Bioethical Expertise: A 'Early-Version' Cross-posting from the Guardian

The other day I was very lucky to have a post published on 'Political Science' a new blog about science and politics hosted by the Guardian. The post is here and I have taken a .pdf copy of it here. There have been some nice comments and reactions to the post, which was very gratifying. Anyway, i thought I would archive an early version of the post here, so here it is:

If I asked you to imagine of an expert there is a fair chance that a scientist would spring to mind. She might be wearing a white coat, and might be a biomedical scientist or perhaps a medical doctor. Science and scientists have become equated with expertise, so much so it is often easy to forget that there are many other kinds of expert. For example some historians might be experts in particular times and places, whilst others might focus on particular individuals and be experts in their life, times and work. This latter focus might add an extra layer to their expertise. It is one thing to be an expert in the scientific work of Robert Boyle, say, and another to be an expert in the literary work of Shakespeare.

If we reflect on what we might call aesthetic expertise, the assumption that the expert is singularly authoritative comes under pressure. We might think that an interpretation of King Lear offered by Carol Chillington Rutter is an expert opinion on the matter, but it does not negate the opinions of generations of teenagers who discuss the book in classrooms every year. Neither do amateur productions negate the expertise of those who stage professional performances. In the light of such cases we might think aesthetic expertise to be a matter of being embedded in a particular culture and discourse and not simply a matter of knowing the correct answer.

Recognising the diversity of expertise can be helpful in reflecting on whether there can be any such thing as bioethical expertise. Whilst bioethics is an interdisciplinary field of academic endeavour, the idea of ethical analysis is one of its central projects. In this context the idea of bioethical expertise can look like a claim to moral authority. Bioethicists working in this domain attempt to offer definitive arguments and seek to answer particular moral concerns. For example, for many years now John Harris and Janet Radcliffe-Richards have both been arguing for the moral permissibility of a regulated market in transplantable human organs. Others, myself included, are of the opinion that such markets would be deeply problematic, morally speaking.

Whilst we might point to the academic debate and consider the participants to be experts in the field of bioethics, this does not negate the range of opinions and moral responses we might find across society as a whole or their political relevance. All things being equal, every human being can be considered a moral agent and, ultimately, their own moral authority. We might suggest that members of any given population have a kind of ubiquitous moral expertise. Such expertise allows them to negotiate the thick normative contexts of the culture(s) they live in. In this view, the idea of morality is broader than that of an ethical code and questions of right and wrong. It is more closely linked to ideas of character or ethos, terms that can be applied to societies and institutions as well as individuals. 

This ubiquitous moral expertise is the ground on which expert bioethical expertise stands and is developed. Bioethicists often recognise the importance of remaining connected to our ‘common morality,’ and what they mean by this is not that bioethics should be consistent with generally accepted moral norms but that it should be comprehensible and responsive to ‘lay’ moral agents. Here it is instructive to consider the role of bioethics in relation to medical practice. If bioethics is to contribute to the moral dimension of medicine it must do so in a manner that is comprehensible to doctors as moral agents. 

Such agency is deeply rooted in the cultural ethos of medicine and the character of the medical professional. What this means is that the bioethicist who hopes to make a concrete contribution to medical ethics must grasp the nature or moral culture of medical practice. They must develop what Collins and Evans have called interactive expertise. Such expertise enables individuals to ‘talk the talk’ of a particular discipline even if they cannot ‘walk the walk.’ In developing an interactive expertise with medical professionals, bioethicists develop a sense of the moral ethos of medical culture and so can better communicate their views. 

Furthermore over the past thirty or forty years bioethics has become deeply embedded in medical culture, and we might think that some medical professionals have developed an interactive expertise with academic bioethics. They are not bioethical experts, at least insofar as they do not contribute to the discipline or academic literature. Nevertheless many make use of bioethical expertise, and medicine as a whole draws on this expertise to help it address the moral concerns that arise in practice. In this view, expert bioethicists and medical professionals collaborate to develop appropriate ethical guidelines that ethically shape clinical practices. Expert bioethics does not eliminate the moral authority of the individual professional or the profession as a whole, but it does seek to augment it. Ideally doctors should do the same in relation to their patients. 

However, whether or not expert bioethics might be an illegitimate form of moral authority needs to be reconsidered in the context of the biosciences. Like medical professionals scientists work within a moral ethos, a normative structure we might call the scientific ethos. Their work does not, however, require the on-going exercise of moral agency, as is required in healthcare. Bioethical governance determines rather than shapes, answers rather than constructs, the moral questions raised by the biosciences. 

In democratic societies even scientific expertise can seem problematic. The elevation of scientific truth or ‘evidence-based policy’ can imply a technocratic style of government at odds with our democratic ethos. On the face of it, the suggestion that there are expert bioethicists might appear to further these anti-democratic implications. Extending expertise from the realm of scientific facts to the realm of moral values reinforces the illusion of a technocratic utopia. However, to accept this illusion would be to forget that bioethics must maintain a connection to common morality, and that the opinions of bioethical experts do not obviate those of other moral agents. 

In the case of medical ethics bioethical experts worked (and continue to work) with healthcare professions to respond to the moral and ethical questions raised by medical practice. In the case of the moral and ethical questions raised by bioscientific research, expert bioethics must find ways to work within the contemporary moral ethos. What this means is that bioethics must not only work with other experts and professionals, with bioscientists, politicians, policy-makers and interest groups, but also work democratically. Bioethics must engage with the public and, in doing so, become engaged by their concerns. It must become part of the drive to make science public.