Tl;dr: Bioethicists are too quiet when people appeal to an illusory “bioethical consensus” in order to justify conventional medical norms that are causing widespread harm.
The Bioethical Illusion
Others here have reframed their opposition to “bioethics” as gloss for opposition to biomedical institutional decision-making. I want to express my qualms with the field of bioethics per se.
The field of bioethics is taken seriously by biomedical decision-makers and practitioners. In non-medical domains, few people feel the need to rationalize their moral judgments and decisions on the basis of a consensus academic ethical position. By contrast, in the medical world, it is relatively common to appeal to a consensus bioethical position as a crucial component institutional decision-making.
As you point out, such a consensus bioethical position may be illusory in many cases. Yet the illusion persists, driving significant real-world outcomes. Let us call this problem “the bioethical illusion.”
The bioethical illusion makes it difficult to put actual bioethical thinking into practice. As long as people subscribe to the bioethical illusion, actual bioethicists and divergent bioethical thinking will come across as “pseudoethics,” the work of cranks.
This makes for an intractable problem, in which the norms of the medical field stem not from a centralized authority (which can be overcome), nor from a cultural norm (which can be changed via healthy debate), nor from consensus academic principles (which can be grounded in a traceable line of argument), but from the bioethical illusion.
The best analogy I can think of is the Latin Bible. The Bible used to be written and read exclusively in Latin, so that common people could not understand it. This allowed the chuch to pretend that church laws and religious doctrines had a Biblical basis, when they in fact did not. But over time, the idea that these features had a Biblical justification became normalized, and questioning whether that Biblical justification itself existed became a form of heresy. While religious authorities did not have a true consensus on many important religious matters, the notion of an illusory Biblical basis for certain rules, and that this could not be discussed, served to greatly inhibit discourse or change.
Likewise, the bioethical illusion functions to establish a false bioethical consensus. One part of the bioethical illusion is the idea that bioethics is the exclusive domain of bioethicists, a subject on which people who are not professional bioethicists cannot reason effectively. To question the bioethical consensus risks compromising a person’s professional standing, and creates political problems for their colleagues. This allows any biomedical norm that is covered by the bioethical illusion to resist challenge or change, or even debate and discussion. They become matters of biodoctrine, not matters of bioethics.
I’m a biomedical engineering grad student at a major US research university. Students in our program are required to take an ethics seminar. No bioethicists and no papers on ethics or bioethics were included in the ethics seminar. The overwhelming impression I had was that students were being impressed with biodoctrine and politics. This is how the bioethical illusion works. Future practitioners in the field are required to an “ethics” class with no ethical content whatsoever—only political and norms-reinforcing content delivered by a non-ethicist.
The Bioethical Illusion Relies on the Complicity of Bioethicists
The bioethical illusion wouldn’t work nearly as well, if at all, if it weren’t for the existence of an actual field of bioethicists. My problem with bioethics is that the field isn’t activist enough. It needs to loudly and consistently point out that:
a) Non-bioethicists are posing as experts in an illusory academic bioethical consensus, while in fact ignoring the field of bioethics.
b) That everybody has a right to consider and participate in bioethical discourse. Medical providers, scientists, regulators and administrators don’t just have a right, but a responsibility to do so.
c) Challenging public misconceptions about the state of bioethical discourse.
d) We need a more ethically-grounded discussion of political/medical issues,with bioethicists being the group primarily responsible for facilitating this shift.
Until the field of bioethics starts working to dismantle the bioethical illusion, it is unintentionally complicit in maintaining the bioethical illusion.
This sounds like a similar argument to “all Muslims are complicit in terrorism unless they loudly and publicly condemn terrorism” or “if your dad’s Facebook account gets cloned, he’s responsible for anyone gets scammed”.
On the one hand, people whose identity is being co-opted to do bad things have a unique ability to fight back. On the other hand, it’s pretty unfair to say that all professional researchers of bioethics need to suddenly pivot into PR because you hold them responsible for the actions of people they’ve never met.
It may sound that way, but it’s not the same argument, and I wish you’d take more time to consider before you make such an uncharitable and contentious interpretation.
Here’s why my argument is different.
The general form of the “all Muslims must denounce Islamic terrorism or be complicit in it” is:
Sharing label X with perpetrators of bad act Y causes good group X1 to have a moral obligation to take a stand against bad group X2.
In my comment, however, I am not accusing the medical establishment (X2) of intentional or uncontroversially bad acts (Y).
Instead, I am identifying a complex coordination problem in which incentives are skewed. Bioethicists are also affected by this situation. However, they have a unique opportunity to take steps toward correcting this situation, by taking the steps I outlined.
Furthermore, a key difference between Muslims, my dad, and bioethicists is that being a Muslim or a dad is a personal avocation or form of cultural participation. Understood in a culturally specific context, being a Muslim or father entails certain duties, but these are limited mainly to personal conduct, certain observances, specific acts in defined conditions, and generally virtuous behavior.
By contrast, occupying a professional role is widely understood to come with an increased social responsibility, both for rendering the services of that role in a competent manner, and for aligning that role in its social context in a proper way. Professional bioethicists can be said to have an obligation to prevent harm and work toward good outcomes in matters related to their profession. This is a widely understood responsibility of many jobs, and is what I’m calling for here.
This responsibility is increased by the fact that many bioethicist salaries ultimately come from the taxpayer. They have a duty to the citizens who fund their work to make improvements in the ethical aspects they purport to be experts on in the medical system.
The cases do seem somewhat different to me as well, but I don’t think this necessarily contradicts my thesis. If the key criticism is something like “bioethicists should make their actual leanings more well-known and influential” I would agree with that. It’s just this seems more modest and less unique than many of the criticisms I have seen.
I think that many of the people you quote are articulating the bioethical illusion. Take Matt’s quote, for example:
I’ve clashed with bioethics Twitter…
And, I don’t know, the ethics experts just disagree about the big picture, obvious controversies...
And then there’s these, I don’t know who, being like, ‘Well that’s not good ethics.’ And I’m like, ‘Well, according to whom?’ Right?...
[W]ho the fuck are you?
He’s saying:
a) It’s not clear who these supposed “bioethicists” are.
b) Whoever they are, they’re misrepresenting their own controversial views as professional consensus.
c) They are also exaggerating their professional standing, and it’s not clear that they do or should have any standing as moral authorities at all.
It seems to me that a primary skill of a competent professional ethicist is to be able to articulate arguments and counter-arguments in their field, and to be able to roughly articulate the professional consensus as well as popular opinion on the subjects they are most expert in. While people are entitled to their personal opinion, if a professional (bio)ethicist speaks out in their professional capacity to politicians or the media, they ought to qualify the strength of their statements based on an accurate representation of the state of the discourse and professional and popular views. This doesn’t have to be done perfectly or in a uniform fashion, but a real attempt should be made.
In turn, bioethicists ought to either work hard to organize their profession around this principle, and to invite the public, journalists, and lawmakers into a more open-minded view of the most pressing bioethical issues of our day. They don’t have to fix PR problems or instill a particular viewpoint on specific bioethical issues, but they need to try to create a perception that bioethics doesn’t have many universally-held conclusions on particular ethical issues in biotechnology. I don’t hold them responsible for failing to restrain their loudmouthed colleagues, but I do feel resentment for their not trying harder to spread a more nuanced and representative view of unsettled debates.
In fact, I think this is perhaps the primary responsibility of an ethicist. It’s not to craft a conclusive argument to settle an ethical issue, but to make strong efforts invite the public and providers into a more refined dialogue in their public communications. If the public doesn’t accept that invitation, it’s not the bioethicists’ fault. I’d like to see more active efforts from bioethicists, and since I don’t—but do see the tails of the field as indirectly contributing to bureaucratic rigidity and journalistic nonsense, with little pushback from the center—I see the field as having net negative value at present. This is the frustration that I read into some of the quotes you’re referencing.
In my comment, however, I am not accusing the medical establishment (X2) of intentional or uncontroversially bad acts (Y).
No one is accusing your dad of bad acts if his Facebook is cloned, AFAICT.
I do accept that there is a difference between a taxpayer-funded profession and a personal/religious/cultural role, but that seems to be the only difference—they really do seem like very similar arguments and I’m a bit surprised to be called uncharitable for bringing it up.
In addition to the what AllAmericanBreakfast said, the issue with “all Muslims are complicit in terrorism unless they loudly and publicly condemn terrorism” is that
a. not all terrorism is committed by Muslims.
b. The shared notion between a) Islamic terrorist and b) normal guy who happens to be Muslim is that they share a belief in the “the will of God”, and they have deferring notions about what the will of God tells them to do.
c. In contrast, (at least in AllAmericanBreakfast’s telling)”the establishment” specifically appeals to the bioethics illusion in their choice to be conservative and allowing people to die by omission. The appropriate comparison might instead be a Muslim imam [1]whose teachings were specifically cited by terrorists as a justification for terror and who chose not to condemn terror (or alternatively, blaming God himself, assuming God is real).
I think this is reasonable. I think it’s also reasonable to assign partial blame to Karl Marx (and contemporary Marxist scholars and firebrands) for the failures of the Soviet Union, and it’s reasonable to assign a small amount of blame to Nietzsche and Kant (as well as contemporary scholars who did not disavow such actions) for the harms of Nazi Germany. Or closer to home, if animal rights terrorism are conducted in the name of Peter Singer, it’s reasonable to assign partial blame to Singer for his speech acts, and especially if he does not disavow such terrorism.
Though that comparison is not exact either, since the illusion is not propagated by individual bioethicists so much as the field overall. So perhaps it’s closer to whether Muslim imams overall have a duty to disavow terror, and I think this is also reasonable (I’d say the same thing about contemporary Marxist scholars re: Stalin and Nietzsche scholars re: Hitler).
I’m a bit surprised to be called uncharitable for bringing it up.
In particular, the religious example you gave has political associations I am eager to avoid. Implying such associations can be used as a rhetorical tactic. Furthermore, you read an extreme statements into my comment that simply is not there:
it’s pretty unfair to say that all professional researchers of bioethics need to suddenly pivot into PR
These things together caused me to read your comment not as a rebuttal, but as a low blow, combining outgroup signaling and weak-man tactics. This is why I called your comment uncharitable. I am explaining this to you because you said you were surprised at this reaction, which indicates to me that you may be unaware of these associations and may not have been reading me very closely.
No one is accusing your dad of bad acts if his Facebook is cloned, AFAICT.
Holding your dad responsible for anyone who gets scammed would be equivalent to accusing him of negligence—a bad omission rather than a bad act, but it is in fact a discussion of omissions that we are focused on here.
that seems to be the only difference—they really do seem like very similar arguments
Given that you didn’t notice this important difference the first time you examined my argument, are you sure you want to trust your impressions of how things “seem” to you the second time around? This is not, after all, the only difference I outlined—the other being that we are dealing with coordination and communication problems rather than intentionally destructive or criminal actions.
Of course, it’s also important to note that it’s not just the number of distinct differences between the argument I’m making and the words you’re putting into my mouth, but the magnitude of each individual difference. A single important difference is enough to robustly distinguish the ethical argument I’m making from the one you’re worrying about.
Tl;dr: Bioethicists are too quiet when people appeal to an illusory “bioethical consensus” in order to justify conventional medical norms that are causing widespread harm.
The Bioethical Illusion
Others here have reframed their opposition to “bioethics” as gloss for opposition to biomedical institutional decision-making. I want to express my qualms with the field of bioethics per se.
The field of bioethics is taken seriously by biomedical decision-makers and practitioners. In non-medical domains, few people feel the need to rationalize their moral judgments and decisions on the basis of a consensus academic ethical position. By contrast, in the medical world, it is relatively common to appeal to a consensus bioethical position as a crucial component institutional decision-making.
As you point out, such a consensus bioethical position may be illusory in many cases. Yet the illusion persists, driving significant real-world outcomes. Let us call this problem “the bioethical illusion.”
The bioethical illusion makes it difficult to put actual bioethical thinking into practice. As long as people subscribe to the bioethical illusion, actual bioethicists and divergent bioethical thinking will come across as “pseudoethics,” the work of cranks.
This makes for an intractable problem, in which the norms of the medical field stem not from a centralized authority (which can be overcome), nor from a cultural norm (which can be changed via healthy debate), nor from consensus academic principles (which can be grounded in a traceable line of argument), but from the bioethical illusion.
The best analogy I can think of is the Latin Bible. The Bible used to be written and read exclusively in Latin, so that common people could not understand it. This allowed the chuch to pretend that church laws and religious doctrines had a Biblical basis, when they in fact did not. But over time, the idea that these features had a Biblical justification became normalized, and questioning whether that Biblical justification itself existed became a form of heresy. While religious authorities did not have a true consensus on many important religious matters, the notion of an illusory Biblical basis for certain rules, and that this could not be discussed, served to greatly inhibit discourse or change.
Likewise, the bioethical illusion functions to establish a false bioethical consensus. One part of the bioethical illusion is the idea that bioethics is the exclusive domain of bioethicists, a subject on which people who are not professional bioethicists cannot reason effectively. To question the bioethical consensus risks compromising a person’s professional standing, and creates political problems for their colleagues. This allows any biomedical norm that is covered by the bioethical illusion to resist challenge or change, or even debate and discussion. They become matters of biodoctrine, not matters of bioethics.
I’m a biomedical engineering grad student at a major US research university. Students in our program are required to take an ethics seminar. No bioethicists and no papers on ethics or bioethics were included in the ethics seminar. The overwhelming impression I had was that students were being impressed with biodoctrine and politics. This is how the bioethical illusion works. Future practitioners in the field are required to an “ethics” class with no ethical content whatsoever—only political and norms-reinforcing content delivered by a non-ethicist.
The Bioethical Illusion Relies on the Complicity of Bioethicists
The bioethical illusion wouldn’t work nearly as well, if at all, if it weren’t for the existence of an actual field of bioethicists. My problem with bioethics is that the field isn’t activist enough. It needs to loudly and consistently point out that:
a) Non-bioethicists are posing as experts in an illusory academic bioethical consensus, while in fact ignoring the field of bioethics.
b) That everybody has a right to consider and participate in bioethical discourse. Medical providers, scientists, regulators and administrators don’t just have a right, but a responsibility to do so.
c) Challenging public misconceptions about the state of bioethical discourse.
d) We need a more ethically-grounded discussion of political/medical issues,with bioethicists being the group primarily responsible for facilitating this shift.
Until the field of bioethics starts working to dismantle the bioethical illusion, it is unintentionally complicit in maintaining the bioethical illusion.
This sounds like a similar argument to “all Muslims are complicit in terrorism unless they loudly and publicly condemn terrorism” or “if your dad’s Facebook account gets cloned, he’s responsible for anyone gets scammed”.
On the one hand, people whose identity is being co-opted to do bad things have a unique ability to fight back. On the other hand, it’s pretty unfair to say that all professional researchers of bioethics need to suddenly pivot into PR because you hold them responsible for the actions of people they’ve never met.
It may sound that way, but it’s not the same argument, and I wish you’d take more time to consider before you make such an uncharitable and contentious interpretation.
Here’s why my argument is different.
The general form of the “all Muslims must denounce Islamic terrorism or be complicit in it” is:
Sharing label X with perpetrators of bad act Y causes good group X1 to have a moral obligation to take a stand against bad group X2.
In my comment, however, I am not accusing the medical establishment (X2) of intentional or uncontroversially bad acts (Y).
Instead, I am identifying a complex coordination problem in which incentives are skewed. Bioethicists are also affected by this situation. However, they have a unique opportunity to take steps toward correcting this situation, by taking the steps I outlined.
Furthermore, a key difference between Muslims, my dad, and bioethicists is that being a Muslim or a dad is a personal avocation or form of cultural participation. Understood in a culturally specific context, being a Muslim or father entails certain duties, but these are limited mainly to personal conduct, certain observances, specific acts in defined conditions, and generally virtuous behavior.
By contrast, occupying a professional role is widely understood to come with an increased social responsibility, both for rendering the services of that role in a competent manner, and for aligning that role in its social context in a proper way. Professional bioethicists can be said to have an obligation to prevent harm and work toward good outcomes in matters related to their profession. This is a widely understood responsibility of many jobs, and is what I’m calling for here.
This responsibility is increased by the fact that many bioethicist salaries ultimately come from the taxpayer. They have a duty to the citizens who fund their work to make improvements in the ethical aspects they purport to be experts on in the medical system.
The cases do seem somewhat different to me as well, but I don’t think this necessarily contradicts my thesis. If the key criticism is something like “bioethicists should make their actual leanings more well-known and influential” I would agree with that. It’s just this seems more modest and less unique than many of the criticisms I have seen.
I think that many of the people you quote are articulating the bioethical illusion. Take Matt’s quote, for example:
He’s saying:
a) It’s not clear who these supposed “bioethicists” are.
b) Whoever they are, they’re misrepresenting their own controversial views as professional consensus.
c) They are also exaggerating their professional standing, and it’s not clear that they do or should have any standing as moral authorities at all.
It seems to me that a primary skill of a competent professional ethicist is to be able to articulate arguments and counter-arguments in their field, and to be able to roughly articulate the professional consensus as well as popular opinion on the subjects they are most expert in. While people are entitled to their personal opinion, if a professional (bio)ethicist speaks out in their professional capacity to politicians or the media, they ought to qualify the strength of their statements based on an accurate representation of the state of the discourse and professional and popular views. This doesn’t have to be done perfectly or in a uniform fashion, but a real attempt should be made.
In turn, bioethicists ought to either work hard to organize their profession around this principle, and to invite the public, journalists, and lawmakers into a more open-minded view of the most pressing bioethical issues of our day. They don’t have to fix PR problems or instill a particular viewpoint on specific bioethical issues, but they need to try to create a perception that bioethics doesn’t have many universally-held conclusions on particular ethical issues in biotechnology. I don’t hold them responsible for failing to restrain their loudmouthed colleagues, but I do feel resentment for their not trying harder to spread a more nuanced and representative view of unsettled debates.
In fact, I think this is perhaps the primary responsibility of an ethicist. It’s not to craft a conclusive argument to settle an ethical issue, but to make strong efforts invite the public and providers into a more refined dialogue in their public communications. If the public doesn’t accept that invitation, it’s not the bioethicists’ fault. I’d like to see more active efforts from bioethicists, and since I don’t—but do see the tails of the field as indirectly contributing to bureaucratic rigidity and journalistic nonsense, with little pushback from the center—I see the field as having net negative value at present. This is the frustration that I read into some of the quotes you’re referencing.
No one is accusing your dad of bad acts if his Facebook is cloned, AFAICT.
I do accept that there is a difference between a taxpayer-funded profession and a personal/religious/cultural role, but that seems to be the only difference—they really do seem like very similar arguments and I’m a bit surprised to be called uncharitable for bringing it up.
In addition to the what AllAmericanBreakfast said, the issue with “all Muslims are complicit in terrorism unless they loudly and publicly condemn terrorism” is that
a. not all terrorism is committed by Muslims.
b. The shared notion between a) Islamic terrorist and b) normal guy who happens to be Muslim is that they share a belief in the “the will of God”, and they have deferring notions about what the will of God tells them to do.
c. In contrast, (at least in AllAmericanBreakfast’s telling)”the establishment” specifically appeals to the bioethics illusion in their choice to be conservative and allowing people to die by omission. The appropriate comparison might instead be a Muslim imam [1]whose teachings were specifically cited by terrorists as a justification for terror and who chose not to condemn terror (or alternatively, blaming God himself, assuming God is real).
I think this is reasonable. I think it’s also reasonable to assign partial blame to Karl Marx (and contemporary Marxist scholars and firebrands) for the failures of the Soviet Union, and it’s reasonable to assign a small amount of blame to Nietzsche and Kant (as well as contemporary scholars who did not disavow such actions) for the harms of Nazi Germany. Or closer to home, if animal rights terrorism are conducted in the name of Peter Singer, it’s reasonable to assign partial blame to Singer for his speech acts, and especially if he does not disavow such terrorism.
Though that comparison is not exact either, since the illusion is not propagated by individual bioethicists so much as the field overall. So perhaps it’s closer to whether Muslim imams overall have a duty to disavow terror, and I think this is also reasonable (I’d say the same thing about contemporary Marxist scholars re: Stalin and Nietzsche scholars re: Hitler).
In particular, the religious example you gave has political associations I am eager to avoid. Implying such associations can be used as a rhetorical tactic. Furthermore, you read an extreme statements into my comment that simply is not there:
These things together caused me to read your comment not as a rebuttal, but as a low blow, combining outgroup signaling and weak-man tactics. This is why I called your comment uncharitable. I am explaining this to you because you said you were surprised at this reaction, which indicates to me that you may be unaware of these associations and may not have been reading me very closely.
Holding your dad responsible for anyone who gets scammed would be equivalent to accusing him of negligence—a bad omission rather than a bad act, but it is in fact a discussion of omissions that we are focused on here.
Given that you didn’t notice this important difference the first time you examined my argument, are you sure you want to trust your impressions of how things “seem” to you the second time around? This is not, after all, the only difference I outlined—the other being that we are dealing with coordination and communication problems rather than intentionally destructive or criminal actions.
Of course, it’s also important to note that it’s not just the number of distinct differences between the argument I’m making and the words you’re putting into my mouth, but the magnitude of each individual difference. A single important difference is enough to robustly distinguish the ethical argument I’m making from the one you’re worrying about.