Normative Methods and Theory
Without proper explanation, the phrase “normative methodology” may conjure up images of marathon meditation sessions from the armchair. Alternatively, one may incorrectly assume it is just a matter of gathering and aggregating the moral opinions of others or stating one’s own moral convictions as fact. In truth, normative methods can provide robust and systematized ways of investigating bioethical inquires without solipsistic self-insertion or bandwagon ethical appeals.
In their 2022 book, A Theory of Bioethics, authors David DeGrazia and Joseph Millum defend a version of reflective equilibrium, a concept popularized by renowned philosopher John Rawls in his 1971 book, A Theory of Justice. The authors utilize reflective equilibrium as the basis for normative methodology in bioethics, describing the process thusly:
We start with our existing ethical beliefs about cases and principles, weed out those that are thought to be unreliable, and then adjust the remaining set in order to make it as coherent as possible. (DeGrazia, Millum, 2022).
The end-goal of reflective equilibrium is “a set of principles that fit together as a single theory and which, along with the relevant empirical facts, entail the moral judgments about cases that we think are correct” (ibid).
For an example of reflective equilibrium in action, consider a scenario described by Millum and DeGrazia. Imagine a discussion arises concerning the ethics of medical assistance-in-dying (MAiD). Per the approach of reflective equilibrium, interlocuters will want to try and demonstrate how their judgments for a particular case are consistent with shared and accepted, overarching moral principles. In the resulting exchange, “Someone might invoke the importance of the right of competent adults to decide what happens to their bodies, or a physician might note the apparent incongruity between causing death and the role of healer” (ibid). Resolution to this quandary will require attempts by the speakers to either reconcile conflicting imperativesor justify privileging one over the others (maybe the patient right to bodily autonomy trumps a physician’s role as healer, or vice versa). Often, one accepted principle will demand mutually exclusive action with the dictates of another principle. Accordingly, the task at hand when utilizing reflective equilibrium is to carefully consider the inconsistencies in one’s own judgments and put a finger on what moral commitments one is most confident about for the case at hand.
Bioethicists have employed additional methods of normative theorizing, such as principlism and casuistry, but these are best understood as variants of (or the result of) the process of reflective equilibrium rather than strict departures or novel approaches. Under principlism, a set of foundational principles serve as the primary action-guidance for dealing with particular cases. Notable principlists Tom L. Beauchamp and James F. Childress introduced the four-principles approach to biomedical ethics, whose titular principles are beneficence, nonmaleficence, autonomy, and justice (Beauchamp, Childress, 2019). Conversely, casuists like Albert Jonsen and Stephen Toulmin emphasize the particularities of individual cases and their contextual elements to derive right moral action. Casuists prefer to analogize from watershed cases for which we hold confident moral judgments rather than take a top-down approach from principles (Jonsen, Toulmin, 1989). The end goal is coherence across judgments, cases, or principles.
Normative Argumentation
Knowing the dos and don’ts of normative argumentation is critical for producing suitable critique and analysis of bioethics literature, as well as for making one’s own normative arguments. Authors Laurence B. McCullough, John H. Coverdale, and Frank A. Chervenak provide a robust tool for the construction and evaluation of normative medical ethics articles in their article, “Argument-based medical ethics: A formal tool for critically appraising the normative medical ethics literature” (McCullough et al., 2004). Table III of this article delineates the following checklist/questionnaire for a reader (or writer) to consider when reviewing (or writing) a normative bioethics article:
- Does the article address a focused ethics question?
- Does the article address a clearly stated and focused ethical issue or problem?
- Is the issue important, and if so, why?
- Is justification for the importance presented? From whose perspective is importance claimed?
- Are the arguments and analysis that support the results (conclusions) of the article robust?
- Is the literature search complete?
- Are the analysis and argument of cited papers reported clearly and accurately?
- What is the quality of the paper’s ethical analysis and argument(s)?
- Is the argument valid (does the conclusion necessarily follow from the premises?)
- Is the argument sound (are all the premises true; are potential objections and counterexamples addressed)?
- Are concepts that are appealed to (e.g., coercion, autonomy, trust, fairness, harm) clearly and carefully defined?
- What are the results? What are the conclusions of the paper’s ethical analysis and argument?
- Will the results help in practice?
- Will the help be practical?
- Will the help be theoretical?
- How should the reader change his or her thinking, aptitudes, practices, or policies?
Reasonable people can and will disagree on fundamental ethical questions (e.g., should the project of ethics be devoted to maximizing happiness and minimizing suffering, or cultivating individual excellence of character, or some other goal?). This fact, however, does not preclude setting shared standards for the proper construction of bioethical arguments. At minimum, compelling bioethics literature ought to possess logical coherence and validity, and the above criteria serve as a good rubric.
Works Cited
Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. Eighth edition. New York: Oxford University Press, 2019.
DeGrazia, David, and Joseph Millum. 2021. A Theory of Bioethics. 1st ed. Cambridge University Press. https://doi.org/10.1017/9781009026710.
Jonsen, Albert R., and Stephen Edelston Toulmin. The Abuse of Casuistry: A History of Moral Reasoning. Nachdr. Berkeley, Calif.: Univ. of California Press, 1989.
McCullough, Laurence B., John H. Coverdale, and Frank A. Chervenak. 2004. “Argument-Based Medical Ethics: A Formal Tool for Critically Appraising the Normative Medical Ethics Literature.” American Journal of Obstetrics and Gynecology 191 (4): 1097–1102. https://doi.org/10.1016/j.ajog.2004.06.060.
Rawls, John. 1999. A Theory of Justice. Rev. ed. Cambridge, Mass: Belknap Press of Harvard University Press.