There are some common pitfalls, when discussing issues in contemporary bio-ethics, and one that is peculiar to medical bio-ethics. To understand the common mistakes, and to see them in the light of a reality check, is to understand when our bias or prejudice is tainting the reasoning process.

Begging the question is to assume to be true what should be proved true. It is obviously easier to just assume a contentious point under debate than to do the hard work of proving it. The one we hear in political platforms is the definition of life: "No mere bit of cells the size of a dot could be a person", when referring to a nine-day-old embryo. In this case, the speaker is not speaking of the DNA composition, or the potential. Rather, it is the size of the being that determines a viable life form. In general, it is not nice to slip a key conclusion over on other people. It should be defended as a free-standing discussion. One must identify and justify the key premises, both factual and evaluative, in any bio-ethical debate.

The fact-value gap in moral reasoning generally is a conclusion about a moral issue and is supposed to follow logically from certain premises. If the premises logically support the conclusion, the argument is said to be valid. In practical reasoning, validity should not be confused with "truth". Validity refers to the form of the argument, whereas truth refers to the content of the premises. A sound argument is one that has both valid form and true premises. In any bio-ethical or moral argument, the conclusion will, of course, be evaluative. The inverse is also true. A bio-ethical argument can never be valid if the evaluative conclusion is derived from solely factual premises. A valid moral/bio-ethical argument must have at least one evaluative premise, so the conclusion is not dictated to by the "factual premises" only, but rather, "flows through" the argument from the evaluative premises to the evaluative conclusion.

When a moral/bio-ethical argument is valid -- that is, when its premises are made explicit and lead properly to the conclusion -- we can see it clearly. We can also see exactly where we agree or disagree with it. When we read the above from an abortion perspective, one set of values come into play. When we discuss it from a euthanasia perspective, different values may come into play. Therefore, in any given situation, the perspective may or may not accept the premises.

Fallacy of ambiguity is to define a single term in more than one way in a set of premises or conclusions. Each key term must be defined in the same way throughout the argument. Obviously then, defining a key term factually in a premise, but evaluatively in the conclusion, commits two fallacies: ambiguity and jumping the fact-value gap. Some philosophers argue that jumping the fact-value gap is in essence a special version of "begging the question". This naturalistic fallacy is sometimes inadvertent, but more often appears when someone does not want to make the real premise explicit. When hidden premises or assumptions are revealed, these premises must be justified, and that can be a difficult job.

Reductio ad absurdum is an argumentative strategy, often used in bio-ethical debates. It literally means, "to reduce to the absurd", which is taking a premise and trying to show it has ridiculous or absurd implications. For example, with the nine-day-old embryo, a reductio reply might be, "So you would baptize all the embryos that fail to survive to become fetuses? And you think Heaven has millions of embryos?"

If the advocate of the premises accepts that the implication is absurd or ridiculous, then the advocate must either give up the premise, or deny that the absurd implication really follows the premise. For example, in arguing about nonhuman animal pain, whether it needs to be included in our moral/bio-ethical premises, someone who disagrees might try a reductio by saying, "If you believe that, you cannot eat hamburgers or hot dogs!" However, the animal rights proponent might accept the implication and not think it is absurd, but merely a consistent implication for living of his general position.

Ad hominem literally means "to the human", and suggests a personal attack on an opponent. In bio-ethics, people need to give objective reasons for their views. So in turn, some people get frustrated with this difficult task and try to short cut the process by attacking the other person, rather than the issues. Suppose two people are arguing about Veterinary Pet Insurance® (VPI®), which is an indemnity insurance system in all states, and the potential capability of an insurance company to control levels of care, such as capitation, disease related groups (DRGs), managed care, etc. The consultant is an advocate of "risk sharing" programs, such as car insurance, and the doctor opposes such a system. The doctor has a hard time refuting the premises put forth, so he states, "You consultants are wined and dined by VPI®, so they are paying you to endorse their product." Here the doctor has made a personal attack on the consultant by implying that the consultant's reasons are badly motivated. In this case, greed. Then if the consultant replied, "You are not even taking the time to research what you are swearing to, so you draw a false analogy between the risk transfer system human catastrophic medical care and the risk sharing of indemnity insurance." In this case, the consultant, too, would have committed an ad hominem fallacy.

Avoiding the evaluative premise in healthcare is a common problem, as professionals acquire and discuss facts, while never mentioning the underlying moral premise. In a system where "getting along" is so important in team-based healthcare delivery, or their training has emphasized an analytical gathering of facts, there is a challenge, when people argue the facts rather than the moral issue they hold so dear. This is a real mistake. For real discussions and any hope of progress, the real moral issues must be identified and discussed.

For example, they are now teaching young, single women, who have unprotected sex, to immediately use common birth control pills at double dosage to stop implantation in the uterine wall. This is called emergency contraception by its proponents. The people that believe that the "person" starts with the combination of DNA in a single cell argue this is abortion. The medical authorities retort there can be no form of abortion, since implantation never occurred. Therefore, no "pregnancy" ever existed. There are many embryos that do not implant in the normal course of life, so most all medical definitions require implantation to define a "pregnancy". Then on the inverse, why should a dictionary define our moral values? Pregnancy is also defined as the likelihood of successful continuation of embryonic development, ignoring the bio-ethical issues. The key factual premise is that birth control pills act to prevent pregnancy, so using them before or after to stop pregnancy is a similar preventative action, and not an abortion.

The point here is that there can be no advance or recourse to the semantics being used if the real moral issue or premise is avoided. In fact, just the opposite often occurs, because the real moral issue -- the possibility of personhood of a very early embryo -- is avoided or begged by semantic obfuscation about contraception. Ultimately, someone has to table the conception issue and first define personhood, whether it be with the combining of the DNA in the new cell, or the presence of brain waves, or even the ability of the fetus to live independently outside the "parasitic state" of what is called pregnancy. The evaluative premise must be stated, or there is no reason to support the individual's bio-ethical position.

Moral disagreement is caused by conflicting standards of morality and conflicting judgments about particular issues. In the famous 1975 case of Karen Quinlan, in a coma due to drug/alcohol induced anoxia, which caused irreversible brain damage, the nuns administering to her at the hospital believed the morality of the unchanging standards of God: Thou shall not kill. Nine months after her admission, the New Jersey Supreme Court ruled she should have the respirator removed, based on the constitutional "right to privacy". The medical terms used to describe Karen in court proceedings, after she was in the coma for over a year, were: "disconjugate", "decorticate", "slow-wave brain activity", "muscles were rigid and contracting", "decubitus ulcers were eating through her flesh", "weight was dropping drastically (one fifteen down to seventy-five pounds)", "hip bones were exposed", "persistent vegetative state (PVS)", and "she was on a respirator and invasive feeding tubes".

She had been moved out of ICU and placed in a corner of the emergency room, so the ER staff could respond if she vomited. Karen's parents and their parish priest believed the moral rules must change to be compassionate to a person who would never again gain consciousness. According to Pope Pius XII, extraordinary means, like the respirator, are not morally required of Catholics.

In 1975, the American Medical Association (AMA) equated withdrawing life support with "mercy killing", thereby equating that with murder. Also, there were no legal court rulings at that time about death and dying.

The physicians decided to wean her off the respirator over many weeks, then transferred her to a nursing home, where she stayed for ten years until she died of pneumonia, never recovering, never responding, never allowed the "right-to-die". It was not until Nancy Cruzan's PVS coma case that led to the landmark decision by the United States Supreme Court in June 1990 that recognized the right of a competent patient to decline medical treatment, so refusing to withdraw the feeding tube, or respirators, was ruled unconstitutional. Inversely, Missouri Law only recognizes evidence of what a formerly competent patient would have wanted, so they upheld the Missouri Supreme Court ruling that there was not a preponderance of evidence of Nancy's desires, so the medical authority could require the feeding tube stay in place. Five months later, the appeals process presented many of her long-time friends, who offered new testimony, and subsequently, a "clear-and convincing" standard for evidence was met. Her feeding tubes were legally removed.

Moral pluralism is accepting the fact that a certain irreducible amount of bio-ethical diversity exists in everyday life. If we consider that the world has several major religions, and no individual believes that his or her faith is the wrong faith, only what Americans consider as the "morally corrupt" try to eradicate religions other than their own. Yet, to those regions where religion and politics blend into one, elimination of the "other faiths" often appears appropriate to them. But pluralism goes a lot further than religion: the rights of the majority versus the rights of the minority, death and dying, active versus passive euthanasia, conception and birth, experimentation and cloning, the individual versus the public good. If pluralism is understood, then publicly adopting an attitude of complete certainty about our own evaluative beliefs can make us seem moralistic, arrogant, prejudiced, and close-minded. Moral pluralism gives us the opportunity to recognize what is valuable in other people's ideas.

Moral truth has been debated as long ago as Socrates. The basic concept of Moral Pluralism raises the question whether there is or is not such a thing as truth in bio-ethics. Is it a limitation of reasoning? Moral skeptics believe that no objective ethical truth is possible. Inversely, bio-ethical/moral theories, which hold ethical statements can be true or false in some objective way, include: cognitivism, realism, perfectionism, and naturalism. Moral truth does not necessarily mean universal agreement, while recognizing its complexity should be an accepted variable.

World view is a comprehensive concept of life. This includes overall philosophies of life, such as religions, political theories, such as Marxism or feminism, psychological theories, such as Freudianism or behaviorism, and specific ethical theories, such as utilitarianism. If we refused to act without the moral certainty of a world view, we would be paralyzed. We actually formulate moral judgments throughout our lives, as best as we can, when making decisions or facing crises: when we marry, give birth, raise children, and bury our dead. We may not be certain about what we should do, but most of us get by.

It is not necessarily a bad thing that we cannot figure out one monistic answer to a question such as, "What makes an act right?" People and people's lives are more complex than monistic answers that such questions would allow. Absorbing different aspects of several world views gives us more flexibility to adapt to changing situations in the modern world, and defines the challenges and latitudes of making bio-ethical and moral decisions, rather than having one, rigid, dictated, view.

Delimiting Moral/Bio-Ethical Issues

Mill's "Principle of Harm" is based on Stuart Mill's classic work On Liberty, published in 1859. It contains an admirable distinction between private life and public morality, a distinction based on the concept of harm.

Issues of personal life are purely private and affect no one else. When someone else is affected, issues move from personal to the realm of moral or bio-ethical decisions. When a society attempts to promote certain values, and at the same time tolerate individual personal disagreement, the issues move into the public policy area. When a society decides to promote certain actions and discourage other actions, without tolerating individual disagreement, issues move into the legality area. So, in summary:

 Personal life concerns actions that are purely private and affect no other person, persons, life form, or community.

 Morality/bio-ethics concerns interpersonal actions. Those situations that one person's actions affect another person, a group of people, other life forms, or some community. For example, Mill's "risk of harm".

 Public policy concerns actions that usually affect other people negatively, but society tolerates, though it attempts to discourage such actions, as by education, or concerns actions that affect other people positively, and society attempts to encourage, as through incentives.

 Legality and illegality concerns positive actions that are, by law, compulsory, and negative actions that are, by law, forbidden. Penalties are imposed for omitting compulsory actions (think about tax laws) or performing forbidden actions (think about traffic laws).

A modern example would be the tobacco issues:

 Smoking is a personal issue.

 Smoking in your child's room is a moral issue.

 Taxing tobacco products heavily is a public policy issue.

 Prohibiting the sale of cigarettes to minors is a legal issue.

So by differentiating issues into the four classifications, it is easier to see why not every aspect of a discussion is a moral or bio-ethical issue.

In our practices, actions associated with animals feeling pain, or not feeling pain, has been changing, due to factual evidence. Yet, it is usually handled as a bio-ethical discussion. In May 2000, the AVMA Executive Board adopted pain management as a mandatory element of anesthetic and surgery procedures, and changed their sample hospitalization consent form in the 2003 Annual AVMA Directory, moving it into public policy.

The above discussions have been provided so people develop their dialogues in some fair and understanding manner. If you understand the different aspects of the moral reasoning and logic-forming process, then bio-ethical discussions become easier. Not the solutions, just the discussions.