From the successful cloning of Dolly the sheep, to the FDA’s approval of BiDil as the first race-specific medication to ongoing discussions concerning the use of gene editing technologies such as “CRISPR,” medical innovations during the past couple of decades have raised a number of significant ethical, social and political questions. Should cloning as human reproduction be limited? Is the pursuit of race-based medicine morally acceptable? Would it be a moral failure to abstain from using gene-editing technologies if they are proven safe to use? For Osagie K. Obasogie and Marcy Darnovsky, the editors of Beyond Biopolitics: Toward a New Bioethics, these questions are further complicated by the specific sociopolitical context in which they arise. How do we understand, for instance, the FDA’s approval of BiDil alongside the history of race and eugenics in the United States? Addressing these questions requires, on their account, a conceptual framework and approach not found in contemporary bioethics.  

To elaborate, for Obasogie and Darnovsky, bioethics currently operates on the basis of principlism. Principlism “provides a common framework by embracing four principles as the foundation of bioethical deliberation: respect for autonomy (antipaternalism, or people should have agency in their decision making), nonmaleficence (do no harm), beneficence (help people), and justice (being thoughtful about the distribution of benefits and burdens)” (5). Obasogie and Darnovsky note that bioethicists have been crucial in rehabilitating trust in the medical community following the revelation of horrific Nazi experiments and the infamous Tuskegee Syphilis Experiment, and even more recently in helping medical professionals understand their moral obligations in light of new developments including in vitro fertilization and artificial organisms. Nevertheless, bioethics has three significant limitations: first, because principlism focuses largely on moral encounters between individuals, especially patients and doctors, it is ill-suited for understanding cases wherein complex social dynamics are at play. Second, bioethicists are often embedded in the very institutions they are meant to oversee, thus making them vulnerable to potential conflict of interest or institutional silencing. Third, while bioethics may help in the development of ethical norms for medical practice, without a regulatory mechanism to enforce those norms, “bioethics is largely without teeth in dealing with the deeply profound and transformative social power of many new developments” (6).

In light of these limitations, Obasogie and Darnovsky argue that a new conceptual and practical approach is required – a “new biopolitics” (8). This approach, unlike modern bioethics, “places social justice, human rights, and the public interest at the center of the analysis” (7). While this “new politics” “remains a project in formation,” it is meant to be distinct from prior articulations of biopolitics traditionally associated with Michel Foucault (8). Obasogie and Darnovsky note five specific concern that distinguish it from mainstream bioethical approaches: first, it is sensitive to the ways in which commercial and market interest may sway deliberations on the social impacts of emerging biotechnologies. Second, it takes seriously the profound implications that the possibility of widespread gene editing has on the notion of humanity itself. Third, it is concerned with the potential of biotechnologies to reaffirm social preferences and biases. Fourth, it is skeptical of the ability of private corporations or committees to successfully serve the public interest. Finally, fifth, it is concerned with the possibility of a new market-driven eugenics aimed at effectively eliminating undesirable populations.

Now, while this “new biopolitics” is again distinct traditional biopolitics and bioethics, work in this field has already begun. The purpose of Beyond Bioethics: Toward a New Biopolitics, then, is to gather those works into a single collection. As such, all articles published in this volume are either reprinted or excerpted from prior publications. Importantly, however, an author’s inclusion in this volume does not indicate that they accept the criticism of traditional bioethics and biopolitics presented by Obasogie and Darnovsky, and/or view their work as aligning with the principles of the “new biopolitics.”

Part I and Part II begin by situating the “new biopolitics” within the social, historical and academic context in which it emerges. As such, Part I, “The Biopolitical Critique of Bioethics: Historical Context,” concentrates on historical abuses of emerging biotechnologies, demonstrating the significant parallels and linkages between the past and the present, as well as their potential impact on the future. For example, in “Why the Nazis Studied American Race Laws for Inspiration,” James Q. Whitman explores the parallels between American miscegenation and segregation law and the Nuremberg Laws enacted the Nazis. Whitman demonstrates that much of the theoretical and legal justifications for the Nazis’ harsh antisemitic and racist laws were influenced by American legal structure. Edwin Black further explores this parallel in “Eugenics and the Nazis: The California Connection” by exploring both how the Nazis adopted the practices of forced sterilization used in California; and the relationships between American and Nazi eugenicists.

Part II, “Bioethics and Its Discontent,” extends upon Obasogie and Darnovsky’s initial criticism of traditional bioethics by pointing towards further limitations of the discipline. Several of the articles here explore the implicit biases inherent in bioethical discourse. For example, in “Disability Approach Toward Bioethics?” Gregor Wolbring examines the tendency within the bioethics literature to equate the notion of ‘disability’ with that of ‘defects,’ ‘diseases’ and ‘abnormalities.’ In doing so, Wolbring reveals the tension between traditional bioethics and the mainstream disability rights movement that centers these issues as matters of social justice as opposed to medical intervention. Likewise, in “Bioethical Silence and Black Lives,” Derek Ayeh contrasts the level of attention given by bioethicists to issues concerning new biotechnologies with their silence on issues of poverty, unemployment and recent police killings of African Americans.

The articles in Part III, “Emerging Biotechnologies, Extreme Ideologies: The Recent Past and Near Future,” tackles the controversial issue of using biotechnologies to develop “designer babies” and “posthumans.” In addressing these issues, several contributors focus on the impact of these new subjectivities on social justice, equality and the common good. Tom Athanasiou and Marcy Darnovsky begin the section by expressing several concerns about the desire by “biotech boosters” to provide each of us the ability to rewrite the human genome. More specifically they argue that, “Unless we harness our moral intelligence and political will to shape them, they will conform to the existing social divides and to the inadequacies of our democracy, and they will exacerbate both” (161). Nathaniel Comfort in “Can We Cure Genetic Diseases without Slipping into Eugenics?” continues this line of inquiry by providing a historical examination of the US eugenics movement, and relating it to the social and political context in which new gene-editing technologies are being introduced. Although Comfort acknowledges that such technologies hold the potential to eradicate serious genetic disorders, it remains an open question whether or it would produce a “eugenics of personal choice” (176).

Parts IV through VI focus on the commercial and market factors presents in the development of new biotechnologies. Part IV, “Markets, Property and the Body,” examines the impact of market forces upon biomedical research. Osagie Obasogie in “Your Body, Your Property” examines a series of court cases wherein the US Supreme Court grants medical institutions the use of biological samples from patients for financial gain. In “Dear Facebook, Please Don’t Tell Women to Lean Into Egg Freezing,” Jessica Cussins argues that the decision by Facebook and Apple to offer egg freezing as a employee benefits for females is ultimately neither beneficial for women nor a real solution to the problems of sex discrimination in the workplace. As she argues, “What we need are family-friendly workplace policies, not giveaways that will encourage women to undergo invasive procedures in order to squeeze our more work for their beloved company under the guise of ’empowerment'” (227).

Part V, “Patients as Consumers in the Gene Age,” critically investigates the promises of ‘precision medicine’ with the possible social, political and economic perils of its widespread implementation. In particular, several of the scholars argue that the increased use of personalized medicine techniques will only continue to foster a bias towards genetic and biological explanations, while further diminishing the role of social, economic and political factors on the onset of disease. For instance, Karuna Jaggar in “Genetic Testing for All Women? Not a Solution to the Breast Cancer Epidemic” argues that the proposal by Dr. Mary Claire King, the geneticist responsible for discovering the link between the BRCA genes and breast cancer, that all women over thirty should undergo genetic testing “fails as a matter of public health to recognize the significant limitations, and harms, of mass genetic testing in the current health care environment” (256).

Part VI, “Seeking Humanity in Human Subjects Research,” focuses on the complex sets of pressure and incentives underlying the use of human subjects in biomedical research. In “Medical Exploitation: Inmates Must Not Become Guinea Pigs Again,” Allen Hornblum and Osagie Obasogie begin the section by criticizing the efforts of the Institute of Medicine to reintroduce the use of prison inmates as medical research subjects. Specifically, they argue that, given the circumstances, prison inmates are far from a position to voluntarily choice whether or not to submit to medical experiment, especially if they are incentivized by the possibility of having their sentences reduced. Harriet Washington elaborates upon these themes in “Non-Consenting Adults” wherein she surveys a number of recent examples wherein vulnerable populations are coerced into medical experiments – these example include a waiver given to the US government permitting them to dose millions of troops with experimental anthrax vaccines between 1996 and 2005, a 1996 laws that allows researchers to conduct research on trauma victims without their consent, and Pfizer’s nonconsensual research on children in Nigeria.

Part VII and VIII focus specifically on assisted reproductive technologies. To this end, Part VII, “Baby-Making in the Biotech Age” focuses on the fertility industry in the United States. Douglas Pet in “Making Me a Baby as Fast as You Can” examines the range of ethical issues inherent in the role of US based companies serving as brokers between commissioning parties and surrogacy clinics in other countries. Part VIII, “Selecting Traits, Selecting Children,” further explores these issues by examining the selection methods and technologies currently used in assisted reproduction, and the ethical and social challenges they present. In “A Baby, Please: Blond, Freckles – Hold the Colic,” Gautam Naik examines the controversial case of Fertility Institutes, a Los Angeles-based fertility clinic, that recently announced it will soon launch a preimplantation genetic diagnosis that will allow clients not only the possibility of choosing the sex of their child, but the hair, eye and even skin color.

Part IX, “Reinventing Race in the Gene Age,” examines the use of race within contemporary biomedical research. In “Race in a Bottle,” Jonathan Khan details the infamous 2005 case of BiDil, the first “race-specific” drug approved by the Food and Drug Administration. In exploring this case, Khan draws attention to the questionable methodology employed by BiDil’s developers. Ultimately, he concludes that while there is no valid evidence that BiDil works better on African American compared to Caucasians, its FDA-approval ultimately serves to legitimize both the pursuit the medical and commercial pursuit of race-based medicine. In “The Science and Business of Genetic Ancestry Testing,” Bolnick et al. argue that far from a harmless recreational tool, commercial DNA tests help promote the false notion that race is somehow a matter of one’s biology, as opposed to society.

Finally, Part X, “Biopolitics and the Future,” explores opportunities for the implementation of biopolitical thinking into current and future policies guiding biomedical research. For example, in “Toward Race Impact Assessments,” Osagie Obasogie argues that new race impact assessments should be implemented to ensure that any conclusions reached about the scientific validity of race are based on sound evidence, as opposed to social understandings of race.

Overall, Beyond Bioethics: Toward a New Biopolitics, provides a useful contribution to the ongoing discussion concerning emerging biotechnologies and their potential social and political ramifications. By grouping these various articles into a single collection, it manages to give both a name and a direction to a more socially conscious ethical and political framework to the controversial issues posed by developments in genomics. That said, while the development of a social approach to issues raised within the medical field is a worthwhile endeavor, it remains unclear from the volume what exactly differentiates this “new biopolitics” from traditional biopolitics already pursued in multiple disciplines from sociology, anthropology, philosophy and even bioethics. While the volume’s introduction makes clear the distinction of biopolitics from bioethics, the differences between biopolitics and “new biopolitics” are less clear. Now, differences may be found – the specific questions that “new biopolitics” is meant to address and even the social and political climate in which it is be conducted differs from its historical antecedent. However, if that constitutes the only differences, then “new biopolitics” seems more akin to a new direction in biopolitics, rather than a field of inquiry “distinct from ”         “these prior articulations.” (8). More analysis, then, is required to both separate “new biopolitics” from traditional biopolitics, as well as to justify the need for it as its own distinct methodology. Nevertheless, given both the limitations of bioethics and the need to remain attentative to the social problems posed by emerging biotechnologies, further work into biopolitics is necessary.

 

© 2018 Jordan Liz

 

 

Jordan Liz is an assistant professor in philosophy at the San José State University.