A blog from the Centre for Research Ethics & Bioethics (CRB)

Month: November 2013

Beware of the vanity of “autonomy”

Important words easily become totalitarian. They begin with communicating some humanly important point, so we listen with attention. But then it is as if the words suffered from vanity and assumed that our attention was directed at them; not at what they were used to say.

Over time, the words become like grammatical codes of importance in human life.

A word that underwent such a process in bioethics is autonomy. It was first used to communicate an urgency, namely, that patients and research participants must be respected. They have a right to information about what is about to happen, and to decide whether they want to undergo some treatment or participate in some experiment.

Patients and research participants have this understandable right to autonomy.

But as the word was used to communicate this urgency, the importance seemed to move into the word. If patients have a right to “autonomy,” mustn’t autonomy be a valuable trait that can be supported so that we increase the value?

Is autonomy perhaps even the most valuable aspect of the human: our characteristic when we are in our most rational state as rational animals. Perhaps autonomy is human essence?

From having been a comprehensible right, autonomy assumed the appearance of a super important value to constantly look for, like for a holy grail.

The question arose: Should we restrict people’s freedom to make own choices, if the choices threaten future autonomy?

We occasionally do disrespect people’s choices: for their sake. What I’m blogging about today is the tendency to replace “for their sake” with “for the sake of future autonomy.”

A new article in the Journal of Medicine and Philosophy deals with the question. You find the article by clicking the link below:

The article is written by Manne Sjöstrand, Stefan Eriksson, Niklas Juth and Gert Helgesson. They criticize the idea of a paternalistic policy to restrict people’s freedom in order to support their future autonomy.

The authors choose to argue from the opponent’s point of view. They thus start out from the interpretation of autonomy as super important value, and then try to show that such a policy becomes self-defeating. Future autonomy will be threatened by such a policy, much like the dictatorship of the proletariat never liberated humans but chained them to a totalitarian order.

The article is well-argued and should alert those enchanted by the word “autonomy” to the need of checking their claims.

Even though the article does not disenchant the concept of autonomy through the philosophical humor that I described in a previous post, I was struck by the tragicomedy of claiming that the ultimate reason why healthcare staff should not comply with a patient’s request for help to die is that… assisted death would destroy the patient’s autonomy.

Pär Segerdahl

Minding our language - the Ethics Blog

Biobank and registry-based research: our publications

At the Centre for Research Ethics and Bioethics in Uppsala, we have since the 1990s been studying the ethics of biobank and registry-based research.

If you are interested to see what we have done in this field, you can find a recently updated list of our publications by clicking the link below:

The compilation also contains abstracts of the publications.

Pär Segerdahl

Approaching future issues - the Ethics Blog

Disciplined behavior and original sin

This is a follow-up on my earlier post, Questionable questionnaires. In the article that I blogged about, Kevin P. Weinfurt provided two cautions to empirical bioethicists who are using questionnaires. I summarize them:

  1. Egocentrism: the all-too-human self-centeredness of the bioethicist who spent years thinking about particular ethical issues in particular ways, and who designs questionnaires as if these issues basically were real in the same way also for patients, doctors, nurses, research participants, donors…
  2. Literal-mindedness: partly because scholars have disciplined their linguistic habits, they easily overlook the possibility that people do other things with their words than literally describe what they think (e.g., when asked how they consider their chance of benefit from an experimental therapy, they may express hope or loyalty with the care team).

Today I want to highlight this remark in the article:

  • “These cautions are not in themselves new types of methodological missteps, but rather two potential underlying causes of frequently encountered missteps.”

Egocentrism and literal-mindedness are sources of methodological missteps, not further missteps. They are “pernicious habits of mind that plague all of us who are trying to understand patients, physicians, research participants, and others.”

I found this remark interesting, because it puts the emphasis on the researcher as a living person rather than on researcher behavior.

Poor sample selection, invalid inferences and other missteps occur in the behavior of researchers. Methodological rules address missteps on the same behavioral level: do this rather than that, and you’ll enter the secure path of science.

The two cautions are different. They challenge us to work on our habits of mind, on our self-awareness. Merely adopting other behaviors as researchers, which methodology typically aims towards, will not be sufficient if we refuse to face the persistent sources of the missteps within us.

It is no coincidence that the cautions are derived from the work of two philosophers, William James and Ludwig Wittgenstein. Philosophy is a self-searching activity.

I take Weinfurt’s article to be saying that there is no methodologically secured path of science, and certainly not if methodology is understood only in terms of disciplining researcher behavior.

Good and honest scientific work needs to include also exercises of human self-awareness. For researchers will continue to exist as living persons, not only as disciplined performers of more or less correct behaviors.

In a sense, one might say that the two cautions are reminders of original sin.

Pär Segerdahl

We think about bioethics : www.ethicsblog.crb.uu.se

Humorous and comical thinkers

In my philosophical reading experience it is striking that some thinkers crack really good jokes. They are humorous and I laugh with them. Others are comical in their unyielding seriousness: difficult not to make jokes of.

Humor is not exactly what you think of when you think of philosophy. Hardly anyone reads philosophy to get a good laugh, and neither do I. But when philosophizing, joking surprisingly often lies just around the corner.

Those unexpected jokes often pinpoint the really sensitive issues.

Philosophy approaches you with such extreme demands. Demands for absolute certainty; demands for complete universality: demands for vantage points so primordial that they don’t even belong to life, but “precede” all tying of shoelaces and other trivialities that people are busy doing without reflecting.

The need to joke arises under the pressure of these demands.

The contrast between the absolute demands and the life that you nonetheless live becomes comical. You can then either persist in making the demands even more rigorously, becoming a comical thinker, or you can become a humorous thinker who cracks jokes under the pressure of the demands – to return you to life.

In this spirit, Derrida made the following joke of the absolutely certain human vantage point that Descartes thought he found in his cogito ergo sum:

  • “I breathe therefore I am,” as such, does not produce any certainty. By contrast, “I think that I am breathing” is always certain and indubitable, even if I am mistaken. And therefore I can deduce “therefore I am” from “I think that I am breathing.”

“Even if I am mistaken”: even if I am dead. Derrida’s joke opens up Cartesian certainty to doubt. Absolute certainty about my human essence that is compatible with my no longer being alive: how can it be “what I am”!?

Wittgenstein said that he could imagine a serious and good philosophical work that consisted entirely of jokes. I could imagine such a work beginning with Derrida’s joke.

The need to think can be a need to joke!

Pär Segerdahl

The Ethics Blog - Thinking about thinking