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Club Bio-Med

by Rick Lewis

This issue of Philosophy Now deals with the very stuff of life, namely bioethics and medical ethics. Bioethics is the analysis of ethical problems arising out of advances in biotechnology, especially genetic engineering. Medical ethics deals specifically with the problems and dilemmas that arise from treating patients, so the two terms overlap. Given that doctors and scientists are striving to save lives, ease suffering and make the world a better place, and are constantly discovering new ways of doing so, you might think that the only ethical problems here would concern which medals and honours we should heap on their heads and in what order. I concur with the sentiment, but have to inform you that some of the problems are a little more serious and intractable than that. Medical knowledge is now advancing at an astounding pace, so this is ethics in a fast-changing environment. Our first three articles concern three ethical conundrums that couldn’t even have been imagined a few decades ago, let alone wrinkled the brows of moral philosophers, namely: designer babies, genetic engineering of animals and testing for genetic diseases. As it is rare for philosophical problems to ever be definitively solved, the appearance of so many brand new ones must raise the concern that we are falling behind. So, philosophize faster, everyone!

To what extent can the main theories in moral philosophy be applied in these particular areas of medical ethics and bioethics? The utilitarianism of Jeremy Bentham probably works pretty well if you are, say, a hospital administrator, trying to use limited resources fairly and effectively for the benefit of all your patients. On the other hand, utilitarianism might be a tough philosophy to have around if you ever happen to be a patient with five healthy organs in a ward full of people awaiting transplants. What about virtue ethics? That sounds better! From your point of view as a patient you’d better hope that the nurses and doctors looking after you are inspired by an ‘ethic of care’. This is a notion taken from feminist philosophy and is a type of virtue ethics. It fits in well with the Hippocratic Oath, that has guided the medical profession since ancient times. The idea is that then you make decisions in the right spirit, the spirit of caring.

Does virtue ethics have other applications here too? Maybe it could include artificially improving your own character and capabilities, or those of your children, through genetic engineering, by taking drugs or through surgery? Perhaps we can engineer future humans to be wiser, less self-centred and less prone to violence. What do you mean that’s not what Aristotle had in mind? He didn’t live in the 21st Century. Why should Aristotle have objected to us using the knowledge we have gained to make us wiser and kinder? You might protest that taking a pill to make us better people is too easy – that it is the struggle to improve that is needed, because it builds strength of character. But why? What if instead I could take an extra pill to improve my strength of character too?

How about Immanuel Kant’s famous categorical imperative? Is his type of duty ethics irrelevant here? No, maybe it just has found a new field on which to battle its old adversary, consequentialism. Read for example Vincent Lotz’s article on HeLa cells. Utilitarians would say, use what you need to use to save millions of lives. But a Kantian looking at the HeLa case might say, never treat a powerless patient like Henrietta Lacks merely as a means to your end – however noble that end might be.

The articles in this issue deal with just a handful of the many questions faced by bioethics and medical ethics. Another concerns the possibility that we’ll one day learn how to beat the ageing process to achieve human immortality, something we’ve discussed in previous issues. The inevitability of death has been one of the major motivations for philosophical reflection since the dawn of human civilization. It has given birth to entire religions and inspired Socrates to say that doing philosophy is ‘practicing for death’. But what if death ceased to be inevitable and became optional, its timing entirely a matter of personal choice? That would raise towering difficulties for society and the individual on every level – philosophical, psychological, sociological, political, economic. But at least we’d have time to think about those difficulties and try to solve them. After all, while there is life, there is hope! You can find a different and less technological approach to the question of death in Rui Vieira’s article on cosmology and personal identity, which asks the beguiling question: Can the ‘multiverse’ give you an afterlife?

Cosmological speculations and medical miracles aside we could do worse than to try to emulate the cheerfulness of this month’s cover model, David Hume – even on his deathbed, he cheerfully cracked jokes and chatted about ideas, which unsettled his old friend Boswell the biographer, who had dropped by to see how an atheist like Hume would cope with the imminent prospect of extinction.

Hume is widely regarded as the greatest philosopher ever to write in the English language, and philosophers are still wrestling with his legacy. Alistair MacFarlane writes here about his life and ideas, while Eugene Earnshaw tries to permanently defuse one of Hume’s most troublesome legacies, a ticking bomb in the foundations of Western philosophy known as Hume’s Problem. As this is a difficulty with the inductive method that underpins so much of modern science, it makes Hume a particularly appropriate philosopher to feature in an issue on ethical problems generated by scientific advances.

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