This book takes readers on a journey through the wide universe of bioethics, raising the following question: what is the proper attitude towards health, life, and death from the perspective of contemporary behavioral economics? Drawing on fields as diverse as economics, ethics, ecology, biology, and philosophy, this book seeks to uncover the bioethics we accomplish, not the moral principles that we advocate. This book covers life-and-death issues arranged around five themes: selves, persons, populations, species, and "Future Earth". Ultimately, the author illustrates two kinds of justice: static and dynamic. Static justice prevails whenever parties are free to bargain with each other, while dynamic justice follows from parties' interactions over time. An examination into these types of justice reveals one particularly striking phenomenon: attempts by others to tip the balance of justice have a tendency to backfire. Of primary interest to behavioral economists, this book will also appeal to scholars studying bioethics, ecology, medicine, and philosophy, as well as all people dealing with issues of health, dying, and death.
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In this book I take a short journey through the universe of bioethics. I go two ways: inward and outward. By going inward, I see inner selves. They deal with many bioethical issues. By going outward, I find that we are linked to other entities in matters of bioethics, too. The universe of bioethics is limited only by our own perception.
Bioethics is about living, dying, and death. By that definition, the universe of bioethics is very big indeed, as many things other than people live and die, too. I read somewhere that the universe ought to include biosphere. I like that vision very much. Still, I see the universe of bioethics as even bigger. I think that Future Earth, which is everything that lives and dies in the future, ought to be in that universe. Also, the universe extends not just outward from me, but also inward from me. A great analogy is quantum physics: the world of elementary particles is as big, if not bigger, than the rest of the physical universe.
So there are a lot of places to visit in the universe of bioethics. In this book I take a very short journey through that universe. I look two ways: inward and outward. By looking inward, I see the mindset of a person. Our mind thrives with bioethics issues. (It is where a lot of behavioral economics comes into play.) By looking outward, I find that we are linked to other entities in matters of living, dying and death. The links are everywhere I look.
Looking both inward and outward, I arrange matters of life and death into four rings: selves, persons, populations (of people), and species. Figure 1 is a picture of the arrangement.
Fig. 1
My itinerary
I wander into each of these rings. In each ring I make two or three stops. At each stop I look around and record whatever justice I see. Then, for the last stop of the journey, I step out of the rings and into Future Earth.
2 Justiceand Ethics
At every stop in the journey, I look for the ethics that we do, not the ethics that we say. I will call “the ethics that we do” simply justice. Ethics that we say and justice are two different things. Here is a very short story:
Two robbers, who do not know each other, are out looking for victims. Then one robber robs the other robber.
Robbery is unethical. But what happened to the two robbers in this story is justice served. Most of us would say: “They deserve each other.” Here is another very short story that shows that an action may be ethical, but the underlying relation is unjust.
The hunter corners the elephant, and then carefully aims the gun at the elephant’s head. The hunter pulls the trigger, and the elephant falls to the ground and dies instantly.
You might say: “But that does not justify the killing!” I totally agree. The hunter is compassionate by aiming the gun at the elephants’ head; nonetheless, the relationship between the hunter and the elephant is unjust to begin with.
Don’t take me wrong. I love to read books on bioethics principles. Still, in the hustle and bustle of an ordinary day, few of us stop to ask if the things we do are ethical or not. We don’t carry a list of “Five Moral Principles” in our pocket and check it every time we do something. That is understandable. We do most things out of habits; we don’t question what we do every day. Even if we should question what we do, few of us would have the answers. What does an ethical action mean anyway?
3 Justices: Static and Dynamic
In my journey, I find two kinds of justice: static and dynamic.
Static justice prevails whenever parties are free to bargain with each other. Static justice is best captured by the Nash Solution (Luce and Raiffa 1957). The Nash Solution basically says: Let’s meet in the middle. That means dividing equally the good thing to which we do not already have before we cooperate but we can have if we cooperate.1
Dynamic justice follows from interactions over time, whether or not the parties bargain. Herbert Simon (1982) uses ecological models to explain this. I will follow him. In several of my visits I am struck by one phenomenon: an attempt to tip “the balance of justice” at any moment has a tendency to backfire. For example, I have seen that, when people raise more pigs to eat, both pigs and people will get sicker and die earlier, so that in the end there will be fewer pigs and fewer people. That is dynamic justice. It is subtle; it is evident only over time, often a very long time.
I report my findings in this book. I hope you enjoy them.
References
Luce, R. Duncan, and Howard Raiffa. Games and Decisions. New York: Wiley, 1957.
Simon, Herbert A. Models of Bounded Rationality, Behavioral Economics and Business Organizations, volume 2. Cambridge: MIT Press, 1982.
Footnotes
1
If there are 10 units of the good thing to share, and if you are already entitled to 3 and I to 1 before bargaining begins, then we would share equally what is left after accounting for these entitlements, or 6 (= 10 – 3 − 1). By dividing 6 in half, each of us would gain 3. Therefore, the 10 units are divided into 6 (= 3 + 3) for you and 4 (= 1 + 3) for me.
Bioethics should adopt the more nuanced view of rationality from behavioral economics. Most of us are conscious and capable of making decisions, but we are not consistently rational about all the issues all the time in all phases of life. And it is not to be taken for granted that we like to make decisions, whatever they are and whatever their consequences are. In this chapter, I make a case for bringing behavioral economics to bear on bioethics, so we have a bioethics that recognizes bounded rationality. I believe that such a “behavioral bioethics” will benefit both physicians and patients by bringing them together.
Modern bioethics is all about how to take care of the patient: What is good for the patient and what are the right ways of relating to the patient. In modern bioethics, the patient is supposed to be clear-headed, far-sighted, informed, and eager to made decisions. In other words, the patient is “mentally competent.”
However, mental competency proves to be a difficult concept. Bioethicists spend a lot of time debating what it means and making sense of it case by case (American Society for Bioethics and Humanities 2017). The fact is that most of us are, strictly speaking, not totally compe...
