The pandemic significantly raised the stakes for the translation of bioethics insights into policy. The novelty, range and sheer quantity of the ethical problems that needed to be addressed urgently within public policy were unprecedented and required high‐bandwidth two‐way transfer of insights between academic bioethics and policy. Countries such as the United Kingdom, which do not have a National Ethics Committee, faced particular challenges in how to facilitate this. This paper takes as a case study the brief career of the (...) Ethics Advisory Board (EAB) for the NHS Covid‐19 App, which shows both the difficulty and the political complexity of policy‐relevant bioethics in a pandemic and how this was exacerbated by the transience and informality of the structures through which ethics advice was delivered. It analyses how and why, after EAB's demise, the Westminster government increasingly sought to either take its ethics advice in private or to evade ethical scrutiny of its policies altogether. In reflecting on EAB, and these later ethics advice contexts, the article provides a novel framework for analysing ethics advice within democracies, defining four idealised stances: the pure ethicist, the advocate, the ethics arbiter and the critical friend. (shrink)

Volume 19, Issue 11, November 2019, Page 80-82.

This paper takes up the question of the role of philosophical moral theory in our attempts to resolve the ethical problems that arise in health care, with particular reference to the contention that we need theory to be determinative of our choice of actions. Moral theorizing is distinguished from moral theories and the prospects for determinacy from the latter are examined through a consideration of the most promising candidates: utilitarianism, deontology and the procedures involved in reflective equilibrium. It is argued (...) that the current lack of any generally accepted method of solving moral problems, together with the extreme improbability of philosophy achieving a plausibly determinate theory, should encourage us to approach the problems in a spirit of agnosticism regarding the way in which theoretical material might be of relevance. The practical test for both moral theorizing and moral theories is thus not determinacy but the degree to which they increase our understanding of moral problems by serving, as they do in philosophy, as a means of inquiry into their nature. (shrink)

Using tombstoning (jumping from a height into water) as an example, this article claims that public health policies and health promotion tend to assess the moral status of activities following a version of health maximizing rule utilitarianism, but this does not represent common moral experience, not least because it fails to take into account the enjoyment that various health effecting habits brings and the contribution that this makes to a good life, variously defined. It is proposed that the moral status (...) of health threatening activities should instead be defined by a version of act utilitarianism where both maximizing value and method of calculation are decided by individuals. In this account personal responsibility for health is reduced to the obligation to undertake calculations effectively, comprising of two duties; epistemic and reflective. If there is an individual epistemic duty, it is plausible to suggest that health promotion should present information in a way which facilitates it, but despite the prevalent language of autonomous choice, discussion of health promotion messages, for example, related to drinking and smoking demonstrates that this currently does not happen. Health promotion strategies should seek to encourage reflection about the harm our health effecting behaviour causes others. (shrink)

Our aim in this article is to bring some clarity to the clinical ethics expertise debate by critiquing and replacing the taxonomy offered by the Core Competencies report. The orienting question for our taxonomy is: Can clinical ethicists offer justified, normative recommendations for active patient cases? Views that answer “no” are characterized as a “negative” view of clinical ethics expertise and are further differentiated based on (a) why they think ethicists cannot give justified normative recommendations and (b) what they think (...) ethicists can offer, if they cannot offer recommendations. Views that answer “yes” to the orienting question are characterized as a “positive” view of clinical ethics expertise. Positive views are distinguished according to four additional questions. First (P1), how are those recommendations generated? Second (P2), what is the nature of the recommendations? Third (P3), we ask, how are the recommendations justified? And finally (P4), how are the recommendations communicated? (shrink)

The evidential value of moral intuitions has been challenged by psychological work showing that the intuitions of ordinary people are affected by distorting factors. One reply to this challenge, the expertise defence, claims that training in philosophical thinking confers enhanced reliability on the intuitions of professional philosophers. This defence is often expressed through analogy: since we do not allow doubts about folk judgments in domains like mathematics or physics to undermine the plausibility of judgments by experts in these domains, we (...) also should not do so in philosophy. In this paper I clarify the logic of the analogy strategy, and defend it against recent challenges by Jesper Ryberg. The discussion exposes an interesting divide: while Ryberg’s challenges may weaken analogies between morality and domains like mathematics, they do not affect analogies to other domains, such as physics. I conclude that the expertise defence can be supported by analogical means, though care is required in selecting an appropriate analog. I discuss implications of this conclusion for the expertise defence debate and for study of the moral domain itself. (shrink)

The legitimacy of clinical ethics consultation is often implied to rest on the legitimacy of moral expertise. In turn, moral expertise seems subject to many serious critiques, the success of which implies that clinical ethics consultation is illegitimate. I explore a number of these critiques, and forward “ethics expertise,” as distinct from “moral expertise,” as a way of avoiding these critiques. I argue that “ethics expertise” succeeds in avoiding most of the critiques, captures what clinical ethics consultants might justifiably do, (...) and expresses a subject matter which can be taught and assessed. (shrink)

A major obstacle to broad support of clinical ethics consultation is suspicion regarding the nature of the moral expertise it claims to offer. The suspicion seems to be confirmed when the field fails to make its moral expertise explicit. In this vacuum, critics suggest the following:Clinical ethics consultation's legitimacy depends on its ability to offer an expertise in moral matters.Expertise in moral matters is knowledge of a singular moral truth which applies to everyone.The claim that a clinical ethics consultant can (...) offer knowledge of a singular moral truth in virtue of her professional training is absurd, false, or gravely immoral.Therefore,The field is illegitimate. (shrink)

This paper raises questions about bioethical knowledge and the bioethical ‘expert’ in the context of contestation over methods. Illustrating that from the perspective of the development of bioethics, the lack of unity over methods is highly desirable for the field in bringing together a wealth of perspectives to bear on bioethical problems, that same lack of unity also raises questions as to the expert capacity of the ‘bioethicist’ to speak to contemporary bioethics and represent the field. Focusing in particular on (...) public bioethics, the author argues that we need to rethink the concept of bioethicist, if not reject it. The concept of the bioethicist connotes a disciplinary or theoretical unity that is simply not present and from the perspective of public policy, it is incredibly misleading. Instead, bioethical expertise would be a capacity of a broader community, and not an individual. Such a conception of bioethics as an expert community rather than as an individual capacity, focuses our attention on the more functional question of what knowledge and skill set any individual possesses. (shrink)

We argue that the way in which the concept of expertise is understood and invoked has prevented progress in the debate as to whether moral philosophers can be said to be ‘moral experts’. We offer an account of expertise that draws on the role of tacit knowledge in order to provide a basis upon which the debate can progress. Our analysis consists of three parts. In the first part we highlight two specific problems in the way that the concept of (...) expertise has been invoked in the moral expertise debate, namely the understanding of expertise as an exclusive concept and the conflation of expertise with the idea of ‘authority’. In the second part we suggest an alternative way of approaching the concept of expertise. This is based on Collins and Evans’ sociological theory of expertises. This theory provides a valuable analytical framework for thinking about claims to expertise and for drawing the kinds of distinctions which allow for different kinds of moral expertises and competencies. In the final part, we show how the application of this theory helps to avoid some of the problematic conclusions which theorists have arrived at to date and provides a common platform for debate. Ultimately, it permits the argument to be made that moral philosophers could be considered specialist members of an expert community of moral decision-makers. (shrink)

Much bioethical scholarship is concerned with the social, legal and philosophical implications of new and emerging science and medicine, as well as with the processes of research that under-gird these innovations. Science and technology studies (STS), and the related and interpenetrating disciplines of anthropology and sociology, have also explored what novel technoscience might imply for society, and how the social is constitutive of scientific knowledge and technological artefacts. More recently, social scientists have interrogated the emergence of ethical issues: they have (...) documented how particular matters come to be regarded as in some way to do with ‘ethics’, and how this in turn enjoins particular types of social action. In this paper, I will discuss some of this and other STS (and STS-inflected) literature and reflect on how it might complement more ‘traditional’ modes of bioethical enquiry. I argue that STS might (1) cast new light on current bioethical issues, (2) direct the gaze of bioethicists towards matters that may previously have escaped their attention, and (3) indicate the import not only of the ethical implications of biomedical innovation, but also how these innovative and other processes feature ethics as a dimension of everyday laboratory and clinical work. In sum, engagements between STS and bioethics are increasingly important in order to understand and manage the complex dynamics between science, medicine and ethics in society. (shrink)

How can one be both a philosophical ethicist and a democrat? In this article I conclude that it can be difficult to reconcile the two roles. One involves understanding, and reconciling, the conflicting views of citizens, and the other requires the pursuit of truth through reason. Nevertheless, an important function of philosophy and ethics is to inform and improve policy. If done effectively, we could expect better, and more just, laws and policies, thereby benefiting many lives. So applying philosophical thinking (...) to policy is an important job. However, it comes with substantial difficulties, not least in reconciling, or choosing between, competing philosophical theories. Despite the importance of the task, and the apparent obstacles, there is relatively little literature on how to apply ethics to real-world policy-making. Democracies need ethicists who can engage in democratic debate and bridge the gap between philosophy and public policy. I offer some tactics here. (shrink)

More than 1.2 million people are killed annually in road crashes all over the world, and still it seems that philosophers and, perhaps more importantly, professional ethicists have not devoted thought to the many moral issues that road traffic was bound to create. This article tries to understand why road ethics is all but ignored by philosophers and ethicists, and makes a plea for a change. By exploring ethically the traffic safety problem of speeding it will be shown that ethical (...) analysis is not only appropriate but mandatory. (shrink)

The kind of expertise someone who specialises in ethics has, or indeed whether it makes sense to talk of moral expertise, is keenly debated and is a far from settled issue. It has been of interest to moral philosophers, partly because of the light it might shine on the nature of morality.1 2 It has also been debated within medical ethics, with some arguing against the idea that expertise in moral philosophy translates into ethical expertise and others arguing that skills (...) in ethical justification can be viewed as ethical expertise.3 4 This issue of the Journal of Medical Ethics includes a number of papers that demonstrate the importance of ethical expertise and some of the distinctive elements of it. Public involvement in research is seen in a number of countries as something valuable and in some, such as Australia, it can be a criterion for research grants. The UK National Standards for Public Involvement in Research are discussed in this issue of JME and McCoy et al provide a good illustration of why ethical expertise is important for framing public policy.5 The appeal of stakeholders having some say into research projects, particularly when they are funded via taxation is easy to understand, so who would not see public involvement as a good thing? However, McCoy et al claim that while there is a substantial and growing literature on public involvement in research that tends to emphasise the importance of public involvement, it doesn’t explain how or what this looks like when …. (shrink)

Philosophers and others have questioned whether or not expertise in morality is possible. This debate is not only theoretical, but also affects the perceived legitimacy of clinical ethicists. One argument against moral expertise is that in a pluralistic society with competing moral theories no one can claim expertise regarding what another ought morally to do. There are simply too many reasonable moral values and intuitions that affect theory choice and its application; expertise is epistemically uniform. In this article, we discuss (...) how similar concerns have recently threatened to undermine expertise in medicine and science. In contrast, we argue that the application of values is needed to exercise medical, scientific, and moral expertise. As long as these values are made explicit, worries about a pretense to authority in the context of a liberal democracy are ill-conceived. In conclusion, we argue for an expertise that is epistemically diverse. (shrink)

Moral expertise requires a level of reliability in moral matters that is significantly higher than that of the average person. The author argues that this requirement of epistemic superiority in moral matters is sometimes fulfilled by our future selves and generally fulfilled by present moral philosophers. Our future selves are more reliable in answering moral questions than we are, when they have been prepared to answer those questions by various epistemic activities. But if our future selves are our epistemic superiors (...) in such cases, moral philosophers are epistemic superiors in moral matters more generally since their epistemic advantages are even more significant. The author concludes by arguing that moral philosophers plausibly even qualify as moral experts. (shrink)

Expertise has become a topic of increased interest to philosophers. Fascinating in its own right, expertise also plays a crucial role in several philosophical debates. My aim in this paper is to draw attention to an important, and hitherto unappreciated feature of expertise: its brittleness. Experts are often unable to transfer their proficiency in one domain to other, even intuitively similar domains. Experts are often unable to flexibly respond to changes within their domains. And, even more surprisingly, experts will occasionally (...) be outperformed by novices when confronted with novel circumstances within their domains of expertise. In section 1, I marshal the evidence in favour of brittleness. In section 2, I argue that appeals to brittleness can advance the dialectic in debates on skilled action and provide reasons to reject a powerful recent argument offered by Christensen et al. : 693–719, 2019). In section 3, I appeal to brittleness to argue against a common conception of philosophical expertise, according to which philosophers possess a domain-general set of reasoning skills. Although my argument in this section is largely negative, there is a twist. Recalibrating our understanding of philosophical expertise opens new avenues of research for defenders of the so-called ‘expertise defence’ against the findings of experimental philosophy. (shrink)

The nature, possibility, and implications of ethics expertise in general and of bioethics expertise in particular has been the focus of extensive debate for over thirty years. What is ethics expertise and what does it enable experts to do? Knowing what ethics expertise is can help answer another important question: What, if anything, makes a claim of expertise legitimate? In other words, how does someone earn the appellation “ethics expert?” There remains deep disagreement on whether ethics expertise is possible, and (...) if so, what constitutes such expertise and what it entails and legitimates. Discussion of bioethics expertise has become particularly important given the growing presence of bioethicists in the clinical setting as well as efforts to professionalize bioethics through codes of ethics and certification efforts. Unlike in the law or in engineering, where there may be a body of knowledge that professional organizations or others have articulated as important for education and training of experts, ethics expertise admits of no such body of knowledge or required experience. Nor is there an entity seen as having the authority to articulate the necessary scope of knowledge. Questions about whether there is such a body of knowledge for particular areas within bioethics have emerged and played a central role in professionalization efforts in recent years, especially in the area of clinical ethics. (shrink)

BackgroundBariatric surgery for children and adolescents is becoming widespread. However, the evidence is still scarce and of poor quality, and many of the patients are too young to consent. This poses a series of moral challenges, which have to be addressed both when considering bariatric surgery introduced as a health care service and when deciding for treatment for young individuals. A question based (Socratic) approach is applied to reveal underlying moral issues that can be relevant to an open and transparent (...) decision making process.DiscussionA wide range of moral issues with bariatric surgery for children and adolescents is identified in the literature. There is a moral imperative to help obese minors avoiding serious health problems, but there is little high quality evidence on safety, outcomes, and cost-effectiveness for bariatric surgery in this group. Lack of maturity and family relations poses a series of challenges with autonomy, informed consent, assent, and assessing the best interest of children and adolescents. Social aspects of obesity, such as medicalization, prejudice, and discrimination, raise problems with justice and trust in health professionals. Conceptual issues, such as definition of obesity and treatment end-points, present moral problems. Hidden interests of patients, parents, professionals, industry, and society need to be revealed.SummaryPerforming bariatric surgery for obese children and adolescents in order to discipline their behavior warrants reflection and caution. More evidence on outcomes is needed to be able to balance benefits and risks, to provide information for a valid consent or assent, and to advise minors and parents. (shrink)

Beginning with Barry Hoffmaster’s charge that we reclaim bioethics from the moral philosopher’s top-down theorizing, I discuss two moral philosophy contexts that offer resources for the kind of complex attention Hoffmaster demands: Iris Murdoch and Cora Diamond in moral philosophy and Margaret Urban Walker, Hilde Lindeman, and Marian Verkerk’s joint take on bioethics. My aim is: 1) to dispel a simplified notion of philosophy in bioethics; 2) to unite two strands of philosophy, which converge on important issues relevant to contemporary (...) bioethics; and 3) to explore these strands in terms of enabling, maieutic work on our ethical points of departure. (shrink)

Research ethics committees in Germany usually don’t have philosophers as members and if so, only contingently, not provided for by statute. This is interesting from a philosophical perspective, assuming that ethics is a discipline of philosophy. It prompts the question what role philosophers play in those committees they can be found in. Eight qualitative semi-structured interviews were conducted to explore the self-perception of philosophers regarding their contribution to research ethics committees. The results show that the participants generally don’t view themselves (...) as ethics experts. They are rather unanimous on the competencies they think they contribute to the committee but not as to whether those are philosophical competencies or applied ethical ones. In some cases they don’t see a big difference between their role and the role of the jurist member. In the discussion section of this paper I bring up three topics, prompted by the interviews, that need to be addressed: (1) I argue that the interviewees’ unwillingness to call themselves ethics experts might have to do with a too narrow understanding ofethics expertise. (2) I argue that the disagreement among the interviewees concerning therelationship between moral philosophy and applied ethicsmight be explained on a theoretical or on a practical level. (3) I argue that there is some lack of clarity concerning therelationship between ethics and lawin research ethics committees and that further work needs to be done here. All three topics, I conclude, need further investigation. (shrink)

Janet Malek (91–102, 2019) argues that a “clinical ethics consultant’s religious worldview has no place in developing ethical recommendations or communicating about them with patients, surrogates, and clinicians.” She offers five types of arguments in support of this thesis: arguments from consensus, clarity, availability, consistency, and autonomy. This essay shows that there are serious problems for each of Malek’s arguments. None of them is sufficient to motivate her thesis. Thus, if it is true that the religious worldview of clinical ethics (...) consultants should play no role whatsoever in their work as consultants, this claim will need to be defended on some other ground. (shrink)

In this paper I investigate the theory-practice relationship in ethics by using the lens of theorist-practitioner relationships. In particular I discuss the contrasts between theorist-practitioner relationship inside and outside the classroom, the ‘extra-mural’ expertise of theorists, and the ethical issues which arise when theorists act as co-practitioners. I argue that understanding these social and ethical issues is essential to understanding the relationship between theory and practice in ethics, and shows the need for more emphasis on practice-oriented forms of ethical theorising.

We have controversial intuitions about the rightness of retributive punishment, keeping promises for its own sake, and pushing the heavy man off of the bridge in the footbridge trolley case. How do these intuitions relate to ethical theories? Should ethical theories aim to fit with and explain them? Or are only uncontroversial intuitions relevant to explanatory ethical theorising? I argue against several views that we might hold about the relationship between controversial intuitions and ethical theories. I then propose and defend (...) the view that ethical theories should only aim to fit with and explain the intuitions that almost all people (who minimally understand the relevant issues) share. I argue that this view has interesting and important implications for ethical theorising and theorising about justice and equality. (shrink)

Discussions of the nature or possibility of moral expertise have largely proceeded in atheoretical terms, with little attention paid to whether moral expertise depends on theoretical knowledge of morality. Here I argue that moral expertise is more theory-dependent than is commonly recognized: Moral expertise consists, at least in part, in knowledge of the correct or best moral theory, and second, that knowledge of moral theory is essential to moral experts dispensing expert counsel to non-experts. Moral experts would not be moral (...) experts absent knowledge of moral theory, nor could they play the testimonial role we would expect them to play in moral inquiry and deliberation absent such knowledge. (shrink)

In a recent issue of the Journal of Medicine and Philosophy, several scholars wrote on the topic of ethics expertise in clinical ethics consultation. The articles in this issue exemplified what we consider to be two troubling trends in the quest to articulate a unique expertise for clinical ethicists. The first trend, exemplified in the work of Lisa Rasmussen, is an attempt to define a role for clinical ethicists that denies they have ethics expertise. Rasmussen cites the dependence of ethical (...) expertise on irresolvable meta-ethical debates as the reason for this move. We argue against this deflationary strategy because it ends up smuggling in meta-ethical assumptions it claims to avoid. Specifically, we critique Rasmussen’s distinction between the ethical and normative features of clinical ethics cases. The second trend, exemplified in the work of Dien Ho, also attempts to avoid meta-ethics. However, unlike Rasmussen, Ho tries to articulate a notion of ethics expertise that does not rely upon meta-ethics. Specifically, we critique Ho’s attempts to explain how clinical ethicists can resolve moral disputes using what he calls the “Default Principle” and “arguments by parity.” We show that these strategies do not work unless those with the moral disagreement already share certain meta-ethical assumptions. Ultimately, we argue that the two trends of attempting to avoid meta-ethics by denying that clinical ethicists have ethics expertise, and attempting to articulate how ethics expertise can be used to resolve disputes without meta-ethics both fail because they do not, in fact, avoid doing meta-ethics. We conclude that these trends detract from what clinical ethics consultation was founded to do and ought to still be doing—provide moral guidance, which requires ethics expertise, and engagement with meta-ethics. To speak of ethicists without ethics expertise leaves their role in the clinic dangerously unclear and unjustified. (shrink)

The development of artificial intelligence will require systems of ethical decision making to be adapted for automatic computation. However, projects to implement moral reasoning in artificial moral agents so far have failed to satisfactorily address the widespread disagreement between competing approaches to moral philosophy. In this paper I argue that the proper response to this situation is to design machines to be fundamentally uncertain about morality. I describe a computational framework for doing so and show that it efficiently resolves common (...) obstacles to the implementation of moral philosophy in intelligent machines. (shrink)

As a relational concept, responsible innovation can be made more tangible by asking innovation of what and responsibility of whom for what? Arranging the scattered field of responsible innovation comprehensively, starting from an anthropological point of view, into five fields of tension and five categories of spearheads, may be theoretically and practically helpful while offering suggestions for both research and management.

I consider whether political deference by a citizen within a liberal democracy to moral experts is morally problematic. I compare and contrast deference in the political and personal domains. I set to one side consequentialist worries about political deference and evaluate its possible intrinsic wrongness, expressed as a worry that deference is inconsistent with the grant to individuals of the power exercised in a democratic vote, just as personal deference is inconsistent with the grant of a power of moral choice. (...) I consider several possible versions of such inconsistency: that a vote to delegate decision-making to experts is self-defeating, that it is unfree, or is blind to the significance of exercising a political choice, or is a denial of democratic equality. I conclude that the worries are ill-founded and that political deference is not in itself morally troubling. (shrink)

This paper is concerned with the ethics of popularizing moral philosophy. In particular, it addresses the question of whether ethicists engaged in public debates should restrict themselves to acting as impartial informants or moderators rather than advocates of their own moral opinions. I dismiss the idea that being an impartial servant to moral debates is the default or even the only defensible way to publicly exercise ethical expertise and thus, to popularize moral philosophy. Using a case example from the public (...) debate about the human use of nonhuman animals, I highlight the benefits and risks of endorsing an advocate’s and a teacher’s or moderator’s role, respectively. I argue for a general requirement of judgment transparency which entails that the publicly engaged philosopher ought to be clear and consistent about the type of role she takes on, her publicly advanced opinions generally ought to be her professional ones and that she ought to flag her private opinions. I finally show that, despite general concerns about conflicts of interest, exercising ethical expertise and engaging in advocacy, i.e., acting as if one were a moral expert, are not incompatible modes of public engagement for the moral philosopher. (shrink)

In this essay I consider whether the political perspective of third wave science studies – ‘elective modernism’ – offers a suitable framework for understanding the policy-making contributions that (bio)ethical experts might make. The question arises as a consequence of the fact that I have taken inspiration from the third wave in order to develop an account of (bio)ethical expertise. I offer a précis of this work and a brief summary of elective modernism before considering their relation. The view I set (...) out suggests that elective modernism is a political philosophy and that although its use in relation to the use of scientific expertise in political and policy-making process has implications for the role of (bio)ethical expertise it does not, in the final analysis, provide an account that is appropriate for this latter form of specialist expertise. Nevertheless, it is an informative perspective, and one that can help us make sense of the political uses of (bio)ethical expertise. (shrink)