This editorial can be found in the September 2024 issue of the American Journal of Bioethics
n light of this empirical study of who bioethicists are and what their values are and then answering the question “What is the future of bioethics?,” we think it’s important to place this question into a broader historical context. Historian Bob Baker has argued that bioethics was formed by a lumpen intelligentsia of humanist physicians, philosophers, lawyers, theologians, and others who created the moral revolution of modern bioethics. In his latest book Making Modern Medical Ethics: How African Americans, Anti-Nazis, Bureaucrats, Feminists, Veterans, and Whistleblowing Moralists Created Bioethics, Baker states the following:
Catalyzing this transformation was a lumpen intelligentsia of feminists—like Downer and the women in the Boston Women’s Health Book Collective—African American civil rights leaders (Jensen, Wiley), whistleblowing health care practitioners (Beecher, Buxtun, Pappworth), disappointed and lapsed Catholics (Callahan, Hellegers, Jonsen, Reich), moral theologians (Childress, Ramsey), disaffected analytic philosophers (Baker, Beauchamp, Macklin), lawyers (Capron, Hyman, Kaimowitz), humanist nurses (Gadow) and physicians (Kelsey)—especially psychiatrists (Gaylin, Katz, Kübler-Ross, Lowinger)—scientists (Hellegers), and medical educators (Pellegrino) who recognized the anomalies and inconsistencies in the trust-the doctors-and-researchers-to-know-and-do-what-is-best paradigm.
In his historical analysis, Baker tries to paint a picture of the early bioethics movement as one comprised of a more diverse group of people who came from a variety of ethnic and professional backgrounds. Yet, this latest study paints a picture of bioethicists as being overwhelmingly white, liberal academics who share similar values. Why is that?
The sorting of professions into certain political views is not new. It’s clear that certain professions (even within healthcare) attract individuals with certain views (as one article stated a few years ago, your surgeon is probably conservative, and your psychiatrist is probably liberal). Is it an issue that our field is overwhelmingly white, educated and liberal? On the one hand, we want a field that is diverse and inclusive. The early history of the field suggested there was greater diversity. Yet, it’s clear that the individuals who were the progenitors of our field were typically outsiders who challenged prevailing norms and were even dissidents. They did not typically share the values of mainstream organizations and institutions. Now that the profession has professionalized, we’re seeing a greater homogenization of the field (whether we’re looking at academic bioethicists or bioethicists working as practitioners). One might be tempted to draw the conclusion (as some press has) that this is concerning or a problem (“a bad thing”) because we may end up with policies and guidelines that are “too liberal” and do not represent the views of the general public.
There are two reasons to think this is NOT necessarily a problem or a bad thing. The first is that bioethicists’ political or ideological leanings do not by itself determine their reasoned conclusions on individual policies and issues—this is evidenced by the finding that on some issues, bioethicists were actually more conservative than the general public (e.g., on compensating organ donors) and in many areas they were aligned (e.g., 59% of bioethicists viewing medical aid in dying as permissible and 54% of the general public). The second is that it is not necessarily a bad thing if bioethicists end up with different views than the general public on key issues (more or less liberal) if we think that the role of a bioethicist is to help shape well-reasoned and justified conclusions on key issues regardless of whether those always alight with popular opinions, which might be ill-informed or misguided.
At the same time, bioethicists’ demographics not matching the demographics of the general public potentially hinder us from understanding what bioethics topics matter to the general public, how our work affects their lives, and how we communicate the importance of what we do in the academy. In short, we run the risk of only speaking to each other in conference rooms, workshops, and hotel ballrooms and not to the rest of the world. Speaking to the public, however, about issues that matter to them and the ways that our work embodies their interests requires prioritizing this type of communication; we have to value speaking to people besides other academic bioethicists. We also must have the skills to do it, something that most bioethics programs do not teach and a skill that most bioethicists learn by trial and error. We also must do the kind of work that actually has implications for the ways that people live their lives and how they engage with institutions that influence their health and wellbeing. Overcoming the disconnection that mismatched demographics creates, begins with an examination of our priorities as scholars and researchers.
Although academic bioethicists do occasionally appear on popular news sources, TV, radio, and podcasts, as well as write op-eds and participate in social media, we can still do a better job connecting with the general public. It’s likely this is a direct result of the make-up of bioethics. According to Pierson et al. we are a privileged group. Anyone who has been around any professional bioethics function already knew this. Perhaps because of our privileges some of us have forgotten that in addition to academic discourse, bioethicists should engage with the general public about the basic tenets of ethics, health, and wellbeing. But we cannot do this if we do not value different forms of diversity. We can start by examining the value of our own work and its applicability to people outside of the academy who do not live exactly as we do or believe exactly as we do. We ought to determine whether our work adequately represents the principles we frequently tout as paramount to our profession and the ideals of advocacy and concern for the least well-off that are at the foundation of our profession.