An Experimental Life

I teach a course at the University of Chicago on the history of bioethics, in which I argue that modern medicine has served as a sort of philosophical laboratory, conducting what amounts to a series of longitudinal trials of different systems of secular moral reasoning. The three systems that have been implemented in this great social experiment are Kantian autonomy, Benthamite utilitarianism and Nietzschean nihilism. Roughly speaking, the story I tell runs like this: Utilitarianism was the first to be tried and is historically most dominant of the three, implemented in the hospitals of post-revolutionary Paris and surviving in one form or another to the present day. Between about 1870 and 1945, this creed was deformed by the doctrine of racial hygiene, a descent into nihilism that culminated in the Nazi medical experiments. Since the Nuremberg Trials, an ongoing reform process has challenged medical utilitarianism and gravitated towards a more Kantian formulation, predicated on the idea of patient autonomy and implemented through the doctrine of informed consent.

A cursory inspection of my academic résumé might not suggest great depths of expertise in the history of ethics. I do possess a couple of oblique qualifications – a doctorate in the history of science for which I wrote a dissertation about the history of archaeology, and a post-doctoral excursion into bioethics courtesy of the Wellcome Trust – but the really relevant experience is missing from that document. Here I would like to confess the true historic passion behind my history of bioethics class. Like the history of medical ethics, my life since age fourteen has constituted a series of experiments in the three great systems of secular moral reasoning. Between the ages of fourteen and nineteen I was a devout nihilist; between nineteen and twenty-five I interpreted the tenets of utilitarianism along revolutionary lines; since then, in an effort to salvage a zone of privacy from the intemperate demands of ideology, my ethical framework has become increasingly Kantian. Each phase had its conversion moments, and each system has been lived with all the zeal of a convert.

I fear that the story of my moral evolution – the sorry tale of how I managed to sink beneath privilege – may be the opposite of inspiring. Perhaps the best that can be said about it is that it represents a series of unwisdoms lived at such a delinquent extreme of tenacity and deliberation that they have eventually matured into their opposite. There is no ideological evil of the twentieth century into whose abyss I have not looked on my own behalf, no Kantian virtue that I haven't championed after discarding as unworkable its more radical alternatives. I am the fool who persisted in her folly, and I like to think that it has made me if not wise, at least well-versed in the infinite variety of human moral recklessness.

My experiment in nihilism had to graft itself on to the stock of an overwrought moral sensitivity. On the brink of adolescence I suffered from a kind of acute moral dread: I crept down to the local Woolworths to insinuate a 2p piece in the spot where my friend had nicked a boiled sweet out of the pick 'n mix; I was reduced to tears by the revelation that another friend sometimes smoked cigarettes and was light-fingered around her mother's wallet; I had a horror of malicious pranks. I did lie rather a lot, but more in obeisance to the moral law than in defiance of it. I had gone through a religious phase at the ages of eight and nine, but by the time I went to grammar school, my governing super-ego was a godless composite of the Law of the Land – a shadowy but awesome presence – and a Law of Correct Action transmitted by my mother.

At the age of fourteen or so, a combination of teenage hormones and the schoolyard drugs of late seventies London hit me with overpowering force. Together, speed, hash, and nascent adolescent reasoning power seemed to expose the vacancy of godless morality. In the absence of God, surely there was nothing behind the...