A Data-Driven Argument in Bioethics: Why Theologically Grounded Concepts May Not Provide the Necessary Intellectual Resources to Discuss Inequality and Injustice in Healthcare Contexts

This article refers to:

There’s No Harm in Talking: Re-Establishing the Relationship Between Theological and Secular Bioethics

In this paper, we use an innovative, empirical, and–as yet–rarely applied method in bioethics, namely corpus analysis, which is commonly used in literature studies (Moretti 2013), linguistics (Baker 2006), and has been recently discussed in the context of the history of ideas (Betti and van den Berg 2016) and philosophy of science (Pence and Ramsey 2018).¹ In contrast to other areas of experimental philosophy, which typically involve surveying folk participants with questionnaires aimed at eliciting their intuitions, our method here connects distant reading (a quantitative approach to the large corpus within Christian bioethics) with close reading (qualitative analysis of selected documents or their fragments with the word “dignity”) of scholarly papers. By demonstrating the ambiguity of the concept of dignity discernible when analyzing its use in normative contexts, our work is a novel contribution to the debates among the historians of ideas about conceptual identity and conceptual drift.

Concerned that theological and secular bioethicists have drifted apart, McCarthy, Homan, and Rozier (2020) claim that “questions of inequality and injustice within bioethics informed by a Christian anthropology” (5) may become a fertile ground for reestablishing the connection between these two camps. In particular, the authors believe that the concepts of dignity, sin, and the common good—because of their emphasis on “the relational dimension of individuals”—may be informative for secular bioethics and may become points of “dialogue for religious and secular thinkers” which “reframe the conversation” (11) around some critical issues in the health sciences.

We disagreed with McCarthy, Homan, and Rozier (2020) proposal, hypothesizing that the way these three concepts actually function systematically within the current Christian anthropology excludes them from being any “dialogical framework.” The lack of space in this commentary article does not allow us to discuss all three concepts thoroughly, so we have decided to present a data-driven argument concerning only the concept of dignity, understood by the Authors as “the inherent equality endowed to all of us by God” (6). While not questioning the definition itself, we hypothesized, against the Authors’ claim, that within contemporary Christian bioethic thought, the concept of dignity does not (at least systematically) recall the relational dimension (“one’s dignity is intimately bound to the other,” 9) and does not have the normative function that the Authors have assumed.

By the normative function of a concept, we mean the ways in which the grasping (or possession of) some concepts are entangled with being disposed to make certain evaluative judgments (Fredericks 2018). In our understanding, some concepts are parts of complex conceptual frameworks (Betti and van den Berg 2014) containing, among other elements, evaluative judgments. This fragment of Evangelium Vitae, in which the normative function of the concept of dignity is used to condemn some kind of scientific experiments, exemplifies our point: “the use of human embryos or fetuses as an object of experimentation constitutes a crime against their dignity as human beings who have a right to the same respect owed to a child once born, just as to every person” (John Paul II 1995). We believe our understanding fits with the McCarthy, Homan, and Rozier (2020) perspective who write that concepts may “encourage dialog” or “self-reflection and self-critique,” and while discussing the Universal Declaration on Bioethics and Human Rights, they even recognize dignity as “a concept that requires actions.” They seem to assume that there is a connection between grasping (or possession of) the concept of dignity and being disposed to evaluate some states or prescribe some action.

METHODS

For the purpose of writing this commentary article, we assumed that the meaning of the concept expressed by the word “dignity” in Christian bioethics may be established by means of systematic analyses of scholarly papers. To test our hypothesis, we have identified a corpus: we reviewed all 283 scholarly journals classified by the Louvain Index of Theology and Religious Studies for Journals (LITARS 2020) as IJ1 (“absolute top-class journals”) and IJ2 (“important journals that have a little less international resonance”), and for the full-text analyses we chose journals that have published the highest number of articles with the term “dignity” since 2010 (for exclusions see the additional supplementary data found at https://osf.io/u9wgq/?view_only=fced42d0f1b44ce18525beab6808b2bc). Then, we systematically browsed the full-text of 4,177 texts published since 2010 in 5 Anglo-American scholarly journals with a specialization (or with the particular interests) in Christian ethics/bioethics that have published the highest number of articles with the term “dignity”: Theological Studies (239 papers with the word “dignity” since 2010), Studies in Christian Ethics (187), Journal of Religious Ethics (141), Christian Bioethics (126), Modern Theology (116). Finally, we qualitatively analyzed all 809 journal papers in which the word “dignity” appeared, excluding 556 texts (editorials, book reviews, etc.; for details see the additional supplementary data found at https://osf.io/u9wgq/?view_only=fced42d0f1b44ce18525beab6808b2bc). Obviously, we are aware of some shortcomings of our analyses, for example, because of time-consuming qualitative analyses we could approach a limited number of papers²; our search method excluded non-English articles; the exclusion of books or non-scholarly popular publications (because of no comprehensive databases).³

RESULTS

As a result of our analysis, we have distinguished between three relevant ways in which the concept of dignity has been used in normative contexts (i.e. giving practical recommendations). An individualistic approach is a traditional stance, at least since Vatican II, with a strong emphasis on prohibitions against abortion, assisted reproductive technologies, embryo research, same-sex parenting, physician-assisted suicide, and euthanasia. A solidarity approach is similar to the one used by McCarthy, Homan, and Rozier (2020) with the emphasis on the rise of economic inequalities and the problem of poverty as well as the Christian feminist understanding of this concept (this perspective often appears also in connection to relations with nature and other species). Finally, a secular approach is the usage after legal texts in secular states, secular philosophers’ views as well as the colloquial usage (for representative papers for every approach see the additional supplementary data found at https://osf.io/u9wgq/?view_only=fced42d0f1b44ce18525beab6808b2bc).

In our analysis, 80 articles (32%) leaned toward an individualistic perspective, 116 (46%) toward a solidarity perspective (8 of those (7%) were focused mainly on species dignity) and as many as 46 (18%) articles discussed a secular approach. We categorized 11 (4%) articles as “between approaches” (when both individualistic and solidarity approaches were relevant). A solidarity approach is slightly more popular than the individualistic one, although in some analyzed texts it happens to be depicted as margin (Brittain 2014). What is more, authors who prefer a solidarity approach often present their ideas as contrasting with the current official doctrine of the Roman Catholic Church, emphasizing their critique toward it (Salzman and Lawler 2013).

From the diachronic perspective (Figure 1), our data show some signs of conceptual drift related to the pontificate of Pope Francis, as some authors have suggested (Engelhardt 2015). Before 2015,⁴ a solidarity approach appeared in about 35% texts included in our in-depth analysis, after 2015 it was 54%—especially Pope Francis’ critique on economic inequality and his stance on climate change were commented on. At the same time, an individualistic perspective remains important within the analyzed journals, but its usage has declinedfrom 42% before 2015 to 24% after 2015. More than 18% of the articles focused only on secular perspective what may suggest that many theologians draw from secular bioethics.

Figure 1. Percentage of articles per year representing two main approaches to the concept of dignity (based on 253 analyzed texts containing the word “dignity” published since 2010 in five selected Christian scholarly journals). AN INDIVIDUALISTIC APPROACH—a traditional stance toward dignity, at least since Vatican II, with a strong emphasis on prohibitions against abortion, assisted reproductive technologies, embryo research, same-sex parenting, physician-assisted suicide, and euthanasia. A SOLIDARITY APPROACH—a relational stance toward dignity with a strong emphasis on the problem of economic inequalities and poverty; includes Christian feminist views; this perspective often appears also in connection to relations with nature and other species. A SECULAR APPROACH and BETWEEN APPROACHES are not included in this figure.

There are significant discrepancies between journals. In Christian Bioethics only 24% of considered articles leaned toward a solidarity perspective, in Studies in Christian Ethics—29%, compared to 73% in Theological Studies, 65% in Journal of Religious Ethics and 44% in Modern Theology. An individualistic perspective is represented in 55% of the analyzed texts in Christian Bioethics and in 35% in Studies in Christian Ethics, but only in 13% in Theological Studies and Journal of Religious Ethics and 11% in Modern Theology.

DISCUSSION

Our findings are crucial for the interpretation of McCarthy, Homan, and Rozier (2020) central thesis because we clearly demonstrate that the concept of dignity, as most of the concepts used by the science or the humanities, is not a static entity that remains identical through time and is not unanimously understood by scholars even within one domain. Initially, we assumed that the “solidarity” approach is in the minority within the current Christian bioethical anthropology. Although this hypothesis has not been confirmed by our in-depth analyses of selected journals, our results show that Christian anthropology may be currently divided almost half-half in the understanding of the concept dignity between an individualistic and solidarity approaches. Moreover, even though only a minority of papers focused solely on a secular perspective, about 32% of in-depth analyzed articles in Christian antropology also invoked a secular approach to the concept of dignity, often as a reference point for a discussion of one of the theological understandings (in this case a paper has been classified as accepting either individualistic or solidarity approach).

All of these are problematic in the context of McCarthy, Homan, and Rozier (2020) central thesis. The use of the word “dignity” in Christian bioethics journals shows that the concept of dignity is a “concept constellation” composed of many main elements or aspects (individual, solidarity, secular), only one of which (solidarity) is used by the Authors. To use any such theological concept to encourage dialogue with secular bioethics, it may be necessary to do justice to all these elements or aspects that compose a core of the concept (in a sense defined by Kuukkanen 2008). Therefore, our view is that before any attempts are made to reestablish the connection between theological and secular bioethics based on the concept of dignity, a significant concept change within Christian anthropology itself should occur: in the case of dignity, a solidarity sense which is currently only one of the main ways of understanding this concept in Christian bioethics should become its sole core (for more on the methods of modeling of conceptual change see: Betti and van den Berg 2014). At this moment, using this conceptual tool of Christian anthropology to engage meaningfully with secular bioethics concerns may be at least difficult, if not impossible.

ACKNOWLEDGMENTS

The authors contributed equally to this work. We thank Bartosz Biskup for his help in identifying a corpus for our research.

DATA AVAILABILITY STATEMENT

Additoinial data for this article can be found at https://osf.io/u9wgq/?view_only=fced42d0f1b44ce18525beab6808b2bc

DISCLOSURE STATEMENT

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research has received funding from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation program [grant agreement 805498]. This article is made open access with funding support from the Priority Research Area Society of the Future under the program “Excellence Initiative – Research University” at the Jagiellonian University in Kraków.

Notes

1 Surprisingly, the method has not been mentioned in any of the 12 papers in a special issue entitled “Fostering Dialogue about Empirical and Normative Bioethics” published recently by AJOB Empirical Bioethics.

2 We are aware that it is possible to use some automatic corpus analyses, see, for example, Macroscope, a web-tool for examining the structure of language based on the English Google Ngram Book corpus, Li et al. 2019, which has its own shortcomings.

3 We plan to present a broader analysis and overcome at least some of these shortcomings in our forthcoming work.

4 The year 2015 is optimal as a threshold, as Pope Francis’ pontificate started 13th March 2013, and taking into consideration the amount of time researchers need to write, as well as waiting time for a publication in journals.