy of a different science, one that is not positive but epistemological: philosophy.
A situation viewed from the standpoint of different versions of bioethics is used to explain that relationship. Five of these versions were selected for this paper . It is shown that the different solutions that each version can provide are due, first, to the differences in the criterion of the ethical judgment that is used and, ultimately, to the concept that the human being has, that depends on the philosophy, specifically philosophical anthropology. The triads of bioethics, ethics and philosophy are established by the dependent relationships that can be observed, since they are tributary sciences among themselves. The bioethics-ethics-philosophy triads are established by the dependent relationships that can be observed, since they are tributary sciences of one another: Sociobiological Bioethics- Teleological Ethics– Materialist Philosophy; Radical Liberal Bioethics–Subjective Ethics– Existentialist Philosophy; Pragmatic Utilitarian Bioethics–Utilitarian Ethics–Pragmatic Philosophy or Pragmatism; Principlist Bioethics– Deontological (Duty-based) Ethics–Rationalist Philosophy; and Bioethics of the Person–Objective Ethics–Realist Philosophy. The sequence of the five triads does not correspond to how they appeared historically within the academic and/or anthropological discourse; the order used for this writing is the one that Sgreccia offers in his Bioethics Manual .
The situation is the following. To develop a new tool to study the psychological reactions of a population group to terrorist aggression, a group of selected individuals is subjected to simulated attacks with grenades and mortars. This is done without their consent, which would distort or corrupt the observational pattern. Naturally, logistic and medical assistance are made available in order to intervene if the reactions of the subjects exceed the limits of their physical and mental safety.
Sociobiological bioethics–Teleological ethics–Materialist philosophy
Sociobiological bioethics, where values and norms depend on the capacity for change or evolution they can produce, and where those values and norms are different because of the very same social evolutionary dynamics (analogous to biological evolution), lend support and endorsement to the research being used as a model. In other words, what is important is the advancement of knowledge that leads to an improvement or variation in the way subjects react to a terrorist attack.
Rational support would be teleological ethics, where what matters are the consequences or outcomes, and the foundation of ethical judgment is the change. If it is present, the situation can be described as good; a fact that did not inspire or promote change will not be good from an ethical perspective.
The philosophy behind this version of ethics is the evolutionary materialism that combines Darwin’s theory with Max Weber’s sociologism and the sociobiologism of Heisseng and Wilson . But several centuries before the emergence of evolutionary materialism, the Greeks provided a foundation that cannot be ignored.
Although not historically proven, it is Pythagoras who is credited with having coined the term “philo-sophia”. From its inception, philosophy had three clear characteristics: content, a method and an objective or purpose. What was sought with philosophy was to afford an explanation of reality, of all things (content), using only reason, the logos (method) to fulfill man’s desire to know and to see the truth (purpose). Accordingly, for the Greeks, philosophy was a selfless love of the truth.
The treatment afforded to each of these three characteristics has resulted in various forms of philosophy . Aristotle’s influence lasted for several centuries and it was only with Descartes’s meditations that the history of philosophy experienced its first and only definitive break so far. Yet, we should not forget that somehow that fissure commenced in ancient philosophy: in the beginning, all reality was understood only as physis (nature) and as cosmos (universe). So, the first philosophical problems can be referred to as naturalist and cosmological. Moreover, the Sophists focused their attention on man. Thus, two other different fields for “philosophizing” emerged: metaphysical (epistemological) and psychological (ethical) problems.
Ever since the Atomists, materialism has positioned itself as one of the currents of thought that attempts to explain the world and the human being. According to this line of thinking, matter is all that exists and is the first, only and ultimate reality. Leucippus and Democritus developed a notion of matter as an aggregate of an infinite number of bodies that are invisible because of their size and volume, indivisible (a-volumes), do not beget and are immutable and indestructible.
For Aristotle, matter (hyle) is that of which things are made and remains in them. However, Aristotle admittedly uses the concept of matter in multiple senses , as do many other philosophers. This concept is far from being addressed only in Greek philosophy . Galileo and Descartes characterized it as extension. Yet, to proclaim that all that exists is material is to go against the evidence .
Radical liberal bioethics–Subjective ethics–Existentialist philosophy
Radical liberal bioethics, which pretends to adopt freedom as the supreme and ultimate point of reference, would regard the situation in question as entirely lawful and reproducible. In other words, the researcher may proceed to experiment because, by virtue the freedom to act, he is able to conduct the study, is not precluded from doing so, and is completely autonomous to act.
The ethical support would be explained as follows: what is intended and accepted as freely willed and does not jeopardize the freedom of others is lawful. This is a question of subjective ethics . in which the basis for ethical judgment is constituted by self-determination: what the individual wants in exercise of his or her autonomous freedom is what is good. What would be bad is what is derived from heteronomy in any of its forms, which is contrary to want or pressures or conditions the freedom to act.
One philosophy that supports this kind of ethics, in the first instance, is existentialism . Although existentialism was born, developed and consolidated in Europe at the dawn of the twentieth century, and the period between wars gave it a historical context of crisis, we can assume this current of thought emerged as a reaction to the characteristic optimism derived from nineteenth century philosophies such as positivism, Marxism and idealism.
Existentialism is based on an anthropology that emphasizes the finitude of human beings, their problematic condition and their capacity for the absurd. Far from regarding the human being as a member of a species, a social group, a system, as a part of a historical or dialectical process, or as an instant of rational processes that explain and understand everything, existentialism has other pillars of support . Four of them are: the non-identification between rationality and reality; the centrality given to the existence of finite human beings; the relationship of existence to a transcendent being, call it world or God; and possibility as a necessary category in analyzing existence itself.
Based on these pillars, there will be various versions of existentialism, depending on the direction given to the push forward particular to the finite human being: the void (Sartre and Camus), freedom (Merleau- Ponty), oneself (Jasper) the world (Heidegger) or God (Marcel).
Pragmatic utilitarian bioethics–Utilitarian ethics–Pragmatic philosophy
Pragmatic utilitarian bioethics also agrees with the experiment in question. The data that can be obtained from the observations will be very useful to understanding the psyche of those who are subjected to terrorist violence, so as to identify patterns of behavior, design restorative therapies, etc.
From an ethical perspective, the foundation of ethical judgment is the utility, the greatest good for the greatest number of people: a utilitarian ethical philosophy. With ethics of this type, what take precedent are the consequences, the results or outcomes of the action: these are consequentialist ethics that relegate ethical objectivity by considering it unimportant. What is truly relevant is the value of what is achieved, the utility .
Utilitarianism, as a philosophy, is the basis of such ethics. Bentham and later the pragmatism of James and Dewey assumed the human being is essentially interested and must look for happiness above all and avoid or suppress pain in an unrestricted way .
Principalist bioethics–Deontological (Duty-based) ethics– Rationalist philosophy
The first version of bioethics is the North American one , which soon became known as principlism. For this type of bioethics, the action in question would be perfectly correct, from the perspective of researchers, since the principles of autonomy, justice, non-maleficence and benefence would be applied in full .
Deontological or duty-based ethics would support this original version of bioethics: what is right is determined by the norm, the law. In this case, the study would be appropriate if supported by a good research protocol in which the actions undertaken, the benefits, risks and rewards are described and justified.
A rationalist philosophy is at the heart of this type of ethics. Rationalism states that all true knowledge comes from a priori principles that are evident and not derived from experience. The only way to reach that truth would be through reason. The senses and all that is sensitive would be only a nuisance and source of confusion for thought. But this rationality has a special feature; namely, a mathematical rationality, where the concepts are clear, distinct, and indubitable and, therefore, an infallible source of certainties .
Bioethics of the person–Objective ethics–Realist philosophy
Bioethics of the person, which is more developed in Europe than in America, is the only version of bioethics that would rule out the study in question. This is because it does not respect the research subjects, their consent is not requested, they are tricked, they are subjected to unnecessary insecurity, and there is no adequate risk–benefit ratio.
The ethics that can provide an adequate explanation for this refusal to conduct the research are objective ethics, where the foundation of ethical judgment is found in the connection between good and the essence or nature of things. In other words, something is right if it is in keeping with the essence of persons, of things. It is wrong when it goes against that nature .
This version of ethics was born at the same time as the emergence of realistic philosophy in Greece during the 5th century BC. Later, in the twentieth century, it was refloated by neo-Aristotelianism, which emerged as a reaction to the crisis originating in modern philosophy, to disappointment, to disillusionment, and to the wear and tear showed by that philosophy when trying to resolve the problems caused by man himself when acting counter to what he is and what exists .
The “kinships” outlined above, which are not beyond appeal, shed light on the consequences of using one or the other to solve the various problems that are the legacy of man’s life. These problems have dissimilar origins and one of them is man himself, when he does not reflect with sufficient care and selflessness, when he puts himself at risk or becomes immersed in situations that he propitiates and that go against him or the surrounding environment.
In other words, synderesis and intellectual honesty are crucial to posing and solving correctly the problems humans face in decisions of any importance or significance. To describe the situation in which man may find himself or may propitiate, the word “problem” is used, as it is common in specialized literature to refer to such situations as dilemmas, which in logic is wrong and reveals a notable anthropological reduction [24,25].
Both gnoseology (the philosophic theory of knowledge) and practical philosophy are essential to succeed in solving problems. It is very important to cultivate prudence in thinking and to attempt to make it grow. This implies that judgments made and decisions taken must not depart from reality. One must know how to differentiate the terms of the problems, their modifiers and circumstances; and speculative habits and practical ones must be activated. This is the field of synderesis as a “corrector of awareness, knowledge and behavior” , an innate habit of the agent intellect that guards the first practical principles, parallel to the habit of intellection of the first speculative principles . Synderesis moves prudence and informs it, as the first superior practical principle .
The first triad prompts a denial of the autonomy of the individual and tends to justify in vitro fertilization, eugenics, cloning. The second triad can support human activity born of hedonism and apparently is the backing for gender ideology, euthanasia and the like.
Research with human embryos and their free availability could be supported by the third triad, as could genetic manipulation, cloning for reproductive purposes, and the use of embryonic stem cells that usually lead to destruction of the embryo. With the fourth triad, it is possible to try to defend pre-implantation genetic diagnosis, abortion, contraceptive sterilization, population control and health systems that are openly unjust, inequitable and lacking in solidarity.
In contrast, the fifth triad, the one that is based on respect for life and the dignity of every human being from conception to natural death, is able to provide elements to adequately address the clinical, social and personal problems that can occur, in keeping with the dignity to which every member of the human species is entitled and in accordance with the common good, which also includes the environment . The postulates this triad offers can be summarized as follows: life is a fundamental value; the person has a relational and transcendent value; it is necessary to have a holistic idea of what the person is; there is a priority and complementary relationship between the person, society and the environment; and it is worthwhile having a notion of human love as stable, exclusive and enduring dedication.
One of the key themes of modern philosophy is the “self ” and its unequal treatment is generally responsible for the mentality of modern man . The philosophy of the self has influenced human action. This is necessarily reflected in many fronts and one of them is bioethics.
It is noteworthy that almost all philosophers felt that the human being is self-something: self-reflection for Descartes , when it is clear that man is more than reason; autonomy for Kant, but not absolute; self-consciousness for Hegel, but also existence; self-consciousness for Marx as well, but in terms of production; self-founded for Nietzsche , not wanting to accept that man is created; self-understanding for Kierkegaard, when needing to be understood and forgiven; linguistic self-realization for Wittgenstein, but dependent on truth and good; and self-completion for Heidegger (a being destined to die) , although it is not in one’s hands to end life.
Seemingly, that self-something shares a status that exalts and ennobles man and makes him self-sufficient with respect to God or apart from Him. But the opposite is true. When man considers himself to be self-something, he is only denying his essential-existential condition and, therefore, becomes less than what he is ontologically and loses his transcendence .
Since clinical practice is not always governed by evidence, opinions often replace rational arguments. However, it is possible to distinguish between expert or authoritative opinions, if they rely on a particular certainty; those derived from common sense, if backed by simple reasoning; opinions involving a commitment, if there are external modifiers that affect them; gut reasoning, based on desire, wants or feelings [35,36]; and ideologized opinions, when they stem from partial, fragmentary and biased observation or reflections on reality.
It is not that opinions are insignificant, at least not all of them. But the search for truth demands a closer approximation to reality, which is something opinions can provide only in part i.e., authoritative opinions and, to a lesser extent, those based on common sense.
With the other types of opinions, approaching the truth it far more tangential and often impossible. Opinions based on commitment, visceral opinions or ideologized ones distort or hinder access to the truth. Consequently, they are to be avoided as substantial components of decisions and adopted only as elements that aid and illustrate thinking.
The strength of the support opinions or knowledge can provide will depend on the philosophical thinking on which they are based. A philosophy that has an unfair or biased perception of reality is more likely to be a source of opinions while one based on reality can provide enough support for a legitimate approximation to the truth.
It is understandable that science looks for certainty, but it can be found only if the object of research allows for an empirical approximation and follows a mathematical rationality. Yet, when it comes to practical-social knowledge, a different qualitative measure should be used, because certainty is not possible for the simple reason that knowledge of this type involves human beings who, by their very nature, are not predictable, nor do they function in a series, or give the same answer to the same problems. So, when the object of study is man himself, what characterizes scientific activity are not certainties but the attitude of search.
However, this does not mean activity in the human sciences is marked by opinions, but merely that the standard of comparison can be none other than human nature itself  and the field of opinions is reduced because its same characteristics (immutability, timelessness, unity, etc.) reflect the truth that is found in the human essence and is not a matter of judgment or opinion .
It is also interesting to note the relationship between the reasoning, opinions and evidence, since evidence can be the basis for both reasoning and opinion, providing them with greater or lesser credibility. Evidence alludes to a contrasting test that permits verification; it is a sign of truth, but not truth itself.
Here, we find one of the constraints of evidence-based medicine (EBM): many things in humans can be “evidenced” in the area of signs, but when it comes to symptoms, there is a connection with the subjectivity of the human being that cannot be ignored. That subjectivity is very important. Not only must the physician be aware of it, he must learn to understand it, so as to ensure his actions are not dehumanizing. In this case, we definitely can speak of opinion, and it would be an expert or authoritative opinion .
When evidence or proof of an assertion cannot be provided, we are in the realm of opinion. Yet, that which is part of an intrinsic certainty, such as a mathematical truth, cannot be referred to as an opinion. For instance, one does not “think” that three plus two is five (3 + 2 = 5), one “knows” it is. Opinions are closer to preferences or tastes, but also to prejudices and illusions. In other words, they are more subjective.
Other dimensions mediate between opinion and knowledge: that which deals with dialogue and that which prompts the move from knowing to doing. One can discuss opinions, but this form of communication lacks true or real backing, which makes it difficult to achieve the depth that contact with the truth lends to those who are involved in the dialogue. In contrast, when talking about reasons, the communication is more direct and there is little room for diffuseness, shortcuts and rhetorical devices, because that contact with the truth implies a consistency between what one thinks, knows, says and does .
It is important to seek a non-subjective approach when analyzing bioethical problems, one that is as objective as possible and can overcome the passions and appropriately orient the feelings that tend to hide or blur reality. The preference is for dialogue over conversation. That objective can be achieved, in the first instance, by analyzing what is done and not why . In other words, the kind of thinking used in bioethics must follow the deliberative guidelines particular to ontological ethics, based on goods, virtues and norms [42,43]. If not, when other types of ethics are used, it is easy to fall into the relativism that is typical of ideologizations.
The move from opinion to rationality necessarily implies backing up bioethical thinking with realistic philosophical anthropology as well as ontologically founded ethics . Only in that way is it possible to provide truly humane solutions to problems that include life in general and human life in particular. Otherwise, the solutions will be partial at best, arbitrary, reductive and reducing, perverse and vile, ones that wound a person’s dignity and, sooner or later, prove to be iniquitous and grossly unfair. When trying to construct dignity with opinions, rather than respecting it on the basis of the reasons for it , man ends up being lacerated, abused and hurt.
When man seeks truth and goodness, when he does not invent or distort them, he transcends, grows internally, rises above himself, and enters into communication with persons.
Part of the tragedy of modern man is in believing he is something, as opposed to being convinced that he is someone. It is in his selfcriticism, in turning inward with a self-serving attitude, in relying on his automovement, in resting on his self-discipline and in severely distorting his autonomy and self-esteem. It is in thinking he is self something and not realizing the matter can be resolved best by accurately knowing oneself.
Bioethical problems are not solved by bioethics themselves or bioethics alone. The ethics used to reflect on these problems are essential, particularly the anthropological notion we have of philosophical anthropology. The strength of this foundation comes from a healthy gnoseology applied with synderesis and prudence, leaving aside any attempt at reductionism and ideologization on what constitutes the human being.
The ethical relativism found in any sort of reductionism and ideologization must be unmasked. This can be accomplished through practical reasoning (rationality), synderesis (intellectual habit) and prudence (cardinal virtue) to capture the true good (individual and common good), and all within the limits of natural law (dignity and solidarity).
This necessitates having clear assumptions: truth exists and can be known; the human person is free and capable of responsibility; freedom follows the individual good and the common good; the human person is worthy and deserves respect; the human body is human person.