This editorial appears in the May 2025 issue of the American Journal of Bioethics.
As the “bio” in “bioethics” suggests, the topics under the purview of bioethics have expanded to include issues that affect our health and well-being that extend beyond clinical settings. This is largely due to our growing understanding of the social, political, cultural, and commercial determinants of health, which has pushed bioethics beyond just medical or clinical ethics but to the ethics of life. I’m not so sure this was a willing expansion, though. The diversity of political and social values, religion, economic and racial backgrounds, and nationalities among bioethicists has forcibly pushed bioethics now more than ever into this new social sphere. That is, bioethicists have called on bioethics to give more attention to issues like environmental injustice, racial, gender, and sexual orientation discrimination and even the racial makeup of bioethics trainees and students. The Jecker et al. article “War, Bioethics, and Public Health” is another extension of this call to bioethics to “broaden its scope”—this time to war’s effect on public health.
Although other calls for bioethics to expand its focus to include so-called “nontraditional topics” such as Ray and Cooper’s “The Bioethics of Environmental Injustice: Ethical, Legal, and Clinical Implications of Unhealthy Environments” argue that pushing bioethics to focus on the health impact of unhealthy physical environments is appropriate given its established ethical commitments and principles, such as nonmaleficence, autonomy, beneficence, and justice, “War, Bioethics, and Public Health” introduces new principles that would justify bioethics’ focus on war as a worthy bioethical pursuit. This essentially is an effort to “call in” bioethics rather than a “call out”: a push to make it better, a push to make us practitioners of bioethics, better. It’s like saying “Bioethics, we need to have a talk about your behavior.” But first, we must be open to doing things differently, according to the authors.
The underlying “call in” in “War, Bioethics, and Public Health” highlights an ongoing identity problem in bioethics and a myriad of questions it forces us to ask ourselves. Given that so many who are practicing bioethics come from different academic disciplines and career backgrounds, what is bioethics and what is it supposed to be? Compared to other academic disciplines like philosophy, mathematics, and biology, bioethics is in its infancy. Does a lack of attention to timely issues like war demonstrate that bioethics is still in the midst of its development? Does bioethics have an identity? It is not lost on me that my own philosophical background and my own attempts to “call in” bioethics and ask bioethicists to care more about issues of injustice shape how I think about these issues of professional identity. I have also participated in questioning the bioethics identity crisis. But it’s a worthwhile endeavor to question whether asking bioethicists to make more concerted efforts to care more about an expanding list of topics, given the changing political and social issues of the world and the accompanying globalization of our world, is asking bioethics to be something it is not, to do something it does it not have the tools for. It could also be the case that this is exactly the point – to push bioethics to be something it is not so that it can become something it should be, which is something relevant to the 21st century.
“War, Bioethics, and Public Health” gives us at least two ways to think about bioethics’ identity. In one instance, the authors note that their call for bioethics to care more about the health impact of war is a part of a larger call for bioethics to broaden its parameters to include public health concerns. This is a legitimate call, given bioethics’ already growing concern for issues like structural injustices, such as racism, the effects of infectious diseases, increased awareness of the social determinants of health, climate change, and immigrant health, among other global issues. Therefore, asking bioethics to care about war aligns with this growing list of bioethical issues.
On the other hand, the authors note that including more issues of public health into the scope of bioethics requires “conceptual retooling and expanding of bioethics principles to address public health concerns” (109). This means that bioethics does not currently have the language to speak about certain issues of public health, such as war. In an effort to develop that language, the authors propose six new principles to facilitate a bioethics response to war:
1. Health justice
2. Accountability
3. Dignified lives
4. Public health sustainability
5. Nonmaleficence
6. Public health maximation
Some of these principles seem derived from the four biomedical principles made popular by Beauchamp and Childress, as well as other long-standing principles made popular by other scholars, such as the principle of “dignified lives” often discussed by disability ethicists. So, to some degree, these principles aren’t new for bioethicists. But in many ways their application makes them new. For instance, although nonmaleficence is typically applied in a clinical context, such as guiding physicians’ care for patients, Jecker and colleagues conceptualize it as “limit[ing] war’s harmful effects on noncombatants” (110). This application mixes the principle of “do no harm” with aspects of just war theory, a theory that has yet to be mainstream in bioethics. As such, on one hand, Jecker and colleagues suggest that war is a natural extension of bioethics. But on the other hand, the authors say bioethics does not have the proper tools to concern itself with the important issue of war and health and thus must rethink its basic principles to accommodate this timely issue.
It is not unheard of to borrow principles from other disciplines or to push the boundaries of our own principles. In that way, Jecker and colleagues are not asking bioethics to do something it hasn’t done before. But I wonder whether adding and reshaping principles is asking bioethics to take a form that is so foreign to it that the importance of the issue will get lost in our attempts to create new languages just so bioethics can be a part of the conversation. But if not us, then who? The very name of our profession asks us to concern ourselves with the ways our social lives affects our health. And if bioethicists cannot adapt and are not a part of the conversation, will we become irrelevant and unable to speak on and lend our expertise to timely issues? Are we inserting ourselves in a conversation better left for other disciplines such as public health, political scientists, and war experts?
In true philosopher-bioethicist form, my reaction to Jecker and colleagues’ eloquent yet hearty push to have bioethicists care more about the public health effects of war has been to ask more questions about the nature of bioethics than to give answers about its identity. Bioethics is still young, though. We are still going through growing pains, and those include learning how to interact with timely issues, and how to adapt what we’ve always done to what the current times call for. Asking bioethics to care more about war may be a natural part of this growth. Although I don’t have the answer, I wonder whether calls for the expansion of bioethics are asking it to be something it is not, and therefore, whether our attempts to speak on certain issues will be incomplete and possibly uninformed. But I also wonder, if we don’t push bioethics to grow will, we become stagnant and unable to fulfill the potential of what bioethics could be? Like any profession, bioethics is developing and maturing, and calls like the one in “War, Bioethics, and Public Health” are ultimately necessary to help us think about what we want our profession to be and how we ought to behave as its representatives.