Wednesday, September 12, 2012

Bioethics: The Failure of a Bad Critique

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 possible:
  • 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 much. 
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 Carl Elliot – 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. 



Blogger TomKoch said...

The Huffington Post piece is a summary of the argument of the book, now shipping from MIT Press. As such it is, of course, short on substantiation and "proof".
The book itself has over 30 pages of citations and a bibliography of over 80 journal articles and books.
So if you wish to seriously treat the critique of bioethics and its relevence, I do suggest you first read the book.

Tom koch

9:17 AM  
Blogger Stuart Rennie said...

Thanks for the message. Your piece was not presented as a summary of an argument in the Huffington Post, nor was it received as such by commentators on the website, who took it to be a rant. I am skeptical about your book being capable of supporting the claims about bioethics you make on Huffington Post, given just how sweeping they are. But if I look into your book and find otherwise, I will write about it on this blog.

12:59 PM  
Blogger TomKoch said...

Fair enough. This was my first "blog" and I erred in not understanding the form. Thus what I thought of as a summary sounded to some like a "rant". I'll look forward to your thoughts when you read the book. There I do, I (and others) think I make my case. Tom Koch

11:31 AM  
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