Moral wisdom in the balance. Reflective Equilibrium as a normative empirical model for bioethics

Abstract

Many bioethics researchers share the aim to produce moral judgements and theories that actually make a difference in practice. The question of how this aim should be achieved is subject to a longstanding debate. Nonetheless, methodology in bioethics research is still underdeveloped and undervalued. In this thesis, we start from the view that ethicists who aim to contribute to resolving practical moral problems should be sensitive to both ethical theory and moral experience. For theoretical concepts and arguments, these ethicists can rely on the work of influential philosophers and on academic debate with peers. To enrich ethical research with moral experience, we argue that ethicists have to look beyond their own perspective. Ethicists generally lack in-depth knowledge of the moral aspects of problems that occur in – for example – health care practices. A deeper understanding of moral situations in a practice can be termed moral wisdom. To benefit from this moral wisdom in bioethics research, two methodological questions need to be answered: how can we gain insight in moral wisdom and what are scientifically valid ways to incorporate (data on) moral wisdom in ethical reasoning? We adopt John Rawls’ Reflective Equilibrium (RE) as the reference theory for our purpose of finding a method to incorporate moral wisdom in ethics. The model is attractive because it allows moral intuitions into the realm of relevant considerations in moral reasoning. These intuitions can be seen as reflections of the moral experience of the holder. However, in the current understanding of RE, there is no place for the moral intuitions of other agents than the person who performs the ethical reasoning (we call this person the thinker). Our view on the importance of moral wisdom – reflected in moral intuitions – implies that we adjust the model of RE. We propose a modified version and call it Normative Empirical Reflective Equilibrium (hereafter NE-RE). Compared to RE, NE-RE has two distinctive features: (i) moral intuitions of other agents than the thinker are included, and (ii) empirical research is used to obtain information about these intuitions. To illustrate several possible roles of empirical research in bioethics, we present three empirical studies. Each study provides data that can be used in research guided by a normative ethical research question. In a subsequent chapter, we describe NE-RE and point out well known objections against reflective equilibrium theory in general. We discuss the relevance of the criticisms for NE-RE and suggest ways to better defend the model against some major objections. The aim was not only to contribute to abstract ideas about moral wisdom and empirical research in RE and in bioethics. The value of putting moral wisdom in the balance through NE-RE should be measured by the quality of the ethical theories achieved through NE-RE and the convincingness of the resulting practical moral views. Therefore, the final chapter of this thesis contains an example of reasoning through NE-RE regarding a real-life moral problem: the case of the severely disabled girl Ashley, who was medically treated to stop her growth.