Bioethics Critically Reconsidered: Having Second Thoughts is a collection of essays in bioethics in name only.  H. Tristram Engelhardt, editor, identifies bioethics not as a field of applied ethics, but as a social movement with its fingers in many pots.  This distinction is at odds with the other articles in the work, many of which are concerned with a meta-ethical analysis of the aim and scope of bioethics.  Each author is committed to a different conception of bioethics; unfortunately Engelhardt fails to reconcile these views, differentiate them from one another, or categorize them.  As a result, the topic hopscotches from essay to essay without focus.  Although many of the authors agree bioethics is vaguely defined, what each contributor takes herself to be discussing is clearly distinct from the editor’s notion.  This collection is not about bioethics, but about things people have indiscriminately called “bioethics.”

This book’s essays vary from personal reflection to meta-ethical inquiry to quasi-historical theorizing, and do not appear to be assembled with regard to any particular audience.  Several contributors note that part of the problem with defining bioethics is that people from many professions count themselves as working in the field, from doctors and lawyers to religious leaders and philosophers.  This work is not aimed at any of these groups, nor does it serve as a suitable introduction to the field.  The latter half of the essays in the book might be suitable reading for an academic audience of philosophers or students studying medical ethics, but this feels coincidental rather than intentional.  My review focuses primarily on these essays.

This collection is bookended by two articles by Engelhardt.  He begins the first with what appears to be a meta-ethical inquiry into the nature of bioethics, but abandons this, stating there are no straightforward answers.  Instead, he argues that bioethics is the result of what he nonchalantly calls “the death of God”, best understood here as arising from uncertainty regarding normative ethical truth.  Engelhardt contends this is the result of the diminished role religion plays in determining our ethical beliefs, rather than the rise of new moral questions that came with advances in science and medicine.

In the second, Engelhardt offers a quasi-historical explanation of the rise and acceptance of bioethics across the globe, contending that bioethics emerged from a moral vacuum in American society.  He theorizes that this vacuum was replaced with moral pluralism, and as a result bioethicists often fails to offer moral advice, instead often merely presenting patients with their medical options.  Engelhardt’s characterization of the origin and motivation of the social movement of bioethics here seems at odds with points previously raised in the collection by other contributors.  In Aaron E. Hinkley’s essay “Two Rival Understandings of Autonomy, Paternalism, and Bioethical Principlism,” he argues bioethics emerged as a response to medical paternalism, and centered around establishing the role individual autonomy should play in the healthcare field.  This focus on autonomy, on this account, was not a moral relativist invasion of professional ethics, but a realization of moral agents as autonomous individuals who deserve a say in their own treatment.  This push for individual autonomy may be consistent with the moral pluralism Engelhardt is concerned about, but it is not clear it was caused by this moral pluralism.

In one of the better essays found in this collection, Laurence B. McCullough distinguishes between two clear tracks in bioethics – 1) applied bioethics, or practical applied ethics with a focus on new and future bioethical technologies, and 2) professional medical ethics.  He claims the former is more glorious, but the latter is more important.  McCullough’s clear distinction contrasts sharply with Engelhardt’s inclusiveness about bioethics, where legal advisers, attorneys, legal liability risk managers, dispute mediators, and professional ethicists count as equal contributors to the field (19).  While Engelhardt is interested in bioethics as a social movement, McCullough offers a sober account of what the field of bioethics is intuitively concerned with – applied ethics.

While McCullough’s distinction is uncontroversially accurate, I remain unconvinced that professional medical ethics is more important to the field than applied bioethics.  The reason applied bioethics so easily grabs our attention is because it is an attempt to answer real moral questions that have arisen with advances in technology; questions that have no default moral analysis even in a religiously uniform society.  While Engelhardt sees bioethics as an ad hoc response the abandonment of a common religious morality, it is uncontroversially true that the commonsense morality was, and in many respects still is, ill equipped to handle the sheer number and scope of emerging medical and technological advances.  With these advances came new, difficult moral questions in need of answers, and applied bioethics just is the field interested in answering those questions.

This collection of essays promises to critique the role and success of bioethics, broadly construed, but instead skitters between the editor’s conception of bioethics as a social movement responding to moral pluralism, and contributors conceptions of bioethics as a broad, too often ill defined field covering applied bioethics, applied professional ethics, and, for some, any and all fields related to medical care.  In the first contributor’s essay, Michael S. Yesley remarks that while serving on a bioethics commission, he was skeptical about the contributions ethicists made, claiming they were more suited to analyzing ethical questions than answering them (33-34).  This collection fails in both regards, and fails its task to review bioethics.  It fails to even offer a consistent account of bioethics, or differentiate between the conceptions discussed.  I get the impression these essays were written in isolation and serve more as brief and varied glimpses into a series of radically different notions of bioethics – notions as much at odds over facts as meta-ethical foundations – than a collection assembled to critique something these authors would be able to jointly recognize as “bioethics.”

© 2012 William Simkulet

William Simkulet, Applied and Professional Ethics at University of Kansas