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.