by Ivan Cavicchi
How is it possible that bioethics has said so little about the “medical question”, that is the deep crisis of the most important profession of medicine? How is it possible that with a full-blown crisis in scientific medicine there are no indications of his work? How is it possible that in the whole pandemic, bioethics as a discipline did not have a public space? That is, how is it possible in a pandemic that has caused hundreds of thousands of deaths to give rise to an absurd dichotomy between bioethics and science? Between bioethics and politics?
27 MAG –
Premise
As has been known for years, my subjects of study are healthcare and medicine.
For gnoseological and heuristic reasons I have personally always preferred philosophy to bioethics, but by philosophy I mean a kind of large “box”, that is a vast department, in which to put everything, in a patient, is irreducible to substance: ontology, heuristics, epistemology, morality, ethics, science, logic, etc.
If medicine is an unparalleled science then its heuristics must be equally unparalleled. It is just a question of complexity.
If I look at the great open problems in both healthcare and medicine and I turn back to see the intellectual path I have made, I declare myself satisfied with my choice. Today without an incomparable heuristic I would certainly not have been able to write and propose everything I have written and proposed.
Is bioethics an incomparable knowledge or not?
Bioethics and more
If I, too, in the 80s, with the same knowledge objectives, had followed, as many have done, the boom in bioethics, officially full-blown bioethics, I would probably have been forced to transform bioethics into the “box” I was talking about before without which I’m sure I wouldn’t have been able to get close to the things I was interested in studying.
Bioethics as a whole is for better or for worse what it is. In my opinion (a completely personal opinion) it is less than what it could be and should be, so it is clear that its value is not only heuristic but also normative and social.
Having said that, I must honestly say that bioethics in comparison with the great complexities, with the great crises, with the great contradictions of medicine and healthcare, despite itself betrays important limitations and blatant incapacities.
Let’s leave aside, as the mathematicians would say, the extremes of the function, that is the “bioethics of everyday life” and the “frontier bioethics” on the relationship between life and death, but to me, who deal with the crisis of medicine and health care, it is these major crises that I would like bioethics to provide us with a contribution by helping us to make the most appropriate choices. That is, helping the whole hut to raise a thought of reform.
But to ensure that bioethics help the shack I consider it quite obvious that bioethics is interested in this crisis, that it studies it with its tools but above all that it comes up with “its” proposals to resolve it. That is, proposals that given the nature of bioethics only bioethics can make. It is not enough that bioethics is in agreement with science or with law or with sociology with management
How is it possible that bioethics has said so little about the “medical question”, that is the deep crisis of the most important profession of medicine? How is it possible that with a full-blown crisis in scientific medicine there are no indications of his work? How is it possible that in the whole pandemic, bioethics as a discipline did not have a public space? That is, how is it possible in a pandemic that has caused hundreds of thousands of deaths to give rise to an absurd dichotomy between bioethics and science? Between bioethics and politics?
I repeat I am not a bioethicist even though I often wonder who bioethicists are and why they are defined as such, but I know that there is bioethics, that there is a CNB, with all its defects and its merits and I know that both in health care and in medicine, for the common good, we should prepare reforms, that is, think about changes, and I know that bioethics could give us, under certain conditions, an important hand with respect to these changes. I also know that if bioethics does not help others will have to work for it, taking its place.
Bioethics (LB)With this conviction and after having participated in an interesting national webinar of biotechists on the problems of medicine masterfully organized by Silvana Cagiada (May 14), teased by the debate and the questions posed, I read the book just released by Luisella Battaglia (from now on one LB) “Bioetica” (Editrice bibliografica2022), that is the book of a bioethicist a true pioneer that I have known and followed for years and that I consider “okay” in every sense.
I must say that the conviction from which I started after reading the book has strengthened. Bioethics, as LB writes well, has its own original space for reflection but which, in my opinion, with respect to the problems of medical reality, probably requires a specific incisive theory, I would dare to say “characteristic” but, I immediately clarify, for the sole purpose of being able to use it specifically in equally specific medical realities that it faces. So for the sole purpose of being able to use it in a pragmatic way. Bioethics is not the declamation of principles but rather their pragmatic use in the given complexities.
Global bioethics
In general, as LB explains very well, citing Jahr, Warren Reich, Danner Clouser and the various masters of complexity, the tendency that prevails is to think of a global bioethics, that is, an all-encompassing bioethics, entitled to intervene on practically everything, but I wonder as an epistemologist how global must bioethics be to specifically bite the world‘s problems?
The question is: given a globality which is its heuristic specificity?
And if in order to be global, other globalities are mimicked until they are superimposed on them? For example, the box of philosophy or that of science? And if in order to be global, one becomes only encyclopedic, that is, unnecessarily holders of formal skills without affecting anything?
In these cases, what can I do with a purely conventional bioethics? To me today, who are grappling with the profound crisis of medicine, we need a bioethics capable of supporting in certain pre-defined fields the necessary reform choices that politics should make if it were able to do its job.
Taking up LB who rightly considers the relationship “society technology medicine” as a privileged object of study of bioethics (even if I add not exclusive), I say what I need and that is a bioethics not so much that knows everything but a bioethics of interconnections, that is, a bioethics that knows how to tell me the problems that exist not in society in technology or in medicine, but specifically in the difficult relationship between society, technology and medicine, helping me to find plausible solutions.
Basically, I think that bioethics should be characterized not through its formal conventional competences but through its substantial solutions, those it proposes as bioethics towards the problems that exist. I am saying that more than his encyclopedic knowledge should be the ways of solving the problems that should characterize the role of bioethics.
The ways of bioethics should be the proper ways of bioethics and differ from other approaches because the other approaches are different from bioethics that is, they are other ways of knowing.
Two big questions: eschatology and ethical space
The discussion with bioethicists and reading LB’s book in particular on the role of bioethics in relation to medicine made me think. And in particular on two issues that I consider crucial.
These are: the eschatological function of bioethics and the ethical space.
It is called eschatology (éskhatos ‘ultimate’), that particular philosophy which has as its object of study the ultimate destiny of the single individual, of the entire human race and even of the universe.
As it is linked to the ultimate expectations of man by now in this society of rights, of self-determination, of the individual, eschatology no longer concerns only our otherworldly problems, therefore our personal metaphysical visions of the world, but also, if not before of everything else, our earthly problems, the physical, bodily ones, the natural ones. The living will (dat) is an example of secular eschatology. In the event of having a disease, deciding in advance what it will be necessary to do or not to do is part of the logic of eschatology.
But if we enter this logic then:
- the cure of human disease would be none other than the use of science to govern eventuality (biological destiny);
- medicine in its turn would inevitably become eschatology, that is, a philosophy as well as a science that takes care of the “ultimate destiny of man”.
Also in order to better specify certain uniqueness of bioethics, if I were a lover of bioethics, I would do an exploration of the relationship between bioethics, eschatology and medicine. If bioethics succeeded in proposing itself as an eschatological reflection on our biological and existential complexities, it would have everything to gain.
The ethical space
The eschatological themes of bioethics all have to do with the problem of man’s vulnerability. If man were not vulnerable, the problem of eschatology would not arise.
Bioethics, as LB well explains, is mainly moral attention towards vulnerable subjects. A sick person is by definition a vulnerable person.
But the moral attention towards these subjects takes place through organized spaces which are called “services” and which as such pose a new question that the NBC has defined as the question of “ethical space”.
I think that the organization of the ethical space is a purely bioethical question. What are we talking about?
To take up the words of the NBC, it is a model with “multiple application potentials” intended as a “place for listening, meeting and exchanging personal and professional life experiences in which to give voice to individual citizens and the associations that represent them. “
Pay attention to the various steps:
- through bioethics, eschatology is joined to dialogue
- bioethics, with regard to care, proposes to conceive health services as ethical spaces;
- this means that bioethics to create ethical spaces proposes medicine to universities to scientific societies to trade unions to rethink the way of doing the clinic of positivist medicine.
This is an example of how bioethics in the midst of the crisis of scientific medicine, under certain conditions, could contribute to the rethinking of medicine itself. It is basically a matter of transforming the important idea of ethical space into a proposal for the reorganization of professional practices and services.
It is evident that the idea of space in question is not the classic Euclidean one of service where the patient is “parallel”, that is juxtaposed to the doctor, but it is the hyperbolic one where many different intersections are possible, that is, many different ways of expressing relational practices.
Bioethics could help us to define through the ethical space what a relational praxis is.
Ivan Cavicchi
27 maggio 2022
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