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Anger and Forgiveness"Are You There Alone?"10 Good Questions about Life and DeathA Casebook of Ethical Challenges in NeuropsychologyA Companion to BioethicsA Companion to BioethicsA Companion to GenethicsA Companion to GenethicsA Companion to Muslim EthicsA Cooperative SpeciesA Critique of the Moral Defense of VegetarianismA Delicate BalanceA Fragile LifeA Life for a LifeA Life-Centered Approach to BioethicsA Matter of SecurityA Mirror Is for ReflectionA Mirror Is for ReflectionA Natural History of Human MoralityA Philosophical DiseaseA Practical Guide to Clinical Ethics ConsultingA Question of TrustA Sentimentalist Theory of the MindA Short Stay in SwitzerlandA Tapestry of ValuesA Very Bad WizardA World Without ValuesAction and ResponsibilityAction Theory, Rationality and CompulsionActs of ConscienceAddiction and ResponsibilityAddiction NeuroethicsAdvance Directives in Mental HealthAfter HarmAftermathAgainst AutonomyAgainst BioethicsAgainst HealthAgainst MarriageAgainst Moral 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EthicsCloningClose toYouCoercion as CureCoercive Treatment in PsychiatryCognition of Value in Aristotle's EthicsCognitive Disability and Its Challenge to Moral Philosophy Comfortably NumbCommonsense RebellionCommunicative Action and Rational ChoiceCompetence, Condemnation, and CommitmentComprehending CareConducting Insanity EvaluationsConfidential RelationshipsConfidentiality and Mental HealthConflict of Interest in the ProfessionsConsuming KidsContemporary Debates In Applied EthicsContemporary Debates in Moral TheoryContemporary Debates in Social PhilosophyContentious IssuesContesting PsychiatryCrazy in AmericaCreating CapabilitiesCreatures Like Us?Crime and CulpabilityCrime, Punishment, and Mental IllnessCritical Perspectives in Public HealthCritical PsychiatryCrueltyCultural Assessment in Clinical PsychiatryCurrent Controversies in BioethicsCurrent Controversies in Values and ScienceCutting to the CoreCyborg CitizenDamaged IdentitiesDeaf Identities in the MakingDeath Is That Man Taking NamesDebating ProcreationDebating Same-Sex MarriageDecision Making, Personhood and DementiaDecoding the Ethics CodeDefining DifferenceDefining Right and Wrong in Brain ScienceDefining the Beginning and End of LifeDelusions of GenderDementiaDemocracy in What State?Demons of the Modern WorldDescriptions and PrescriptionsDesert and VirtueDesire, Practical Reason, and the GoodDestructive Trends in Mental HealthDeveloping the VirtuesDid My Neurons Make Me Do It?Difference and IdentityDigital HemlockDigital SoulDignityDignityDisability BioethicsDisability, Difference, DiscriminationDiscrimination against the Mentally IllDisordered Personalities and CrimeDisorders of VolitionDisorientation and Moral LifeDivided Minds and Successive SelvesDoes Feminism Discriminate against Men?Does Torture Work?Double Standards in Medical Research in Developing CountriesDown GirlDrugs and JusticeDworkin and His CriticsDying in the Twenty-First CenturyEarly WarningEconomics and Youth ViolenceEmbodied RhetoricsEmerging Conceptual, Ethical and Policy Issues in BionanotechnologyEmotional ReasonEmotions in the Moral LifeEmotions in the Moral LifeEmpathyEmpathy and Moral DevelopmentEmpathy and MoralityEmpirical Ethics in PsychiatryEncountering NatureEncountering the Sacred in PsychotherapyEngendering International HealthEnhancing EvolutionEnhancing Human CapacitiesEnoughEros and the GoodErotic InnocenceErotic MoralityEssays on Derek Parfit's On What MattersEssays on Free Will and Moral ResponsibilityEthical Choices in Contemporary MedicineEthical Conflicts in PsychologyEthical Dilemmas in PediatricsEthical Issues in Behavioral ResearchEthical Issues in Dementia CareEthical Issues in Forensic Mental Health ResearchEthical Issues in the New GeneticsEthical LifeEthical Reasoning for Mental Health ProfessionalsEthical TheoryEthical WillsEthically Challenged ProfessionsEthicsEthicsEthicsEthics and AnimalsEthics and ScienceEthics and the A PrioriEthics and the Discovery of the UnconsciousEthics and the Metaphysics of MedicineEthics at the CinemaEthics at the End of LifeEthics Case Book of the American Psychoanalytic AssociationEthics Done RightEthics ExpertiseEthics for EveryoneEthics for PsychologistsEthics for the New MillenniumEthics in CyberspaceEthics in Everyday PlacesEthics in Health CareEthics In Health Services ManagementEthics in Mental Health ResearchEthics in PracticeEthics in PsychiatryEthics in PsychologyEthics in Psychotherapy and CounselingEthics of PsychiatryEthics without OntologyEthics, Culture, and PsychiatryEthics, Sexual Orientation, and Choices about ChildrenEvaluating the Science and Ethics of Research on HumansEvilEvil GenesEvil in Modern ThoughtEvil in Modern ThoughtEvolution, Gender, and RapeEvolutionary Ethics and Contemporary BiologyEvolutionary Psychology and ViolenceEvolved MoralityExperiments in EthicsExploding the Gene MythExploiting ChildhoodFacing Human SufferingFact and ValueFacts and ValuesFaking ItFalse-Memory Creation in Children and AdultsFat ShameFatal FreedomFellow-Feeling and the Moral LifeFeminism and Its DiscontentsFeminist Ethics and Social and Political PhilosophyFeminist TheoryFinal ExamFirst Do No HarmFirst, Do No HarmFlashpointFlesh WoundsForced to CareForgivenessForgivenessForgiveness and LoveForgiveness and ReconciliationForgiveness and RetributionForgiveness is Really StrangeFoucault and the Government of DisabilityFoundational Issues in Human Brain MappingFoundations of Forensic Mental Health AssessmentFree WillFree Will And Moral ResponsibilityFree Will and Reactive AttitudesFree Will, Agency, and Meaning in LifeFree?Freedom and ValueFreedom vs. InterventionFriendshipFrom Darwin to HitlerFrom Disgust to HumanityFrom Enlightenment to ReceptivityFrom Morality to Mental HealthFrom Silence to VoiceFrom Valuing to ValueFrontiers of JusticeGender in the MirrorGenetic PoliticsGenetic ProspectsGenetic ProspectsGenetics of Original SinGenetics of Original SinGenocide's AftermathGetting 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DeliberationPatient Autonomy and the Ethics of ResponsibilityPC, M.D.Perfecting VirtuePersonal AutonomyPersonal Autonomy in SocietyPersonal Identity and EthicsPersonalities on the PlatePersonhood and Health CarePersons, Humanity, and the Definition of DeathPerspectives On Health And Human RightsPharmaceutical FreedomPharmacracyPharmageddonPhilosophy and This Actual WorldPhilosophy of BiologyPhilosophy of Technology: The Technological ConditionPhysician-Assisted DyingPicturing DisabilityPilgrim at Tinker CreekPlaying God?Playing God?Political EmotionsPornlandPowerful MedicinesPractical Autonomy and BioethicsPractical EthicsPractical Ethics for PsychologistsPractical RulesPragmatic BioethicsPragmatic BioethicsPragmatic NeuroethicsPraise and BlamePreferences and Well-BeingPrimates and PhilosophersPro-Life, Pro-ChoiceProcreation and ParenthoodProfits Before People?Progress in BioethicsProperty in the BodyProzac As a Way of LifeProzac on the CouchPsychiatric Aspects of Justification, Excuse 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How Much?Why Some Things Should Not Be for SaleWisdom, Intuition and EthicsWithout ConscienceWomen and Borderline Personality DisorderWomen and MadnessWondergenesWould You Kill the Fat Man?Wrestling with Behavioral GeneticsWriting About PatientsYou Must Be DreamingYour Genetic DestinyYour Inner FishYouth Offending and Youth Justice Yuck!
Back at the beginning of this decade, the research program of pragmatic bioethics seemed to be dynamic and productive. The movement seemed largely fuelled by Glenn McGee, who was then at UPenn, and Joseph Fins and his associates, who championed clinical pragmatism. The first edition of his collection Pragmatic Bioethics came out in 1999, and the second edition, with three added articles, came out in 2003. Springer published Pragmatist Ethics for a Technological Culture in 2002. The Journal of Medicine and Philosophy had a special issue in the area in 2003. However, since then, no major books on pragmatism and bioethics have been published. It's a research program that declined quickly, and it might not be too soon to report its death.
One might attribute this to the work of John Arras, with a pair of articles, "Freestanding Pragmatism in Law and Bioethics," and "Pragmatism in Bioethics: Been There, Done That," which effectively demolish the project. The first, from 2001, is reprinted in this collection, and the second was published in a 2002 collection, Bioethics. As Arras pointed out in the article reprinted in the second edition, the new pragmatism resisted being tied to the views of the classical American pragmatists, Peirce, James and Dewey, yet this meant that there is nothing distinctively pragmatist about it, and to the extent that it does make any claims, there is nothing novel about it. Maybe most damning, he also argued that there was nothing helpful about it in its ability to guide us in ethical action. Arras's arguments are compelling, especially when one considers the range of ideas that people claim for pragmatic bioethics in the rest of the articles in this collection.
For example: Beth Singer's "Mental Illness, Rights, Competence, and Communication" draws on George Herbert Mead's analysis of communication. C. Griffin Trotter uses Josiah Royce, especially the views that ideas are potential plans of action, that there an ethical imperative to coming a person, and that persons are constituted by voluntary commitments to various communities. (I have to confess I had very little idea what those views were meant to mean.) William Gavin uses a few comments by William James from different places to criticize how medical ethics has discussed death. Herman Saatkamp in a paper on genetics alarmingly says that the "moral tone of pragmatic thought can be more accurately described as maintaining the priority of the good over truth and as strongly favoring some form of individualism" (166). Bruce Wilshire draws on James's radical empiricism and his rejection of old dualisms in a discussion of the life of Black Elk. There is no shared core of pragmatism among these papers; all they have in common is using some aspect of the thought of some historical figure who has been identified as a pragmatist. Pragmatism is clearly not an illuminating or helpful label in this context.
Of course, within medical ethics, one of the central debates is over Beauchamp and Childress's "principlism," and pragmatism is used as way to avoid adherence to any single ethical theory. Fins, Bacchetta and Miller give a long description of a case and then a very brief discussion which seems to favor moral eclecticism. Mary Mahowald draws on the Pierce, James, and Jane Addams to discuss helping people to die, and concludes that we should avoid killing people. She says that a Jamesian will use all moral theories when they aid resolution to a problem, so she is happy to combine principlism with casuistry. This magpie approach to ethics may help to solve problems in a practical sense that people do not complain too much once it is done, and may even provide some sense of resolution. However, with such eclectic ethical approaches, we have no way of assessing whether the proposed solution was actually a good one. Or at least, this elaboration of casuistry needs much more elaboration and defense to be acceptable. This is an interesting project, but it is now no longer associated with the label of pragmatism; it is closely connected with moral particularism, and is gaining in support.
Despite my claims pragmatic bioethics has ceased to be a useful category, there are places where pragmatism still has a distinctive place in the philosophy of medicine. A paper by Martin Benjamin discusses the determination of death. Benjamin sets out the various definitions of death that have been advocated, and suggests that we should decide which to use on pragmatic grounds. Although he squeezes a quotation out of William James for the paper, he does not relate to any philosophical views of the pragmatists. Nevertheless, aside from pragmatist theories of truth, this sort of approach strikes me as the best heir to the pragmatist philosophy.
Derek Bolton is his recent monograph What is Mental Disorder? argues that it is impossible to tie down a naturalist definition of mental disorder, and so it is a flexible category. He outlines the sorts of considerations we should take into account when deciding what should count as a disorder, and these are largely to do with the associated benefits and costs. This approach deserves the label of a pragmatic account, since, as with Benjamin's paper, it is using pragmatic considerations for our concept choice. This form of argument doubtless has a role to play in other debates too. Far more plausible than a pragmatic theory of truth, the pragmatic theory of category or concept choice is simply a version of nominalism, and as such is part of a venerable tradition that goes back to before the American Pragmatists. Indeed, to call it a pragmatist theory at all may cause more confusion and suspicion than it is worth, given the shambolic state of the rest of pragmatism. Nevertheless, I put forward the proposal at least as worth considering.
Work in bioethics that builds on the work of Pierce, James, and Dewey, deserves to be called Pierciean, Jamesian and Deweyan, and similarly for work following other Pragmatists. There may be some rare occasions where it is helpful to label other projects in the philosophy of medicine pragmatist. However, the main lesson from the collection of papers from this and other books mentioned above from 2002 and 2003 is that pragmatist bioethics as a whole was not a successful project.
© 2009 Christian Perring
Christian Perring, Associate Professor of Philosophy, Dowling College, New York.