Pragmatism is an approach to philosophy that has experienced a
revival in recent years, after a long time of comparative disrespect
in the philosophical community. It is no surprise that the philosophical
potential of pragmatism is now tested, among many others, in relation
to bioethics, another burgeoning field of philosophical inquiry.
Pragmatic Bioethics, edited by Glenn McGee, is a collection
of eighteen articles that appears in the series "Vanderbilt
Library of American Philosophy", a series that, according
to the publisher, is dedicated both to exploring the historical
roots and innovative developments in American Philosophy. Nevertheless,
Pragmatic Bioethics is intended to be not only of interest
to scholars in American Philosophy. As McGee has already made
clear in his The Perfect Baby (1997),
he assumes that pragmatism has something valuable to offer to
anybody interested in bioethics. Just how valuable, becomes clear
in his introduction, where he promises that Pragmatic Bioethics
will address nothing less than the question "How should the
field of bioethics think and act in a time of social crisis?",
and advance answers to "questions about the emphases of the
field, its identity, and its method" (xii). It will "make
manifest the outlines and dimensions of pragmatic philosophy"
and "speak to the coherence of a single pragmatic core of
methodical emphases and theoretical claims" (xv). However,
at the same time, the authors will "represent a plurality
of perspectives, identifying both different approaches to pragmatism
per se and different ways in which pragmatic philosophy is expressed
in the worlds of science and medicine" (xv).
These are high stakes, if taken seriously. So what does the volume
deliver? In the first part, "The Pragmatic Method in Bioethics",
the authors focus on Dewey as main proponent of pragmatism. The
topics of their articles range from general reflection on naturalism
and pragmatism in contemporary bioethics (Moreno) over descriptions
of pragmatic reasoning in bioethics (McGee; Fins, Bacchetta and
Miller, Hester) to the role of bioethics committees (Parker).
In both the second and the third part, specific issues in bioethics
are discussed; they only seem to differ in the degree to which
the authors refer to traditional pragmatists: in the former, Peirce,
Royce and James play an important role; in the latter such references
largely disappear. The second part, "Current Debates and
American Philosophers", deals with two different topics,
namely the collaborative character of medical practice (Mahowald,
Trotter) and the experience of deep significance in medical treatment,
especially in the treatment of the severely ill or dying (Gavin,
Hester, Wilshire). The third part, "Pragmatism and Specific
Issues in Bioethics", takes up common bioethical issues like
mental illness (Singer), genetics (Saatkamp, McGee), death (Benjamin,
Lachs) or the health care system and its ethics institutions (Kegley,
Lysaker and Sullivan, Secundy) and is meant to illustrate how
a pragmatic approach to these issues might look like.
The articles in the volume are of very uneven philosophical quality,
and many conform somewhat to the stereotype according to which
pragmatists have a rather impressionistic style of writing and
do not give much importance to strict arguments. Personally, I
found those articles most interesting that in some way, explicitly
or implicitly, relate pragmatism to other approaches in bioethics.
Moreno, for example, argues in "Bioethics Is a Naturalism"
that much of current bioethical writings is already latently naturalist
and pragmatist - and orientation that he describes as "prevalent
but unrecognized" (15). He describes the kind of naturalism
that pragmatism (especially Deweyan pragmatism) proposes as a
naturalism in which an emphasis on the scientific method is coupled
with acknowledgement of the importance of context, personal experience
and interpersonal interaction. He points out how bioethics currently,
especially in its institutional realizations, can be described
as naturalist in this sense.
Mahowald's "Collaboration and Casuistry" uses Peircean
concepts to analyze the collaborative practice of medicine and
its casuist methodology in pragmatic terms. She argues succinctly
that Peirce fares better than Jonsen and Toulmin in their The Abuse of Casuistry (1988)
in explaining and guiding medical practice, and especially in
avoiding the charge of anti-intellectualism and relativism.
Finally, Trotter's "The Medical Covenant: A Roycean Perspective"
aims at developing a Roycean understanding of the nature of the
doctor-patient relationship. Instead of the usual accounts of
the doctor-patient relationship that are largely framed in terms
of autonomy vs. paternalism (with a tendency toward the legalistic),
he uses the concept of loyalty to characterize this special relationship.
Loyalty, according to Trotter, is not only important for the doctor-patient
relationship, but also within the broader community. He claims
that such loyalty provides the missing link that makes it possible
to consistently realize autonomy as well as beneficence.
As these examples show, pragmatism in Pragmatic Bioethics
is indeed understood pluralistically, as McGee claims in his introduction.
What about also establishing a coherent "single pragmatic
core" within such pluralism? It is less clear whether the
volume is successful in this respect. Above all, there seems to
be a core of concepts that appear again and again throughout the
essays: experience and flexibility, context and consensus, community
and loyalty. These play an important role in pragmatic thinking,
and given that at least some of them have been underrepresented
in much of traditional ethical theorizing, it is probably justified
to present them as pragmatist contribution to bioethical thinking.
Nevertheless, it is not entirely clear how distinctly pragmatist
they are, given that e.g. virtue ethics, care ethics, communitarianism
and casuistry focus on these or related concepts, too. Unfortunately,
there is no general reflection on the relation of pragmatism to
these other approaches.
The volume delivers, I think, the least with respect to the promise
of "method". One somehow gets the impression that thinking
as a good pragmatic bioethicist will not require any method at
all, but be self-evident for any respectful and attentive democratic
citizen. To be fair, perhaps something of this kind is, after
all, an adequate general understanding of pragmatic bioethics;
perhaps the pragmatic method in ethics can really only be conveyed
through some general concepts and a series of examples (as done
in this volume), given the role that apparently pertains to personal
experience. Nevertheless, given the pragmatic conviction that
pragmatic thinking has the same structure in theory and practice
alike, it is at least surprising that the possible relevance of
pragmatic methodological reflections on e.g. truth and inquiry
for ethics is hardly mentioned, let alone explored in any depth,
not even in the part of the book that is explicitly dedicated
However, for those who are not predominantly interested in moral
theory, but look for alternatives to traditional bioethical reasoning,
this volume may be of greater interest. All in all, it is definitely
interesting to see the use of pragmatic thought and concepts in
the realm of bioethics. On the whole, the uneven philosophical
quality and at times impressionistic arguments are not too surprising
for a collection of bioethical writings, be they pragmatist or
not. However, given the title and the claims in the introduction,
the reader may be expecting too much - Pragmatic Bioethics
offers some pragmatically inspired new (or at least less clearly
traditional) ideas for bioethics, but not yet enough to recognize
a self-standing approach to bioethics.
© 2001 Heike Schmidt-Felzmann. First serial
Heike Schmidt-Felzmann holds
graduate degrees in philosophy and psychology from the University
of Hamburg, Germany. She is currently a doctoral candidate in
philosophy and works on ethics in psychotherapy.