IEEN workshop report: aims and methods in interdisciplinary and empirical bioethics

Bioethics is a diverse field that accommodates a broad range of perspectives and disciplines. The recent explosion of literature on methods in interdisciplinary and empirical ethics might appear, however, to overshadow the fact that ‘bioethics’ has long been an interdisciplinary field. ¹ The Interdisciplinary and Empirical Ethics Network (IEEN) was established, with funding from the Wellcome Trust, to facilitate critical and constructive discussion around the nature of this disciplinary diversity and shift focus away from the ‘empirical turn’, towards the ongoing development of bioethics as an evolving field of interdisciplinary study. Membership of the network is open, and it can be joined by emailing the authors of this paper. New members are added to the mailing list, and will be notified of future events and other items of interest relevant to the group's primary activities. Further details of the network are available online at http://www.birmingham.ac.uk/research/activity/mds/projects/HaPS/PCCS/MESH/ieen/index.aspx.

In April 2012 the IEEN organized a workshop at the Centre for Public Policy Research, King's College London, dedicated to discussing the relationship between aims and methods in interdisciplinary and empirical bioethics. The workshop had two primary objectives: first, the morning session was devoted to exploring some of the disciplinary ‘conflict’ that has developed in recent years by bringing together representatives from philosophical, legal and social scientific perspectives. Researchers from these disciplines often pursue their research according to different aims and methods, which has generated disagreement about the correct purpose of, and right way to conduct, bioethical scholarship.^2–7 Such disagreement can be a distraction for research, but it may also provide an opportunity for critical and constructive discussion, which might lead to new understandings and novel developments. The second objective of the workshop was therefore to consider the potential for greater cross-disciplinary collaboration in bioethics research, through discussion of examples of interdisciplinary and empirical bioethics research in practice. Throughout the workshop attendees were invited to bear in mind the following core questions: (1)

What is the relationship between disciplinary perspectives in bioethics scholarship?

Richard Huxtable (University of Bristol) opened the morning session by reflecting upon the relationship between law and bioethics. He argued that law, at least in principle, ought to be seen as an essentially moral enterprise so that legal and ethical studies can be seen as two disciplines with compatible aims, albeit with somewhat divergent methods. He neatly outlined the contribution that might be made to bioethics scholarship from a legal perspective in terms of law providing (i) a product for bioethical analysis, (ii) expertise in due process, and (iii) a site for practical decision-making. He then highlighted some potential difficulties in terms of (a) the adversarial style of law being a potential barrier to collaborative interdisciplinary bioethics, (b) the stress on action hindering some of the important theoretical nuances inherent to bioethics scholarship, as well as (c) concerns that bioethics may aspire to something richer than the minimal standards for conduct often provided by legal analysis.

Next, Mark Sheehan (University of Oxford) shared insights into the nature of bioethics from his background in philosophical scholarship. He began by characterizing bioethics as primarily concerned with answering ‘practical-ought’ questions, and claimed that addressing questions of practice and/or policy directly is essential to bioethical scholarship. Philosophical contributions to bioethics generally come in the form of providing normative and conceptual arguments that aim to justify certain practices and/or policies, and that the authority of these arguments reside in their universality - their capacity to be binding independently of any particular standpoint or context. Mark then pointed out that such abstractness exposes the limits of the contribution philosophy can make to bioethics. The universality, and consequent abstractness, of philosophical arguments is what provides them with their normative authority and may be the very thing that can make them unconvincing and impractical, because (1) they are insufficiently sensitive to the context in which they are to be applied and (2) they fail to persuade those who must act on their conclusions. These limitations reveal the need to explore new forms of interdisciplinary scholarship in bioethics involving a potential collaboration between abstract philosophical arguments aimed at rational and/or normative justification and more socially embedded forms of scholarship.

Ilina Singh (King's College London) began by asking how social scientists can contribute to bioethics. Her initial suggestion was that they can highlight ethically problematic situations/practices and identify how people understand and experience the problem under consideration. She gave the example of her research on the VOICES programme, ⁸ a study that interviewed children who have been prescribed stimulant drugs in order to develop a better understanding of their experiences of this treatment. Ilina argued that the experiences of the participant children is not only highly relevant to understanding the ethical dimensions of this prescribing practice, but also assists in the evaluation of the wider ethical discourse surrounding it. The descriptive methods of social science provide a means of understanding the ethically relevant facts of the situation. Ilina stressed, however, that the normative question of what ought to be done given understanding of these facts remained unaddressed, and it was in answering such normative questions that collaboration between social scientists and philosophers might be useful. For example, she suggested that it might be possible to use the views of the children interviewed to support the normative arguments that are made about prescribing stimulant drugs. In this sense, one model for an empirical ethics would be to combine elements of philosophical normative reasoning with an understanding of context to produce ethically informed practical policy recommendations.

An open discussion then followed which centred on the way such a model of interdisciplinary or empirical bioethics might work in practice. Mike Parker (University of Oxford) pointed out that many social scientists are interested in asking and addressing normative questions, so that reasoning about ‘ought’ questions ought not to be considered the sole preserve of philosophers. James Wilson (University College London) asked what the potential for interdisciplinary collaboration between philosophers and social scientists was if, as Mark Sheehan had suggested in his presentation, philosophical approaches to normative reasoning derive their strength from operating from an abstract universalist position. Mark responded by saying that such a process may start by considering ‘practical-ought’ questions in a specific context and then seeking to show how abstract philosophical reasoning may clarify issues at stake and suggest a way forward. Mikey Dunn (University of Oxford) echoed this point by suggesting that one of the major uses of philosophical method in bioethics will be to illuminate the hidden value judgements inherent within social scientific description. Angus Dawson and Jonathan Ives (both University of Birmingham) suggested that a critical reflexive attitude was essential for developing a model of interdisciplinary empirical bioethics directed at answering practical ought questions. Such a model can be seen as providing a variety of tools with which to address a range of complex ‘practical-ought’ questions, which might only be defined once enquiry has begun.

The afternoon session began with a presentation from Erica Haimes (University of Newcastle) in which she described her experience of working on ‘atheoretical’ empirical research projects, sociologically framed empirical research projects, and projects which seek to combine sociology and bioethics. She argued that there is nothing inherently ‘better’ about empirical research if it is conducted without reference to overarching epistemological and methodological framings, since any empirical work within bioethics requires (i) a theoretical framing for including that work and (ii) attention to methodological requirements in conducting that work. Erica outlined how she sees bioethics as capable of performing a combination of descriptive, analytical and normative tasks and how she has sought to do just this in her own work. This was illustrated with reference to a recently completed study investigating the perceptions of women providing eggs for research in exchange for reduced in vitro fertilization fees. ⁹ In practice, her role as someone involved in interdisciplinary bioethics has included appointments to various policy advisory and ethics committees, for which both descriptive and normative insights must be combined to produce practical and actionable advice for policymakers. Erica stressed that policy-oriented work has very different aims and methods to research in academic bioethics, underlining the need for reflexivity and awareness of the different purposes that distinguish one form of bioethics from another.

Next, Mikey Dunn presented a methodology for undertaking interdisciplinary bioethics research, which he framed as being intentionally provocative. He opened by posing three questions: What do valid methodologies look like? What counts as an ethical argument? What counts as an empirical argument? He went on to ask whether we can derive a valid methodology from the sort of research question that we are interested in, and proceeded to argue that, ostensibly, we can. Mikey illustrated his argument through reference to a recent research project that was concerned with the provision of community mental health care, and particularly with the question of whether practitioners should use leverage on their patients to promote adherence. The methodology Mikey used to answer this question was based on incorporating practical ethical reasoning into the research encounter itself. Focus groups were held in which participant practitioners were asked to construct normative arguments that would justify their decisions and subsequent actions. The researcher interacted with participants by using a form of Socratic method to examine, and at times challenge, the attitudes and experiences of practitioners. Thus, the focus group contained both empirical and normative elements, with data and normative analysis being synthesized in situ. Mikey explained that the goal of the focus groups was to give rise to convincing practical ethical arguments to answer the ‘practical ought’ research question based on the strength of the philosophical justification provided by argument. Mikey concluded by mentioning his concern that this approach may be disruptive for practitioners, particularly if focus groups generate conclusions that are not aligned with their experiences or current methods of practice.

Jon Ives (University of Birmingham) presented work from his research project on the Moral Habitus of Fatherhood, which highlighted a confluence of academic, policy and practitioner ‘drives’ that present a reason to be interested in the transition to fatherhood from a moral perspective. Jon identified a number of core normative questions that seemed central to the debate on this topic, including: does the transition to fatherhood present a problem that can, and should, be ‘fixed'?; Is the ‘fragmentation of fatherhood’ a moral and/or practical problem?; What sort of fathers do we want to create, and why? In answering these questions, Jon suggested that attention must be paid to the process by which men become fathers, and in particular to the normative agenda and moral discourses surrounding men's transition to fatherhood. His project has a particular focus on how first-time fathers construct and negotiate tensions between the various obligations they feel they must fulfil, and considers the role of the health services in this construction and negotiation. Jon went on to briefly describe a theoretical framework and series of epistemological commitments for this sort of research that explain and justify why a focus on normative issues requires a broad engagement with empirical and interdisciplinary questions. He proposed that a process of ‘reflexive balancing’ might be combined with a form of justificationary coherence theory, in a method that facilitates a rounded and complete normative analysis. He outlined briefly a concept he is developing called ‘quasi-moral foundationalism’, which would give this coherence theory its justificationary authority.

The workshop finished with a discussion session in which Zuzanna Deans (University of Bristol) brought up the question of whether, as well as being logically coherent, bioethics must seek to convince an audience. Mikey Dunn suggested that convincingness is crucial to bioethics since delivering a practical impact is a necessary characteristic of bioethics. While others disagreed with this characterization of bioethics as necessarily and exclusively oriented towards practice, it was agreed that engaging and convincing an audience posed problems for the presentation of bioethics research, both across and beyond the academy.

Jon Ives then brought the day to a close by offering five concluding points: (1)

There seemed to be broad agreement from those in attendance that interdisciplinary and empirical forms of ethics, and bioethics in particular, can benefit from engagement with a range of disciplines and there is significant scope for greater engagement in cross-disciplinary research in this area.