Particularism and personalised medicine – reflections on a conference

I attended a conference last week hosted at Manchester Metropolitan University – there is a link to the conference details here.

This was an interesting experience – I’ve attended more philosophically orientated conferences before and always enjoyed myself as they provide a very different form of discussion from most of the academic meetings I attend. Also this meeting was in the first week back after the festive period and I thought it might provide a good way of easing back into work again…

The meeting was held over two days – with talks throughout the first day and then morning talks on the second before a more general round table discussion over lunch and for the second afternoon. Unfortunately I had to leave slightly early on the first day as I had home commitments to attend to – slightly frustrating as the last talk of the day was proving very interesting…

I thought it might be interesting to offer some reflections on the meeting from my perspective as a clinical psychiatrist and researcher – somewhat more at the sharp end of decision making but with some experience of both clinical and research ethics committees. Qualifying statement at this point however – I am not a moral philosopher so my understanding of the conference likely took place at a slightly less than meta-physical level. My only formal ethical training was at medical school and largely consisted of standing with my hand over my heart reciting the principles of biomedical ethics outlined by Beauchamp and Childress. Any other experience is entirely self-directed through my own reading…

Particularism – qu’est ce que c’est?

So… first a stab at understanding (roughly) an outline of particularism? This is based on my own understanding and the fantastic Stanford Encyclopaedia of Philosophy.

“Moral Particularism, at its most trenchant, is the claim that there are no defensible moral principles…” (Moral particularism – Stanford Encyclopaedia of Philosophy)

“The strongest defensible version, perhaps, holds that though there may be some moral principles, still the rationality of moral thought and judgement in no way depends on a suitable provision of such things…” (ibid)

So – rather than stating a series of generalisable principles that should inform our moral thinking we should approach each situation as an individual – to be considered in an holistic manner informed only be the circumstances before us.

Decision making in Ethics committees

The talks at the conference were all interesting and enjoyable – but I thought that for the purpose of reflection I thought I would focus on the first talk on the second day as, for me, it served as the point where most of my own thoughts in the meeting crystallised.

This talk was delivered by Anna Zielinska and focussed on a project she had conducted in England, France and Germany examining the decision making process of research ethics committees.

She presented an overview of the history of research ethics committees and biomedical ethics as a discipline. Her argument opened with a critique of the informing principles of biomedical ethics – which she formulated as lacking a proper foundation and historically informed by religious principles.

She then presented the data from her study – where she studied the decisions taken by medical research ethics committees and the ethical principles that inform these decisions. Her argument in this case was that ethical principles in themselves were unnecessary for the decisions that the committees reached – which could be reached from consideration of the cases on their own merits. In incidences where research projects, or amendments, were rejected on ethical grounds she argued that these were methodological considerations primarily and that the attendant ethical principles were therefore not needed.

Her concluding argument was that expertise in moral decision making could be gained through experience and study. That a principled approach to bioethics is unnecessary and that instead experts should be gathered to approach each case on an individual basis.

Reflections

As I’ve said this last talk really helped me in my thinking in relation to the conference as a whole. I have had a couple of varying experiences in relation ethics committees and I think what I was left wondering with in this conference was how do we cope with anxiety and uncertainty?

Particularism, as presented in this conference, reminded me strongly of my understandings of virtue ethics. My difficulty with the position outlined was – how do we reach decisions in uncertain situations?

Considered hypothetically I found the position outlined as particularism quite attractive – every situation considered on its own merits seems to avoid the misapplication of a more principled approach. However – in the heat of the moment when faced with a number of choices how can we reliably decide? The argument from a virtue ethics position, from my understanding, runs that through fostering virtues we, in ourselves, become virtuous (eudaimonia) and therefore reach correct decisions.

This feels uncertain to me and at times unsafe to me. Perhaps this is because I fear attack and wish to reach a defensible position where I can explain my-self to others in a readily understandable post-hoc position and I realise that this is a weak argument. However – when I am struggling to keep my head above water in a flood what I look for is a solid grounding, a rock to which to cling. I believe that psychologically this analogy holds – we seek firm points on which to ground ourselves – our social identifies, religious faiths etc…

This to me is the power of an approach such as that outlined by Beauchamp and Childress – it provides us with a firm position in times of uncertainty. During more leisurely, un-pressured, reflection the principles can be challenged – and indeed they will not hold in all cases of crisis, however in the heat of the moment they may be beneficial.

How do we work in this situation? The intellectual arguments of a particularist position are to me seductive. However I also fear losing my firm base…

How can this be resolved??? Or perhaps there’s not even a question here?

More uncertainty…