This special issue of Nordic Journal of Applied Ethics is dedicated to the work of Icelandic professor of philosophy, scholar of bioethics and medical ethics, Vilhjálmur Árnason. The recent retirement from his longtime workplace in University of Iceland, Faculty of Philosophy and from chairing of the work of Centre for Ethics is an excellent opportunity for a celebratory yet critical engagement with his academic corpus.

 

A long and productive academic career, whilst certainly significant and valuable, is in itself perhaps not a sufficient reason for a dedicated special issue. The rationale, in the case of Prof Vilhjálmur¹, lies in the remarkable interdisciplinary range and practical impact of his research (Vilhjálmur 2005). For the readers of the Nordic Journal of Applied Ethics it is the bridges he has built between the domains of healthcare, social policy and philosophy that are most relevant. The foundations for Vilhjálmur’s writing have been decidedly philosophical but he has long fruitfully explored cross-disciplinary methods in helping to untangle and solve practical bioethical problems as well as topics of wider social concern – like his work on exploring the causes and implications of the Icelandic financial crises 2008-2011(Vilhjálmur 2018). In addition to introducing and contributing to bioethics on Iceland, Vilhjálmur has strongly promoted Icelandic bioethics internationally (Vilhjálmur 2010).

Bioethics and applied ethics have long faced criticism for their predominantly individual-centric focus. Vilhjálmur’s work has consistently examined how the interplay between the cultural, economic and other social domains impacts on the ethical discussions regarding research, healthcare ethics and governance. He has been a tireless promoter of the concept and practice of solidarity, so crucial for the European health care systems, and has at length discussed the implications of biobanking and personalized medicine for its future (Vilhjálmur et al. 2004). Moreover, he has contributed to reinterpreting a foundational concept of human dignity – which forms the basis of ethical and social regulation in Europe and beyond – within new technological contexts (Vilhjálmur 2004, 2021).

 

The firmly social nature of human existence has been a fundamental conviction of Vilhjálmur throughout his various writings, regardless of the particular field he is writing about. An example of this pertains to the work that he published on Icelandic sagas where, combining the analytic tools of literature and moral philosophy, he offered a socially rooted reinterpretation of the traditional individualistic values usually associated with heroic stories of the past (Vilhjálmur 1991). Incorporating insights from political philosophy, he developed original ways of conceptualizing the role of scientific citizenship for the purposes of ethical research governance, especially as applied to biobanks and personalized medicine (Vilhjálmur 2013).

 

Vilhjálmur’s work is a nuanced example of applied ethics and the role of an ethicist taken seriously. His legacy lies in his ability to connect foundational philosophical concepts and methods with practical ethical challenges, contributing thus towards governance that is explicitly ethical. He has stood, in his writing as well as in his activities, for ethical integrity, for relationships that are built upon public trust and in which care and attention is given for ethical considerations.

 

Reflections on his work over the last decades also offer a chance to reassess the usefulness of certain theoretical frames for bioethics. This special issue offers a chance to critically rethink a selection of these broader but nonetheless fundamental issues for bioethics and bioethicists in Northern Europe. An open call for papers by this journal has now resulted in four peer-reviewed submissions and a response by Prof Vilhjálmur.

 

Margit Sutrop’s contribution discusses Vilhjálmur’s critique of the individualistic focus of contemporary bioethics, particularly the “four principles approach”. Vilhjálmur is urging bioethicists to consider political and social contexts in their evaluations and to engage in public deliberation on new technologies, thus better integrating both personal and political dimensions in bioethics. Vilhjálmur has argued that individual-centered bioethics often fails to address the broader social implications of emerging technologies and advocates for an ethical framework that includes collective values like solidarity, emphasizing the interconnectedness of individual moral agency and socio-political context. Sutrop contends that moral disagreements are inevitable due to varying ethical theories and sociopolitical influences on individual decisions and suggests that bioethicists should recognize these complexities in their work and in their roles as scholars.

Henrik Lerner’s article studies the ethics of dialogue in Vilhjálmur's work and then applies it in quite a different context, specifically that of One Health. His aim is to construct, with the help of Vilhjálmur, a normative argument about the necessary criteria for ethical dialogue in a multicultural context. The paper highlights the necessity of proper pre-framing, sufficient time for discussions, and addressing of power dynamics to create a fair and reciprocal dialogue, suggesting that these criteria can strengthen ethical discussions and promote the inclusion of marginalized groups.

Bjørn Hofmann follows Vilhjálmur’s approach to provide alternatives to informed consent, where consent has turned out to be difficult or illusory to obtain. Hofmann explores the options of giving authorizations. Where Vilhjálmur has explored the use of authorization for biobank research and future use of health data, Hofmann elaborates and extends this for a wide range of person-related biological entities, such as cell lines, organoids and xenografts. Hofmann argues that the authorization approach suggested by Vilhjálmur deserves more attention than previously given, especially for addressing new forms of biotechnological research.

In her contribution, Svava Sigurðardóttir discusses the evolution of Vilhjálmur's book "Ethics of Life and Death" over its three Icelandic editions, highlighting its focus on ethical decision-making in healthcare. Throughout all editions, respect for human beings and the importance of dialogue remain central, with an increasing prominence of care and virtue ethics apparent. While his main ideas have remained consistent, a gradual move towards a more nuanced conceptualization of autonomy (as relational) and the significance of situational contextualization in ethical decision-making is noticeable. To quote from Vilhjálmur, via Sigurðardóttir: “Ethical principles without situational judgment are empty, but moral intuition without knowledge of general duties and values is blind” (Vilhjálmur 2023). The book continues to be a significant contribution to ethical reasoning and decision-making in Icelandic healthcare.

Finally, we are pleased to have Prof Vilhjálmur respond to the commentators and take this opportunity to expand on some of the central themes in his work. The enduring challenge of balancing the normativity of ethics with the powerful meaning-making social and cultural contexts requires continuous reflection, regardless of whether the changes are occurring in politics or biomedical research. He is also clear about how his thinking has evolved over the years, as demonstrated by the discussions on the appropriate format and role of consent in contemporary biomedical research, as well as on the opportunities and perils of scientific citizenship and public deliberation. Running through these diverse theoretical and practical reflections is one enduring conviction: the vital role and responsibility of an ethical thinker.

Last but not least, we would like to highlight the work that Prof Vilhjálmur has done in bringing together scholars of bioethics and medical ethics in the Nordic-Baltic area. In 2009 the Nordic Network for Philosophy of Medicine was funded by Nordforsk, spearheaded by Prof Lennart Nordenfelt. In 2011 the funding ran out but despite that the forum for the bioethicists and philosophers of medicine of the area continued to function. A small but dedicated group of scholars from Sweden, Lithuania, Iceland, Norway, Latvia, Finland, Denmark and Estonia has continued to meet annually since then. The Nordic-Baltic Network for Philosophy of Medicine is informal and centrally unfunded but has succeeded in meeting every year (with the exception of the Covid year of 2020). Vilhjálmur Árnason as head of that network has played a crucial role in ensuring that those meetings – where one of the central aims has always been to provide an informal and friendly venue for early career researchers – continued despite all obstacles.

In addition to the authors and reviewers of the special issue we would like to thank the core group of scholars from the Nordic-Baltic Network for Philosophy of Medicine for their continued dedication to the network and for their support with this special issue: Signe Mezinska and Ivars Neiders from University of Latvia, Vilius Dranseika from Jagiellonian University, Eugenijus Gefenas from University of Vilnius, Pekka Louhiala from University of Tampere, Henrik Lerner from Marie Cederschiöld University and Gardar Árnason from University of Akureyri.

Notes

¹ In Iceland the surname – Árnason – is a patronymic and a description rather than a name. Icelanders use and are known by their given name. This practice is followed throughout this special issue and Vilhjálmur Árnason will be referred to as Vilhjálmur when citing his works.

 

References

Gardar Árnason, Salvor Nordal, & Vilhjálmur Árnason (2004). Blood and data: ethical, legal and social aspects of human genetic databases. University of Iceland Press & Centre for Ethics.

Vilhjálmur Árnason (1991). Morality and Social Structure in the Icelandic Sagas. The Journal of English and Germanic Philology, 90(2), 157–174. http://www.jstor.org/stable/27710482

Vilhjálmur Árnason (2004). Dignity and Dialogue in the Patient-Professional Relationship. Laguna: Revista de Filosofía(14)

Vilhjálmur Árnason (2005). Sensible discussion in bioethics: Reflections on interdisciplinary research. Cambridge Quarterly of Healthcare Ethics, 14(3), 322-328. CrossRef

Vilhjálmur Árnason (2010). Bioethics in Iceland. Cambridge Quarterly of Healthcare Ethics, 19(3), 299-309. CrossRef 

Vilhjálmur Árnason (2013). Scientific citizenship in a democratic society. Public Underst Sci. 22(8):927-40. CrossRef 

Vilhjálmur Árnason (2018). Have Icelanders Learned Their Lesson? The Investigation of the Icelandic Collapse and its Aftermath. In Throstur Olaf S., Schwarzkopf, D.L. and Bryant, M. (Eds.) The Return of Trust? Institutions and the Public after the Icelandic Financial Crisis (pp. 173-193). Emerald Publishing Limited.

Vilhjálmur Árnason (2021). In defense of dignity: Reflections on the moral function of human dignity. Bioethics, 35(1), 31-39. CrossRef

Vilhjálmur Árnason (2023). Siðfræði lífs og dauða. Heilbrigðisþjónusta, rannsóknir, lýðheilsa. (3rd ed.) Háskólaútgáfan