This thesis investigates whether the research ethics guidelines for MGE research, constructed from Western regulations, are appropriate within the Saudi context. Therefore,
I will argue in this section that empirical bioethics and more specifically the normative policy- or practice-oriented bioethics (NPOB) approach, that uses both normative analysis
and empirical data to inform the analysis of each other (Ives and Draper, 2009), is the most suitable approach to achieve the aim and objectives of this thesis.
The importance of normative analysis in this thesis stems from the complex nature of the normative challenges surrounding MGE research and the specific Saudi Arabian context. However, different disciplines have different ways of identifying these challenges.
Some might argue that applying ethical theory and moral reasoning are enough to answer the question in hand. There are two reasons why this is not the case and why there is a need for empirical research as well as normative reflection. Firstly, my overall research question starts with posing a normative question about how MGE research ought to be regarded in the Saudi-specific context. Such a question calls for studying the context empirically to understand Saudi culture and attitudes to donating blood for MGE research as a first step to reflecting upon the policies and investigating those policies’
appropriateness. Secondly, philosophical reasoning and intuition are among the most important tools in moral philosophy; for decades these tools have led moral philosophers to come up with highly respected moral theories. However, relying on these tools alone would not be enough to resolve conflicts between two or more principles if those principles are equally justified in the philosophy literature, but contradict each other. In such situations, disagreements between theories would enrich further debate and reasoning but would be of limited applicability and value for someone trying to identify which one is more suitable within a specific context (Hoffmaster, (1992). For example, some writers support genetic exceptionalism, arguing that genetics ought to be treated differently to other research disciplines because it generates unique medical data that may be a greater
risk to participants than other kinds of health information (Green and Botkin, 2003).
Genetic exceptionalism is, then, used to justify exceptional measures for the regulation of genetics research. Others argue that genetic information is not exceptional and that the same risks can be associated with any personal information and, therefore, require no exceptional treatment. Using only a philosophical analysis approach would add to the body of knowledge and might contribute to one or both of these positions on genetic information. Philosophical analysis could be rated as a necessary contribution to the field of applied ethics but of little benefit to the discussion of the policies in question, as the outcome should be more inspired by the culture (Moorlock, 2013).
Concentrating exclusively on the philosophical debate would be problematic because philosophy as a discipline is not a part of any Saudi education curriculum, including the higher education systems (Goucha, 2007). It is, therefore, extremely rare to find a normative analysis or rigorous philosophical debate about values in Saudi Arabia. Most bioethics papers are either practice-oriented or propose an Islamic version of bioethics, where authors try to find a connection between medical/research practice and Islamic law.
Therefore, philosophical analyses alone would be of limited value because it risks being alien and might not be acceptable. Knowing how Saudi stakeholders in the context of MGE argue for their normative values and what seems important to them, one can provide potentially less resistible advice that is more likely to be followed which cannot be identified by looking at philosophical literature, and so must be done empirically.
For centuries, normative analyses, through moral reasoning and reflection, were among the most important tools that enabled moral philosophers to produce their moral theories. In the same vein, but with a twist towards empirical bioethics, Hedgecoe (2004) suggests the importance of introducing a ‘[r]igorous normative analysis to the lived moral
experience in addition to critical empirical work which is usually the best way to assess the lived moral experience’ (Hedgecoe, 2004, p120-122). In this same paper, Hedgecoe (2004) argues for the need for empirical work to inform philosophical reasoning and intuition. The social science critique describes traditional applied ethics as: a) abstract, b) rooted mainly in rational and formal argument, c) being based on the assumption that moral norms are prescriptive and binding through rationality, d) believing that solving problems relies on the application of moral theory, and e) overlooking cultural differences (Hedgecoe, 2004).
Those criticisms have influenced my aims to provide a contextual understanding of MGE research in Saudi Arabia as an essential step to conducting a culturally sensitive normative analysis. Based on Hedgecoe’s (2004) work, I considered that, if any work attempts normative analysis with appropriate cultural understanding in the way that this work promises, it cannot afford to neglect the need for empirical data that shed light on the intuitions and experiences of stakeholders in the analysed context. To the best of my knowledge, no work has yet investigated the intuitions of stakeholders in health research in Saudi Arabia. This means that such important intuitions can be easily overlooked if this work based its methodology only on traditional ways of reasoning in moral philosophy.
The social science critics believe that morality would not make sense if the solution to an ethical problem did not consider empirical understanding the nature of the problem to which the solution was offered. To be effective, any solution to an ethical problem must pay close attention to the potential problem that this solution might address. For example, one might suggest that Saudi MGE research ought to be regarded in a specific way that empowers full autonomy through informed consent documentation; this suggestion would be of limited value if in Saudi Arabia it would be regarded as an example of undermining tribal cultural systems. Those imposed suggestions potentially could, at the least, create
adherence issues that could be circumvented if the context were considered for the suggested solution.
Over the last twenty years, there has been a significant increase in the use of empirical data and its analysis in bioethics, as well as numerous references being made to data collected and published by others (Sugarman et al., 2007; Borry et al., 2006; Leget et al., 2009). Despite that, there is no consistency on what is meant by empirical bioethics either theoretically or practically (Molewijk & Frith, 2009). Therefore it is important to outline in the beginning what I mean by empirical bioethics which is in general terms conducting both ethical analysis and empirical analysis and allowing each analysis to inform the other
In the previous paragraphs, I illustrated the importance of the empirical bioethics for this thesis and stated how Molewijk & Frith (2009) criticised a lack of consistency in how empirical bioethics is approached in the literature. To detail this claim Molewijk (2004) suggests three different ways in which authors use empirical bioethics: a) Prescriptive applied ethics - the data collected by the empirical investigation are only used as a premise in an argument or to measure how people are behaving. In prescriptive applied ethics priority is given to the theory over any data collected empirically. b) Theory building - the main aim of a theorist is to produce a theory, thus they need the data to refine the theory in a one-way relationship, from theory to empirical finding but not the other way around. c) Critical applied ethics - this mainly uses both the empirical analysis and the philosophical analysis in two-ways relationship and neither is prioritised. This means allowing the data to inform the theory and vice versa (Leget et al., 2009). There are many different and equally valid methodological approaches and the important thing is to employ that one that best addresses one’s aims. In the context of this thesis, the main promise is to provide an
understanding of what is going on in the field of Saudi MGE research ethics as a necessary step to providing answers to more important normative questions like how Saudi MGE research ought to be regulated. In order to do that, it is important to follow the methodology that would allow the context to inform the theoretical analysis and visa versa in a critical way.
Hedgecoe (2004) outlines a concept of ‘critical bioethics’ which uses social science techniques as tools to better inform normative analysis. This approach to bioethics can be regarded as critical of common bioethics practice (i.e., not using empirical data) from a social scientist point of view. It calls for the development of a methodology that would have stronger potential to bring the empirical data into ethical analysis and theorising.
Such a call has paved the way for the suggestion of a different methodological empirical approach which ‘is important in two significant ways: to achieve a contextual understanding, and to understand meaning’ (p251); this methodological approach is called empirical bioethics (Ives and Draper, 2009).
1.4.1 Normative policy- or practice-oriented bioethics
As Ives and Draper (2009) see it, a policy must be in harmony with the community that will be expected to follow it. Empirical work is a means of uncovering what the stakeholders think about, and how they react to, those policies. Stakeholders’ input cannot, however, be taken as the sole authority for the regulation of MGE research in Saudi Arabia. Giving such authority to such views could lead to the ‘defence of the indefensible’, or at least face the difficulty of justifying conflicting points of view (Moorlock, 2013, p4).
Instead, stakeholder views will be combined with philosophical reasoning so as to come up with a better understanding of the MGE research practice in Saudi Arabia. It is essential to provide the needed ‘encounter with experience’ (Ives, 2008) which has yet to be assessed
in the MGE research in Saudi Arabia. This, Ives describes as ‘[b]ringing philosophical ethical analysis to the ground, and rooting it in real people and in real problems’ (Ives, 2008, p3). Thus, for the sake of providing a better critique of policies in Saudi Arabia, it is important to employ empirical analysis in addition to philosophical analysis. Accordingly, the most appropriate research approach is the NPOB approach, as this will help to understand the normative assumptions of the Saudi MGE-regulating policies, as well as to determine what value is attached to MGE research in Saudi Arabia (i.e. whether people think it a valuable thing to do and why) by combining both normative analysis and empirical analysis. Another important reason for why NPOB seems the most suitable approach for this thesis is the importance of both intuitions in moral philosophy and the empirical data in gaining a more accurate understanding of the Saudi MGE research context. NPOB’s main promise is ‘to integrate empirical data and philosophical bioethics is to utilize empirically gathered lay intuition as the foundation for ethical reasoning in NPOB...[this]... involves a modification of a long-established tradition on non-intervention in qualitative data gathering, combined with a form of reflective equilibrium where the demands of theory and data are given equal weight and a pragmatic compromise reached’
(Ives & Draper, 2009 p 249). Thus it was the best approach that would fulfil this thesis aims.
1.4.2 The is/ought fallacy
Some might argue that such a work, if undertaken lightly or uncritically, would fall foul of the is/ought fallacy. The is/ought fallacy refers to accepting the descriptive value (what is usually practiced by people) to be a prescriptive value (a statement of what they therefore ought to do or value). According to David Hume you cannot derive an ‘ought’
from an ‘is’ because the ‘is’ statement is descriptive while the ‘ought’ statement is
prescriptive. In other words we cannot have a moral conclusion based on premises that do not have at least one moral claim among them. Consider, for example, society X prefers doing Y, therefore doing Y should be regarded as morally acceptable. The fallacy here is accepting a moral claim Y based solely on what society X prefers, without seeing that we need at least one premise that ‘bridges’ the descriptive and the normative, such as: ‘where a society prefers an action it is what we ought to do’. To avoid the is/ought fallacy, I will not use the empirical data in the embedded study to make moral claims, but rather they will be used to inform my moral reasoning. Thus, using data will help provide better analysis insofar as data are used in the same way that intuition uses example and scenarios; it is mainly by informing the reasoning for moral theories and by respecting the idea that facts and values are not distinct in practice (Ives & Dunn, 2010). In the context of the empirical project in this thesis, to ensure that it will not fall foul of the is/ought fallacy, it is essential not to advocate any moral conclusion based on the data analysis alone without critical moral reasoning. The plan is to use the data as well as personal reflexivity to ensure an
“encounter with the experience” (Ives & Draper, 2009) of the stakeholders and use the understanding gained to help develop a more encompassing normative analysis without claiming that because in the Saudi context, X action is happening therefor X should be an accepted moral practice.
In conclusion, the empirical part of this research aims to explore the current practice of MGE research in Saudi Arabia, not in order to provide a sociological understanding of how social actors react with each other, but to provide an overview of the normative assumptions that tacitly guide donors, researchers, and policy-makers with regard to MGE research. The Saudi stakeholders’ normative assumptions will be compared with the normative assumptions explored in the Chapters regarding the guidelines that are supposed
to guide MGE research practice in Saudi Arabia. Accordingly, this work can be understood as an empirical study in bioethics, specifically normative policy-oriented bioethics (NPOB), as described by Ives and Draper (2009). NPOB refers to the blending of normative bioethics analysis and empirical data analysis in the examination of normative principles underlying policies (Ives and Draper, 2009). This approach will better serve the overarching aim of this research, which is to contextualise ethical theories related to the ethical issues of relevance to thinking about genetics for policy-makers in Saudi Arabia.