Clinical Ethics >
Volume 3, Number 4 >
Pp. 160-163
Guest Editorial |
* Department of Psychiatry, University of Cambridge, Cambridge
Centre for Family Research, University of Cambridge, Cambridge
Centre for the Study of Global Ethics, University of Birmingham, Edgbaston, Birmingham, UK
E-mail: mcd30{at}cam.ac.uk
The rise of a ‘new’ empirical bioethics, which aims to ground normative judgments in ‘real-world’ data relating to different ethical problems in the biomedical sciences, has been well-documented in recent years.1–7 Indeed, the journal Clinical Ethics was established as a valuable forum for the dissemination of research that embraced an empirical approach to the exploration of ethical problems in clinical practice. For postgraduates who see themselves as engaging in bioethics research, these developments present both a real opportunity to adopt a broad range of disciplinary perspectives in exploring their chosen topic, and a series of challenges in producing rigorous and respected work that might lead to an established academic career.
The breadth of the field called ‘bioethics’ is well-suited to postgraduate research. At this level, researchers have a great degree of freedom to draw on different theoretical and methodological traditions in developing projects that address new problems in different ways. Indeed, one might say that this freedom to explore and experiment with different perspectives is what makes undertaking a PhD so special. However, this process of experimentation is also conducive to producing identity crises. When asked to describe the work that we do, we might respond by saying, for example, that it has a social scientific, a philosophical, a legal and a psychiatric component. When asked how these components integrate, or when called to account on the basis of the quality of our research by supervisors, reviewers or examiners, we have an uneasy sense that everything might unravel around us, our projects amounting to less than the sum of their parts.
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The lively and engaging papers presented at the conference displayed great diversity of backgrounds (including medicine, law, social sciences, biomedical sciences and philosophy), substantive questions and interests. Strikingly, each paper brought a story of movement from a unitary discipline into collaborative and interdisciplinary frameworks. We are grateful to the editors of Clinical Ethics for publishing three papers presented at the conference,8–10 and another paper that emerged from discussions held at the conference,11 in this issue. These papers demonstrate, in various ways, how junior researchers schooled in a particular discipline have embraced different disciplinary ideas and approaches in the work that they do.
In addition to postgraduate papers, the conference also hosted five plenary presentations from leading academic researchers from various fields. Their papers engaged with substantive, conceptual and disciplinary questions, not least of which addressed their own disciplinary allegiances. These issues directed discussion and stimulated extensive debate over the course of the two days, and we aim to outline and explore a few of those debates in this editorial.
It is fair to say that disciplinary tensions were evident within the conversations that took place. One broad tension raised was the putative ‘colonizing’ tendency of bioethics into established research agendas within other disciplines. In his controversial plenary, Adam Hedgecoe suggested that medical sociologists have always engaged critically with the ethical dimensions of the social phenomena that they study, citing the work of Renee Fox and Judith Swazey into organ donation,12 and Charles Bosk into genetic counselling,13 as paradigm examples. Expanding on this claim, he insisted that the correct response to the empirical turn in philosophical bioethics was simple: become a medical sociologist.14 Not surprisingly, this generated a strong reaction from the audience. Those members of the audience who had a background in philosophy accepted that sociologists do engage with the ethical aspects of their work, but felt that they tend to do so in a way that is fundamentally different from the normative analyses that philosophers undertake, and with different aims.
The difference here lies in the meaning of ‘engagement’. For philosophers, engaging with an ethical issue means identifying the nature of the problem and offering a normative solution, defending that solution in terms of what is ‘right’ and what is ‘wrong’, and incorporating elements of moral theory to justify their moral premises. Conversely, engaging with an ethical issue for social scientists traditionally entails identifying the social world in which that issue is situated, and developing appropriate, primarily empirical, methodologies to understand that social world in ways that do justice to those individuals who stand in relation to that world. When exploring ethical issues, social scientific understanding might incorporate an explicit ethical dimension, but this is not the same as offering normative solutions based on concepts of ‘right’ and ‘wrong’. Arguably, many people are combining these approaches (this is exactly what the ‘new’ empirical bioethics requires), but to simply claim this combination belongs to sociology seems rather imperialistic and perhaps misrepresentative. While we should no doubt take Hedgecoe's claim in the way it was intended – an intentionally contentious statement designed to generate debate – it captures very well the real problems faced by junior researchers who are genuinely trying to integrate approaches and walk the tightrope between different disciplines.
This ‘colonizing’ approach was countered by those who warned against drawing on disciplinary generalizations in order to avoid a polarized characterization of ‘them’ versus ‘us’. Jonathan Ives argued that we should seek to explore how philosophy and the social sciences could be brought together in happy, rather than dysfunctional, ‘marriages’.4 Others, such as Bobbie Farsides, described her personal journey into empirical bioethics as a positive one of discovery and enlightenment. We believe that this is a common experience shared by many postgraduates who emerge bleary-eyed into bioethics research following extensive training in unitary disciplines which are defined by particular approaches, methodologies and epistemological foundations that they may have hitherto assumed without question. As a response to this experience, Ruth Chadwick outlined the notion of ‘informed thoughtfulness’. This, she argued, offered a way of embracing, rather than challenging, the different disciplinary perspectives that could inform research projects and bioethical understanding more broadly.
In contributing to these discussions, postgraduate students were able to explore these problems, organize their ideas and formulate new avenues for research in ways that were truly interdisciplinary. Two particular strategies emerged through which both junior and established researchers have directed their personal research agendas; the conference provided the opportunity for these researchers to explore how these strategies might be adopted to address a range of different questions.
First, nebulous ‘organizing concepts’ emerged as opportunities for orienting future research; the concepts of ‘vulnerability’ and ‘authenticity’ were outlined as ways of organizing research that could draw productively on the resources of different disciplines to offer new ways of looking at a range of different issues. Michael Dunn, for example, outlined how the concept of ‘vulnerability’ had been drawn upon in specific ways in legal and policy contexts to construct ‘vulnerable adults’, such that protective interventions could be authorized into the lives of these men and women that might otherwise be judged to be morally indefensible.15
Second, a number of speakers framed future agendas in bioethics research around ‘options for action’. Papers by Amel Alghrani and Sheelagh McGuinness on the possibility of male pregnancy and womb transplantation, by Eva Asscher on developments in preimplantation genetic diagnosis, and by Katja Stoppenbrink on the potential scope of psychopharmacological enhancement, all considered how future scientific developments should be used to focus and orient bioethical inquiries of today.
Throughout the entire event, delegates explored bioethics ‘in conversation’. Normative, conceptual and empirical research was discussed, and the value of broad, inclusive and open-minded debate was clear to see. The opportunity to unite postgraduate students working on very different projects, but engaging in similar approaches and techniques under the umbrella of ‘bioethics’, gave the impression that real progress was being made in developing confidence and belief in what we are doing, and how and why we are doing it.
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Such problems of definition are not limited to postgraduate students. The development of a ‘new’ empirical bioethics has led to attempts to consolidate this fledgling field around specific theoretical and methodological conventions. Considering recent developments in psychiatric ethics, for example, models for how empirical ethics might be undertaken have been developed. McMillan and Hope16 have produced a cyclical model that seeks to define empirical ethics research (Figure 1).
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However, the very strengths borne out of defining how empirical bioethics might be done also exposes certain weaknesses. An integrated approach to undertaking empirical bioethics research may fail to incorporate the relevant ‘expertise’ provided by the specific disciplines that junior researchers come from. This might pose a threat to the quality of the research, either in real terms or as a way of discouraging junior researchers from undertaking this interdisciplinary approach entirely. For junior researchers, the question of how to ensure quality in our research, if we need to be able to demonstrate not only depth (facilitated by taking a disciplinary approach) but also breadth (facilitated by taking an interdisciplinary approach), remains acute.
Moreover, the prescriptive quality of these models could be potentially restrictive. The very benefits that an interdisciplinary bioethics conference attended by scientists, lawyers, social scientists and philosophers can give rise to might be limited by a way of doing bioethics research that is exclusive rather than inclusive. The risk of not being inclusive in attempts to define empirical bioethics is illustrated by another example drawn from psychiatric ethics. Widdershoven and van der Scheer have developed the concept of ‘pragmatic hermeneutics’ in order to show how empirical and normative analysis might be integrated, and as a way of directing methodological approaches accordingly.19 Taking a pragmatic hermeneutic approach to empirical ethics in psychiatry requires the collection of empirical data relating to practical moral knowledge. Appropriate methodologies are those which ‘expose the practical processes of meaning-making, related to concrete problems’,19 with researchers having a responsibility to grasp the meanings experienced by participants in order to identify the normative claims inherent to these meanings and experiences. This approach is described very much in the language of the social sciences, requires particular kinds of qualitative methodologies, and is borne out of a particular theory of understanding the social world. Such an approach is, however, likely to represent a tremendous clash of culture for postgraduate researchers arriving at bioethics from backgrounds in philosophy, medicine or the biomedical sciences.
A further problem with models such as these is that they can, at best, lack substantive content and, at worst, be frustratingly vague. For example, McMillan and Hope do not tell us how the ‘ethical analysis’ and the ‘new data’ should relate, only that they should be inter-related, and this lack of clarity could prove problematic methodologically. We believe that understanding these smaller, but essential, details now that the ‘big idea’ has got a foothold is vital if junior researchers are going to feel confident in utilizing expertise from different disciplines to undertake high quality bioethics research. Perhaps, this is an area that junior researchers themselves can make a substantive contribution to methodological developments in bioethics research?
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If we see recent attempts at defining empirical bioethics as a move towards asserting disciplinary boundaries around an interdisciplinary approach that combines empirical and normative analysis, a number of issues are raised. We wish to outline four that we think are especially pertinent to junior researchers working in bioethics.
The first issue concerns training. Do we have the necessary skills to undertake interdisciplinary empirical bioethics research, and how might we maintain some degree of ‘quality control’ in the research that is carried out? How do we, having undergraduate degrees in philosophy, for example, embrace the social scientific conventions of qualitative or quantitative research so that we can obtain relevant and valid data about the issue that we are studying? Are top-up courses provided by social scientific or philosophy departments appropriate for this purpose, or do we need training courses and Masters degrees that are specifically tailored to train ‘bioethicists’ in ways that are conducive to undertaking empirical bioethics research in an academically rigorous and productive way?
The second issue concerns publication. Where do we publish the outputs of our bioethics research when journals are still very much oriented around single disciplines? For postgraduate students, the need to publish in recognized journals is particularly pressing if they wish to develop an academic career. In a fledgling field such as bioethics, it is difficult to gain a foothold on the publication ladder, especially when the work that we are often engaging in is, by definition, pushing against existing disciplinary boundaries. While journals such as Clinical Ethics represent a valuable and meaningful step in the right direction, it is telling that much empirical bioethics research is published in edited collections or special issues. Perhaps, however, we are being too impatient or too ambitious, and should focus our efforts on publishing outputs that fall squarely within a defined and established discipline. This might certainly make life a lot easier, but in doing so we might feel we are trying to fit our research into a box that is not the right shape.
The third issue concerns funding. If we are going to obtain funding for our research, we need to know that funding bodies will take our applications seriously. While the Wellcome Trust has been instrumental in funding and developing an empirical approach to bioethics in the UK, and have indicated that they will not consider proposals that do not have an empirical component, will sufficient funding bodies recognize the legitimacy of this approach to doing bioethics research? As we have already described above, one particular problem is in defining a methodology. Research that explores methodologies in this area would no doubt be a very welcome addition to the evidence base in this field. However, with research councils often being oriented towards unitary disciplines themselves, obtaining funding for exploratory methodological research might prove difficult, with the entire field of bioethics research suffering as a result.
The final issue concerns the possibility of obtaining a permanent academic position. While junior researchers who have undertaken interdisciplinary bioethics research will likely have a series of skills that set us up for academic careers, university departments remain oriented towards research and teaching in particular disciplines. The plenary speakers who presented at the conference were characterized by their very different career paths. While some established researchers undertaking bioethics research might identify themselves personally as bioethicists, some might be labelled as bioethicists by others, but few will be situated in academic bioethics departments. Accordingly there are a number of difficult questions that junior researchers must face up to: where do we fit? Who and what will we teach? And, perhaps of greatest concern, who will take us seriously and give us a job?
It is, without doubt, an exciting time for junior researchers working in bioethics. The success of this postgraduate conference, and its continuation this year at the University of Manchester, gives a clear indication that junior researchers are undertaking genuinely new kinds of research and looking at new issues in new ways. However, bioethics is a fledgling field seeking definition and clarity, and it is junior researchers who face perhaps the most significant challenges in defining our academic identity, ensuring that the quality of our research remains of a high standard as this field continues to develop. In building careers, the ways that these challenges are addressed, or not, will shape whether we become respected academic bioethicists, or simply jacks of all trades, masters of none.
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Zeynep Gurtin-Broadbent is a PhD student at the Centre for Family Research, University of Cambridge. Her thesis examines Turkish women's experiences of infertility and fertility treatments. Her research interests include gender, social aspects of reproductive medicine, patient–clinician interaction and narratives of reproductive experiences in general. Zeynep is Convener of the Cambridge Interdisciplinary Reproduction Forum.
Jessica Wheeler is a PhD student in the Learning Disabilities Research Group, Department of Psychiatry, University of Cambridge. Her thesis investigates the social and emotional environments of offenders and alleged offenders with intellectual disabilities, focusing on those who live in the community with support from statutory health or social care services. Her current work is framed by tensions between UK health policy commitments to autonomy, independence and community care; home office rhetoric favouring public protection; and a de facto increase in the prevalence of secure hospital provisions for the detention and treatment of offenders with intellectual disabilities.
Jonathan Ives is a Research Fellow at the Centre for the Study of Global Ethics at the University of Birmingham, and is just about to begin a lectureship in Behavioural Science in the School of Medicine. He is currently working on a research project examining health-care workers' attitudes to working during pandemic influenza. His other research interests include fatherhood and the family, empirical bioethics and the ethics of medical education.
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