A Skeptical Reassessment of Bioethics

Abstract

What is bioethics? Who is a bioethicist? Who is a health care ethics consultant or clinical ethics consultant? There are no straightforward answers to such questions. Indeed, the attempt to answer such questions usually engenders controversies. Bioethics is a puzzle. Bioethics is itself a controversy, a theater of dispute. Across the world, there are persons who call themselves bioethicists. But there is no agreement as to what ends they are doing what they do, as to what they should be doing, or even as to what they are doing. In hospitals across the world, there are persons who are paid as clinical ethics consultants (aka health care ethics consultants) and who are often held to be engaged in helping resolve normative questions about health care decisions. But there is no agreement as to what norms they should engage. This is because there is real dispute about the content and character of both morality and bioethics. As a result, there is a puzzle as to how properly to characterize the nature of the normative questions posed to bioethicists, as well as the answers bioethicists give. Bioethicists are asked, for example, about when a particular medical intervention is inappropriate (or futile), about who should make life-or-death decisions, and concerning what information should be provided in order for a patient adequately to consent to treatment. The question is what kinds of norms and which norms should frame such questions. In answering such questions, what norms and which norms should guide the answers? Are the norms at stake those established at law? Is the ethics about which health care ethics consultants (HCEC) give advice simply an account of relevant law and public policy, as well as of how law and public policy is customarily applied? Or are the norms moral norms? If so, norms of which morality? These puzzles about the nature of bioethics justify second thoughts about the entire endeavor of bioethics.