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  
Blogger jimmy wilson said...

Exceptional article I really like your current content; really like the method that you described as much as possible, you do a terrific task most of other people just like you by means of that sort of useful blogs provide recognition to be able to us in connection with many points. When i examine another useful information sites through your web sites and I will be much interested along with your blogs expertise, We in addition begun to generate document which sort discussion genuinely support us out there. My spouse and i currently bookmarked your current web page in addition to distributed your own web sites to my acquaintances besides everyone although every one of them like ones running a blog ability, trust a person create much more useful blogs this way a single as well as best of luck for the upcoming blogs.

Jimmy Wilson from Crystal Clutch Bag

5:53 PM  
Blogger Zheng junxai5 said...

2015-10-13 zhengjx
Louis Vuitton Handbags Outlet On Sale
michael kors handbags
cheap jordans
ugg australia
cheap nfl jerseys
Lebron 12,11,10 Shoes For Sale
Louis Vuitton Outlet 100% Authentic
ugg boots
Louis Vuitton Handbags Outlet Stores Online
canada goose outlet
coach outlet
michael kors outlet
Louis Vuitton Handbags Outlet Sale
michael kors outlet sale
Coach Factory Outlet Online Sale Discount
canada goose outlet
michael kors outlet online
cheap louis vuitton
Coach Outlet Store Online Clearance
Michael Kors Outlet Online Sale Free Shipping
coach outlet store online
ugg boots
nike outlet,nike shoes,nike store,nike air max,nike free run,air max,nike free,nike blazers
Louis Vuitton Outlet Discount Handbags
cheap ugg boots
hermes birkin
ugg boots
Coach Factory Outlet Discount Online
true religion jeans
nike air max

9:07 PM  
Blogger Unknown said...

THIS MIGHT SOUND UNBELIEVABLE BUT TRUE!!!!!!!!! For more than 4 years now i have been suffering from HIV Infection,until the day God sent one of my friend who directed me to Dr Molemen, i contacted Dr Molemen via email, I told him about my health status and also the pains i was going through with the rashes over my body, after been in contact with Dr Molemen i also requested for his healing medicine, he told me not to worry that he was going to prepare some herbal medicine for me which i was to drink for some days, he gave me directions on how to get his medicine after all the process i received the Some Herbal Medicine from Dr Molemen which he sent to me here in my country, i used them daily as i was directed and now i have regain my health the rashes that was in my body are all gone.
It`s been 7 months now after taking Dr Molemen medicine and i have not had any symptoms of HIV infection, i truly believe in his medicine as it has worked for me and i will advice everyone to request for his herbal medicine to treat and cure any disease infection.
You can contact him on ( / or call him on +2347036013351).

6:05 PM  
Blogger raybanoutlet001 said...

ray ban sunglasses
mlb jerseys
cheap oakley sunglasses
eagles jerseys
jordan shoes
ugg outlet
michael kors outlet
ecco outlet
louis vuitton sacs
minnesota vikings jerseys

11:28 PM  
Blogger sehatwanita said...

It is great to have visited your website. Thanks for sharing useful information. And also visit my website about health. God willing it will be useful too

Obat Pelancar Haid paling Ampuh
Cara Menghilangkan Bopeng Bekas Jerawat
Cara Membersihkan flek di Paru-paru
Pengobatan Herbal Rematik/Rheumatiod Arthritis
Obat Herbal Walatra Berry Jus
Cara Mengobati Telapak Kaki Berlubang
Obat Koreng Bernanah Alami

9:57 PM  
Blogger TomKoch said...

I am not sure why this is reappearing in 2018. The origional piece, my first "blog," was written shortly after the publication of my critique of bioethics. It's intent was to direct interested parties to the argument in the book. Comments by those who said "show me the data" werre referred to the book itself. In the intervening years I have heard from ethicists and others at varying institutions who have considered the arguments--pro and con--with some care. I'd recommend the same to others, whether they re fans of bioethics or, like me, dissatisfied with its performance. The basic argument was, and remains, that bioethics has not served either patients or medicine since its founding. Those who wish to consider that argument may consider some new arguments of mine, now in press, and of course, the realities of the profession and many of its most prominent proponents themselves. Tom Koch.

8:33 AM  
Blogger Unknown said...

Hello everyone out there, I'm here to give my testimony about a herbalist doctor who helped me. I was infected with HERPES SIMPLEX VIRUS in 2011, I went to many hospitals to heal myself but there was no solution, so I was thinking how I can get a solution so that my body can be well. One day I was in the river thinking about where I can go to get a solution. so a lady walked towards me telling me why I'm so sad and I open everything by telling her my problem, she told me she could help me, she introduced me to a doctor who uses herbal medicines to cure the SIMPLEX HERPES VIRUS and gave me your email, so I sent you an email. He told me everything I had to do and also gave me instructions to take, which I followed correctly. Before I knew what was happening after two weeks, the SIMPLEX HERPES VIRUS that was in my body disappeared. therefore, if you also have a broken heart and need help, you can also send an email to {}or whatsapp him number: +2349038382931 or Facebook page
Contact him today and he will have a testimony ... Good luck!

Dr. OLIHA also cures:
2. HERPES 1/2
4. ALS (Lou Gehrig's disease)
5. Hepatitis B
6. chronic pancreatic
7. emphysema
8. COPD (chronic obstructive pulmonary disease)

10:56 PM  

Post a Comment

<< Home