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.

Keywords: pragmatism