1. Bioethics: Problems and Prospects
Author(s): Samuel GorovitzSource: Noûs, Vol. 18, No. 1, 1984 A. P. A. Western Division Meetings (Mar., 1984), pp. 17-20Published by: WileyStable URL: http://www.jstor.org/stable/2215017 . Accessed: 10/11/2014 15:18Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at . http://www.jstor.org/page/info/about/policies/terms.jsp . JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range ofcontent in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new formsof scholarship. For more information about JSTOR, please contact support@jstor.org. . Wiley is collaborating with JSTOR to digitize, preserve and extend access to Noûs. http://www.jstor.org
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2. Bioethics. Problems and Prospects
(ABSTRACT)
SAMUEL GOROVITZ
UNIVERSITY OF MARYLAND
It is little over a decade since a variety of concerns about moral
dilemmas in contemporary medical practice and health care coalesced
into what is now known as the "field" of medical ethics or, as it
is often called, bioethics. In some respects, it is a field, despite its
youth, like any other. It has practitioners, conventions, a basic
literature including many specialty journals and books, courses of
study at most colleges and universities, and even an encyclopedia.
In other respects, it is unusual. There is no single discipline with
which it is associated; rather, work is contributed to the field by
philosophers, scholars in religious studies, lawyers, economists, physi-cians,
sociologists, and many others. And it is controversial. Its
methodologies are obscure, its standards of quality are often ill defin-ed,
and the value of its contributions to scholarship and to health
policy and practice is a subject of sharp dispute.
Over this past decade, the subject matter of bioethics has evolved,
the extent of interest in it has soared, and its literature has multiplied
and multiplied again. What was unrecognized even as a potential
field just a few years ago is now widely covered by the print and
electronic news media, and the concerns of the field have been
reflected in the deliberations of Presidential and Congressional Com-missions,
in Congressional hearings, in state legislatures, and in
various other public forums. I know no other field that has risen
so rapidly to such widespread acceptance and visibility.
These developments have brought many scholars and practi-tioners
together who might otherwise have had little exposure to
one another's disciplines. The interactions among them have been
mutually enriching at times, and mutually baffling at other times.
And their activities have been viewed from outside the field with
everything from admiration to disdain. Diverse expectations, disap-
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3. 18 NOUS
pointments, and criticisms surround this new field, even as it con-tinues
to grow in scope and acceptance.
I propose to enumerate the criticisms of the field of bioethics,
to evaluate each of them, to formulate an account of what it is
reasonable to expect of the field, and to make recommendations
about its future directions.
Among the criticisms I shall consider are these:
1. Bioethics is not legitimate work in philosophy, or in any
other discipline. In its harshest form, this criticism characterizes
bioethics as a betrayal of the standards, traditions, and commitments
that should motivate a scholar in the humanities. In milder form,
this criticism holds that bioethics is merely common sense, or is
an example of the sort of "applied humanities" which, however
useful it may be to the public or to practitioners, is not worthy
of respect as work in the humanities.
2. Bioethics cannot be taught. Rather, classes in bioethics sim-ply
steal valuable time from more solid and useful subjects, in order
that students may engage in discussions and debates that lead
nowhere and have no lasting value. A variant of this criticism is
that ethics in general cannot be taught, but is a matter of character
that depends on non-academic influences for its development.
3. Bioethics has no practical benefits. It is a purely abstract
inquiry, unrelated to the problems faced outside the ivory tower.
It may be an engaging pursuit for the intellectually curious, but
should not be mistaken for something that will also provide benefits
in the arena of practical affairs.
4. Bioethics makes matters worse. It engenders confusion on
the part of health care providers, heightens the anxiety of patients,
complicates the processes of planners and policy makers, and pro-motes
the adoption of regulations that impede clinical practice-such
as excessively demanding requirements of informed consent,
and medical research-such as unwarranted prohibitions on the use
of certain classes of research subjects.
5. Bioethics has no legitimate methodology. Unlike work in
the sciences, which can be evaluated according to standards that
can be articulated explicitly, work in bioethics is simply a collection
of expressions of opinion, without any prospects of verification.
6. Bioethics pursues unanswerable questions, and is therefore
futile. The appeal of these questions may be understandable, but
it is counterproductive to invest resources in addressing them, since
in the end there will be no significant sense in which answers to
them have been found. They should instead simply be accepted as
an inevitable part of the struggles associated with matters of birth,
life, health, illness, and death.
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4. BIOETHICS: PROBLEM AND PROSPECTS 19
7. The utility of bioethics is unconfirmed, both in respect to
the -value of teaching courses in the field, and in respect to the
significance of the scholarly work for anyone other than those in-volved
in doing it. So it has not earned its place in an already over-crowded
curriculum, nor in the competition for scarce resources
available to support research.
8. The field has no foundations. Unlike mathematics and
physics-even unlike the study of languages, literature, and
history-bioethics is built on the shifting sands of diverse moral sen-timents,
and on such a foundation no solid edifice can be built.
9. Bioethics is a self-indulgent field, in which writers con-template
problems drawn from health related fields, but do so merely
as exercises for their own benefit, instead of confronting such prob-lems
as they are lived by the people who must deal with them. Thus,
the philosopher who espouses stringent standards of informed con-sent,
with no concession to the realities of clinical practice, deserves
the scorn of the physician who must act in the interests of patients
who may be dysfunctional with fear, pain, or drunkenness, or who
in other ways fail to fit the bioethicist's naive vision of the rational
patient.
10. Bioethics systematically overemphasizes certain social
values, such as liberal individualism, to the neglect of religious values
or other features of the social environment that actually determine
how people feel and behave, and how they ought to feel and behave.
That these criticisms are voiced with earnestness and convic-tion
is beyond dispute; witness Daniel Greenberg's "suggestion"
that "perhaps the most inflated non-issue currently absorbing time
and energy in the health community and its government command
posts is that loose amalgamation of anxieties and passions that comes
under the banner of medical ethics"([3]).
Although many such complaints about medical ethics appear
in print, many others have simply been voiced in repeated conver-sations
in and around the field. I will document the complaints that
have been published, but will treat unpublished objections with equal
seriousness.
Each of these criticisms has some basis in fact, and each is to
some extent misguided. To sort all of this out, it will be necessary
to consider the origins of each of these criticisms, the various inter-pretations
to which they are open, the assumptions on which they
rest, and the extent to which they strike the mark.
Having done that, I intend to address the prospects of the field,
providing a critique of its methods and standards, and offering pro-posals
for future directions in respect to the teaching of bioethics,
the selection of research topics, the training of professionals in the
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5. 20 NOUS
field, and the participation of bioethicists in the processes of public
policy determination.
REFERENCES
[1] Daniel Callahan, "The Ethics Backlash," The Hastings Center Report, Aug (1975):18.
[2] K. Danner Clauser, "Medical Ethics: Some Uses, Abuses, and Limitations," The New
England Journal of Medicine, Aug (1975):384-87.
[3] Daniel Greenberg, "Ethics and Nonsense," The New England Journal of Medicine Ap
(1974):977-78.
[4] Franz Inglefinger, "The Unethical in Medical Ethics," Annals of Internal Medicine, Aug
(1975):264-69.
[5] Charles Moore, "This is Medical Ethics?" The Hastings Center Report, Nov (1974).
[6] J.D. Swales, "Medical Ethics: Some Reservations," Journal of Medical Ethics, Sept
(1982): 117-119.
[7] Mark Seigler, "Cautionary Advice for Humanists," The Hastings Center Report, Ap
(1981): 19-20.
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