Thinking about the ethical implications of your iGEM project can be a daunting task. To make it easier, the 2020 iGEM team at the University of Copenhagen has made this step by step guide to help future iGEM teams in creating a better ethical framework for their project.
The guide will proceed by first sketching out a method for moral reasoning called “casuistry”, and then showing how this method can be applied to iGEM projects. The teams used as case studies will be the iGEM 2020 University of Copenhagen project, and the iGEM 2020 University of Lund project. First, it is necessary to make clear what the purpose of a method like casuistry is.
Tools for moral reasoning
This guide will not get into the specifics of different abstract moral theories, like deontology and consequentialism. There are two reasons for this. Firstly, the Technion 2017 iGEM team has made an excellent introductory guide to a range of ethical theories, and have shown how they can be applied to specific iGEM projects. Secondly, this guide is aimed towards tackling a slightly different issue. Namely,
how do we draw clear ethical conclusions from cases which are ambiguous and muddled?
It is useful to keep in mind what makes an action morally permissible, but such knowledge is surprisingly inadequate for determining how we should act morally. There is a difference between knowing what makes an action moral (its accordance with a rule, its consequences, and so on), and what actions are moral. An illustrative analogy might be in order. One might know what esthetic characteristics make Leonardo Da Vinci’s Mona Lisa a great painting, but this knowledge is probably useless when trying to determine whether a Cezanne painting is better than one by Van Gogh. When determining whether one action is more moral than another moral principles are often useless. Instead some practical reasoning is required. To see how we now turn to casuistry.
Leonardo da Vinci: Mona Lisa, Paul Cézanne: Still Life with Fruit Dish, Vincent Van Gogh: Dish with Citrus Fruit
Casuistic reasoning about morals
The first question to answer is: What is casuistry? Casuistry (derived from Latin meaning: case or occurrence) was for a long time used as a derogatory term for someone who is intellectually dishonest or deceitful. The term has been reappropriated to mean a type of moral reasoning that takes a bottom-up approach. That is, moral knowledge of a particular case is not found in some moral principle (e.g. consequentialist or deontological philosophy), but in weighing and analysing the particular facts of the situation under investigation. Applying abstract moral principles to concrete cases is notoriously difficult. Starting deductively with an ethical theory requires an a priori formulation of moral principles that usually do not apply neatly to the complexities of real word scenarios. As a method for moral reasoning, casuistry tries to incorporate the messiness of the world in our moral deliberations.
Casuistry has had a modern revival, but as a practice it has roots all the way back to Roman jurisprudence, rabinnic teaching and Greek philosophy (Bleyer, 2020, p. 212). As mentioned the casuist holds that one should forgo the formulation of abstract moral theories (or at least one should not pay too much attention to them), and instead draw moral conclusions from the particulars of the case one is investigating.
Moral questions are always embedded and partly determined by the context they appear in. As such Attention to the particulars of that context is crucial for gaining moral insight.
Casuistic moral reasoning has its most thorough modern examination in the works of Stephen Toulmin and Albert Jonsen. They define casuistic moral reasoning as:
“The interpretation of moral issues, using procedures of reasoning based on paradigms and analogies, leading to the formulation of expert opinion about the existence and stringency of particular moral obligations, framed in terms of rules or maxims that are general but not universal or invariable, since they hold good with certainty only in the typical conditions of the agent and circumstances of actions” (Jonsen, 1991, p. 297)
There is a lot in the passage above that needs unpacking. Such as the meaning of paradigm, maxim, and reasoning by analogy. We will get back to this later. For now, it is important to note that there are three guiding considerations for casuistic reasoning: 1) morphology
Borrowing the term from traditional biology, Toulmin and Jonsen see Morphology as encompassing two key features of moral reasoning (1). The first is analysing the circumstances in the case under evaluation. The second is formulating moral maxims (or moral identities) that appropriately apply to the case under evaluation.
(1) Morphology literally means the study of the form of things. morphē roughly translates to “form” or “shape” and logia roughly translates to “study of”.
How do we analyse the circumstances that make up our case? There are several components to this. First, it includes describing all the circumstances or facts of the case. That is, one should answer all the “who, what, when, where, why, and how” questions. For an iGEM team this might include answering questions such as “who are the end consumers of our product (conversely, who are we as providers)? What is it, in great detail, that we are providing? Where are we expected to make an impact (have you mapped out the relevant socio-economic and cultural factors of your target community?) There is, of course, many more, but I will leave it at that. Not all of the details will feature in your final moral analysis, but given that the moral conclusions you can make are partly determined by these details, it is important to properly analyse them.
The second part of the morphology step is identifying what you think might be relevant moral maxims for the case you're evaluating. The moral maxims are at the center of your case.
Moral maxims are not moral rules or principles that determine what is right or wrong. Rather, moral maxims are brief rule-like sayings that give moral identity to your case.
It can be viewed as an important moral proposition that informs what kind of research you should be doing. If mapping out the relevant circumstances of your case is telling a story, the maxims are the moral of that story. These can be ethical considerations that show themselves to be relevant as one starts investigating the details of the case. A case can have several moral maxims. If a case is worth moral deliberation in the first place, then it is usually because there are several conflicting moral maxims that are associated with it.
There is no specific method for determining what moral maxims apply to your case. As mentioned, moral maxims give moral identity to your case, but they do not make a moral argument, or allow one to make any moral judgments. After you have mapped out the relevant facts of your case, you hopefully have an intuition or a gut-feeling regarding what moral maxims applies to it. Moral maxims are not supposed to be anything more than such intuitions.
After the morphology step, we should have two component parts: The relevant circumstances of the case, and the moral maxims of the case. Of course, these component parts interact. The process of determining the relevant moral maxims should be influenced by the circumstances of the case, and the identification of the relevant moral maxims should guide further research into the circumstances. The identification of relevant moral maxims will also reveal what descriptive facts of the case are morally relevant and should be used in our final analysis.
Morphology in an euthanasia case We will later get into specific iGEM cases, but for now, it might be useful to set up a standard case of euthanasia for illustrative purposes.
A resident in obstetrics is called late at night to see a young woman whom he does not know. On reviewing her chart he sees that she is in the terminal stages of ovarian cancer. Entering her room, he notes her emaciated state and obviously great pain. She pleads, "let's get this over". The resident administers a heavy dosage of morphine (Jonsen, 1991, p. 298)
If we want to determine the moral value of the action performed by the resident, we would need to figure out the morphology of the case. As the philosopher Jonsen points out this includes facts about the expected roles of the physician and the patient, the terminal nature of the patient’s illness, the patient’s mental and physical distress, the import of the request, previous commitments taken by the physician (like the hippocratic oath) and more (Jonsen, 1991, p. 298). What might seem like less important facts should also feature, like the lateness of the hour or the dosage administered by the physician. These are descriptive elements of the case.
As mentioned, the descriptive facts of the case should give rise to some moral maxims. In this case they might be propositions like “physicians should respect the wishes of patients”, “physicians should strive to relieve pain”, “thou shalt not kill” and “physicians should not administer deadly poisons”. These are moral guidelines that seem to be relevant to the described case. As we can see these moral maxims are contradictory, so we have our work cut out for us. We now turn to the taxonomy step.
It is in the taxonomy step that the brunt of the ethical work is done. The morphology step is concerned with mapping out, and applying maxims to, the case that we need to reason morally about. When we have thoroughly sketched out our case, it should become obvious that it is of a certain type. That is, it is one case among many that raise a specific kind of moral issue. It is one case among many that share a specific moral maxim.
All cases of the same type are alike in some aspects and different in others. That is, the morphology of cases belonging to the same type is different, but sufficiently similar to be grouped together under one type. All cases that belong to the same type as our euthanasia case presumably deal with physicians in some way bringing about the death of their patients. The relevant questions for cases belonging to this type will be whether the doctor has the right (or possibly duty) to act as he does, whether the patient has a right to make this request of the doctor, whether the patient or doctor is the responsible agent, what conditions of competence, pain, terminality should obtain to make the act permissible, and so on (Jonsen, 1991, p. 301).
Once we have done the morphology of our case and identified which type it belongs to, it is possible to make a taxonomic ordering belonging to it. Given that our case type raises the questions mentioned above, its taxonomic category is presumably one that deals with killing. Most likely all euthanasia cases will have the maxim “thou shalt not kill” as a moral identifyer. This is of course not the only taxonomic ordering you could fit euthanasia cases into. Most likely euthanasia cases could be fitted into a taxonomic ordering dealing with patient autonomy, or something similar. However, given that the most pressing moral issue pertaining to euthanasia cases is usually whether the action performed by the docter constitutes killing, it makes sense to use a taxonomic ordering that deals with killing.
Highest in the ordering of cases that deal with killing are the ones that exhibit a clear moral judgment beyond any reasonable discussion. This is called a paradigm case. The biblical story of Cain killing Abel might serve as a clear case illustrating the moral wrong-doing of unprovoked killing, and as such can be considered a paradigm case. Next in the taxonomic line might be cases that illustrate provoked killings, such as self-defense or preemptive defense. Such cases do not exhibit as clear a moral judgment. The taxonomic ordering is done entirely by an analogous way of reasoning. That is, we check for similarities and differences in morphology and conclude that the cases exhibiting most similarities with the paradigm case are most likely to be morally equivalent, or closer in moral status, to the paradigm case.
Somewhere on the spectrum, the euthanasia type will be located. Given that our euthanasia case is taken up for deliberation in the first place, we can assume that it is located among cases on the spectrum that we are unsure whether violates or fulfills the paradigm case. We can now investigate the similarities between euthanasia cases as a type and the paradigm case of Cain and Abel. By doing so we can determine whether “thou shalt not kill” is a moral maxim that gives identity to a euthanasia case.
First, let’s look at the differences. If a case is of the euthanasia type, the patient needs to ask (while in a clear state of mind) the doctor to administer a lethal dose of morphine (or another lethal drug), while Abel does not wish for his own killing. Furthermore, the patient is already terminally ill, while Abel could potentially have lived a long and painless life. Another relevant factor is that the doctor is acting with the intention to reduce the suffering of the patient, while Cain killed Abel out of jealousy.
The most relevant similarity to the paradigm case of killing is that in both cases one person intentionally brings about the death of another person. However, the context of the euthanasia case makes the moral proposition expressed by the paradigm less applicable, as it allows other moral maxims to be used as rebuttals. The fact that the patient asks (while perfectly lucid) the physician to end her life is compatible with the moral maxim of respecting a person's autonomy. Furthermore, the fact that the physician acts based on the knowledge of the patient’s terminality and suffering, is compatible with the moral maxim of reducing suffering when possible.
These moral maxims conflict with the moral proposition expressed by the paradigm case of Cain and Abel. Of course, this does not mean that we can say with certainty that euthanasia is morally permissible, but the moral maxims that arises in the differences exhibited by the euthanasia case indicates that these differences needs to be in place in euthanasia is to be permisible at all.
Notice however, that such a partial argument in favor of euthanasia is entirely contextual. The force of the argument lies in the difference in morphology between the standard euthanasia case and the Cain and Abel case. If the context changes, the argument will also change. For example, if we assume that the patient asked for a lethal dose, but was not in a lucid state while doing so (or the doctor was not competent enough to evaluate her mental state properly), then the moral maxim of respecting a person’s autonomy would not apply. For example, in our case the physician does not know the patient before entering the room. For that reason one could argue that he was not competent enough to evaluate the import of the request (or her state of mind), meaning that the consent aspect is on shaky grounds. Given such a contextual change, it would be harder to argue that our euthanasia case is sufficiently different from the Cain and Abel case to not constitute murder.
When the circumstances are right, we have a somewhat forceful moral argument. If the circumstances in an euthanasia case are such that the patient, being in a lucid mental state, ask a physician she knows to relieve her of the suffering caused by a terminal illness, we have good reason to hold that the morally relevant factors in the paradigm case, do not apply to our case.
Borrowing a term from classical physics, the term “kinetics” refers to the changes in judgment that can be made when the circumstances are sufficiently different (Strong, 1999, p.398) (2) . As mentioned before, moral knowledge is found in the facts of the case. Changing those facts will naturally also change the moral conclusions we can draw from it.
Kinetics is an attempt to loosely quantify or weigh the importance of the circumstances that together make up a case.
(2) Kinetics comes from greek “kinein” which means “to move”
We have identified what differentiates our case from the paradigm case of Cain and Abel. The facts of our euthanasia are such that the moral conclusion we can draw from it are not as clear cut as the one we can draw from the paradigm case. These differences in facts thus carry some moral force. We go from a moral wrong beyond any reasonable discussion in the paradigm case, to a euthanasia case with the same maxim (moral identity), but where the moral conclusions we can draw are less obvious. One should note that our euthanasia case might still be morally wrong (maybe for other reason than illustrated by the paradigm case), but we now have an idea of what circumstances must serve as necessary conditions for euthanasia being morally permisibble. Now one can weigh how important these necessary conditions are for differentiating the moral status of the euthanasia case from the paradigm case. This includes facts about how lucid the patient needs to be when making the request, how well the doctors should know the patient, how painful her disease is, and what the likelihood of survival, or living a satisfactory life until the end, is.
There is no precise method for how the differences in context should be weighed. It requires what Aristotle called practical wisdom. The different facts are weighed not by some deductive argument or mathematical formula, but by relying on previous experience, contextual information and situational awareness. Unfortunately this type of ethical work is not a science, and some common sense is required. Exactly how much one should weigh patient autonomy, or how lucid patients should be in euthanasia cases is hard to determine. However, we know that such circumstances needs to be weighed heavily if euthanasia is to be permitted at all. If these factors are missing from our case, then our case would look more like the paradigm case of Cain and Abel.
Sources Bleyer, B. (2020). Casuistry: On a Method of Ethical Judgement in Patient Care. In HEC Forum. Springer Netherlands. (pp. 212) Jonsen, A. R., & Toulmin, S. (1988). The abuse of casuistry: A history of moral reasoning. Univ of California Press. Jonsen, A. R. (1991). Casuistry as methodology in clinical ethics. Theoretical medicine, 12(4) (pp. 297-298, 301) Strong, C. (1999). Critiques of casuistry and why they are mistaken. Theoretical Medicine and Bioethics, 20(5). (pp. 398)