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The rise and fall and rise again of bioethics (2019)

Sarah Franklin has written a very thoughtful, informed and at the same time provocative essay in a recent issue of Nature.

It traces the rise of bioethics in the 1970s through its high water flourishing in the 1980s and the 1990s to its more recent drift ‘into uncharted waters’ and evolution into something less ‘codified’, more ‘interdisciplinary’, more ‘pragmatic’, diverse of representation, and more ‘sociable’. It concludes with the ringing demand that ‘we must all be ethicists now.’ As its current Chair it is gratifying to read her enthusiastic endorsement of the Nuffield Council on Bioethics and its role in this new context of advising policy makers with an approach that combines interdisciplinary expertise with extensive public consultation. But – and there has to be a ‘but’ – the narrative she provides does not tell the whole story and it tells a certain kind of story, one that will be familiar to those who engage in practical normative theory. Her comment thus provides a useful opportunity to try to address some possible misapprehensions of what exactly ‘bioethics’ is, and also to re-affirm the value of normative theory. I prefer to say I am a normative theorist rather than describe myself as an ‘ethicist’, a term I heartily dislike and often publicly disavow. Sarah is right when she claims that few of the Council working groups that produce our reports have been chaired by ‘bioethicists’. Yet many have been chaired by those who engage in practical normative theory albeit not as academic philosophers but as, for instance, academic lawyers. All working groups have certainly included such theorists and amongst my predecessors as Chair have been several distinguished examples of such theorists.

Sarah dates the birth of bioethics to the 1970s and its place of birth as the US. This is the well-known Georgetown version of how bioethics emerged and – as we shall see – what form it should take. It overlooks the prior initiatives immediately after the Second World War – and crucially in response to the egregiously bad actions within that war of medical practitioners - to identify those moral principles by which doctors and medical researchers should henceforward act. Central here are such documents as the Nuremburg Code (1947) and the Declaration of Geneva (1948). The canonical Helsinki Declaration (1964) which identifies the duty to obtain informed consent and the duty of beneficence as key precepts predates the first edition of Beauchamp’s and Childress’ Principles of Biomedical Ethics by fifteen years.

Yet Sarah is right that academic bioethics as it was created in Georgetown in the 1970s took a certain form, one often called ‘principalist’ and which she characterises as ‘philosophically derived mandates codified into textbook formulas’. She is also right that ‘professional bioethics’ snaffled the bulk of funding generated for the analysis of the new biotechnologies. Capital ‘E’ and lower case ‘l’ and ‘s’ is how the Ethical, Legal and Social Implications (ELSI) of scientific developments were practically understood. But, of course, there are real differences between ‘professional’ and ‘academic’ bioethics, as there are between bioethics in the US and in Europe.

Most importantly, there are philosophical differences between the various approaches that might be taken to the ethical analysis of the extraordinarily rich and varied range of issues thrown up by developments in genomics, reproductive science, biology, AI and robotics, neuroscience, geroscience, and much more besides. It is not that, as she says, bioethics ‘drifted into uncharted waters’, became ‘unmoored’ and encountered ‘ethical quagmires’; it is rather that bioethics began to stand within a wide and variegated landscape whose diverse theoretical features reflected the full range of philosophical possibilities. Not just ethics, but metaphysics, epistemology, conceptual analysis, jurisprudence and philosophy of science define this bioethical ground. Bioethicists can also be virtue theorists, Kantians, utilitarians, and more, as they see fit.

Certainly, the issues to be understood got more complex and broadened beyond simple doctor-patient and researcher-subject relations to encompass questions of public health and even what it means to be ‘human’. But this doesn’t mean losing one’s moorings or drifting, nor sinking into quagmires. It means finding the means to try to understand what may never have previously been thought about.

It is important not to conflate the complexity of bioethical thinking with the real practical difficulties of regulating sciences that are developing at extraordinary speeds driven in many cases by entrepreneurial imperatives and within a world of significant national and cultural differences. Philosophers are not always very good at recognising the realities of the world they choose to comment on. She is right to praise Mary Warnock for her hard-headed acknowledgement of what practically was needed to get the Human Fertilization and Embryology Act drafted and passed into law. She is insufficiently praised by philosophers for her work and too easily traduced as a fudger and compromiser. I too greatly admire her work in this area. But, as I argued, in a Nuffield Council discussion of the 14-day rule for the preservation of embryos, her position was a subtle mixture of the philosophical and the pragmatic. It is not that she abandoned philosophy to adopt a pragmatic compromise. Indeed, as Sarah recognizes, she offered ‘several overlapping types of argument’ to justify her position.

And here is the challenge for bioethics: it is not to give up on normative theory. It is not to stop distinguishing ‘is’ and ‘ought’. It is rather to defend what ought to be the case with a clear and intelligent appreciation of what is the case and what might be the case. Those normative theorists who work within the world of law and policy should not abandon the imperative to understand, define and defend the claims of what ought to be done.

Interdisciplinarity is a great thing, and it defines the work of the Nuffield Council that brings together in collegiate and constructive dialogue individuals working in business, clinical medicine, biological research, media, culture, law, and philosophy to tackle the most important issues thrown up by developments in biological and medical research. It is a Council ‘on’ bioethics but not of bioethicists. But interdisciplinarity starts from the existence of different disciplines. ‘Ethics’ is one such discipline. It would be lovely to think we can all be ethicists now. It would however diminish and misunderstand the project of bioethics to think that this can be achieved by denying what marks out ethics as a distinct discipline.

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