Abstract
In its short 50-year history, bioethics has had an uneven relationship with sociology. On the one hand, sociologists have the skills that bioethicists need to describe, measure, and analyze bioethical moments in the clinic and in research. On the other hand, the penchant of sociologists to locate the profession and practice of bioethics in its social and historical context is not always welcomed by bioethicists who see it as a challenge to their legitimacy.
Given the uneasy alliance between sociology and bioethics, it is interesting that the editors Jonathan Moreno and Sam Berger, who are bioethicists, invited four sociologists to be among the 16 contributors to their anthology. Even more interesting is that the sociology they provide is, for the most part, of the contextualizing sort. In order to understand why the editors drew on this sociological approach to bioethics, we must begin with what they hoped to accomplish with Progress in Bioethics. The uninitiated reader will find their title misleading. For those unfamiliar with the culture skirmishes within the field of bioethics that occurred during the presidency of George W. Bush, the title suggests an impartial history of bioethics and its role in the world of science and politics. In fact, the editors have a much more partisan goal: to help “bioethicists and the lay public alike to better understand what progressive bioethics is, and why in the current political climate it is so sorely needed” (p. xix).
Moreno and Berger explain the need for a progressive bioethics in their introduction. In brief, they see a move from the halcyon days of the “Great Bioethics Compromise”—“an agreement to remain civil and outside the larger political currents”—to a politicized bioethics generated by the controversies over cloning and the decidedly conservative cast of George W. Bush’s President’s Council on Bioethics (PCB) (p. xviii). This shift to the political right caused consternation in the world of bioethics. President Clinton’s National Bioethics Advisory Commission (NBAC) had busied itself with generating sensible guidelines for responding to complicated ethical quandaries, including decisional capacity in the mentally impaired, the use of stem cells, and the handling of human biological materials. Bush’s council changed the focus. Where the NBAC examined the means required to do research and provide care ethically, PCB opened a conversation about the ends of research. One of the PCB’s first publications, for example, considered how “the pursuit of happiness” was affected by biotechnology (rather than suggesting ethical guidelines for the development of that technology). The NBAC was seen as neutral, a bureaucratized bioethics. With the coming of the PCB, sides were taken and it was imperative that a progressive bioethics respond in order to prevent a presidentially sanctioned conservative bioethics from impeding progress in the life sciences.
The five sections of the book consider the situation and future of progressive bioethics. They examine the politicization of bioethics, strategies for promoting a progressive bioethics, the ways progressive ideas can inform the organization and ideas of bioethics, disagreements about the place of biotechnologies in improving life on earth, and the value of efforts to find common ground in an increasingly divided bioethics.
Considering their goals, the editors found a contextualizing sociology most useful. Not surprisingly, it is a sociology that often challenges the overall mission of the book. In his chapter, for example, Richard Lempert argues for a non-political bioethics. He admits he is made “uneasy” by the term “progressive bioethics” and goes on to insist that “bioethics should be neither progressive or regressive…[it] should be just good, sound ethics applied to the often difficult moral problems posed by present day medicine and the genomic revolution” (p. 23). To the extent that there is a place for progressive bioethics, it is to “advance the application of sound bioethical principles in public life” (p. 42).
Given that bioethics is now a half-century old, one would expect the field to have a clear sense of mission and a set of criteria for defining who is, and who is not, a bioethicist. But, as sociologist Paul Root Wolpe points out, this is not the case. Bioethics is “torn between its potential role as watchdog … and its function in lubricating the social acceptance of technologies” (p. 110) and there are no agreed upon criteria for entry into the profession of bioethics, both of which weaken an up-and-coming profession that would be the arbiter of matters ethical in medicine and the life sciences.
John Evans examines the history of the relationship between bioethics and religion, arguing that the waning influence of theologians in bioethics was not because of their insistence on faith-based ethics. In fact, many of the theologians influential in creation of bioethics were “willing to translate their theological beliefs into a secular language for consumption in the public sphere (p. 121), but they were gradually excluded because they wished to talk about the “big questions” generated by new medical technologies, questions about ends. He suggests that progressive bioethicists could re-engage liberal religious groups (potentially useful allies) if they were willing to discuss these “big questions.” Evans believes that such a re-engagement offers a third way between hard line progressives and hard line conservatives.
The final sociological contribution comes from James Hughes. Like Evans, he uses his sociological imagination to advise progressive bioethicists. Focusing on human enhancement, he offers a brief but nuanced look at the historical factors that generated a number of “biopolitical organizations” ranging from religious bioconservatives, to libertarians, to “left bioconservatives” (wary of techno-eugenics and the relationship between industry and the academy), technoprogressives, and groups that represent fusions between types. He encourages progressive bioethicists to find their place in this plethora of positions and to cultivate constituencies from segments of the population predisposed to support scientific solutions for the problems of living.
While the editors are to be commended for seeing the value of a critical, contextualizing sociology, gaps remain in their approach to understanding the place of bioethics in the world of healthcare. They focus exclusively on the regulatory function of research ethics, but bioethicists also play an important role in the clinic—adjudicating ethical impasses—and in medical education. Important to progressive goals is the way bioethics displaced medical sociology in health care settings. Beginning in the 1950s, medical sociologists were asked to provide a non-clinical perspective to clinicians in training. Bioethics, with its more compatible case-based approach to the problems of health care, has increasingly taken over this task. Lost in the rise of clinical bioethics, progressive or otherwise, is the cultural and structural critique offered by sociology.
The final section of the book seeks “progress beyond politics” and includes incisive essays by Daniel Callahan and William F. May, both of whom argue for creating a common ground between the political factions of bioethics. Callahan finds that common ground in efforts to repair America’s failing health system and May sees hope for reconciliation of left and right in the recognition of the value of diverse traditions and rejection of a bioethics grounded in a religious dualism that separates the world into “us” (the good guys) and them (the bad guys). An engaging read, Progress in Bioethics, would be a fine text to use in courses exploring the sociology of bioethics.