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Bioethics: The Failure of a Bad Idea

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Bioethicists are everywhere these days, commenting on abortion, euthanasia, and health policy. They people hospitals, major research centers, and advise governments. We need them, bioethicists tell us, because the old ethics of medicine won't serve in the new world of advancing medical science and technology. They call that the "Georgetown Mantra," the principle justification for their professional existence.

Their primary training is in philosophy, not biology, genetics, or medicine. Most are generally untutored in either social science or statistics. Bioethicists rarely work with patients, a good thing because nobody carries Kant (still probably the most cited authority in bioethics) to the bedside. Nor do adepts quote Hegel, Wittgenstein, or even the 20th century philosopher Hare, in a hospital budget meeting or at a Research Review Board meeting. Since the expertise of bioethics is supposedly founded on an ethicists' familiarity with philosophical methods and arcane texts, why think they have any expertise that may enlighten us all in the face of complex choices of care, of life and death?

The foundation myth of bioethics, the "demi-discipline's" self-professed raison d'etre is at best inadequate if not demonstrably false. Its grounding lies not, as bioethicists insist, in a robust ethic of care necessitated by new science and a failed Hippocratic sense of duty and care. Instead its origins and purpose demonstrably rest upon its service to the neoliberal, postmodernist economics that made health a commodity rather than a service.

Governments like those of Ronald Regan needed a way to say health care was an expense to be limited, a cost to be reduced. Bioethics provided the means by which officials could justify "rationalizing" the care of persons to fit the cost-cutting goals of government and, not coincidentally, to promote the needs of business.

"Ethicists have been a guest in the house of medicine," wrote Prof. Mark Kuczewski, a former president of the American Society of Bioethics and the Humanities, "and in order to survive in that environment have had to align themselves with money and power." Bioethics isn't about ethics or philosophy, truth or the "right," but... money and power.

But from Plato through Kant ethicists were, critics never cheerleaders for money and power's easy disregard of the vulnerable. Until bioethics the role of the ethicist was that of the outsider critique of power on the basis of a philosophy arguing the nature of us all and the needs of each of us within the communities we inhabit.

Bioethicists insist they are champions of "autonomy," and personal choice. But the choices they propose are restricted, not fulsome and often they willingly sacrificed the individual and his or her choices where those choices seem inconvenient, costly, or merely different.

Thus bioethicists promote in the name of "autonomy" a kind of consumerism disastrous for both the patient and the medical professional who seeks to practice on behalf of patients. Its professionals have reduced the patient-in-need to a health consumer whose care (as a "consumer") depends, in large part, on his or her monies. As dangerously, some and perhaps many bioethics promote a eugenicpresent and future, pruning the human tree, as "rational" by which is meant cost efficient.

We have faced periods like this before, notably in the 1920s and 1930s. What is new is the sheen of philosophical respectability given by bioethicists seeking tenure in university and a place at the policy maker's table. To attain those goals they have become, in essence, risk managers rather than medical advocates or professionals. They are become like the old lags in the prison who mop the floors and say life is fine and prison grand because everything is so... tidy.

That's why the bioethical literature is littered with arguments on triage and the cost constraints of health but near bereft of articles on the systems of governance that provide billions for bomber and fighter planes that like the F-35 and the raptor, will not fly or at least not fly safely.

That's why bioethicists are what Confucius once called "thieves of virtue," oily faced official worthies who pretend to a care they do not deliver.

Others have critiqued bioethics as a field that promises much and delivers little. There was, for example, Wesley J. Smith's Culture of Death published in 2000. And, too, there were the bioethicists who in a 2010 special issue of the journal bioethics argued the demi-discipline was dead, dying, or merely irrelevant. What distinguishes this work from its predecessors is its willingness to meet bioethics on its own ground, that of philosophies and their resulting ethics, and challenge it on that basis.

Tom Koch's Thieves of Virtue: When Bioethics Stole Medicine was published in 2012 by MIT Press.