On Three Dogmas of Bioethics and A Treatment

Angus Dawson (Keele University), one of the co-editors of the excellent journal Public Health Ethics, has a provocative and fascinating article in a recent theme issue of Bioethics devoted to the "future of bioethics."  The article is entitled The Future of Bioethics: Three Dogmas and a Cup of Hemlock.  Here is the Abstract:

In this paper I argue that bioethics is in crisis and that it will not have a future unless it begins to embrace a more Socratic approach to its leading assumptions. The absence of a critical and sceptical spirit has resulted in little more than a dominant ideology. I focus on three key issues. First, that too often bioethics collapses into medical ethics. Second, that medical ethics itself is beset by a lack of self-reflection that I characterize here as a commitment to three dogmas. Third, I offer a more positive perspective by suggesting how bioethics may benefit from looking towards public health ethics as a new source of inspiration and direction.

Highly recommended.  As readers of MH Blog are likely aware, I share many of Dawson's concerns regarding dominant discourse in Western bioethics.  I also share Dawson's interest and focus on public health ethics, although I have some reservations on the latter, particularly because the overlap between what seems to me to be the most pressing matters of population health (e.g., the social determinants of health, chronic, non-communicable disease, health inequities) and public health practice are not nearly as extensive as I would hope.

Thoughts? 

Comments

[Kelly Hills]

Mmm... bioethics saved philosophy, and now public health will save bioethics? Somehow, that strikes me as rather inaccurate.

Until I can swim across the street to the library, I'm stuck responding only to the abstract, of course, but here's my take:

1 - Agreed. Bioethics often does collapse into medical ethics. I think this is probably a function of two things. The first is age/origin; bioethics is younger than medical ethics, and medical ethics is something like the parent of bioethics. Until the field gets some more years under it's belt - time to establish itself as a genuinely separate field, this conflation will keep happening.

2 - Mmm. If you don't want to conflate bioethics and medical ethics, point two probably shouldn't be focusing on medical ethics instead of bioethics. As to the charge, I think there are bigger issues in medical ethics that this skirts around, and it goes back to the conflict and resentment that seems to happen when non-MDs "invade" the medical world.

3 - Well, I think I already made my point about public health ethics "rescuing" bioethics, but I'm longwinded... a few years ago, someone I worked with expressed concern that bioethics was moving away/out from philosophy. More and more, if not most, "professional" bioethicists were coming out of public health programs, and the problem there is that public health doesn't teach thinking in the same way that philosophy does. In fact, I'd say that an emphasis on public health is moving exactly away from the sort of critical, Socratic dialog that Dawson is indicating he thinks the field itself needs.

[PG]

"a few years ago, someone I worked with expressed concern that bioethics was moving away/out from philosophy."

Aren't bioethics programs generally inter-disciplinary? Certainly mine was; I took courses not only in philosophy, but also several in religious studies, politics/law/government and public health (plus a mandatory basic course in biology). My internship seminar was run by someone with joint appointments as a Professor of Pediatrics and as a Professor of Religious Studies, while the internship itself was with someone in Health Evaluation Sciences.

(Incidentally, the study I helped her do -- and presumably similar ones done around the country -- appears to have borne some fruit in the health care reform law, which now allows pediatric Medicaid beneficiaries to use hospice services while still pursuing curative treatment.)

[Daniel S. Goldberg]

Hi PG,

Re your question, bioethics is generally perceived to be a second-order field of study, which means it is indeed built on the foundations of several disciplines. But there is no question that as to Anglo-American bioethics at the very least, it has extremely deep roots in analytic (moral) philosophy. These roots are not exclusive, of course, but few dispute the very deep and close ties between applied ethics and moral philosophy. Even those like myself who are quite concerned about the extent and direction of this connection do not deny its signifance.

(As an aside, the interdisciplinary question is even more interesting because cross or even multi-disciplinary approaches and interdisciplinary methods are different in important ways, IMO. I am dubious that much bioethics work is truly interdisciplinary).

Thanks for reading!