The shift from medical ethics to bioethics signifies a transition from a religiously dominated field, to a secular scientific area of study. This secular evolution has its roots in the Enlightenment Period’s Scientism, which proposes a false dichotomy between the practice of medicine and medical ethics. These distinctions are based upon a misunderstanding of subjective vs objective and lead to a slippery slope toward moral relativism.
FROM MEDICAL ETHICS TO BIOETHICS
Medical ethics finds its root in the Hippocratic Oath from 400 B.C. Physicians still take a form of this oath as they begin their healing practice. This oath found its significance as the medical practice separated from religious leaders. As Patrick Guinan, M.D. claims, “[m]edical ethics originated in prehistory when the shaman, or religious leader, became distinguished for the doctor or expert in physical healing.” These religious roots explain the common name of medical ethics, namely, pastoral ethics. People did not understand the need for ethics when the spiritual leader was the one practicing the medicine. Of course, this assumed that the religious leaders were themselves ethical… (An assumption that we have since moved away from.)
Rise of Bioethics
Biologist Van Rensselaer Potter introduced the term “bioethics” in his book “Bioethics: the Bridge to the Future.” This change in nomenclature importantly implies that ethical decisions are no longer monopolized by religious leaders. Additionally, this change moved ethical health care decisions outside the medical profession. Society as a whole needed to grapple with these issues. Of course, the 24/7 media often sensationalizes these debates as click-bait. But this was not the most dramatic evolution with the change of name. The conversion to “bioethics” marked the end of thinking of these issues from a religious perspective and began its secular thought.
The literature has grown exponentially since the secular name shift. The once almost exclusively Catholic field now found itself dominated by secular papers. Catholic healthcare ethics was rarely contested by different views. Yet, it became an everyday occurrence. Joint ventures between Catholic and non-Catholic facilities require value assessment to ensure moral alignment. Education and formation of secularly taught healthcare professionals became needed to maintain their Catholic Identity. These are now challenges of faith-based healing ministries seeking to align with their foundation. But what was the foundation of this new “Bioethics”?
SCIENTISM CAUSED THE SHIFT FROM MEDICAL ETHICS TO BIOETHICS
The foundation for the shift from medical ethics to bioethics seems to be in the eighteenth century’s Age of Enlightenment. The European wars between Catholics and Protestants caused skepticism in the laity. How can so many people kill over religion? People began to turn away from God and place their trust in natural science. This paradigm shift gives the time period its name, “The Age of Enlightenment”. Religious dogmas are not as easy to prove as the technological applications of science. In the face of incredible scientific advances, dogma created division, and strife. “Scientism” was the ideology that purported to resolve this conflict.
Scientism asserts that we only know things through scientific investigation. Thus, science must be free of subjective judgments (e.g. values). It is important to note that this idea did not align with the renowned scientists of the time. Galileo, Newton, etc, were all God-fearing believers. But the followers of Scientism insisted that Faith and Reason opposed each other. Saint John Paul II (JPII) defines Scientism as “the philosophical notion which refuses to admit the validity of forms of knowledge other than those of the positive sciences; and it relegates religious, theological, ethical, and aesthetic knowledge to the realm of mere fantasy” (emphasis added).
Saint John Paul II’s Argument Against Scientism
JPII offers a critique of Scientism:
“Science would thus be poised to dominate all aspects of human life through technological progress. The undeniable triumphs of scientific research and contemporary technology have helped to propagate a scientific outlook, which now seems boundless, given its inroads into different cultures and the radical changes it has brought. … And since it leaves no space for the critique offered by ethical judgments, the scientistic mentality has succeeded in leading many to think that if something is technically possible it is therefore morally admissible.”
JPII correctly asserts that scientific progress seems to be boundless. Look at modern medicine’s ability to cure and extend life has been incredible. The life expectancy in the U.S. grew ten years from 1960 to 2015. We can manufacture babies in petri dishes, and change every appearance of sex. How can we stop such “progress”? Scientism asserts that scientific progress is the only value. If we can do something, we have the obligation to. Ability implies a moral requirement.
The idea that we can only know things through scientific discoveries is a reduction of facts.
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Additional Arguments Against Scientism
The idea that we can only know things through scientific discoveries is a reduction of facts. I do not perform a scientific investigation to tell me that my computer is black. You can see that Scientism quickly turns into skepticism. Since I only have a subjective experience of color, I would need to demonstrate that each color I see does emit the proper wavelengths of light. This is a ridiculous task. Even if it was possible, you must use your subjective experience to interpret the instrument, which measures the wavelengths of light. It is impossible to step out of our personal experience of the world.
Aesthetically, a scientific experiment cannot tell me if a sunset is beautiful or not. Despite the ability to scientifically prove it, human experience tells us all that beauty does exist. Beauty is a value that we experience in the world. It is not a mere chemical reaction in our brains. A world without values is a world with no beauty.
The analytical argument against Scientism is that it is self-refuting. The claim that “knowledge is only known by science” cannot be proven by science. This worldview would require one of the “fantasy realms” as JPII calls it, such as philosophy, to prove. Science must be given boundaries from something outside of itself. It is philosophy’s and ethic’s role to set the limits of scientific investigation.
THE SUBJECTIVE VS OBJECTIVE DICHOTOMY CAUSES A SHIFT FROM MEDICAL ETHICS TO BIOETHICS
The failures of valueless Scientism were no stranger to the enlightenment period. Another ideology called Romanticism arose to oppose Scientism. This movement sought to construct a value structure aesthetically. Thus a dichotomy between “objective” Scientism and “subjective” Romanticism was born. CP Snow famously traces this as the genesis of the distinction between humanities and science in his work “The Two Cultures.” This was the basis for separating science and humanities. The humanities were thought to be subjective, while science was objective. The medical field was not immune to this distinction; this ideology placed medical ethics into the humanities and medical practice into science. But this is a false dichotomy.
Subjective Objective False Dichotomy
Many of us want to think of medical practice as a science, but it is an art that uses science to obtain a value-based goal. The end of every medical intervention is the patient’s goal of care. The patient’s values and desires establish the goal of care. It is a life that the patient sees as worth living. The clinician’s role is to use their technical and scientific knowledge to reach that goal or create a life for the patient that is worth living. There is a technical skill in the process, just as a painter needs technical abilities and knowledge to paint a picture. Anyone who works in healthcare can tell you that it is far from objective science. A plus B does not always equal C. Furthermore, the patient may not even want C, but D. Medicine is anything but valueless!
The issue is even worse if we think of medical ethics as only a subjective humanitarian pursuit. Thinking of it in this way reduces ethics to a matter of taste. The academic tradition refers to this as “relativism.” What tastes good to you may not taste good to me. Since there are no objective criteria to judge taste, it is a matter of personal preference. Without objective criteria to judge moral values, each way is as good as the next. Thus, we can see the foundation for societies’ pluralistic value structures and beliefs. There have become as many value systems as candies in the grocery store, one for each person’s pallet.
Quick thoughts on Relativism
I will rely on Saint JPII’s quote to respond to relativism:
“Once the idea of a universal truth about the good, knowable by human reason, is lost, inevitably the notion of conscience also changes. Conscience is no longer considered in its primordial reality as an act of a person’s intelligence, the function of which is to apply the universal knowledge of the good in a specific situation and thus to express a judgment about the right conduct to be chosen here and now. Instead, there is a tendency to grant to the individual conscience the prerogative of independently determining the criteria of good and evil and then acting accordingly. Such an outlook is quite congenial to an individualist ethic, wherein each individual is faced with his own truth, different from the truth of others. Taken to its extreme consequences, this individualism leads to a denial of the very idea of human nature.”
As JPII points out, relativism rests on an incoherent notion of truth. Simply because people disagree about the truth value of a fact, does not mean that there is no truth to the fact. We must resist the idea of making our naïve intuitions the measure of facts. Experience tells us that taking innocent lives is wrong, not a mere disgust sensitivity, but morally wrong. Human reason has the ability to know the good. Yes, this may be through a subjective experience. But it is false to think that subjectivity precludes a truth value from being assigned.
Concluding Thoughts
I am not giving a proper response to relativism. But I will write more on it in the future and link it here. The goal was to explain the historical evolution from medical ethics to bioethics. Traditional medical ethics may not be objective in the strict sense of the term, but it was objectively true. We must call out the false dichotomy between “subjective” medical ethics, and “objective” medical practice. Both play critical parts in serving patients in need.
It is false to think that subjectivity precludes a truth value from being assigned.
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Have you read a good critique of moral relativism? Or do you see the shift from medical ethics to bioethics differently? Let me know by tweeting @PaulWagle or commenting below.
