Carl Elliott

At dinner after a recent meeting about ethics and genetics, a guest told me that he had never been to a conference of bioethicists before. The person next to him sat up straight, as if insulted, and said: ‘But I’m not a bioethicist.’ They turned to me. ‘Don’t look at me,’ I said. ‘I’m no bioethicist.’ We asked the other guests at the table, and while the verdict was not unanimous, many said no, they didn’t really consider themselves bioethicists either. To an outsider, it must have seemed an odd response. Most of those present work in bioethics centres, publish in bioethics journals, belong to bioethics associations and write books with the word ‘bioethics’ prominently displayed on the covers. I do many of those things myself.

Bioethicists have an expanding role in American public life. They are on the staff of government organisations such as Nasa, the Veterans’ Administrations and the National Institutes of Health, as well as professional bodies such as the American Medical Association. They help oversee the ethics of biomedical research by serving on local Institutional Review Boards and they write most of the regulations and guidelines that determine what research is approved. Thanks to the clinical ethics movement, white-coated bioethicists work in hospitals and medical schools – advising doctors and nurses, writing notes on patients’ charts. Bioethicists serve as consultants to managed care organisations, advisers to non-profit medical foundations, and expert witnesses in court. Online news outlets such as CNN.com and MSNBC.com feature regular columns written by academic bioethicists, and it is a rare newspaper or television story about a medical issue of moral concern that is not accompanied by expert bioethics commentary. In 1995, Clinton created a National Bioethics Advisory Commission, which Bush replaced with a President’s Council on Bioethics. Bioethics (or medical ethics) has been established in the UK for about as long as it has been in the US. The Journal of Medical Ethics was founded in 1975; ethics is now routinely taught in British medical schools; the UK is home to a number of bioethics institutions, such as the Nuffield Council and the Institute of Medical Ethics. But bioethics centres and chairs are far fewer in number, and there are no professional associations specifically for bioethics. In the US there are two: the American Society for Bioethics and Humanities (ASBH) and the American Society for Law, Medicine and Ethics (ASLME), each of which has about fifteen hundred members.

But bioethics is taking a beating these days. The assault began a few years ago with a blistering profile by Ruth Shalit in the New Republic. Shalit’s article, entitled ‘When We Were Philosopher Kings’, portrayed bioethicists as pompous blowhards who are widely ignored even as they insist on their own importance. One, remarking on the reception of his ethics lectures in a hospital, told Shalit: ‘People were literally putting their heads down on the desk. It was very humiliating.’ The piece cut pretty deeply, and struck the two themes that have run through many subsequent crit-iques of bioethics: intellectual arrogance and moral weakness. In Our Posthuman Future, Francis Fukuyama, though a member of the President’s Council on Bioethics, accuses bioethicists of pandering to scientists, remarking that in any discussion of controversial ethical issues, ‘it is usually the professional bioethicist who can be relied on to take the most permissive position of anyone in the room.’ Wesley Smith, author of The Culture of Death, offers a more sinister vision of the ethics business, depicting bioethicists as a self-appointed corps of elite liberals plotting to take control of the American medical and judicial systems. Critical essays and editorials have recently appeared in magazines such as Wired, the Scientist, Commentary, the Weekly Standard and First Things accusing bioethicists of hypocrisy, corruption or vanity. One of the cruellest insults was unintentional. Commenting on the testimony of a bioethics expert witness in Florida, a district judge wrote: ‘His testimony was often very abstract, describing such things as the “metaphysical” and “epistemological” issues associated with the “post-Kantian world”.’ The judge went on to classify the bioethicist’s remarks as ‘harmless error’, noting: ‘It is not surprising that all of the lawyers essentially ignored this testimony during closing arguments.’

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