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Bioethics Forum Essay

Should Bioethics Respond to Authoritarian Populism?

In the wake of the Trump administration and populist movements abroad, Mildred Solomon and Bruce Jennings published a provocative essay, “Bioethics and Populism: How Should our Field Respond?” in the March-April issue of the Hastings Center Report. Their call for the field of bioethics to respond to “authoritarian populism” and the threat it poses to liberal democracy is especially significant in that Solomon is president of The Hastings Center—one of the leading bioethics organizations in the world, which has been instrumental in promoting the field since its inception. After laying out reasons in support of the thesis that bioethics has a role to play in responding to populism, the authors, argue for three areas of engagement, “a more relational view of autonomy,” “a greater focus on justice,” and democratic deliberation and civic learning.” While I share, in large part, the political orientation of the authors as reflected in the essay, I take issue with their argument.

Solomon and Jennings assert: “We must come to the aid of civil liberties and political rights—the rights to vote, assemble, and engage in free speech—when they are threatened. Bioethics should be part of their defense.” Why should bioethicists in their capacity as bioethics scholars, as distinct from informed citizens or public intellectuals, take on this role? Solomon and Jennings provide some reasons for why “bioethics should respond to authoritarian populism,” but, as a bioethicist, I don’t find them persuasive.

It is true, as Solomon and Jennings point out, that mainstream bioethics is committed to broad principles, which are embedded in institutions of liberal democracy; however, what makes an appeal to these principles qualify as bioethics is their application to ethical issues relating to health, including medicine, biomedical research, and public health. Most of the normative problems posed by authoritarian populism, such as tight restrictions on immigration and economic nationalism, are outside the domain of bioethics, as generally understood.

Another of their reasons is that “If the environment of free and open normative discussion and debate becomes constricted, our field would be intellectually and morally hobbled.” Despite the tilt towards authoritarian populism of the Trump administration, I see no evidence to suggest that we are in or approaching such a constricted environment; but if it were to occur, much more important than the threat to bioethics would be the consequences for the role of journalism and freedom of public expression in democratic politics. Entirely different, however, are matters of public discussion and policy that bear directly on the domain of health. Bioethicists have valuable contributions to make, for example, in challenging unwarranted skepticism about childhood vaccination and a proposal to remove the requirement to demonstrate efficacy before new drugs are approved by the FDA—issues that have been under discussion by Trump and his supporters.

It is important to recognize that commitment to liberal democracy and opposition to authoritarian populism leaves open a wide range of divergence on matters of politics and policy. Solomon and Jennings give the impression that bioethicists all do, or should, subscribe to a stance of liberal progressivism. Evidence for this view is the way that they advocate for “a greater focus on justice” as one of the ways in which bioethics should respond to populism. The section of their essay devoted to this position gives no attention to competing conceptions of justice; rather, their discussion of distributional and “structural” dimensions of justice provides a liberal progressive perspective, as filtered through a communitarian lens.

Regardless of the political affiliations of most bioethicists, bioethics is not politics. While the scope and limits of bioethics are open to debate, I see risk without compensating benefits in the call for bioethics to expand its mission to encompass political opposition to populism. There is a danger of undermining the integrity of bioethics if the important work of bioethics scholarship is conflated with political advocacy.

Franklin G. Miller, PhD, a Hastings Center Fellow, is a professor of medical ethics in medicine at Weill Cornell Medical College.

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  1. When Trump and his appointees–including Gorsuch–succeed in constricting the autonomy and the substantive choices that patients have about their own care, especially at the end of life, it will be too late for bioethicists to mount any kind of meanginful challenge to an increasingly authoritarian and ignorant regime in Washington, DC.

    Remember Martin Niemoller.

  2. Thank you Dr Miller for your measured response to an increasingly politicized view of many fields, including bioethics. I find myself increasingly concerned about the “groupthink” that is becoming dominant in our broad field of study. As a social and fiscal conservative clinical ethicist, our field risks becoming exclusive of my worldview and ethical positions, and especially since the recent presidential election. Regardless of ones personal opinions regarding President Trump, our field of study has been a relatively “safe” place to honor diversity in thought and viewpoint. Let’s not jeopardize that diversity in reaction to one election. We have just seen the Republican party demonstrate that health care is a much more complex issue than can be easily changed along ideological lines. Remember that for all of its strengths (and weaknesses) the Affordable Care Act took well over a year to pass, with a filibuster-proof majority in the Senate, and with some “strange and wonderful” amendments to placate the holdouts from various special interest groups. The current administration will find it nearly impossible to “stuff the genie back into the bottle” without significant compromises, and hopefully some improvements to the health care system that impact all Americans. And for my colleagues who believe that nationalized healthcare is the only true solution, I respectfully disagree.
    In conclusion, this country moved politically and ideologically to the Left during the last eight years in a significant manner. The current “populism” is largely a reaction to that shift and should be expected. Many of the “social justice” gains of the last eight years will become part of our culture. Some will naturally be rejected and the balance of competing ideas and ideals will be heard. This is not an event to be feared and reviled, but an opportunity for thoughtful people of goodwill to hear alternative voices and find compromise. Let’s focus on being more ethical and less ideological.

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