The subject and power of bioethics

Abstract

Summary The present paper argues that late work of Michel Foucault is helpful in understanding contemporary bioethics. Specifically, Foucault's writings on biopower and subjectivity are increasingly relevant as we consider the intersection of public policy and clinical ethics in a socio-political context increasingly structured by the demands of neoliberalism. Although Foucault's earlier work on the clinical gaze has been important to bioethics, that is no longer as important as his later, incomplete research into power and subjectivity. The paper develops this argument in four steps. In the first, I look at a classic phenomenological approach to clinical bioethics by Richard Zaner, starting from which I develop a Foucauldian perspective. In that section, I also offer a basic outline of what I take Foucault's primary theoretical contributions to be by way of an initial explication of the biopower-subjectification nexus. The following two sections of the paper present exemplary applications of Foucauldian theory to two areas at the intersection of public policy and clinical bioethics. The first is the procedure for testing women for the BRCA1/2 mutations, mutations that impose on carriers a significant risk of developing breast and ovarian cancer. A comparison between American and Dutch practices underscores not only the new ways that genetic testing interprets the body, but also the importance of local political and cultural contexts for understanding how the test is presented, administered and managed. The second is a consideration of the intersection of employee wellness programs and wearable technologies. In it, I develop Foucault's thought that subjects in the Christian West have long been encouraged to understand themselves confessionally, offering to authority figures the “truth” about themselves. I then interpret the compulsory use of wearables as a verification strategy for compliance with wellness programs as exemplary of such confessional strategies. The final section ties the discussion back to the clinical encounter as Zaner formulates it as an inherently moral encounter structured by vulnerabilities that matter for understanding the selfhood of patients. Based on the preceding examples, I make the case that American understandings of selfhood are increasingly separated from any sense of publicness and that this structuring of selfhood is of increasing importance in framing and adequately understanding bioethics today.