The Ethics of Bioethics

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Is bioethics worthwhile? Is it an activity to which Christian scholars should devote their professional activity and to which Christian health care professionals should pay heed? Or, rather, is bioethics such a hopelessly corrupt field that our only appropriate response is to recoil from it in disgust and opposition? While the field of bioethics certainly has numerous enthusiasts, many others have questioned the legitimacy of this interdisciplinary enterprise that has all but taken over the way we engage in serious discussion about ethical issues in medicine and the life sciences.

In recent years bioethics pioneers such as the late Fr. Richard McCormick and lawyer Wesley J. Smith have taken bioethics to task on moral grounds, arguing that the field as conducted today too often does moral harm to medicine and society. McCormick wonders (in the May 1, 1999 issue of America) whether bioethics has become "a moral vacuum," while Smith complains (in the April 3, 2000 edition of The Weekly Standard) that in "mainstream bioethics, human beings per se have no special rights or moral value." In this brief essay I would like to address the attack on bioethics, as well as defend the field as a vital area of intellectual endeavor to which Christians have a responsibility to contribute.

The term "bioethics," like architecture and theology, refers to both a process and a product. The process of bioethics consists of critical reflection on the moral dimensions of health care and medical science. The product encompasses the literature and resources amassed in journals, books, conference programs and other places. In addition to these familiar distinctions, bioethics also refers to the social structures in which these discussions take place and in which the products of the enterprise are displayed. As is the case with architecture and theology, bioethics refers to a social institution, a convergence of people from diverse professional groups which comprises a community in which bioethics is done. Critics of bioethics might be referring to the product of certain bioethicists, to the process of bioethics itself or to the dominant institutional arrangements that make up bioethics. Perhaps some critics wish to target all three of these.

Bioethics is without doubt the best developed of the many fields of applied professional ethics that have emerged in the past few decades. Almost all hospitals have ethics committees (usually mandated by accreditation agencies), and such grassroots work is mirrored at the more theoretical level by a network of bioethics centers, journals and conferences. Importantly, bioethics has obliged medical professionals to share these intriguing and critical discussions with lawyers, social scientists, theologians and philosophers.

Given the strong monopoly physicians had long enjoyed over the right to speak to the ethical questions surrounding human health, how did it ever fall into the hands of philosophers, theologians and others? In part, this shift was due to the 1960's advent of new technologies in biomedical science, which rendered dilemmas in medical ethics too "public" to leave to medical specialists alone. Biomedical ethics began to see the need to draw upon the wisdom of the broader community, upon philosophical and theological work. Although confessing some "temerity" as a theologian presuming to speak on medical ethics, pioneering Christian bioethicist Paul Ramsey nonetheless insisted in his book The Patient as Person that:

The problems of medical ethics...are especially urgent in the present day. These are by no means technical problems on which only the expert (in this case the physician) can have an opinion. They are rather the problems of human beings in situations in which medical care is needed. Birth and death, illness and injury are not simply events the doctor attends. They are moments in every human life.

In his recent analyses, Smith offers a sound and morally well-grounded criticism of much that goes on today under the name of bioethics, and those of us who espouse human dignity are grateful for his forceful and eloquent voice. He alleges that an "ideology of mainstream bioethics" opposed to sanctity of life and similar values dominates the field. To "matter" in the field of bioethics, Smith believes, one must endorse this ideology. Among contemporary bioethicists Smith criticizes are Peter Singer, Ronald Dworkin, Tom Beauchamp and John Robertson.

Indeed, many of today's bioethicists, following the lead of "situation ethicist" and patriarch of the field Joseph Fletcher, "see themselves as the creators of a new moral paradigm that will replace the archaic Judeo-Christian order as the philosophical underpinning of society." In light of the errors of such people, Smith calls for a "counter-bioethics movement to resolve the issues with which bioethics grapples."

McCormick worries that the field might be the equivalent of a moral vacuum for a number of reasons, but of chief interest here is his critique of the way bioethics exalts autonomy:

[If] the primary and exclusive emphasis is on autonomy, we will have excluded from consideration those goods and values that make choices right or wrong. But these are precisely some of the key factors that make bioethics a moral enterprise. For they are the factors that support or undermine, promote or harm the person. When the rightness or wrongness of choice is reduced to the single factor that it is this individual's choice, morality has been impoverished.

While McCormick specifically criticizes Jack Kevorkian, he has positive words for Daniel Callahan and Leon Kass. McCormick doesn't advocate abandoning the field, but argues that we need to move beyond the procedural questions of "who should decide" and address the substantive issues of ethics more courageously.

Smith's and McCormick's criticisms seem to presuppose that bioethics is a rather monolithic school of thought. That monolith is regarded as morally objectionable in that it is out of step with the traditional values of both society and medicine. This would amount to an attack on bioethics on all three levels - process, product and social institution. How correct is it to characterize the field as monolithic, as being characterized by an anti-traditional ideology? Interestingly, in his response to the moral criticism of bioethics, Gorovitz noted the following irony:

It is amusing that the offending content is held by some to be unquestioning endorsement of traditional values - especially such values as individualism, respect for life, or the autonomy of the family - while it is held by others to be a pernicious undermining of those same values.

Such irony remains today. While Wesley Smith objects that there is a "bioethics ideology" that is at odds with traditional values, bioethicist Gregory Pence laments that bioethicists are overly cautious morally, and that their work "is often too simplistic, even sensational." He faults bioethicists for such things as "insisting on Olympian standards" for new technologies and the motivation of those who will use them, demonizing new inventions, distrusting the motivations of everyday people and failing to advocate change. He charges that practitioners of bioethics often react to innovations in biotechnology with "knee-jerk reactions" (January 12, 2001 issue of the Chronicle of Higher Education). Pence looks at the same field as does Smith, but where Smith sees rigid conformity to radicalism, Pence sees cautious conservatism.

Contrary to being monolithic, bioethics is in fact a field open to contributions from those with diverse insights. My own observation is that while there are indeed strong anti-traditional voices in bioethics, the voices of those who uphold human dignity and who reflect traditional and biblical values are also being heard. There is now a much greater acceptance of bioethical engagement from explicitly Christian perspectives; some authors write from a philosophical perspective, while others base their work in moral theology. Following the cloning of Dolly the sheep, prominent religious ethicists such as Gilbert Meilaender, Jr.; Stanley Harakas; Edmund Pellegrino; and Leon Kass delivered eloquent testimonies against human cloning before the National Bioethics Advisory Commission. In addition to the work being done by scholars connected to The Center for Bioethics and Human Dignity, its European counterparts - The Linacre Center for Health Care Ethics, The Centre for Bioethics and Public Policy and the Lindeboom Institute for Medical Ethics - have also influentially entered into today's bioethical debates. Leading secular bioethics journals, such as the Hastings Center Report, are more likely than before to give serious attention to issues of faith, spirituality and the religious dimensions of health care. Explicitly Christian perspectives on bioethical issues are being published in a variety of places, including journals such as Ethics & Medicine and Christian Bioethics: Non-Ecumenical Studies in Medical Morality. Bioethics books, conferences and other initiatives are also increasingly rooted in Christian perspectives.

As the field of bioethics continues to evolve, the philosophical confidence in the foundations of ethical theory are being challenged as never before in our lifetime. I believe that there has never been a better time to influence the direction of bioethics by mounting a strong challenge to the Kevorkians and Singers of the field. Christians should be devoted to shaping the world of bioethics as it continues to morph and change in the twenty-first century.