Critical Theoretical Methodology for Nonideal Contributions to Bioethics

Abstract

Karl Marx argued that the preferable starting point for influencing social practices is to understand their workings—not to simply moralize social systems through idealization. This thread in Marx informs contemporary critical social theories such as feminism and critical race theory. Such work attempts to diagnose and analyze internal contradictions, limitations, and dysfunctions in social structures as they actually are in order to connect them to normative dissatisfactions in lived experience. This critical theoretical methodology thus embodies what Charles Mills calls for in nonideal explanatory models that abstract without idealizing. In this chapter I argue that Marx’s theory of society, which informs his critique of political economy in Capital, offers bioethics a nonideal framework through which to analyze normative dissatisfactions in health care practice. What may appear to be moral problems or dilemmas in health care can be the result of, or significantly influenced by, structural patterns in health care’s material production—not its abstract moral content. Therefore, understanding health care structurally, as a set of productive practices within a larger systematic whole of capitalist production, can help diagnose systemic dysfunctions in health care’s material production that produce or make worse normative dissatisfactions of concern for bioethics. I call such morally significant structural dysfunctions social pathologies of health care, and contend that a Marx-informed bioethics can descriptively theorize structural bases of moral discontent and conflict in health care, and therein inform its social and political transformation for the better.