August 12, 2022

Is a day of doom looming for bioethics?

Predictions of a Ragnarök for bioethics surface regularly in academic journals.

Ragnarök is the day in Norse mythology when gods and men meet their doom. After three years of continuous winter, bloody battles and many natural disasters, the world will be flooded, and all but a few will die.

Predictions of a Ragnarök for bioethics surface regularly in academic journals. The latest comes from a sociologist at the University of California, San Diego, John H. Evans, the author of The History and Future of Bioethics: A Sociological View. Writing in the Journal of Clinical Ethics, he forecasts a bleak future for practicioners of bioethics when they seek to offer advice for large organisations.

Before bioethicists start claiming that “ethics” demands an action that is contrary to the interests of people with actual power, they should become clearer on the basis of their authority … Note that there are very few possible claims to authority for the bioethics profession.

Many professional jurisdictions are made through claims to truth, justified by science. Engineers have jurisdiction over designing hospital buildings that will not fall over in an earthquake, because they use methods that have been almost universally accepted as producing truth (for example, physics]. Doctors claim jurisdiction over heart surgery because it is “true” that cutting this way instead of that leads to higher survival. Lawyers claim jurisdiction over certain tasks in the hospital because the government has essentially granted them jurisdiction through public law.

But, by whose authority does the bioethicist assert their truth? The problem, in the U.S. in particular, is that “ethics” are not thought to be “true,” but rather relative to its citizens. No one is entitled to his or her own view of scientific facts, but everyone is entitled to their own view of ethics. Bioethics has thus always had a very weak claim of authority.

To recap: it has never been clear how the bioethics profession justifies using “accepted ethical principles” in [healthcare ethics consultation] when it is supposed to be clarifying the ethics of others. This is a weakness and may lead to challenge. More critically, before bioethicists move too strongly into organizational ethics, where they will encounter people with true power, they should derive an answer to the questions: “Whose ethics do you represent?” and “How do you know what their ethics are?” Two answers that will not work in a pluralistic liberal representative democracy are: “I represent my own ethics,” and “I represent the ethics of the collective wisdom of a particular academic tradition.”

Dr Evans recommends that whatever the public thinks should become the constitutional dogma of bioethics, as determined by sociologists. This obviously has its own problems. The distinguished bioethicist Daniel Callahan, in a response to the Evans paper, points out that “if surveys had been relied upon to fashion policy, there would be few rights for women and minorities”.

The good news is that the world is born anew in Norse mythology. Perhaps bioethics will spring alive after the apocalypse.

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