1. Introduction
Integrative bioethics is a predominantly Croatian school of thought founded at the end of the 20th century whose proponents claim to have initiated an innovative and recognizably European concept of bioethics capable of dealing with the most pressing issues of our time. By relying on already existing criticisms of integrative bioethics (Bracanović 2012; Ivanković and Savić 2016; Savić and Ivanković 2017) and by taking into account its proponents’ more recent publications, this paper aims to show that actually the opposite is true: that integrative bioethics is a poorly articulated and arguably pseudoscientific enterprise that is fundamentally incapable of dealing with bioethical challenges and as such does not merit the “European bioethics” label.
The paper has four sections. Its first section is purely descriptive and provides the basic outline of integrative bioethics: its historical development, major proponents, geographical context and philosophical foundations. The second section is a criticism focused on three shortcomings of integrative bioethics: the absence of normativity, inevitable collapse into ethical relativism and frequent inconsistencies. The third section addresses the issue of a large number of typically pseudoscientific features of integrative bioethics: verbose language, constant self-glorification and isolation from mainstream science. Based on preceding considerations, the fourth and concluding section of the paper argues that integrative bioethics cannot be considered European bioethics when it comes to its quality, reception or identity.
2. Integrative bioethics: History, geography and philosophy
Integrative bioethics is a predominantly Croatian brand of bioethics established at the end of the 20th century.1 Its development is usually associated with the period when Ante Čović––the founding father of integrative bioethics, formerly ethics professor at the Department of Philosophy of the Faculty of Humanities and Social Sciences in Zagreb––initiated and led three research projects with the financial support of the Croatian Ministry of Science: Bioethics and Philosophy (1996-2002), Bioethics and Philosophy (2002-2006) and the Foundations of Integrative Bioethics (2007-2011). The international expansion of integrative bioethics began in 2004 when the circle of scholars gathered around Čović’s projects connected with the circle of scholars associated with the project Nutzenkultur versus Normenkultur: Zu den intrakulturellen Differenzen in der westlichen Bioethik, led by Walter Schweidler at the Ruhr University in Bochum (Germany). In the ensuing years, the two groups organized seven conferences on bioethics in Southeast Europe (Croatia, Bosnia and Herzegovina, and Serbia) and several international summer schools on integrative bioethics (Croatia, Germany, Greece, and Bulgaria). The most important event of integrative bioethics is the annual conference Lošinj Days of Bioethics, held in Mali Lošinj in Croatia for over twenty years.
The development of integrative bioethics is also reflected in the growth of the number of its centers in Croatia: Referral Centre for Bioethics in Southeast Europe (founded in Zagreb in 2006), Documentation and Research Centre for European Bioethics “Fritz Jahr” of the University of Rijeka, Centre for Integrative Bioethics of the Faculty of Philosophy in Zagreb, Centre for Integrative Bioethics of the Faculty of Philosophy in Split, Centre for Integrative Bioethics of the J. J. Strossmayer University in Osijek (all founded in 2013) and the Centre of Excellence for Integrative Bioethics (founded in Zagreb in 2014).
The establishment of the Centre of Excellence for Integrative Bioethics resulted from Čović’s 2012-2013 project (funded by the University of Zagreb) Integrative Bioethics: Developing the Centre of Excellence and the Doctoral Program at the University of Zagreb. Although the doctoral program in Zagreb was not established, similar programs were launched in other European cities: in Sofia (Bulgaria), there is an MA program called “Integrative bioethics”; at the distance-learning university in Hagen (Germany) exists a module (encompassing a number of courses, lectures and summer schools) in integrative bioethics, and the University of Crete (Greece) runs an MA and Ph.D. program that “operates according to the integrative-bioethical foundations”.2
The history of integrative bioethics is also the history of its publishing projects. Its vital publication hubs are the two journals of the Croatian Philosophical Society, Filozofska istraživanja, published since 1980 in Croatian language, and Synthesis Philosophica, published since 1986 in several foreign languages. Although neither of these journals initially specialized in “bioethical” or “integrative” issues, they progressively opened their pages to such topics since the mid-1990s, especially as the proponents of integrative bioethics assumed editorial positions. Moreover, after 2006, when Čović was appointed editor-in-chief of both journals for the second time, both journals were officially proclaimed the “journals for integrative thought”.3 As for other publishing projects, a key role is played by the publishing house Pergamena from Zagreb. Since 1997, when Čović established and became the editor of its “Bioethics” series, it has published almost 50 books and collections of papers on various bioethical topics (dominated, of course, by authors of an integrative-bioethical orientation). Abroad, the publishing house Academia Verlag from Sankt Augustin in Germany published, from 2005 to 2014, six collections of papers devoted primarily to integrative bioethics topics and issues. The Bioethics Society of Bosnia and Herzegovina also (between 2007 and 2012) published three collections of papers dedicated to various questions of integrative bioethics.
As its proponents tell us, the place of integrative bioethics in the global development of bioethics is unique and essential. Bioethics in the 20th and 21st centuries, according to Čović (2011), had three developmental stages. The first stage was “new medical ethics”, focused on moral reflection about issues arising within healthcare and biomedical research. The central work of this developmental stage of bioethics was the Principles of Biomedical Ethics by Beauchamp and Childress (11979, 2013). The second stage was “global bioethics”, making a turn towards “ethical pluralism” and “scientific interdisciplinarity”, as well as towards a much broader scope of problems related to life and its social, political, and ecological context. The central work of this stage was Global Bioethics: Building on the Leopold Legacy by Potter (1988). The third stage, according to Čović, is his own “integrative bioethics”, in which methodological turn was made not only to “ethical pluralism” but also to “pluriperspectivism”. The scope of integrative bioethics encompasses not only issues related to healthcare and biomedical research (as was the case with “new medical ethics”) or to issues related to life and its social, political, and ecological context (as was the case with “global bioethics”), but also
(…) the philosophical-historical dimension, in which the character of the scientific-technical epoch and the role of modern science are illuminated, the changes in the fundamental relations of man to what is historically given are considered, and the processes of refraction of world-historical epochs are detected. (Čović 2011, 20-21)
In addition to implicit reference to his publications, Čović singles out Jurić’s (2007) paper on Potterian “roots” or “footholds” of integrative bioethics as one of the most important works of this “integrative” stage of bioethics.
The question is, of course, what makes integrative bioethics so unique compared to its alternatives? Its proponents’ answer is the following: Integrative bioethics is a response to the “misuse of scientific results that can cause irreversible and catastrophic consequences for man and life as a whole” (Čović 2004, 164) but also to “bioethical reductionism” or the one-sidedness of other bioethical traditions.4 The scope of problems they plan to address is very broad and they define their bioethics as
(…) an open area for the encounter and the dialogue between different sciences and activities, as well as for different approaches and worldviews, which is meant to articulate, discuss and resolve ethical questions related to life, to life as a whole and to all parts of that whole, to life in all its forms, stages, phases and appearances. (Jurić 2007, 83)
The methodological principles of integrative bioethics are best presented through their “official” definitions: (1) multidisciplinarity (the gathering of “all human sciences and activities that are relevant for bioethical questions”), (2) interdisciplinarity (to “encourage dialogue and to find a mode of cooperation between all these disciplines”), (3) transdisciplinarity (to “overcome mutual differences” and unify them “into a unique bioethical view focused on questions that cannot be unraveled from the perspective of one science or one area”), (4) pluriperspectivity (meaning “unification and dialogical mediation of not only scientific, but also of non-scientific, i.e. a-scientific contributions”, such as “diverse ways of reflection, diverse traditions of thought and cultural traditions, that is, diverse views that rest on cultural, religious, political and other particularities”), and (5) integrativity (gathering “all the abovementioned differences into a unique bioethical view, rather than into a disciplinary and disciplined scientific framework”) (all quotations are from Jurić 2007, 84-5). This set of principles should create “footholds and standards for orientation when it comes to questions about life or about conditions and circumstances of its preservation” (Čović 2004, 11).5
Integrative bioethicists very often describe their position in laudatory “European” terms as the project that “Europeanizes bioethics” by “regenerating the spiritual potential of the European philosophical heritage” (Čović 2005, 12), as the “developmental shift” that “transferred bioethics from the United States to Europe” (Čović 2011, 21), as “original and foundational concept of the European bioethics” (Čović 2023, 14), as bioethics that “transcended the imagined framework of South and Southeast Europe” and “encompassed the entire European context” (Pavić 2014, 583), as “innovative and recognizably European concept of bioethics” (Tomašević 2013, 494) and as the “striking development of the bioethical discipline in Central and Southeastern Europe in the last thirty years” (Perušić 2019, 323). As will be shown here, none of these descriptions is justified.
3. Integrative bioethics: Problems with normativity, relativism and consistency
What qualities should a new and unique bioethical theory have if it hopes to deal with pressing issues caused by the development of science and technology? A minimal set of such qualities would undoubtedly include a specific set of normative principles for resolving moral conflicts, the internal consistency between its essential parts and a clearly defined scope of problems it wants to address. By relying on objections to integrative bioethics developed in Bracanović (2012), Ivanković and Savić (2016), and Savić and Ivanković (2017), as well as by analyzing some integrative bioethicists’ more recent publications, I will try to corroborate the view that all these qualities are conspicuously absent from integrative bioethics.
A severe problem of integrative bioethics is its lack of normativity or action-guiding capacity. This can be summarized as follows: (1) integrative bioethicists are right to highlight the moral threats posed by scientific and technological advancements, (2) they are right to emphasize that dealing with these threats requires considering all relevant perspectives, but (3) they do not deliver when it comes to providing their unique account as to how one should decide between mutually exclusive perspectives when facing particular bioethical dilemmas. Since finding solutions to such dilemmas is the raison d’être of the entire field, integrative bioethics fails in the most critical mission: telling us how to choose among diverse perspectives and arrive at the morally correct answers. Collecting the opinions of all affected parties in various bioethical dilemmas is praiseworthy, but this is typically done by descriptive sciences like sociology or psychology researching, for example, the public opinion on issues such as healthcare, preservation of the environment, animal rights, etc. The normative or action-guiding principles that would distinguish integrative bioethics qua bioethics are simply absent from its agenda. This absence of normativity is a severe problem, especially as integrative bioethicists emphasize that they do not wish merely to “articulate” but also to “ resolve ethical questions related to life” (Jurić 2007, 83, emphasis added). A convenient illustration of this problem can be provided via Katinić’s “round table” account of integrative bioethics:
Figuratively speaking, integrative bioethics is conceived as a huge round table where experts of different profiles and representatives of different domains of social life sit and in a lively and fruitful discussion find the best solutions to complex and difficult problems such as the treatment of newly conceived human beings, transhumanist theories and practices, genetically modified organisms, energy crisis, etc. (Katinić 2012, 599)
Assume that participants in this integrative round table represent conservative and liberal worldviews, respectively, discussing the permissibility of abortion. Both sides will probably be prepared to listen to (maybe even agree with) the scientific theories about the development of the fetus and its characteristics. Will this, however, eliminate the fundamental moral disagreement between them? Hardly. For conservatives, even the early embryo will have that one additional (normative) property that science, by definition, cannot address: the absolute right not to be destroyed, which is comparable to the right of an adult person. For liberals, even a relatively mature fetus will lack that one additional (normative) property that science, by definition, cannot address: a right to life that could outweigh the mother’s right to control her body. Anyone familiar with this long-lasting debate should know these views are fundamental (practically defining) for the parties in this dispute. Conservatives can say, of course, that the liberal views about the value of fetal life are wrong, whereas liberals can say the same for the conservative views.
How can an integrative bioethicist settle this dispute with their insistence on pluriperspectivism? While other bioethical theories (e.g. deontological or utilitarian) have specified criteria for making decisions in such cases, integrative bioethics inevitably ends up in a normative cul-de-sac: it lacks the basic normative principles needed to determine which participants of their round table hold morally acceptable views and which hold morally unacceptable ones. It, therefore, fails as a bioethical theory and collapses into a relativistic mosaic of diverse but normatively equivalent moral perspectives.
Lovro Savić and Viktor Ivanković (2016, 2017) criticized integrative bioethics along the same lines by introducing the notion of “semantic incommensurability”. According to them, integrative bioethicists’ enthusiasm for treating all perspectives as equally respectable participants in a bioethical dialogue implies that these perspectives are “non-hierarchical and cannot claim superiority in reaching truths over other acknowledged perspectives” (Ivanković and Savić 2016, 328). As we have seen, this nips in the bud the integrative bioethics’ potential to resolve conflicts between perspectives. However, even if integrative bioethicists somehow agree that some perspectives have to be excluded, the “semantic incommensurability” problem will remain: the vocabularies of participants in the dialogue may look the same (“commensurable”), although they radically differ when it comes to the meaning (“semantics”) of their central terms. A term that Savić and Ivanković (2017, 274; drawing on Fan 1997, 309) use to illustrate this is “autonomy”. In the Western context, “autonomy” means self-determination, a subjective conception of the good and individual independence. In the East Asian context, it means family determination, an objective conception of the good and the value of harmonious dependence. “Semantic incommensurability” may affect various bioethical terms (such as “life,” “death” or “dignity”) and integrative bioethicists need to address it (which they do not) if they want to avoid pointless dialogues between perspectives that, despite their superficial similarities, talk past each other.
Let us now consider how integrative bioethicists respond to objections like these. Not long after the appearance of the “absence of normativity” objection (Bracanović 2012), Amir Muzur (2014) offered his response in a letter to the editor published in the journal Developing World Bioethics. Although Muzur’s response is brief, it seems to be considered in the circle of integrative bioethicists as “the best defense of integrative bioethics from the narrowing of the imposed normativity” (Smiljanić 2022, 571). Muzur sketched several strategies of possible defense, but three of them deserve to be singled out and briefly commented on:
(a) “Why”, asks Muzur, “should ethics and bioethics be (only) normative at all?” (2014, 109) Except for the fact that every relevant dictionary defines bioethics as a normative discipline, an obvious answer to this question is that setting norms or guiding action is the main reason why bioethics came into being in the first place. Integrative bioethicists themselves, as we have seen, present their school of bioethics as a discipline that is supposed to “resolve ethical questions related to life” (Jurić 2007, 83). Since “resolving ethical questions” is undoubtedly a normative activity, Muzur’s idea of removing the normative component from bioethics is inconsistent with the primary motivation behind establishing integrative bioethics.
(b) “Normativness”, Muzur is protesting, “imposes instant, one-sided solutions and thus often leads to mistakes” (2014, 109). It is unclear why he sees “one-sidedness” as a necessarily bad by-product of “normativity”. Consider the analogy: A judge in the court of law reaches the verdict (normative judgment) based on impartial consideration of facts and arguments presented by both parties. That the judge ultimately decides in favor of one party does not mean that they are one-sided. The same applies to bioethical judgments: After impartially considering all arguments about a specific issue, we make a judgment that we believe is objective and correct. Muzur, however, seems to think that any normative judgment, as soon as it is made and irrespective of how it is made, is necessarily a one-sided imposition of one’s norms or values on others. Such a typically relativistic approach paralyzes any bioethical decision-making process.
(c) For Muzur, bioethics, instead of being normative, “might be closer to a kind of buying time for humaneness until technology and science (if ever) provide us with crucial answers about life” (2014, 109). This might be the pinnacle of inconsistency within the integrative bioethics school. The task of integrative bioethics, as we are often told, is to deal with the “misuse of scientific results that can cause irreversible and catastrophic consequences for man and life as a whole” (Čović 2004, 164). However, if integrative bioethics (as Muzur maintains) is only about “buying time” until “technology and science” find answers to the burning ethical questions, then its historical role may not be as crucial as its founders typically claim. They claim, namely, that integrative bioethics is a spark of a “new ethical culture” that will provide us with “epochal orientation” (Čović and Jurić 2018)––not that it is some lowly placeholder for some future science and technology. In other words, Muzur’s “buying time for humaneness” thesis may be a case not only of intra-theoretical inconsistency but also of intra-theoretical heresy.
The inconsistency of integrative bioethics becomes especially visible when one takes a closer look at the positions of its various proponents on ethical relativism (which, as we have seen, is a serious problem for its normative aspirations). Not all integrative bioethicists seem to view relativism as necessarily problematic. Sonja Kalauz (2011, 256-57), for example, defines integrative bioethics in a highly relativistic way, as a “polyvalent discipline” that has a “logically structured form” and “with the help of which every active participant, in accordance with his own theoretical and methodological templates, can come to the final normative judgment” (the talk about “one’s own theoretical-methodological template” seems to imply not only relativist but also subjectivist reading of integrative bioethics). Although not willing to explicitly acknowledge the relativist status of integrative bioethics, Jos Schaefer-Rolffs (2012) interprets its “pluriperspectivism” in a way that is difficult to differentiate from a dictionary definition of ethical relativism: for him, pluriperspectivism means “(a) the non-hierarchic discourse of (b) multiple different points of view on one topic that are (c) rooted in different ideals and worldviews” (2012, 114). Some defenders of integrative bioethics also define its “orientational knowledge” in typically relativistic terms: as “a social norm” or “a set of patterns of mutual relations in the community” or as the “criterion of how it should be, as the community requires, and not as it actually is” (Smiljanić 2022, 570).
And yet, when it comes to the inner circle of the discipline’s founders, they vigorously dissociate themselves from ethical relativism. Consider Jurić’s dismissal of the relativistic interpretation of pluriperspectivism:
Terrible “accusation” directed towards pluri-perspectivism (“Pluri-perspectivism is nothing but pure relativism”) has no ground. Certain “relative relativism” inside the pluriperspectivistic way of discovering, viewing and constructing is unavoidable, just like in any approach which tends to be comprehensive, but it is something different from the “absolute relativism” of monoperspectivistic approach, because it can in no way embrace the whole: it always sacrifices some (massive) segments of the life and the world in order to achieve theoretical rigidity, self-sufficient coherence and consistency, in other words––“mythical” ideals of “exactness” and “objectivity”. (Jurić 2012, 89)
In addition to being inconsistent with interpretations of “pluriperspectivism” offered by other defenders of integrative bioethics, an evident problem with this defense against the charge of relativism is its vagueness. What exactly is “relative relativism” as distinct from “absolute relativism”? What is this mysterious “whole” that the “monoperspectivistic” approach cannot embrace? What is it that the pluriperspectivistic approach “discovers”, “views”, and “constructs”? None of this is explained, despite the promise that pluriperspectivism is the superior tool of integrative bioethics that outcompetes all other schools of bioethics.
That the pluriperspectivist bioethical approach is nothing more than relativism in disguise should also become apparent from Jurić’s claim that “exactness” and “objectivity” are “mythical ideals”. Integrative bioethicists seem to have two mutually exclusive aims. On the one hand, they want to gain as many theoretical allies as possible (such as lawyers, physicians, or theologians), which explains the aggressive advertising of their “pluriperspectivism”. On the other hand, they desperately want to avoid all associations with ethical relativism––if for no other reason than because most of their theoretical allies (especially theologians) do not subscribe to relativism. Unfortunately for them, sitting on this bioethical fence cannot go undetected forever, despite all the intentional and unintentional vagueness surrounding their normative agenda.6
Besides maintaining its internal consistency and providing a specific set of normative or action-guiding principles, a contender for a new and unique school of bioethics should have a clearly delineated scope of the issues it attempts to deal with. Integrative bioethics fares terribly in this respect too––not because it tries to cover too little ground, but because it tries to cover too much of it. Luka Perušić provides a vivid illustration of this overreach of integrative bioethics:
If we produce vehicles whose exhaust pipes pollute the environment, it is a bioethical issue, just as the use of mobile devices containing ores mined by minors is a bioethical issue; the Panama Papers is a bioethical issue, nootropics are a bioethical issue and political and trade agreements and alliances, excessive production of toilet paper, regulation of the legal capacity of mentally challenged people and extraplanetary expansion, terrorism and surveillance, the concept of prisons and penitentiaries, GMO and the application of artificial intelligence, gender issues and the status of plants and animals, inter-religious conflicts, education and training systems, huge oxygenation and warfare and philosophical questions about the phenomena that arise in all problems, entail the area of the moral dimension of life and thus necessarily enter (integrative) bioethics as possible subjects of investigation. (Perušić 2019, 346-47)
If all the mentioned issues, from the production of toilet paper to extraplanetary expansion, are typically integrative-bioethical issues, a common-sense question arises: Which issues then remain to be dealt with by, for example, biomedical ethics, applied ethics, AI ethics, ethics of war, ethics of sexuality, ethics of information, political philosophy, social philosophy, environmental ethics or, simply, ethics? If integrative bioethics is the approach for dealing with all these issues, questions and problems, do we even need any other approach? If we are to believe its proponents, integrative bioethics will ultimately put all other practical or applied philosophical disciplines out of work. Given its weaknesses discussed so far (but also those to be addressed in the next section), this could not be further from the truth.7
4. Integrative bioethics: The pseudoscientific features problem
A severe objection to integrative bioethics is that it has too many pseudoscientific features, especially the verbose and obscure language, a constant and unjustified self-glorification, a penchant for conspiracy theories and isolation from mainstream science.8
Verbose and obscure language is frequently used by various types of pseudoscience. Although new disciplines tend to generate new terminology and writing styles, integrative bioethics took this tendency too far. Some of its hard-to-understand phrases were already registered in Bracanović (2012), such as “phylonic responsibility”, “theoretical absurdism”, “epochal orientation” or “inductio ad absurdum”. In the meantime, integrative bioethicists––ironically, in an attempt to explain their discipline––generated a novel series of claims of the same level of unintelligibility. For example, Perušić explains:
As a paradigmatic system that possesses a kind of method algorithm, integrative bioethics determines its own horizon of problem reception based on the fundamental determinants of its cognitive and practical activity. (Perušić 2019, 385)
The multidisciplinarity, pluriperspectivity and integrativity, explains Hrvoje Jurić, were necessitated, among others things, by the fact that “we are living in the world” in which “the science of nature lost its right to philosophy”, the fact that “we are living in the world where the philosophy lost its right to poetry”, and the fact that “we are living in the world where the poetry became so marginalized that it lost any right” (2012, 86). The necessity of the integrative bioethics itself, explains Željko Pavić, follows from the fact “that life––even in its ‘non-living’ form––happens as a constant mutual overflow, fusion, separation, differentiation, rise and fall” and that “no single scientific ‘subject area’ nor any idea of life can replace or explain life itself” (2014, 585). Luka Janeš explains that
(…) integrative bioethics with its consideration of the general values of Earth’s plurality, come as a certain ‘post-technological Prometheus’ who ought to banish enclosed darkness of technicized science with the burning flame of morality governed by the principle of All-Oneness. (Janeš 2017, 47)
It is difficult not only to make sense of these “explanations”, but also to see how they all constitute explanations of the same thing (integrative bioethics).
Self-glorifying claims, as another typically pseudoscientific feature, are very common among integrative bioethicists. As indicated in the first section of this paper, integrative bioethicists have strong convictions about the historical and global importance of their enterprise, and they do not hesitate to describe it in terms like the “original and foundational concept of the European bioethics” or the “innovative and recognizable European concept of bioethics”.
An intriguing method of self-glorification is to pick great names from the history of philosophy and science and interpret them as their predecessors. For example, in their paper on German priest Fritz Jahr (credited for coining the term “bioethics” in 1927), Amir Muzur and Iva Rinčić claim that Jahr’s work “might be interpreted as an anticipation by several decades of the integrative bioethics perspectivism of Croatian bioethicist Ante Čović” (2011, 136). In her paper on Russian existentialist Nikolai Berdyaev, Marija Selak claims that his “notion of ‘new medievalism’ can be understood as the predecessor of the concept of integrative bioethics” (2009, 612). German philosopher Karl Löwith, as Selak claims in a different article, is also “a precursor and incentive to the idea of integrative bioethics” (2011, 525). Slavko Amulić claims that the work of the famous physicists Fritjof Capra “perfectly fits into the orientational framework of bioethics as the pluriperspectival area” (2007, 422). Dževad Hodžić claims that American mathematician Alfred N. Whitehead is “interesting and significant for the integrative horizon of bioethics” (2011, 296). The founding father of integrative bioethics himself, Čović, claims, for example, that “Plato’s dialogues can be read as elementary exercises in pluriperspectivism”, as well as that “for the historical-philosophical reconstruction of the pluriperspectivist understanding of truth especially important are explicit forms of perspectivism endorsed by Leibniz, Nietzsche and Ortega y Gasset” (Čović 2009, 191). The champion of self-glorification is probably Janeš (2018, 313), who talks about “the explosive power of optimism and of the scientific, life-augmenting cognitive light that integrative bioethics exudes in relation to the potential treatment of psychological suffering” (notice the hint about no less than potentially healing powers of integrative bioethics).
Integrative bioethicists desire to be seen in good company and keep up appearances. To what extent, however, is that desire justified? It is complicated to provide evidence that something is not as important as someone claims it to be (since the only evidence of the non-importance of something is the absence of evidence of its importance). Still, we can mention two pieces of indirect evidence that this self-glorification is an unjustified peculiarity of the Croatian branch of integrative bioethics.
The first evidence is the MA and Ph.D. program in bioethics at the University of Crete. As we have seen, the Croatian integrative bioethicists proudly claim that it “operates on the basis of integrative-bioethical principles”.9 However, if we examine the publicly available data about this program,10 it does not seem to have any kinship to integrative bioethics. For example, the program does not have a single course on anything “integrative” or “pluriperspectivist”, but it does have many well-conceived and bioethically relevant courses like “Conceptual foundations of bioethics”, “Introduction to modern biology”, “Philosophy of science” or “Theories of distributive justice”. As for the required literature, no publications of integrative bioethicists are mentioned and almost all courses are based on English-language (some would say “analytic philosophy”) classics like John Rawls, Tom Beauchamp, Ronald Dworkin, Helga Kuhse, Peter Singer, Bernard Williams, etc. Also telling is the following detail: Whereas Croatian integrative bioethicists claim that bioethics is about everything related to “life in all its forms, stages, phases and appearances” (Jurić 2007, 83), avoiding the language of “normativity” because it “imposes instant, one-sided solutions and thus often leads to mistakes” (Muzur 2014, 109), their Greek colleagues describe their MA and Ph.D. bioethics program in reasonable terms as “primarily the normative investigation of moral challenges resulting from developments in the life sciences and biotechnology” (emphasis added).11 Apparently, the only conceptual connection between the Crete MA and Ph.D. program with the Croatian brand of integrative bioethics seems to be the word “bioethics”.
The second piece of evidence that should make one skeptical about the self-glorifying claims of integrative bioethicists can be obtained by browsing recent German literature on bioethics and applied ethics. Why German? Remember that the internationalization of integrative bioethics occurred due to the cooperation between two groups of philosophers (Croatian and German), who, among other things, published six volumes of papers with the German Academia Verlag. Did this publishing project have any Wirkungsgeschichte in the German bioethical community? Apparently not, and if it did, it surely was not as revolutionary as integrative bioethicists would like us to believe it is. For example, in 2015, Sturma and Heinrichs (2015), in cooperation with the Deutsche Referenzzentrum für Ethik in den Biowissenschaften (DRZE), published the Handbuch Bioethik, containing entries on 28 concepts of bioethics, 46 bioethical topics and eight interfaces between bioethics and other disciplines or social areas. Integrative bioethics is not mentioned.12 This is surprising if integrative bioethics really is “the widest concept of European bioethics” (Perušić 2018, 316) and “the original and foundational concept of European bioethics” (Čović 2023, 14). Even more surprising––and somewhat ironical––is that even the closest German partners of Croatian integrative bioethicists are also not too eager to mention “integrative bioethics” in their other publications. For example, in 2018, Walter Schweidler published his Kleine Einführung in die Angewandte Ethik. In this book, Schweidler discusses many bioethically important topics (from science, technology and medicine to economy, society and environment), but he does not mention “integrative bioethics” or any of its proponents. In a nutshell, the entire integrative bioethics agenda seems to be assigned a much greater value by its Croatian proponents than by their German colleagues.
Isolation from mainstream science, according to Michael Gardner (1957), means that pseudoscientist stands “outside the closely integrated channels through which new ideas are introduced and evaluated”, does not “send his findings to the recognized journals”, in most cases “is not well enough informed to write a paper with even a surface resemblance to a significant study”, speaks “before organizations he himself has founded, contributes to journals he himself may edit, and (…) publishes books only when he or his followers can raise sufficient funds to have them printed privately” (1957, 11). Anyone familiar with integrative bioethics must be aware of the following: (1) Integrative bioethicists rarely, if ever, talk at conferences not organized by themselves or their partners. (2) Integrative bioethicists rarely, if ever, publish in journals not edited by themselves or their partners (many of their papers are published in journals Filozofska istraživanja and Synthesis Philosophica, whose editor-in-chief is Čović). (3) Integrative bioethicists rarely, if ever, publish books with publishers they do not control (almost all books on integrative bioethics in Croatia are published with Pergamena, a publishing house whose editor of the “Bioethics” series is Čović). If one searches the Web of Science database for the phrase “integrative bioethics”, it is almost impossible to find a paper published in an independent journal or by an author not a member of their circle.13 Works of integrative bioethicists are also rarely cited in papers published by non-members of their circle.14
A detail supporting the “isolation from mainstream science” thesis about integrative bioethics is that, in 2013, the Croatian Minister of Science publicly criticized prominent integrative bioethicists for abusing their positions in two journals of the Croatian Philosophical Society ( Filozofska istraživanja and Synthesis Philosophica). It was discovered that the members of their editorial boards (which is the same in both journals) published a large number of papers in these journals, facilitating thus their academic promotions (some of them even got promotions to senior positions based exclusively on papers published in “their” journals).15
A further detail supporting the same thesis is the following: In 2019, the Faculty of Humanities and Social Sciences of the University of Zagreb launched an investigation into whether Čović should have his full professor title revoked. A committee appointed for this purpose, consisting of three philosophers working in different traditions, reported, among other things, that Čović
(…) did not fulfill the prescribed conditions for promotion to the position of full professor, largely because he violated the basic and generally accepted norms of academic ethics for years, which led to the fact that, for the vast majority of his works, there is a sound suspicion that they did not undergo the necessary and impartial professional evaluation and verification before publication.16
The committee concluded that
(…) in almost 30 years of his university career (from 1976 to 2005), Professor Čović failed to publish a single original scientific article anywhere else except in those two journals in which he was the editor (in the vast majority of cases the editor-in-chief) during that period, or there was a suspicion of bias in the evaluation of his articles.17
The Faculty Council of the Faculty of Humanities and Social Sciences in Zagreb accepted this report and decided (with 47 votes in favor, 22 against and 13 invalid) to initiate the process of revoking Čović’s title.18 To make the long story short, integrative bioethicists seem pretty isolated from mainstream science and rarely exposed to independent evaluation of their ideas.19
5. Concluding remarks: Is integrative bioethics “European”?
Practical disciplines like ethics and applied ethics are relatively diverse in Croatia, encompassing analytic, continental and neo-scholastic approaches. Still, integrative bioethics is undoubtedly the most widespread and visible. Only integrative bioethicists run a number of regional centers (and the independent Centre of Excellence), at least two philosophical journals, a regular annual conference, a bioethics book series with an independent publisher––they even managed to introduce their bioethical teachings into the ethics curriculum for high schools.20 Such an expansion of integrative bioethics in Croatia can be explained either by the fact that bioethics is an attractive field in itself or, alternatively, by the programmatic promise of integrative bioethicists that everyone (philosophers, theologians, physicians, artists, even laypersons) has a guaranteed place at their pluriperspective “round table”. A complementary explanation (for which there is not enough space here) would be a kind of “sociology of integrative bioethics” examining possible connections between the expansion of integrative bioethics and the academic and political positions held by its proponents during the past 30 years in Croatia (ranging from ministers and deputy ministers of science, over university vice-rectors and heads of philosophy departments, to members of various committees in charge of things like government subsidies for scientific books and journals or academic promotions).21
All in all, there is no doubt that this curious spread of integrative bioethics in Croatia is not a testimony that integrative bioethics is a “developmental shift” that “transferred bioethics from the United States to Europe” or the “original and foundational concept of European bioethics” or the project that “Europeanizes bioethics” by “regenerating the spiritual potential of the European philosophical heritage”. In Croatia, the adjective “European” is frequently (mis)used as a “virtue signal”, intended to indicate that some enterprise has transcended the local context and become globally known and appreciated in terms of accomplishing either European quality, European reception or European identity. We can complete our discussion by summarizing how integrative bioethics fares concerning these three levels of its hoped-for “Europeanization”.
It should have become evident by now that, judging by its accomplishments, integrative bioethics does not deserve the “European” label. Here is just a selection of keywords that should remind one of its theoretical shortcomings: absence of normativity, inconsistency, poorly defined scope of problems, not addressing concrete bioethical issues, verbose and obscure language, constant and unjustified self-glorification, low scholarly standards, isolation from the mainstream science. Why have they failed, in nearly three decades, to publish anything of bioethical significance? An educated guess could be that their research program was designed and controlled by latecomers to bioethics who spent the formative years of their academic careers working in a typically Marxist-socialist paradigm, who were strangers to English-language (bio)ethical literature, and who continued to apply their old patterns of murky reasoning to newly discovered bioethical issues. Of course, their younger colleagues and students could perform much better by engaging with more recent bioethical debates and literature. Yet, it seems they may have succumbed to self-censorship and decided not to go beyond the standards set by the founders of the movement. This is probably one of the reasons why integrative bioethicists never apply their allegedly unique methods to concrete bioethical problems but remain focused on the eternal “laying of the foundations” ( Grundlegung) of their discipline. This is a strange destiny for an allegedly revolutionary school of bioethics. Instead of becoming inherently practical, focusing on specific problems created by science and technology, integrative bioethics remains highly theoretical, focusing predominantly on itself.
Integrative bioethicists, as we have seen in the first section, unabashedly claim that their brand of bioethics is the “original and foundational concept of the European bioethics” and a “striking development of the bioethical discipline in Central and Southeastern Europe in the last thirty years” that “encompassed the entire European context”. In the third section, however, we could see that such claims are way too exaggerated, not only because most activities of integrative bioethicists (especially of their Croatian branch) are always limited to the same circle of scholars organizing conferences, summer schools, round tables and lectures with more or less the same circle of participants, not only because they typically publish their papers and books only in venues they control, but also because the standard reception of integrative bioethics, in terms of its advocates being cited in publications by independent scholars, is practically non-existent. (Moreover, as we could also see, even their closest foreign partners omit to mention integrative bioethics in their other publications and projects.) Integrative bioethicists have a stable collaboration with scholars and institutions from several European countries, but that is “business as usual” that many scholars from Croatia and neighboring countries are engaged in without claiming any European glory. Integrative bioethics, therefore, has no recognizable European reception because the belief in its “epochal” role rarely travels beyond the narrow circle of their main proponents.22
Finally, although integrative bioethicists claim that they are “Europeanizing bioethics” by “regenerating the spiritual potential of the European philosophical heritage”, nothing in their writings justifies such a claim. Ironically, if one takes a closer look at the philosophical heritage they most frequently invoke, it does not seem particularly European or, for that matter, particularly philosophical. Integrative bioethicists frequently point out, for example, that their position has “footholds” in the work of V. R. Potter. However, Potter was neither European (he was American) nor a philosopher (he was a biochemist and oncologist). They also frequently invoke the ideas of Aldo Leopold, although he was also an American and non-philosopher (his education was in forestry). They are particularly keen, as we could see in the second section, to find their “predecessors” or theoretical allies amongst a heterogeneous group of thinkers, like American mathematicians and physicists, Russian existentialists or German pastors. Although this group also includes several German philosophers, this is too meager and unsystematic to justify any talk of a unique European identity of integrative bioethics.23 In a nutshell, integrative bioethics turns out to be a blind alley of European bioethics.
Acknowledgments
This paper was produced within the project “Ethics and Social Challenges” at the Institute of Philosophy in Zagreb, monitored by the Ministry of Science, Education and Youth of the Republic of Croatia and financed through the National Recovery and Resilience Plan 2021–2026 of the European Union––NextGenerationEU. I am grateful to two anonymous reviewers for the European Journal of Analytic Philosophy for their valuable comments.