Facts and Values

It soon became evident that such questions required more than a casual response. Two important tasks emerged. One of them, logically the first, was to distinguish the domain of science from that of ethics and values. As a consequence of the triumphalist positivism that during the late nineteenth and the first half of the twentieth century had come to dominate the general understanding of science, matters of ethics and values had been all but banished from serious intellectual discussion. A sharp line could be drawn, it was widely believed, between scientific facts and moral values (Maclntyre, 1981b). The former were solid, authoritative, impersonally true, while the latter were understood to be "soft," relativistic, and highly, even idiosyncratically, personal. Moreover, doctors should make the moral decisions no less than the medical decisions; indeed, a good medical decision was tantamount to a good moral decision. The first task of bioethics, then, was to erase the supposedly clear line that could be drawn between facts and values, and then to challenge the belief that those well trained in science and medicine were as capable of making the moral decisions as the medical decisions.

The second important task was to find or develop the methodologies necessary to come to grips with the new moral problems. If there is no sharp line between facts and values, how should their relationship be understood? If there is a significant difference between making a medical (or scientific) decision and making a moral decision, how are those decisions different and what kinds of skills are needed to make the one or the other? Who has a right to make the different kinds of decisions? If it is neither sensible nor fair to think of moral and value matters as soft and capriciously personal, hardly more than a matter of taste, then how can rigor and objectivity be brought to bear on them?

As the scope and complexity of these two large tasks became more obvious, the field of bioethics began to emerge. From the first, there was a widespread recognition that the moral problems would have to be approached in an interdisciplinary way (Callahan, 1973). Philosophy and religion, long the characteristic arenas for moral insight, analysis, and traditions, should have an important place, as should the historical moral traditions and practices of medicine and biology. Ample room would also have to be made for the law and for the social and policy sciences. Moral problems have important legal, social, political, and policy implications; and moral choices would often be expressed through court decisions, legislative mandates, and assorted regulatory devices. Hardly less important was the problem ofwhich moral decisions should be left to private choice and which required some public standards. While there was a strong trend to remove procreational choices from public scrutiny, and thus to move toward the legal use of contraception and abortion, environmental choices were being moved from private choice to governmental regulation. Debates of this kind require the participation of many disciplines.

While the importance of an interdisciplinary approach was early recognized, three other matters were more troublesome. First, what should be the scope of the field? The term bioethics, as it was first used by the biologist Van Rensselaer Potter, referred to a new field devoted to human survival and an improved quality of life, not necessarily or particularly medical in character. The term soon was used differently, however, particularly to distinguish it from the much older field of medical ethics. The latter had traditionally been marked by a heavy, almost exclusive emphasis on the moral obligations of physicians and on the doctor—patient relationship. Yet that emphasis, while still important, was not capacious enough to embrace the huge range of emerging issues and perspectives. Bioethics came to refer to the broad terrain of the moral problems of the life sciences, ordinarily taken to encompass medicine, biology, and some important aspects of the environmental, population, and social sciences. The traditional domain of medical ethics would be included within this array, accompanied now by many other topics and problems.

Second, if the new bioethics was to be interdisciplinary, how would it relate to the long-standing disciplines of moral theology and moral philosophy? While those disciplines are able to encompass some interdisciplinary perspectives, they also have their own methodologies, developed over the years to be tight and rigorous. For the most part, moreover, their methodologies are broad, aimed at moral problems in general, not just at biomedical issues. Can they, in their broad, abstract generality, do justice to the particularities of medical or environmental issues?

Another problem becomes apparent. An interdisciplinary field is not necessarily well served by a tight, narrow methodology. Its very purpose is to be open to different perspectives and the different methodologies of different disciplines. Does this mean, then, that although parts of bioethics might be rigorous—the philosophical parts taken by themselves or the legal parts—the field as a whole may be doomed to a pervasive vagueness, never as strong as a whole as its individual parts? This is a charge sometimes leveled against the field, and it has not been easy for its practitioners to find the right balance of breadth, complexity, and analytical rigor.

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