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Finding the “Beef” in Bioethics

Several things struck me recently when I attended my first ASBH (American Society for Bioethics and Humanities) annual meeting. As I got to meet some of the most respected scholars in bioethics, I sensed that they were as excited to meet me – a 2009 college graduate working in the field – as I was to meet them. At the same time, with each successive plenary session by another person at the top of the field, I sensed unease about the current trajectory of bioethics.

Zeke Emanuel called for us to “get serious about being a serious discipline” through greater use of “analytically rigorous data.” Annette Dula contended that we have created a socially and racially inequitable health care system where individuals are held morally culpable for social determinants of health. Carl Elliott called attention to a shift from critical investigation to “boosterism,” what he saw as bioethicists being more concerned with being quoted than with writing something substantive. Ruth Faden advocated a greater consideration of the social justice implications of bioethics. While each spoke of great things bioethics has been able to accomplish, so too was there an inclination that things needed to change.

These lectures, albeit slightly sobering to a young mind, resonated as legitimate explorations of the future of bioethics as a discipline. Principle among my thoughts was the nature of bioethics as a truly rich and interdisciplinary discipline. While I have often seen the difficulty of defining bioethics as a barrier to legitimating the work that bioethicists do, I think Zeke is right to caution us about becoming too concerned with the “who,” rather than the “what” of bioethics. We should embrace the fact that bioethics represents a confluence of the sciences, philosophy, political science, sociology, religion, history, and the arts, not fear that we lack the same established standards as more traditional fields of study.

It does not seem to matter whether I call myself a bioethicist with a focus in public policy, or a political scientist with a focus in bioethics. It is more important that I reach the relevant analytical ends, not necessarily the name by which I classify my methodology. Although bioethics is still in relative infancy (having just recently reached the four-decade mark) and faces the ongoing struggle to carve out a special niche in intellectual discourse, we must not systematically deter valuable minds and contributors by formulating a strict definition of bioethics.

While I agree with Zeke’s concerns about focusing too much on defining bioethics, I worry about his prescriptions for improving the discipline. He asked, “Where’s the beef?” before setting out a course for bioethics founded in increased use of empirical data. Zeke argued that such an approach would, for example, help bioethicists and clinicians to better understand and improve upon current shortcomings in the informed consent process. While we bioethicists do need more “beef” sometimes, it does not logically follow that empirical research is the best way to accomplish that.

An over reliance on data might lead us to shortsightedly validate our claims on trends, perceptions, and quantitative efficaciousness, rather than the deep normative calculus that bioethics has sought to cultivate since its founding. More studies aimed at examining how well research subjects comprehend the informed consent process may prove valuable in improving the process, but they are not enough. Bioethics is set apart from the hard sciences by its contemplation of values and principles such as liberty, beneficence, and justice. If data – whether it is about informed consent or other bioethics issues – were to overshadow these methods of moral analysis, bioethics would be at a loss.

Perhaps the real “beef” may be lacking when it comes to bioethics engaging with the public. Jonathan Imber claims that bioethics has become “the public relations division of modern medicine.” Bioethicists are called upon to be “experts” when controversial issues such as Dolly the sheep, Terri Schiavo, or Octomom appear in the news, but to what extent do our comments move the discussion forward? Although Zeke and others fear that bioethics has been reduced to sound bites, I believe that bioethics can find a valuable place in public discourse.

As Art Caplan recently stated in a response to Zeke’s speech, “bioethics… has a duty to engage the public with bioethical issues.” Although we should not attempt to authoritatively solve or prescribe remedies to complex bioethical issues, bioethicists should help the public to construct cogent ways of examining ever increasing public moral conflicts. Doing this will require methods of analysis that consider cultural, political, social, historical, religious, and economic interests that are constantly evolving.

Behind every bioethical issue are individuals, each with a narrative of his or her own, each with a perspective to share, each with a piece to add to the puzzle, and each impacted by outcomes. For this reason, we must lend our insights and seek to cultivate consideration of bioethical issues in the places where they have their ultimate manifestations: the lives of all individuals in society.

Going forward, I see the need for bioethics to find a middle way between pushing ivory tower-like morally prescriptive academic papers and becoming media darlings who offer up the quote of the week about the latest science controversy. If we can make bioethics relevant to the average person in a way that helps us all better understand the social implications of complex issues, then we will have accomplished something meaningful.

Perhaps by heeding Carl Elliott’s charge for more “muckraking” to discover the stories that escape mass media consumption, we will be able to better understand the intricacies of the most complex bioethics issues. I am optimistic about the ability of our developing discipline to carve out such a niche, if we acknowledge the strength in attempting to transcend categorical fields, continue to engage the public in controversial issues in ways that makes them interested moral agents, and seek to lend a diversity of perspectives to the intellectual life of our society.

Ross White, a 2009 graduate of Davidson College, is a research assistant at The Hastings Center.

Published on: November 2, 2009
Published in: Bioethics

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