Should there be sub-specialties in bioethics? To split or not to split…

Looking down at shoes and legs from above, left foot is on plain red carpet, right foot is on brightly patterned carpet

Credit: Joshua Coleman

By Cynthia Forlini, Wendy Lipworth, Ainsley Newson (who all contributed equally)

In May 2018, Wendy gave a seminar at our Centre on whether there was more than one way of ‘doing’ bioethics. She talked about the ongoing phenomenon of splitting bioethics scholarship into sub-specialties.

This question arose for her because she had been grappling with how to pull together her many research interests into a coherent narrative, with the goals of developing a productive research program and progressing in her career (e.g. having a story to tell in grant and promotion applications). Specifically, Wendy was wondering whether she can and should construct a new sub-specialty of bioethics in pharmaceutical ethics, given that this theme seemed to connect many of her interests.

This got us all talking, because it turns out that each of us had had a similar experience, at various points in our careers, across three continents. Each of us identifies with mainstream bioethics, but can be said to work in a sub-specialty that addresses a distinct subject matter. Wendy’s work seems to coalesce around issues to do with therapeutics, Cynthia’s expertise lies in neuroethics, and Ainsley has spent a very long time thinking about ethics and genetics.

At the same time, we also realised that despite our different day to day domains of application, many similar concepts underpin our work, which led us to wonder: what’s the point of naming a sub- specialty if we are all working on similar concepts?

So, we came together over a glass of wine to think through the pros and cons of having sub-specialities in bioethics. This is not a new issue, but we thought it was worth re-inventing the re-invented wheel, in the hope of gaining some traction this time.

In her talk, Wendy referred to a 2007 paper by Fritz Allhoff that she found helpful. Allhoff makes a useful distinction between what he called ‘metaphysical splitting’ (which is the claim that these things are somehow new or different) and ‘pragmatic splitting’ (which entailed paying attention to particular things even if they are not really unique). Wendy also drew on some of her earlier work on exceptionalism in evidence-based medicine, biobanking and big data that showed that there are both advantages and disadvantages of viewing emerging phenomena as different from existing ones.

Over the course of our evening, we discussed some of the key claims for and against splitting bioethics (aka creating sub-specialties). These resonated with our collective experience of navigating specific areas of interest within mainstream bioethics.
Arguments for metaphysical splitting basically collapse into arguments that things are new, and therefore warrant special attention. This novelty might stem from:

  • a new practice or scientific technology that needs examination (e.g. gene editing);
  • a new scale or urgency of an existing issue (such as privacy issues associated with “big data” and machine learning);
  • a new moral problem (such as free will in neuroethics) or form of moral argumentation (such as the claim in public health ethics that the hegemonic status of individualism should be challenged); or
  • a new meta-ethics (e.g. in neuroethics where you think about how brains “do ethics”)

The primary claims against (naïve or unjustified) metaphysical splitting are that it:

  • draws false distinctions, and thus sacrifices richness and depth of scholarship;
  • precludes opportunities for cross-fertilisation of ideas;
  • gets confusing, as people use different terms to mean the same thing;
  • can entrench blind spots, because scholars cannot see that they have common concerns;
  • legitimates hype by portraying issues as being new and different; and that it
  • obscures the opportunity to actually identify any real differences.

It could be argued that, even if a phenomenon is not really new or different, there is still benefit in acting as though it is and paying special attention to it (i.e. pragmatic splitting). Pragmatic splitting is supported by claims that it is impossible for us to be across every issue, concept and theory. Focusing on a particular sub-specialty allows us to gain expertise of that speciality and acquire the necessary deep knowledge (including practical or policy knowledge) to do high quality research.

Being a specialist also, for better for worse, allows us to attract funding and be known for a particular domain of work. Further, we all come from ‘somewhere’ and we bring with us our disciplinary footprints.

Claims against pragmatic splitting are that it tends to be driven by money, self-importance or ivory tower interests rather than genuine need. It can treat certain issues exceptionally, such as how genetic information should be managed. This isn’t an argument against splitting so much as a perverse consequence of it. Pragmatic splitting also draws attention to certain things over others; and that attention can be misguided, such as devoting energy to arguing about the right to pay for cosmetic surgery when there are entrenched inequities in access to basic healthcare.

So where does this leave us?

We took away from this discussion that there is no one position here that is clearly superior—at least for the moment. If we do want to try to figure out an answer (and we weren’t quite in agreement about whether an answer is necessary or possible), then we will need to address several fundamental questions: What is bioethics for? What outcomes do we want it to achieve, and how? What kind of a field do we want to work in, and how might specialising help or hinder?

One thing we do agree on is that, if we do keep some ‘walls’ up in bioethics, it is important to take a peek over the top every now and then. If we don’t, we may miss opportunities for rich scholarship, where similar concepts and theories have traction across numerous specialties in bioethics. Each of us also might also be wise to reflect on our academic journeys (no matter how far along the road we are), and to question our intuitions and practices with respect to sub-specialties in bioethics.

Dr Cynthia Forlini is a Research Fellow in neuroethics at Sydney Health Ethics, University of Sydney. She was awarded an Australia Research Council Discovery Early Career Research Award (2015-17) for her work on cognitive ageing.

Associate Professor Wendy Lipworth is a bioethicist and health social scientist at Sydney Health Ethics, University of Sydney.

Ainsley Newson is Associate Professor of Bioethics and Deputy Director of Sydney Health Ethics at the University of Sydney

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