Sally Satel has a pretty good survey of the field of bioethics over at American Enterprise Institute. While I am no fan of AEI, I have to admit Satel’s piece is actually quite fair. Her section on conservative bioethicists is harsh and clear. Her critique of both liberal and conservative bioethicists came down to how they did their work and the role they played in a patient’s life. Money quote:

Ultimately, the bioethicist presents his analysis to the designated decision-maker–typically a physician or an administrator–who is accountable to his patients and his employer. Bioethicists should not advocate for patients or physicians or hospitals; they should advocate for disinterested moral deliberation. Nor should they mistake consensus, which is required in order to take action, for the discovery of moral truth. The role of the bioethicist, then, should be to illuminate debates, not to settle them. In the parlance of medicine, they do not have prescribing privileges.

Regardless of what one things of Satel or the AEI, this is a true statement. Unlike typical screeds from the AEI, Satel’s piece applies to advocates and opponents of frontier biotech research alike. Whether one is for or against therapeutic cloning and genetic enhancement, Satel lays out reasons why an ethicist’s position in policy should be limited. Of course, her writing isn’t all even handed. She takes a nasty swipe at Arthur Caplan – whose position on organ donation I disagree with, but of whom I am generally a fan – and uses him to typify a liberal bioethicist:

Caplan is a bioethicist; his titles [at UPenn] imply an expertise in ethics. [Douglas] Hanto served as the chair of the Ethics Committee at the American Society of Transplant Surgeons. Yet what are we to make of their willingness to issue life-and-death pronouncements involving other people? Well, we know a few things about them. First, that they share an absolutist approach to egalitarianism: If all cannot benefit, then none should benefit. Second, as ethicists they presume to know how despairing patients should conduct their private affairs. And third, they appear to have few qualms about conveying to desperately ill people a message of hopelessness: Be passive, dying patients–wait your turn and take no initiative to save your own life.

Clearly over the top, but there are kernels of truth in her rhetoric. Neither Caplan or Hanto cheerfully tell someone they are going to die anymore than Leon Kass or Francis Fukuyama does when they say that “death gives life meaning.” Isn’t it funny how Satel managed to not mention that, for Kass and Fukuyama, pain and suffering are the great character builders and all you sick people should just toughen up, grin, and bear it? What an odd omission. But she wins back major points with her general critique of conservative bioethics:

So deft are some conservative bioethicists at conjuring apocalyptic visions of a post-human future that the journalist Will Saletan has characterized them as “standing athwart history, sighing ‘Oy.'” He has a point. To be sure, they sigh with erudition and with eloquence. Should conservative bioethicists–or any bioethicist, for that matter–counsel us on reasons for vigilance? Yes, but too often they warn us not to make any progress at all. There is an irony here. For all the deference that conservative bioethics pays to the implicit wisdom of the ages, it rarely mines the recent past for lessons. Instead of concentrating on the ancients, why not also study the history of in vitro fertilization, paid egg donation, and surrogate motherhood to learn about cultural resistance and adaptation to such practices?

Even better, why not consider earlier practices that were deemed repugnant in their day but are now unexceptionable? The list of these moral apocalypses that never were is a distinguished one: vaccination, anesthesia, blood transfusions, life insurance, artificial insemination. Perhaps the systematic analysis of these practices holds little interest for conservative bioethicists because most of society now regards them as nonissues. Or more likely, they regard an objective assessment as irrelevant given their convictions that certain practices pose such an affront to human dignity that they should not be pursued at all, no matter how much good can come of them.

True that. (H/T Dvorsky)

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