Beyond Bioethics: Review

Osagie K. Obasogie & Marcy Darnovsky (eds) Beyond Bioethics: Toward a New Biopolitics (University of California Press, 2018) 

Pity the poor bioethicist, the universal whipping dog of modern academia. For if she is not being told to “get out of the way” of research by Steven Pinker, then she is being called a “thief of virtue” by Tom Koch.[1] She is either a hinderance to progress or a schill for the neoliberal research enterprise, a regulation-spouting roadblock on the way to curing disease, or a craven fig leaf for the depredations of rapacious healthcare corporations.

Into this unseemly fray, enter Osagie Obasogie and Marcy Darnovsky: editors of this new  collection. They have a different beef with bioethics: it is no longer fit for purpose. To them, bioethics’ traditional focus on individual choice leaves it incapable of addressing the social and political challenges of contemporary biomedicine, in particular ‘advances’ in genetics and reproductive medicine. Informed consent, they argue, is no way to think about the morality of DNA forensics, for example, or the rights and wrongs of human enhancement. Instead, Obasogie and Darnovsky have assembled an array of (mostly) previously published pieces which they contend constitutes “the new biopolitics”. These (this?) “new biopolitics” profeses to attend to the political perspectives of race, gender, class, sexuality, disability, privacy and democracy, that (or so they argue) are elided or ignored by bioethics’ exhausting focus on individual choice, and are necessary to meet the challenges of modern biomedicine.

This is a nice proposition, but it is hardly a new one. The critique of bioethics as essentially asocial, that is, unattentive to context or politics, has long been associated with sociological perspectives on the field – notably Renee Fox and Judith Swazey. Historians, too, have bemoaned bioethics’ distinct lack of social and political awareness. This can be seen most clearly in a two review articles written, fifteen years apart, by the Roger Cooter. In his 1995 review of, amongst other bioethics luminaries, John Harris and David Rothman, Cooter professed himself ‘dismayed at the shallowness (or absence) of socio-economic and political understanding… Hardly ever does this literature consider the socio-economic and political possibilities for and constraints upon asking the ‘right’ questions and arriving at the ‘right’ ethical conclusions.”[2] Fifteen years later, Cooter had developed this critique into an assault on the political uses of informed consent. “At root,” he wrote, “the history of bioethics is not about medicine and morality at all… but rather a reconfiguration of what it is to be human. Crucial to this reconfiguration within and without bioethics was the concept of “informed consent”… Predicated on a historically constructed notion of human nature in which persons/patients are defined primarily in terms of their ability to act autonomously or to make choices and take risks, “informed consent” per se spoke not to a revised medical ethics widened to the laity… but to a prioritization and celebration of personhood within a particular politico-economic context.”[3] In short, for Cooter, bioethics’s obsession with autonomy and consent was in effect little more than a function of the Thatcherite/Reaganite/neoliberal (delete as applicable) discourse that sought to elevate the individual at the expense of the social.

Beyond Bioethics is a direct, if apparently unknowing (Cooter doesn’t get a look in) descendent of this critique. The editors are anxious to distance themselves from what they call “mainstream bioethical approaches” and present five “particular concerns” that comprise their new biopolitics, namely: 1) reckoning with the role of markets and commerce in biomedicine and biotech, 2) understanding the human genome as part of the common heritage of humanity, 3) avoiding technical developments and genetic narratives that embed social and political preferences at the molecular level, 4) ensuring democratic oversight of powerful human biotechnologies, 5) steering clear of market-driven eugenics. (8-9). If that seems at all familiar, it is not simply because it effectively describes the papers at any given medical sociology conference of the past twenty years, but because it is essentially the progressive politics of contemporary liberal America. Markets are to be reckoned with. Damaging narratives to be avoided. Oversight is to be ensured. No horses are to be startled. For an ”emerging field” so concerned with the political, the new biopolitics are surprisingly bland. The contributions to parts IV and V, for example, which explore “Markets, Property and the Body” and “Patients as Consumers in the Gene Age” are as politely critical of big Pharma and big Biotech as any Obama-era cabinet appointee, but seem disinclined to extend their critiques of medical marketplaces to the American/North-Atlantic obsession with marketisation in general. None of the laissez-faire unpleasantries they describe are unique to biomedicine in their ideology or structure, but signs of engagement with a broader, more radical economic critique come there none.

Despite the lack of engagement with American political economy, this is a primarily American collection. The editors argue that “though they focus on developments in the United States, the volume’s essays and articles articulate a range of concerns and perspectives prompted by new human biotechnologies worldwide” (10). Almost every contributor is based at an American university or American public interest group, and the vast majority of their examples and cases are American. For example, both parts VII and VIII, on human subjects research and assisted reporductive technologies – matters of clear and pressing interest in the global South – are written exclusively by people based in American institutions. These are all sharp, well-argued contributions, but if the new biopolitics just means American-based academics speaking about problematic things on behalf of people “worldwide” then one might ask just how new it is after all. If that sounds a bit harsh, then it is only because it is a reaction born of disappointment that a more globally diverse set of voices has not been brought to bear in this collection.

This is not to say there are not excellent articles contained within Beyond Bioethics. Far from it. John Evans’s explanation of the dominance of principlism within bioethics is as clear and compelling a piece of the sociology of knowledge as one could hope to come across. Maggie Little makes an unassailable case for a feminist approach to bioethics. Nathaniel Comfort makes us commendably uncomfortable as he firmly positions the drive for genetic cures within a history of eugenic medicine. Catherine Myser’s article on the normativity of whiteness in bioethics is as important now as it was in 2003. The late Adrienne Asch will never not be worth re-reading. It is to say, however, that the boundary work being done by bringing these articles together may not be entirely convincing. For there to be any such ‘new biopolitics’ there has to have been an old bioethics. According to Obasogie and Darnovsky, the new biopolitics, in contrast to bioethics, “places social justice, human rights, and the public interest at the centre of its analysis”. Certainly, some of the ‘old bioethics’ was maddeningly uninterested in such contexts – as Roger Cooter was well aware – but such narrowness of focus can hardly be said to characterise the work of recognisably ‘mainstream’ bioethicists such as Ruth Faden, Hilde Lindemann, Alta Charo, Franklin G. Miller, Onora O’Neill, Matthew S. Liao, Julian Savulescu or, for that matter, the entire oeuvre of the Nuffield Council on Bioethics (to name but a few).

Defining bioethics one way or another is the autoparodic favourite pasttime of bioethicists. As Duncan Wilson once wrote that “of all the questions bioethicists have tackled in recent decades, few have proved as enduring as what exactly is bioethics?”[4] Beyond Bioethics is perhaps best understood as a contribution to this debate, one which foregrounds attention to the political, rather than, say, the place of theology or empirical data within the field. Principlism – the autonomy-obsessed bogeyman of Beyond Bioethics – was once memorably described as the ‘Borg of bioethics’ – assimilating any and all critiques into its hegemon.[5] On reflection, the real Borg is bioethics itself: since its inception in or around 1970 it has absorbed and assimilated myriad debated definitions, expanding and contracting to describe its remit simultaneously as everything from a one-off clinical encounter to the very fate of the planetary environment itself. Bioethics – whether the self-identified academic endeavour, or just the act of asking moral questions about medicine – has always been political in one way or another. Even Roger Cooter’s critique acknowledged this, pitching bioethics as a broadly – if unavowedly – conservative enterprise. Beyond Bioethics asks us to pay more attention to those politics. That is something we absolutely should do, but I suspect we will probably end up calling it political bioethics – as we did feminist bioethics, empirical bioethics and narrative bioethics before it – rather than the new biopolitics.

Dr Dan O’Connor is Head of Humanities and Social Science at the Wellcome Trust.

__

[1] Steven Pinker, “The Moral Imperitive for Bioethics”, The Boston Globe (01.08.2015). Tom Koch, Thieves of Virtue: When Bioethics Stole Medicine (MIT, 2012).

[2] Roger Cooter, “The Resistible Rise of Bioethics”, Social History of Medicine, 8:2 (1995), 259-60.

[3] Roger Cooter, “Inside the Whale: Bioethics in History and Discourse”, Social History of Medicine, 23:3 (2010), 668.

[4] Duncan Wilson, “What Can History do for Bioethics?” Bioethics, 27:4 (2013), 215

[5] John D. Arras, James Childress, Mathew Adams, “Prinicplism: The Borg of Bioethics”, in John D. Arras (ed.), Methods in Bioethics: The Way We Reason Now (OUP, 2017) DOI:10.1093/acprof:oso/9780190665982.003.0001

Leave a Reply

Your email address will not be published. Required fields are marked *