The origin and emergence of empirical ethics

Abstract

Psychiatry is a medical sub-discipline with its own task (the care of mentally ill patients), its own practice, its own research questions, and its own ethical challenges. Psychiatric ethics covers different domains, from ethical questions concerning research into mental illnesses, to the professional ethics required in the fields of psychiatric practice and psychiatric care, and the range of moral problems arising in the mental health care setting and organization (Radden 2002). Psychiatric ethics, however, is not fundamentally different from medical ethics. It is in fact medical ethics, shaped and conditioned by the different purposes of psychiatric practice, research, and organization. By its grounding in medical ethics, psychiatric ethics has always been about how ethical principles such as autonomy, beneficence, and confidentiality can guide psychiatric practice and research. A philosophical and moral challenge, for example, has been to determine the extent to which psychiatric patients possess the capabilities necessary for being an autonomous agent or for being able to give informed consent. In addition to these philosophical issues, in the last two decades various topics in psychiatric ethics have been studied in an empirical way, for example informed consent in the context of mental illness (Stanley et al. 1987; Roberts 1998; Sugarman 1999).In the field of medical and bioethics, the interest for, and the number of publications (Borry et al. 2006a) with an empirical design has recently increased. Renowned bioethicists (Callahan 1980; Thomasma 1985) made appeals for ethicists to work together with social scientists, being convinced that their research findings could improve ethical decision-making. These appeals did not fall on deaf ears; various authors in the past decade have indicated that a novel form of scholarship in bioethics (Brody 1990) or a ‘new form of ethics paper’, has appeared (Arnold and Forrow 1993) and that ethicists’ interest in empirical data continues to grow (Molewijk 2004). By ‘a new form of ethics paper’ we mean literature that is categorized as sociological (Fox and De Vries 1998), empirical (Singer et al. 1990), or experimental (Thomasma 1985), but which also focuses on bioethical themes. This alternative bioethical literature has methodological roots in the social sciences and uses methods such as case studies, surveys, experiments, interviews, and participatory observation. The common objective is the gathering of qualitative and quantitative data about ethical issues. We consider the empirical field developed here to be an interdisciplinary one that benefits not only from the work of sociologists and social psychologists, but also from researchers in medicine and public health, epidemiologists, health economists, physicians, and ethicists.In the first part of this chapter a number of hypotheses will be advanced as to why the relationship between ethics and the empirical sciences has improved. These hypotheses involve an analysis of how a theory-driven bioethics that did not sufficiently take practical reality into account has been criticized, how clinical ethics increased the awareness of empirical research in bioethics, and how the paradigm of evidence-based approaches is taken up in the vocabulary of bioethics.The second part of this chapter will focus on three reasons which could explain why medical ethics and bioethics did not take the empirical sciences seriously or incorporate empirical data into their normative concepts and judgements. The three reasons are: dialogues between disciplines run the added risk of communication problems and opposing objectives; the social sciences have historically been absent partners since the genesis of medical ethics and bioethics as a discipline; and the meta-ethical distinction between ‘is’ and ‘ought’ has created a ‘natural’ border between ethics and the social sciences (Borry et al. 2005).