Dick Willems

Comments on Rein Vos: Promoting the valuable?

Dick Willems

The main point of this paper is that the teleological concept of values should be abandoned in favour of (or at least completed by) another approach which Vos does not give a name but has strong Aristotelian overtones. This change of perspective, Vos says, is necessary for the ethics of technology, and in the paper, he mainly shows this to be the case for the example of tandem mass spectrometry screening (MS/MS), although life and death are among his examples, as well.

I have doubted for some time whether Vos had a point here, but I ended up thinking he does.

Technology, he says, is teleological: MS/MS aims at detecting newborns with serious, though extremely rare diseases, with the aim of starting treatment at a moment when this is most useful, which means before the disease can be diagnosed. That’s what testing is done for. An interesting novelty in MS/MS compared to other forms of predictive testing is the quantity of tests done simultaneously. Values also seem to have a teleological nature: to say that something is good is to say that it deserves to be promoted, bad that it deserves to be prevented.

With regard to MS/MS this leads to questions about the weights of benefits to the child. With MS/MS, diseases may be detected that cannot (yet) be treated. Crucial question: is treatability (in the sense of being able to cure, or to forestall death, or to improve quality of life) still essential as a criterion? Should screening absolutely be in the interest of the screened? What if it is mainly in the interest of others (the parents, society)?

Asking such questions, Vos argues, implies an antagonism between the interests of the child and those of the parents.

This leads to balancing as the core activity of ethics as a practice: weighing one ‘good’ against another, or of a good against a bad. Balancing is about weights, not strengths. So what Vos argues against is essentially a market metaphor of ethics, or a notion of value that remains within the exemplary situation of the client who needs to weigh advantages and disadvantages of one product against another. I think he absolutely has a point here, because applied ethics takes balancing as a central metaphor for its expertise.

Instead of asking how valuable something is (compared to something else), Vos says, we should ask how to value something. Instead of asking what is in the interest of the child and what is in the interest of the parent, we should ask what good parenting is (and also, maybe, good ‘childing’?), and to what extent knowledge about the presence or absence of extremely rare diseases fits into this. This is what I would call an aristotelian alternative: does MS/MS fit with being a good parent (and a good child)? I deliberately call this Aristotelian, because I feel this is as teleological as anything (and teleology was dear to Aristotle) and I fail to see how valuing something differs from encouraging it, letting it flourish, even promoting it.

I do not think Vos really escapes from teleology but he might escape from ethics as a trade-off, as a market.

Let’s look a bit closer at the discussion on MS/MS. In the discussion at the Dutch Health Council, most of the participants stuck to a definition of ‘interest of the child’ in terms of treatment possibilities. Some of them, however, within the model of balancing interests, came up with a different standpoint: they argued it would be in the interest of the child if its parents would know that it would be getting an incurable disease. These people said, or were close to saying that it is part of being a good parent to know, as far as you can, what is in store for your child.

What would normative debate on MS/MS be about if not about interests and balancing, if not about establishing weights? It would be about how we value of knowledge of the future, and about the value of uncertainty, of an open future, about the dysvalue of knowledge that closes off the future of a child. Even though in Vos’s treatment of the example, it could seem as if valuing parenthood leads to a straight acceptance of MS/MS, this is not necessarily so. The question for the ethics of technology would then become: ‘Do those involved value the kind of life or parenthood that this technology brings along with it?’ Or, put differently, ‘Does this technique fit into a practice or a way of life that people want to maintain?’ Fitting, in my view, would be a good alternative for balancing as a central metaphor in the ethics of the technology. Firstly, because fitting is what technicians do, so the metaphor has a large face value for technology, and secondly, fitting demands that ethical debates about technology are about the technology itself, not only about the use people make of it.

To conclude, I think the normative debate on screening technology such as MS/MS would flourish, would be promoted, helped, or even cured if the questions would not be raised in terms of balancing interests, but in terms of fitting technology to valued ways of life. Sorry if I ended on a teleological note.