Health 89: 11 (1999). Reproduced with permission of American Public Health Association.91 Renata Lindeman, “Down Syndrome Screening Isn’t About Public Health. It’s About Eliminating a Group of People,” from Washington Post, June 16, 2015. Reproduced courtesy of Renata Lindeman.
92 Ruth Marcus, “I Would’ve Aborted a Fetus with Down Syndrome: Women Need That Right,” Washington Post, March 9, 2018. Reproduced with permission of Washington Post / PARS.
93 Neil Levy, “Neuroethics: Ethics and the Sciences of the Mind,” pp. 69–74 (extract) from Philosophy Compass 4: 10 (2009). Reproduced with permission of John Wiley & Sons.
94 Anders Sandberg and Julian Savulescu, “Love Machine: Engineering Lifelong Romance,” pp. 28–29 from New Scientist 2864. © 2012 Reed Business Information. Reproduced with permission of Tribune Content Agency.
95 Francesca Minerva, “Unrequited Love Hurts: The Medicalization of Broken Hearts is Therapy, Not Enhancement,” pp. 479–485 from Cambridge Quarterly of Healthcare Ethics 24: 4 (2015). Reproduced with permission of Cambridge University Press.
96 Walter Glannon, “Stimulating Brains, Altering Minds,” pp. 289–292 from Journal of Medical Ethics 35 (2009). Reproduced with permission of BMJ Publishing Group Ltd.
97 Felicitas Kramer, “Authenticity or Autonomy? When Deep Brain Stimulation Causes a Dilemma,” pp. 757–760 from Journal of Medical Ethics 39 (2013). Reproduced with permission of BMJ Publishing Group Ltd.
98 Sara Goering and Rafael Yuste, “On the Necessity of Ethical Guidelines for Novel Neurotechnologies,” pp. 882–885 from Cell 167 (2016). Reproduced with permission of Elsevier.
Introduction
The term “bioethics” is often mistakenly ascribed to the biologist Van Rensselaer Potter, who used it in the 1970s to describe his proposal that we need an ethic that can incorporate our obligations, not just to other humans, but to the biosphere as a whole.1 However, a historically correct account should probably give credit for coining the term to Fritz Jahr, a German Protestant pastor, who in 1927 published an article called “Bio‐Ethics: A Review of the Ethical Relationships of Humans to Animals and Plants.”2 Jahr tried to establish “bioethics” both as a discipline and as a moral principle. Although the term is still occasionally used in the sense of an ecological ethic, it is now much more commonly used in the narrower sense of the study of ethical issues arising from the biological and medical sciences. So understood, bioethics has become a specialized, although interdisciplinary, area of study. The essays included in this book give an indication of the range of issues which fall within its scope – but it is only an indication. There are many other issues that we simply have not had the space to cover.
Bioethics can be seen as a branch of ethics, or, more specifically, of applied ethics. For this reason some understanding of the nature of ethics is an essential preliminary to any serious study of bioethics. The remainder of this introduction will seek to provide that understanding.
One question about the nature of ethics is especially relevant to bioethics: to what extent is reasoning or argument possible in ethics? Many people assume without much thought that ethics is subjective. The subjectivist holds that what ethical view we take is a matter of opinion or taste that is not amenable to argument. But if ethics were a matter of taste, why would we even attempt to argue about it? If Helen says “I like my coffee sweetened,” whereas Paul says “I like my coffee unsweetened,” there is not much point in Helen and Paul arguing about it. The two statements do not contradict each other. They can both be true. But if Helen says “Doctors should never assist their patients to die” whereas Paul says “Sometimes doctors should assist their patients to die,” then Helen and Paul are disagreeing, and there does seem to be a point in their trying to argue about the issue of physician‐assisted suicide.
It seems clear that there is some scope for argument in ethics. If I say “It is always wrong to kill a human being” and “Abortion is not always wrong,” then I am committed to denying that abortion kills a human being. Otherwise I have contradicted myself, and in doing so I have not stated a coherent position at all. So consistency, at least, is a requirement of any defensible ethical position, and thus sets a limit to the subjectivity of ethical judgments. The requirement of factual accuracy sets another limit. In discussing issues in bioethics, the facts are often complex. But we cannot reach the right ethical decisions unless we are well‐informed about the relevant facts. In this respect ethical decisions are unlike decisions of taste. We can enjoy a taste without knowing what we are eating; but if we assume that it is wrong to resuscitate a terminally ill patient against her wishes, then we cannot know whether an instance of resuscitation was morally right or wrong without knowing something about the patient’s prognosis and whether the patient has expressed any wishes about being resuscitated. In that sense, there is no equivalent in ethics to the immediacy of taste.
Ethical relativism, sometimes also known as cultural relativism, is one step away from ethical subjectivism, but it also severely limits the scope of ethical argument. The ethical relativist holds that it is not individual attitudes that determine what is right or wrong, but the attitudes of the culture in which one lives. Herodotus tells how Darius, King of Persia, summoned the Greeks from the western shores of his kingdom before him, and asked them how much he would have to pay them to eat their fathers’ dead bodies. They were horrified by the idea and said they would not do it for any amount of money, for it was their custom to cremate their dead. Then Darius called upon Indians from the eastern frontiers of his kingdom, and asked them what would make them willing to burn their fathers’ bodies. They cried out and asked the King to refrain from mentioning so shocking an act. Herodotus comments that each nation thinks its own customs best. From here it is only a short step to the view that there can be no objective right or wrong, beyond the bounds of one’s own culture. This view found increased support in the nineteenth century as Western anthropologists came to know many different cultures, and were impressed by ethical views very different from those that were standardly taken for granted in European society. As a defense against the automatic assumption that Western morality is superior and should be imposed on “savages,” many anthropologists argued that, since morality is relative to culture, no culture can have any basis for regarding its morality as superior to any other culture.
Although the motives with which anthropologists put this view forward were admirable, they may not have appreciated the implications of the position they were taking. The ethical relativist maintains that a statement like “It is good to enslave people from another tribe if they are captured in war” means simply “In my society, the custom is to enslave people from another tribe if they are captured in war.” Hence if one member of the society were to question whether it really was good to enslave people in these circumstances, she could be answered simply by demonstrating that this was indeed the custom – for example, by showing that for many generations it had been done after every war in which prisoners were captured. Thus there is no way for moral reformers to say that an accepted custom is wrong – “wrong” just means “in accordance with an accepted custom.”
On the other hand, when people from two different cultures disagree about an ethical issue, then according to the ethical relativist there can be no resolution of the disagreement. Indeed, strictly there is no disagreement. If the apparent dispute were over the issue just mentioned, then one person would be saying “In my country it is the custom to enslave people from another tribe if they are captured in war” and the other person would be saying “In my country it is not the custom to allow one human being to enslave another.” This is no more a disagreement than such statements as “In my country people greet each other by rubbing noses” and “In
