Theories or No Theories—Is Anything Evolving?

Abstract

R. M. Hare suggested half a century ago: "If philosophers are going to apply ethical theory successfully to practical issues, they must first have a theory." 1 Apart from the obvious literal interpretation-if you want to apply something, you must have that something-he may have been right or wrong. Many bioethicists do well without explicit theories and even those who rely on theories develop them all the time. 2 , 3 , 4 , 5 , 6 , 7 This special section contains eight contributions pertaining to the topic. The Role of Theories and ArgumentsThe first four entries discuss the role of theories and extant arguments in bioethics. Can good bioethical work be done without involving grand theories? What was the vision of the field's pioneers on its workings? Apart from the discipline's obvious pragmatic aim, does it have room for pragmatism as an ethical theory? Does the nature and use of bioethical arguments evolve as the real-life phenomena studied become more familiar and mundane?Søren Holm opens the proceedings by addressing the first question. According to him, purely critical and empirical contributions to bioethics can easily survive without involving major theoretical frameworks. As long as the aim is to show flaws in existing views and policy suggestions, authors can simply point out inconsistencies in the argumentation or discrepancies in the presentation of the facts of the case in hand. When it comes to constructive efforts, however, the situation is different. If the aim is to provide a new argument or a new approach, reliance on a wider moral or political view is often required. And even analyses that do not initially seem to lean on substantive ethical doctrines have to seek support from theory fragments or formal principles such as analogies and reflective equilibria. 8 Mathias Schutz examines the early programmatic declaration in Daniel Callahan's 1973 essay "Bioethics as a Discipline." 9 Callahan made a plea for a comprehensive approach embracing all the academic fields that are involved in solving the biological, medical, psychological, social, political, and cultural issues in biomedical research, clinical work, and healthcare arrangements. His ideal was systematic knowledge and understanding. Instead, bioethics soon became a project concentrating on particular issues-abortion, euthanasia, the ethics of genetics, to name a few-and dominated by philosophy, clinical medicine, and law, at the expense of theology, history, and the social sciences. The advent of principlism a few years later was an attempt to reconcile belief systems and faith traditions, but it also turned bioethics into a problem-solving machine with no time for wider connections. 10 , 11 , 12 The way bioethical inquiries should be conducted has, of course, been vividly discussed ever since.