The History and Future of BioethicsA Sociological ViewJohn H. EvansOxford University Press, $45, 199 pp.
John Evans’s engaging new work, The History and Future of Bioethics, assesses a discipline—and a profession—in crisis.
In a recent New York Times piece, the philosopher Colin McGinn suggested that the academic discipline of philosophy faces a sort of identity crisis. Those outside the academy think of philosophy as the exploration of matters of wisdom and meaning, while actual philosophers understand their work very differently. McGinn suggested a radical resolution—dropping the name “philosophy” and replacing it with a new one. “The present name,” he wrote, “is obsolete, misleading, and harmful.”
Something very much like this diagnosis is applied to the field of bioethics in sociologist John Evans’s engaging new work. The History and Future of Bioethics assesses a discipline—and a profession—in crisis. By Evans’s count, there have been eleven federal bioethics commissions since 1974, and while the work of the early ones was largely uncontroversial, recent commissions have generated division and provided a prominent battleground in the ongoing culture war. For example, the Human Embryo Research Panel and the National Bioethics Advisory Commission were sharply criticized and largely dismissed by conservatives, while liberals pilloried President George W. Bush’s Council on Bioethics. Evans brings the skills of a sociologist to explaining how the consensus around the social value of public-policy bioethics has completely eroded.
One way forward is for the profession to engage in some rigorous redefinition. To make the case that some scholars—like me—should stop calling themselves “bioethicists,” Evans divides the work bioethicists do into four areas or jurisdictions. Health Care Ethics Consultations functions in a clinical context; Research Bioethics governs human-subjects experimentation; Public Policy Bioethics makes recommendations about policy for emerging technologies; and Cultural Bioethics explores the core values of science and technology. The crisis within bioethics is focused primarily in the last two jurisdictions.
Using a sociological theory about how professions compete for jurisdictional authority and control, Evans examines three eras in the history of bioethics. In the first, beginning in the 1960s, scientists and physicians had authority over the ethical issues raised by science and medicine, but competed with theologians over how to understand the deeper meaning of emerging technologies. In the second era, theologians wrested some control from scientists and physicians by highlighting ethical lapses in science and medicine and by translating theological discourse into secular terms that eventually constituted the lingua franca of bioethics. In the third era, the emerging field of bioethics consolidated its control over health-care and research ethics and sought greater authority over public-policy and cultural bioethics.
Essentially Evans attributes the success of bioethics in capturing these areas to the fact that the foundational norms of bioethics—what he calls common-morality principlism—are widely shared and well adapted to both clinical and research settings. The principles of autonomy, beneficence, non-malificence, and justice provided bioethics the abstract body of knowledge it needed to be constituted as a profession and to compete for authority in various domains. These principles can be understood as secular analogues to traditional theological norms, and Evans notes the irony that their formulation in strictly secular terms left little for theology to contribute to bioethics, and as a result theological writers became marginalized.
This marginalization met little resistance in the fields of clinical and research ethics, but it was fiercely resisted in the area of public-policy bioethics, where issues like embryonic stem-cell research and human genomics sparked continuing disagreements. For many religious believers, ceding the authority to recommend public policy to bioethics professionals was tantamount to extinguishing all religious voices in the public square. Yet religious believers who could not make their voices heard through the profession of bioethics found other means of expressing their views. In Evans’s telling, social-movement activists began to compete with bioethicists for control of the public-policy jurisdiction; such activism has increasingly led interest-group politics to dominate public-policy debate, inflaming the crisis in bioethics.
This background illuminates Evans’s recommendations for securing the future of bioethics. Given the lack of consensus about which values should determine public policy regarding emerging technologies, he considers it folly for bioethicists to act as if merely applying the principles of autonomy, beneficence, non-malificence, and justice to the issues raised by (for instance) synthetic biology will yield a policy widely acceptable to our diverse society. Instead, Evans advises, bioethicists need to acknowledge that there are in fact competing norms for approaching public-policy questions, and that bioethics has frequently ignored religious values not easily translated into secular terms.
Does this mean that bioethicists cannot compete for authority in the jurisdiction of public policy? No; but it does mean that they will have to function in that arena the same way they do in clinical bioethics—as professionals trained to clarify values and to mediate disagreements rooted in core convictions they do not necessarily share with all parties involved. To this end Evans suggests that bioethicists would be well served by collaborating with social scientists to determine empirically the values that citizens deploy in thinking about novel technologies. At that point, he foresees, “bioethicists would do what bioethicists who use principlism are good at—weighing and balancing conflicting principles and determining if the means in question…maximizes those principles.” As a profession, Evans believes, bioethics should not be in the business of advocating public policy on the basis of a thinned-out conception of the good that does not take into account values widely held in society in general. If, for example, the profession of bioethics took religious concerns about technology as seriously as it should, bioethicists would say no to emerging technology much more frequently than they currently do.
The History and Future of Bioethics is an exceptionally insightful source of perspective on the formation of the field over the decades. On the prescriptive side, it clearly recommends a chastened bioethics. “Don’t call yourself a bioethicist when you publish an op-ed piece endorsing stem-cell research or therapeutic cloning” is Evans’s message to folks like me. I’m not sure I like being stripped of my chosen designation, and by a sociologist no less. On the other hand, if philosophers are willing to relinquish that designation and hand it over to those who have no degree in the discipline but are nonetheless seeking wisdom, I’d be happy to call myself a philosopher.