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Abstract

This paper explores an emerging sub-field of both empirical bioethics and experimental philosophy (“x-phi”), which has been called “experimental philosophical bioethics” (“bioxphi”). As an empirical discipline, bioxphi adopts the methods of experimental moral psychology and cognitive science; it does so to make sense of the eliciting factors and underlying cognitive processes that shape people’s normative judgments, particularly about real-world matters of bioethical concern. Yet, as a normative discipline situated within the broader field of bioethics, it also aims to contribute to substantive ethical questions about what should be done in a given context. What are some of the ways in which this aim has been pursued? In this paper, we employ a case study approach to examine and critically evaluate four strategies from the recent literature by which scholars in bioxphi have leveraged empirical data in the service of normative arguments.
Vol.:(0123456789)
Theoretical Medicine and Bioethics (2021) 42:91–111
https://doi.org/10.1007/s11017-021-09546-z
1 3
Experimental philosophical bioethics andnormative
inference
BrianD.Earp1,2 · JonathanLewis3 · ViliusDranseika4 ·
IvarR.Hannikainen5
Accepted: 15 September 2021 / Published online: 17 November 2021
© The Author(s) 2021, corrected publication 2021
Abstract
This paper explores an emerging sub-field of both empirical bioethics and experi-
mental philosophy, which has been called “experimental philosophical bioethics”
(bioxphi). As an empirical discipline, bioxphi adopts the methods of experimental
moral psychology and cognitive science; it does so to make sense of the eliciting
factors and underlying cognitive processes that shape people’s moral judgments,
particularly about real-world matters of bioethical concern. Yet, as a normative dis-
cipline situated within the broader field of bioethics, it also aims to contribute to
substantive ethical questions about what should be done in a given context. What
are some of the ways in which this aim has been pursued? In this paper, we employ
a case study approach to examine and critically evaluate four strategies from the
recent literature by which scholars in bioxphi have leveraged empirical data in the
service of normative arguments.
Keywords Experimental philosophy· Empirical bioethics· Experimental
philosophical bioethics· Normative inference· Moral judgment
* Jonathan Lewis
jonathan.lewis-2@manchester.ac.uk
Brian D. Earp
brian.earp@yale.edu
1 Departments ofPhilosophy andPsychology, Yale University, NewHaven, CT, USA
2 Uehiro Centre forPractical Ethics, University ofOxford, Oxford, England,UK
3 Centre forSocial Ethics andPolicy, The University ofManchester, Manchester, UK
4 Interdisciplinary Centre for Ethics and Institute of Philosophy, Jagiellonian University, Kraków,
Poland
5 Department ofPhilosophy, University ofGranada, Granada, Spain
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Introduction
In 2019, the first international conference on experimental philosophical bioethics
(bioxphi) was held at Yale University [1]. The aim of the conference was to bring
together experimental philosophers working on bioethical issues and bioethicists
interested in using experimental methods from cognitive science and experimental
moral psychology to inform their normative inquiry. A short position statement was
drafted, and later published, spelling out the distinctive features of this emerging
sub-field of both empirical bioethics and experimental philosophy (x-phi) [2].
One important aim of the workshop and the ensuing position statement was to
probe the relationship(s) between, on the one hand, empirical findings in the cogni-
tive sciences and, on the other hand, normative or other philosophical questions at
the heart of bioethics. In this paper, we aim to build on that ambition by exploring
in greater detail how bioxphi studies have already offered normative insight into key
bioethical issues, including the criteria for death determination and the necessary
conditions for giving valid consent. Through a series of case studies, we analyze
four argumentative strategies adopted more or less explicitly in recent scholarship.
These case studies help to illustrate the pragmatic spirit of bioxphi, by which it
seeks to build bridges between the empirical and normative programs of bioethi-
cal inquiry. At the same time, the cases represent good-faith attempts to assuage the
concerns of moral philosophers who caution against drawing normative conclusions
directly from empirical facts, as we will discuss.
Let us start by saying what this paper is not. It is not an attempt to recatego-
rize existing methods or approaches within the parent disciplines of bioxphi, namely
x-phi and empirical bioethics, nor does it seek to place those methods or approaches
into a new typology. With respect to empirical bioethics research, for example, we
recognize that a large number of methodologies have been employed which are not
accounted for in the case studies below (see, e.g., [3]). Consequently, by exploring
these four recent strategies for drawing normative conclusions from premises that
include empirical content, we do not suggest that these are the only strategies biox-
phi practitioners should employ. Rather, we hope to elucidate such strategies as they
are currently being pursued within bioxphi, while remaining open to the possibility
that other strategies from empirical bioethics could be adapted to research that rests
more heavily on experimental study designs. To this end, we will start by situating
this new area of research within its historical and disciplinary contexts.
Situating bioxphi: principlism, empirical bioethics, andexperimental philosophy
Broadly speaking, bioethics grew out of the need to make real-world moral decisions
in response to gross human rights abuses, from Nazi war crimes to the Tuskegee
Syphilis Study [4, 5]. Rapid innovations in health care during the 1960s also raised
pressing ethical questions, including questions about how to fairly allocate life-sav-
ing technologies [6]. By the 1970s, it was clear that the field lacked a unifying the-
ory for guiding such moral decisions, with different practitioners relying on different
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Experimental philosophical bioethics andnormative inference
meta-ethical frameworks along with their own individual moral judgments about
particular cases. Responding to this situation, scholars Tom Beauchamp and James
Childress led the development of a shared normative framework that sought to
incorporate long-standing clinical duties to maximize benefits and minimize harms,
while also addressing concerns about justice and autonomy [7]. This approach was
thought to provide a common source of normative guidance that bioethicists from a
range of theoretical backgrounds could appeal to in their deliberations.
The four principles approach to bioethical analysis remains widespread to this
day [8]. But even taking such principles for granted, questions remains about how
they should be applied to specific scenarios or balanced against one another insitu-
ations where they seem to conflict [9]. A common strategy has been to take a coher-
ence-seeking approach in which the practitioner tries to achieve a kind of reflec-
tive equilibrium. That is, she attempts to “harmonize all the elements contributing
to moral judgment, including intuitions about cases, moral principles, moral theo-
ries, and background theories of moral agency and social organization” [10]. Within
this method, moral theories and principles function to “organize, explain, criticize,
and extend our intuitive responses to cases,” while at the same time, “those very
responses can, in turn, help us to amend and sharpen our principles and theories
when they prove inadequate to the complexities of emerging cases” [10].
To better appreciate this general strategy, it is necessary to ask who the implied
“we” is in the reference to “our” intuitive responses to cases. For the sake of clar-
ity, the responses of interest here are judgments regarding particular bioethical sce-
narios—for example, judgments that a certain course of action is morally preferable
to another or that a given behavior is permissible or impermissible. These sorts of
judgments have, traditionally, been those of the bioethicist, philosopher, theologian,
or legal professional (in what follows we will shorten this list to “bioethicist” for
simplicity). In this way, the judgments of particular individuals have long provided a
key source of data for “armchair” approaches to bioethics, including the coherence-
seeking kind described above. But what if the judgments of bioethicists differ from
those of lay people [11, 12], or from those of other stakeholders with different levels
of expertise who operate across the relevant domains (e.g., health care practitioners,
policymakers, patients, their families)? One possibility is that a bioethicist’s specu-
lative reflection, especially on abstract or idealized cases, might fail adequately to
capture the concrete normative and empirical issues at stake in clinical contexts.1
This, in turn, might call into question the real-world relevance of such reflection
for both practice and policy.2 If the goal is to develop a normative position regard-
ing everyday clinical practice, for example, might the judgments of doctors or their
patients constitute more relevant data? And supposing that the relevant empirical
data pertaining to various stakeholder judgments have been identified, (how) can
normative inferences be drawn on the basis of such data?
1 For a robust account of the different ways in which bioethics can bring moral reason to bear on practi-
cal issues, see [8].
2 For example, see [8, 13] for potential problems with a well-known theoretical critique of the distinction
between active and passive euthanasia [14].
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Empirical bioethicists have responded to these questions in a number of ways.
According to a recent systematic review [3], the majority of methodologies
employed in empirical bioethics can be classed as either dialogical or consultative.
Dialogical approaches involve actual dialogues between researchers and stakehold-
ers aimed at reaching a shared understanding and a joint resolution to a particular
bioethical problem. Consultative approaches involve collecting empirical data relat-
ing to stakeholder views, attitudes, and experiences, and then using these as a basis
for drawing normative conclusions. For the majority of consultative approaches, the
end goal is the achievement of coherence either between stakeholder data and moral
theory (narrow reflective equilibrium) or between stakeholder data and broader con-
siderations, such as background theories, moral principles, expert intuitions, morally
relevant facts, and considered judgments (wide reflective equilibrium).
According to Rachel Davies and colleagues, the key difference between dialogi-
cal and consultative methods is the role of participants: whereas participants in dia-
logical approaches work together with researchers to analyze stakeholder data and
develop normative conclusions regarding discrete problems on the basis of consen-
sus, participants in consultative approaches do not take part in the analysis or the
process of forming normative conclusions [3]. Furthermore, the aims of consultative
approaches vary, “ranging from theory development to the generation of concrete
answers to discrete problems” [3, p. 7]. In addition, when consultative approaches
aim to reach normative conclusions regarding a specific problem, they tend to
employ coherence-based methodologies like the ones described above [3].3
Now we can ask how practitioners of x-phi, the other parent discipline of bioxphi,
glean (meta)philosophical insights—including but not limited to normative infer-
ences—from empirical data regarding human psychology. The answer to this ques-
tion depends on how these practitioners interpret the purpose or function of x-phi
in general. At least two main purposes have been identified, corresponding to two
separate research programs, each of which can be understood in relation to the tradi-
tion of conceptual analysis in analytic philosophy [2025].
The first program aims to make a positive contribution to conceptual analysis,
though not necessarily through the provision of necessary and sufficient conditions
for concept application (positive x-phi). The second program engages negatively by
providing evidence against the intuitive assumptions of more traditional approaches
to conceptual analysis (negative x-phi). However, as Joshua Knobe argues, regard-
less of which program they may claim to be pursuing, what x-phi researchers typi-
cally do in their studies is investigate experimental effects on psychological struc-
tures thought to underpin judgments held by participants [22, p. 42]. Consequently,
the cognitive science characterization of x-phi suggests that experimental philoso-
phers study causal effects on people’s judgments in order to map and explain such
3 Many moral philosophers hold that one cannot directly infer an “ought” from an “is.” By contrast,
within the domain of health-related public policy, empirical research has often been viewed as affording
direct normative insight into what should be done or recommended. For instance, the United Kingdom’s
Human Fertilisation and Embryology Authority (HFEA) seems to have grounded a public policy posi-
tion denying sex selection for social (non-medical) reasons on the normative weight of public opinion
alone [8, 1519].
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Experimental philosophical bioethics andnormative inference
judgments using theories about underlying cognitive processes [22, p. 50]. As we
demonstrate in the five case studies below, it is this characterization of x-phi as cog-
nitive science that is especially important for understanding what some recent biox-
phi studies have been trying to achieve, specifically in terms of generating normative
conclusions from premises that include empirical assertions.
Bioxphi: aims andexperiments
Building on the insights and methodological approaches of its parent disciplines,
bioxphi seeks to contribute to three main aims. It seeks to (1) facilitate studies of
a wider range of stakeholder judgments, going beyond those of professional phi-
losophers, bioethicists, and the like, (2) investigate how these judgments play out in
more ecologically valid contexts (e.g., by employing thought experiments or exam-
ples that closely resemble the features of clinical or other real-life situations), and
(3) develop a richer understanding of the underlying cognitive processes and elicit-
ing factors that shape the judgments themselves, such as by modeling the “variation
in judgments across cases as a function of carefully controlled variables” [26, p.
xxiii]. It is the last of these aims, with its focus on experimental methods, that distin-
guishes bioxphi—methodologically—from empirical bioethics; and the second aim,
with its focus on realistic bioethical scenarios, that distinguishes it from x-phi more
broadly construed.
Within the four approaches to bioxphi discussed below (parsimony, debunking,
triangulation, and pluralism), the running theme is that a deeper understanding of
the criteria underlying judgments about bioethical cases can help to address impor-
tant normative questions in bioethics. Taken together, then, we suggest that the
three aims just mentioned—broadening the pool of judgments, increasing ecologi-
cal validity, and unpacking causes and cognitive mechanisms—may help research-
ers discern whether, when, or under what conditions bioethical judgments should be
accorded some degree of normative weight. Nonetheless, the experimental study of
bioethical judgments alone does not exhaust the scope of this emerging field. Biox-
phi can also involve experiments probing people’s use of ethical concepts or means
of drawing moral inferences (among other psychological phenomena) as these relate
to bioethical decision-making and policy development (see, e.g., [2224, 26]).
Something more concrete should be said about the kinds of experiments under
discussion, given that these are part of what distinguishes bioxphi from empirical
bioethics. Although virtually any experimental method drawn from cognitive sci-
ence or moral psychology could be adapted to a bioxphi context, the dominant
method of x-phi for the past few decades, and hence of bioxphi more recently, has
been a particular type of modified questionnaire involving the so-called contrastive
vignette technique (CVT) [2729]. In its simplest form, the CVT involves designing
a pair of vignettes that carefully describe a particular situation but differ by a spe-
cific detail that is expected to impact on participant responses (e.g., how much they
think an agent described in the vignette is morally responsible for bringing about
some outcome). This detail constitutes the experimental manipulation. The study
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then seeks to investigate the effects of the experimental manipulation on participant
responses (see, e.g., [30]).
Explicit responses, such as moral judgments, typically are measured on a Likert-
type scale or continuous visual analog slider, and statistical comparisons are made
between the distributions of responses provided by the two groups. Because partici-
pants are randomly assigned to one or the other group, mean differences between the
resulting response distributions should be attributable to the experimental manipu-
lation itself. This is very similar to experiments in other areas of research, such as
placebo-controlled studies in medicine or crop yield prediction trials in agriculture.
In experimentally testing the factors that influence participant judgments, bioxphi
shares methodological features with x-phi. The latter discipline, in turn, has bor-
rowed methods from cognitive science and experimental psychology.4 However, it
should be noted that although x-phi (and hence bioxphi) has tended to rely on exper-
imental survey methods, such as the CVT, proponents have suggested that it should
employ the full range of experimental methods used in the psychosocial sciences in
order to expand the range of questions addressed [26, p. xxii]. This could involve,
for example, the use of transcranial magnetic or direct-current brain stimulation
devices to influence neural processes thought to be involved in shaping normative
judgments [35]; the careful administration of psychoactive substances, such as psilo-
cybin or MDMA, that appear capable of altering the moral sensibilities of the user
[36]; or a combination of experimental and non-experimental approaches, such as
interviews, qualitative studies, analyses of linguistic corpus data, and anthropologi-
cal work [30, 37]. Regardless of the specific empirical methods employed, a major
difference between x-phi and bioxphi is that the latter explicitly aims to inform nor-
mative discussions within bioethics.
Normative inference: frompremises withempirical content
tonormative conclusions
Recall that bioxphi seeks to study the moral judgments of a broad range of relevant
stakeholders; that it seeks to do so in an ecologically valid manner that captures real-
istic pertinent features of bioethical situations; and that it uses experimental meth-
ods to identify the elicitors and psychological processes that yield these judgments.
To what extent, and in what ways, should empirical findings regarding stakeholder
judgments play a role in devising solutions to bioethical problems?
Let us start by dealing with a red herring. We take it as uncontroversial that the
most ethically justified conclusion is not always, or simply, the most popular one
based on common opinion. However, as we acknowledge in the next section, empiri-
cal approaches to bioethics can, when certain conditions are met, appeal to the pres-
ence of prevalent, robust, or highly consistent stakeholder judgments revealed by a
4 Concerns have been raised about the replicability of results in experimental (social) psychology [31
33]. Meanwhile, there is evidence that x-phi studies have a replication rate of over 70% [34], more than
twice as high as typical estimates generated for social psychology.
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study as one (ultimately defeasible) reason that counts in favor of a particular nor-
mative claim.
At the same time, we recognize that simply deferring to putative ethical experts
can also be problematic, especially when their judgments or associated normative
conclusions defy those of other stakeholders. Such knee-jerk deferral to a circum-
scribed group of people can enshrine prejudices and lead to dogmatism and parochi-
alism [23, pp. 126–148]. As Julian Savulescu and colleagues observe, some laws and
policies do in fact run counter to public preferences [38]: bans on voluntary assisted
dying in the United States, United Kingdom, and Australia, for instance, have been
put in place despite large majority preferences for permitting assisted dying [1719].
Other laws and policies, however, seem to be grounded in mere public sentiment,
which is to say they reflect majority attitudes—including attitudes of repugnance
toward newfangled technologies—without necessarily appealing to more principled
normative considerations [8, 1519].
Typically, neither a direct appeal to an argumentum ad populum nor a simple
appeal to a single set of supposedly expert judgments will provide reliable guidance
toward normative solutions, proposals, or arguments that meet the needs of patients,
practitioners, and policymakers. To get out of this bind, Savulescu and colleagues
have introduced a number of preliminary proposals. First, they suggest that it is nec-
essary to identify the intuitions of those who have been careful in their reasoning
and have a “clear understanding of the issues” [38]. But who are these careful and
reliable reasoners and how does one find them? They might be among those ethical
experts previously mentioned: professional moral philosophers, bioethicists, legal
professionals, and the like. However, members of these groups make up a tiny frac-
tion of the population, and between them they may have idiosyncratic perspectives,
conflicting judgments, moral disagreements, and incompatible moral inferences.
Furthermore, debates surrounding a specific bioethical or philosophical issue may
have reached a stalemate with good reasons for adopting several positions and/or no
adequate way for the experts to agree upon which position should be implemented in
policy and practice. Consequently, Savulescu etal. offerthe view that ethical policy
should rely not only on “refined expert intuitions,” along with guidance from formal
ethical theories, but also on “widespread public responses” [38].
A potential problem with such proposals is that they do not spell out what to do
when widespread public responses, such as common moral judgments, and those
of putative experts diverge or, indeed, what to do when they seem to agree. More
generally, how do ethical theories, expert judgments, and the judgments of ordinary
people relate to one another, and how can this information be integrated to draw
normative conclusions? We will employ a series of bioxphi case studies to articulate
and explain the four integrative approaches mentioned above: parsimony, debunk-
ing, triangulation, and pluralism.
We do not conceive of these approaches as (necessarily) fitting into an overarch-
ing step-wise procedure. That is, we do not suggest that one should start with par-
simony, move to debunking, then to triangulation and end with pluralism. Rather,
answering a bioethical question in the field of bioxphi might involve the application
of just one of these suggested approaches, or more than one, either in parallel or in
varying sequence. Indeed, as we noted earlier, bioxphi studies might conceivably use
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still other methods not covered here. Accordingly, our aim is modest: it is to shed
light on a small selection of recent strategies in the burgeoning field of bioxphi for
generating normative conclusions from premises that include empirical components.
The parsimony approach
The first strategy is based on a principle of parsimony. This view assumes that ordi-
nary people’s judgments about certain cases carry significant (albeit defeasible) nor-
mative weight, such that experts who wish to make claims about what ought to be
done should begin by carefully studying those judgments. The strategy is parsimo-
nious, then, in that it relies on the simplest possible model for deriving normative
content from the moral judgments of ordinary people: it holds that those judgments
should be given at least some positive normative weight. In short:
Parsimony. If relevant stakeholders consistently make a judgment p which
encodes moral claim M, then M has prima facie normative weight.
One of the aims of studies employing this strategy is to gather data relating to stake-
holder judgments, often with the assumption that no matter what these judgments
are, they are normatively significant. Once the data have been gathered, a proponent
of the parsimony strategy might then identity the most consistent (e.g., common or
robust) moral judgments revealed by a study and give these prima facie normative
weight when deciding on a solution to an associated bioethical problem. Note that
the normative weight accorded to such judgments need not be especially strong. The
parsimony strategy requires only that these judgments, to the extent that they are
consistent or prevalent, be viewed as providing some normative weight in a moral-
philosophical argument. They will never be enough on their own to deliver an all-
things-considered normative conclusion.
In this way, bioxphi studies that employ the parsimony strategy are consistent
with consultative approaches to empirical bioethics, insofar as the latter rely on the
robust judgments of some group of stakeholders as a basis for arbitrating between
competing normative claims. However, consultative approaches in empirical bioeth-
ics tend to be concerned with identifying the most prevalent judgments (or attitudes,
preferences, etc.) of the group, primarily through observational or cross-sectional
methods. By contrast, bioxphi studies that adopt a parsimony strategy typically look
beyond the mere prevalence of a given judgment and instead emphasize the robust-
ness of an experimental finding (e.g., across methods, materials, or operationaliza-
tions of a causal stimulus) regarding a given effect on participant responses (see,
e.g., [39]).
There are two interrelated concerns with employing this approach in the context
of bioxphi studies. First, it is highly likely that traditional moral philosophers would
hesitate to accept such a method on the basis that it seems to derive normative con-
clusions from empirical premises without necessarily appealing to more principled
normative considerations. Therefore, although the parsimony approach has been
employed in the field of bioxphi, as seen in case study 1, alongside broadly similar
consultative approaches in the domain of health-related public policy [8, 1519],
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we must reiterate that it is not an effective means of delivering all-things-considered
normative solutions to bioethical puzzles.
This caveat relates to a second potential concern, which is that the parsimony
approach seems to reduce bioethics to a popularity contest. We think this concern
is unwarranted. As noted earlier, the fact that a study reveals consistent normative
judgments does not entail that the associated bioethical issues are thereby conclu-
sively settled. Rather, consistent judgments are just one factor counting in favor of a
given moral claim, and the normative weight accorded need not be strong. Indeed,
reasons for granting more normative weight to a particular set of judgments are, ulti-
mately, defeasible if it can be convincingly shown that these judgments are unreli-
able or outweighed by some other moral consideration. In short, this approach puts
the burden of proof on those who would claim that one should not respond to the
ethical issue in question by according some normative weight to the most consistent
judgments of relevant stakeholders.
Case study 1. Parsimony
“Judgments of moral responsibility in tissue donation cases” [40]
Consider a child who needs a tissue donation in order to survive. Suppose that her biological parent
could donate the needed tissue. Insofar as it seems intuitive that the parent has a moral responsibil-
ity to donate the tissue, what drives this judgment? Is it the biological relation between the donor
and recipient [41] or the fact that the donor is uniquely suited to provide tissue that will work for the
recipient [42]? John Beverley and James Beebe, in a study involving a series of contrastive vignettes,
found that “unique ability rather than biological relatedness was the primary predictor of people’s
judgments of moral responsibility” [40]. To distill the normative relevance of this finding, the authors
adopt a metaphilosophical stance: folk judgments need not “rigidly constrain philosophical theorizing,”
but counterintuitive normative views (e.g., that moral responsibility stems from biological relatedness)
carry an explanatory burden [40]. As such, the parsimony model would maintain that the “unique abil-
ity” judgment be assigned prima facie normative import.
The debunking approach
In contrast to the parsimony approach, which assigns prima facie (though not neces-
sarily strong) normative weight to stakeholder judgments, one might wish to argue
that certain judgments should not be accorded normative weight when considering
a solution to a given bioethical problem. One might make such an argument by test-
ing whether the judgment is unreliable, in the sense that the psychological processes
outputting the judgment are not disposed to produce a sufficiently large proportion
of true judgments [23, p. 96]. In other words, a judgment is unreliable if it is the
result of a psychological process that is not disposed to reliably either “arrive at the
truth” [43, p. 227] or “track the truth” [44, p. 54] as measured by some agreed-upon
standard. A judgment could be unreliable in this way if it is the output of a psy-
chological process that, for example, has been substantially influenced by prejudice,
epistemological distortions, or morally irrelevant differences in how a case is pre-
sented (i.e., framing effects). In order to investigate whether a judgment should not
be accorded normative weight in a bioethical argument, one might wish to pursue
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a debunking strategy derived from the following general argumentation scheme
employed in x-phi (adapted from [24, pp. 31–56]):
Debunking.
(P1) Judgment p is the output of a psychological process that possesses the empir-
ical property of being substantially influenced by factor F. (empirical premise)
(P2) If a judgment is the output of a psychological process that possesses the
empirical property of being substantially influenced by factor F, then it is pro tanto
unreliable. (bridging normative premise)
(C) Judgment p is pro tanto unreliable.
Such an approach can be employed to assess whether ordinary people revise their
judgments under various treatment conditions. Take exposure to a particular philo-
sophical argument. If people update a given judgment about a specific bioethical
case after having reflected on a philosophical argument, then at least two points
might follow: (1) they had not previously considered the philosophical argument in
question; and (2) once they did, they abandoned their original judgment. But even if
a particular judgment is shown to be pro tanto unreliable, why is this a prima facie
reason for others to disbelieve the judgment?
The literature on moral judgments and their susceptibility to framing effects
delivers two interrelated answers. First, as James Andow observes, the substantive
influence of morally irrelevant factors on judgments is important because “it is capa-
ble of radically altering the moral position that one ends up endorsing” [45, p. 908].
If a person’s judgment about some case is the output of a psychological process that
has been substantively influenced by a morally irrelevant factor, then there is a prima
facie reason to doubt that judgment. But more than this, there is a reason to believe
that a process of reflection based on that judgment “will only lead one deeper into
error” [43, p. 244]. At least, the pro tanto unreliability of a judgment is one factor
that counts against accepting it as a premise in a normative argument.
Second, according to Edouard Machery, “when a judgment-forming process is
unreliable, the judgments it produces are severely deficient from an epistemic point
of view” [23, p. 99]. Accordingly, the unreliability of a judgment undermines its
justificatory status; that is, the judgment is not justified without independent confir-
mation that grants the judgment holder the ability to infer that judgment [44]. Here,
when we say that a judgment is justified, we mean that a person ought to make it as
opposed to suspending it, because she has “adequate epistemic grounds for believing
that it is true (at least in some minimal sense)” [44, p. 48].
Accordingly, if a bioxphi study finds that a judgment is unreliable to the extent
that it is the output of a psychological process that is subject to the substantive influ-
ence of a morally irrelevant factor, then there are inadequate epistemic grounds for
believing that it is true—unless an individual can independently confirm the unre-
liable judgment by making some appropriate inference or argument [44, p. 51].
It follows that its unreliability is a prima facie reason for a person to suspend her
judgment in relation to the bioethical case in question. Consequently, through the
debunking approach, the result of empirical investigation—namely, the pro tanto
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unreliability of a judgment—can be used as a prima facie reason that counts against
the normative weight of the judgment in an argument that might be developed on the
basis of it.
But a word of caution is warranted. When bioxphi studies adopt a debunking
strategy, it should not be assumed that those conducting the study believe that the
target judgment should in fact be accorded normative weight in a given argument.
Rather, prior to pursuing the debunking approach, researchers in bioxphi would
already have identified a normative argument or conclusion (for example, in the
published literature) that appeals to this target judgment. The purpose of the bioxphi
study in this context would be to employ the debunking approach to demonstrate
that the judgment in question is, or is not, pro tanto unreliable. Evidence that it is
in fact unreliable could then be interpreted as debunking the pre-existing normative
argument.
In addition, when stakeholders hold a judgment that has been shown to be pro
tanto unreliable in a specific instance, alternative explanations should be explored
for why the target population holds that judgment. After all, one can never be sure
that a particular judgment can be debunked in general: debunking proceeds by look-
ing at isolated, specific ways in which the psychological processes outputting certain
judgments can be deficient (see footnote 5). To see what we mean, consider a hypo-
thetical study, inspired by Edmond Awad etal. [46], in which participants tended to
favor saving females over males in a life-threatening situation, all else being equal.
According to most contemporary moral theories, a sex-based distinction by itself is
not a valid basis for treating otherwise equal persons differently. In such a case, how-
ever, the revealed judgment favoring females over males could turn out to be a mere
proxy for some other distinction that is, in fact, widely agreed to be normatively
relevant. Suppose that males vastly outnumber females in the surveyed society, lead-
ing to significantly negative social consequences. If participants from that society
make a judgment that females should be saved over males, then it might not be sex
per se that is driving their survey responses, but rather a preference for rebalancing a
skewed sex ratio and/or alleviating attendant social ills.
However, even when remaining considerate of possible alternative explanations,
one must also acknowledge that judgments can be affected by a number of factors,
and at least some will be irrelevant to the moral question. Whether a particular pro
tanto unreliable judgment is deemed to be relevant will, as in this example, depend
on background theoretical assumptions that independently confirm the judgment,
grounding the inference of those who infer it [44]. In this case, the relevance of the
judgment that females should be saved over males depends on the principled nor-
mative basis by which sex-based judgments are deemed justifiable under one set of
conditions but not another.
Experimental philosophical bioethicists can play a valuable role in cases where
there are plausible alternative explanations for what appears to be a normatively
unjustified judgment. In particular, they can conduct experiments to test the alterna-
tive explanations, often by carefully manipulating relevant contributing factors. For
instance, in the above study, researchers might observe whether a pro tanto unrelia-
ble judgment persists when participants are asked to consider a hypothetical society
in which females outnumber males. Depending on the results, such an experiment
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102
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could provide evidence for or against the alternative explanation for the original sus-
pect judgment. In what follows, we show how the debunking approach might be pur-
sued in practice, using two separate case studies drawn from the burgeoning biox-
phi literature: (1) case study 2 highlights an apparently failed debunking attempt,
providing evidence that ordinary people’s judgments, in a specific instance, are not
largely biased by a particular factor that would have made the judgments unreliable;
and (2) case study 3 highlights an apparently successful debunking attempt, pro-
viding evidence that ordinary people’s judgments, in a specific instance, are largely
biased by a particular irrelevant factor and so should not be trusted in the relevant
case.5
Case study 2. Debunking: failed
“How do people use ‘killing’, ‘letting die’, and related bioethical concepts?” [49]
Laypeople distinguish killing and letting die by evaluating the morality of the physician’s intervention
[50]. For example, doctors who employ end-of-life interventions that honor the wishes of terminal
patients are seen as allowing them to die, whereas doctors who employ interventions that disregard
patients’ wishes are seen as killing them [49]. The judgments of ordinary people may afford little
normative insight here, in part because they lack the requisite understanding of the medical and clinical
issues in play. This objection makes a straightforward empirical prediction: if laypeople acquired the
relevant medical knowledge, they would abandon their untrained judgments in favor of the canonical
distinction between killing and letting die as commissive versus omissive life-ending acts, respectively.
However, David Rodríguez-Arias and colleagues found no evidence of this: doctors, medical students,
and laypeople revealed strikingly similar judgments about end-of-life cases [49]. The determining fac-
tor appears to be whether the patient wished to live or die, and not how the patient’s death was brought
about (i.e., via action or omission). Thus, the ordinary judgment could not be debunked on grounds of
ignorance of clinically relevant details.
Case study 3. Debunking: successful
“Gender bias in pediatric pain assessment” [51]
Do people have a gender bias in assessing children’s pain? To answer this question, Brian D. Earp and
colleagues conducted an experiment in which they manipulated the perceived gender of a young child
getting a finger-stick to draw blood (based on [52]). To keep the experiment as controlled as possible,
participants viewed a single video stimulus of a child whose sex could not be visually determined
(i.e., the same video in both conditions). In one condition, participants were told the child’s name was
Samuel, and in the other, Samantha. Participants then watched the video and rated how much pain the
child experienced. Earp etal. found that participants rated the child named Samuel as experiencing
more pain than the child named Samantha. Thus, perceived gender alone appeared to bias observer
interpretations of felt pain (for alternative explanations, see [53]). Such evidence plausibly undermines
the trustworthiness of judgments that, say, boys and girls should receive different pain treatment given
a comparable injury.
5 There is an asymmetry between these two cases. If there really is conclusive evidence that a popular
judgment is grounded in some factor that undermines its normative force (successful debunking attempt),
then the judgment should be set aside or discounted. But if one fails to debunk a given judgment, this
does not automatically entail that it should be trusted. Rather, it might still be normatively suspect on
other grounds that have not yet been tested. So one should try to test, and rule out, the most plausible
debunking explanations, and if one reliably fails in this, it becomes reasonable to treat the judgment as
carrying prima facie normative weight—a process akin to Popperian falsificationism, notwithstanding its
various shortcomings (see [31, 47, 48]).
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Experimental philosophical bioethics andnormative inference
The triangulation approach
Suppose that the judgments of philosophers, bioethicists, legal professionals, or
those with other kinds of expertise differ from the judgments of lay people. Alter-
natively, suppose that there are conflicting judgments within the domain of expert
stakeholders, such as between bioethicists, legal professionals, health care practi-
tioners, policymakers, and patients. What should be done about such divergences?
In such cases, experimental philosophical bioethicists could helpfully pursue a
coherence-seeking strategy of narrow reflective equilibrium discussed previously.
Accordingly, the coherence they seek will be between competing expert judgments
and/or between expert judgments and those of lay stakeholders. We refer to this
approach as a type of triangulation.6
Triangulation. Divergence among the judgments of various groups of experts
and/or between expert and lay judgments requires the following: adjusting,
pruning, or supplementing the normative conclusions derived from either
expert or lay judgments in order to accommodate the normative implications
of the opposing views.
Experimental philosophical bioethicists can perform three important roles in pur-
suing a triangulation strategy. First, using empirical means, they can identify the
judgments of various experts and lay stakeholders in response to a specific norma-
tive problem, ensuring that the judgments respond to relevant features of ecologi-
cally valid contexts. Second, using the aforementioned argumentation strategies of
x-phi and the methods of cognitive science and experimental psychology, they can
experimentally investigate the cognitive mechanisms underpinning these judgments,
ensuring that various expert and lay judgments are not pro tanto unreliable (and/or
setting aside or discounting those judgments that are shown to be pro tanto unreli-
able). Finally, they can execute trade-offs among the respective pro tanto reliable
judgments, revising normative conclusions as coherence and mutual support seem
to require.
According to the standards of reflective equilibrium, the normative conclusions
arrived at through this process, together with revisions to competing judgments, will
be justified if and only if there is reason to believe that they will maximize the coher-
ence of the overall set of relevant considerations. However, in order to avoid the
standard objection that the equilibrium arrived at “may be no more than a reshuffling
of moral prejudices” [55, p. 22], the triangulation approach might be better charac-
terized as a coherence-seeking methodology based on a “moderate foundationalism”
[56, pp. 26–30]. The problem that Richard Brandt identifies is that the coherence
constraint on its own may not succeed in correcting for all the errors or biases in the
6 Scientists and certain philosophers of science employ the term “triangulation” to refer to the use of
multiple and independent sources of evidence in order to generate causal inferences from data to phe-
nomena (as opposed to phenomena-to-theory deductive inferences) [54]. Analogously, triangulation in
bioxphi is one of the means by which experimental philosophical bioethicists have generated normative
inferences on the basis of multiple, independent, and pro tanto reliable pieces of empirical evidence.
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respective judgments [55]. As already observed in the section on debunking, it will
not succeed if the antecedent judgments are so unreliable that further reflection on
these judgments will only lead bioethicists deeper into error. As a result, proponents
must also explain how it is antecedently or independently rational to regard some or
all of these competing judgments as (pro tanto) reliable [43].
It is at this point that we can appreciate one of the opportunities afforded by
bioxphi: by employing experimentally based argumentation strategies that, in
principle, give reasons to believe that certain judgments are not the output of
psychological processes that have been substantively influenced by (particu-
lar) irrelevant factors, bioxphi allows conclusions to be drawn regarding the pro
tanto reliability of those judgments. Once certain judgments have survived vari-
ous attempts at being shown to be pro tanto unreliable,7 the resulting judgments
can be employed as initially credible judgments in the given process of triangu-
lation. Such an approach is moderately or modestly foundationalist because the
degree of justification provided by the expert or stakeholder judgments that are
each accepted as pro tanto reliable may be relatively low. Proponents of reflective
equilibrium maintain that sufficient justification requires mutual support among
the set of judgments—and, in many cases, among judgments, background theo-
ries, principles, and morally relevant facts [57].
According to T.M. Scanlon, those adopting the model of reflective equilibrium
should ask whether there is more reason to revise a normative conclusion in the
light of conflicting judgments or to give up the judgments that conflict with it
[58]. Ultimately, as Ralph Wedgwood suggests, what is being proposed is a thor-
oughgoing form of fallibilism [43, pp. 64–65]. On this approach, it can never be
guaranteed that one will not be rationally required to revisit and reconsider, and
perhaps revise, the normative conclusions derived from the process of triangu-
lation if and when further reliable empirical evidence is identified. In this way,
reflective equilibrium, even of the narrow variety, is an ideal that is unlikely ever
to be reached [43, p. 265].
In practical circumstances, when, in pursuit of “good bioethics” [8], one is
required to generate arguments that meet the needs of patients, practitioners, and
policymakers, one will often have to bite the bullet, so to speak, and commit to
a specific normative claim on the strength of available empirical data and the
degree of coherence one has been able to achieve. As Scanlon suggests, such a
commitment must be based on the best reasons counting in favor of the specific
claim [58].
Case study 4 provides an example of the problems that experimental philosophi-
cal bioethicists may encounter when trying to navigate between expert and lay
judgments. In such cases, proceeding with a triangulation strategy may not be as
straightforward as seeking a simple compromise or accommodation. Rather, it will
often be necessary to ask, in the case of judgments about a normative concept, for
example, what the concept is trying to do—that is, what its function is (as opposed
7 See footnote 5 for a discussion of some of the problems with attempting to demonstrate the general
reliability of moral judgments.
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Experimental philosophical bioethics andnormative inference
to its meaning) [13, 59]. As Sally Haslanger puts it, “What is the point of having
these concepts? What cognitive or practical task do they (or should they) enable us
to accomplish? Are they effective tools to accomplish our (legitimate) purposes; if
not, what concepts would serve these purposes better?” [60, p. 33].8
Once again, it is possible to envisage a vital role for bioxphi in answering such
questions. As Jennifer Nado argues, “the experimental philosopher’s focus on under-
lying psychological mechanisms seems to be a promising route (though of course
not the only possible route) for discovering the purposes our concepts serve, and the
means by which these purposes are achieved” [37, p. 92]. On this view, judgments
about some normative concept should be empirically investigated to determine
whether the normative concept in question is already fulfilling its intended functions
to a reasonably good degree.
Case study 4. Triangulation
“Commonsense consent” [63]
In a series of experiments, Roseanna Sommers found that lay participants tended to think that deceived
individuals could grant meaningful consent [63]. By contrast, in various legally relevant domains,
including medicine, agreement or assent under deception is not considered valid. In this way, common-
sense consent seems to diverge significantly from the notions of consent that prevail in the law and in
the relevant philosophical literature. One reason this divergence matters is that lay people sit on juries
that can be asked to establish whether consent was present—often without explicit guidance on how to
understand consent. This empirical finding can motivate: (a) contextual education for jury members;
(b) reform of the legal concept; or (c) some adjustment of both concepts in light of additional consid-
erations (triangulation).
Depending on how the function of a bioethical concept is understood in the relevant
contexts, different conclusions will be reached about how to navigate divergences
among different expert judgments or between expert and lay judgments. Faced with
a divergence, one might be tempted to make improvements to a given concept—that
is, to increase clarity, reduce vagueness, remedy confusion, or bring about (other)
desirable outcomes. Take the concept of futility as discussed by John McMillan [8,
pp. 154–155]. On the one hand, physicians deem medical treatment to be futile if it
is very unlikely to improve the well-being of the patient. On the other hand, physi-
cians also employ the concept of futility when an intervention does not succeed as
a treatment, regardless of their beliefs about the patient’s well-being. McMillan pro-
poses to resolve the confusion between these two concepts of medical futility on the
basis of their respective functions and uses.
With regard to case study 4, it might be determined that standard ethical and
legal accounts of consent already adequately serve the forms of inquiry in which the
concept is employed. On that basis, given that patients, physicians, and the public
will be required to use the concept in legal and/or medical situations, some form
of contextual reeducation might be needed to clarify, or remedy confusions in, lay
8 For other broadly functionalist, experimentally based approaches to navigating conceptual disagree-
ment, see [21, 23, 37, 61, 62].
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judgments regarding consent—that is, to bring the lay use of the concept into line
with the expert view. For instance, one application of the triangulation strategy
could be to make improvements or modifications to the legal system in which the
concept is employed (e.g., providing jury members with explicit definitions of the
legal concept of consent and its relationship with deception) so that the intended
normative work performed by the concept is no longer threatened by the divergence
between expert and lay judgments.
Suppose, however, that a particular canonical concept is already clear, sharp,
and free of confusion. Its application may nonetheless engender moral obligations
that conflict with those that lay people intuitively recognize and, indeed, with those
recognized by various other experts. In these circumstances, we might recommend
wholesale replacement of a specific expert concept with an ameliorative one—
namely, one that possesses a superior practical function for the forms of inquiry in
which lay people and other relevant experts employ the concept. For example, in
light of persistent philosophical debates (and disagreements) about the distinction
between the concepts of active and passive euthanasia, new concepts, with contrast-
ing functions, were developed: physician-assisted suicide, palliative sedation, and
withdrawing life-sustaining treatment [13]. Compared with the concepts of active
and passive euthanasia, these new concepts have allowed a broader range of experts
as well as the public to navigate the ethico-legal terrain more successfully [13, pp.
34–35].
Nonetheless, the real problem hinges on whether the bioethical terms that have
been developed for use in legal and philosophical practice are suitable for fulfill-
ing the purposes that previous terms have served in health care and medical law
contexts. However, we recognize that for conceptual reform to be based on an all-
things-considered judgment, merely appealing to a divergence between expert and
lay judgments will be inadequate. Although the triangulation approach is a useful
starting point for conceptual reform insofar as it attempts to navigate between expert
and lay judgments, it will require supplementation by, for example, seeking coher-
ence between the diverging judgments and broader normative considerations, such
as background theories, principles, morally relevant facts, and the like (wide reflec-
tive equilibrium).
The pluralism approach
This brings us to the fourth strategy. Suppose that the best reasons count in favor of
preserving two or more diverging expert judgments or the competing judgments of
experts and lay stakeholders. In other words, suppose there are equally good reasons
for adopting two or more different expert judgments or for adopting both an expert
judgment and a lay judgment as the basis for (competing) normative conclusions,
with no better reasons for adjusting, pruning, or supplementing the different posi-
tions. In some cases, such a scenario might justify a pluralistic response.
Pluralism. In cases where expert and lay stakeholders hold conflicting, yet
pro tanto reliable, judgments or where multiple and independent communities
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each reveal persistent disagreement between two or more conflicting, yet pro
tanto reliable, judgments, these judgments may all have comparable normative
weight.
The pluralism approach is similar to, and consistent with, the shared decision-
making approach that has recently become an important part of clinical practice
and health policy. To be successful, shared decision-making relies on two sources
of expertise: (1) the health professional as an expert on the effectiveness, probable
benefits, and potential harms of different treatment options; and (2) the patient as
an expert on herself, her preferences, social and personal circumstances, attitudes
toward illness and risk, tolerance for pain and discomfort, long-term outlooks, and
broader values [6466]. As Jonathan Lewis notes, shared decision-making is most
appropriately applied under conditions of uncertainty, which arise when a treat-
ment decision is preference-sensitive—that is, when medical evidence and clinical
expertise suggest that there is more than one medically reasonable option, and the
choice of which option is best for a given patient depends on her values and prefer-
ences [66]. In short, so long as the patient can fulfill certain conditions of autonomy,
then she should choose the particular intervention that best satisfies her attitudes and
preferences [6668]. Case study 5 demonstrates how a bioxphi pluralism strategy
can generate sets of pro tanto reliable judgments with comparable normative weight.
Case study 5. Pluralism
“Minds, brains, and hearts: an empirical study on pluralism concerning death determination” [69]
Pluralism concerning death determination states that people should be allowed to choose—within
reason—what criterion will be applied to determine their own deaths [70]. It assumes that death
determinations take place under conditions of uncertainty in the presence of more than one medically
reasonable option. Against this backdrop, Ivars Neiders and Vilius Dranseika presented study par-
ticipants with a possible description of the process of dying that was divided into a number of stages,
beginning with the onset of health deterioration and concluding with the onset of corpse decay [69].
They were asked at which of these stages they would prefer their own death to be declared. Three of
these stages were designed to mimic the main conceptions of death discussed in the bioethics literature:
higher-brain death, whole-brain death, and cardiopulmonary death. Given that the data reveals widely
differing preferences concerning death determination criteria, Neiders and Dranseika argue that the
pluralist solution fits best with the way lay people think about death determination. If one agrees that
people should be allowed to choose their own conception of death, then, given that most participants
chose one of the three criteria discussed in the bioethical literature, the study provides some prelimi-
nary empirical evidence for which conceptions of death should be used in generating a choice set.
Conclusion
Bioxphi differs in important ways from its parent disciplines. In contrast to empiri-
cal bioethics, bioxphi typically favors experimental methods, derived from cognitive
science or x-phi, which help to characterize the features that shape our judgments
(i.e., their determinants), as well as the processes that support them (i.e., the cogni-
tive mechanisms). Moreover, whereas x-phi attempts to derive (meta)philosophical
conclusions on the basis of empirical data, bioxphi is specifically concerned with
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understanding the normative implications of such data as they pertain to matters of
bioethical concern.
Having traced the contours of this emerging discipline, we illustrated four ways
in which experimental philosophical bioethicists have employed experimental meth-
ods to confront various normative questions that have captured bioethicists’ atten-
tion. Furthermore, we attempted to formalize the specific argumentative strategies
of these approaches, while highlighting certain limitations and possible concerns
inherent in each. Thus, our paper is not intended as a definitive map of the path-
ways leading to normativity, nor as a comprehensive defense of any single approach
against the range of philosophical objections. It is more of a sampling platter, an
exploration, an invitation for further discussion.
Most of the time, as the five case studies make clear, it is not obvious whether
a particular scientific portrait of judgments vindicates or undermines their norma-
tive worth. Many of the case studies we presented involve ambiguous circumstances.
How, then, can normative guidance be drawn from empirical research? The four
approaches detailed here each provides the same answer: by bringing in further reli-
able evidence. Once that evidence is established, bioxphi offers an opportunity to
better navigate competing views of different experts, as well as competing views of
experts and lay stakeholders. Adopting a minimally realist perspective on morality,
we might hope that this back-and-forth between different views (guided by theoreti-
cal frameworks and arguments) and the empirical evidence pertaining to diverging
judgments can bring us closer to discerning what we have most reason to believe is
morally true in the bioethical domain.
Acknowledgements We are immensely grateful to Joshua Knobe for his dedication to this project, as
well as his support, guidance, and invaluable comments and suggestions during the writing process. We
also gratefully acknowledge the respective contributions of the two anonymous reviewers, and we wish
to thank Katelyn MacDougald for doing such a stellar job editing the manuscript as well as Kristien Hens
and Andreas De Block for inviting us to contribute to this special issue.
Author contributions BDE and JL share first authorship of this paper.
Funding Vilius Dranseika was supported by the European Research Council (ERC) under the European
Union’s Horizon 2020 research and innovation program (grant agreement 805498).
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License,
which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as
you give appropriate credit to the original author(s) and the source, provide a link to the Creative Com-
mons licence, and indicate if changes were made. The images or other third party material in this article
are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the
material. If material is not included in the article’s Creative Commons licence and your intended use is
not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission
directly from the copyright holder. To view a copy of this licence, visit http:// creat iveco mmons. org/ licen
ses/ by/4. 0/.
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2020. Identity, well-being and autonomy in ongoing puberty suppression for non-binary adults: A
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... Although questions have been raised as to whether this contrastive-vignette technique (CVT) should be used so exclusively (Mihailov et al. 2021;Earp et al. 2021a), an advantage of the approach is it allows researchers to zero in on well-defined aspects of the self that might change as a result of some imagined intervention, so that fine-grained discriminations can be made between potential factors shaping participant judgments (Reiner 2019). ...
... The second aim is normative: it is to harness these models and associated findings to help reach ethically warranted conclusions in bioethics (e.g., regarding public health policy or clinical decision-making) (Earp et al. 2021a). A. Illustration #1: Parsimony ...
... The triangulation strategy holds that divergence among the judgments of various individuals or groups of stakeholders requires the following: adjusting, pruning, or supplementing the normative conclusions derived from the competing positions in order to accommodate: (1) the normative implications of the opposing view(s); and (2) normative considerations derived from, for example, ethical or legal principles, background theories, morally relevant facts, and/or the best arguments for a normative position in the relevant expert literature (Earp et al. 2021a). To illustrate this strategy, we will refer to recent work conducted by Dranseika and colleagues (unpublished) on judgments about the right of study participants to withdraw from research after undergoing significant personal change. ...
Chapter
Full-text available
The question of what makes someone the same person through time and change has long been a preoccupation of philosophers. In recent years, the question of what makes ordinary or lay people judge that someone is—or isn’t—the same person has caught the interest of experimental psychologists. These latter, empirically oriented researchers have sought to understand the cognitive processes and eliciting factors that shape ordinary people’s judgments about personal identity and the self. Still more recently, practitioners within an emerging discipline, experimental philosophical bioethics or “bioxphi”—the focus of this chapter—have adopted a similar aim and employed similar methodologies, but with two distinctive features: (a) a special concern for enhanced ecological validity in the examples and populations studied; and (b) an interest in contributing to substantive normative debates within the wider field of bioethics. Our aim in this chapter is to sample illustrative work on personal identity in bioxphi, explore how it relates to studies in psychology covering similar terrain, and draw out the implications of this work for matters of bioethical concern. In pursuing these issues, we highlight recent work in bioxphi that includes the perceived validity of advance directives following neurodegeneration, the right of psychologically altered study participants to withdraw from research, how drug addiction may cause one to be regarded by others as “a completely different person,” the effect of deep-brain stimulation on perceptions of the self, and the potential influence of moral enhancement interventions on intuitive impressions of a person’s character.
... For instance, descriptive ethics studies explore stakeholders' responses to bioethical questions and try explain how people arrive at certain moral opinions Open Access *Correspondence: emilian.mihailov@filosofie.unibuc.ro and reasoning patterns [13][14][15][16][17][18][19][20][21][22]. Empirical research can investigate whether people and healthcare professionals comply with ethical guidelines and how ethical solutions are translated into practice [13-15, 18, 23-29]. ...
... At the same time, debates in bioethics often involve controversies about how to define concepts, what concepts are relevant or appropriate [57][58][59], and for that identifying theoretical issues is also needed. Empirical work on theoretical goals is increasingly being carried out in the field of experimental philosophy (x-phi) and experimental bioethics (bio-xphi) [19,20,[60][61][62][63][64]. Drawing on x-phi and bio-xphi literature, there are pleas to use of empirical methods to inform our understanding of concepts like health and disease [65,66]. ...
Article
Full-text available
Background: This is the first qualitative study to investigate how researchers, who do empirical work in bioethics, relate to objectives of empirical research in bioethics (ERiB). We explore reasons that make some objectives more acceptable, while others are deemed less acceptable. Methods: Using qualitative exploratory study design, we interviewed bioethics researchers, who were selected to represent different types of scholars working in the field. The interview data of 25 participants were analyzed in this paper using thematic analysis. Results: From the eight objectives presented to the study participants, understanding the context of a bioethical issue and identifying ethical issues in practice received unanimous agreement. Participants also supported other objectives of ERiB but with varying degrees of agreement. The most contested objectives were striving to draw normative recommendations and developing and justifying moral principles. The is-ought gap was not considered an obstacle to ERiB, but rather a warning sign to critically reflect on the normative implications of empirical results. Conclusions: Our results show that the most contested objectives are also the more ambitious ones, whereas the least contested ones focus on producing empirical results. The potential of empirical research to be useful for bioethics was mostly based on the reasoning pattern that empirical data can provide a testing ground for elements of normative theory. Even though empirical research can inform many parts of bioethical inquiry, normative expertise is recommended to guide ERiB. The acceptability of ambitious objectives for ERiB boils down to finding firm ground for the integration of empirical facts in normative inquiry.
... Hegarty, 2022), to medical research and rules proposed to protect participants' rights (Dranseika et al., unpublished), to the understanding, use, or application of relevant legal concepts (Sommers, 2020;Demaree-Cotton and Sommers, 2022), to evaluation and regulation of cognitive enhancement or other emerging biotechnologies (Faber, Savulescu and Douglas, 2016;, or (more generally) to human-technology and human-biosphere relations (for overviews, see Earp, 2019;Earp et al., 2021;Earp et al., 2022). ...
... In any case, it must be remembered that merely appealing to a divergence between sets of moral judgments will be inadequate to deliver an "all-things-considered" normative conclusion or recommendation. Although the triangulation approach is a useful starting point, adjusting, pruning, or supplementing opposing judgments will, in many cases, also require engagement with broader normative considerations, such as, for example, background theories, legal and moral principles, morally relevant facts, and the like (i.e., "wide reflective equilibrium") (DeGrazia and Millum, 2021;Earp et al., 2021). ...
Chapter
Full-text available
This chapter summarizes an emerging sub-discipline of both empirical bioethics and experimental philosophy (“x-phi”) which has variously been referred to as experimental philosophical bioethics, experimental bioethics, or simply “bioxphi” (Earp, Latham and Tobia, 2020; Earp et al., 2020; Lewis, 2020; Mihailov, Hannikainen and Earp, 2021). Like empirical bioethics, bioxphi uses data-driven research methods to capture what various stakeholders think (feel, judge, etc.) about moral issues of relevance to bioethics. However, like its other parent discipline of x-phi, bioxphi tends to favor experiment-based designs drawn from the cognitive sciences (Knobe, 2016)—including psychology, neuroscience, and behavioral economics—to tease out why and how stakeholders think as they do.
... Bioxphi describes an approach to normative theorizing in bioethics that employs evidence about laypeople's moral judgments as derived from psychological experiments. In a recent publication, we proposed several means of drawing substantive normative conclusions from argumentative premises that include such evidence (see Earp et al., 2021). We will rehearse some of those proposals in a later section, where we explore potential implications of our findings for competing normative positions in the debate about advanced directives. ...
... The normative recommendation of such accounts does not accord with the judgments of many of our participants who judged both that (a) the person at Time 2 was (in one sense or another) the same person as the one at Time 1, but (b) the preferences of the person at Time 1 should not determine what happens at Time 2. A bioethicist who wanted to argue that the Dworkinian view is, nevertheless, correct, might need to explain why so many laypeople are getting it wrong. For example, such a bioethicist might want to undertake a "debunking" strategy (see Earp et al., 2021;Mukerji, 2019), conducting further experiments to show that the judgments of laypeople about this case are influenced by inappropriate (that is, normatively irrelevant or unreliable) factors. ...
Article
Full-text available
In the present chapter, we seek to better understand how laypeople reason about the “true self" of a person with advancing dementia. We are also interested in how such reasoning bears on laypeople’s views about the validity or invalidity of an advance directive (AD) regarding that person’s treatment. Toward that end, we will report the results of two empirical studies we undertook to gain insights into this relationship: namely, between judgments about the true self and whether to follow an AD. To justify our empirical approach, we draw on arguments from the emerging literature on experimental philosophical bioethics, also known experimental bioethics or simply “bioxphi” (Earp, 2019; Lewis, 2020; Mihailov et al., 2021). Bioxphi describes an approach to normative theorizing in bioethics that employs evidence about laypeople’s moral judgments as derived from psychological experiments. In a recent publication, we proposed several means of drawing substantive normative conclusions from argumentative premises that include such evidence (see Earp et al., 2021). We will rehearse some of those proposals in a later section, where we explore potential implications of our findings for competing normative positions in the debate about advanced directives.
... Bioconservative attitudes are often characterized as stemming from an embodied and intuitive aversion, in the form of disgust [27,28] or vertigo [29], to the use of emerging biotechnologies; and empirical research attests to an association between disgust sensitivity and bioconservative views on enhancement [16]. These appeals to nature have been subject to intense philosophical scrutiny [30,31], effectively asking whether intuitive and affective processes ought to be discarded as unreliable guides in the moral domain [32]. ...
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People overwhelmingly recognize patients' needs for medical care intended to restore cognitive or physical health that has deteriorated below what is considered typical, due to disease or disorder (e.g., psychostimulant medication to sustain attention in the case of attention deficit disorder). When asked whether a healthy individual may undergo the same intervention for the purpose of exceeding typical functioning, people often express greater hesitation. The present work examines this phenomenon, known as the treatment-enhancement distinction, and builds on prior research in moral philosophy and cognitive science to ask why it might arise. In two experiments, we provide evidence that the accessibility of health-related interventions determines their perceived descriptive normality (Experiment 1), and that gains in descriptive normality of such interventions weaken the moral distinction between treatment and enhancement (Experiment 2). In short, these findings suggest that the treatment-enhancement distinction may be driven, at least in part, by assumptions about descriptive abnormality; and raise the possibility that normalizing novel biomedical interventions by promoting access could alleviate people's selective opposition toward enhancement, rendering it morally equivalent to treatment.
... In closing, we would like to draw on two examples from the published literature, which serve as a template for what an exercise in empirically-informed normative ethics could entail. These studies-which belong to a growing body of research in Experimental philosophical bioethics (Earp et al. 2020(Earp et al. , 2021)-blur the traditional distinction between descriptive and normative bioethics. They raise questions in normative bioethics, whether theoretical ("How should we 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 distinguish between killing and letting die?") or practical ("Does the irreversible cessation of an individual's brain function mark their death?"); ...
... However, seeEarp, Lewis et al. (2021) on the potential need to first experimentally probe certain intuitions to ensure that they are robust (e.g., not highly susceptible to normatively irrelevant framing effects; see Demaree-Cotton, 2016, for discussion), to clarify what features of cases they are responding to, and so forth, before relying on them as "settled" intuitions to be entered into a process of (collective) reflective equilibrium. ...
Article
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For the use of artificial intelligence in clinical ethics to be ethically justified, it should improve the transparency and accuracy of ethical decision-making beyond that which physicians and ethics committees are currently capable of providing.
Article
The review discusses the content of the concept of health in scientific and philosophical discourse. Taking into account the correlation of the subjects of clinical, preventive and social medicine, the historical stages of studying the problem of the health of the person (individual) and public health are briefly described. The content of the concept of health is revealed in accordance with the concept of B.G. Yudin in three dimensions: as a fact, norm and value. A methodological analysis of the definition of health in the WHO Constitution is given. The issue of legal correctness of Part 1 of Art. 27 of the Federal Law “On the Fundamentals of Protecting the Health of Citizens”. The problems of the philosophy of health are covered in the context of bioethics, the relevance of ethical control and health care is emphasized. The review defines the guidelines for the coverage of some problems of the philosophy of health in teaching in the system of domestic medical education.
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In characterizing the nature of law and its proper interpretation, philosophers of law often appeal to empirical assumptions about the mind and language. However, psychological research has emphasized social norms (sustained through personal interaction), while comparatively neglecting positive rules (introduced by an authority). Addressing this imbalance, recent empirical work has begun to tackle foundational questions in jurisprudence, such as the connection between law and morality, the extent and origin of cultural variability in legal concepts, and the overlap between ordinary and expert concepts in this domain. This chapter provides an overview of ongoing research in the nascent field of experimental jurisprudence and takes stock of its implications for the concept of law. This preliminary sketch of legal cognition raises deeper questions that only a more diverse research program could answer. In closing, we advocate that research in experimental jurisprudence ought to investigate proximate and ultimate questions in parallel so as to paint a detailed portrait of the ‘legal mind’.
Article
There is an emerging experimental trend in bioethics and neuroethics. We briefly review several topics in this trend and discuss how the existing and future studies can have normative implications related to bioethical/neuroethical issues. Particularly, we consider three major ways to draw such implications; (1) contributing to conceptual analysis and philosophical (counter-)evidence, (2) figuring out the unreliability of moral thinking and thereby providing a debunking argument, and (3) estimating the feasibility of ethical norms and policies.
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A core challenge for contemporary bioethics is how to address the tension between respecting an individual’s autonomy and promoting their wellbeing when these ideals seem to come into conflict.This tension is often reflected in discussions of the ethical status of guardianship and other surrogate decision-making regimes for individuals with different kinds or degrees of cognitive ability and (hence) decision-making capacity, specifically when these capacities are regarded as diminished or impaired along certain dimensions (or with respect to certain domains). In this essay, we raise some key considerations for how to evaluate potential tradeoffs between wellbeing and autonomy should these arise.
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The late Robert Veatch, one of the United States’ founders of bioethics, never tired of reminding us that the paradigm-shifting contribution that bioethics made to patient care was to liberate patients out of the hands of doctors, who were traditionally seen to know best, even when they decidedly did not know best. It seems to us that with the advent of COVID-19, health policy has come full-circle on this. COVID-19 gave rise to a large number of purportedly “ethical” guidance documents aiming to assist health care providers and practitioners with responding to the ethical challenges that might arise in their response to the pandemic. Ethics has two primary functions: provide clear action guidance, and provide clear action justification. The documents in question arguably reflect the ultimate policy triumph of bioethical “principlism”, and, perhaps surprisingly, as a corollary, the ultimate triumph of “doctor-knows-best”.
Article
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We discuss the central ethical conundrum for clinicians working with young people like Phoenix: namely, how to respect, value and defer to a person’s own account of their identity and what is needed for their well-being, while staying open to the possibility that such an account may reflect a work in progress. This conundrum thus relates both to what will be beneficial for that person and what constitutes respecting their autonomy, and clinicians must dwell on these questions when deciding what forms of medical intervention to offer.
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Campaigns to circumcise millions of boys and men to reduce HIV transmission are being conducted throughout eastern and southern Africa, recommended by the World Health Organization and implemented by the United States government and Western NGOs. In the United States, proposals to mass-circumcise African and African American men are long standing, and have historically relied on racist beliefs and stereotypes. The present campaigns were started in haste, without adequate contextual research, and the manner in which they have been carried out implies troubling assumptions about culture, health, and sexuality in Africa, as well as a failure to properly consider the economic determinants of HIV prevalence. This critical appraisal examines the history and politics of these circumcision campaigns while highlighting the relevance of race and colonialism. It argues that the "circumcision solution" to African HIV epidemics has more to do with cultural imperialism than with sound health policy, and concludes that African communities need a means of robust representation within the regime.
Article
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In this article, we analyse the novel case of Phoenix, a non-binary adult requesting ongoing puberty suppression (OPS) to permanently prevent the development of secondary sex characteristics, as a way of affirming their gender identity. We argue that (1) the aim of OPS is consistent with the proper goals of medicine to promote well-being, and therefore could ethically be offered to non-binary adults in principle; (2) there are additional equity-based reasons to offer OPS to non-binary adults as a group; and (3) the ethical defensibility of facilitating individual requests for OPS from non-binary adults also depends on other relevant considerations, including the balance of potential benefits over harms for that specific patient, and whether the patient’s request is substantially autonomous. Although the broadly principlist ethical approach we take can be used to analyse other cases of non-binary adults requesting OPS apart from the case we evaluate, we highlight that the outcome will necessarily depend on the individual’s context and values. However, such clinical provision of OPS should ideally be within the context of a properly designed research study with long-term follow-up and open publication of results.
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Debates about the ethics of ICU triage often build on the assumption that triage policies exhibit a trade-off between feasibility and justice. Auriemma and colleagues dispel this concern, arguing that (a) categorical exclusion criteria are no easier to implement than sophisticated prioritization methods, while (b) sophisticated prioritization methods are indeed more just. Thus, they conclude that categorical exclusion criteria should be abandoned in favor of more nuanced prioritization frameworks.The article advances a slew of concerns about categorical exclusion criteria and their repercussions, some of which are amply documented in primary research (e.g., detrimental effects on clinician mental health). Others—in particular, the idea that categorical exclusion criteria would uniquely erode public trust—are not, to our knowledge, supported by direct evidence. In our commentary, we elaborate and test this empirical prediction in a vignette-based experiment (N = 297). Each vignette describes a doctor who either applies a simple exclusion criterion (the patient’s age, essential worker status, or comorbidity) or considers all three characteristics simultaneously, and weights them to form a composite score. Indeed, we find that people manifest a preference for composite over simple exclusion criteria: They view a doctor’s decision as better (p = .013), and more ethical (p < .001) when based on a composite score, and also consider that she should be more satisfied with the decision she made (p = .008). Yet, our results also contain a word of caution: The preference for comprehensive exclusion criteria is attenuated when triage policies are either dictated by a collegial team or implemented by artificial intelligence—suggesting that physician discretion may undergird the public’s support for sophisticated prioritization methods.
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Précis: Some people with dementia are transformed by the disease, to the point that family members may describe them as a "different person." These transformations may be negative or positive. What factors affect the judgements of ordinary people about whether an advance directive (AD) should be followed in such cases? We conducted three studies to test the influence of (1) positive versus negative transformation and (2) "treat" versus "withhold treatment" AD on the judgements of US participants (n = 1676) as to whether the AD should be followed and the extent to which the late-stage dementia patient had become a different person. We found that participants generally endorsed following the AD, irrespective of condition, but much less so when the patient had a positive transformation. Participants also favored "treat" over "withhold treatment" ADs. Unexpectedly, we found that AD type affected "different person" judgments: participants registered significantly weaker agreement with the proposition that the patient had become a different person when the AD instructed treatment. We discuss these results in the context of Walsh's (2020) newly proposed normative model for AD decision-making.
Chapter
Two books have been particularly influential in contemporary philosophy of science: Karl R. Popper's Logic of Scientific Discovery, and Thomas S. Kuhn's Structure of Scientific Revolutions. Both agree upon the importance of revolutions in science, but differ about the role of criticism in science's revolutionary growth. This volume arose out of a symposium on Kuhn's work, with Popper in the chair, at an international colloquium held in London in 1965. The book begins with Kuhn's statement of his position followed by seven essays offering criticism and analysis, and finally by Kuhn's reply. The book will interest senior undergraduates and graduate students of the philosophy and history of science, as well as professional philosophers, philosophically inclined scientists, and some psychologists and sociologists.
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This book presents a complete theory about the nature of normative thought, that is, the sort of thought that is concerned with what ought to be the case, or what we ought to do or think. This theory implies a kind of metanormative realism, according to which normative truths or facts are genuinely part of reality. At the same time, the theory aims to provide a substantive account of the nature of these normative facts, and a substantive explanation of how it is possible for us to know these facts and to refer to them in language or thought. In providing these explanations, the theory relies on a version of the idea (which has been much discussed in recent work in the philosophy of mind) of the normativity of the intentional. This is the idea that there is no way to explain the nature of the various sorts of mental states that have intentionality or representational content (such as beliefs, judgments, desires, decisions, and so on) without stating normative facts. This idea provides the basis for a systematic theory that deals with the following three areas: the semantics of normative statements (which investigates the meaning of statements about what ought to be); the metaphysics of normative facts (about the nature of the facts stated by these statements); and the epistemology of normative belief (about what justifies us in holding beliefs that these statements express).
Article
Several authors in bioethics literature have expressed the view that a whole brain conception of death is philosophically indefensible. If they are right, what are the alternatives? Some authors have suggested that we should go back to the old cardiopulmonary criterion of death and abandon the so-called Dead Donor Rule. Others argue for a pluralist solution. For example, Robert Veatch has defended a view that competent persons should be free to decide which criterion of death should be used to determine their death. However, there is very little data on people’s preferences about death determination criteria. We conducted online vignette-based survey with Latvian participants (N = 1416). The data suggest that the pluralist solution fits best with the way our study participants think about death determination—widely differing preferences concerning death determination criteria were observed. Namely, most participants choose one of the three criteria discussed in the literature: whole brain, higher brain, and cardiopulmonary. Interestingly, our data also indicate that study participants tend to prefer less restrictive criteria for determination of their own deaths than for determination of deaths of their closest relatives. Finally, the preferences observed in our sample are largely in accord with the Dead Donor Rule for organ procurement for transplantation.