Beyond utilitarian and fundamentalist approaches to bioethics’ problems

Interdisciplinary and pragmatic character of bioethics make all kinds of radicalism, absolutism and fundamentalism rather unwellcome on its grounds. However, on the other hand, attitudes “waiting around the corner,” gaining much popularity in the present conditions of cultural and ideological pluralism, ambiguity of all possible authorities and competence assessment, are-in their very founding design-infected by some contestation of the idea of moral as a strictly autonomous and unreducible domain. Still, again: these naturally attractive for bioethics, who is a part of our pluralist, democratic culture of public life, bear the labels-like pragmatism, utilitarism, discourse ethics, and even (rarely in a postive sense) “relativism”-which for the academic “philosophy for philosophy,” exercised without any special prospects for possible applications and without related responsibility are always “on edge,” subject to havy criticism. It is, of course, criticism forwarded by these currents, who identify themeselves and are acctually identified with this what in philosophy seems to be authoritative through its sens of classic, age and constitutiveness for what is meant by the word “philosophy” on the Continent. The refrain of this multitracked criticism is the argument, that every kind of pragmatism, either in a form of the rational negotiating theory, or in a form of some utilitarian account, is an escape from the purely normative, ontically specific character of a moral situation as such and moral commitment as such, consisting in reductionism of some kind, reductionism involved in an old-fashioned fight against windmills of metaphysics.

I share an aversion against post-neopositivist, analitical and allied resentiments, although I also share a deep disgust with the level of arumentation proposed by the ideological defenders of the moral principles, exorcizing the devils of “relativism” and “postmodernists.” I also realise how inefficient classical discources of philosophical ethics, with all their metaphysical burden, are, when attempts are made to translate them into the language of legislative practice and to apply them in shaping procedures of the complex institutions, like these of public health care infrastructure ones. Nevertheless, so visible and supposedly well-deserved preponderence of those who support the “practical point of view” in bioethics does not have to mean any udeniable authority of the pragmatist doctrine. In a series of articles and conference papers I have produced in recent years, I tryied to show that the respect for the ontological instance of the practice, to the “how it really works in life” does not need to go always together with the hostility towards any fundamentalism, ant that the latter leads sometimes to the plainly immoral effects, when becoming not a guidepost for morality, but selfish, narcistic and vain dogmatism. This “metapermissivism” of mine or metatheoretical flexiblity seem to harmonize with the methodological situation of bioethics, where nobody is more clever than the others: a philosopher than a doctor, a doctor than a sociologist, and all together have to observe the requirement that their contributions have to be understandable for the others and to match somehow to the overlapping and family unity of the whole discipline.

I can mention here, but of course not develop, three examples, three themes, in which the proposed attitude of metatheoretical flexibility in bioethics constitutes itself.

1. The first one is the question of the trust for the competence of medical and scientific societies in moral issues connected with their acctivities. The precondition of any rational discussion around these issues, which is the expertise, being here in doctors’ and scietists’ disposal is unsurpassable. Problems, for instance, of the gene techniques, of the proceeding with terminally ill persons, of the quasi-aborting operations are in their major aspects just medical problems and the related practices does not and cannot match the simlified and naive imaginations of the broad public. In effect even in courts the decisive advise will be given by medical experts. This substantial and selfevident authority, sharply limiting all possible ways of social control over the medical world, imposes on the physicians and the health care system agents a great responsibility. However, paralely, this unsuspendable authority constitutes the circumastances which extort a dose of paternalism, being, after all, another side of the public trust enjoyed (since there cannot be otherwise) by the doctors. Thus, in this case I defend a kind of traditionalism and paternalism, turning out as a “pragmatic conservatist.”

2. The second example is provided by the classical question of abortion. The way it is often publicly discussed, especially in theocratically inclined countries, shows how much soulless and cruel the ideological fundamentalism can be, when it refers to the inviolable moral principles and imposes at the same time a very restrictive and punitive attitude towards abortion, irrespective of whether it leads to limitation of this phenomenon or quite in opposite. It seems to be evident that whenever the problem of abortion is concerned (like many others in bioethics), the leading question puting in motion whole discution is: “what-to our best knowledge-legal and institutional solutions might contribute to minimizing a given phenomenon?.” This is a purely pragmatic point of view, however perfectly justified from the purely moral position, and even more: imperatively commanded as an universal rule of prudence in a given type of cases.

3. The third example at last. It is provided by the reflection on the part which the ethicist is supposed to play as a little authoritatve commentator of the medical life in his country, undergoing the farreaching reforms and dominated by corrption at the same time. May an ethicist remain a severe mentor in these circumstances? Shall anyone listen to him or obey her? Certainly not. And this is exactly for the same reasons which make the morally overcorrect doctor poves to be unefficacious in the morraly insane medical society and achieves there less, that it can be a case with someone more flexibile in moral terms, someone able to undertake a specific moral risk: the risk of transgression. Here I opt, again like in friendship with pragmatic and utilitarian tendencies, for some permissivism and moral minimalizm. And again my motivation is partly metatheoretical: facing the conditions of the “true life,” the theory has to show some temperance, if it is to be relevant at all.