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Language politics is playing an increasingly important role in bioethics, both in a positive sense, which has recently been possible to attribute to it, and in the negative sense, which, since the sophists, traditionally belongs to it.
In the positive sense, language politics proceeds through the re-appreciation of concepts, promoting its accuracy, contributing to a better understanding of the situation, and facilitating the most adequate ethical decision. In the negative sense, language politics proceeds through the redeﬁnition of concepts, reshaping reality following speciﬁc interests and leading to the adoption of certain practices accordingly. In this perspective, language politics affects the soundness and integrity of the ethical reﬂection and the objectivity and credibility of the decisions taken. Brieﬂy, it affects the legitimacy of bioethics’ arguments and deliberations.
This entry describes the context that gives way to language politics, within the triangulation of thought, reality, and language, deﬁnes how it can take place, and reviews some paradigmatic examples of language politics in bioethics, both good and bad.
The way language politics can work and the impact it can have are presented through examples selected from different biomedical areas.
The expression “language politics” refers, in a very broad sense, to the way language is dealt within the political sphere and in a more precise way to political decisions concerning a spoken language. In this context there are two major domains for political action in the ﬁeld of language. Firstly, the policy concerning the designation of ofﬁcial languages, namely: when there is more than one ofﬁcial language in a country; or when, together with the ofﬁcial language, there are other spoken languages; the cultural policy to preserve these minority languages or dialects; the obligation for immigrants to reach a satisfactory level of ﬂuency in the ofﬁcial language to obtain citizenship; etc.
Secondly, and quite of a different kind from the former, the political correctness, which evolves throughout time, for example, the use of the masculine pronouns “he,” “him,” and “his,” as if they were neutral, is now challenged and there is a demand to replace them with expressions like “he or she,” “him or he,” and “them,” to respect women’s rights and to comply with an equal treatment for both, men and women; the use of words with a negative connotation to refer to persons or peoples such as “black” or “gypsies” are being substituted by “African-American” and “Romani” to ﬁght racism and xenophobia; and new expressions such as “disabled people” and “senior citizens” replace the old ones of “handicapped” and “old people” (or elderly person), to ﬁght discrimination and exclusion.
These two kinds of language politics have ethical implications and can play a signiﬁcant role in bioethics. For instance, policy toward the languages spoken in a country or a region can become important in the patient-healthcare professional relationship, where dialogue is crucial and can be compromised if the persons involved do not speak the same language; on the other hand, the depreciation or the downgrading of groups of people through language, through the use of pejorative and prejudicial nouns and adjectives, turns them more vulnerable in a clinical setting or especially within clinical trials. Particularly in this last case, the language used reﬂects the values shared by the majority and it is when these values evolve that language also changes.
An interesting example of how the evolution of values can dictate a change on language would be the concept of “queer.” This word has been used, in a deep pejorative meaning, to qualify homosexuals, when their sexual orientation was not only criticized by common morality but also refrained by the public ofﬁcial speech and sometimes even forbidden at the professional standard level or at the legal and national level. The political correct expression became LGBT, lesbian, gay, bisexual, and transgender. Throughout time, the LGBT community has grown stronger and more powerful, also aspiring and playing indeed a relevant role at the political level. Recently, some members and groups of the LGBT community claimed the word “queer” to refer to this political commitment they share, reading it as referring to their own and very speciﬁc political identity, that is, with a positive connotation.
Notwithstanding the ethical and bioethical relevance of the issues just raised, these are not the speciﬁc language politics that have been developing within bioethics, with a major impact both at the theoretical level, in what concerns the deﬁnition and characterization of a situation, and at the practical level, in what concerns the due course of action recommended. Reference then is made, within bioethics, to a deliberated and calculated use of words, frequently with a positive or axiological neutral signiﬁcation, to describe a situation, frequently under a negative interpretation, in order to inﬂuence or to manipulate the public’s perception of that situation and to lead the persons to smoothly accept it. This is the kind of language politics that has become quite typical in bioethics and that has the strongest impact in the ﬁeld. Therefore, this is the one to be focus on.
On the other hand, reference will also be made to a broader perspective on language politics, subscribing it to a possible positive meaning for language politics in its re-appreciation of words and expressions, proposal of new concepts, reevaluating their correct use for a clearer understanding of reality, and a more adequate intervention on the situation.
Brieﬂy, while stressing the major importance of the negative and more common perception of language politics (strict sense), this entry will also refer to the good use of language politics (broad sense).
The Triangulation Of Thought, Reality, And Language
Language politics, in its strict and more common negative sense, can only occur due to two factors. The ﬁrst one is that there is an unbreakable tie between thought, reality, and language: reality feeds thoughts and thoughts interpret reality (reality is never absolutely objective but is also partially constructed by man); thoughts are expressed by language and different languages present different resources for thoughts to express themselves (the vocabulary richness of each language is not the same and there are words in some languages that have no translation in other languages, what means that languages can promote differently the development of thought and the access to reality); and reality is transmitted to one another by language and language classiﬁes reality (the description of reality among people is done mainly through language but language also deﬁnes reality differently, according to the viewer). It is within this triangulation and because the total coincidence of the three is not possible that language politics take place.
The second fact to take into consideration is that neither words nor their contexts are axiological neutral. And this is true not only for discourses in general but can also apply to technical or scientiﬁc language: the intentional choice of words to describe or classify a situation or a fact can and does frequently induce the perception and the interpretation that is meant to be.
Language is never absolutely objective, but it can and it should be very close to reality. Language is closer to reality when it sticks to the facts or is very well justiﬁed by facts presenting itself more of a descriptive nature. It can also be of an interpretative nature when it adds a subjective point of view to reality in itself, although presenting a justiﬁable and well-grounded interpretation.
Language politics can present itself as being of a descriptive nature, in its positive sense; however, most frequently it aims not only to transmit an interpretation but also to make it prevail. Therefore, it falls under a different category, neither simply descriptive nor interpretative, but close to manipulation, handling of language in a skillful manner in order to reach speciﬁc goals. Manipulation would be the hard and intentionally fraudulent way of using language; politics is the soft and persuasive way. Both ways can be used by scientists, academics, and different professionals, namely, lawyers, media, and politicians, among others, with impact within their own domain of professional activity and ultimately in the public opinion.
Within bioethics, language politics, in this strict sense and the most problematic from the ethical point of view, refers to the different strategies used to inﬂuence the interpretation of a certain fact or situation and, subsequently, the decision-making process, through a supposedly conceptual clariﬁcation that, indeed, contributes to an equivocal and/or ambiguous conceptualization that intentionally leads people to take a speciﬁc position on a particular issue. The main goal is not theoretical but practical, that is, to change the course of action, at the ethical and legal levels, toward the issue in cause.
Ethical Issues In The (Re)Definition Of Old Concepts And Proposal Of New Concepts
Conceptual accurateness is obviously essential to all academic ﬁelds, but we dare to say that it is even more crucial in a trans discipline as bioethics.
Indeed, bioethics cannot be considered just as a new discipline that would emerge by itself. It cannot even be considered an intersectional ﬁeld of other disciplines, that is, a meeting point of many well-established disciplines in their ethical questioning, extending the knowledge within each of these disciplines. Bioethics is a trans discipline, that is, a new discipline that originated from the ethical issues raised by the development of other existing disciplines, but that has rapidly evolved beyond, developing its own objectives and methodologies and also, of course, its own language.
The language of bioethics has originated from different scientiﬁc ﬁelds and mainly from philosophy, especially from ethics. Therefore, the need for language accuracy goes beyond the normal requirements of each scientiﬁc ﬁeld and philosophical discipline, since it also has to take into account the interrelation of these concepts from so many different origins, integrating them in a new reasoning and a new speech about a new reality, created by biotechnological progress, to which bioethics refers.
Conceptual accurateness works as a solid foundation to an objective understanding of the situation under appreciation, to a wise identiﬁcation of the ethical dilemmas at stake, and to ethically justiﬁable proposals of different possible courses of action.
Bioethics has been working on conceptual clariﬁcation following two different but complementary ways. The ﬁrst one is through the redeﬁnition of concepts, either because they are not sufﬁciently precise to become operational in practice or because they can acquire speciﬁc signiﬁcance in the context of bioethics where they are used. A second one is through the proposal of new concepts and new expressions, sometimes to establish conceptual distinctions which contribute to the clariﬁcation of both.
Bioethics offers, throughout its history, many examples regarding the need of accurate (re)deﬁnition of concepts as well as the proposal of new concepts and new conceptual distinctions as a sound way to build up a clear understanding of the situation and to draw ethically acceptable ways of acting. Under the presupposition of the same goals and the same means, bioethics also offers examples of ambiguous deﬁnitions of concepts and equivocal proposals of conceptual distinctions which, instead of promoting good and sound clariﬁcation and help the decision-making process, try to inﬂuence the perception of reality and the decision of action according to particular groups of interests. The latter are also examples of language politics.
The Good Examples: The Path Of Precision
Good examples of the bioethical requirement of conceptual accurateness are easily found, and they show how important language clariﬁcation can be for decision making. These examples go back to the beginning of bioethics and one of the most paradigmatic is a classic case, from 1975, the Karen Quinlan’s case.
Karen Quinlan was a young woman who, in a friend’s birthday party, consumed alcohol (few gin and tonics) while under barbiturates (diazepam, dextropropoxyphene), provoking a synergistic effect, each intensifying the other. She suddenly appeared to faint and was taken home by her friends who put her to bed. Fifteen minutes later they checked on her and she wasn’t breathing. A friend of hers tried mouth-to-mouth resuscitation while waiting for the ambulance. Finally, Karen started to breath but she never recovered consciousness. Probably the cumulative effect of the drugs she took, added to the diet she was under, caused anoxia (loss of oxygen to the brain) and, subsequently, irreversible brain damage. She was admitted at an intensive care unit where she was connected to a ventilator because she didn’t breathe deeply enough, and also to prevent aspiration of vomit into her lungs. Later she was moved to a new and more sophisticated ventilator that required a tracheotomy. Karen remained in a coma and was considered to be in a persistent vegetative state, which is almost always irreversible.
The Quinlan case is a classic example of ethical decisions regarding the end of life and went down in history as a ﬁght for the right to die, pursued by her (adoptive) parents. Nevertheless, reference to it is made here for a different reason: to illustrate how a new conceptual distinction helped to clarify an unprecedented situation.
Back in the early 1970s the resuscitation techniques were still very new and the public opinion and even the healthcare professionals were not duly aware of all of its possible consequences. Recommended in some cases of cardiac failure and respiratory arrest, resuscitation techniques were able to bring back to life patients who had stopped breathing and who would previously been pronounced death.
At the medical level, a distinction between cardiorespiratory death (clinical death) and brain death imposed itself. An ad hoc committee of Harvard Medical School had already published, in 1968, a series of criteria to determine brain death, but they were not yet widely accepted. Most countries formulated their own criteria for brain death, Finland being the ﬁrst European country to legally do so, in 1971. But it was indeed only after the Quinlan case that different initiatives – medical, legal, and ethical – decisively implemented brain death as an acceptable indication of death.
At the anthropological (and philosophical) level, a new distinction imposed itself: between biological life, proved by cardiorespiratory functioning, and personal life or relational life, which requires some level of interaction, of relationship with others, whatever the means used (an eye blinking or a hand pressing can be ways of communicating). A permanent unconsciousness state does not allow any kind of relationship.
Unfortunately, although some of the resuscitated patients can recover the cardiorespiratory function, autonomous or assisted, they never regain consciousness. Therefore it is not surprising that the question of being dead or alive was put: Karen was alive, which was obvious because she was breathing (spontaneously, after some months) and, at the same time, she seemed to be dead because she remained unconscious. The distinction thus made between biological life and personal life or relational life was determinant to clarify this situation and also to help the decision-making process in what concerns the best way to cope with the uncertainties raised by this case and the best way to act regarding Karen: she was alive, from a biological perspective, but dead, from a personal perspective, being incapable of establishing any kind of relation with whomever.
At the ethical level, a new conceptual distinction became necessary between killing, a deliberate act to cause death, and letting die, a deliberate omission of action leading to death. Killing is primarily perceived as morally wrong while letting die can be morally justiﬁable if it is an omission to delay death without being able to avoid it on a short term, if it is an omission to extend life at a cost of a great suffering. And at this point it becomes helpful to retrieve another important conceptual distinction in the ﬁeld of bioethics: the one between ordinary and extraordinary means of treatment or of prolonging life. The ordinary or standard means are morally required; the extraordinary or nonstandard ones can sometimes be dispensable and even necessarily rejected when they cause more burdens than beneﬁts.
It is common knowledge that, if we follow the evolution of bioethics, these major conceptual distinctions have been challenged at one time or another. Nevertheless, they are still defensible, many of them still remain needed, and they were all decisive at the time they were made. In what concerns the distinction between ordinary and extraordinary means of treatment, it was fundamental to build a consensus about the moral acceptance of letting die, whenever the burdens of artiﬁcially prolonging life outweigh the beneﬁts.
And how did these distinctions help to better understand Karen’s situation and facilitate an ethical decision making? While Karen was connected to a ventilator, there was room for a debate about considering this new technology an extraordinary means of treatment that was imposing more burdens than beneﬁts, condemning her to a biological life empty of a personal life, since there is no real hope to recover from a persistent vegetative state. Disconnecting Karen from the ventilator could, then, be regarded as letting die. It could also be regarded as killing if the ventilator were considered a way to postpone death and the omission to do so a direct act leading to death. After Karen recovered autonomous breathing, any action to hasten her death would be qualiﬁed as killing and the only ethical way to go would be to keep caring, without initiating any extraordinary means of treatment and let life (her biological life) take its course. That is what happened when, eleven years later, Karen suffered from pneumonia and no treatment was provided to her, being considered that, in her state, without a personal life, all drugs to treat a disease were to be considered extraordinary. Karen was letting to die.
Conceptual accurateness proved to be fundamental to an objective evaluation of the situation and a moral decision making.
The Bad Examples: The Path Of Manipulation
Bad examples of the bioethical requirement of conceptual accurateness use it as an opportunity to unduly inﬂuence the perception of a situation or a fact and the decision upon them, that is, language politics in a strict sense are also easy to ﬁnd in bioethics.
If we pick up from the last example – a good example – the one about the end of life and the claim to the right to die, one can immediately be driven to one of the most complex processes of conceptual clariﬁcation: the one referring to euthanasia.
The attempt of clariﬁcation was hard from the very beginning. The historical background was the Nazi euthanasia program under which it is estimated that from 200 to 275 thousand “lives unworthy of life” were eliminated. A strong negative connotation was severely embedded in the word euthanasia. The goal was, however, to give it a positive connotation in order to allow the debate about the eventual circumstances under which its practice would be morally acceptable. This debate was totally put aside after the Second World War and euthanasia was a kind of forbidden word.
Two strategies were followed to restore the true signiﬁcation of euthanasia, from which rules of application could eventually be drawn: etymological and conceptual. However, both present several different problems that do not really contribute to a deﬁnitive clariﬁcation of euthanasia but, on the contrary, originated a plurality of equivocal interpretations. Both will be consider very brieﬂy.
From the etymological perspective, euthanasia was presented in its Greek roots: eu (good) + thanatos (death) = good death, having or giving a good death.
Perhaps with the intention to reinforce the accuracy of an etymological deﬁnition, some other words from the same etymological family were considered together such as dysthanasia and orthothanasia. From the Greek, dys (bad) + thanatos (death) = bad death, dysthanasia refers to the prolonging of life of those who are seriously or terminally ill and who are potentially experiencing severe suffering. Opposing dysthanasia to euthanasia should contribute to a better understanding of the second in particular and should lead to the rejection of the ﬁrst – imposing suffering in the process of dying – and to the acceptance of euthanasia, a merciful death to free the person from suffering. Orthothanasia, also from the Greek, ortho (correct) + thanatos (death) = correct or natural death, refers to a dying process free of aggressive human intervention or invasive technologies or to the deliberate stopping of artiﬁcial or heroic means of maintaining life. Orthothanasia is, then, presented as opposed to dysthanasia (does not postpone death, prolonging the suffering) and close to euthanasia (allows death to occur, although not actively hastening death to put an end to the suffering).
This putting together of three Greek root words, instead of contributing to the clariﬁcation of each of them, created a common ground for different but related realities that deepened the ambiguity of all of them.
The equivoque went even further when combined with the conceptual perspective. At this level, academics established a distinction between passive euthanasia, which it is said to correspond to orthothanasia, and active euthanasia or euthanasia in a strict sense. This distinction would also be equivalent to the one between omission and action, respectively. But then, the conceptual distinction would turn even more nebulous since euthanasia is never really an omission, but an act of giving death for mercy and therefore can never be passive but is always active. Orthothanasia, passive euthanasia, omission, and letting die describe the same situation from different perspectives but have nothing to do with the reality of euthanasia, active euthanasia, action, and killing.
The question that imposes itself is why the conceptual perspective did not contribute to the clariﬁcation of the concepts. The answer is not difﬁcult and has to do, precisely, with language politics: under an announced conceptual clariﬁcation, there was an intentional establishment of an ambiguous situation that could facilitate an interpretation leading to the acceptance of euthanasia. By putting both the withholding of treatment to avoid suffering (passive) and the action of killing also to avoid suffering (active), under the same designation of euthanasia, the ﬁrst goal was to gain a wide acceptance of what is called passive euthanasia and which is nothing more than the withholding of treatment and allowing a patient to die, when he/she is in severe pain and suffering and is terminally ill, with no hope of recovery. After the acceptance of one kind of euthanasia, the way to accept the other, and the ﬁnal goal, would be just an extension of the former and therefore much easier to reach.
The way language is handled can be decisive in the acceptance or refusal of some practices.
Another classic bad example of language politics, this time at the beginning of human life related to assisted reproductive technology (ART) and particularly on the issue of stem cells research, would be the introduction of the new concept “pre-embryo” to distinguish it from the “embryo.”
The concept of pre-embryo was introduced to designate the very early stage of embryonic development, since the formation of the zygote, a single cell formed by the union of two gametes, until the 14th day of development, when the nesting occurs in the uterus. This is an important stage of the embryonic development for the mother, who can then be aware of her pregnancy, and for the new life that, after this period, cannot go through embryo twinning anymore.
Pre-embryo was introduced in scientiﬁc literature in 1979 by Clifford Grobstein and later, in 1984, by the Warnock report, after which it became widely used. The context was the discussion about possible destinations to be given to surplus embryos from assisted reproductive technologies, namely, the possibility to unreservedly use them for research purposes. The distinction between the pre-embryo, until the 14th day, and the embryo, from the 15th day on, was made to convey the idea that until the 14th day of embryonic development it was not really an embryo but a previous life-form. Being the embryo the earliest stage of human life, it deserved protection; being the pre-embryo a life-form previous to the earliest stage of human life, it could not yet be considered worthy of the protection given to human life. Consequently, the pre-embryo could be freely disposable, by potential parents and medical doctors, as a surplus of assisted reproductive technologies, and also freely used, by scientists, in biomedical research, namely, stem cell research.
This reasoning could be convincing was it not the case that, according to all embryologists, the zygote is already a human life-form, the earliest stage of embryonic development, and this is continuous, without discrete periods. The term pre-embryo was deliberately introduced to ethically justify the destruction of human embryos, without scientiﬁc grounding.
Another kind of bad example of language politics, still at the beginning of human life, would be adding an adjective with a very positive connotation to a noun with a bad or dubious connotation in the attempt that the good connotation outweighs the bad and that the ﬁnal expression can be perceived as good and therefore accepted. One of the most positive adjectives would be “therapeutic” which can be added, for example, to “abortion,” therapeutic abortion, or to “cloning,” therapeutic cloning. In these cases, even for those who are against or have doubts about the morality of abortion or of cloning, if these practices are considered therapeutic, they tend to accept them or, at least, not to oppose them. A therapeutic abortion would consist of the deliberate act to end a pregnancy to save the mother’s life or to preserve her health. The range of applications of a therapeutic abortion, however, rapidly expanded to also include the abortion of embryos affected by major abnormalities. In this case it is reasonable to ask who is being treated, who is beneﬁting from what is presented as a therapy? Again, it seems that the adjective “therapeutic” is incorrectly but intentionally used to ease the acceptance of abortion in the case of embryo abnormalities.
The same very broad deﬁnition of therapeutic also applies to cloning. Therapeutic cloning refers to a cloning technique (and there are quite a few), most frequently to the harvesting of embryonic stem cells to grow tissues and other biological products with therapeutic value. Indeed, the expression “therapeutic cloning” is introduced to oppose to “reproductive cloning” which is consensually rejected. Instead of banning cloning all together, this distinction between “therapeutic cloning” and a “reproductive cloning” would allow concentrating all the negative arguments on this last one and saving the possibility to pursue the ﬁrst one. This reasoning could be convincing were it not the case that, scientiﬁcally, both the therapeutic and reproductive cloning can use the same cloning techniques and the difference between both is, indeed, only the aim or purpose of the procedure: the reproductive cloning is aiming at the creation of a new being identical to the one from whom the original cell was harvested; the therapeutic cloning is aiming to pursue scientiﬁc research in order to discover a therapeutic value for cloning which is not yet established. Objectively it would be more accurate to refer to cloning for reproductive purposes and cloning for research purposes.
This succession of examples could easily go on. Nevertheless, the point has been made about the importance of language politics within an academic and scientiﬁc ﬁeld at the theoretical and practical levels, and speciﬁcally in what concerns bioethics, and also about the power of language to shape the perception of reality and inﬂuence situation-speciﬁc decision making.
Language is never axiological neutral; concept deﬁnition is never totally innocent; new words and new expressions are never introduced without a connotation. Therefore, the dominion of language is always an important and sometimes a decisive tool that should be used with precision and never manipulated. Precision in language demands scientiﬁc and mainly philosophical accuracy, and the rejection of all kinds of language handling for speciﬁc agendas has to be done through the promotion of scientiﬁc integrity and moral responsibility.
Bioethics cannot neglect the theoretical and practical value of language for its work. Bioethics needs to invest seriously in language accurateness if it wants to be recognized as a credible scientifically valid academic ﬁeld. And accuracy in language requires the most objective deﬁnition of concepts, according to the state of the art of the scientiﬁc ﬁeld involved, accompanied by logical rigorous philosophical reasoning. This is the ground for good bioethical reﬂection and practice.
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