What is "Bioethics"? pg.7

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XI. The Penetration of Bioethics

Regardless of a multitude of failings and flaws, these bioethics principles of autonomy, justice and beneficence have been used -- as originally defined -- as the explicit basis for many major public policies,160 governmental regulations, private sector and industry guidelines, even international guidelines still in use today - e.g., the federal OPRR regulations on the use of human subjects in medical research, The Common Rule, Institutional Review Board Guidebooks, Hospital Ethics Committee Guidebooks,161 most policies for hospitals and other health care facilities, the international CIOMS/WHO Guidelines for the use of human subjects in Third World countries, etc. That is, these bioethics principles are explicitly defined in these documents in the same way as they were defined in The Belmont Report and by the early bioethicists, e.g., Beauchamp, Childress, Walters, etc. These bioethics principles also now literally redefine the "ethics" of other disciplines, e.g., business ethics,162 and ethics in engineering.163 Even our country's military schools have restructured their ethics courses and have essentially reduced them to courses in bioethics (often using many of these same bioethicists as their professors). Many colleges and universities already require a course in bioethics in order to graduate, and most medical and nursing schools have incorporated it in their curricula. Bioethics is even being taught now in the high schools. And what is being taught as bioethics are the Belmont principles, or renditions of one or more of these principles as defined in Belmont terms. Nods may be given to "alternative" propositions here and there, but in the end it is the language of principlism which sets the standards.

Bioethics has also influenced the law164 and the media.165 It is now often even referred to as "federal ethics"166 because of its federal origins and its application in public policy making. (Indeed, the web address for NBAC is "bioethics.gov"). As Jonsen remarks, "'Federal ethics' became a significant source of opinion in bioethics as public moral discourse took place not only on federal premises but also in state agencies, professional societies, institutional committees, and public forums."167

Bioethics is now international. As of 1997, there is an International Association of Bioethics, whose founders were Australian bioethicists -- their first president being Peter Singer. The Council for International Organizations of Medical Sciences (CIOMS), associated with the World Health Organization and UNESCO, has demonstrated interest in bioethics for decades now, and has issued international guidelines on many topics, including transplantation, the definition of death, and human research. Since 1985, the Council of Europe has had a Committee of Experts on Bioethical Issues, which with wide international consultation, composed a Convention for Bioethics containing guidelines on major bioethical issues. UNESCO formed an International Bioethics Committee in 1993. The European Community and its legislative arm, the European Parliament, have formulated bioethics policy and sponsored bioethical studies. Centers and institutes of bioethics exist worldwide, "from Bonn to Beijing, and from Bangkok to Buenos Aries", as Jonsen quips. The 1994 UNESCO Directory lists 498 such centers outside of the United States.168

C. Is Bioethics A "Discourse"?

X. Bioethics: Discipline or Discourse?

So, what is bioethics? Is it a legitimate "science", an academic field with it's own proper subject matter and method, and therefore with its own proper "experts"? It is the same as "ethics per se", or as "medical ethics per se"? Or is it something else?

A. Does Bioethics Have a Proper Subject Matter?

In observing even the little presented above, the answer is obviously "no"; bioethics does not have a proper subject matter. From the very beginning, as the historical details and documents have demonstrated, bioethics is a very recent sub-field of normative philosophical ethics which was created by the National Commission in 1979 in its Belmont Report -- by mandate of the U.S. Congress.

But it's normative "theory" has been proven to be theoretically and practically defunct -- even by many of the Founders of the field themselves, as well as by others inside and outside the field. Its "ethical principles" are theoretically indefensible, and practically impossible to logically and coherently apply. It never did and never could have had a well-defined subject matter that could pass the muster of serious critical academic evaluation -- on any level. Yet it continues to be understood, taught and applied as "principlism", and its "experts" continue to flood the halls of health care facilities, courts, congress and government departments and agencies.

Precisely because of the inherent failure of the "Belmont principles", eventually many other "voices" within bioethics, and "outsiders" who were interested for one reason or another, were brought into the fray. Today "bioethics" is in fact a disunified "polyglot" of many different systems of ethics, theology, philosophy, politics, commerce and federal government. As Jonsen puts it:

We return to the question, "is bioethics a discipline? In the simplest sense, it certainly is. A discipline is a body of material that can be taught, and bioethics is and has been a teachable and taught subject since the mid-1970's. In the strictest sense, it is not a discipline. A discipline is a coherent body of principles and methods appropriate to the analysis of some particular subject matter. Bioethics has no dominant methodology, no master theory. It has borrowed pieces from philosophy and theology. Its theological pieces are the secular remnant of the sanctity of the person, the urgency to examine human experience in light of some sort of transcendent values, and the concern to translate those values into practical life. It adopted several pieces of philosophy: the relatively recent division of ethical discourse into two normative theories, deontological and consequentialist, and the modern version of traditional contract theory. It also took another philosophical piece that is largely methodological, namely, the critical work of casting questions in logical form and inquiring about the premises behind them. In addition to these philosophical and theological pieces, fragments of law and the social sciences have been clumsily built onto the bioethical edifice.169 (emphases mine)

It would seem rather disingenuous, however, for Jonsen to try to duck the question by defining "bioethics" now as a "discipline" in the "simple sense" rather than in the "strict sense". Either bioethics is a valid discipline -- with its own valid proper subject matter, ethical principles, method and experts -- or it isn't a proper discipline at all.

B. Does Bioethics Have A Proper Method?

The answer again is "no"; bioethics does not have its own proper method. The method of bioethics from the beginning has likewise been controversial, controverted, and "polyglot". This is not new, as Jonsen would seem to suggest. It has recently simply become more "polyglot" -- a condition actually viewed enthusiastically by Jonsen: "The notion of a discipline as a body of principles and methods surrounding a dominant theory is attractive, but probably an archaism. Academic disciplines today are mosaics of theories, with principles and methods formulated in diverse ways."170

In fact, however, its classroom "method" usually consists of the Harvard Law School rendition of the legal method of case studies, "evaluated in the light of one or another of the bioethics principles."171 But a legal does not an ethics method make; nor can the law fundamentally tell us what is ethical or not. And yet once again, by what justification is one bioethics principle chosen over either of the other two bioethics principles so as to "enlighten" us as to what is "ethical" or "not"? Haven't we been here before?

C. Is Bioethics A "Discourse"?

It is precisely because bioethics never could sustain the inevitable criticisms that emerged that many bioethicists now prefer to divert attention away from such failures and blithely try to claim that bioethics is "just a kind of public discourse", rather than a formal academic discipline. As Jonsen states, bioethics is "public discourse carried on by many people in many settings".172 Such "discourse", it is argued, is more "democratic" and appropriate in our multi-cultural pluralistic society. "Consensus ethics", as fostered early on by the likes of Gustafson, is the rage -- as if it is more morally "neutral" and therefore more "democratic" than other ethics systems.

But "consensus ethics" too is normative -- it takes a stand on what is ethical or not ethical. And as already expressed and documented, bioethics committees and commissions have not been and are not now so "democratic" and "innocent", thus calling into question the "moral" and "democratic" legitimacy of their "ethical" conclusions. In fact, it can be argued that bioethics has appropriated the "democratic process" instead, deconstructing it and using it simply as a mechanical means by which to determine beforehand the conclusions desired that will advance the latest bioethics agenda. It is, let us not forget, the Belmont principles which are articulated and expected to be followed in these "democratic" settings -- not the "opinions" of the people. And the "majority" of its members are usually bioethicists and their associates. If bioethics wants to call itself just a "discourse", it must frankly admit at least that it is a very ideologically driven one. And "democratic" it is not.

D. Are Bioethicists "Experts"?

As pointed out elsewhere,173 only a very tiny percentage of "professional bioethics experts" have any formal academic degrees or credentials in bioethics at all, and even for those few that do there is no uniform or standardized curriculum, most teachers don't really know the subject matter themselves, the courses vary from institution to institution, there are no local, state or national boards of examinations, and no standardized professional responsibilities are required. There is not even a code of ethics for bioethicists. Most "bioethicists" by far have never taken even one course in bioethics. It would seem that bioethicists are not "experts" in the serious sense of that term.

But if bioethics is just a "discourse", then why are its practitioners still referred to and regarded as "experts"? Or perhaps this is one way to maintain the influence of an "expert" without having to be held accountable for really being one. If bioethicists are simply "discoursers", then they are really not "experts" in anything, other than "discoursing".

E. Either/Or:

It seems to me that you can't have it both ways. Either bioethics is a serious legitimate proper academic discipline, or it is just a "discourse". Either it is "ethics", or it is "discourse". And it's practitioners are either "experts" or they aren't. If bioethicists themselves don't know what their field is, and what they are experts in, who does?

Questions abound. If bioethics is not strictly a discipline but only a "discourse", then why are so many federal regulations and laws based on the Belmont principles, which principles are required to be followed by Institutional Review Boards, Hospital Ethics Committees, and untold numbers of other similar groups and organizations? And if bioethics is just a "discourse", then why have the Belmont principles been incorporated into a plethora of national and international codes and laws? If bioethics is just a "discourse", then why is public policy still being based on these normative Belmont principles? If even only one or two of the Belmont principles are being used in a particular setting, they are still being used as defined and taught by the Belmont bioethicists -- as normative, as "ethics", and therefore as not "neutral". If bioethics is just a "discourse", it would seem logical that it's "discoursers" should admit that they are not professional ethicists or ethics experts, and graciously step down from their positions as "international moral gurus", removing themselves from all the power and influence normally reserved for real experts -- especially in legal, health care, and public policy making areas. Relatedly, either they are legally accountable as other "experts", or they aren't. If bioethics is just a "discourse", then it is also time to urgently rewrite all of the federal and private regulations, laws, etc., which are explicitly or implicitly grounded on these Belmont "ethical" principles or any rendition of any one of them. If bioethics is just "discourse", then it is clearly not ethics or medical ethics -- much less Catholic medical ethics.

And why are we even talking about "ethics"? Whose "ethics", and which "ethics"? I would suggest that perhaps this was at least another of "the small error in the beginning" that has led to this "multitude of errors" in which we find ourselves today.


Jonsen refers to the "savants" in the early history who "spoke in the language of science." They were obviously not welcome at the bedside. And it is understandable why the earliest bioethics wanted to check the arrogance of such physicians and researchers who had caused horrific abuse of human subjects in research by providing input from those outside these fields who might bring to the table other relevant "values" to consider. But it was naive, at least, to think that philosophers, theologians, politicians and others would not themselves become just as arrogant and create in turn a "secular ethics" which was just as unfair and unbalanced. Today instead we have the arrogance of "savants" who "speak in the language of bioethics" -- the "strangers at the bedside" of whom Rothman wrote.174

This has resulted not only in the politicization of "ethics," but in the politicization of medicine and science as well -- including and especially the science of human embryology. Scientific facts are now to be determined to be factually true or false by "democratic" representatives with absolutely no expertise in those fields, using a "democratic" process of "consensus" in place of the scientific method proper to the lab. Science itself has become "relative," depending on a public or political "consensus" for its verification. The consequences for health care and public policy alone will be profound.

But more disturbing is the possibility that in a deep sense we have really come full circle. It was not just the "arrogance" of the early physicians and scientists that resulted in the systemic abuse of so many human subjects in research, but often the arrogance of physicians and scientists of an essentially eugenic mindset. Much as we have tried to "distance" ourselves from the eugenic atrocities of the Nazi era and similar more recent events, our official "silence" on eugenics in the academy and elsewhere has served only to blind us to its creeping acceptance in principle in the corridors of academe and government. Has "an Eugenic Age" indeed finally arrived, or is it still just the stuff of sci-fi novels? One only has to hear the many voices of many of the current leaders of the bioethics community around the world to ascertain an accurate answer. But that assumes that we know who these bioethics leaders are, and that we listen to what they are saying.

The "stranger" at the bedside may be more odious than we want or are prepared to acknowledge. Might that really account for Jonsen's "silence" as he abruptly and prematurely halts his history of the "birth of bioethics"? Is bioethics today the golden brick path to the eugenics of the 21st century? Can we afford to remain distant and silent any longer, or do we wait until it is no longer even possible to raise the question, as has happened before? I ask you.

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