How to depolarise the ethical debate over human embryonic stem cell research (and other ethical debates too!)
- 1Centre for Healthcare Ethics, Stockholm, Sweden
- 2School of Innovation Sciences, Section for Philosophy and Ethics, Eindhoven University of Technology, Eindhoven, The Netherlands
- Correspondence to Martin Peterson, School of Innovation Sciences, Section for Philosophy and Ethics, Eindhoven University of Technology, Den Dolech 2, Eindhoven 5211 MB, The Netherlands;
Contributors Both authors contributed equally to this paper.
- Received 12 July 2011
- Revised 30 January 2012
- Accepted 2 February 2012
- Published Online First 28 February 2012
The contention of this paper is that the current ethical debate over embryonic stem cell research is polarised to an extent that is not warranted by the underlying ethical conflict. It is argued that the ethical debate can be rendered more nuanced, and less polarised, by introducing non-binary notions of moral rightness and wrongness. According to the view proposed, embryonic stem cell research—and possibly other controversial activities too—can be considered ‘a little bit right and a little bit wrong’. If this idea were to become widely accepted, the ethical debate would, for conceptual reasons, become less polarised.
- Stem cell
- degree of rightness
- lottery paradox
- moral dilemma
- stem cell research
- concept of health
- philosophical ethics
- allocation of organs/tissues
Throughout the history of ethics, philosophers and others have proposed a wide range of criteria for distinguishing right acts from wrong ones. Utilitarians, Kantians, contractualists and virtue theorists may disagree about what the appropriate criteria are and how they should be applied to real-world cases, but they all agree that there is a sharp distinction to be drawn between right and wrong acts, and that there is nothing in between.1–4
In light of this widely accepted dichotomy between right and wrong it is not surprising that we see deep polarisation in many debates over complex ethical issues. The heated debate over human embryonic stem cell research is an excellent illustration of this.5 ,6 A few years ago, when it was discovered that human skin cells from adults could be converted into cells that have many of the properties of embryonic stem cells, the discussion seemed to simmer down. However, now only a few years later the ethical issues that momentarily seemed to have disappeared are back again alive and kicking. Experts agree that research on embryonic cells is unlikely to be replaced by studies of non-embryonic stem cells within the foreseeable future.7 Hence, there seems to be no way we could avoid having to take a stand on whether human embryonic stem cell research is morally right or wrong. Although the new US policy introduced by President Barack Obama in 2009 may have changed the tone of the debate, it did not resolve the underlying ethical concerns.8
In the current debate there are at least two opposing views. On one end of the ethical spectrum we have those who argue that a human embryo has the same or almost the same moral status as ordinary adults. If accepted, this view could be taken to justify the conclusion that destroying embryos for the purpose of producing embryonic stem cells is morally equivalent to killing a human being.9 On the other end of the spectrum we have those who argue that human embryos have the same moral status as any other unconscious living organism. According to this view, embryonic stem cell research is far less problematic.10 ,11 There seems to be no simple solution to this conflict of ethical outlooks.
Moreover, the two opposing camps are more or less forced to remain in their respective corners since there is, conceptually, no room for middle ground. Even if arguments from the opposing camps were to be perceived as legitimate there would be no way to fully take this into account if ‘right’ and ‘wrong’ were the only ultimate deontic properties in the offering. This is unsatisfactory from a theoretical point of view and is also, apparently, too heavy handed from a practical point of view.
In this article we argue that the ethical debate over embryonic stem cell research is polarised to an extent that is not warranted by the underlying ethical conflict. We argue that this ethical debate (and probably other ethical debates too) could be rendered more nuanced, and less polarised, by introducing a non-binary notion of moral rightness and wrongness. Instead of trying to convince people of opposing ethical opinions to drastically change their views, a more fruitful approach is to consider the possibility that one's opponent is, literally speaking, somewhat right and somewhat wrong.
Let us try to render this moral hypothesis more clearly. In the view we propose, some particular acts—including acts that involve research on embryonic stem cells—are neither entirely right nor entirely wrong. These acts rather have some other status that falls between the two extremes, and they are best thought of as being simultaneously right and wrong to some degree. That an act is right to a certain degree means that it is more right than an act that is right to a lower degree. This idea that moral rightness varies in degrees is a structural claim about deontic verdicts, which can be rendered compatible with a large number of ethical theories and outlooks. However, rather than discussing its compatibility with different ethical theories, in what follows we will try to defend our hypothesis by showing how it can account for a number of observations about the structure of the embryonic stem cell debate.
Conflicting reasons and deontic leaps
We take it to be fairly uncontroversial that the ethical principles or values that people disagree so heavily on in the embryonic stem cell debate, as well as in other polarised ethical debates, cannot be easily dismissed. On the one hand, embryonic stem cell research promises to solve many of the important medical challenges of the present day and the future. This speaks in favour of continuing with this type of research. On the other hand, embryonic stem cell research requires the destruction of human embryos. This speaks against this type of research (for various reasons, which there is much disagreement on). For the purposes of this article, we do not have to take a stand on exactly what ethical principles or values are relevant here. Let us just note that it is widely agreed that there are some principles or values that give rise to a conflict, even if there is little agreement on exactly how those principles of values should be articulated. Let us call the reasons that support the view that we should continue with embryonic stem cell research the ‘pro’ reasons, and the reasons that support the opposite conclusions the ‘contra’ reasons, respectively.
The main advantage of the degree-based view we propose is that it allows us to formulate a more nuanced moral conclusion that accurately reflects the pro and contra reasons. By claiming that embryonic stem cell research is right to some degree and wrong to some degree, we preserve the intuition that the pro and the contra reasons should be fully reflected in the final ethical verdict. Some pro and contra reasons do not lose their force when considered together with other reasons.
The dominant view about practical conflicts is what we call the resolution view. Advocates of the resolution view believe that conflicting pro and contra reasons can always be balanced and resolved into a binary moral conclusion. The two key assumptions in this approach are that:
(i) all ethical reasons can always be compared and balanced against each other on a single scale, and
(ii) an act is right if and only if the pro reasons are on balance stronger than the contra reasons.
Some scholars reject this view in favour of what we call the dilemma view. Advocates of the dilemma view believe that conflicting pro and contra reasons in some cases cannot be compared in terms of their mutual strengths, which leaves both pro and contra reasons undefeated. The two key assumptions in this approach are that:
(iii) some ethical reasons cannot be compared and balanced on a single scale, and
(iv) an act is wrong if and only if the applicable contra reasons are not outweighed by the pro reasons.
Advocates of the dilemma view believe that whenever (iii) applies to some contra reasons, then that contra reason is not outweighed by the pro reasons for the other alternatives, meaning that all alternative acts are wrong.
In our view, an important argument that speaks against the resolution and the dilemma view is that these positions are both committed to deontic leaps. We use the term deontic leap as a technical term for describing the process in which an ethical principle or theory assigns some ethical status to an act that does not correspond fully to the ethical reasons that pertain to the situation at hand. For example, if you have a strong ethical reason to tell the truth to your patient and also a strong ethical reason to not reveal some part of the truth, and your ethical theory merges these conflicting reasons into the unqualified verdict that, ‘it is right to tell the truth’, then a deontic leap has occurred: your ethical code or moral theory assigns a deontic status to an act, but that deontic status does not fully reflect all the ethical reasons that actually pertain to the situation.
Deontic leaps can be compared with a similar phenomenon in epistemology. Imagine, for instance, a fair, million-ticket lottery that has exactly one winning ticket.12 The rules of the lottery are known by each player, so it is rational to believe that, ‘some ticket will win’. However, also suppose we agree that one should not believe things that are not very likely to be true, and that an event is considered to be ‘very likely’ only if the probability of it occurring is greater than, say, 0.999. On these grounds it is rational to believe that ticket 1 of the lottery will not win (since the probability that ticket 1 will not win is higher than 0.999). Since the lottery is fair, it is rational to believe that ticket 2 won't win either; indeed, it is rational to believe for any individual ticket i of the lottery that ticket i will not win. However, believing that ticket 1 will not win, and believing that ticket 2 will not win, and so on, seems to entail that it is rational to believe that no ticket will win, which contradicts the premise that one ticket will definitely win.
An influential response to the lottery paradox is to argue that we should reject the idea of outright belief altogether. The traditional all-or-nothing account of belief is inadequate and needs to be replaced by a notion that allows for beliefs to come in degrees.13 So, on this view, the appropriate degree of belief that ticket i will not win is simply 0.999999. To fully believe that ticket i will not win is to make an unjustified epistemic leap from 0.999999 to 1.
The idea here is that the structure of the doxastic reasons we have for believing something sometimes resembles the structure of polarised debates such as the stem cell debate. Suppose you have some reason to believe that the weather tomorrow will be sunny, and also suppose that you have some reason to believe that the weather will be rainy. On these grounds, it would be odd to fully believe that it will be sunny (or rainy). A more nuanced conclusion would be to believe to some degree that it will be sunny and believe to some degree that it will be rainy. Correspondingly, if there were some reason to assign the deontic status of rightness to stem cell research, and also some reason to assign wrongness to it, then it would be odd on these grounds to say that stem cell research is entirely right (or entirely wrong). The more nuanced conclusion, which takes into consideration and reflects the underlying reasons in play, is that stem cell research is a bit right and a bit wrong; that is, right and wrong to some degree.
In the lottery paradox every lottery ticket has equal prior probability, but that insight plays no role in our ethical argument. Our point is just that all verdictive epistemic reasons—that is, reasons that that are not defeated by other reasons—in the lottery paradox should be reflected in the final epistemic conclusion. We propose that something similar also holds true in ethics. If there are several conflicting but verdictive (ie, non-defeated) ethical reasons, then this should be reflected in the final ethical conclusion.
We believe that our non-binary notion of rightness and wrongness is the appropriate response to the challenge from deontic leaps.
In the case when the applicable ethical reasons can be compared on a single ethical scale, it may be that there are strong verdictive reasons that speak in favour of an act and also weaker verdictive reasons that speak against it. Our view then entails that the act is right to a high degree and wrong to a low degree. However, since all the remaining reasons are verdictive, the reasons for the act do not defeat the reasons against it, and therefore there is no deontic leap.
In the case when the ethical reasons cannot be compared on a single scale (which leave some pro and contra reasons undefeated) our view does not conclude that all alternatives acts are wrong in a binary sense, as in a traditional moral dilemma. That would not accurately reflect all the underlying verdictive pro reasons, for example, the fact that the potential benefits of embryonic stem cell research are huge. In this type of case, our view simply claims that the act is right to some degree and wrong to some degree. And since all the applicable reasons are reflected in the final ethical verdict there is no deontic leap.
Depolarising the stem cell debate
In our view, the explanation of why the ethical debate over embryonic stem cell research is so polarised is that all the previously existing analyses involve deontic leaps. In the final ethical verdict we are always told that stem cell research is either right or wrong in a binary sense. Such a binary conclusion cannot fully reflect the structure of the underlying ethical reasons. For instance, although we have some verdictive reason for assigning a very high moral status to a human embryo, we also have some verdictive reason for not doing so; therefore an outright black-or-white conclusion seems unwarranted.
Our proposal is thus that our ethical conclusions, much like our doxastic ones, should be non-binary. Instead of claiming that embryonic stem cell research is entirely wrong or entirely right, all participants in the debate could presumably concede that the best arguments of one's opponent are likely to qualify as verdictive ethical reasons, which entails that they be given some weight and cannot be entirely defeated by other verdictive reasons. Although it is not difficult to find examples of moral philosophers who claim that their opponents are entirely wrong (just read the literature!), we believe that such a categorical rejection of the view of one's opponent has little warrant, at least in some cases. Arguably, a rational agent should sometimes assign at least some weight to the views of his ethical peers. Therefore, the most reasonable ethical conclusion is that the endpoints of the ethical spectrum should be avoided. Or, in other words, if we consider all the applicable verdictive reasons for and against embryonic stem cell research, the most reasonable conclusion seems to be that this type of research is simultaneously right and wrong to some degree.
The upshot of the non-binary approach we propose is that both parties in the debate should modify their ethical positions at least a little bit. Rather than insisting on defending one of the two binary positions they should all revise their standpoints, at least to some extent, which entails that the distance between the two main camps in the debate will decrease. Hence, if the non-binary approach were to gain ground the debate would depolarise.
At least two objections could be raised against our proposal, but neither of them is particularly forceful. First, professional ethicists and moral philosophers could object that it is simply false that moral rightness and wrongness are non-binary concepts. Although intuitively appealing, this view is after all incompatible with the standard interpretations of a number of major ethical theories. Our response to this objection is that ethical theories need to be continuously updated and rendered compatible with new ideas and intuitions as they arise.
The second objection is practical. Even if one were to accept our non-binary approach, it does not follow that all diverging views would converge into a single position. There would still be some space left between the modified positions, although the distance would no longer be so great. In order to address this remaining disagreement, we would like to briefly mention an ongoing debate among philosophers about moral uncertainty.14 Roughly, if we accept that there may be an infinite number of alternative moral positions between the two endpoints of the moral spectrum, it seems very likely that our moral opinions are wrong. If there are just two options to choose from, right and wrong, the (objective) probability that you chose the right opinion is 50%. However, if the number of alternative opinions is much larger, it is easy to see that it is very likely that your opinion is incorrect, at least to some degree. Therefore, it seems reasonable to also take this moral uncertainty into account when drafting ethical policies. That is, if you realise that it is very likely that your moral opinions are at least partly incorrect, you should be more willing to compromise and accept opinions that lie within your moral margin of error. This will make it easier to reach compromises that everyone can live with.
Let us apply this theoretical idea to the practical debate over embryonic stem cell research. From the point of view of the resolution view, embryonic stem cell research is either right or wrong. Therefore, if two or more people disagree about this issue, they might both end up feeling morally uncertain about what is right and wrong, but it seems difficult to get any further than that. The practical problem about what to do and how to formulate an ethical policy still remains.
However, by combing the notion of moral uncertainty with a non-binary notion of rightness and wrongness we gain something important. If two or more parties disagree about the ethics of embryonic stem cell research, they may nevertheless be able to conclude that embryonic stem cell research is neither entirely right not entirely wrong. Imagine, for instance, that some person or group of people A concludes that embryonic stem cell research is right to degree 0.8 (on a scale from 0 to 1; we leave it open how the scale should be constructed) while B concludes that embryonic stem cell research is right to degree 0.7. Now, given that neither party can be entirely sure about the correctness of their own conclusion, it seems rational for both parties to think that the rightness of the act in question lies somewhere in, or near, the interval from 07 to 0.8. Therefore, since the remaining disagreement is only partial—both parties agree that certain parts of the interval can be ignored—we actually obtain some substantial act guidance: we should avoid policies stating that embryonic stem cell research is entirely wrong. If everyone in the debate were to agree that the rightness of embryonic stem cell research most likely lies somewhere in the interval suggested above, then this should be reflected in our policies.
Decision making and degrees of rightness
The claim that moral rightness and wrongness should be conceived of as non-binary concepts raises a number of theoretical questions. Exactly what does it mean to say that an act is simultaneously right to some degree and wrong to some other degree? What is the logical structure of such verdicts? And what kind of principle for decision making fits best with this structural position? Although we believe that all these questions are important, all we will attempt to do here is to answer the question about decision making, and mention that we have addressed the other questions elsewhere.15
The headline news is that our suggestion that embryonic stem cell research is a bit right and a bit wrong is logically compatible with a number of different views about decision making. That said, we of course believe that some of these alternative views are more implausible than others. To begin with, note that just because an act is right to a certain degree and some other act is right to a slightly higher degree, it does not follow that a rational agent should always perform the act that is right to the highest degree. In fact, we believe it is not irrational, in a means–ends sense, to sometimes perform options that are right to a lower degree. Why? Because we should give each verdictive reason its due. If two or more verdictive reasons clash, it would be a mistake to think that one set of verdictive reasons could somehow balance out the others. In order to see this, it might be helpful to consider an analogy.
If the football team PSV Eindhoven beats Ajax by 2 goals to 1, then the number of goals scored by each team can be compared and evaluated on a single scale. It would therefore be a mistake to say that one team ‘won to a high degree’ and the other ‘won to some lower degree’. The team that scored the greatest number of goals won, and if the result were a draw we would say that neither team won. However, in the debate over embryonic stem cell research the situation is different. Here it actually makes sense to claim that each of the incompatible acts is right to some degree, that is, that several incompatible alternatives ‘won’ the match, since this is a case in which different verdictive reasons clash.
We propose that in a choice between acts that are somewhat right and somewhat wrong, the rational thing to do is to give the verdictive reasons that speak in favour of each act their due. This arguably requires randomisation. If you cannot compare and balance the verdictive ethical reasons that apply to a case, it seems odd to maintain that these verdictive ethical reasons should somehow dictate your choice. Why should they? For instance, if it is almost entirely right to make a donation to famine relief (but also a tiny bit wrong since the overhead costs of the aid provider are high), and it is right to a somewhat lower degree to make a donation to medical research, then the rational thing to do is to randomise between these acts. By doing so, the agent gives the verdictive reasons speaking in favour of the two acts their due. The general principle is that if an act is at least somewhat right, that is, right to some non-zero degree, then it should be performed with some non-zero probability.
In this context randomisation does not require that we literally roll a die or toss a coin. The point is rather that the professional ethicist who happens to be sitting on an ethics committee that is about to make a decision of the sort considered here may, we propose, let other considerations than purely ethical ones settle the decision about what to do in a particular case. It therefore seems reasonable to maintain that in this type of case the rational thing to do is to temporarily put aside the ethical considerations and pay more attention to contingent, practical considerations. To be more precise, we propose that the practical, contingent considerations should be allowed to govern the decision in such a way that, if repeated a large number of times, the decision could equally well have been taken by rolling a die. Although the decision on a particular occasion was not actually settled by, say, the verdictive pro reasons, the external observer cannot exclude that it was. In that sense, the verdictive pro reasons got their due on that particular occasion, and the next time the verdictive contra reasons will get their due. If all available acts are right to roughly the same degree as they are wrong, and there are no other relevant differences between the acts, our proposal thus entails that one should let other considerations settle the decision between the available alternatives, in such a way that the final conclusion appears to have been taken (although it wasn't actually taken) by tossing a fair coin. We believe that this proposal establishes a morally attractive form of correspondence among the underlying verdictive reasons; the deontic verdicts about the available acts and the practical decision. The key insight, that the debate over embryonic stem cell research involves a conflict between clashing verdictive pro and contra reasons, is on this proposal visible in the final ethical verdict and also in the practical decision about what to do.
Note that it would make little sense to maintain that an act’s degree of rightness always corresponds directly to the probability with which it should be performed. This is because there is no structural requirement on deontic degrees that they should always sum up to one, while this of course is a requirement on probabilities. Perhaps it would be almost entirely right to make a donation to famine relief at the same time as it would be a tiny bit less right to make a donation to medical research. If these alternatives are jointly incompatible, they cannot both be performed with a probability of almost one. If you make a donation to famine relief with a probability that is close to one, then the probability with which you make the donation to medical research will be close to zero. Moreover, one can imagine cases in which one act is entirely right while some other alternative is right to a fairly high degree, but not entirely right. Although this is a controversial claim, we feel inclined to say that in such a case it would not be rational to perform the entirely right act with probability one. Why not? Well, since the other alternative was also somewhat right, it would actually be fitting to perform it with some non-zero probability. As we noted above, if you cannot compare and balance the verdictive ethical reasons that apply to a case with each other, it seems odd to maintain that these verdictive ethical reasons should nevertheless dictate your choice.
According to the view developed here, embryonic stem cell research is—literally speaking—a little bit right and a little bit wrong. If this view were to become widely accepted, the ethical controversy over stem cell research would, for conceptual reasons, become less polarised. Very briefly put, it would be easier to formulate polices that all or nearly all participants in the debate could live with, even if there would of course still be some remaining disagreement.
It is worth pointing out that the general theoretical framework developed here could also be applied to other ethical controversies, such as the debates over abortion, cloning and human enhancement. To enter those debates is, however, beyond the scope of this article.
The authors would like to thank Anthonie Meijers for fruitful discussions on the depolarisation of ethical debates.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.