Let’s say that bioethics was invented in the United States,
and is now being imported into developing countries. That might not be a bad
thing: cellphones have been a boon to southern Africa, particularly in countries
where landlines would be prohibitively expensive. But if bioethics is wasteful,
useless or dangerous, then it is certainly wrong to spread its influence. In that
case, it should not exist, even in its place of origin. This seems to be the
position of Tom Koch, who has written an opinion piece today entitled ‘Bioethics: Failure of a Bad Idea
’ on Huffington Post.
Koch offers a series of assertions about the evils of
bioethics that are difficult to communicate without already seeing what is
wrong with them. But let me try to summarize the main ones as neutrally as
- The primary training of bioethicists is in
philosophy, not biology, genetics or medicine. Their ‘expertise’ is therefore
irrelevant to complex choices of patient care.
- The foundation of bioethics is not an ethics of
care, but its origin and purpose rest upon its service to the neoliberal,
postmodern economics that have turned health into a commodity. Their
championing of patient autonomy reinforces health consumerism.
- Ethicists in the history of philosophy used to
be outsiders that spoke truth to power in the name of the vulnerable. Current bioethicists,
being beholden to medical institutions that pay them, cannot do so.
- Bioethicists basically provide arguments to
justify the rationing of health care and the cost-cutting goals of government.
Koch’s piece is mentally paralyzing. By the sixth paragraph,
I may have drifted into a coma. Because when someone presents a balanced
argument with some contentious elements, it is not difficult to respond. But
when you are smacked upside the head with a snarled potpourri of generalizations and
caricatures, it is hard to know where to start.
Is the primary
training of bioethicists philosophy? Show me the data: some are lawyers,
some are social scientists and some (gasp) are clinicians. Bioethicists are a
motley crew. Is Kant irrelevant to clinical decision-making? Maybe. Is knowing
how to identify, parse and evaluate arguments that involve values irrelevant? Not so
Is the origin and
purpose of bioethics the neoliberal consumerism of medicine? Show me the
literature: there are plenty of bioethics criticisms of purely market models of
everything from organ donation to patent restrictions on essential medicines.
Similarly, are bioethicists rationalizers of the cost-cutting goals of
government? Oh please: some people in bioethics work in purely conceptual
domains, while others find the economics of medicine so unrelentingly boring
(or depressing) they couldn’t care less.
As for the point about
speaking truth to power
, bioethics admittedly could and should do more in
the whistleblowing and ass-kicking department. But I would much rather read
– an incisive clinician/bioethicist with a strong philosophical
background -- on that one.
One of the commentators on Koch's piece on the Huffington Post website complains about Koch's leaps of logic and asks why he should be given a soapbox on that site. The answer seems to be that Koch is promoting his Thieves of Virtue: When Bioethics Stole Medicine
, where he apparently presents much of the same stuff, only longer. The author appears to have as much feeling for irony as he does for nuance: criticizing all bioethicists for being slaves to consumerism while flogging his new book on a commercial website owned by AOL.