A Rich BioethicsPublic Policy, Biotechnology, and the Kass CouncilAdam BriggleUniversity of Notre Dame Press, $30, 240 pp.
In the apocalyptic closing lines of After Virtue, Alasdair MacIntyre worries about the contemporary West’s decline into moral barbarism.
If my account of our moral condition is correct...we ought also to conclude that for some time now we too have reached that turning point [from civility to barbarism].... This time however the barbarians are not waiting beyond the frontiers; they have already been governing us for quite some time.
According to MacIntyre’s narrative, we face a stark choice: Aristotle or Nietzsche. Either we can return to a teleological conception of human nature and remember the importance of the virtues in human communities, or we can slide still further into the muck of a Nietzschean nihilism. If the former, what matters is that we build communities of virtue and civility capable of sustaining intellectual and moral life. Thus, in the final sentence of After Virtue MacIntyre writes: “We are waiting not for a Godot, but for another—doubtless very different—St. Benedict.”
Anyone familiar with MacIntyre’s narrative of decline and hoped-for renewal is likely to be struck by the similarities with this account of Adam Briggle’s depiction of contemporary bioethics in A Rich Bioethics. In Briggle’s view, bioethics is in disarray largely because it has succumbed to what he calls “instrumentalism.” Although he never fully defines instrumentalism, Briggle sketches a set of views about nature, rationality, and the self that is decidedly modern and characteristic of instrumentalist thinking.
For instrumentalists, nature is nonteleological and therefore provides no moral guidance; values are largely personal preferences; and the self is atomistic and presocial. Given these commitments, instrumentalists settle for a “thin” bioethics. They do not engage in substantive debate about the ends of human life but instead rely on procedural accounts of justice and autonomy when confronting new technologies in medicine and science. They are inclined to a language of rights and risks but shun comprehensive visions of the good. What Briggle calls a rich bioethics is substantive and holistic. It “explicitly describes and evaluates ends, goods, or perspectives on the meaning of being human and living well.” Unlike the instrumentalists, proponents of a rich bioethics understand the self to be communal and embodied.
If the terms of this contrast seem tendentious, that’s because they are. Briggle describes instrumentalism as exclusionary, partial, formalist, isolationist, and undemocratic, while rich bioethics is robust, holistic, and, well, rich. It “sheds light” where instrumentalism “casts shadow.” Briggle grudgingly concedes that there is a place for instrumentalist approaches in bioethics, but the Manichean cast of this volume is unmistakable. The book is populated with heroes and villains. Heroes include Aristotle, Plato, C. S. Lewis, and Hans Jonas, while Kant, Mill, Sartre, and Rawls are cast as villains. Who plays the role of the latter-day St. Benedict? None other than Leon Kass, the first chairman of President George W. Bush’s Council on Bioethics (PCB).
The volume is divided into two parts. In the first part, Briggle sketches the history of public bioethics committees in the United States and argues that instrumentalist approaches to policy issues dominated (and marred) the work of most of these committees. He examines the work of the Kass council and suggests that it provides a model for a different kind of bioethics, one rooted not in questions of procedural justice but in a humanism that wrestles with issues about the meaning of human life. The second part of the book examines the many charges of partisanship and politicization that were lodged against the Kass council. Some of those charges, Briggle believes, resulted from a failure to understand that Kass was conducting an experiment in a humanities-based approach to bioethics. When the first meeting of the PCB involved a discussion of Nathaniel Hawthorne’s short story “The Birthmark,” many complained. The well-known physician Jerome Groopman remarked that the council might want to begin with facts rather than with fiction.
Other attacks on Kass and the council, however, were rooted in political and moral disagreement and designed to delegitimize the council’s work. Briggle examines three charges in particular: that individual council members were not reappointed after disagreeing with Kass; that in some instances members were not able to express their dissent in council reports; and that Kass had conflicts of interests that interfered with his role as council chair. Briggle concludes that, while there were some instances of politicization that gave rise to legitimate concern, the charges were mostly “off the mark and reflected more the polarized climate of American bioethics and politics than the actual structures and procedures of the council or the behaviors of its members.”
It’s a shame that a lot of A Rich Bioethics reads like a medieval morality play, for there is much of value in Briggle’s book. His examination of the history of public bioethics committees in the United States and his effort to situate the Kass council within this history is important. His case for the Kass council’s humanities-based approach to bioethics is compelling. And I agree with Briggle that Kass and the council were often unfairly criticized, and that the council produced an important body of work. Like Briggle, I would like to see more bioethics work confront questions of meaning and value that can’t be answered with a utilitarian calculus. I, too, believe that bioethics would be strengthened by the inclusion of more religious voices.
But because of the book’s polemical undertone, I can recommend it only with caution. Its account of what it calls the instrumentalist view is a caricature. Praising the council’s report Beyond Therapy, Briggle writes: “A well-balanced, integral—that is, healthy—life that resonates in tune with the world is the goal, not a life of untroubled ease divorced from reality.” But who exactly is advocating a life of untroubled ease divorced from reality? If you can get beyond this sort of facile characterization, A Rich Bioethics is well worth reading. If nothing else, it offers a model for public ethics committees that merits serious consideration.