When Scientific Method Clashes With Philosophical Inquiry
Imagine a team of researchers attempting to catalog every argument about the ethics of euthanasia. They meticulously search databases, screen thousands of articles, and extract all the reasons for and against medical aid in dying. They approach this moral question with the same systematic rigor that scientists would use to analyze clinical trial data for a new blood pressure medication.
But can profound ethical questions about life and death truly be captured through this scientific method?
This scenario represents an ongoing methodological revolution—and controversy—in the world of bioethics. In recent years, there's been a surge in attempts to conduct "systematic reviews" of ethical arguments in bioethics, mirroring the gold-standard approach used in medical science.
But a growing number of scholars argue this approach is fundamentally misguided, even going so far as to suggest we should remove the term "systematic review" from bioethics entirely 1 4 .
To understand the controversy, we must first appreciate what makes systematic reviews so valuable in medicine and healthcare. A systematic review is a rigorous, structured approach to synthesizing all available evidence on a specific clinical question. Unlike traditional literature reviews that might selectively cite papers, systematic reviews aim for comprehensiveness and transparency.
Minimizes selection bias by searching multiple databases simultaneously (e.g., MEDLINE, Embase, Cochrane Central).
Reduces bias by pre-specifying methods before beginning the review (e.g., registering on PROSPERO).
Evaluates reliability of evidence using standardized tools (e.g., Cochrane Risk of Bias tool for clinical trials).
Provides precise effect estimates through meta-analysis of data across multiple trials.
| Feature | Purpose | Example in Healthcare |
|---|---|---|
| Protocol Registration | Reduces bias by pre-specifying methods | Registering review methods on PROSPERO before beginning |
| Comprehensive Search | Minimizes selection bias | Searching MEDLINE, Embase, Cochrane Central simultaneously |
| Quality Assessment | Evaluates reliability of evidence | Using Cochrane Risk of Bias tool for clinical trials |
| Transparent Reporting | Enables verification and replication | Following PRISMA reporting guidelines |
| Quantitative Synthesis | Provides precise effect estimates | Meta-analysis of blood pressure reduction across multiple trials |
This systematic approach has proven so valuable in clinical medicine that it's natural researchers in adjacent fields would want to adopt it. But what happens when this method developed for clinical science encounters the very different terrain of moral philosophy?
Bioethics occupies a unique space between medicine and philosophy. It addresses pressing practical questions about healthcare, medical research, and biotechnology, but does so using tools from moral philosophy. This interdisciplinary nature has created what some scholars call a "methodological identity crisis" 1 .
Adopting scientific methods may increase perceived legitimacy
Systematic approaches may enhance impact on healthcare policy
Scientific methodology may attract research funding
| Aspect | Systematic Reviews of Empirical Data | Systematic Reviews of Ethical Arguments |
|---|---|---|
| Primary Material | Numerical data, clinical outcomes | Conceptual arguments, moral reasoning |
| Quality Assessment | Standardized tools for risk of bias | No consensus on assessing argument quality |
| Synthesis Method | Meta-analysis, quantitative pooling | Thematic analysis, conceptual mapping |
| Neutrality Ideal | Strives for objective summary | Interpretation inherently involves normative stance |
| Outcome | Clinical recommendations, effect estimates | Identification of moral considerations, ethical positions |
The fundamental question is whether these systematic reviews of ethical literature are producing genuine insight or simply creating an illusion of scientific rigor where it doesn't belong.
The most forceful argument against systematic reviews in bioethics comes from Giles Birchley and Jonathan Ives, who in a 2022 paper titled "Fallacious, misleading and unhelpful: The case for removing 'systematic review' from bioethics nomenclature" argue that the very concept is fundamentally unsuited to the field 1 4 .
In clinical systematic reviews, researchers can assess the quality of studies using standardized tools—evaluating whether a clinical trial was properly randomized, blinded, or used appropriate statistical methods. But how does one assess "quality" in ethical arguments? A philosophical argument isn't true or false in the same way as a clinical finding. As Birchley and Ives note, "Bioethical arguments are evaluative, so notions of quality and bias are inapplicable" 1 .
Scientific systematic reviews strive for objectivity—the idea that different researchers following the same method would arrive at similar conclusions. But in ethics, the classification of concepts is itself an act of interpretation. Categorizing arguments inevitably involves philosophical judgments that cannot be neutral. The process of determining which arguments belong together or how they relate to each other requires the very ethical reasoning the review is supposed to be mapping 1 6 .
Perhaps most fundamentally, ethical arguments are conceptual rather than numerical. They build on each other, respond to objections, and develop through a dialectical process that doesn't lend itself to straightforward categorization. The raw materials of bioethical articles are simply not suited to methods designed for clinical trial data 1 .
| Criticism | Explanation | Implication |
|---|---|---|
| Misapplied Quality Standards | Cannot assess "quality" of ethical arguments using scientific criteria | Lacks the quality assessment cornerstone of scientific systematic reviews |
| Inevitable Interpretation | Categorizing arguments requires normative judgments | Undermines claims of neutrality and objectivity |
| Conceptual Incompatibility | Ethical reasoning is dialectical, not data-driven | Systematic method fails to capture how ethical discourse develops |
| Misleading Nomenclature | Uses scientific terminology for philosophical work | Creates false impression of scientific rigor |
| Threat to Authentic Development | May prioritize "scientific-looking" methods over appropriate philosophical ones | Could stunt methodological development in bioethics |
To understand this debate in practice, consider the systematic qualitative review of ethical issues in open-label placebos (OLPs) mentioned earlier 2 . This review identified 17 articles explicitly addressing OLP ethics and extracted 37 distinct ethical issues, grouping them into five themes: sociocultural factors, implementation logistics, informed consent, patient health behavior, and therapeutic relationships.
On its face, this seems like a valuable contribution—it organizes a scattered literature and provides a comprehensive map of ethical concerns. But from a critical perspective, we might ask: What determines whether an ethical concern belongs in one category versus another? How were distinctions made between similar arguments?
The process of categorization itself required ethical judgments that went beyond mere summarization. The reviewers likely had to make philosophical decisions about whether a particular concern was primarily about autonomy, beneficence, or justice—decisions that reasonable ethicists might disagree on. This isn't a failure of execution; it's inherent to the subject matter. Ethical arguments don't sort themselves into neat categories the way clinical trial results might be sorted by outcome measure.
If systematic reviews are problematic for bioethics, what alternatives exist? Critics suggest bioethics should look to review methods developed in the social sciences and humanities rather than clinical medicine 1 .
Generates theory through interpretation of literature, acknowledging and making explicit the interpretive role of the reviewer.
Identifies and explores conceptual themes across literature, allowing for conceptual connections rather than forced categorization.
Traditional review with explicit methodological reflection, maintaining philosophical engagement while being transparent about approach.
Maps key concepts and debates without claiming neutrality, providing overview without pretending to be value-neutral.
| Approach | Description | Advantages for Ethical Literature |
|---|---|---|
| Critical Interpretive Synthesis | Generates theory through interpretation of literature | Acknowledges and makes explicit the interpretive role of the reviewer |
| Thematic Review | Identifies and explores conceptual themes across literature | Allows for conceptual connections rather than forced categorization |
| Methodologically-Transparent Narrative Review | Traditional review with explicit methodological reflection | Maintains philosophical engagement while being transparent about approach |
| Bioethics Scoping Review | Maps key concepts and debates without claiming neutrality | Provides overview without pretending to be value-neutral |
| Argument-Based Systematic Review | Adapted systematic approach focused on argument structure | Specifically designed for conceptual rather than empirical literature |
What these approaches share is recognition that reviewing ethical literature is itself an act of ethical reasoning, not a technical procedure that can be systematized. They prioritize depth of engagement with arguments over comprehensive extraction of "data points."
You might wonder whether this is just academic quibbling—does it really matter what we call these literature reviews? The critics argue that it matters profoundly 1 4 .
Calling something a "systematic review" suggests a level of scientific rigor and objectivity that may be misleading when applied to ethical arguments. This could lead readers to give undue weight to conclusions that are presented as systematic but actually involve significant philosophical judgment.
The appeal of scientific methods might draw bioethicists away from developing review methods actually suited to their subject matter. Instead of creating approaches that engage deeply with ethical reasoning, researchers might spend their time developing ever-more elaborate search and extraction protocols that miss the philosophical point.
This isn't to say that bioethics literature reviews shouldn't be thorough, transparent, or methodical. The critics emphasize that "all areas of enquiry need thorough and informative literature reviews, and efforts to bring transparency and systematic methods to bioethics are to be welcomed" 1 . The issue is with appropriating a specific method—and name—developed for a very different type of inquiry.
The debate over systematic reviews in bioethics represents a broader tension in an interdisciplinary field constantly negotiating its relationship with both medicine and philosophy. As bioethics seeks to influence medical practice and policy, the temptation to adopt scientific language and methods is understandable. But this adoption comes at a cost when those methods are ill-suited to philosophical inquiry.
The critics mounting a case for removing "systematic review" from bioethics nomenclature aren't arguing for sloppy or less rigorous literature reviews. Rather, they're advocating for review methods that respect the nature of ethical reasoning—methods that acknowledge the inevitable role of interpretation and judgment in engaging with moral arguments.