claim I never made. Disagreements certainly exist within the field. But they are more akin—with some exceptions—to the arguing of people who agree on fundamentals but disagree on details—sort of like Catholics bickering with Lutherans.
Most bioethicists recoil at their depiction as “true believers” subject to orthodox precepts and the emotional zeal generated by intensely felt ideology. Their self-view is that of the ultimate rational analyzer of moral problems who, were pipe smoking still fashionable, would sit back, pipe firmly in mouth, acting as dispassionate “mediators” between the extremes of medical technology and the perceived need for limits.13
But that is self-deception. Once bioethics moved away from ivory tower rumination to actively influence public policy and medical protocols, by definition the field became goal oriented. Indeed, University of Southern California professor of law and medicine Alexander M. Capron noted that from its inception, “bioethical analysis has been linked to action.”14 If dialogue is linked to action, at the very least that implies an intended direction, if not a desired destination. Even bioethics historian Albert R. Jonsen, a bioethicist himself, calls bioethics a “social movement.”15 Has there been any social movement that was not predicated, at least to some degree, in ideology? Moreover, bioethics pioneer Daniel Callahan, cofounder of the bioethics think tank the Hastings Center, has admitted that “the final factor of great importance” in bioethics gaining societal respect was the “emergence ideologically of a form of bioethics that dovetailed nicely with the reigning political liberalism of the educated classes in America.”16 Thus, mainstream bioethics is explicitly ideological, reflecting the values and beliefs of the cultural elite.
I asked the venerable author, medical ethicist, and physician Leon R. Kass, MD, whether he shares my opinion. Kass told me, “With due allowances for exceptions, I think there is a lot to be said for that view. There are disagreements about this policy or that, but as to how you do bioethics, what counts as a relevant piece of evidence, what kinds of arguments are appropriate to make, there is a fair amount of homogeneity. If you don’t hone to that view, you are considered an outsider.”17
The noted sociologist Renée C. Fox, a close observer of bioethics from its inception, told me in a similar vein, “I would call it an inadvertent orthodoxy. You could even call it ideology, depending on how you define the term.” Fox added, “I do think bioethics has gotten institutionalized. It is being taught in every medical school in this country. The training people receive and the content of the curriculum of the short courses as well as the masters’ and doctoral programs, can be quite formulaic. In that sense, I think you could talk properly about orthodoxy.” And while Fox told me that she does not believe (nor do I) that all bioethicists share the same “doctrinaire values and beliefs,” she noted, “If you are referencing that, again and again, bioethical reasoning, deliberation, and maybe even outcomes take certain forms, that may be correct.”18
British philosophy professor David S. Oderberg and Australian Supreme Court barrister Jacqueline A. Laing agree, writing, “It is plain that bioethics has been dominated by a certain way of doing moral philosophy,” what they call an “establishment view.”19 In this regard, Fox and her co-author, Judith P. Swazey, president of the College of the Atlantic in Bar Harbor, Maine, have written, “Bioethics is prone to reify its own logic and to formulate absolutist, self-confirming principles and insights,” as bioethicists “have established themselves, and their approach to matters of right and wrong, as the ‘dominant force’ in the field.”20 Those are pretty good descriptions of the mind-set of ideologues.
Sociologist Howard L. Kaye, PhD, author of The Social Meaning of Modern Biology,21 believes that this bioethics establishment view conceives of itself “less as an attempt to arrive at an ethical regulation of biomedical developments” and more as a system in which “biology [is] transforming ethics.” Kaye observes that many bioethicists “believe fervently that there needs to be a radical transformation in how we live and how we think based on new biological knowledge because our values, our ethical principles, our self conception are based on outmoded religious ideas or philosophical ideas that they think have been discredited.”22 If Kaye is correct—and there is abundant evidence that he is—the ultimate bioethics agenda is startlingly radical: dismantling the values and mores of our culture and forging a new ethical consensus in its own self-created image. There’s a word for such a breathtaking agenda: ideology.
Adding heft to my claim was the adverse reaction within the field generally to the appointment of Leon Kass by President George W. Bush to head the relatively conservative President’s Council on Bioethics in 2001. Never had a bioethics council received such a high profile. Moreover, as a prominent ethics professor at the University of Chicago and elsewhere, no one questioned Kass’s academic or intellectual credentials. But rather than being pleased that the field’s prominence had been recognized by the president of the United States, the attacks on Kass from prominent bioethicists and policy advocates flew fast and furious.
Liberal science writer Chris Mooney interviewed several prominent bioethicists for his piece “Irrationalist in Chief,” published in the American Prospect, which concluded that Kass brings “a sixteenth-century sensibility to guide us through twenty-first-century [bioethical] conundrums.”23 In a similar vein, bioethicist James Hughes castigated Kass as a “bio-Luddite,” while cloning-advocate Gregory E. Pence branded him as a “false prophet of doom.”
The torrent of criticism jumped the shark when (then) University of Pennsylvania bioethics professor and editor in chief of the American Journal of Bioethics Glenn McGee editorially attacked Kass for advocating the moral concept of intrinsic human dignity into ongoing bioethical debates:
It has become the era of Leon Kass, brought back to scholarly life by a call from President George W. Bush. It was a call to become a Presidential bioethics advisor [as head of the President’s Council] in the service of putting a stop to embryonic stem cell research, and if possible, putting a stop to a number of other scientific and clinical projects objectionable to the far right wing of the Republican Party, and in particular, Southern Baptists.24
Bioethicists pride themselves on rational discourse, but this was rank diatribe from the head of an influential bioethics journal. Kass is Jewish, not Southern Baptist (and for that matter, neither is former President Bush nor, as far as I know, were any council members.) Claiming his approach to be in the service of the “far right” of the Republican Party did an injustice to Kass’s nuanced and meticulous approach to bioethics. Moreover, demonstrating how politicized bioethics has become, McGee and his equally chagrined colleagues would have surely cheered if Kass had worked to “put a stop” to clinical projects held to be “objectionable” by the far left of the Democratic Party.
Why is this important? “Bioethics is a phenomenon of great social importance that extends far beyond medicine”25 and, as Dr. Kaye noted, many leading bioethicists are generally dismissive of Western values and traditions and indeed seek to dismantle them. That would be of little consequence if the movement were relegated to the cultural fringe. But mainstream bioethicists are among society’s most influential members. They serve on influential federal and state government public policy commissions, influencing the evolution of public policy. They are public advocates influencing popular views. They write health policy legislation. They consult in medical controversies at the clinical level, often influencing life and death decisions. They testify as expert witnesses in court cases and submit “friend of the court” briefs in legal cases of major significance. They appear on television and in the print media as “expert” commentators. Behind the scenes, they advise politicians from the local level all the way to the federal bureaucracies and, indeed, the president of the United States.
Every medical school teaches bioethics to every student, significantly influencing the attitudes of our doctors of tomorrow toward the health care system generally and their future patients specifically.
