Philosophical wisdom and bioethical expertise: a wittgensteinian approach

This paper explores the interconnections between philosophical wisdom and bioethical expertise, arguing that the latter can be enlightened by the former. First, it analyses the arguments of those who think that philosophy has nothing to say to bioethics, and afterwards, it shows that philosophical wisdom has an irreducible ethical component, which in turn helps bioethics to reach its aims. Thus, this paper shows that some Wittgensteinian commentators (e.g


Introduction
In his chapter "Bioethics, Wisdom, and Expertise" of the book edited by Carl Elliott, Slow Cures and Bad Philosophers: Essays on Wittgenstein, Medicine, and Bioethics, Paul Johnston argues that since there is no independent adjudication of conflicting moral claims, there can be no experts in bioethics. In this paper, I reject Johnston's skeptical views. In doing so, I show that philosophy-particularly a Wittgensteinian approach that is based on wisdom-may in fact lead to some kind of bioethical expertise. In turn, this expertise can help researchers/doctors (in their dual role) and research participants/patients to take decisions when faced with tensions and apparent dilemmas in their professional lives.
To achieve this goal, I will divide this paper into three parts: in the first, I will reconstruct Johnston's arguments in detail and examine his main assumptions and conclusions; in the second, I will defend a "return to Wittgenstein," critically examining Johnston's views; in the third, I will illustrate how a Wittgensteinian approach to philosophy may help bioethicists to achieve their objectives by providing theoretical instruments for researchers/doctors and participants/patients to reach better decisions.
My aims in this work are modest: namely, I intend to make a small contribution to the centenary of Wittgenstein's seminal work Tractatus Logico-philosophicus by showing that its main conclusion "Wovon man nicht sprechen kann, darüber muss Philosophical wisdom and bioethical expertise 53 Rev. Filos., Aurora, Curitiba, v. 34, n. 63, p. 51-67, out./dez. 2022 man schweigen," (normally translated as "What we cannot speak about we must pass over in silence") can be read as an expression of Socratic wisdom, which is of crucial importance for current bioethical debates.

Wisdom and Expertise in Bioethics
Paul Johnston has made significant contributions both to Wittgensteinian scholarship (JOHNSTON, 1989;1993) and to our understanding of moral philosophy (JOHNSTON, 1999). Without wishing to oversimplify, I would argue that Johnston's main work in ethics amounts to the meta-ethical view according to which there is no way of resolving conflicting moral claims since judgments of human action simply reflect the different dispositions or preferences of the people who make them. This is clearly an epistemologically non-cognitivist and ontologically antirealist metaethical view. However, some problems emerge in both Johnston's interpretation of Wittgenstein's late work and his conception of what modern morality amounts to. In this paper, I will mainly focus on Johnston's skepticism regarding philosophy's possible contributions to bioethics.
To assess the work "Bioethics, Wisdom, and Expertise," it is crucial to first make a detailed reconstruction of Johnston's main arguments. Before doing that, however, I would like to stress that I do agree with Johnston's reading of Wittgenstein as someone who, throughout his life, held that ethics cannot be a science. More specifically, I agree that "The essence of [normative] ethics is the claim that there are ways of acting that everyone should recognize as right and wrong." (JOHNSTON, 2001, p. 150). However, pace Johnston, from the fact that moral claims cannot be derived from logic or be supported by empirical evidence, it does not follow that ethics cannot be an autonomous field of enquiry with specific methods and its own standards of justification. And it does not follow that moral judgements cannot be seen as objective and thereby apply to every person. I would like here to recall briefly the Tractatus to illustrate this point: both logic and ethics are said to be transcendental even though there are no ethical (and logical) propositions, that is, pictures of states of affairs. Ethics does not deal with facts but with (absolute) values-which can be shown, although not propositionally. Moreover, To start assessing Johnston's arguments against bioethical expertise, it is essential to quote his own definition of expertise: "…an expert is someone who claims authority on the basis of having mastered a body of knowledge." (JOHNSTON, 2001, p. 151). To show that there are no experts in bioethics, Johnston refers to some conflicting views on contraception, abortion, and infanticide. He argues that since people strongly disagree, for instance on abortion, there is no place for an expert to say: "I have studied these matters deeply, and these are the conclusions I have reached," since people would continue to perform abortions or decline to have abortions irrespective of the expert's views. According to Johnston (2001, p. 152), this makes any talk of expertise problematic and, consequently, "the bioethicist cannot claim to be the purveyor of a body of knowledge arrived at by an approach or method accepted by everyone, not can she demonstrate the correctness of what she says." As we can see, Johnston's first argument relies on the well-known problem of moral disagreement. And I will return to this later.
Johnston's second argument recognizes that valid medical moral problems exist and need to be solved, but it denies that an expert in bioethics could help in any abound, and bioethics itself was born as an independent field in the 1970s −separately from medical ethics− exactly because of a medical scandal (the infamous Tukesgee case, to which I will return soon). If I asked Johnston why bioethicists should not decide, he would simply reply by questioning what proper training might be in this area. To make his point, he asks (2001, p.154): "does not twenty years of studying the arguments surrounding euthanasia or a lifetime or working with the terminally ill give someone a special qualification for speaking about this issue?" And his response is simply that the bioethicist's judgments would have no special status-without further debate. Again, his reason is that there is no body of moral knowledge to be mastered by the expert; therefore, she has no moral authority. Johnston's meta-ethical view, then, amounts to holding a non-cognitivist moral epistemology, which I will scrutinize further in sections two and three.
The third argument relates to how philosophy (assuming here a distinction between knowledge and wisdom: the sciences and philosophy) could contribute to helping bioethicists. To mark the difference, Johnston calls a "moralist" the person who holds that ethics (and bioethics as its subfield) deals -as the above definition made clear-with the correct way of acting and can thereby differentiate the wise (ethical) decision from the foolish one. Thus, according to the moralist, not all moral judgements are merely a matter of opinion or simply express the preferences of the person who makes them. A moralist is, meta-ethically speaking, a cognitivist (epistemically) and realist (ontologically). Johnston, however, argues that while the bioethicist could claim to have wisdom rather than expertise, this assertion is not one people in our society are encouraged to make, or -at least -there are no universally accepted wise persons since there is no single morality.
Finally, and closely related to the third argument, Johnston explores the idea that bioethics can be seen as involving not wisdom, but the mastery of a technique. That is, the bioethicist would be an expert in helping people to develop their powers of moral reflection. For this argument, he suggested the example of a bioethicist saying that prescribing drugs that have been tested on animals is something a doctor needs to think deeply about, but that prescribing drugs produced from genetically modified animals is not (JOHNSTON, 2001, p. 157). Again, Johnston rejects this kind of 56 DALL'AGNOL, D.
Before assessing Johnston's arguments, I would like to point out that he in fact believes that there is a modest place in our society for a bioethicist (obviously, not someone claiming moral expertise) in some institutions including those which debate medical ethical issues. The two main tasks would be: (i) contributing to the debate by arguing in favor of a particular moral approach or by criticizing other approaches, and (ii) recording what the debate is all about and the different views that are being put forward (JOHNSTON, 2001, p. 159). These functions are restricted because our society has no single or dominant moral code-so no one can be seen as having the role of solving difficult moral issues.
To finish this section, I would like to say that the two limited tasks Johnston reserved for bioethicists (a role that anyone could really perform without any expertise!) contrasts with what scientists expect from philosophy and with the birth of bioethics as a discipline. It is worth recalling that one of the first authors to use the word 'bioethics' explicitly related it to wisdom (von POTTER, 1971, p. 1). The American oncologist held that we need a new kind of wisdom, namely, "'the knowledge of how to use knowledge' for man's survival and for the improvement in the quality of life." Potter's main idea was -in a context were life itself was in danger of disappearing because of pollution, nuclear threat, and so on-to reunite facts and values: the knowledge of sciences and the values of the humanities. There is no doubt that a doctor needs scientific training, but neither is there much doubt that she needs education in the humanities, including in philosophy. The question then turns out to be: what kind of contribution can philosophy make to helping bioethics achieve its aims? I believe Wittgenstein can help us here.

Back to Wittgenstein
In this section, I would like to return to Wittgenstein in order to briefly discuss some of Johnston's (mis)appropriation of his ethics both from the Tractatus and the Philosophical Investigations. The intention is to show that a real Wittgensteinian approach to philosophy can help bioethics to reach its aims by supporting people to take wise First, I will discuss the ethical sense of Wittgenstein's first book -and perhaps of his entire work. The positivistic reading was that the Tractatus allowed only for meaningful discourse in the natural sciences by showing that all the rest was nonsensical. As I have argued elsewhere (XXX), this is mistaken since Wittgenstein indeed held that there are no propositions in ethics (…keine Sätze der Ethik …, 6.42), but not that moral judgements are unspeakable. Understanding the difference is of paramount importance. Thus, consider metaphysical attempts to ground ethics either by postulating some kind of deity (and holding some kind of divine command metaethical theory) or by holding a naturalistic approach to 'good,' 'right,' and so on (and trying to reduce their normative meanings to the descriptive ones of the natural sciences).
According to Wittgenstein's Tractatus, both are trying to say more than can be said.
It is exactly against these metaphysical attempts to ground morality that Wittgenstein directs the last remark of the Tractatus. It does not follow, however, that ordinary moral judgements cannot be uttered. To illustrate this point, it is sufficient to give an example from the Lecture of Ethics. Johnston (strangely enough) is well aware of this text, and indeed the lecture presents similarities with some remarks in the Tractatus. I quote Wittgenstein (1965, p. 5

):
Supposing that I could play tennis and one of you saw me playing and said "Well, you play pretty badly" and suppose I answered "I know, I'm playing pretty badly but I don't want to play any better," all the other man could say would be "Ah, then that's all right." But suppose I had told one of you a preposterous lie and he came up to me and said, "You're behaving like a beast" and then I were to say "I know I behave badly, but then I don't want to behave any better," could he then say "Ah, then that's all right"? Certainly not; he would say "Well, you ought to want to behave better." Here you have an absolute judgment of value, whereas the first instance was one of relative judgment.
The same view clearly appears in the Tractatus: a moral judgment of the form "thou shalt … [e.g., not lie]" is not a proposition in the technical sense. Rather, it is an absolute judgment of value showing that there must be some kind of ethical reward and punishment and that "they must reside in the action itself" (… in der Handlung selbst liegen, 6.422). Ethical judgements that try to ground morality metaphysically go against the limits of sense (they are unsinnig), but day to day moral judgments are simply categorical ones (sinnloss only in the way of logical tautologies) showing what to 58 DALL'AGNOL, D.
Rev. Filos., Aurora, Curitiba, v. 34, n. 63, p. 51-67, out./dez. 2022 do. Consequently, from the fact that there is no metaphysical foundation for ethics, it does not follow that in our daily lives we cannot express a moral judgement.
If this interpretation is right, then Johnston's insistence that there is no way of solving conflicting moral claims since judgments of human action simply reflect the different dispositions or preferences of the people who make them is mistaken. It conflates, using Wittgenstein's distinction, judgements of relative value with judgements of absolute value. As Wittgenstein illustrates in his Lecture, if a person lies and is reprehended, she "certainly" (to stress Wittgenstein's original word) cannot just say: "I know I behave badly, but then I don't want to behave any better." Therefore, there are no substantial, deep moral agreements but only disagreements about whether one should play tennis well or not. To practice a specific sport or to subscribe a particular metaphysics is a matter of taste, not morality: no one may choose to invent a preposterous lie about another person. According to Wittgenstein, then, metaphysics is ungrounded. Thus, if a person justifies her moral judgements by appealing to a deity or to nature, she is trying to say more than needs to be spoken since morality only shows itself. I will explore the bioethical implications of this agnostic stance in metaphysics below, arguing that it provides sound reasons to respect the bioethical principle of respect for autonomy.
Before doing that, I would like to better specify the ethical sense of the Tractatus. There is, as Laraway showed (1992), a close similarity between a Socratic approach to wisdom and Wittgenstein's late philosophy. I believe, however, that we can also read Socratically the Tractatus' main (ethical) conclusion "what we cannot speak about we must pass over in silence" as a moral imperative not to say more than we know. To illustrate this, it is sufficient to recall Socrates' conclusion regarding his own wisdom: "I am wiser than this man; it is likely that neither of us knows anything worthwhile, but he thinks he knows something when he does not, whereas when I do not know, neither do I think I know, so I am likely to be wiser than he to this small extent, that I do not think I know what I do not know." (PLATO,Apology,21d) According to Socrates, there are things he knows well and there are things he does not know; to be wise is to recognize the difference between them and to be honest about it. Thus, for both Socrates and Wittgenstein, it is a moral imperative "to say no more than we know." As the author of the Das blaue Buch wrote: "In der Philosophie liegt die Schewierigkeit darin, nich mehr zu sagen, als was wir wissen." (WITTGENSTEIN, 1989, p. 75) This (to say no more than we know) shows that wisdom has an irreducible ethical ingredient as well as an epistemic one.
One bioethical implication I would like to draw here-which relates to another of Johnston's confusions, this time regarding modern moral philosophy-concerns the special status of the principle of respect for autonomy. It is exactly because many metaphysical attempts to ground morality exist (and all fail) that we must assume a common principle: to respect a person's choice of whether or not to participate in scientific research, or to refuse an experimental medical treatment to keep oneself alive at all costs, and so on. Since metaphysics is irrelevant to ethics, it is not only logic that must, according to Wittgenstein, take care of itself ("Die Logik muss für sich selber sorgen."), but ethics too. That is, ethics is an autonomous field of knowledge.
As Johnston correctly saw, ethics cannot be derived from logic, empirical sciences or metaphysics, but that does not matter since values show themselves. This implies that respecting a person's decision is the only ethical way of pursing scientific and technological knowledge. Recognizing this point is a piece of philosophical wisdom, which leads to an important consequence for understanding that a bioethicist also has expertise: she knows what can be scientifically known and what cannot and, therefore, it must be left to the persons involved to decide. Consequently, there is no longer any place for an autocratic and paternalistic view in modern bioethics.
The challenge, then, is to understand that despite metaphysics (and indeed because of metaphysics' failure), we are still capable of justifying common (bio)ethical principles. There is nothing paradoxical in denying knowledge in metaphysics while also arguing that there is moral knowing-how (e.g., acting virtuously). In this sense, Laraway (1992) is right in pointing to a Socratic and Wittgensteinian conception of the moral life as a kind of techne.
This point requires further exploration. In his paper "Wittgenstein's Method and Socrates's Craft: The Moral Life as a Techne," Laraway writes (1992, p. 6): Without offering an extended defense of the claim, I would like to suggest that elenchus activity is a sort of craft for Socrates, and insofar as he possesses this sort of practical knowledge, we may take him to be something of a "craftsman of virtue." By knowing how, through his execution of the elenchus to remind himself and his interlocutors of the limits of 60 DALL'AGNOL, D.
Rev. Filos., Aurora, Curitiba, v. 34, n. 63, p. 51-67, out./dez. 2022 theirs own knowledge, he is continually able to reclaim the only piece of knowledge that he is willing to explicitly profess, "human" wisdom (Ap,, which is precisely the recognition of one's own ignorance. Laraway then goes on to show that Socrates' elenchus is a meta-ethical cognitivist approach based on knowing how or being capable of showing how to be moral. I would like to add that having moral expertise is knowing-how to act (e.g., how to take care of a patient respectfully). This, however, shows that Johnston is just mistaken in using Wittgenstein's late philosophy as if the latter held a non-cognitivist perspective.
The clearest evidence is that Wittgenstein has some practical aims his work; that is, he wants to get rid of metaphysical confusions to reach a "sound human understanding." Therefore, his method in the Philosophical Investigations is a kind of Socratic' elenchus which aims at providing a therapy with an ethical aim, namely knowing how to live better. This shows, again, that Johnston' non-cognitivist approach is mistaken and that Wittgenstein's late work can be reconstructed in cognitivist (and universalist) meta-ethical terms.
I would here like to develop further this interpretation in order to later extract some bioethical implications. Wittgenstein's notion of 'form-of-life' (Lebensform) may seem ambiguous, but it receives-in the first part the Philosophical Investigations-a meaning very close to that of 'species,' when he mentions dogs, lions, humans, and so on. Now, the predominant use is the one related to humans. As he points out in paragraph 241: "it is what human beings (Menschen) say that is true and false; and they agree in the language they use. That is not agreement in opinions but in form of life (Lebensform)." Humans have propositional language; other animals may have a kind of Augustinian language-game to communicate with each other, but if a lion could speak, we would not understand him because we do not share his form-of-life.
We can now recognize why Johnston's non-cognitivist reading of Wittgenstein's late philosophy is ungrounded. It is not only the case that we can, based upon the notion of Lebensform, speak of "the common behavior of mankind" (Die gemeinsame menschliche Handlungsweise… § 206), but we can also point to some moral behaviors that nobody would deny. For instance, we can state that caring is essential in medical contexts, that pursing the truth (e.g., by not falsifying data) is paramount in scientific research, that patients and doctors must respect one other, and so on. The common behavior of mankind is a reasonable ground for the objectivity of moral judgements. More specially, however, it opens the door to arguing for a special kind of cognitivist approach to morality. To give another trivial example: any normal human being would feel pain if subjected to surgery without anesthetic.
Consequently, doctors must know the proper means not to let patients suffer, but they must also know-how not only to relieve pain and, more importantly in moral terms, to know-how to take care of their patients. To do otherwise is to infringe the most basic principles of biomedical ethics.
Although it is not the goal of this paper to enter into meta-ethical discussions, it is worth quoting a passage from the Philosophical Investigations to illustrate the above point. In paragraph 151, Wittgenstein wrote: "The grammar of the word 'knows' is evidently closely related to that of 'can', 'is able to'. But also closely related to that of 'understands'. ('Mastery' of a technique.)" I have developed this idea by showing that moral knowledge involves not only knowing-that, for instance, cancer is a disease that requires treatment, but also knowing-how to do it: first by examining the patient, then treating the disease or performing a surgery, and above all, knowing-how to take care of the patient all the way though, for instance, respectfully. I have called this approach Practical Cognitivism. Unfortunately, I cannot pursue this approach here (see: XXX for further details), but it fits well with Laraway's characterization of Socrates' views.
We can, then, conclude that the late Wittgenstein gave us valuable philosophical methods, including conceptual analysis, which can be applied in bioethics. In the next section, I will illustrate this by means of some real applications of how philosophical wisdom may inform bioethical expertise.

Can Philosophy help Bioethics?
Practicing bioethicists (in hospital committees, institutional review boards Senior's "early treatment" etc.). Bioethics was born to make them accountable.
Consequently, Johnston's optimism regarding scientists' morality and his pessimism concerning philosophers' contributions seem to be based on bias.
After the publication of the Belmont Report, Beauchamp and his colleague Childress wrote the book that is now the classical approach to biomedical ethics. In their book, they proposed the principles of respect for autonomy, non-maleficence, beneficence, and justice-which are now the basis of Brazilian legislation in the area (Res. 466/12). Since the concept of 'person' may have a metaphysical assumption, they prefer to use respect for the agent's autonomous choices. This work made significant contributions to bioethics, some of which will be illustrated below. As we can see, philosophers may help to format the basic principles for specific subfields of ethics, not only bioethics, but also ecoethics, zooethics, roboethics, and so on.

Final Remarks
Wittgenstein would not, pace Johnston's views, prevent philosophers concerned with bioethical issues from sitting on a committee (including IBRs) that aims to contribute to reaching wise decisions. On the contrary, he would be sympathetic to such a practical engagement. Of course, bioethicists with a philosophical background must also learn legislation; they must learn to see things from an interdisciplinary perspective; and so on. But they can make significant contributions in defending objective principles such as respect for autonomy by explaining that the failure of metaphysics requires equal respect among all humans (doctors and patients alike), that what counts as benefits/harms needs to take into consideration the person's will, and therefore, that a doctor or scientist must not act in a paternalistic or autocratic way.
"Wittgensteinians" sometimes turn against philosophy and hold a pessimistic stance, but Wittgenstein was only against metaphysical views (e.g., those involving category mistakes, conceptual confusions, etc.). He reserved a positive therapeutic task for real philosophers with clear ethical aims-as he himself was and had. He even built up a conceptual framework (e.g., language-games, family-resemblances, etc.) to criticize the metaphysician's errors (e.g., the assumption of private language), and he gave us a method requiring particular skills so we could continue philosophizing on many topics, including bioethical issues.
To finish this paper, without defending a conclusive view, I would like to point out that between the Tractatus and the Investigations there is a kind of Socratic continuity. That is, not only can the last remark of the first book can be read as showing that one must not say more than one knows, but also the later work can be seen as an example of epistemic humility in showing that one must not pretend to know something one does not know. This piece of philosophical wisdom needs to be