Photo by Mark Romero

Photo by Mark Romero

What is Bioethics?

Bioethics is both a practice discipline and an organized way of thinking about moral problems related to technology and the biosphere. Bioethical problem solving is useful in medicine, the life sciences, research, social sciences and other fields where ethical conflicts may arise. Moral violations, particularly the atrocities of WWII, the subsequent Nuremberg trials and code, combined with the establishment of the Declaration of Human Rights, laid the ground for modern Bioethics. 

Bioethicists are trained to facilitate moral decision making in ethically complex situations. To provide bioethics consultation, one does not have to be a member of the profession wherein a specific conflict has arisen. A doctoral trained bioethicists may be equally as competent to facilitate moral decision making, in a medical case, as a physician-bioethicist. In general Bioethicists train in PhD programs or in fellowships related to their clinical or scientific disciplines.

Principle Based Bioethical Problem Solving for Beginners

Bioethical conflicts manifest as tensions between competing ‘goods.’ The goods are most often considered to beneficence, autonomy and justice. Those conflicts usually show up as simple eyebrow raising events. Those events are the sort of thing that a person senses to be not quite right, but may not be certain that it is entirely wrong. If the risk to an individuals, or environment is high, exploration of the event should be stringent and organized.  

Resolving conflict between ‘good’ and ‘bad’ is comparatively easy. It’s the shades of gray that paralyze moral action, particularly at times when action is most needed i.e. Industry may be important to the economy, but also damaging the environment. Many people run and hide from those shades of gray.  Bioethicists jump into the fray with the intention of promoting the principles of beneficence, autonomy and justice — by weighing appropriate considerations. 

Beneficence is defined functionally as “doing good” with scientific and technical knowledge. Autonomy is the right of persons to do that which is in their enlightened self interest, and justice is the equal distribution of burdens or benefits. Interestingly, all the great stories of history, religion, literature and film embody these same principals.

To promote scientific knowledge the process of scientific inquiry has to be rigorous enough to produce the most accurate information that can be elucidated. When considering bioethical conflicts, the principal based paradigm for bioethical decision making ranks considerations. Beneficence is greater than autonomy, autonomy greater than justice. In reality, each principle is equally important. This paradigm is only a decision making tool. 

Bioethics is an applied field. Its goal is to facilitate action, not simply to theorize. Beyond training, successful bioethicists have attributes allowing them to absorb complex information, facilitate exploration, prioritize and communicate recommendations. 

Casuistry and Bioethical Problem Solving: Universal Stories, Myth, Literature and Film

Casuistry is using cases or narratives to argue points of  conflict and promote their resolutions. Medicine and Law are both fields where cases model approaches to ethical decisions in complicated situations.  Religious books, literature, drama and film can be used in Casuistry. Moral reasoning does not have to be facilitated only by narratives in a specific field because. At its core, Casuistry requires solving a second unrelated case, using the logic of the original narrative. Closely related to Casuistry is Carl Jung's theory that there are archetypes to which the human psyche best responds. Author Christopher Booker, after 34 years analyzing literature, theorized that writers tell stories in one of 7 archetypical forms. Those forms, still follow the Aristotelian Plot Curve evolving response from the readers. These 7 plot forms are referred to as Universal Stories and their appeal reflect matters transcending race, culture, class or whatever man-made separations there are between people. 

The 7 Universal literary archetypes stories outlined by Booker are:

  1.  Overcoming the Monster: in which the hero must venture to the lair of a monster which is threatening the community, destroy it, and escape (often with a treasure).
  2. Rags to Riches: in which someone who seems quite commonplace or downtrodden but has the potential for greatness manages to fulfill that potential.
  3.  The Quest: in which the hero embarks on a journey to obtain a great prize that is located far away.
  4.  Voyage and Return: in which the hero journeys to a strange world that at first is enchanting and then so threatening the hero finds he must escape and return home to safety.
  5. Comedy: in which a community divided by frustration, selfishness, bitterness, confusion, lack of self-knowledge, lies, etc. must be reunited in love and harmony (often symbolized by marriage).
  6.  Tragedy: in which a character falls from prosperity to destruction because of a fatal mistake.
  7.  Rebirth: in which a dark power or villain traps the hero in a living death until he/she is freed by another character's loving act.

Embodied in these plots are commonalities focused on the life cycle: man, woman, life (child), death and infinity.  Aristotle postulated in the Poetics that audiences are able to grapple complex mortal experiences through drama because there is no threat to the viewer who steps outside of themselves.   In this way the story is both therapeutic, and the lessons learned may be transferred to other cases. The capacity to  understand the ubiquitous story telling of our cultures, literature and screen, is important.

Casuistry can be helpful but is also ripe for abuse. The story teller may use the narrative for nefarious purposes. Critical examination of the mechanism and the psychological persuasion of stories and their vehicles is important. We do not know where, for instance, our "movie memories" go. If they are indeed  filed as though reality, when do they surface and to what avail?   Practice seems to increases the capacity to apply understanding, gained from 'cases,' in considering  true moral conundrums. We call that Casuistry.

References

The Universal Declaration of Human Rights http://www.un.org/en/universal-declaration-human-rights/

The Nuremberg Code http://www.cirp.org/library/ethics/nuremberg/

AR Jonsen, A, Siegler, M, Winslade, W. Clinical Ethics, 7th edition. McGraw-Hill, 2010. https://depts.washington.edu/bioethx/tools/4boxes.html

The Belmont Report, Ethical Principles and Guidelines for the Protection of Human Subjects of Research The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Researchhttp://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/

Environmental Bioethics https://bioethics.georgetown.edu/explore-bioethics/environmental-ethics/

 Christopher Booker, The Seven Basic Plots: Why We Tell Stories, Continuum 2004.

Albert Jonsen and Stephen Toulmin, The Abuse of Casuistry: A History of Moral Reasoning, Berkeley, U California Press (1990)

September Williams' Bioethics Screen Reflections http://www.bioethicsscreenreflections.com/?spref=tw

Williams, S.  Justice, Autonomy, and Transhumanism: Yesterday. In: Colt H.,  Quadrilli S., Friedman L., Editors. The Picture of Health. New York: Oxford University Press. 2011. p. 84-89 http://www.oxfordscholarship.com/view/10.1093/acprof:osobl/9780199735365.001.0001/acprof-9780199735365-chapter-13

Williams, September. “Bioethics at the Movies.”  Review of Bioethics at the Movies. ed. Sandra Shapshay. The Journal of Bioethical Inquiry.  vol 7 Issue 3, pp 329-331. http://link.springer.com/article/10.1007/s11673-010-9245-3#page-1%20first%20online%20May%202010.

Ninth Month Consults: A Bioethics Consultation Service  http://www.ninthmonthconsults.com-

Lighten Up - Slide Show on Bioethics and Film https://www.youtube.com/watch?v=mYZEABtqnJg

September Williams at the University of Chicago MacLean Center for Clinical Medical Ethics presents  Transplant and Prime Time Television https://www.youtube.com/watch?v=KrdmPjyZNlA