by Michael Thomson
Standard accounts of the emergence of bioethics are typically anchored in the progressive politics of the sixties. In these narratives, bioethics is cast as a response to the Nuremberg trials and a series of abuses committed in the name of research in the decades that followed. These originary tales position bioethics alongside the civil rights movement. It is a counter-cultural force protecting the rights of individuals, checking the excesses of (some) researchers, and an increasingly technological, commercial, and industrialized health system. As the bioethicist and historian Albert Jonsen argued, early bioethicists were “pioneers” who “blazed trails into a field of study that was unexplored and built conceptual roads through unprecedented problems.” The pioneers “radically change[d] the practice of scientific research in America.” Since these early days, bioethics has grown to attain a particular place in the governance of science and technology. It has “spawned a new profession and seeded novel social institutions.” It acts directly through structural requirements for ethical review, as well as indirectly through the ways in which bioethics has come to shape public deliberation. It has also influenced processes of legal reasoning and governance, with law becoming increasingly undifferentiated from bioethics and both “seen as normative modes that can preempt and control biomedicine.” As José López concluded over a decade ago, “In little over 30 years, bioethics has managed to position itself as a key node through which a variety of social, political and scientific activities are refracted.”
However, the operation and effectiveness of bioethics has long been questioned, with a “cottage industry of sceptics” keeping pace with the growth of the field. Critics have challenged dominant accounts of the emergence of bioethics and its ability—and willingness—to check the “overreach” of science and technology. Here, the bioethics enterprise is cast as a mode of permissive governance rather than a contesting presence and voice. In the most cutting of these critiques, bioethics is the “public relations division of modern medicine,” lambasted as medicine’s “showdog rather than a watchdog.” This Article focuses on the important charge within this wider criticism that mainstream bioethics fails to account sufficiently for the social; that is, “the social, political and economic arrangements that simultaneously create and constrain us.” This is understood as at the heart of bioethics’ failure to live up to its originary narratives and sufficiently contest the power and reach of modern biomedicine.
In response, I argue for the mobilization of Martha Fineman’s vulnerability theory as a new framework for bioethical analysis and deliberation. Fineman argues for a reorganization of our political discourse to respond to our shared vulnerability, which is “universal and constant, inherent in the human condition.” The aim of this Article is not to replace mainstream bioethics, but to enrich it with the “embodied and embedded” vulnerable subject: a subject whose embodied vulnerability and social embeddedness creates inevitable dependency on others. While calls to expand “the matrix of bioethical thought” are not new, there has over the years been little change in the “style of thought, or the ideologies” of mainstream bioethics. Nevertheless, it is argued that the “new biosocial moment” emerging in the life sciences may provide the conditions of possibility for the reorientation and revitalizing of bioethics. In areas such as neuroscience, epigenetics, and pro-social models of evolution, the body is increasingly figured as responsive at a molecular level to the environments within which it is embedded. As these biosocial knowledge claims proliferate, attending to the social in ethical debate becomes not only more pressing but also possible if strategic alliances are built across diverse disciplines. Thus, this Article identifies vulnerability theory as a response to a long identified weakness in bioethics, and also provides the mechanism whereby incorporation into bioethical thought and practice may be achieved.
This Article starts by outlining the foundational proposition that the objects of ethical concern are not preordained; they were not “always already” there waiting to be discovered and mobilized. This is achieved by setting out a particular genealogy, whereby the dominance of analytical philosophy and processes of institutionalization within medicine lead to a focus on certain objects and a neglect of the social as a core concern for analysis. Vulnerability theory is then introduced and the potential for incorporation into mainstream bioethics is identified through leveraging increasing cross-disciplinary concern with the biosocial—that is, with the “embodied and embedded” experience of being human. Here this Article details the social turn in the life sciences, with developmental neuroscience and neuroethics used to illustrate this increasingly prevalent thought style, its possibilities, and the limitations of current mainstream ethical responses. Finally, the potential for vulnerability theory to recast our objects of ethical concern is illustrated.
Before proceeding, it is important to clarify the bioethics that is the focus for this discussion. Reference is made across the literature to “mainstream” bioethics, distinguishing a core from feminist and other critical accounts. This term recognizes that while bioethics is an increasingly diverse field, it is still possible to identify a “mainstream” in terms of preoccupations and approaches even as the focus of bioethical analysis broadens. This is illustrated below in the context of neuroethics, and such criticism has also been levelled against innovations such as public health ethics. In referring to bioethics, this Article refers to the mainstream conception, which, importantly, also shapes how bioethics is practiced in the public sphere. Influence on public debate—shaping dominant accounts of the ethical in public and institutional discourse—places demands on bioethics to assess the tools it mobilizes in fulfilling its public roles. The focus on mainstream bioethics and the arguments made here should not, however, be read as a dismissal of the significant breadth of voices and approaches in the field as a whole, including feminist, reformist, and post-conventionalist bioethics.
I. “BIOETHICS IS NOT JUST BIOETHICS”
According to Daniel Callahan, bioethics is concerned with the “determination . . . of what is right and wrong, good and bad, about scientific developments and technological deployments of biomedicine. What are our duties and responsibilities in the face of those developments?” While Callahan’s definition continues to reflect the parameters of contemporary mainstream bioethics, the statement lacks history and context. In this, it may be taken to suggest that this definition and the particular objects it identifies as ethically important are self-evident and natural, rather than the result of specificities of time and place, including the “turf-wars” and “boundary-work” that shape all professional projects and claims to expertise. Indeed, the endeavor that Callahan describes is the product of a very specific set of alliances and jurisdictional scuffles. These explain why and how we end up with Callahan’s vision, rather than the bioethics conceived by Van Rensselaer Potter, the Wisconsin oncologist who first proposed a modern definition. Potter conceived of bioethics as a bridge: between present and future, nature and culture, science and values. Potter’s expansive ecological and medical vision was superseded by the much narrower understanding reflected by Callahan. It is important to ask how—from Potter’s open and inclusive starting place—we ended up with the particular disciplinary parameters we have today. Specifically, why have certain objects become of significance to bioethics while others have not?”
READ MORE (AND SEE CITATIONS) HERE: Michael Thomson, Bioethics & Vulnerability: Recasting the Objects of Ethical Concern, 67 Emory L. Rev. 1207 (2018). Available at: https://scholarlycommons.law.emory.edu/elj/vol67/iss6/6