I’m guessing a lot of the disagreement comes from looking at different time-slices of ‘bioethics’, and different parts of the field. From Luke Muehlhauser:
[...] For many decades, doctors were the presumed authorities on medical ethics, and their approach was fairly pragmatic and utilitarian, i.e. focused on competently and professionally doing what is best for the patient.
Starting in the 1960s, new medical capabilities (e.g. heart transplants) and some medical ethics scandals (e.g. the Tuskegee syphilis experiment) seemed to demand ethical analysis, but for the most part, the professional medical community generally didn’t want to spend its time with such “distractions” from the practice of medicine.
A mix of scholars, often theologians or philosophers, began to fill this void by devoting themselves full-time to studying and writing about questions of medical ethics. These people began to call themselves “bioethicists.”
Then, when some key government commissions and court cases came about in the 70s and 80s, the bioethicists had done enough work to establish themselves as “the experts” on these topics that they had a large and lasting influence on some important early laws and court decisions concerning various issues in medical ethics. Since the medical community had also neglected to develop curricular materials for teaching medical ethics, this void was also filled by texts written by bioethicists rather than by medical professionals, and thus whole generations of medical professionals were trained in the bioethicists’ early approach to medical ethics rather than (say) an approach developed by doctors.
These developments annoyed many medical professionals. In part, this was because they felt that professional medical expertise was necessary (and perhaps sufficient) for thinking through the ethical issues that arise in the practice of medicine. Another source of annoyance may have been that bioethicists of the time tended to be more theological and deontological (i.e. less utilitarian), and more cautious about developing and deploying new medical capabilities, compared to doctors.
The early laws and court decisions related to bioethics continue to have an outsized effect, though bioethicists today are probably more diverse than they were in the earliest years of bioethics, and (e.g.) many of them are explicitly utilitarian.
[...] In Europe, by contrast, organized medicine neither abandoned medical ethics nor abdicated moral authority. Consequently, just as alcoholic and caffeinated beverages retained jurisdiction over social life in European pubs and cafes, rendering soft drinks to the status of second-class beverages, so, too, organized medical and scientific societies (e.g., the British and Dutch medical societies and specialty colleges) retained jurisdiction over medical ethics — relegating aspiring European bioethicists to the status of second-tier authorities.
Thus, the Royal Dutch Medical Association… was able to negotiate physician-initiated euthanasia practices with Dutch legal authorities without involving “bioethicists” in any major decision.
Similarly, the British National Health Service… was also able to initiate a covert rationing scheme limiting use of dialysis and other expensive technologies to younger patients — effectively resolving the rationing problem created by the Scribner shunt by denying access to the elderly — without annoying discussions or protests from “bioethicists.”
Having retained jurisdiction and moral authority over medical ethics, organized medicine in Europe had the prerogative of negotiating with governments to determine the appropriate nature of end-of-life care (euthanasia) or the allocation of scarce resources (age rationing).
In America, by contrast, laissez-faire ethics rendered medicine unwilling to express authoritative moral positions and thus unable to negotiate them with the U.S. government. Thus, these issues were negotiated with “outsiders” invited into the once exclusively medical jurisdiction of “medical” ethics; that is, they were negotiated with “bioethicists.” …to deal with American medicine’s abdication from moral authority, American bureaucrats joined with government and private foundations to empower a hodgepodge of ex-theologians, lawyers, philosophers, social scientists, and humanistic nurses, physicians, and researchers to address issues raised by research ethics scandals and by morally disruptive technologies…
This is a possibility, admittedly my evidence doesn’t say much about the old state of the field. If so I think that would be a good reason for optimism, so I kind of hope you’re right. That said, I think some of the state of research has to come down to unintentional consequences as well. The Belmont Report is too strict even as intended for instance, but I think a great deal of its harm comes from the vagueness of the guidelines it inspired.
I’m guessing a lot of the disagreement comes from looking at different time-slices of ‘bioethics’, and different parts of the field. From Luke Muehlhauser:
Luke quotes Baker’s Before Bioethics:
This is a possibility, admittedly my evidence doesn’t say much about the old state of the field. If so I think that would be a good reason for optimism, so I kind of hope you’re right. That said, I think some of the state of research has to come down to unintentional consequences as well. The Belmont Report is too strict even as intended for instance, but I think a great deal of its harm comes from the vagueness of the guidelines it inspired.