Posted on March 6, 2018 at 7:39 PM
by Craig Klugman, Ph.D.
As part of my Bioethics in Society: Critical Studies of Bioethics course, students have noticed a divide in bioethics writing between what we are calling mainstream bioethics and conservative bioethics. A The former group centers around the idea of multidisciplinarity, an openness to considering varied viewpoints, and a belief that bioethics is important. The latter is defined by the belief that bioethics (specifically bioethicists) is a problem (lack of expertise and standing; does not support a “culture of life”), that more traditional moral values should be at the core of decision-making, and that there is a definitive right and wrong.
Recently, I was pulled into this divide. I wrote last weeks’ blog on the ethics of PetCPR in a tongue-in-cheek manner. I presented ethical questions that would be raised by this practice of allowing first responders to give CPR to pets such as: If a single EMT was to be faced with the choice of resuscitating a person or an animal (but could not do both), which would they choose? I then suggested a pragmatic response (the human) as well as a more nuanced approach (is that speciesist?).
These blogs are always posted to social media as well as appearing on bioethics.net. This fact is important to understand what happened next. In my personal feeds, the article elicited a stream of people suggesting that the answer was to save the pet first for a variety of reasons. “Dog, any day. I know a lot of people and I still like dogs better” and “I’ve taken both dog and human CPR classes. You bet I’d help the dog first.” There were even some more nuanced statements that one would need to consider who the specific people were who would be potentially be saved, “What if the dog is Lassie and the human is Hitler?” Most of these were offered in playful discussion. This stream reaches people who tend to be more politically liberal and secular.
Other social media streams provided different reactions. These streams reach a broader evidence that includes more people on the right as well as on the left. The comments left here were in the opposite direction and took my writing in a more serious light: “The human, this is not a question worth considering further.” Perhaps the most interesting comment was a full blog written by conservative thinker Wesley Smith in The National Review. In “Should EMTs Save Humans or Dogs First,” Smith explains that I really “knew my audience” for even asking this question: “Bioethicists never cease to entertain — if some of the dangerous views pushed by the mainstream movement can be considered ‘entertaining’.” Smith goes on to ask with incredulity, how someone could take this idea seriously? When I explain that this answer depends on many factors, including your point of view, Smith says, “Yikes. Talk about not taking a stand!” When I suggest that if there is PetCPR, then maybe we need PetPOLSTS, he responds, “That’s bioethics, folks! Good grief.”
To conservative bioethics way of thinking, the question of whether an animal would ever receive consideration before a human is not an idea worth being taken seriously, even in jest. Smith criticizes bioethics for not taking stands on issue, as well as for leading conversations in areas he would say are outside are expertise. As someone who falls into the conservative bioethics camp, Smith is not a fan of mainstream bioethics. ‘The bioethicists have set themselves up, almost like Napoleon crowning himself emperor, as the arbiters of what is moral and ethical in health care,” he says in Culture of Death: The Assault on Medical Ethics in America.
Conservative bioethics is a fairly recent enterprise, evolving in the last 20 years. In 2006, Ruth Macklin wrote about this new movement that created its own journal (The New Atlantis), its new bioethicists (whom she says no one had ever heard of before), and came about during conservative U.S. presidential administrations to further conservative political values against the permissiveness of bioethics. Conservative bioethics hold that no matter what our questions, the culture and values of society should not be changed by the answers or possibilities. According to Yuval Levin in The New Atlantis, “A conservative bioethics proceeds by dissecting taboos, but it has as its mission to prevent our transformation into a culture without awe filled with people without souls.”
The answer is often based in a religious morality—more often than not, a conservative Christian morality (though some on the conservative side identify as Jewish, never secular). A second consideration on the right is that bioethicists are people who speak on issues over which they have no expertise. For example, philosophers speak about medical decisions when they are neither doctors nor priests. Or they speak about clinical research when that is something in which they do not engage. From this perspective, only those engaged in and trained in the specific activity can speak about it—there is no valid external perspective. Conservative bioethics sees mainstream as pushing an agenda that does not represent the majority of (good conservative) Americans: “Outside critics, particularly conservatives, complain that bioethicists have anointed themselves society’s philosopher-kings and hold views out of step with those of most Americans.” Conservative bioethics sees mainstream bioethics as having rejected religion and set themselves up as “secular priests” instead: “The result has been the emergence of what we might call expert bioethicists, a cadre of professionals who, while logical and friendly, have, nevertheless, been ordained as secular priests.”
Conservative bioethics tends to see that there are simple, universal rights and wrongs grounded in what many of us view as religious principles—the dignity of life (that all humans are created in a divine image), a belief in the sanctity of life (all life, no matter its status or desire of the person, should be maintained as long as possible), and an inviolable belief in “a rich view of human personhood”. Thus, they are against notions of artificial reproduction, cloning, embryonic stem cell research, advance directives, withdrawing life support, withholding life support. After all, conservative bioethics coined the notions of “passive euthanasia” which is not pursuing all medical possibilities to save a life: In mainstream, we call this the liberty to make one’s choices and the right to refuse unwanted treatment. Not surprisingly, conservative bioethics relate more to Republican politics. Their tent is little.
On the other side is mainstream bioethics which is the majority of modern bioethics. This is the enterprise that evolved to change the medical model from one of paternalism to one of patient autonomy. Part of this movement has moved toward secular philosophy in its analysis. This is big tent bioethics that welcomes people from a variety of disciplines (philosophy, other humanities, social sciences, law) and is more open to their being different notions of morality (though the moral universalism versus moral relativism debate is another issue). In many cases, mainstream bioethics, as evidenced in clinical ethics, provides recommendations of better and worse choices but usually avoids telling others what is right and wrong. Rather than being sources of moral certainty, mainstream bioethicists help guide others to make their own decisions. Sometimes those choices are not ones with which we agree, but by holding autonomy as a foundational issue, we grant that people can make choices with which others disagree.
I see mainstream bioethics’ strength in being a big tent that welcomes a diversity of methods, perspectives, and moralities. It is also on this basis that conservative bioethics criticizes the mainstream as being too permissive and in permitting people to make wrong choices. Mainstream bioethics relies on logic, facts, and philosophical theories. Conservative bioethics relies more on traditional values, moral intuitions, and appeals to the sanctity of human life. In many ways, it is a challenge for each side to see the other. To me, the idea of moral certainty and telling others what to do is arrogance and moral colonialism.
These characterizations are generalized and therefore ignore nuances and differences that exist within each group. I prefer to view bioethics as a spectrum with scholars and ideas spreading across the possibilities in examining the moral issues of the life sciences. What concerns me is that when there are so many issues that could benefit from our work, we should not be spending our time in knocking down strawman versions of ourselves from within.