Bioethics, Our Crowd, and Ideology

Abstract

Not long ago, Philippe Lazar, Director General of the French biomedical agency INSERM - the equivalent of our National Institutes of Health - complained about the impact of bioethics in his country. Not only, he said, has it led to restrictive legislation, smothering a diversity of ethical opinion because of the fears of a minority, it has also over-emphasized the potential abuses of scientific knowledge rather than the new possibilities it offers. I read that news with a sigh of nostalgia. They used to say that about us. Not any more. In this country those who would legitimate morally controverted scientific research long ago learned how to put together commissions and panels to include sympathetic and progress-affirming ethicists. In the early days of bioethics there was an interesting debate between the views of Joseph Fletcher - who never said no - and those of Paul Ramsey - who usually said no and who argued that the capacity to do so was a test of moral seriousness. It appears that Fletcher won the day. While bioethics creates problems now and then for mainstream, right-thinking trends, it mainly serves to legitimate them, adding the imprimatur of ethical expertise to what somebody or other wants to do. It is hardly likely that the National Institutes of Health (NIH) Human Genome Project would have set aside 5 percent of its annual budget for the Ethical, Legal, and Social Implications program if there had been even the faintest likelihood it would turn into a source of trouble and opposition; and it indeed hasn't. Now my generalizations are not wholly reasonable or fair. It is by no means the case that all forms of biomedical research deserve a "no"; most in fact merit a moral defense. Nor is it the case that everyone in bioethics is a patsy, easy to co-opt into the service of biomedical aspiration. Though she was a cochair of the NIH embryo research panel, Patricia King boldly opposed its recommendation that embryos be created for research purposes. I have no doubt, moreover, that many of those ethicists who give out what Richard John Neuhaus has called "permission slips" are as serious, as full of gravilas, as those who say no. Only the morally smug could think all virtue is on one side or the other in most bioethical debates. Yet even as I concede these points I remain uneasy. While they thankfully have little of the nastiness that marks the larger moral struggles of our society, the bioethical debates are beginning to reflect those culture wars. Isn't it increasingly easy to predict the "expert" views of bioethicists knowing only their age, religious convictions (or nonconvictions), educational background, and social class? This first became evident in the abortion debate but has now spread to physician-assisted suicide, fetal tissue and embryo research, surrogate reproduction, and assorted other issues. It is not, it seems, ethical theory of the kind bioethicists like to include in the textbooks that makes much difference, but plain old-fashioned ideology - whether one is, to paraphrase Gilbert and Sullivan, "acculturated as a little liberal or a little conservative." Perhaps this was inevitable once bioethics entered the mainstream, becoming a respectable part of the biomedical establishment. Bioethics ceased being a cultural curiosity, or a neighborhood crank, and became an accommodating handmaiden. Its practitioners came in with the trappings of the culture around them. In any case, few can say no all or most of the time over many years without a loss of credibility, and it gets wearisome in any case. I do not by any means exclude myself or The Hastings Center from this observation. We courted legitimacy, sought money from the big foundations, tried to make it in the higher reaches of academia, and endlessly worked to persuade physicians and biomedical researchers that we should be seen as allies and not opponents. That was not a pose. We felt that way and worked to convey that feeling. …