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Medicine, Health Care and Philosophy

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29.08.2017 | Scientific Contribution

Against the integrative turn in bioethics: burdens of understanding

verfasst von: Lovro Savić, Viktor Ivanković

Erschienen in: Medicine, Health Care and Philosophy | Ausgabe 2/2018

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Abstract

The advocates of Integrative Bioethics have insisted that this recently emerging project aspires to become a new stage of bioethical development, surpassing both biomedically oriented bioethics and global bioethics. We claim in this paper that if the project wants to successfully replace the two existing paradigms, it at least needs to properly address and surmount the lack of common moral vocabulary problem. This problem points to a semantic incommensurability due to cross-language communication in moral terms. This paper proceeds as follows. In the first part, we provide an overview of Integrative Bioethics and its conceptual building blocks: mutlidisciplinarity, interdisciplinarity, and transdisciplinarity. In the second part, we disclose the problem of semantic incommensurability. The third part gives an overview of various positions on the understanding of interdisciplinarity and integration in interdisciplinary communication, and corresponding attempts at solving the lack of common moral vocabulary problem. Here we lean mostly on Holbrook’s three theses regarding the character of interdisciplinary communication. Finally, in the fourth part, we discuss a particular bioethical case—that of euthanasia—to demonstrate the challenge semantic incommensurability poses to dialogues in Integrative Bioethics. We conclude that Integrative Bioethics does not offer a methodological toolset that would warrant optimism in its advocates’ predictions of surpassing current modes of doing bioethics. Since Integrative Bioethics leaves controversial methodological questions unresolved on almost all counts and shows no attempts at overcoming the critical stumbling points, we argue for its rejection.

These developmental stages are categorized in the following manner: (1) New Medical ethics, (2) Global bioethics and (3) Integrative Bioethics. See: Čović (2011), pp. 19–21.

We hinted at the issue of semantic incommensurability in the previous paper, as suggested by the quote from the “Semantic incommensurability” section, but there we mostly left the issue aside. The incommensurability that we discuss in that paper concerns failures to escape substantive bioethical stalemates in values between different perspective-holders, while semantic incommensurability between bioethical paradigms is left unexplored. Once again, we thank Neven Petrović, who pointed us to the latter problem.

As moral languages and conceptual moral frameworks, we understand systematically organized networks of concepts within academic and non-academic communities designed or spontaneously emerging with the aim of resolving moral controversies. Oftentimes, especially when moral languages arise in similar cultural contexts or a single plural one, there will be a single word (e.g. autonomy) capturing different semantic scopes, or different words capturing the same or overlapping ones. One synonymous notion that can be borrowed in part from philosophy of science is that of paradigm. We will say more about this concept when we discuss the analogy between moral languages and natural languages, and why this is a limited analogy, later in the paper.

The notion of ethno-cultural perspective should not here be mistaken with language as the mode of communication within that ethnic and cultural community, though they certainly may be expected to affect one another. There are important differences between miscommunication arising from linguistic differences and from different conceptual nomenclatures within disciplines. We will come back to this later in the paper.

This may be a point of contention. A numbers of authors (See for example: Kukoč 2012; Zagorac 2011) within the IB camp have paid homage to German philosopher Fritz Jahr and his bioethical imperative, according to which it applies to all forms of life that they should, when possible, be treated as ends rather than means (See: Jahr 1927, p. 4). Insofar, the IB project is viewed by these authors as an extension of Kantian ethics, but one which resolutely rejects anthropocentrism. However, if that were the case, the bioethical imperative would act as a principled constraint on the pluriperspective dialogue, and many positions would be exempt from it. IB could not then merely be a project about a dialogue-enabling method, with a substantive principled constraint looming over it. Now, it may be possible that different authors within the IB camp have different aims for the project in mind, since the project should be able to overcome both the problems of semantic as well as value incommensurability, as we later claim. Still, this is yet another instance where the aims and features of the project are poorly articulated and need at least some elaboration. We thank Nino Kadić for this point. For an account of independent reasons for why the bioethical imperative might be too severe to act as a constraint on the pluriperspective dialogue and value incommensurability, see Ivanković and Savić (2016).

We will not be able to discuss the very concept of semantic incommensurability and its competing variants at length here. The way in which we use the concept is roughly adopted from a Kuhnian understanding, according to which semantic incommensurability entails the problem of translatability between semantic sets in which meanings of terms are interdependent (Kuhn 2000).

Even this claim might be brought into question, or at least softened. Wittgenstein’s language games, which infer that alternate modes of symbols and understanding may enable communication complex enough for, say, a group of construction workers speaking different languages to build a small structure, show that certain overlaps in conceptual networks may facilitate communication when there are no overlaps in natural languages. This also seems correct. However, the breakdowns in communication between construction workers may occur when reasons ought to be provided for why one method of building at a particular stage of construction is to be preferred to another. Bioethics, as a normative and discursive discipline, is primarily a domain of providing reasons for action, and deals with (what for basic communication would certainly be) a difficulty of reference. The bioethical lingua franca alone then hardly takes communication far off the ground.

We discuss this understanding of integrativity at length in the aforementioned paper (Ivanković and Savić 2016).

One objection might be that there are sociological reasons for why scholarly disciplines resist extinction apart from purely scientific ones. Although that may be the case, we are satisfied with the soft claim that there is at least some connection between the efficient attainment of scientific knowledge and the way in which scholarly disciplines are organized, and leave the sociological objection aside.

Springer Medizin

Abstract

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