Reviewed: Progress in Bioethics: Science, Policy and Politics, Jonathan D. Moreno and Sam Berger, eds., The MIT Press, 2010. (First appeared on www.cbc-network.org.)
“The fatal metaphor of progress, which means leaving things behind us, has utterly obscured the real idea of growth, which means leaving things inside us.” (G.K. Chesterton, Fancies Versus Fads)
Political science, for Aristotle and other ancients, was considered the surest path toward human flourishing for communities of individuals. Progress in Bioethics exemplifies a few ways that we’ve wandered from the ideal of seeking a robust and thick moral account of how to share public life. Interacting with each of the contributors would be worthwhile, and as with any edited volume, the whole does not necessarily represent the parts. Here, I comment more generally, and I offer three worries that reveal what is, at bottom, a lack of philosophical precision and political virtue.
“What is progressive bioethics?,” the book’s editors wonder (xvii). That’s a great question, which fifteen contributors address through reflections on the nature of progressive politics and values, advancing biotechnology, the role of religion and other “value-laden” ideologies, justice in health care and medicine, and how bioethics operates in public.
To set forth some sort of positive account or manifesto of progressivism in bioethics, most of the contributors are content to attempt a basic presentation of their positions, without much in the way of reasons or argument. What remains is political and ethical analysis and general systematizing—a sort of bioethical accounting for the political left. This is no criticism; indeed, I read with deep interest to hear these writers’ take on contemporary liberal bioethical identity.
The cumulative effect of the volume is threefold: (1) a commitment to the autonomy and priority of science, (2) an eschewing of ideological (moral or religious) limitation, (3) and a clear commitment to the progressive stance in the rhetorical games of contemporary politics.
The autonomy of science. Many writers note progressives’ concern for “getting the science” right—an effect of their academic approach to bioethics. The concern is of course legitimate. All bioethicists find themselves betwixt advancing scientific technique and ethical regulation—a sparkling few are ever experts in both fields. By definition, science and ethics concern different spheres: science is concerned with physical reality and ethics is concerned with moral reality. How we interpret this will lead to vastly different bioethical principles. The reigning interpretation among many a conservative and progressive alike is one of conflict: that scientific advance and ethical guidance find common ground only on a battlefield.
Moreover, progressives and conservatives alike are nobly concerned with finding a way to reconcile this conflict. The bioethical left emphasizes the autonomy of science. This allows for widespread, free and mostly unbounded technological exploration. This attitude is overwhelmingly clear in Progress in Bioethics. Moreno and Berger note “[a] distinctively progressive bioethics is a natural outgrowth of the close connection between progressivism and science . . . focus[ing] on results rather than ideology” (8), “letting empirical fact and not ideology drive regulatory and governmental decisions” (274). Richard Lempert thinks progressive bioethics entails a scientific “methodological commitment” (23). There is an overall greater concern for getting the science right than getting the ethics right.
On this point, I want to suggest an alternative approach for thinking about the relationship of science and ethics—one that respects the nature of both types of inquiry, and introduces a third “mediating” factor: metaphysics, that is, an over-arching appreciation of the nature of technology, morality, and especially human beings—we, the technical–moral souls-incarnate—who are involved. Metaphysics, I think, helps us keep the complex and very politically charged relationship of science and ethics in perspective. Now, this is no political agenda. It’s not a conception of ideological tyranny over science. It is an appeal to the nature of morality: ethics is concerned with the character and actions of moral agents. And by our nature, we moral agents practice science, so naturally, bioethical evaluation (and regulation, if we are to take the action-guiding nature of ethics seriously) will be deeply concerned with the morality of technological progress.
Eschewing ideology. In praise, a few essays offered outlying, insightful contributions on issues of ideology and values. William F. May’s suggestion of a “campus” or “open terrain” for bioethics would provide a careful and open bioethical discourse in public, with ample room for scientific and ethical voices. Laurie Zoloth makes a religious appeal to challenge the scope of contemporary bioethics—suggesting greater attention on the poor, and ill and under-represented, fitting a Judeo-Christian view of social justice for the most vulnerable of humanity. This would be an extension of our bioethical vision, within which we need to avoid the tendency to focus on areas of technique (means) more than people (ends). Daniel Callahan’s discussion of medical advance and access to health care offers a more robust concept of the good in public health and medicine: “The provision of health care to a society, relying on the art and science of medicine as its primary vehicle, should be—as medicine itself should be—an altruistic enterprise, seeking the health of its citizens. To put at the heart of that enterprise a set of values . . . that makes individual free choice, not health or the good of the community, its central commitment, is a dangerous move” (251). Hard words—both for the proponent of reproductive choice and the free-marketer–commercialist about medicine.
But these pieces are a deviation from the norm of the book, which is a general suspicion and distaste for moral and religious values. This is predicated on a dualism not unrelated to the science–ethics conflict discussed above. R. Alta Charo characterizes progressivism in bioethics as the Enlightenment value of dualisms: “logic versus faith . . . optimism versus pessimism . . . embracing vs. resisting” (52); she calls for “freedom to do research,” scolding value-driven “endarkment” limitations on a form of messianic science (58). James J. Hughes joins her to parade “the supremacy of reason over dogma and tradition” (163). Richard Lempert warns that “[p]rogressive bioethics has little use for symbolic statements that serve primarily to assert the moral supremacy of one group’s values over those of another group” (31). Sociologist John H. Evans describes the public–private split that exists as the secular progressive standard, which seeps from the leaves of Progress in Bioethics. That is, any liberal religious voice must be kept from public debate. Moreno and Berger reveal the ideological crisis within progressive bioethical identity: “Progressive bioethics must remain non-ideological . . . [y]et this lack of ideology should be restricted to means” (17). But what, precisely, would it be to isolate values to ends, while operating, legislating, evaluating and pronouncing right or wrong in a value-neutral? I have no idea. At bottom, this strategy seems like an effort to save their position from self-defeat.
But this endeavor is headed for failure. The ethicist working without reference to or immediate use of ideology, value or any sort of content-laden outlook (in the ends and the means) is essentially not doing ethics anymore. They might be doing science, which is inherently empirical; or politics, which likes to pretend about moral neutrality. But the fear and avoidance of ideology that enjoys the majority position in Progress in Bioethics is simply not ethicizing. Of course, these contributors are doing bioethics, and so such an ideological crusade against ideology appears to be self-defeating.
Playing politics. Even given their scientism and preference for moral neutrality, the contributors make no effort to hide their political ideals: individual autonomy and choice, social justice and equality, technological optimism, pragmatism, pluralism, change, change, and, oh yeah, more change. Further, they openly strategize around rhetoric and political moves—as evidenced by their worried analysis of conservative bioethics thinktanks and national commissions. Lempert’s shameless call for political tactics debases the bioethical enterprise. Of course, underhanded rhetoric is an option only for philosophically weak bioethics—well-represented by his article. Marcy Darnovsky sees this problem clearly: “We have suffered through years of politically polarized environment that makes thoughtful deliberation about human biotechnologies difficult” (212). Charo’s stance exacerbates just this issue: her theory of bioethics as necessarily and hopelessly political (53) conflates the political with the public, which leaves us to the perils of the existing bipartisan political machine, rather than reasonable, faithful and neighborly public discourse.* Arthur Caplan’s short piece is an honest reflection about ideology, but he too sees the power that bioethics wields as predominantly political. The contributors are wrestling with so many thoughtful questions about the nature of public bioethics. But the book’s cumulative stance on this point is represented by Caplan: “bioethics has taken a turn down a road [to politics] from which there is no return . . . bioethics has made a [political] bed it now must sleep in” (223). This acceptance of the entrenched status quo is inconsistent with the progressive political rhetoric we’re all familiar with, which is constantly espoused in the book. And this suggests there is some change—some real, hopeful, growth for the human community—that progressives are unwilling to make.
Progress in Bioethics betrays a deep-seated insecurity about the state of left-leaning bioethics. This is marked by some contributors’ anxiety about conservative bioethics, which has had, these authors admit, notable influence over the past several years, punctuated by the leadership of G.W. Bush’s President’s Council on Bioethics (2001–2009). Leon Kass (last year’s recipient of the CBC’s Paul Ramsey Award) bears the brunt of this anxious criticism: ten of the fifteen contributors quote and/or interact with Kass, most in attempt to discredit or ridicule his views. An entire chapter is dedicated to “the New Conservative Crusade.” And the general tone (with a couple exceptions) is flooded with a hyper-awareness of conservative moral and religious ideology. (Even the CBC and some of our colleagues are called out in a less-than-loving manner.) This strategy is at best rhetorically and philosophically dissatisfying; at worst, it deflates (even undercuts) the book’s attempt to construct a coherent and clear identity for progressive bioethics. The tired jargon just plays bad. But this appears to be the fatefully bipartisan and ethically thin political endeavor most of us are now well-familiar with—each side existing as a reaction to the other.
This picture starkly contrasts with Aristotle’s notion of political science as the best context for enacting and communicating eudaimonia (the good life) to our community. Aristotle had a very specific idea of the good life—one that was heavily value-laden and had a robust metaphysic, grounded in human moral and theoretical reason to support it. And this concept of the morally good life was inculcated and explicitly taught to young people and the morally deficient, helping them form habits that would eventually lead them to be virtuous, flourishing people in all realms of life, including science and technology.
*For an account of the “decoupling of the political and the public,” see James Davison Hunter’s To Change the World (Oxford: Oxford University Press, 2010).
