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====== THE ROLE OF PHILOSOPHICAL REFLECTION WITHIN THE FIELD OF BIOETHICS ======

While there is no attempt to rigidly define philosophy and exclude those perspectives that do not neatly fit the definition, this does not mean that there is no guiding sense of what philosophy is about and what it brings to the field of bioethics. Philosophers bring an interest in clarity and transparency, simplicity and economy of expression, and systematicity. And perhaps most distinctly, philosophers bring these interests together in order to grasp in thought the essential aspects of a practice, and understand these essentials in the light of previous aspirations (its history) and future goals. Such transparency for thought, simplicity of focus, and systematic reflection on the diverse elements of practice and context provide the vantage point for both criticism (e.g., does the practice live up to its ideals?) and constructive alternatives for improvement (how can  practice be reconstructed so that deficiencies are diminished, inconsistencies eliminated, and goals realized?). To this extent, philosophy is constitutive of human life more generally; it is essential to the way knowledge is created in science, and the ways such knowledge is realized in the learned forms of practice. When one refers to the “discipline of philosophy” or “the philosopher,” one is simply concerned with these activities in a more disciplined, rigorous, thoroughgoing, and explicit form.

To think of philosophy in this way highlights both what it might include and what it does not. First, regarding what philosophy is not: as a moment of life more generally — albeit an essential moment for the realization of human excellences — it is not the whole thing. As much as philosophers from Plato to Hegel have made pretense to subsuming the whole, or at least what was essential in it (whether as form or concept), and despite the earlier history where “science” (with the exception of theology) generally came under philosophy (as in “natural philosophy” for what we would call “natural science”), today the philosopher must accept a more modest place, especially when discussing the role of philosophy within bioethics and healthcare more generally. Any attempt to define philosophy in a way that encompasses the content of scientific knowledge would make the term useless in our current context — as if a physician-in-training learns the “philosophy” of anatomy upon entering medical school. Whatever philosophy of anatomy might mean, it can’t simply be equated with a knowledge of the essentials in that domain.

As a moment of life and not the whole, philosophy presupposes and directly relates to a content that is outside of its own domain; namely it relates to that which is not philosophy, or at least not just philosophy. Philosophy of science relates to science; philosophy of medicine to medicine. The same thing is true for the role of philosophy in bioethics. Although it is not as obvious as in the case of anatomy or medicine, bioethics is not simply philosophical ethics applied to healthcare. Bioethics is now an established practice, with its own history, culture, and norms. Like medicine, it has a body of knowledge and even its own apprenticeships. Bioethics can thus be presupposed by the philosopher in the same way that biology can be presupposed by the philosopher of biology.

All this does not imply that philosophical activity is somehow merely external to bioethics. It is, in fact, constitutive of the practice. But the philosopher cannot construct bioethics de novo, as if the norms of the field could in Euclidean fashion be spun out of “pure” philosophical premises. This kind of philosophical reconstruction might serve as a regulative ideal, but I am skeptical that the norms of health care can ever be established in such a manner. (Many philosophers will disagree with me on this point.) Whether or not they can be, we are not at that place; current attempts are at best provisional. This means that  the messiness and contingency ofthe field will be readily apparent in any attempt to take stock of it philosophically. Such messiness will be apparent even in the general divisions and categories used to describe the main areas. It is only with some violence that standard contrasts such as theory vs. practice or policy vs. clinical ethics can be used to organize this volume. In fact, a good case can be made that the next step in bioethics involves a challenge to some of the traditional divisions that have dominated the field to this point (see e.g., Bayertz and Schmidt in this volume).

Positively stated, the philosopher takes the given content of bioethics — that material that now constitutes its practice and conveys its norms — and subjects this to critical analysis, seeking to make explicit what is essential, analyze this in terms of deeper principles, and provide guidance for the next stage in reform. Paraphrasing what Joseph Boyle says about moral reasoning generally: the philosopher seeks to bring the moral life of health care under rational scrutiny. By reflecting on the history, goals and norms of health care, its moral life can be made transparent, allowing for the attainment of goals that are only partially realized. That is what the essays in this volume seek to accomplish.