Pragmatist Bioethics, the Relevance of Context, and Some Problematic Situations in Healthcare

Abstract Bioethics has expanded considerably over the last few decades in the academic enterprise and policy arena. However, despite the progress, the history of bioethics exhibits methodological controversies among contributors in the field. Generally, the contention is related to bioethics' complex and contested relationship with philosophical theory, contributors' perspectivism, and a "reliance upon high-flying ethical theory," as well as "skepticism of the applied nature of bioethics," which further point to differences in interpretation of the logic and epistemology of morality and moral judgments. On the other hand, it is claimed that pragmatic ethics, mainly on the grounds of incorporating the components of different understandings of ethics, its interdisciplinarity, and its practical focus, avoid the controversies over the methods and goals of bioethics through a consideration of the context in ethical inquiry and serves as a method. In this dissertation, I focus on investigating the methodological dimensions of bioethics while emphasizing topical issues in the field, including gestational surrogacy, healthcare allocation, rationing, and organ trade and trafficking in Africa. On the whole, I look at the methodology and goals of bioethics mainly, from the point of view of pragmatist ethics, following the line of John Dewey's ethics. I also investigate specific moral problems in bioethics to further illuminate the methods of pragmatic bioethics and show the practical usefulness for solving specific moral dilemmas arising in a particular context. The dissertation is devided into seven chapters. In Chapter One, I discuss the background of the study and locate the problems of the study by showing the contested nature of the methodological terrain of bioethics. Further, I discus the disagreements about the logic and epistemology of morality, moral judgment and decision making, the nature of moral issues, and the practical goals of bioethics. Finally, I also look at how pragmatist bioethics avoids methodological disagreements in bioethics. In Chapter Two, I examine the methodological dimensions of bioethics and show how a pragmatist approach and consideration of context are relevant in bioethical investigations. I also provide an overview of the recently introduced context-sensitive methodologies, theories, and principles of bioethics in the global South and East and show the relevance of context-based bioethical research and bioethical deliberations. Finally, discusing the epistemic ground of morality and the nature of bioethics, I argue that a pragmatist-empirical turn in bioethics can help us think about and make decisions about specific bioethical dilemmas. In Chapter Three, I further discuss the meta-method of bioethics by examining Dewey's inquiry ethics and the case of gestational surrogacy. First, I mainly revisited Dewey's ethical inquiry method and pragmatist bioethics and then identified steps of pragmatist bioethical inquiry. Using these steps, I discuss the moral dilemma of gestational surrogacy at the level of a public issue that needs social policy and suggest pragmatic ways to come up with solutions. In the last part of this chapter, I undeline the significance of Dewey's emphasis on education, deliberative democracy, and institutions as the basis for solving bioethical issues arising in different societal contexts. Next, in Chapter Four, I examine the ethical dilemma of healthcare allocation and rationing from a pragmatist ethics perspective, again mainly following Dewey's work. The moral dilemma of distribution always entails rationing: denying service to someone to benefit others. Such aspects of allocation and rationing and the normative-relational aspect of disease and health render the problem morally controversial. It is not easy to reach on agreed upon principles of healthcare resource allocation and rationing applicable across different contexts. Hence, in this chapter, I argue that the moral challenges of healthcare rationing ought not to be addressed through an appeal to principles but rather through deliberation that embraces a more pragmatic and democratic approach to thinking with sensitivity to context. However, this does not mean that moral principles and values are unnecessary when allocating healthcare resources. In Chapter Five, I further illuminate the methods of pragmatist bioethics and moral challeges of healthcare allocation and rationing by using the context of African healthcare systems and the COVID-19 pandemic. In the first part of this chapter, I critically review the African healthcare crisis's factors and suggest pragmatist means to address justice issues in healthcare allocation in the region. In the second part, I present the worldwide and Sub-Saharan African situations during the COVID-19 pandemic and examine the place of moral principles in the allocation and rationing of healthcare resources. In this chapter, I mainly argue for the relevance of go