BIOETHICS AND MORAL EXPERTISE AS A COLLECTIVE ENTERPRISE    By    Chet McLeskey                              A DISSERTATION    Submitted to  Michigan State University  in partial ful llment of the requirements  for the degree of    Philosophy–Doctor of Philosophy   ABSTRACT    BIOETHICS AND MORAL EXPERTISE AS A COLLECTIVE ENTERPRISE    By    Chet McLeskey    Moral expertise is not a fantasy contrived by those who would wish to  wield it. Moral expertise is something that is achieved through training and  experience, just as any other form of expertise. While it shares many  features with other forms of expertise, it carries with it a form of authority  that is di erent and distinctive due largely to its inherently normative  nature. I examine moral expertise by rst examining expertise itself. Given  what we understand about expertise, how it is achieved, and the impacts it  has on the cognition of those who achieve it, I claim that moral expertise in  bioethics is best seen as something achieved by groups rather than  individuals.                                        For my girls–Lori, Brianna, and Kyla. Without you this would not have been  possible.  iii    ACKNOWLEDGEMENTS      As with any long project, there are many people who have helped me  in a variety of ways and the list is far too long (and my memory far too  poor) to mention everyone here. There are a few people in particular that  have pushed me, at di erent points in my career, to be a better scholar and  philosopher. Anna Gotlib and Terry Wilfong are largely responsible for me  going to graduate school in the rst place (for better or worse), and their  support and guidance has been critical to any success I have had. Debra  Nails and Jason Mask aided me in my journey through all things ancient  Greek. Conversations with Matt McKeon, Michael O’Rourke, Marilyn Frye,  Victor Caston, William Blake Tyrrell, and Bill Lawson have been especially  helpful and in uential both professionally and personally. Emily Katz  provided expert supervision of the Aristotelian material in the dissertation,  and Hilde Lindemann provided much formal and informal guidance and  motivation at key junctures. Robert Pennock, in addition to being on my  committee, has been extraordinarily supportive and I am fortunate and  grateful for his mentoring and friendship. Eric Berling has been proven to  be a true friend and colleague, making ventures into unknown territory  much easier to bear. Lastly, the linchpin in all of this, Jamie Nelson. She has  been my advisor, mentor, therapist, and most importantly my friend  throughout. Doktormutter captures only part of what she has been to me.   iv    TABLE OF CONTENTS      Chapter 1: Introduction….………………………………………………………………… 1  1.0 The Thesis……………………………………………………………………….... 1  1.1 The Backdrop…………………………………………………………………….. 2  1.2 The Problem(s)................................................................................................. 5  1.2.1 Expertise.......................................................................................................... 6  1.2.2 Moral Expertise........................................................................................... 12  1.2.3 Expertise at the Group Level……………………………………………...16  1.2.4 Training Present and Future Bioethicists……………………………...18  1.2.5 Philosophers and the Future of Bioethics…………………………….20  Chapter 2: Expertise.......................................................................................................24  2.1 Expertise as a subject matter......................................................................24  2.2 Expertise and Social In uence: Sociological and Psychological  Approaches to expertise ................................................................................... 25  2.2.1 The Sociology of Expertise..................................................................... 28  2.2.2 Psychology, Neurobiology, and Expertise…………………………....32  2.3 Philosophy and Expertise: What Experts know and How They  Know It................................................................................................................... 39  2.3.1 Knowledge and Expertise........................................................................ 42  2.3.2 Identi cation of Experts………………………………………………….. 47  2.3.3 Expert Testimony and Being a Responsible Agent………………...49  2.4 The Inner and Outer Lives of the Expert……………………………….56  Chapter 3: Moral Expertise..........................................................................................60  3.1 It’s… complicated..........................................................................................60  3.2 The problems.................................................................................................62  3.2.1 The Rejections............................................................................................ 62  3.3 An Aristotelian Response........................................................................... 69  3.3.1 Defending Moral Expertise..................................................................... 76  Chapter 4: Bioethical Expertise...................................................................................81  4.1 Problems and Asymptotes.......................................................................... 81  4.2 Bioethical Expertise: Groups, not individuals……………………….... 85  4.2.1 Group Judgments and the Role of the Bioethical Expert…….......86  4.2.2 Interactional Expertise and Listening to Reason………………….. 89  4.3 Teleology, Structure, and the Work of Moral Theory……………….93  4.4 Parting Remarks............................................................................................ 94    REFERENCES..................................................................................................................96  v    Chapter 1: Introduction        1.0 The Thesis  Moral expertise is not a fantasy contrived by those who would wish to wield  it. Moral expertise is something that is achieved through training and  experience, just as any other form of expertise. While it shares many  features with other forms of expertise, it carries with it a form of authority  that is di erent and distinctive due largely to its inherently normative  1 nature. While most forms of expertise involve a speci c, fairly well de ned  subject matter and skillset, moral expertise is unique in that its practitioner  may need to make use of many other forms of expertise in order to  successfully employ it. This may make it a rare form of expertise, but the  di culty in attaining it ought not be a mark against its existence.  Commonly attributed to a single person, the di culties involved in  mastering all that would be required to achieve it are o en taken to be  2 reason enough to discard it.    While it could be true that the sort of moral expertise one needs to  live a properly moral life is properly regarded as an individual achievement,    One  could  say that all forms of expertise are normative, but the normativity involved with  moral  expertise  is  categorical  in  a  way  that  other  forms are not. Whereas one could simply  give  up  the  hypothetical  imperative that gives force to other forms of expertise, one cannot  simply give up the demands of morality.    2 This will be addressed in more detail in chapter 3.   1 1    there are contexts in which moral expertise is best seen as a group  achievement. One such context is bioethical inquiry and practice. Bioethics,  as a discipline, makes use of contributions from a variety of elds that each  have their own forms of expertise. As such, the complexities that arise in  bioethical contexts require the input from a varied group of experts as well  as the normative training needed to deal with complex moral and political  issues. Due to this complexity and the movement toward higher levels of  specialization in all forms of expertise, bioethical expertise ought to be  attributed to groups, not individuals.    1.1 The Backdrop  Bioethics is a relatively young discipline still searching for the best ways to  make its contributions. The need for the contribution is clear, but the  content of the contribution and its ideal methods of transmission are still  being sorted out. The name ‘bioethics’ suggests that a bioethicist ought to  have some expertise in a kind of ethics pertaining to the pre x ‘bio’—that  much is clear. Commonly attributed to Van Resselaer Potter, the term  3 originally denoted a broad constellation of topics. The bioethics penumbra  casts wide, including elds like organizational ethics, environmental ethics,  and medical ethics. Indeed, under this formulation, bioethics takes its pre x  quite literally—almost any discipline or intersection of disciplines (or any  3 See especially (Potter 1971, 1996)  2    elds composing these disciplines) that deals with the application of human  values to life, broadly construed, is subject to its gravitational pull.  This view of bioethics no doubt in uenced the evolution of the term  into biomedical ethics, with the pre x attached to a eld of study and  practice which obviously has much to do with life. As happens with so many  words and concepts, ‘bioethics’ has evolved in its usage. The in uence of  Hellegers and the founding of the Kennedy Institute at Georgetown  provided for this evolution and, along with the pioneering work of Daniel  Callahan and the Hastings Center, pushed the term more toward the  4 intersection of medicine and ethics. Some no doubt continue to use it the  broader sense that Potter hand in mind, but as Kuhse and Singer note, it is  now commonly used in this narrower sense to refer to the intersection of  5 biomedical science and ethics. This shi toward a narrower sense of the  term and what would typically fall under its purview does not change the  6 fact that bioethics is, at its heart, an interdisciplinary eld.   Interdisciplinary work is tough—even when the participants agree  that a given discourse is best served by input from specialists in a variety of  disciplines and elds within those disciplines. This comes as no surprise for  anyone that has worked on a multidisciplinary team, but the sorts of    (Reich  1994)  goes  into  greater  detail  on  this  history  and  the  potential  gaps  in  the  various  accounts. See also (Andre 2004) for a comprehensive treatment of eld.  5 (Kuhse and Singer 2013, 3–5). See also (Callahan 2012) and (Khushf 2004).  6  In what follows I will use ‘bioethics’ in this narrower sense. I recognize, however, that there  are  times  when  the  broader notion is more appropriate. When circumstances suggest using  the broader sense I will acknowledge the shi in usage.   4 3    disciplines that o en get pulled into bioethics discussions tend to resist the  kinds of collaboration necessary for progress. Disciplines that tend to be  highly specialized, with their own jargon, technical use of terms common to  other discourses, and methodologies make it di cult to nd common  ground – the sort of approach and starting point necessary for the work to  be done. While it is a common problem for elds within disciplines, for  instance, oncologists discussing treatments with cardiologists or  pulmonologists, it is even more of an issue when disparate disciplines meet.  Lawyers, physicians, sociologists, philosophers, to name but a few  contributors to the bioethics discourse, all have their own disciplinary  7 cultures. These cultures are o en integrated so deeply into the psyche of  the practitioner that she has little awareness of it. It is this cognitive,  emotional, and social aspect of becoming an expert in a given eld that both  enables and inhibits one’s ability to work e ectively on interdisciplinary  problems.   These di culties are exacerbated by pressure associated with the  movement toward more support for interdisciplinary work within  8 universities and funding agencies. Projects looking to get funded or  departments looking for university support are increasingly needing to  show their ability to work with other disciplines. For some disciplines it may    These  cultures  include  the  methodological,  epistemic,  and  social  norms  of  a  discipline,  and contribute to the practitioner’s ability to participate in the life of the discipline.  8   Michigan  State  University  provides  a  good  example  of  this  move  toward  more  interdisciplinary  work,  with  both  an  NSF-funded  center  for  interdisciplinary  study  of  evolution and a new center interdisciplinary research.  7 4    be easier to work with others, and the sorts of problems being addressed will  dictate the methods of measuring success, the nature of the individual  contributions to the whole, and other aspects of communal working. It is  here that bioethics sets itself apart from many other interdisciplinary  endeavors—the nature of the problems that are addressed are less well  de ned, more nuanced, and o en delicate. Much of the apparent (and in  many cases, real) recalcitrance of these problems stems from the domain set  by the root word ‘ethics’. As anyone who has grappled with bioethical issues  will attest, the eld is fraught with complications, ambiguities, and slippery  concepts. If anyone says that they deal with ethical problems and nd them  easy to solve, they are missing something.    1.2 The Problem(s)  The nature of bioethics as a discipline gives rise to a unique set of problems  in addition to the sorts of problems it seeks to resolve. No other discipline  brings together as many seemingly disparate specialists under the same  heading. As we will see during the course of the present work, this is both a  great and necessary aspect as well as an area needing more attention. Given  the emphasis on specialization in virtually all forms of inquiry, one might  well wonder just what it is to be a bioethicist. When a person is labeled  something with the su x ‘-ist’, ‘-er’, or ‘-ian’, and a root word denoting a eld  of inquiry or practice, it implies that she has some level of expertise in that  5    area. This suggests that the ‘bioethicist’ has some expertise in ethics with the  further need to esh out the 'bio' pre x. This implied expertise in ethics is  the focal point for what follows. Using ethical or moral expertise as a center  of gravity I will explore a subset of orbital problems. In particular, I want to  pay special attention to the ways in which philosophical issues with moral  expertise, both ethical and epistemological, combined with the nature and  scope of bioethics, form a unique set of issues. These issues include  problems with explicating the sort(s) of expertise involved in bioethics,  di culties in identifying those experts, issues surrounding the content and  import of the experts’ contributions, as well as questions regarding the  training of future experts. The result of the present examination of these  topics is an account wherein ‘the expert’ is not an individual, but rather a  group of people, and that within this group philosophers play a vital role. A  sustained inquiry into these issues will be of importance to not only  bioethics but also philosophy. I am not the rst philosopher to engage with  these issues, but I hope the present discussion is a worthwhile contribution  to the overall discourse.     1.2.1 Expertise  Both the philosophical and bioethical literature call into question the  existence of moral expertise. Even those willing to admit such expertise may  worry about its content. Much of this discussion rests atop a larger  6    discussion regarding the nature of expertise in general. This discussion  includes concerns regarding the conditions necessary to claim expertise. As  issues surrounding the concept of expertise more generally form the basis  on which the discussion of moral expertise stands, it is necessary to spend  some time on them. Speci cally, given that a moral expert is an expert, one  needs a set of criteria by which to judge expertise more generally. It may  turn out that moral expertise is di erent in important ways from other  forms of expertise, but without some working notion of expertise in general  one has no baseline from which to work.  That expertise involves a kind of knowledge is uncontroversial. What  is slightly more contested is the sort of knowledge the expert has and  employs. Work done by philosophers and psychologists is especially  in uential here. Di erent modes of understanding come into play in a way  that sheds light on the complexities of the issue. For instance, it is possible,  on a common account of knowledge, to separate knowing how to do  something and knowing that something is the case. If these two modes of  knowing are di erent it is reasonable to suggest that there could be experts  that can perform actions without being able to provide an account of how or  why they can do them, as well as experts who can give accounts for ways of  doing things but not be able to do those things themselves at an expert level  of performance. For a practical discipline like ethics, this is an important  distinction. One could potentially be able to do the right action but not be  7    able to give much detail regarding 'why' it is the right action or, on the other  hand, one could say why something is the right thing to do but fail to do so  (as in cases of akratic behavior). Both of these scenarios are debated in the  moral philosophical literature and any conception of expertise that will be  useful in de ning moral expertise will have to address them.   The conception of expertise that is relevant to the current project  involves a kind of propositional knowledge that is internalized and a ects  the ways in which the agent perceives situations and thus how the agent acts  in those situations. This two-fold account of the epistemology of expertise is  important. The true expertise rises above the level of a knack or natural  talent and involves the ability to provide an account for why a given action  was taken and/or why that act was superior to others. Additionally, the agent  develops a sensitivity toward features/aspects of situations that involve one's  area of expertise. These features/aspects of the situation strike the expert  di erently than the non-expert, and factor into the expert's judgment in  ways that di er from the non-expert. These features of expertise are  intimately tied to action, and that brings out a crucial element to expertise  that is easily overlooked; experts not only know, but act. An example of this  would be a physician observing a patient and noticing things that are  relevant to the diagnosis of the ailment that the patient did not notice or did  not see as relevant. This will then lead the physician to diagnose and treat in  a certain way (i.e. act in a certain way).  8    Within this discussion of expertise a few further issues will be  addressed. In particular the following three questions are explored:  1. How do people identify an expert?  2. How does one responsibly incorporate the testimony of an  expert into one’s own epistemic position?   3. What happens when experts disagree?  The import of question one is straightforward in the sense that if one  cannot identify the expert or distinguish her from the novice then one has  problems on both a theoretical (one's account of expertise is suspect) and  practical (in today's world people depend on input from experts more than  ever) level. Accounts of expertise, both specialist and lay, typically make use  of a success component or criterion. That is, experts must be more  successful at doing activities that are associated with their expertise. If one is  an expert basketball player, one must be able to play the game better than a  novice or average player. If one is an expert in the history of ancient Greece  one must be able to give accounts of that history in ways that rise above  common knowledge. There are various sorts of success criteria that apply to  various sorts of expertise, but in some cases what counts as success is less  clear. In order to properly account for the varieties of expertise we nd in  the world, we must get clearer on this success criterion.  The second question involves two notions of responsibility.  First, one must be an epistemically responsible agent. By this I mean one, in  9    general, seeks to understand and hold true beliefs, and if one is to do this in  areas where one has little knowledge (due to the complexity of the subject  matter or other factors) one will have to incorporate expert knowledge from  others. How does one know that the expert's testimony is true? If one cannot  know this, how does one proceed responsibly? This second-hand knowledge  is o en taken for granted in areas such as the sciences, but it is worthwhile  to address it because as one gets into value laden elds, such as healthcare,  forms of responsibility other than epistemic are at work. This gets into the  second notion of responsibility – that of moral responsibility. Given that  one acts from what one believes is true, and o en times one must act based  on input from experts, expert testimony o en factors directly into one's  moral life. Though an expert may still be wrong, and one may not be held  culpable for mistakes made by experts, one could be held responsible for  decisions made based on insu cient vetting of the experts or testing of their  propositions.  The third question involves situations where one may have identi ed  more than one expert in a eld and is receiving con icting accounts from  those experts. This raises the issue of levels of expertise and whether some  experts are more trustworthy than others. This leads to a further concern  that, in some elds, there may not be one, true, account or solution to a  problem, or that there is insu cient information or evidence, leading to  experts forming hypotheses rather that seem like mere opinions to  10    non-experts. This is a regular occurrence in the sciences but when the  question concerns healthcare the stakes are di erent. In order to act  responsibly in a context fraught with ambiguities and potential life-altering  decisions, one must have some way of adjudicating these matters, or at the  9 very least, be able to determine when one is encountering such a situation.   These questions gure into the subsequent discussion in two ways.  First, when moving to the group-level analysis of moral expertise we will  nd experts dealing with fellow experts — not only in their own elds but  also in elds that are beyond their own knowledge base. This e ectively  reduces experts to novices due to the shi in content and context, though  not entirely so. The problem of extension will rear its head here and in  subsequent chapters. In most elds, part of being an expert is the ability to  reason well and make use of the knowledge one has. However, while the  ability to reason can be applied to many things, one’s knowledge is o en  contextual and limited in scope. This leads to blindness toward aspects of  situations that are not typically relevant to one’s area of expertise and  hinders the extension of one’s expertise to other areas.    Second, an account of moral expertise must address the fact that  judgments will have to be explained and disseminated to non-experts.  Multiple factors are involved in the dissemination of judgments based on    It  is  not  uncommon  for  experts  to  appear  in  complete  command  of  their  subject  matter  and  delivering  the  ‘truth’  when  they  o er  advice.  However,  upon  seeking  further  opinions  one o en nds that there is more room for error than the expert’s demeanor suggests.  9 11    expert level analysis. Issues in the use of technical language are common,  where lay people may not be used to the use of technical language generally,  not to mention the technical language of a given subject area.  Compounding this language gap is the fact that, in the case of bioethics, the  judgments being made are value judgments, taking place in sensitive  contexts with results that can be far reaching in terms of personal  stakeholders as well as at the societal/political level.    1.2.2 Moral Expertise  This form of expertise is something that philosophers and theologians have  found particularly interesting and at times controversial. The connection  between bioethics and the concept of moral expertise provided the impetus  behind this project. Ought bioethicists be 'telling' people what to do, as  though they are experts in the moral matters in the relevant sphere of  action?  Among the elds that contribute to bioethical discussions, philosophy  has been particularly active. While it is hard to deny the importance of  philosophical analysis in the myriad bioethical debates there is a tension in  the role played by moral philosophers in particular. The question is 'what is  it, speci cally, that moral philosophers contribute to the discussion?' and it  is not an unreasonable one. The idea is that current bioethical discussions  involve a series of experts providing input on speci c issues with the goal  12    being a resolution to a problem. With most disciplines, the identi cation of  relevant experts is thought to be rather straightforward, as is the nature and  value of their contributions to a given discussion. For instance, physicians  develop expertise in certain sub-disciplines of medicine through training  and experience. Successful doctors in these elds are then considered  experts. In legal matters, a lawyer that has mastered the legal literature and  can identify the legal rami cations for given solutions would be seen as an  expert. The ndings of these experts are taken as inputs in the larger  decision procedure and only other experts within the given sphere (e.g.  medicine or law) are entitled challenge those ndings.    With this in mind, it seems natural to inquire into the nature of the  contributions from moral philosophers in these discussions. In what,  speci cally, does their expertise lie? An easy answer would be that they are  to be seen as moral experts, due to having an understanding of the history  of ethical theory and a general understanding of the arguments within that  history. However, while the history of moral thought is no doubt  fascinating, it is o en claimed that such knowledge is not all that useful in  practical contexts. Many see a disconnect between an understanding of the  history of ethical theory, or even the development of new ethical theories,  10 and the expertise or authority to make ethical judgments.     This  is  a  common  criticism  that  will  be  addressed  later.  For  an  especially  representative  expression of this concern, see (Cowley 2005).  10 13    This suggests a problem; is there such a thing as 'moral expertise'? If  so, how would we identify expert practitioners? What is the relationship  between moral philosophy and moral expertise? In complex situations, such  as those posed by bioethics, ought we be looking to one person as the expert  in the matter? Lastly, what do the answers to these questions mean for  bioethics? These are important questions for many reasons, not the least of  which concerns the role that moral philosophers should play in bioethical  debates. I claim that the concept of moral expertise is not as outlandish as  many believe. In fact, when viewed from an Aristotelian perspective, moral  expertise is a natural end to be achieved. This expertise is attained through  the development of sensitivities to the normative features of situations. This  enhanced sensitivity is combined with a greater understanding of what it  means for human beings to ourish as well as how to best achieve that state  by way of the proper use of practical reason. Furthermore, this Aristotelian  perspective is not merely a historical curiosity. Rather, it is a legitimate  contender in moral philosophy that is uniquely positioned to both describe  11 and improve our moral lives as well as further moral and social agendas.   An Aristotelian view has the advantage of simultaneously embracing the    One  might  question  the  use  of  an  Aristotelian  framework  here,  arguing  that  one  could  simply  choose  to  use  a  di erent  framework  and  thus  come  up  with  a  di erent  conception  of  moral  expertise  and  its  role  in  bioethics.  I  shall  not  spend  too  much time defending the  Aristotelian  ethical  framework  I  use--it  is  clear  that  such  a  framework is a respected one in  the  philosophical  literature.  I  will,  on  occasion,  gesture  in  the  direction  of a defense of this  framework  as  I  do  believe  it  to  be  a  superior  system.  On  the  whole,  however,  I  will  use  it,  including  the  many metaethical and moral psychological implications, as a starting point in  my work.  11 14    inherent uncodi ability of ethical issues and maintaining a level of moral  realism that allows for answers to ethical questions and explanations for  preferring some actions to others, all while embracing both the  propositional and the practical dimensions of expertise found in the  scienti c literature.   The most important feature of an Aristotelian approach is that it  provides an account of expertise that, when combined with some  contemporary work on social epistemology and group agency, provides a  unique view of what moral expertise would look like in the complex  scenarios that bioethicists encounter. The Aristotelian view espouses a form  of ethical naturalism and moral epistemology that welcomes the input from  medicine and leads to a fruitful interaction between ethical theory and  medicine. Finally, the Aristotelian view can be seen as breaking down the  traditional barrier between theory and practice by showing how the two are  interrelated, allowing for a kind of application that many have denied to  ethical theory in general.  The result of this line of inquiry is an account where moral expertise  is seen as a combination of the proper application of practical reason,  knowledge of the relevant features of the situation, and the training of one’s  desires to align with one’s reasoned judgments. Given that the problems  presented in bioethics involve the input of multiple specialists who are  experts in their own elds and that these specialists have particular insight  15    into the many features that give these problems their complexion, along  with what we know about expertise generally, we see that it is unreasonable  for any one individual to have and make good use of the knowledge  necessary to make good judgments. This is not to say that moral expertise is  therefore a useless concept or something to be deleted from the discourse.  Rather it tells in favor of a reimagining of moral expertise in the bioethics.  This reimagining involves moving moral expertise from the level of the  individual to the level of a group.    1.2.3 Expertise at the Group Level  The move from the individual-level to the group-level is motivated by  concerns raised in the previous two sections. By 'group-level' I mean groups  of individuals seen as one collective rather than merely a bundle of  individual agents. This group takes on a limited form of agency and is more  than a mere some sum of its parts. This is opposed to the individual-level  where individual people are seen as the locus of concern and ascribed the  status of moral expert. It is the latter that is common in the literature and is  considered problematic by many. The move to ascribing moral expertise to  groups provides a means to reconcile the positions of interlocutors in the  debate.   There are a few primary issues that group-level moral expertise  answers immediately. The most obvious is the problem of the vastness of  16    the particulars that are present in the kinds of di cult moral situations  facing an agent (group or otherwise) in this context. Bioethics o en deals  with problems in which varied and sometimes disparate spheres of  knowledge are relevant. In such cases, there are o en experts within each  sphere of knowledge who are good judges of the relevant aspects of the  situation but who would be less e ective judges when it comes to other  aspects that involve the expertise of a di erent sphere. This can be seen in  medical diagnoses, where experts from di erent elds in medicine come  together to argue about whether a certain symptom or ailment might be  primary (i.e. of immediate concern, or the ultimate cause of the larger  disease, etc.) and then, based on that, what course of action is best for the  patient. In cases involving bioethical issues, this problem could extend in  many di erent directions. There could be legal issues at work,  communication issues between patients and physicians, religious concerns,  and other ethical issues that may supervene on some or all of the other  issues mentioned. If one could bring together a group of experts in each  sphere, one might be able to make more progress toward a defensible  position on the matter.  This may be well and good, in theory, but it will mean nothing if such  a group cannot actually be formed and then perform as the theory intends.  It is here that I draw upon the resources of work done in social  epistemology and group agency in the philosophical literature. People such  17    as Carol Rovane, Christian List, Philip Pettit, Alvin Goldman, and others  have done work on matters of great importance to my project and they  provide a starting point for my account of group-level moral expertise. I  consider four primary problems that are associated with making this theory  work.  1. How will the knowledge of each individual contribute to the collective  knowledge of the group?  2. How will the group of experts form collective judgments?  3. In what ways can this group ‘act’ in bioethical contexts?  4. How is responsibility for any actions taken by the group distributed to  the individual members?    1.2.4 Training Present and Future Bioethicists  The model of group agency and moral expertise I have in mind depends on  the individual agents being trained in speci c ways. The dictum 'get to them  early and o en' applies here. One of the key features of Aristotle's view on  practical reason is his use of 'vision' as a key metaphor for how practical  reasoning works. This form of cognitive perception is critical, according to  Aristotle, because it is the basis from which the rest of the reasoning process  proceeds. If an agent makes a mistake (that goes uncorrected) at this point in  the deliberative process the rest of the process will simply carry the agent  farther down the mistaken path. As a result, if my conception of group  18    agency and moral expertise is to work within this Aristotelian paradigm, the  individual agents will need to be trained in speci c ways in order to  facilitate this kind of perception and this training will have to start early in  their education.   Aristotle is famous for (among other things) claiming that character  development starts when one is quite young and that this early training is  critical. The ideal agent is brought up with an appreciation for good things  and recognizes them as good things. This paves the way for further  development later as one is already acquainted with and attracted to the  proper things and will be more responsive to what reason says is good and  proper in more di cult, less obvious cases.   This same basic ideal applies to the constituents of group-level moral  expertise. In order for the collective judgment of the group to work  properly each agent will have to be trained, early and consistently, to  respond in certain characteristic ways. One of the rst and most crucial  factors here will be the agent's facility with normative language and  concepts. Normative concepts such as justice, courage, integrity, and others  will form the foundation of any moral discussion and it will be imperative  that each member of the group-agent be at ease with the di culty and  inherent complexity involved with such terms/concepts.  Along with a basic understanding and facility with using normative  concepts one has to attain a level of moral maturity that will be furthered by  19    this training. Understanding how and why other people might disagree with  you, the basic forms of argumentation, and perhaps most importantly a  willingness to charitably examine the views of others are all skills and  dispositions that will be critical for the agent to attain. These skills and  dispositions are not inculcated quickly; it will take time and repeated  exposure in order for them to be properly absorbed. This could mean that  as early as undergraduate pre-med, pre-law, and other preliminary  curricula would need to include courses that aim to instill these states.  Graduate seminars and clinical rotations with a variety of people already a  part of group-level moral expert would help to further instill these states.  Use of Responsible Conduct of Research (RCR) training modules will also  facilitate the required understanding as well as further develop it later in  one's career. Lastly, it will be of critical importance to include moral  philosophers in this training as well as the development of its curriculum.    1.2.5 Philosophers and the Future of Bioethics  There are many roles for moral philosophers in bioethics. The primary  roles, as I see it, involve the training of future bioethicists, substantive  contributions to the moral discourse, and the speci c roles that moral  philosophers play in group-level moral expertise. While some of these roles  will be readily accepted and already entrenched in the bioethics  community, other roles I discuss may not be so readily implemented.    20    The fact that moral philosophers play a role in the training of  bioethicists is not news. One of the primary contributions of philosophy in  general to bioethics has been the introduction of moral concepts, methods  of moral analysis, and the history of moral argumentation. As mentioned  previously, many think this is where moral philosophy does its best work in  bioethics and should be the sole domain for philosophers who wish to  contribute to these discussions. To this I respond by claiming that, yes,  moral philosophy has much to say here, but it is merely one role of many  that philosophers ought to be performing, and even this training ought to  be done with a larger goal in mind. The thought is that this is not merely a  matter of teaching people what has happened in the past so as to not repeat  those mistakes (though that is an important lesson). The goal of training  ought to be the development of the normative maturity mentioned  previously—a kind of character development. This will involve an e ort on  the part of moral philosophers to further investigate and develop  techniques aimed at sharpening skills and helping to develop the knowledge  bases necessary for group-level moral expertise. This will lead to the  discovery of new problems and new approaches rather than mere avoidance  of things done wrong in the past.   In terms of the substantive contributions of philosophers in bioethics  discussions, much praiseworthy work is already being done. It is worth  noting here that there is much philosophical work to be done in bioethics  21    contexts. One feature of bioethical discussions that philosophers ought to be  engaging more is the fact that these discussions o en push the boundaries  of our concepts. Whereas much of philosophy utilizes thought experiments  in order to illuminate and, o en, complicate matters, bioethics provides a  fertile ground of di cult examples and problems that even the most  inventive of philosophers would be hard pressed to match. This, in my view,  moves bioethics into a di erent position than many contemporary  philosophers admit. Rather than being a eld or topic area to which we  apply philosophy, bioethics is better seen as an area in which philosophers  can do philosophical work — new problems arise (e.g. within the  metaphysics of identity, agency, moral epistemology, etc.) and some  established problems can be seen in stark relief, leading to problems for  established moral (and other) philosophical approaches (e.g. the role of  moral perception in practical reason). Moral philosophers can contribute in  more ways than simply attending ethics committee meetings. In fact, in the  account of moral expertise I develop, much of the work needs to be done  prior to such a meeting. By writing books, articles in peer reviewed journals,  and even blogs, for instance, the philosopher (as well as other contributors)  is contributing to the background of moral knowledge and understandings  that will help to frame and illuminate moral debates and facilitate  resolutions.    22    The last topic discussed in this chapter will be the speci c role that  philosophers should play in the group-level moral expert. Here, the  philosopher is to be seen as a kind of conductor or midwife, as opposed to  the person that is seen as having the answer. The philosopher’s training in  rigorous forms of reasoning and facility with the normative language and  the use of related concepts puts her in a unique position to dialectally guide  the discussions of the group expert. Much of this will depend upon the  training explored in previous sections, as the philosopher will be of little use  if the rest of the participants cannot or will not participate in the dialogue.  Having a shared background of terms, concepts and methods of reasoning  will be critical, but having a shared sense of purpose and focus will be just as  critical. In order for the group to function properly as an expert it must  have not only a common background to which each member can refer and  build upon when discussing delicate moral matters, but it must also have  someone who is rigorously trained in dialectic methods and reasoning to  guide the discussion. The philosopher is uniquely positioned to take on this  role due to her training as well as the character that is likely to be instilled  because of that training.    23    Chapter 2: Expertise        2.1 Expertise as a subject matter  When making decisions, people o en seek input from others who are  presumed to know more. This tendency manifests in di erent ways--from  asking technologically savvy friends for advice on what computer to buy to  more serious matters, such as asking a physician about the best course of  action to treat an illness. As a society becomes more specialized and  technical, this becomes more entrenched. There are also times when we  seek advice from others not simply due to a presumed knowledge gap, but  because we seek a di erent perspective. We routinely seek advice from our  epistemically equal peers, and are encouraged to get second opinions when  considering undergoing a medical procedure. In these cases, we seek  con rmation, previously unseen options, and other inputs that are not  necessarily a function of the other person's greater knowledge.   These rather common occurrences illustrate some of the primary  issues with expertise. That experts know more than non-experts is not  12 uncontroversial, but it is widely accepted. That experts perceive situations  di erently than non-experts might not be as obvious or uncontroversial, but    There  are  critiques  of  this  view  to  be  explored,  largely  stemming  from  a  postmodern  point  of  view.  As  we  will  see,  much  of  the  content  of  these  critiques  involves  the  label  ‘expert’ and the privilege attached to it rather than explicit knowledge claims.   12 24    13 upon re ection most, I think, will nd this reasonable. The relevant work  regarding expertise deals with the background conditions that make these  claims true and whether the truth of these claims vary with the area or kind  of expertise in question. There is also the matter of how experts get to be  such--what forms of training are required in order to achieve expertise?  Before turning to these questions, however, it important to at least partially  set the stakes for the discussion. The study of expertise is no mere  intellectual exercise; societies tend to give great weight to the  pronouncements of experts. The normative overtones associated with  expertise broadly construed end up a ecting who is allowed to be called an  expert and, in some cases, whether people are willing to admit that experts  14  in a given domain can exist at all.   2.2 Expertise and Social In uence: Sociological and Psychological  Approaches to expertise.   As soon as a eld of inquiry matures to the point of having experts, it is their  opinions that tend to hold sway when relevant decisions are made. There is  a form of epistemic dependence that arises whenever a society advances in  some area of importance. For instance, we have a legal culture that relies    The  situations  I  have  in  mind  here  are  those  where  the  expert’s  expertise will have some  relevance. This is addressed in more detail later in this chapter.   14   In  some  cases,  people  who  su er  from  forms  of  discrimination  are  not  deemed  capable  of  expertise  in  part  due  to  the  social  status  that  will  be  a orded  to  them. For more on this,  see  (Danso  2007).  In  certain  cases  this  issue  is  quite  pronounced,  as  in  the  case  of  moral  expertise I explore in the next chapter.   13 25    heavily on actions, inputs, and judgments of experts. The lawyers that one  would hire in such a case represent a class of experts, and there is good  reason that it is rare for people to represent themselves in court cases that  could lead to life altering outcomes. Judges are legal experts as well, and are  tasked with the preservation and interpretation of not only the law, but  aspects of the legal system having to do with argumentation, evidence, and  other protocol oriented matters. This reliance on expertise in court extends  beyond lawyers, judges, and other forms of legal expert--lawyers o en rely  on the testimony of those with relevant expertise to bolster their case. The  idea is that if an expert says something, it carries more weight than if  someone with a layperson’s level of understanding were to say the same  thing.    The prominence and in uence of experts ranges from the more  mundane matters of everyday life to more important, o en life-altering  matters. From food critics to neurosurgeons, there are attributes shared by  all experts, but the existence of a knowledge gap is the de ning feature.  Experts know more than their lay counterparts. This knowledge can take  various forms, from knowing facts to knowing how to do something with  extraordinary skill. It is this knowledge that forms the basis for the expert’s  authority and in uence.   This rather straightforward account is commonly traced back to the  middle-ages and the guild culture, with its apprenticeship model of  26    professional development. Members of important guilds held considerable  social clout and it was not uncommon for their opinions to be sought a er  even in areas where they held no speci c expertise. One could not achieve  true expertise in the eyes of public without being recognized by one's peers  and being accepted into the group of experts.   In our own society, as it grows more and more specialized, we see a  continuation of this phenomenon. We have schools that certify people as  experts in a given area, board examinations for elds such as law and  medicine. Experts in some elds have a social clout or gravitas that extends  beyond their area of expertise. Physicians are a common example of this, as  are some famous scientists (e.g. Einstein), and even some entertainers. If  persons have expertise in an area of inquiry or performance that society  values, their in uence commonly extends to matters which have little to do  with their speci c expertise. Given the in uence that experts have it is no  small matter to determine not only the nature of expertise itself but also  how the layperson can identify an expert (or, perhaps more importantly, a  charlatan). There is a tacit authority that any epistemically responsible agent  must consider when dealing with an area that has established experts, but  one must also have a sense of when to challenge this authority.    27    2.2.1 The Sociology of Expertise  During the past y to sixty years, much of the work on expertise has been  done by sociologists. Not surprisingly, the focus has been largely on  scienti c expertise. Scientists are seen as paradigmatic experts—they have  esoteric knowledge and can thus speak with authority on scienti c matters.  The work done during this period focused almost exclusively on a  propositional form of scienti c knowledge, along with the power and social  in uence that went along with it. In their piece “The Third Wave of Science  Studies”, Collins and Evans consider three periods (or ‘waves’) that mark  shi s in the ways that sociologists approach expertise and particularly  15 scienti c expertise. The rst wave, beginning in the 1950’s, focused  primarily on understanding the nature of scienti c knowledge and how this  knowledge could be reinforced and propagated. One of the hallmarks of  this period was the tacit acceptance of what would be a contested claim  later—the idea that scienti c knowledge is esoteric. This is critical, in that it  presents science as a sort of walled garden. Lay persons would be essentially  silenced, in the Austinian sense, because they did not have the training and  understanding that would give them the authority to challenge the  conclusions and judgments of scientists.  Due to the esoteric nature of the knowledge scientists held a position  of immense power when it came to scienti c matters. In an age when  15 (H. M. Collins and Evans 2002)  28    science was becoming more and more in uential in society, due in part to  its relationship to the technological advances of the time, this led to some  16 concern. In 1962 the philosopher/historian of science Thomas Kuhn wrote  the in uential book The Structure of Scienti c Revolutions. While Kuhn was  focused primarily on understanding the nature of the epistemology of  science and its relationship to scienti c theory, many sociologists saw this as  a turning point in the study of scienti c expertise. In uenced by  postmodernist thought, many took Kuhn’s work on paradigm shi s and  concerns surrounding the foundations of scienti c theories to re ect aws  17 in the scienti c enterprise as a whole. The sociological approach to  expertise took a turn that is still evident now.  The hallmark of this sociological period is a general rejection of  expertise and it is most evident in the work done on scienti c expertise.  This ‘second wave’, as Collins and Evans describe it, is characterized by a  commitment (either tacit or explicit) to social constructivism. Using the  conceptual resources of constructivist thought, sociologists began to  question the existence of expertise in science as well as a more general sort  of ‘technical’ expertise. The questioning, and eventual rejection, of expertise  18 began with the rejection of the esoteric nature of scienti c knowledge. The    It  should  be  noted  that  it was not only sociologists who were concerned and saw the need  to  challenge  science  and  scientists.  Philosophers  of  science,  including  Kuhn  as  well  as  the  much-maligned  logical  positivists,  saw  aws  in  the  epistemology  of  science  and  the  need  for further work on the matter.  17   Kuhn  saw  this  a  warping  of  his  views  and  wrote  a  piece in an attempt to clarify his views.  See (Kuhn 2013)  18 (H. M. Collins and Evans 2002)  16 29    claim made by many at the time was that the sort of knowledge that these  technical people had was no di erent than the sort of knowledge common  to us all. It was not something that is di erent in kind, and so not esoteric in  the way many previously thought. This leads to the breaking down of the  expert/non-expert dichotomy by removing the barrier that led some to  think that non-experts were in no position to criticize or question the  pronouncements of the experts. While it could very well be the case that  scientists have a deeper understanding of something, it remains a matter of  degree and thus opens the door for lay-persons and even so-called  19 ‘lay-experts’.   At the heart of this sociological movement was a concern with the  label of ‘expert’ and the social and political power it holds. By questioning  the foundations and nature of expert knowledge, these individuals were  attempting to break down barriers and categories that they saw as both  politically and socially damaging. Building upon what they saw in Kuhn’s  work, they claimed that the methods of the experts themselves, in this case  scientists and the scienti c method, did not have the resources to truly end  debates. What was really at work in these scienti c disputes were power  structures, paradigms, and other non-scienti c factors. The objectivity  claimed by the scientists of previous generations was, on this view, a myth.   A ‘lay-expert’ is someone who has enough experience in an area to count as an expert, but  not  the  formal  training  and  attendant  credentials  of  the  ‘true’  expert.  More  on  this  as  we  move forward.  19 30    Without this objectivity and appeals to ‘matters of fact’, many took the  notion of scienti c expertise to be largely vacuous. Science was just another  paradigm and thus in no better position to determine fact from ction than  other, competing paradigms.  We still see remnants of this line of thought today. It is common for  those versed in sociological theory to have a general, perhaps nascent,  distrust of expertise and the sorts rights and privileges that are seen to  accompany it. While it is true that objectivity is di cult it need not be seen  as impossible. Much of the sociological work that leads to this relativistic  rejection of expertise focuses on individual scientists or scienti c  movements. Many will claim that conclusions drawn from the studies of  individuals and groups of scientists can be applied to science as a whole or  as an endeavor, but such claims are problematic at best and most likely false. 20 Some of the problems with the constructivist line stem from  misunderstandings of the epistemology of science, and of expertise more  broadly. Other problems stem from problematic views concerning the  nature of practical reason and political authority. What is needed is a  systematic approach that pays attention to the concerns that this  constructivist sociology rightly raises, but also delves into the philosophical  underpinnings of expertise and what follows from them. Fortunately, many  philosophers have taken on this challenge, both directly and indirectly.   20 More on this later in the chapter.  31      2.2.2 Psychology, Neurobiology, and Expertise  Just as with the studies that come out of social science, psychological studies  on the nature of expertise provide critical insights regarding its nature and  operation. Where the sociologists tend to focus on how experts are  identi ed and function within society, psychology focuses on the mental  features that set experts apart from the laity. At a general level, the  hypothesis being tested is something like ‘experts behave di erently than  non-experts, and the di erence lies in the way experts process information’.  As one would expect, there are di erent ways of de ning key concepts in  this hypothesis—what it means to ‘process information’ gets the bulk of the  attention. While this is certainly a large part of the psychological approach,  studies have also moved into the rami cations of expert studies. For  instance, using neurobiology and education theory, some scientists have  ventured into theories regarding the making of future experts, giving  special attention to the learning environment and biology that enables one  to build expertise e ciently. Before moving into these latter topics, though,  it will be helpful to delve into the history of psychological studies of  expertise and how the current theoretical and experimental understandings  have evolved.   Psychology started focusing attention on expertise in the 1940’s. These  early studies were particularly in uenced by behaviorism. Psychologists  32    were concerned with determining which combination of environment and  habit, or stimulus-response pairs, would combine to produce expert  performance. Using scenarios in which most would agree to there being a  gulf between an expert and a novice, such as playing chess, the  experimenters would analyze seemingly complex operations in terms of the  21 input/output that de ned behaviorism. While these studies are largely  seen as producing signi cant results, their greatest contribution arguably  lies in their inadequacy—they forced psychology (and other elds, as we will  see) to develop new models for characterizing the complex processes taking  place. Di culties associated with the acquisition of mental skills, the  development of novel memory functions, and the proper role of general  mental ability and native intelligence led many to abandon behaviorism as a  22 psychological model.   Studies were suggesting that the processes involved in expert  performance were varied and complex, and scientists sought to understand  these processes as well as how to develop them. This forced the scienti c  community to explore new ways of understanding and characterizing the  mental activities at work in expert performance. Recent progress in  computer science and linguistics suggested a new framework based on the  brain’s ability to process information. These computational models quickly  (Ericsson et al. 2006, 43)    This  is  not  to  say  that  were  it  not  for  these  studies  of  and  concerns  about  expertise,  behaviorism  would  have  survived  further  scrutiny.  It  does  appear  as  though  work  on  expertise  expedited  the  death  of  the  behaviorist  model,  and  led  to  new  work  that  would  revolutionize (and even create) many elds of study. See (Ericsson et al. 2006, 41–46)  21 22 33    replaced the behaviorist paradigm. No longer a matter of inputs and  outputs, the objects of study were the internal mechanisms that produce  expert level results (seen largely as the ability to function highly under  stress/challenge) as well as the environmental components that allow for  23 these mechanisms to function and ourish.   While much of this history is interesting and important, one  conceptual distinction in particular has proven critical for future work on  expertise. This distinction involved the di erences between strong and weak  24 methods of achieving intelligence in computational systems. When  developing models of the intellectual processes involved in expertise many  turned to developing computer programs and algorithms that mimicked  the way experts described their thought processes. These early attempts at  arti cial intelligence employed weak methods for achieving their goals.  Weak methods involve reasoning and problem-solving strategies that are  broad in scope and not particular to any one eld or situation. Some  examples of this are trial and error, means-end analysis, and other methods  that are largely a function of the program applying any and all possible  25 steps to solving a problem until one succeeds. This is a generalist (as  opposed to specialist) sort of approach in that the methods are highly  portable (i.e. they apply to many di erent situations and problem types), but  (Ericsson et al. 2006, 45)  See (Ericsson et al. 2006, 43) and (Newell, Simon, and Others 1972)  25 See (Ericsson et al. 2006, ch.5 and ch.6)  23 24 34    for all of their portability they are resource intensive and their success rate  diminishes as problem complexity and di culty increases.  Strong methods have largely won the day when it comes to studies of  expertise. Where weak methods lead to success with many di erent  problem types at a fairly shallow level of complexity, strong methods lead to  success in a small set of problem types with high levels of di culty and  26 complexity. These methods were developed as researchers discovered  more about the thought processes, mental and conceptual frameworks, and  27 attitudes toward problems in cognitively demanding elds. Scientists  discovered experts in these demanding elds, such as medicine, employed  methods that were tailored to their respective domains. This tailoring  involved the use of complex strategies infused with domain-speci c  knowledge of language and concepts. These methods were far less portable  than the more general, weak, methods, but they were also far more  successful when it came to solving di cult problems. This led many to see  experts as ‘specialists’ in the same way we currently use that term to  describe physicians that study a particular area of medicine.  Due to this early success, psychology and education have largely  favored strong methods when it comes to modeling expertise—favoring  domain-speci c skills and understandings that do not transfer well to other  elds. Further developments of the strong methods approach to both  26 27 See above.  (Pauker et al. 1976; Shortli e 1976)  35    psychology and arti cial intelligence (which was o en used as a test bed for  the newly developed eld of cognitive science) revealed a number of  ndings regarding experts. According to these ndings, experts are not only  faster and more successful at solving problems within their domain, but  they also use qualitatively di erent means of solving these problems when  28 compared to novices. They also spend much more time qualitatively  analyzing problems before attempting solutions when compared to novices.  Also, experts tend to view given situations quite di erently from novices  29 and even experts in other elds.   Those concerned with education (both within psychology as well as  elds in need of new experts) have focused on these strong methods and  how best to pass along knowledge and skill to subsequent generations. By  de ning expertise in terms of performance in di cult circumstances,  psychology, in particular, tipped the scales in favor of supporting and  developing knowledge and skills that favor strong methods. There is a  tension here, not unnoticed by some in the eld, between the critical  thinking and broad knowledge associated with weak methods and the  extensive knowledge and experience within a single domain associated with  30 strong methods. It is unclear just how much one’s general intellectual  prowess factors into expertise in a given domain. Some promising work  (Ericsson et al. 2006, 44)  (Ericsson et al. 2006, 44)   30 (Chi 1978; Ericsson et al. 2006, 46–47)  28 29 36    suggests that the development of weak methods will support the further  development of strong methods later in one’s education. It is also possible  that the achievement of expertise in one domain will lead to a lower form of  31 expertise in adjacent domains.   While work on these issues continues, a bulk of attention has gone to  the development of specialists. Expertise is something gained over time, and  typically it is quite a long time. It would be natural to think that one could  simply teach a novice the way an expert approaches problems in her  domain, but studies have shown this to be false. The way to expertise, then,  is one of exposure over time. The experience gained over this period leads  to the mindset necessary to achieve expert performance. The problem is  that studies show the need for speci c sorts of experience—not just any  experience will do. Focused, directed, deliberate practice centered on the  32 intricacies of the domain have been shown to be the most e ective. In  order for the proper inculcation of the mindset necessary for expertise one  must be challenged in ways that develop the intellectual resources critical to  the domain. These resources include a vocabulary of both concepts and  patterns of perception and thought.  That last bit regarding patterns of perception and thought is critical  for this project. Philosophers o en remark on the importance of saliency  and of seeing situations correctly. One of the more interesting things to  31 32 This will come up again in chapter 4.  See (Hambrick et al. 2014).  37    33 come out of studies of expertise is the concept of ‘chunking’. When  presented with a situation, experts see things in ways novices (and experts in  other elds) do not. Chunking refers to the cognitive habit of breaking down  scenarios into components. A common example involves patterns of chess  pieces on a board. Expert chess players are able to break down the layout of  the pieces into patterns or ‘chunks’ that can then be moved around and  combined in di erent ways. The higher the level of expertise in a eld, the  larger and more complex the chunks seen in a situation. This chunking  activity involves the expert’s memory of previous games, in the case of  chess, and thought processes and knowledge that will lead to better moves  based on what is presented.  Chunking is of vital importance when it comes to expertise. How one  views a situation is determined by how one breaks down things down and  then organizes them into an understanding of what is happening. The  knowledge gained over the course of one’s training a ects how one  determines what counts as a component or chunk, as well as the relative  importance of it and how it factors into the larger mental picture. This  mental picture of the situation is the starting point for further thought  processes that lead to action on the part of the expert. Given that experts are  to be specialists in a domain and the knowledge and cognitive skills  developed during training are largely domain speci c, it is likely that  33 A term borrowed from Herbert Simon, see (Ericsson et al. 2006, 55).   38    experts in di erent elds will see the same situation quite di erently. What  is more, they will also have a hard time seeing things the way the other  expert sees them.  This sort of training, favoring strong methods that lead to increased  specialization, results in experts that are molded to t their domain. Higher  education, primarily at the post-undergraduate, has followed (if not driven)  the specialization train toward some unforeseen consequences. One  consequence in particular has wide and potentially disturbing  e ects—specialists will develop cognitive dispositions and viewpoints that  will lead to what I will call blindspots. A blind spot results from an inability  to discern features of a situation due to one’s training. The phenomenon is  not unheard of—physicians speak of neurologists seeing everything as a  brain problem, whereas cardiologists see everything as a heart problem.  While this is usually said in partial jest, it turns out to be a real and  potentially dangerous trait. One’s mind can, in e ect, be conditioned in a  way that makes it quite di cult to see relevant details whose saliency is due  to factors outside of one’s own domain of expertise. To a hammer,  everything looks like a nail.     2.3 Philosophy and Expertise: What Experts know and How They Know It  When asked what makes a person an expert a common answer is that the  expert knows more about a given subject than non-experts. Philosophers  39    reading that last sentence are likely to have alarms going o in their  heads--the term 'know' is notoriously ambiguous and fraught with  complications. As one examines the literature on expertise one nds a  common distinction being made regarding what purported experts know. In  some cases, the expert knows more information about a given domain. This  amounts to knowing more facts about a topic--a kind of propositional  knowledge. This is commonly attributed to academicians, where one might  know a great deal of information about a given period of history or the ner  points of photosynthesis. Knowledge of this sort is o en claimed to be  merely theoretical and is compared to more practical forms of knowledge,  leading to a distinction in types of expertise--intellectual expertise and  34 performative expertise.   In the latter case, an expert would be a person who could perform  some task better than a novice or intermediate. Common examples here are  professional athletes, chess players, and others whose expertise depends  upon more than mere knowledge of facts about the domain in question but  also in an ability to act in a certain way on a consistent basis. For instance, in  the common example of the chess player, it is not as though the  grandmaster knows the rules of chess any better than a novice or  intermediate player, but rather that the grandmaster 'plays the game' better.  This 'playing of the game' involves much more than just the understanding    These  categories  are  disputed  in  myriad  ways.  Some  of  these  disputes  are  addressed  in  the current chapter, while others are addressed in subsequent chapters.  34 40    of the rules or even the understanding of strategies.35 It involves the ability  to consistently apply those rules and strategies. In some cases, the expert  may not realize (or, in other words, may not know) exactly what strategy she  is employing. In this case, she is just playing the game without the conscious  realization of how she is doing so. Studies of chess players show marked  di erences in the ways the board is viewed.36 Expert players view the board  in patterns and potential patterns that go unnoticed by novice players. In  terms of this distinction, some expert players may be able to describe in  detail the sort of moves they see as available and even o er names for those  moves. It could also be that an expert player might not know how to  verbalize what they see and do, but nonetheless are able to perform the  moves and anticipate those of their opponent.   This same sort of performative expertise could be attributed to an  athlete like Michael Jordan. In Jordan's case, his expertise was not a matter  of knowing the rules of the game any better or even of knowing certain  strategies. Players o en speak of 'being in the zone' when playing especially  well. This sort of phenomenon is o en thought to be categorically di erent  from the more propositional sort of understanding and expertise in that  there is no conscious realization of how the performer is acting. When  asked, the performer might honestly say that he does not know how he did  all of those wondrous acts in the game. The fact that the purported expert  35 36 This will come up again later in this chapter.  See (Ericsson et al. 2006, 100–103)  41    (such as Jordan, in the example) cannot spell out exactly what he was doing  or how he operationalized certain facts does not diminish his status as an  expert.   Contrast this performative form with the more intellectual approach  of a coach. In many cases the coach of a given player/team is able to spell  out in many ways the things that need to be done to win, including the  strategies and skills that lead to success. This does not mean the coach  him/herself can perform the activities at the same level of the athlete. For a  variety of reasons one might know what needs to be done while not being  able to do it at the level required. These examples lead to two basic sorts of  experts: expert knowers and expert performers.    2.3.1 Knowledge and Expertise  This basic division between a more propositional sort of expertise and a  more performative form can also be seen in the philosophical literature  concerning the epistemological underpinnings of expertise. This split is  taken as signi cant in that one might have one form of expertise within a  given domain whereas another person might have a di erent form of  expertise within that same domain.37   Take for instance one common complaint amongst those with  experience in a technical eld that have no formal education in that eld. A  37 See (Bruce D. Weinstein 1993, 59–62)  42    common complaint about many college grads involves their having plenty  of ‘book learning’ without having the requisite practical experience to use  any of it. This is a regular occurrence in elds that, for historical and  cultural reasons, have people who were trained ‘on the job’. These people  o en have years of experience working in a particular eld such as  mechanical engineering but very little formal training of the sort a college  graduate would be expected to undergo.   One result of this gap in experience is that two forms of expertise  arise. The engineer with years of experience can o en solve problems that  the younger college graduate cannot. This is due to a kind of performative  expertise that has developed over time. This engineer has a bevy of  experience on which to draw when facing problems and much of the  38 problem-solving process will be non-propositional in nature. In many  cases, the engineer in question will not be able to fully articulate why a  given solution is a good one, even though it will o en turn out to be so. This  engineer may be able to put things in a more colloquial language and  explain to other suitably experienced engineers why the solution  should/does work, but the explanation will be limited.   Contrast this with the college graduate engineer that has 4-5 years of  academic training and some limited experience working in labs and on  projects within that time frame. What o en occurs is that these college    If  not  entirely  non-propositional,  the  understanding  this  person  has  will  resist  codi cation.  38 43    graduates have some di culty transitioning to the work force. When paired  with an older, more experienced engineer with less formal training they can  sometimes be faced with what seems to be a case of speaking a di erent  language, even though they are presumably working on the same  project/problem within the same eld. What the training has given them is  a kind of propositional knowledge of the eld. This propositional  knowledge o en takes the form of ‘x types of solutions work in y types of  problem scenarios’.   The worry that immediately arises is that it may in fact be a di erent  sort of problem that is being faced. The experienced engineer can identify  certain sorts of problems faster given that she has faced this sort of problem  (or one that was relevantly similar) in the past. She may not be able to fully  articulate why a given solution will work but may have a workable solution  nonetheless. Years of experience and an associated trial and error process  have led to a certain inventory of solutions and an intuition regarding the  sort of problem being faced. The propositional knowledge of the college  graduate will not help if the relevant particulars are not recognized, treated  as salient, and then used to call forth the proper propositional content.   The propositional knowledge is not wholly useless, however, in that  this sort of understanding can lead to new, innovative solutions and a  recognition of larger-scale issues that might be present. This can o en go  unnoticed by those lacking the formal training due to a lack of experience  44    with the principles (and phenomena?) that enable the recognition. This  di erence is o en couched in terms such as ‘practical experience’ and ‘book  learning’, but it could also be put in the terms we examining; namely,  performative and propositional expertise. The idea is to separate di erent  forms of expertise and allow for a variety of di erent experts, accounting  for the existence of those that know how to do something and do it well  without being able to explain why a given solution works or how, exactly,  she is doing it.   This is not foreign to philosophers. The di erence between  knowing-how and knowing-that is a common topic in the cannon, even  though it is not always explicitly addressed. Plato and Aristotle, whose  discussions of noûs, technē and epistēmē deal with this distinction (among  other things), and, more recently, Gilbert Ryle and Jason Stanley have  reinvigorated discussions regarding the details and ultimate existence of the  distinction. For the purposes of the present work, I will forgo discussing  arguments for and against the distinction and assume that the distinction is  a real and useful one. What we have thus far is a distinction between  intellectual and performative expertise. This can be further broken down  into two forms of each.   Intellectual:  1. Technical and holistic knowledge of facts and  strategies/methods, typically acquired by way of training.   45    2. A lesser, more performative sort of intellectual expertise. The  activity being performed is intellectual in nature (e.g. chess) but  the understanding one has is not technical and holistic in the  way it is for a trained expert. One ‘knows’ what to do and can do  it, without being able to readily give an account of why she does  it.  Performative:  1. Being able to perform at a high level some physical activity.  Knowing how to do something without being able to explain  how you do it (e.g. professional athletes).  2. Being able to explain how something is done and being able to  demonstrate it without being able to perform the activity/task at  an expert level (e.g. coaches).  The performative and intellectual forms of expertise are distinct but they  are not separate. It is possible to speak of the intellectual aspects of  performative expertise (as in coaches of professional athletes) as well as the  performative aspects of intellectual expertise (e.g. chess players in a park).  This gradation of expertise will come up again when we discuss  interactional expertise and the sort of maturity that needs to be instilled in  order for experts of disparate elds to communicate with each other  e ectively.  46    This still leaves much work to be done. A philosophical account of the  implications of the distinction is critical. With this in mind, we need to  examine how one can identify experts and how one is to responsibly  incorporate the testimony of experts into one’s own deliberation and  knowledge.     2.3.2 Identi cation of Experts  One key factor in the identi cation of experts lies in their knowledge of a  given domain. When asked, an expert is expected to act in way that a novice  could not. The form this act takes will vary with the domain of expertise.  For instance, a physician, as an expert in medicine, ought to be able to give a  novice a rundown of the various parts of the body and how they work--both  independently and together with other parts and systems. This rather  obvious observation disguises a critical element of how experts can be  identi ed. When asked, an expert can provide more than a mere statement  of fact--she can o er an account of how that fact is connected to other facts.   Aristotle is instructive here. His account of what it means to know a  thing involves the grasping of its cause (An.Post. 71b-9-11). Put another way,  in order to truly understand a thing we need to be able to give some account  of the ‘why’; i.e. why is it this way and not that way (Physics 194b 17-20). The  Greek word here is aitia and is o en translated as ‘cause’ but it could also be  47    39 translated as ‘explanation’. So, for Aristotle, in order to claim knowledge of  something, one must grasp and be able to o er an explanation for why it is  40 true. This explanation must, ultimately, cohere with explanations of other  phenomena within the domain of expertise, but also, ultimately, with  phenomena outside of that domain.   An example of this coherence at work occurred in 2011, when  scientists at the Large Hadron Collider detected what they thought was a  41 particle traveling faster than the speed of light. The nding con icted with  well-established understandings of how particles worked in light of special  relativity. What was so striking about the event was not the mere  inconsistency of the nding with what special relativity holds, but rather the  nding of faster than light travel juxtaposed with the evidence in favor of  special relativity. The fact that special relativity has been used to explain and  predict other phenomena over a substantial period of time lends credence  to the view. The anomalous nding at the collider threatened to unravel our  understanding of physics because it threatened the explanatory power that  special relativity had already established. This led to skepticism within the  scienti c community and a search for an explanation. Further investigation  led to the discovery of an error that explained the odd nding. The lack of  See (Hocutt 1974; Frede 1980)    Important  to  note  that  this  is  for  certain kinds of knowledge. For  rst principles, we have  noûs  and  this  is  di erent--they  are  the  end  of  the  line,  so  to  speak,  and  have  no  further  causes/explanations.  They  are  bare/basic  facts  about  reality  that  form  the  basis  for  explanations of subsequent phenomena.   41 For a quick review of this incident, see (Cartlidge 2012)  39 40 48    coherence led to skepticism that led to further inquiry to explain the issue  and achieve coherence.  The identi cation of experts, then, involves identifying individuals  who understand the relevant kinds of explanations. The sort of explanation  we seek is one that explains more than an isolated incident, but rather has  the capacity to place that incident in a larger context while retaining a sense  of coherence. Most are familiar with the notion of coherence in use here,  and people by and large have the ability to spot inconsistency and  incoherence when interacting with others. Even when a novice faces an  explanation from an expert, there are qualities that can be assessed from the  novices standpoint. Getting a sense of the coherence of the expert’s claims  and explanations is a good start. This alone, however, is not enough. It is  plausible for a novice to be in such a diminished epistemic position with  respect to the expert that an assessment of the coherence of the expert’s  claim is quite limited. In cases like this there are other factors that can aid in  the identi cation of experts.     2.3.3 Expert Testimony and Being a Responsible Agent  Authority is closely associated with expertise. As we have seen, in some cases  experts are identi ed as authorities in their eld. The use of ‘authority’ is  important and controversial in some circles. In many ways it is  straightforward and unavoidable. For instance, the patient-doctor  49    relationship is one wherein the doctor has a kind of authority over the  patient due to her superior understanding of medicine. This sets up an  asymmetrical relationship where the patient is dependent upon the doctor  for advice on how to proceed or to perform a procedure.   Problems arise when the input of experts is meaningfully tied to  decisions we make that have practical and/or moral import. If we are  deciding what we should do on behalf of an incapacitated loved one, for  instance, our decision and subsequent actions have moral implications. The  information we use (as well as how we use that information) is tied to the  testimony of experts, and necessarily so. Most of us do not have the  understanding required to make complex medical decisions and thus rely  on the input of doctors. This reliance on the testimony of others does not  completely absolve us of moral responsibility, however, and we must utilize  the inputs of experts responsibly.  This responsibility is not restricted to moral situations. The broader  concept at work is epistemic responsibility. Being an epistemically  responsible agent means being held to account for one’s beliefs, how one  forms those beliefs, as well as the decisions that stem from those beliefs.  This applies to knowledge acquisition as well as evaluation of beliefs already  formed.   In eshing out the variety of issues here, Alvin Goldman’s work on  expertise provides a good starting point. Of particular use is Goldman’s  50    discussion of two problems: the novice/expert problem and the  42 expert/expert problem. Beginning with the novice/expert problem,  Goldman reviews some of the literature regarding the relationship between  novices (people without expertise in the given domain) and experts. The  primary concern is how to justify one’s dependence upon and use of expert  testimony. There is a sort of skepticism about justi cation that concerns  Goldman, and rightly so. The problem amounts to a perceived lack of  justi cation on the part of the novice. Because the novice, by de nition,  does not have the epistemic resources needed to properly judge the expert’s  claims we are le with a justi catory gap.   John Hardwig, as noted by Goldman, tries to avoid this skepticism by  claiming that the novice must place a kind of ‘blind faith’ in the expert’s  43 assertions. For Hardwig, this epistemic gap between the novice and expert  is unavoidable and irreconcilable. The solution, then, is to admit this as a  brute fact of our existence and allow for the novice to gain knowledge by  way of expert testimony without a robust sense of justi cation. This strategy  is essentially setting aside the problem of justi cation and admitting that,  strictly speaking, we are not rationally justi ed in taking the testimony of  experts as true, but we are perhaps pragmatically justi ed in doing so.   This problem is reminiscent of another problem in the (slightly older)  literature--the Meno problem. In Plato’s Meno, we get Socrates admonishing  42 43 See (A. I. Goldman 2001)  Hardwig (1985 and 1991)  51    44 Meno for endorsing a “debater’s argument” (80d-e). The Greek word,  eristikon, refers to being fond of wrangling and/or arguing, part of a contest,  45 and is associated with sophistry and sometimes considered fallacious. The  argument boils down to this: one cannot inquire into the things he knows  and one cannot inquire into what one does not know because you either  know something or you do not know it, and both disjuncts lead to a lack of  inquirability in general. At the heart of this problem is notion that  knowledge is a binary concept--either you have knowledge or not. Socrates  addresses this problem in terms of recollection of previous knowledge  stemming from an immortal soul, leading to us always having knowledge  but not always accessing it. This move is repeated in Phaedo and other  46 dialogues and is related to Socrates’ maieutic activity.    Aristotle, too, addresses the Meno problem in Posterior Analytics 1  when he writes about knowledge acquisition coming by way of previous  knowledge (71a29-b9). Here, Aristotle discusses the possibility of knowing  something in a sense, but also being ignorant of that same thing in another  sense. The way we acquire knowledge is cumulative. We build on basic and  imperfect understandings of things, starting with perceptual input when we  are young, and moving toward a greater and more thorough grasp as we  age, by way of experience and, ideally, training. This acknowledgement of a  All references to Plato are from Cooper 1998 unless otherwise noted.   See (Liddell and Scott 1945, 314)  46 For a good overview of Socrates as a midwife see (Tomin 1987).   44 45 52    capacity to know something partially, using sense perception and inductive  principles (even before we understand these as mechanisms for knowledge  acquisition), means that we are rarely, if ever, truly without the knowledge  necessary to begin an inquiry.  What is at stake here is more than just the starting point of inquiry.  Both the legitimate acceptance of testimony (and its role in knowledge  acquisition) as well as the relationship between the expert and novice  depend on getting these details right. The Meno problem is connected to a  larger set of epistemic issues, including what sources of input we can utilize  when we inquire into topics about which we know little. In order for the  testimony of others to be a proper source of knowledge we need to establish  what sorts of checks we need to put in place, as epistemic agents, to  safeguard against mere acceptance of anything we are told. This seems  doubly true when the goal of the inquiry is to acquire knowledge that will  lead to action. There is a trust factor at work here, as well as a sense in which  communication of any sort depends upon the (admittedly defeasible) prima  facie justi cation for accepting testimony. This latter concern is clearly on  Goldman’s mind as he works through the skeptical arguments and  assumptions that Harding and others take so seriously.   Goldman shares the struggle with justifying testimony as a source of  knowledge with many others.47 While I do not have the time or space for a  47 (Audi 1997)   53    grand theory of testimony, it seems to me that an account of why and how  we should accept testimony blossoms from what has been said. We have a  hypothetical imperative to augment our senses in science. We take what our  senses give us, but we also seek to enhance them by way of telescopes,  microscopes, and other tools. If we are a er the truth about a given subject,  and that subject involves our senses, we have an obligation to make those  senses as acute as possible. If there are devices that will make our senses  more acute in ways that aid in the nding the truth we ought to be using  them.   This holds with respect to testimony as well. If we are a er facts, truth,  etc. about a given subject one of the things we have an obligation to do is to  take seriously the input and thoughts that others have had on this issue. In a  sense, we trust that the telescopes and other instruments are providing good  data—we could learn about the workings of such things but it isn’t necessary  to know all of the inner workings of our instruments in order to take  seriously what they give us. The same could be said of testimony. We have  an obligation to listen to experts in a given eld, if there are any, if we seek  to know the truth about that area.   Testimony is a starting point for both knowledge and further inquiry.  In this sense, testimony is on the same footing as perceptual/sense data. We  typically take sense data as given and unproblematic unless we have clear  reasons to do otherwise. We understand that sense data is defeasible and  54    imperfect, but in most cases it is reliable enough to use. We understand at  least some of the conditions under which sense data is likely to be  compromised (noisy environments, bad lighting, one being incapacitated in  some fashion). All of this is equally true of testimony. If someone tells us  something that seems wrong or improbable we question it on multiple  fronts. Did we hear them correctly? Is what they say consistent with other  things we know to be true? Are they in a position to know better than we do?  Do they say other outrageous things? Just as we test and calibrate  instruments to ensure reliability of data, we test the testimony of others,  even if we do so implicitly.  This all too brief account of testimony and its justi cation has two  related elements. One, more reductionist in tone, lays out a justi cation in  terms of inductive principles and our ability to spot inconsistencies. The  other element is more of a transcendental argument for the need to trust  testimony in a defeasible way if we are to know much of anything. Just as in  the case of sense data, testimony is required for us to know (or inquire into)  anything beyond our immediate experience. We are justi ed in trusting the  word of others as part of a larger knowledge acquisition program. Grice’s  work on conversational rules is a useful source for defending the role of  trust in testimonial knowledge.48 If we are to engage in conversation in a  meaningful way there are rules to follow. We do this unconsciously most of  48 (Grice 1975)  55    the time, but when a rule is violated we notice and react. Part of what these  rules of conversation preserve is truth by way of testimony.49     2.4 The Inner and Outer Lives of the Expert  Given what we know about the nature of expertise, human neurobiology  and psychology, and the interactions between/amongst these, we are in a  position to say some interesting and important things about experts and  their experiences. We can look at experts in terms of their inner and outer  lives, allowing for a glimpse of how experts experience the world around  them as well as how the world relates to them.   Beginning with the inner life of the expert, we see that being trained  in a given area is likely to imbue the expert with cognitive frameworks,  reasoning strategies, and conceptual resources. These are the qualities and  resources that make the expert perform well at tasks within their domain.  Expert chess players begin to see patterns (in terms of chunking) that  novices do not. Physicians begin to see situations in terms of diagnostically  relevant features, and what is ‘relevant’ will depend upon the specialization  in question. This leads to biases, blind spots, and limitations on what experts    There  is  far  more  to  be  said  about  testimony,  but  the  above  will  su ce  for  the  purposes  of  the  present  work.  In  particular,  more  needs  to  be  said  about  the  reductionist  vs.  non-reductionist  approaches  for  the  justi cation  of  testimony. This is especially true in the  case  of  very  young  children,  for  whom  the  inductive  capacities  outlined  will  not  be  available.  In  that  case,  a  non-reductionist  approach  is  necessary,  but  I  would argue that the  transcendental  sort  of  argument  listed  above  would  ful ll  this  need.  That  there  is  a  justi cation  is  enough  for  young  children  to  responsibly  use  testimony  as  a  source  of  knowledge, regardless of whether or not they are aware of the justi cation.   49 56    in one eld can reasonably say about problems in other elds. Lawyers will  see a problematic situation in ways that di erent from how a physician or  an accountant would view the very same situation. What makes an expert  perform so well in their own eld will prevent them from seeing things in  what philosophers would call full saliency. The process of becoming an  expert involves developing specialized cognitive lters and sensitivities that  are great for separating relevant information from noise and then  processing that information.   However, this is not conducive to seeing complex situations in all of  their nuance. This explains why multiple experts in di erent elds will see  the same situation quite di erently and come up with solutions that could  very well undermine each other. This is the problem of extension, where  expertise in one eld does not necessarily translate to expertise in another  eld. In fact, in some cases, expertise in one eld will prevent expertise in  another eld. For instance, someone who has been trained to see things in  concrete, actionable terms will by nature resist ambiguity and uncertainty.  This is evident in cases where decisions must be made quickly and action  taken immediately, such as emergency medicine. A philosopher, someone  likely to be trained in ways that seek out ambiguities and examine their  consequences would most likely not do well in emergency medical  situations.   57    What we end up with is a person who is trained to see and interact  with the world in a certain way. This conditioning is psychological and  neurological, leading to a character that is not easily changed or  circumvented. The greater the level of specialization the deeper this  conditioning goes, and given the push toward greater and greater  specialization in a variety of elds and disciplines, this has far reaching  consequences. These consequences are not always recognized by those  outside the domain of expertise, leading to the outer life of the expert being  di cult to negotiate in certain circumstances. For instance, con icts can  arise quite quickly when one group of experts is approaching a situation  with their cognitive apparatuses and another group with their own quite  di erent apparatuses. Thankfully, some have seen this as an issue worth  exploring and remedying. With the push toward greater interdisciplinarity  in the academy (and elsewhere) things like the Toolbox Project are helping  specialists bridge these conceptual gaps. Studying the consequences of  expertise and specialization makes the need for such projects all the more  apparent.   Dealing with laypeople can be even more frustrating for experts. A  result of their highly-trained approach to problems and a well-developed  understanding of the intricacies of their eld, experts o en have a hard time  expressing themselves to those with no relevant experience. It is common  for experts to be thought of as having some kind of esoteric knowledge of  58    facts about their domain. While this may be true, what is truly esoteric  about expert knowledge is what happens between facts and gures--it is the  causal relationships, relative importance, and an understanding of how  things interact with each other that truly characterizes the expert as  opposed to a novice. Philosophers sometimes speak of ‘rule-following  considerations’ when describing the di erence between someone being a  novice and an expert.50 The expert knows the rules of, say, chess, but also  knows strategies, can anticipate moves based on an opponent’s behavior, has  the ability to recognize patterns quickly and knows the consequences that  follow from the interactions of those patterns. The novice knows the rules  of the game, but the expert knows how to play.   Di culties in communication arise from an expert having to interact  with someone outside of their domain. This is true if the outsider is an  expert in an adjacent eld or is a novice in the larger area of inquiry. Being  an expert in another eld, especially a eld that is similar in key ways, will  no doubt aid in overcoming these di culties, but only once they are  recognized and addressed. A shared vocabulary and conceptual framework  is needed for communication to take place, and experts have to work at  developing these shared resources among various domains. Without this  work, experts end up talking past each other, leading to confusion and  frustration.      It  is  not  always  put  in  terms  of  ‘novice’  and  ‘expert’,  but  the considerations clearly apply.  See (Boghossian 1989) for excellent overview of the philosophical concerns.  50 59    Chapter 3: Moral Expertise        3.1 It’s… complicated.  Elitist, paternalistic, and condescending – these are commonly attributed to  the notion that there is such a thing as moral expertise. Some detractors  claim the concept of a moral expert is not even tenable. Discussions  regarding moral expertise can be found in the philosophical, sociological,  psychological, bioethical, and legal literature. These discussions are o en  embedded in larger discussions regarding the relative merits of moral  theories, the nature of expertise broadly construed, the political impact of  expertise, and other broad topics. For the purposes of the present work, I  am focusing on what I take to be examples of common arguments against  moral expertise in the bioethical literature, with aid from speci c  philosophical treatments of both moral expertise as well as moral theory in  general.51 In responding to these objections and the issues they raise, I will  develop an account of moral expertise from Aristotelian point of view.52     I  am  using  the  bioethical  literature  as  a  starting  point  for  reasons  that  will  be  clear  in  chapter  4,  but  also  because  this  literature  includes  issues,  concepts,  and  arguments  from  a  variety of other elds.   52  I am using an Aristotelian framework, but I shall not be defending that framework against  objections  from  other  common  moral  frameworks  (e.g.  Kantian  deontological  approaches,  or  Utilitarian  approaches).  To  do  this  sort  of  work  would  be outside the scope of this piece,  although  I  join  others  in  believing  that  Aristotle’s  work  can  be  so  defended,  and  that while  he was obviously wrong about some things, he got quite a few things right.   51 60    Expertise is uncontroversial in most areas of inquiry, yet many nd  extending it to morality and moral inquiry to be a step too far. Critics deny  the existence of moral expertise for a variety of reasons ranging from the  metaphysical to the social/political. There are also divergent views  regarding the relationship between moral action and moral theory, and  depending on your view you may see the concept of an expert in the area to  be untenable. In most of the prominent critiques there is a combination of a  more or less implicit conception of what a moral expert would look like  combined with claims about moral reasons. One of the more problematic  assumptions regarding moral expertise, or more speci cally, moral experts,  is that their primary function is to issue action-guiding pronouncements in  morally challenging situations.53  These criticisms, and the views of moral expertise upon which they  are predicated, provide a useful place to begin. In developing a preliminary  de nition that is in line with its use in the literature, I shall include in the  concept 'moral expertise' both the relevant knowledge and skills that the  supposed moral expert possesses.54 Building upon the previous chapter’s  account of expert knowledge, we have the possibility of the moral  knowledge of the expert being di erent in content or in the way it is known.  I suggest that while there is o en some di erence in content, it is the way  53 For an excellent treatment of this assumption see ( Jones and Schroeter 2012).   While some make the distinction between morality and ethics, that is not my concern  here. For the purposes of this piece ‘moral expertise’ and ‘ethical expertise’ are  synonymous.   54 61    moral content is known that is most constitutive of expertise. While moral  knowledge is no more esoteric than any other form of knowledge, it does by  nature carry with it features and implications that make it unique among  the forms of knowledge. This will be made clearer as we progress through  the next few sections.    3.2 The problems  I made reference to a number of types of problems people have with moral  expertise. For the sake of argument I am going to make a few concessions.  First, any conception of moral expertise will be bound by a moral theory.  This means that any account of it will have to grapple with issues such as the  existence of moral facts/properties, moral alienation, the role of reasons in  action, and myriad others. However, my focus is on epistemic and social  problems and I will set aside (for now) the more metaphysical sorts of issues.  The Aristotelian approach that I embrace here has many answers to o er,  but time and space constraints force me to save those for future research.     3.2.1 The Rejections  In order to organize the material regarding moral expertise and the typical  issues raised in the literature, I am using two articles as a starting point. The  points raised in these articles touch on major themes in both the  philosophical and the bioethical literature--the elds with which I am most  62    concerned. The rst piece is “A New Rejection of Moral Expertise” by  Christopher Cowley.55 Cowley’s primary concern is with what he calls  ‘descriptive moral expertise’ (DME).56   DME: The ability to make expert moral judgments about what ought  to be done in this situation and the capacity to justify such judgments.  Cowley contrasts this view of moral expertise with ‘performative moral  expertise’, with the distinction being closer to intellectual or propositional  expertise contrasted with performative expertise as discussed in the  previous chapter. The moral expert in Cowley’s account is someone who  makes judgments, argues successfully in favor of these judgments, and thus  commands a kind of authority in moral matters. His use of clinicians as  examples is telling, as he treats clinical (and scienti c) expertise as the  standard to which moral expertise is held. Just as a non-expert would be  considered irrational if he were to challenge the authority of the clinician  when diagnosing and preparing a treatment plan, so too would he be  considered irrational for challenging the moral expert’s judgments--that is,  if moral expertise is a genuine sort of expertise.57  Of course, for Cowley, moral expertise is not a genuine sort of  expertise. Cowley cites, and occasionally argues for, a few primary  (2005)  This is a concept he borrows from the work of Weinstein. See (Bruce D. Weinstein 1993)  and (B. D. Weinstein 1994)  57 Cowley does make concessions to the ever-expanding lay understanding of medicine, but  it is assumed for the sake of his examples that the situations faced are beyond such  understandings. See (Cowley 2005, 276–277) for more on this.  55 56 63    motivations for this claim. First, Cowley claims that there is no ultimate  arbiter of truth in ethical disputes.58 Expertise is tied directly to the moral  theory that gives it content. Cowley claims that we all have a (more or less)  implicit moral framework that colors the way we perceive situations. Here,  he is appealing to moral perception, and claiming that this perception is  determined by our moral framework. For instance, if our moral framework  is largely concerned with rationality, we will see situations di erently than if  we were primarily concerned with sentiment. According to Cowley, “the  meaning of the situation to a speci c individual, the way that individual  experiences the situation” is due in large part to this moral perception and  this is something that takes place prior to deliberation. The individual’s  reasons and judgments are made from within their moral framework and  derive meaning and force from this framework, not from any objective  moral reality.59   Cowley takes this to mean that disagreements in ethics are di erent  than in other areas of inquiry. They are more entrenched and intractable  because they do not track an objective reality. Since we have moral theories  that describe moral frameworks that are mutually exclusive, and it is  legitimate to support (and presumably embody) any of these frameworks,  ethical disagreements are destined to be intractable. This leads to a number  of issues, with the most important being moral judgments lacking  58 59 (Cowley 2005, 274)  (2005, 276)  64    normative force. There is a limit to how much one persuade another in  moral matters if the two agents start from di erent moral grounds (i.e.  employ di erent moral frameworks and thus perceive situations  di erently). The content, de nitions, feelings, etc. will be fundamentally  di erent and there is no reconciling that. If someone disagrees with you  about the nature of an ethical issue or situation, there is little more you can  do than say “do you not see?”.60  This is, in Cowley’s view, reason enough to “ban the term ‘ethicist’”  and to claim that moral philosophers have no special role to play on  research or clinical ethics committees.61 The sort of expertise that is possible  in moral matters is essentially useless, as it would depend upon a viewpoint  that is easily contested, limited to speci c moral frameworks that are not  shared by all, and devoid of meaning for those who would disagree. Cowley  claims that this is not a form of relativism and that there are things that can  be learned to help in ethical disputes. Better reasoning skills, for instance,  would help, and perhaps some training in political con ict resolution would  aid in bringing opposing ethical actors to an arrangement. These are not  unique skills, however, and amount to little more than critical thinking  skills.   Philosophers reading Cowley’s piece would no doubt take issue with  many of his claims. Indeed, some have taken him to task on a few of the  60 61 (2005, 278)  (2005, 279)  65    so balls he has thrown at the work of moral philosophers.62 Despite the  temptation to deal with each of Cowley’s points in turn, circumstances  dictate that I narrow my focus. Although it clearly involves metaphysical  issues, which I previously claimed I would set aside for the moment, it is  important to at least touch upon Cowley’s claim that moral perception does  not track objective reality. This is not unique to Cowley--indeed, he uses a  quote from a clinician to make this point clear.63 That morality is largely (if  not entirely) a subjective thing is common in non-philosophical circles, and  as such it is worth say something in the direction of a response.   There is another thread to pull in Cowley’s piece--what is sometimes  called the Problem of Disagreement.64 There are a few di erent takes on this  problem, but they all boil down to concerns regarding the nature of moral  disagreement and the implications these disagreements have for the  tenability of moral expertise. The claim is that the disagreements among  ethicists (and moral philosophers) undermine any legitimate claim to  expertise. There is no, or at best very limited, consensus regarding the scope  of the domain, the meaning of the central terms, and other fundamental  aspects. Cowley uses this as a foundation for his claims against the tenability  moral expertise.   See especially (Crosthwaite 2005)  (2005, 274) citing Ruth Shalit.  64 See (A. Goldman and Whitcomb 2011) ch.9 for a good overview.  62 63 66    The second critique is found in “Why Moral Philosophers Are Not and  Should Not Be Moral Experts” by David Archard.65 Archard sets out some  preliminary remarks regarding expertise in general that will later play into  his critique, and I will focus on two that are particularly important. First,  Archard makes great use of the exclusionary nature of expertise.66 Experts  command knowledge and/or skills that others do not--if everyone were an  expert, no one would be an expert. Archard takes this to be baked into the  concept of expertise and the source of authority experts have within their  domain.   Archard also makes a distinction between being an authority on some  subject matter, and being in authority. Being in authority means that one’s  judgments and pronouncements have the force of commands, as a general  in battle would have over his or her troops. Being an authority means that  one’s judgments are to be taken seriously, but not taken as orders or  commands. For Archard, this is how moral expertise ought to be taken if it  is to be defended at all. The moral expert would make judgments that the  non-expert ought to take seriously and would have reason to consider  strongly, but they are not de nitive. Experts disagree, and it is possible for  an expert to be wrong. Archard takes this, too, as simply part of the  de nition of expertise and uncontroversial.67    (2011)  (2011, 120)  67 (2011, 121)  65 66 67    A er this brief discussion of expertise in general, Archard lays out  three arguments against moral expertise that he nds unconvincing.68  Ultimately, Archard believes that moral philosophers can claim some  limited form of moral expertise.69 Philosophers have an understanding of  proper reasoning, the ability to disambiguate, as well as facility with  concepts and theories that would seem to put them at an advantage when it  comes to normative judgment. However, Archard claims that moral  philosophers ought not urge non-philosophers to accept and act upon these  potentially superior judgments for two related reasons. First, if what we are  seeking is to have people acting morally then we must have people acting  from judgments that they themselves make. The assumption here is that in  order to act morally one must perform the action because it is morally  required (or, at least, morally permissible). There is an implicit internalism  here that I shall explore in the coming pages.  The second, related, reason is that there is a value to democracy that  could undermined should the laity start acting upon the judgments of  experts rather than their own judgments.70 Archard puts this in terms of  ‘self-governance’ but the argument could be extended to include the  broader (and less politically oriented) concept of autonomy. It is this latent  appeal to autonomy that forms the relation between the two reasons he  I will return to these arguments shortly.  (2011, 125)  70 (2011, 125–126)  68 69 68    o ers. While he does not go into detail regarding the relation between  moral reasons, motivation, and action, the signs all point to this being his  primary concern.  With these two articles, and the concerns they raise, we have a sample  of the sorts of critiques that are commonly raised against moral expertise.  In sum, we have concerns regarding the nature of morality and the level of  disagreement about moral concepts and theoretical frameworks. We also  have concerns about the role of perception and how much of moral  judgment is determined by pre-rational factors. Additionally, there are  epistemological concerns regarding the nature of moral testimony, moral  deference, and the relation between moral knowledge, motivation, and  action. Lastly, woven through all of this is a concern regarding the impact  that knowledge of moral theory has on the actions of those who have it.    3.3 An Aristotelian Response  It should be said that no serious philosopher would claim moral expertise is  easily achieved, but this di culty does not entail impossibility. Critics are  right to point out that the sort of moral theory one espouses will determine  (at least in part) what sort of moral expertise is possible. The argument from  disagreement throws down a challenge that needs to be addressed--if there  is so much disagreement among moral theorists regarding the fundamental  concepts of the moral domain, why trust any of them? The space required  69    for a full response to this is far outside the scope of this piece, but the  question is important and I shall at least gesture in the way of a response.   Archard dismisses the argument from disagreement, largely because  he sees disagreement regarding fundamental precepts of a discipline in  areas in which we acknowledge expertise.71 He cites examples in statistics,  physics, and biology, claiming that there are disagreements among experts  in these elds that go beyond what we nd in moral philosophy. Archard is  right to point this out, and he is not alone in doing so, but one could simply  accept this and claim expertise is not possible in these elds, either.72 It is  interesting, and important, that for the most part this level of skepticism is  reserved for moral (and o en political) matters. It speaks to a common  concern that will run through most any discussion in ethics--the seemingly  deeply personal nature of moral belief.   Moral philosophers will see the spectre of relativism here. We have  good reasons to reject moral relativism and, I believe, good reasons to  embrace moral realism and the attendant cognitivism. I assume the truth of  these, but I do so with open eyes to the implications of such a stance. It is  possible, for instance, for someone to wrong about a moral issue. It is  possible for someone to be wrong about what is good for themselves, as  well. We are not always the best judges of what is good for us and it is worth  pausing and taking note of this. It also important to note that while this is  71 72 (2011, 121–122)  ( Jones and Schroeter 2012)  70    true, if we are wrong about what is good for us in a situation (or many  related situations) a moral theory must have a story to tell explaining how we  came to the wrong conclusion, not simply that something is the wrong  conclusion.  Aristotle, along with 2,300 years worth of commentators, classicists,  philologists, and like-minded philosophers developed an approach to ethics  that can be called Aristotelian. This approach is o en referred to as virtue  ethics in contemporary literature, though it is important to note that there  are other forms of virtue theory that t just as well in that general category.73  The tradition from which I work is most appropriately labelled  eudaimonism, and more speci cally the Aristotelian tradition of  eudaimonism. Providing a full account of this tradition is not the aim, here,  but rather demonstrating how this theoretical approach can inform the  work on moral expertise and provide a picture of what a moral expert  would be like. As such, I will refer to Aristotle’s work as well as the work of  others in the tradition, but I shall not defend speci c interpretations against  rivals within the tradition. What follows will be recognizably Aristotelian to  any familiar with the canon.  Aristotle’s ethical system is based primarily on his psychology, with a  healthy dose of epistemology.74 Ethics, Aristotle claims, is di erent from and  Christine Swanton has done wonderful work in this vein. See (Swanton 2015, 2005)   For a good introduction to how Aristotle’s psychology is broader than our own notion, as  well as how the study of the soul, or psuchê, forms a critical component of Aristotle’s entire  philosophical system, see (Caston 2005).  73 74 71    less precise than other elds of inquiry (NE 1094b12-27). One ought not  expect the precision of, say, mathematics when seeking normative truths.  There are a few key features that answer to the objections typically raised  against moral expertise. First, some of the basics of his account of action,  and how habituation aids in the training of the agent’s psyche. For Aristotle,  desire (orexis) is what moves us or makes us act -- reason alone cannot  motivate (NE 1139a35). However, Aristotle’s account of desire is unique (in  comparison to, say, Kant and Hume) in that reason has a desire associated  with it. Human beings are composite beings in Aristotle’s view, with  vegetative, animalistic, and rational aspects.75 The human soul shares in all  three of these and there are aspects of the human psuchê that correspond to  each. Each of these aspects has a corresponding desire or psychological  impulse toward action. It is this impulse that motivates the human to action,  and it can originate in any of these aspects of the soul (see especially DA  414a29-416b31, 418a).  This account of desire is critical. We inherit from Hume the view that  reason and desire are separate, and we o en think of desire being opposed  to reason (Treatise 2.1-2.3). The picture is di erent, according to Aristotle.  The rational aspect of our psyche accounts for our ability to reason, to think  abstractly, etc. and there is a desire that is particular to this. It is variously  Talk of ‘parts’ of the soul is common, but it is important to note that commentators  disagree on precisely what Aristotle is claiming. I say aspects to avoid confusion regarding  what sort of separability is meant when speaking of parts. See Miller 2012 for more on the  various notions of separability in Aristotle, and Alexander of Aphrodisias’ commentary on  De Anima for a compelling treatment of the unity of the soul.  75 72    translated as ‘rational wish’ or ‘reasoned desire’ but the Greek word is  bouleisis. This sort of desire arises out of one’s reasoned view of things; i.e.  while reason or knowledge itself does not motivate, there is a type of desire  that stems from this sort of activity due to the type of soul we have. One’s  reasoned judgments can and o en do result in desires just like the needs for  food, water, sex, social acceptance, recognition, etc (see NE I.13, VII.4).76  One of the most important things that sets these non-rational desires  apart from the rational ones is the fact that the rational ones have a causal  link to our conception of the good as such--what is to be done or not in an  inclusive sense--whereas the non-rational desires do not have such a link.  So, when one is young, one may have impulses toward rash behavior when  one is thought to have been insulted (say, quick tempered). There can be a  thought associated with this (i.e. part of the content of the desire could  include) that says ‘when one is insulted one ought to respond in X fashion’.    On Aristotle’s view this is entirely likely, but that thought does not  mean that it is a reasoned desire in the sense of bouleisis. When one is  trained and habituated properly, the anger here will ‘listen to reason’ -- i.e. it  will respond in a way that reason dictates (NE 1149a25). In this sense, reason  persuades the passions -- one can, by use of reason, investigate the true  nature of the good for humans and thus change one’s conception of what is  worthy of getting angry over and not. It is the rational part of the soul that  76 See also (Cooper 1989)  73    investigates the good, and its ndings are to be communicated to the  passions by way of training and habituation--the process of character  formation.    This initial training by habituation is to start, crucially, when one is  young. Guided experience, following the lead of others in the community,  starts the character formation process. One begins to see what is good or  bad due to this in uence by others, emulating their actions and developing  a sense for what is valuable and what is not. Eventually, one’s reason  develops and one can begin to investigate for oneself. One begins to  develop a more nuanced view of what, say, anger is and its proper outlets  and subjects, or why certain foods are better than others and the proper  amounts. So, the normal and basic thoughts that accompany anger, such as  ‘when slighted one ought to punish the slighter’, will, as a result of the  in uence of reason, become nuanced. One might, for example, get a  broader sense of what a ‘slight’ is, when it is appropriate to respond and the  proper responses to various sorts of slights, and so on. If one is virtuous,  then one is ruled by one’s reasoned desires. That is, one’s passions are  informed and tempered by reason (NE II.1-3).77   For Aristotle, when this occurs, one will come to see the world  di erently--di erent aspects of situations will become salient and one will  perceive situations di erently than before one was virtuous. The use of  77 See Taylor 1990 p.132-133  74    analogies to sight and vision are common in both Plato and Aristotle, and  this moral perception is a critical component of virtuous agent’s character.  There is a grasp of the various ethical features of situations that comes along  with the combination of habituation and formal training. While the details  regarding this perception’s development and use are fascinating, and  controversial in some respects, the fact that it can be trained and is not  beyond the reach of rational deliberation is well established.   Another key feature of Aristotle’s ethics is the way knowledge needs to  be internalized in order for it to play its proper role in the life of an agent.  This is most clearly seen in Aristotle’s account of akrasia, or weakness of will. 78 It is not enough to know moral principles in some haphazard way, but  rather one must know them in a way that a ects the way situations present  themselves. There is a connection between moral perception and  knowledge that cannot be overstated. As one comes to know more about  what is good for human beings, and this knowledge is properly assimilated,  the agent will no longer see, for instance, a chocolate cake as something to  be devoured. It is, rather, seen as something to be enjoyed in moderation.  Things are seen as good or as bad in an immediate, perceptive way, prior to  any deliberation in the moment. It is this assimilation of moral knowledge  that sharpens one’s moral perception.79  There is a whole literature on how akrasia is best translated. The use of ‘will’ is typically  frowned upon, but its prominence in the rest of the philosophical literature leads to its use  here, as well. For more on this, see (Michael and David 2011).  79 There is more to be said regarding the internalization/assimilation of knowledge, but it  would be beyond the present scope. It is related to the particular, and the minor premise of  78 75    All of this training is meant to develop what Aristotle calls phronēsis, or  ‘practical wisdom’. Practical wisdom involves the use of knowledge in the  pursuit of living well (NE 1140a28). One who is practically wise sees moral  situations properly, with the various moral features being properly salient,  as determined by what is constitutive of a good life (NE 1140b20). Phronēsis  is the goal of ethical training and is inherently practical, meaning that when  we undertake ethical training and develop theories about how best to do it  we are aiming at making people act better. Ethics is a practical discipline and  concerned with action, not mere knowledge of principles.    3.3.1 Defending Moral Expertise  We are now in a position to say, in essence, what a moral expert would be  like in an Aristotelian framework and respond to the concerns raised in the  previous sections. First, Aristotle’s moral expert would be a person of  practical wisdom, or phronimos. This person is able to see all of the ethical  nuances of a situation, is motivated to act as virtue requires, and does so  successfully. She has been trained by those around her, taking advantage of  second-hand moral knowledge and gradually developing the wisdom to act  a practical syllogism. (Kenny 1966) speaks of this in terms of ‘knowledge ready to hand’ and  how the agent needs to be able to use the knowledge one has. He makes a useful reference  to Theaetetus and the aviary example. I believe much of what Kenny does in this article  paves the way for later work, like (Destrée 2007) and my own, to speak in terms of  assimilation and internalization. See especially pp. 170-175. It is also important to note that  (Filip Grgić 2002) makes use of the knowledge of the particular but fails to focus on the  importance of assimilation and phantasia -- see especially 344-347.  76    on her own. With this in mind, we can already see solutions to the above  problems presenting themselves.   Starting with the argument from disagreement, there are a few things  to be said. First, ethics is not a precise domain--it deals with things that can  be true in some cases and not in others. For instance, returning what is  borrowed is something that is good to do and worthy of being a moral  principle. However, one ought not return their neighbor’s axe when said  neighbor is in a t of rage.80 Ethical features of a situation can be quite  slippery and tough to discern, and there can be more than one way morally  defensible action to take. As noted above, Aristotle warns us against  expecting more precision than the subject matter will allow.  This leads us into the notion of disagreement. Not all disagreements  are equally troubling. The most troubling form is one in which the  fundamental aspects of a eld or domain are in question. Cowley is  concerned with this sort of disagreement when he claims that ethicists o en  disagree about the basic concepts (the meaning of moral terms) and that  there is no arbiter of truth to act as a backstop against regression. While it is  true that expertise and the knowledge that makes it possible is tied to  theoretical frameworks (a deontological moral expert would look di erent  than a eudaimonist or utilitarian expert), this does not mean that expertise  is doomed to vacuity. Archard notes similarly fundamental disagreements  80 This example is based on Republic 331c.  77    in elds where we readily acknowledge expertise, such as economics.81 It  should also be noted that ethicists tend to agree on many things. Rape and  murder are bad, for instance, and a whole host of other features of moral  life are in wide agreement and acceptance. When disagreements do arise,  the Aristotelian model o ers an arbiter, namely, the same reality that acts as  an arbiter in scienti c matters.82 Claiming that such an arbiter is theory  bound may well be true, but this is true in science as well, and is not unique  to ethics.  Worries regarding moral perception are addressed as well. The  Aristotelian model takes this concern very seriously and has a story to tell  regarding the importance of seeing a situation properly from the start, as  well as how to train and sharpen this perception. Contrary to Cowley’s claim  of it being pre-rational and immune from persuasion, moral perception is  formed over time due to the in uence of other moral agents and the e ects  of habituation and other training. It is true that in any speci c moment the  way something appears to an agent is not subject to deliberation, but the  mechanisms behind this perception can be persuaded and a ected. If my  emotions are trained to respond to reason, as described above, then my  reaction can be tempered and adjusted in light of new information. This  will, in turn, a ect how I see (and react to) future situations. This  81 82 (2011, 121–122)  (Taylor 1990)  78    development and continued sharpening of moral perception is just the sort  of persuasion that Cowley thinks is missing.  Archard raises concerns about motivation, deference, and the role of  moral testimony. The idea that a moral expert is someone who hands out  reasons for action like a morality Pez dispenser is problematic in a number  of ways. The moral expert is not there merely to give prescriptions for  action or to hand down decisions on which the agent acts. The moral expert  is better seen as a guide, or a coach, passing along what is known about  morals and ethically-challenging situations.83 This is reminiscent of a  Socratic concern regarding teaching, with Socrates rejecting the idea that he  is a teacher.84 What Socrates is rejecting is the notion that the sort of  knowledge he is a er is something that can be handed over to another  person, like pouring wine into a vessel. In order for knowledge to truly be  achieved, it needs to be internalized. This is something the expert can  facilitate by way of moral testimony and the modeling of good behavior,  but the agent ultimately needs to make it her own.   While moral expertise can, I believe, be defended against these  standard objections, there are problems that need to be addressed. The  most troublesome issue arises out of the studies of expertise mentioned in  the previous chapter. We know from these studies that expertise is  In the Socratic case the expert could be seen as a midwife. See (Tomin 1987).  Probably the most famous example of this is Apology starting around 19c. There is more  to be said regarding the Socratic rejection of sophistry and epistemology behind it.   83 84 79    something that trains the mind to see and react in speci c ways--to the  exclusion of other ways of doing so. This seems to imply that if one is an  expert in a given eld, then one will have di culty in discerning the ner  points of issues in other elds. We inculcate cognitive blinders when we  train people, as evidenced by sayings like ‘everything is a surgical problem,  if you are a surgeon’.   This may be ne in some cases, but in ethics it could be extremely  problematic. For instance, if one is an expert facing an ethical situation that  involves detailed knowledge of another discipline, as is common in hospital  ethics committee meetings, then it could turn out that one is necessarily  blind to the ethical features of the situation that arise from this other  expertise. In the next chapter, I go into this problem in more detail and  show why we need to start looking at moral expertise in a new way.                  80    Chapter 4: Bioethical Expertise        4.1 Problems and Asymptotes  Most common criticisms of moral expertise arise from concerns regarding  moral motivation and moral authority. While I believe there are answers to  these concerns readily available in an Aristotelian framework, this is not to  say that a fully worked out theory on these lines will be problem free.85  There are concerns that stem from the psychological and neurological work  done on expertise and learning, discussed in chapter 2, that require some  additional conceptual resources to handle properly.   The problems I have in mind result from the process of attaining  expertise and the changes that this process forces onto the minds (and  brains) of those undergoing it. We have what some call the problem of  extension, which is the notion that expertise in one area does not  automatically extend to other areas.86 So, if one were an expert in biology,  one is not therefore an expert in, say, physics. This might seem obvious, but  what studies have shown is that the sorts cognitive tools that experts develop  The present work is not intended to be this fully worked out theory, but rather the start of  such.   86 (Buchanan, Davis, and Feigenbaum 2006, 89)  85 81    are typically domain speci c, and as one becomes more specialized within a  eld of study these tools also become more speci c and specialized.87   Take a eld like physics. If one were to ask a group of self-identi ed  physicists where their expertise lies, they would likely say more than simply  ‘physics’. They would more likely claim to be an expert in thermodynamics,  particle physics, theoretical physics, cosmology, or some other sub- eld of  the discpline. There is certainly some overlap among these areas, but what  we nd in the studies of expertise is that the tools necessary are sometimes  quite speci c and the information needed ready to hand can be immense.  What works well in one area might not be ideal in another.  Further complicating matters is the fact that one cannot simply use  di erent tools. In chapter two I brought in some of the research on how  training in speci c areas leads to changes in the ways the expert approaches  problems more generally. During the training process, experts inculcate  strategies and methods of thinking, analysis, memorization, etc. that  actually make changes to way their brains operate.88 What we end up with  are people who have skills tailored to the speci cs of the problems they  commonly face. This is great for solving problems in their respective  domains, but it leads to something like a blind-spot when dealing with other  domains. When facing a complicated case, for instance, a cardiologist is  more likely to pick up on symptoms associated with cardiovascular issues  87 88 (Feltovich, Prietula, and Ericsson 2006, 43, 46)  See (Hill and Schneider 2006) for an overview of the current research.  82    while a neurologist examining the same case would be more likely to pick  up on neurological symptoms.   While these di erences may seem minor in the case of similar elds,  as in the di erences between medical specialties, they are far from minor  when extending to problems involving very di erent forms of expertise. A  scientist specializing in one area is likely able to speak with other scientists  in related areas, such as physicists of di erent types all discussing themes in  the larger body of physics. This is true, as they all have a kind of  intermediary form of expertise.89 If we think of knowledge as a tree, physics  might be a branch, with smaller branches representing the various  sub- elds. The analogy could be extended to include other sciences as  branches of a larger branch, a generic ‘science’ branch of knowledge. There  are commonalities among the sciences, but those commonalities mean less  the further out on the tree you travel.  The larger problems arise when dealing with entirely di erent  branches on the tree. For instance, if a quite complicated issue arises that  involves not only medical concerns of various sorts, but also social concerns,  legal concerns, nancial concerns, political concerns, and the list could go  on. The likelihood of someone being able to command the nuances of such  a case is virtually nil. When lawyers face these kinds of issues in their cases,  they rely on expert witnesses to help them sort out details to judge where  89 This will be discussed in more detail shortly.  83    best to focus their attention. The bringing together of experts in di erent  areas to address complex problems is common in some areas of society. Of  particular interest presently is how this happens in bioethics. Centers, think  tanks, and ethics committees are examples of this--experts from di erent  elds coming together to examine the problems of a domain.   The connection to moral expertise is this: when speaking of moral  experts, it is common to speak in terms of one individual being the moral  expert. However, if we are facing a situation as complex as those found in  bioethics, we are likely to nd a wide variety of features that carry moral  weight. There could be legal issues that complicate matters, and when  combined with medical concerns and political factors the moral landscape  of a particular case could quickly get very technical and di cult for one  person to handle. If we are to admit that nuances in a variety of areas (say,  political, legal, medical, etc.) have moral implications, and some of these  nuances are things that only experts can truly see and evaluate, then we  have a situation where it is unreasonable to expect one individual to have  the knowledge and cognitive toolset to be a moral expert.   Of course, this does not rule out the possibility of an individual being  a moral expert in matters of everyday life. Indeed, if the Aristotelian  phronimos is thought of as a moral expert, it would be damning to nd  evidence against the existence of moral expertise writ large. It seems  reasonable to expect moral expertise to come in degrees, just as other forms  84    of expertise, with the phronimos being an ideal that we pursue and achieve  only asymptotically.    While this is an interesting line to pursue, I want to turn to the case of  bioethics in particular. The case for moral expertise in bioethics receives a  fair amount of attention in the literature, and I chose the example sources in  the previous chapter in part for this reason. Bioethics, and its practitioners,  have the opportunity to in uence policy at many levels of society. They  o en deal with particular situations with the health and well-being of  people at stake. Explicating and defending the notion of expertise in this  domain is critical if we are to make the best decisions possible and lay a  consistent and stable normative groundwork for others to build upon.     4.2 Bioethical Expertise: Groups, not individuals  It might be possible to develop a model of moral expertise for all occasions,  but restricting moral expertise to a speci c domain is more tractable and  arguably more useful. Beginning with the basic account of moral expertise  sketched previously, we can move into an account tailored to the needs of  bioethics. As noted earlier, a variety of elds contribute to bioethics. Experts  within these elds bring their knowledge and talents to bear on questions  that are multifaceted and o en emotional. Given the complex nature of the  content, we face the problem of it all being too much for one person to truly  handle and thus earn the title of ‘expert’. Rather than searching for the  85    polymath capable of such a feat, we ought to be attributing bioethical  expertise to groups of people, rather than an individual.   Moving the attribution of expertise from individuals to groups is both  useful and necessary. It would be natural to harbor a bit of skepticism about  the move--expertise is normally something we associate with individual  agents. It is easier, for instance, to conceive of an individual having the  knowledge base necessary for expertise rather than a group having such a  knowledge base, if only because we typically speak of individuals knowing  things, not groups. Agency is also a potential problem, as it is less  straightforward how a group could act, perform, or be responsible for  something. A full-scale accounting for these concerns will take time and  space not presently available, but work in social epistemology combined  with the Aristotelian framework sketched above gives quite a bit of insight  into how such an account would work.    4.2.1 Group Judgments and the Role of the Bioethical Expert  Moral experts should be able to make reliable judgments about the ethical  features of a situation, their relative importance, and how best to  proceed--most agree with this even if they think it is untenable. If presented  with a complex situation, like the majority of bioethics issues, it is not  uncommon to nd some subset of members of the group expert  disagreeing with the others. In such cases it is di cult to identify the  86    judgment of the group, let alone what sorts of prescriptive actions might  follow from that judgment.   Philip Pettit’s work on these issues gestures at a path forward. Pettit  uses the idea of a rational unity when discussing what he calls purposive  groups.90 In short, Pettit claims that groups of individuals that share a  common purpose can display a level of rational consistency on par with that  of an individual. Rational consistency--accepting the premises of an  argument as well as the conclusion that follows--can be threatened by a  member of the group who agrees with the facts of the case yet refuses to  accept the judgment that follows (the conclusion). In cases where one or  more members of the group disagree about key features in the group  judgment (i.e. what facts are most relevant, what follows from those facts,  etc.) the group can remain consistent due to its being ontologically distinct,  but not separate from, the individuals of which it is composed.   This sort of work is useful for those occasions requiring a prescriptive  judgment from which an action ought to follow. However, this is not the  only function of the bioethical expert. There will be many cases in which  the bioethical expert takes on a more advisory role. Aristotle was right to say  that ethics is less precise than other domains of inquiry. Two things follow  from this; rst, there are times when explicating and disambiguating is  enough of a step forward to warrant acceptance. Some cases are so fraught  See (A. I. Goldman 2004) for a brief overview of Pettit’s view, with the full treatment  being in (1996 ch.2) and (List and Pettit 2011), especially chapter 2.  90 87    with myriad issues and ethically salient features that de nitive judgments  about what ought to be done will be di cult to determine. In such cases it is  enough to have made progress on the topic by detailing the features in need  of attention. This is especially true in bioethics, where these features will  likely be under the purview of disparate administrative bodies. For instance,  it could very well be that there are legal hurdles that are causing problems at  the level of patient care in ways that have gone largely unnoticed (or, at  least, unaddressed). Final judgments about what to do may be dependent  upon the resolution of these prior con icts.   Another thing that follows from the imprecision of ethics is that it  could very well be the case that there is no one correct action to take. In  some cases, there could be more than way to achieve one’s ethical goals. The  nal judgments made in such cases may take the form of a disjunction, with  various possibilities being open to the agents involved. Group members  may favor one take on the situation over another while admitting that there  are other, equally valid, ways of seeing things. In these cases the members of  the group could present their ndings to the larger community of  bioethicists as a means of moving the conversation forward. There will no  doubt be a number of others for whom a similar problem arises and having  had a peer do an analysis that could feed into your own can be very useful.91  91 This is especially true in clinical settings, where decisions may have time restrictions.   88    This latter point regarding the communication of di ering analyses is  critical. Not only will there be cases where more than one ethical analysis is  consistent with the group’s goals, but there will be cases where there is  genuine disagreement about the case as whole. In these situations coming to  a consensus regarding the relevant details of the case as well as possible  solutions may be impossible at the time. We see a similar phenomenon in  the courts, especially in the Supreme Court. The majority and dissenting  opinions o er di erent analyses of the case, emphasizing or acknowledging  di erent features and usually o ering di erent conclusions and actions to  be taken. These disagreements are important in that they show that there is  more work to be done in coming to a consensus, as well as a roadmap of  where future scholars and other inquirers can begin that work. With the  bene t of hindsight we will see that in many cases the majority was wrong,  but without the work of those dissenting progress toward seeing those  errors will be slow.    4.2.2 Interactional Expertise and Listening to Reason  It is not enough to simply acknowledge that disagreements will happen  when bringing experts together. Some disagreements arise due to factors  that can be dealt with, given proper training and certain level of humility  among the players. One of the primary areas that leads to disagreement  among the experts that form the group-expert involves language and the  89    use of concepts. O’Rourke and Crowley lead a project that aims to  ameliorate the di culties involved in interdisciplinary research, and their  work can be directly applied here.92 What they nd is that there are  assumptions, ranging from epistemic to metaphysical, that can lead to  confusion due to group members from di erent disciplines talking past  each other. It is not much a of leap to see these sorts of issues arising in  bioethics, with the bringing together of individuals from disparate  disciplinary backgrounds.   However, the members of the bioethics group-expert will need more  than a shared vocabulary that facilitates communication. In order to truly  embody the Aristotelian model of moral expertise, the group would need to  have a kind of group-level phronēsis. This involves the ability to see, at least  in part, the features of a situation from the point of view of the members.  On the face of it, this may seem impossible given what we know about  experts and the ways their cognitive faculties are shaped by their expertise.  Experts from di erent disciplines will perceive the same situation  di erently and this is a function of the very training that makes them viable  (and valuable) members of the group-expert.  There are two conceptual resources that together form a way out of  this problem. The rst is interactional expertise, which is the ability to  converse expertly regarding the subject matter of another discipline without  92 (2013)  90    being an expert in that discipline.93 This is achieved, in part, by way of the  sort of training that takes place in the Toolbox approach pioneered by  O’Rourke and Crowley. There is a kind of enculturation that takes place  over time as individuals gain an appreciation for how other disciplines use  concepts and language. In a domain like bioethics, where the members  share a common goal or direction, we can start to see the formation of a  new discipline that expands upon the conceptual resources brought by its  members to develop its own usage and de nitions of those resources. What  we end up with is the individual members having a sort of interactional  expertise in the other elds that contribute to bioethical inquiry, and the  formation of a new form of expertise that is speci c to bioethics--one that  combines the individual’s native expertise with the interactional expertise  described. The nature of the interactional expertise required is determined  by the contextual bounds of bioethics, i.e. ethical and political issues  regarding healthcare broadly construed.94   The second is an ability to take the input of other group members  with a sort of charity and intellectual humility that allows their reasoning to  take hold in one’s own reasoning. This is admittedly vague, but combining  some work by Kahneman and Aristotelian moral psychology gives us some  insight into how this would work and why it is so important. Kahneman’s  (H. Collins 2004)  This is assuming the de nition of bioethics as a eld concerned with healthcare, as  described in chapter 1.  93 94 91    work on system 1 and system 2 modes of cognition is a start. System 1 is the  intuitive, immediate, perception like cognition that we use the vast majority  of the time.95 System 2 is the purposeful, intentional, and far slower mode  that we use when we ‘stop to think’ about something. When experts develop  a sense for things in their eld they are developing system 1, particularly the  pattern recognition aspects and associative memory. System 2 does much of  the work in programming system 1, by making connections within one’s  expanding knowledge base and making these available to the quicker  associative memory in system 1. During one’s training the system 1  responses get inculcated by learning new material, techniques, etc. in  system 2 to the point where they are internalized, or made readily available,  to system 1.   The details of precisely how these systems work is an ongoing matter  of research, but the basics just outlined are widely accepted. What follows  from this is that experts develop a way of perceiving situations that  immediate and di cult to dislodge. This is where philosophical training  and, in particular, a kind of training that takes cues from Aristotle’s call for  emotions to ‘listen to reason’. Philosophers are trained to take other points  of view seriously and charitably. Part of this training involves the  inculcation of a sort of intellectual humility that can check one’s immediate  judgments. Obviously, some philosophers are better equipped in this way  95 See (Kahneman 2011 ch.2-5) for a more in depth summary of the two systems.  92    than others, but philosophers tend to display this sort of trait more than  many other disciplines. In order for the group-expert to function, this  ability to both recognize and temper one’s immediate responses,  judgments, and even deployment of their domain speci c expertise.     4.3 Teleology, Structure, and the Work of Moral Theory  One of the bene ts of embracing an ethical theory, in this case an  Aristotelian approach, is that it o ers an ethical framework that aids in  de ning key concepts and aids in the development of the group-expert’s  rational consistency. For instance, the goals of the group-expert are set by  reference to the end, or telos, of the theory more generally. In this case, the  end is eudaimonia for the individuals involved. This will need further  re nement, as there are di erent ways of lling out the concept of  eudaimonia, but that is precisely the work that moral theory ought to be  doing to aid the e orts made by those in bioethics.96   Another aspect of the Aristotelian model that aids in the work done by  bioethicists is the emphasis it places on the relationship between ethics and  politics. There are di erent takes on the details of the relationship, but the  general point is that ethics and politics are distinct but not separate.97  Judgments in ethics have rami cations for politics, and vice versa. If one  determines that proper healthcare is critical for the ourishing of a person,  96 97 This is work I intend to do in the future.  See (Bodeus 1993), esp sections 4 and 6, for a useful introduction to this.  93    then the political structure of society ought to re ect to that. One of the  more important functions of ethical and political theory is to provide a  means and structure for the critiquing of society, as well as some indication  of how aws in the system are to remedied.    4.4 Parting Remarks  By taking a good look at what we know about expertise and experts  themselves, along with what we expect from someone purporting to be a  moral expert, we see that thinking that one person to could achieve it is a  tall order. When we combine this with the speci c requirements of a eld  like bioethics, the tall order becomes untenable. Training in any area that is  subject to expertise changes the would-be expert in ways that make it highly  unlikely, if not impossible, to be an expert in many di erent areas. For an  interdisciplinary eld like bioethics, this is an especially di cult problem.  Ethical features can be attached to any number of aspects of a  situation, and this gets more complicated if the situation involves multiple  types of problems. In bioethics, for instance, we nd cases where there are  di cult social, physical, political, legal, religious, and familial problems all  wrapped up in one brain-splitting situation. It takes the knowledge and  conceptual resources of an expert to dig through any one of these types of  problems, let alone a situation where they are all present. The fact that  experts in one domain are likely to blind to features of other domains  94    means that there are going to be ethical features of situations that will be  missed or not properly appreciated.   This can be mitigated, if not eliminated, by moving moral expertise to  the group level for domains like bioethics. Taking advantage of the expertise  of a variety of practitioners organized using resources from moral theory  and epistemology allows us to better parse the details of di cult cases while  preserving sensitivity to the ethical features and implications that might  otherwise be missed. 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