Bioethics: The Revolution is Over

Author

Craig Klugman

Publish date

November 10, 2015

by Craig Klugman, Ph.D.

At the recent 17th Annual Meeting of the American Society for Bioethics & Humanities, the association honored Baruch Brody with the Lifetime Achievement Award. During his address, Brody said that we are in the era of “normal” bioethics. The age of the revolutionary nature of this field is long over.

Brody talked about Thomas Kuhn’s, “The Structure of Scientific Revolution.” In this tome, Kuhn talks about two types of science—normal and revolutionary. Revolutionary science is what happens when an accumulation of data and observations shows that the world does not work as theory predicts. As an example, Kuhn talks about how when subatomic particles were discovered, the prevalent theory of physics—Newtonian physics—could not explain the behavior of these very small particles. This forced a creative revolution that led to the positing of quantum mechanics from which Einstein found the general theory of relativity and even today, physicists search for the grand unified theory.

But once a new theory is proposed and accepted, the work of science moves to normal science where the theory is further proven, refined and its implications and applications are explored. For example, in 2012 the predicted Higgs Boson was discovered at CERN. In 2011, the results of the Gravity Probe B project proved that Einstein’s predictions about the behavior of gravity around an object in space.

Brody described the founding of bioethics as a moment of revolution. Bioethics moved philosophy out of the ivory tower and into the clinic; it connected humanities scholars with government panels and the media; and it shifted the focus from doctors paternalistically making decisions to patient autonomy. Bioethics revolutionized the way that patients interacted with the health care system and providers (in fact, they became providers), how we handle human subjects research, with how moral issues in health care settings are dealt.

Normal bioethics then has been the application of these insights and ideas to the world. This can be seen in the establishment of degree programs (undergraduate and graduate), professional societies, a code of ethics, even the new attestation program to professionalize clinical ethics. These are examples of a revolution becoming normalized. Even the work in bioethics is not earth shattering. Year after year at the ASBH meetings I hear colleagues say, “There’s nothing new here.” In some ways, it seems like each new technology (genetics, neuroscience) or situation (pandemic flu, Ebola, crisis management) is an opportunity to apply what already exists to a new topic. This is the definition of normal sciences—applying the theory to new areas. Just as it took time for quantum mechanics or the germ theory to be accepted, bioethics has been exported to countries around the world. The theory has even moved into the mainstream: You would be hard-pressed to find a health care provider who does not know the Four Principles of Biomedical Ethics.

Brody stated that there is nothing wrong with doing normal bioethics because normal is what is done the majority of time even in science. But we have to consider that while we are busy applying our theories to new realms, we haven’t seriously asked whether there are outliers to our theories—cases and situations where the current theories may not work or may give advice that is not “right.” Yes, there are dozens of criticisms of principlism. But where are the new proposals? Where are the new theories that are a better fit of explaining how things work? Even in Clinical Ethics, we have frameworks for how to go about doing a consult but they do not break new ground on decision-making.

Kuhn said that people doing the revolutionary work were often outsiders—people whose ideas were rejected because they violated the accepted theory. There may be people who are developing innovative tools and theories that do bioethics better but they dwell in obscurity. Only when there was enough proof of the theory failing did Kuhn say that a new theory could be entertained by the larger world. At the moment, our theories are working and allow us to do what we do—moral deliberation on issues in the life sciences. We are no longer outsiders.

In 1999, When Al Jonsen received his Lifetime Achievement Award from ASBH, he talked about how “bioethics was boring” which became the subject of an article he published a year later. His point was bioethics is an insider now, a polished part of “medical, scientific and social policy.” He thought the way to get over this boredom was to expand to “neighboring” disciplines (sociology, biology, etc.) and that it needs to go global. Both of these goals have happened or are happening. However, claiming new territory is not revolutionary, it is normal.

In science, a revolution becomes necessary because observed facts deviate from the theory. This is where the analogy breaks down because bioethics is normative and prescriptive. When observation deviates from ethical theory, we day that it’s because of the is/ought fallacy rather than a clear indicator that the ethical theory does not work in all situations. Or, it could be that bioethics uses a large toolbox of theory in its work anyway so whereas most physicists work with quantum mechanics, the bioethicist may use principlism and virtue ethics and narrative ethics and deontology. Also consider that our theories do not describe how things are but rather how things ought to be.

Even if the analogy is imperfect, it does beg the question of what a revolution in bioethics would look like? A new theory? New territory? New media outlets? Or the end of bioethics?

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