Table Of ContentOUPCORRECTEDPROOF–FINAL,8/10/2018,SPi
The Methods of Bioethics
OUPCORRECTEDPROOF–FINAL,8/10/2018,SPi
ISSUES IN BIOMEDICAL ETHICS
GeneralEditors
JohnHarrisandSørenHolm
ConsultingEditors
RanaanGillonandBonnieSteinbock
The late twentieth century has witnessed dramatic technological develop-
ments in biomedical science and the delivery of health care, and these
developments have brought with them important social changes. All too
oftenethical analysis haslaggedbehindthese changes.The purposeof this
series is to provide lively, up-to-date, and authoritative studies for the
increasinglylargeanddiversereadershipconcernedwithissuesinbiomed-
ical ethics—not just health care trainees and professionals, but also philo-
sophers,socialscientists,lawyers,socialworkers,andlegislators.Theseries
features both single-author and multi-author books, short and accessible
enoughtobewidelyread,eachofthemfocusedonanissueofoutstanding
currentimportanceandinterest.Philosophers,doctors,andlawyersfroma
numberofcountriesfeatureamongtheauthorslinedupfortheseries.
OUPCORRECTEDPROOF–FINAL,8/10/2018,SPi
The Methods
of Bioethics
An Essay in Meta-Bioethics
John McMillan
1
OUPCORRECTEDPROOF–FINAL,8/10/2018,SPi
3
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OUPCORRECTEDPROOF–FINAL,8/10/2018,SPi
Contents
Acknowledgements ix
1. HowtoFindYourFootinginBioethics 1
Part I. Bioethics
2. WhatIsBioethics? 7
TheOriginsofBioethics 7
MyDefinitionofBioethicsandWhatItNeedstoDo 10
TheEssenceofBioethics 11
Battin’sTrichotomyandClinicalConsultation 11
BioethicsandPublicPolicy 13
ScholarlyBioethics 15
MoralReason 16
MedicalEthicsversusBioethics 17
BioethicsasDistinctfromAppliedEthics 19
PhilosophicalBioethics 19
EmpiricalBioethics 21
PhilosophicalBioethicsversusMissionaryBioethics 21
EthicsasDistinctfromLaw 23
Conclusions 25
3. ‘Good’Bioethics 28
NoSpecialPleading 30
TheStrengthof‘NoSpecialPleading’ 32
EngagementwithExperience 35
GoodBioethicsAlwaysInvolvesSoundReason 40
Conclusions 42
Part II. The Spectres of Bioethics
4. FourSpectresofBioethics 47
TheMoralMantraMistakeandtheTediousTheoryTendency 47
FourPrinciplesandtheSearchforTheory 49
TheEthicsSausageMachine 53
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vi
OtherEthicsSausageMakers 62
PhilosopherKingsandOtherQueensoftheSciences 63
TheSnootySpecialistSpectre 64
OtherQueensoftheSciences 66
Sociology‘of’Bioethics 67
5. TheFact/ValueSpectre 71
PutnamandtheFact/ValueDistinction 74
IfNotEmpirical,ThenNonsenseorSubjective(Positivism) 76
BioethicsResearchPositivism 78
EvidenceBasedMedicine 79
ValuesBasedMedicine 80
Conclusions 82
Part III. The Methods of Bioethics
6. Empirical,SocraticBioethics 87
PhilosophicalForefathers 91
SocraticReasoning:SpeculativeReasonand
DrawingDistinctions 92
BioethicsShouldBeRigorousandSystematic 93
EmpiricalandSocratic 94
Non-invasivePrenatalTesting 95
AnencephalicBabiesandtheDead-DonorRule 96
EpistemicHumilityandPhilosophy 104
EpistemicHumilityandMoralTheory 105
EpistemicHumilityandtheAdditionalComplications
ofBioethics 106
AKantianArgumentforWhyBioethicsMustInvolve
ConceptsandtheEmpirical 108
7. WhatIsanEthicalArgument? 113
BuildingaCase 117
PickinganEthicalQuestionorClaim 117
ConstructingaSyllogism 119
ThinkCreativelyAboutAlloftheIssuesThatMight
BeRelevanttoThatQuestion 119
ThinkAboutWhichPartsoftheArgumentAre
EasyorHard 120
QuestioningandExaminingFactualClaims 120
MinimizeYourTheoreticalAssumptions 122
FreedomandHarm-BasedArguments 125
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vii
8. SpeculativeArgumentandBioethics 128
SpeculativePracticalReason 129
SpeculativeReason:TheCounterexample 130
SpeculativeReason:TheArgumentbyAnalogy 133
SpeculativeReason:DeepeningMoralUnderstanding 138
SpeculativeReason:IntuitionPumps 140
SpeculativeReason:TheHeuristicDevice 145
Conclusions 146
9. DrawingDistinctions:Defining,Reclaiming,and
AnalysingMoralConcepts 149
DrawingProgrammaticDistinctions 150
DrawingDistinctionsThatMarkImportant
MoralDifferences 154
ClarifyingtheImplicationsofaConcept 156
ReclaimingMoralConcepts 159
ClarifyingConcepts 161
10. DrawingDistinctions:Novel,Sublime,andSlippery
MoralConcepts 169
IntroducingMoralConcepts 169
TranscendentalDistinctions 174
Slippery-SlopeArguments 176
Conclusions 180
11. WhatItIstoReasonaboutEthics 182
Index 185
OUPCORRECTEDPROOF–FINAL,8/10/2018,SPi
OUPCORRECTEDPROOF–FINAL,8/10/2018,SPi
Acknowledgements
Over the course of several years Adrian Walsh and I have discussed
theimportanceofargumentforbioethics,andhowthereseemstobe
an overemphasis on theory, and a number of the names that I have
given to parts of this book arose out of discussions I’ve had with
Adrian.Theideathatweshouldviewtheobstaclestogoodbioethics
as‘spectres’ishis,anditdescribeswellthewayinwhichanumberof
historical issues continue to haunt bioethics. It was his idea that we
canthinkofthetwobroadclassesofstrategyusedinethicalreasoning
as‘speculation’and‘drawingdistinctions’,andthissuggestion,aswell
asmanyothershehasmade,helpedtoshapethisbookintotheform
itnowhas.FrommyfirstinteractionswithbioethicsIwasawarethat
this is an area where a degree of humility is required: if you come
fromaphilosophical,legal,orsociologicalbackgroundyoushouldbe
aware of the expertise that others bring to ethics, especially in a
clinical context. Adrian suggested that the best description for this
concept is ‘epistemic humility’; I have developed that idea, and it
playsanimportantroleintheargumentofthisbook.
I’m indebted to Julie McMillan-Kearns, Bruce McMillan, and
ThomasineKushnerforinvaluablecommentsondraftsofthismaterial.
The two anonymous reviewers who read this book for Oxford
UniversityPressmadeanumberofinsightfulcommentsandspotted
gapsintheargument.Thisbookismuchimprovedasaresultoftheir
efforts.Otherswhohavemadeparticularlypenetratingandinsightful
comments include: Tony Hope, Julian Savulescu, Tom Douglas,
MarkSheehan,MikeyDunn,andMikeParker.
When thinking through the structure and claims of this book,
I was fortunate to give seminars at The Uehiro Centre for Practical
EthicsandtheEthoxCenterattheUniversityofOxford.Ialsogavea
talkbaseduponthisbookatthe2017InternationalBioethicsRetreat
in Paris. A number of people who were present at the consortium
