The ongoing debate regarding the case of Alfie Evans has brought medical ethics once again under the spotlight, with particular scrutiny on the relationship between medical ethics and scientism. Science is undoubtedly entwined with medical practice; it is scientific research that has and will continue to allow modern improvement in medical care. Nevertheless, a discussion of shortcomings of scientism in directing ethical medical care is required, as scientism is incapable of providing such guidelines and is altogether damaging to the pursuit of medical ethics.
A fundamental danger of scientism – the belief that science alone can and will solve all, or almost all, of our problems- encroaching into medical ethics is that it attempts to claim which realities exist and limits experiences to validation by science. Only scientific explanations of certain phenomena – such as human suffering – are valid accounts worthy of attention, disregarding highly subjective experiences of consciousness and ultimately reducing the quality of patient care to cold and calculated numeric value.
The Problem of Quantification
How would medical ethics be affected if it becomes dependent on scientism? Should quantification methods used in science, such as computational models that produce genetic signatures to predict cancer survival, be the source of ethical decision-making? Medical practice is a human endeavour, as on both ends is a conscious being, and it requires intervening variables like medical ethics, resource distribution, and public health policies to inform the best possible approach. Medical practice demands a certain paradigm to complete any task.
Consider human suffering. Medical conduct is influenced by the moral theory of utilitarianism, where the end-goal is to alleviate “sadness” and “suffering,” while maximizing “well-being” and “happiness” in nature and for the greatest number of people. These abstract notions, personalised and conscious experiences, are both incapable of designation of moral weight by scientism and of quantifiable significance. Recent debate about whether pre-natal detection of Down syndrome should alone justify an abortion is a modern example of the limitations of scientism. A common argument from pro-abortionists is that Down syndrome negatively affects an individual’s cognitive abilities and consequently, financial aspirations. Frequently, pro-abortionists invoke the affected family’s emotional burden and reduce the value of life to one’s ability to contribute financially to society. Such an arbitrary and ill-defined line of suffering begs the question of where other “unfavourable” traits, such as a genetic predisposition to an invasive cancer or myopia, fall on the scale of suffering.
Scientists use statistical probability, not certainty, to distinguish between significance and insignificance, relying on p-value’s to discern the likelihood that an observation or result from an experiment is due to chance and not experimental conditions. The p-value cut-off of 0.05 (meaning there was less than a 5% chance that the result of an experiment was due to chance, thus findings in the research are meaningful or can be generalized to larger populations) that most scientists use is arbitrary and not universally accepted. Considering certainty is unattainable in explaining interactions between non-human subjects, such as with the efficacy of a drug, then capturing the diversity of human experience is ever more dubious. Even if the most high-tech neuro-imaging techniques were utilized to study the human experience, the challenge to find a truly objective definition of human experiences like suffering would persist.
The Scientific is Political
Despite the persisting ambiguity in interpreting data and drawing significance for the purpose of ethical medical decision-making, human experience requires ethical decision-making. In the absence of an objective religious moral foundation, some arbitrary individual must emerge to fill the void, set parameters for action, and distinguish between right and wrong. If suffering or well-being is determined numerically, based on potential financial contribution to society, then policy created about these topics is inevitably linked to power and economics. Such policy is within the context of competing domestic constituents, each with vested interests, further underscoring the fluid and undisciplined nature of a secular, scientific approach to bioethics.
The global debate on stem cell research further elucidates this. While the United Kingdom supports funding such research, countries like Germany (largely influenced by Germany’s history with human experimentation) have been reluctant. Domestic institutions and constituents settle disagreements about the moral status of an embryo and the concept of personhood. Domestic industry leaders have reduced initial German reluctance by highlighting perceived economic and material benefits (namely, Germany’s competitiveness in science) that would result from easing restrictive stem cell research laws.
The cases above illuminate how ethics is susceptible to radical change, whether because of pressure from sector leaders or other potential incentives. In order to avoid the trap of emotiveness when discussing ethics, a stringent epistemological framework is required, one that is firmly rooted and intellectually rigorous enough to keep up with rapid medical advances. Approaching medical care in a comprehensive way requires re-centering the human being as mind, body, and spirit. As Muslims, we must return to our tradition and deconstruct current paradigms, building and applying an Islamic framework to deal with modern ethical questions to avoid susceptibility to unstable paradigms like the one scientism provides. After the shocking case of Alfie Evans, may he rest in peace, let us finally begin this transformation of bioethics in earnest.
About the author: Mohamed Zammam is a PhD student studying Neuro-Oncology.