Is Bioethics “One-Directional”? Influences on Moral Theory

The practical situation can inform the ethics to some degree. Yet bioethics seems one directional, using theory to generate rules. Then, the rules are applied in clinical situations. Some argue for reflective equilibrium (situations influencing principles, i.e., the process of reflecting on and then revising philosophies) as a component of bioethics. Reflective equilibrium prevents certain prevailing philosophies like deontology from operating without exceptions. Absurd results can follow when rigid philosophies govern situations. (If it is always wrong to steal, one would allow their own child to die…)

The two-directional approach should be distinguished from a middle ground approach like principlism. Real life does make people reflect on morality, ethics, rules, priorities, and decisions. For example, in trauma-informed theories, the observation of trauma and how it affects processes, people, and cultures informs theory and can become a theory. Using multiple methods, phenomenology that studies the experience, and some sociology or psychology empirical research methods to discern and measure the significance of the trauma, policy (at the government or hospital level) can adapt. A study of the on-the-ground experience triggering a policy change may indicate that a philosophy was wrongly applied to a situation or necessitate a new philosophy. Similarly, in my work on refusals, the inability to refuse care affects trust in doctors and hospitals. If a moral theory were one-directional, it may lead to saying it is always right to override a parent or a patient, using an outcomes-based, odds-dependent, and impersonal approach even when the outcome is uncertain or there are many ways to achieve the best outcome. Such an approach would fail to reconcile, value, or appreciate the loss of trust.

While reflective equilibrium, to me, does not quite hit the nail on the head, bioethics does have to be two-directional or multi-faceted. One theory cannot prevail over all others regardless of the situation. Adding complexity to the use of philosophy, theory, and principles is necessary to hash out the stake of the different stakeholders, the workable solutions that avoid the pyrrhic victories of lost trust, and to protect those whose circumstances are different or reflect suffering. Many people (whether deemed “marginalized” or “vulnerable” (bioethics buzzwords) or not) can inform philosophy, policy, and solutions, many of which need to reflect not just propensity to suffer but past traumas.

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