On flogging concepts that refuse to die

Cultural reproduction is a strange thing. It is normal and often desirable to transfer cultural artifacts to future generations. We want to instill certain values in own children. We want to ensure that our mother tongue survives and retains its integrity. We want to keep scientific progress going, and we want to perpetuate valuable institutions like the law and modern medicine. There is much good in this. However, it is easy to get the mistaken impression that cultural reproduction is under our control. Culture also has a life and momentum of its own, and some aspects are reproduced even if we think they have worn out their welcome. Racism, homophobia and sexism live on, and a whole host of other dubious inheritances besides. And efforts to discredit these inheritances from a rational point of view seem to have less effect than we sometimes suppose. An artifact can exist, even thrive, despite being pretty much debunked.

These were my reflections while reading a recent article in the journal Bioethics by Heather Widdows, entitled "Localized Past, Globalized Future: Towards an Effective Bioethical Framework Using Examples from Population Genetics and Medical Tourism." Widdows takes dead aim at the concept of individual autonomy, claiming that (a) the individual autonomy is conceived as a crucial or foundational value in bioethics and (b) the concept is inadequate to make sense of (or help resolve) bioethics issues. It is like turning up to a gunfight with a plastic spoon. She uses the issues of population genetics and medical tourism to make her point, but the point has far wider applicability. The thing is, though, this has all been said before, in a variety of ways: it would not be hard to draw up a long list of bioethics articles devoted to debunking the oversold status of individual autonomy.

I am not criticizing Widdows for flogging a dead horse. Yes, debunking autonomy is practically a cottage industry, but I am guilty of contributing to it as well. What I am saying is that the horse has been flogged for ages, it is still not dead, and the current zombie-like state of the concept requires an explanation. Why is it, say, that people still find it attractive to say that organ trade between the rich and the poor could be reasonably conceived as a fair and unproblematic trade if conducted between consenting adults? Or that exploitation in international health research is morally acceptable if the 'exploited' party in the transaction adequately consented and might be worse off if he or she did not join a certain study? When a notion seems to be debunked but somehow survives, it is tempting to look past its content and look at the social function it may continue to serve. What does the use of the concept of autonomy 'do' for (some) people when deployed in bioethics arguments? Who gains and who loses when these issues are viewed and defended within frameworks that see individual choice as paramount?