The ethics of bioethics: Mapping the moral landscape (review)

The Ethics of Bioethics: Mapping the Moral Landscape is a compelling, thoughtful, sobering examination of the moral practice of bioethics. Jonathan D. Moreno sets the tone in the foreword by unsettling the reader with questions from critics about the intellectual legitimacy of bioethics (e.g., the frequent tensions of political ideology with normative expertise in the public debate) and the practices of some in bioethics (e.g., the controversial roles in for-profit industry or health care). Twenty-five essays follow, addressing issues and activities that mark the relatively brief history and much of the scope of bioethics practice. Each essay turns bioethics practice inward to lay bare, explore, and possibly reposition its values, goals, standards, and activities. For those who work in bioethics, one cannot help but affirm, over and over again, that the analyses contained in this work are deeply personal and disturbingly relevant.

These are formative years of rapid development in the relatively young life of bioethics. The field does not have the long-established experience and practice of more mature fields. Practitioners of bioethics—whose own codes of ethics are still in draft form and are still controversial within the field—are seeking to have a rewarded, trusted, respected, and influential place in the moral landscape of societies globally; and yet those same societies do not yet have a developed long-term perception of the value being added by bioethics contributions. Overall, the bioethics community is becoming more aware of the implications arising from its activities, its precarious positioning close to centers of influence and power, and its evolving roles. Its practitioners (both individually and collectively) are testing alternatives, learning humility, and taking more responsibility. Accordingly, this set of essays reflects a maturing and increasingly sophisticated bioethics community.

As with many compelling landscapes, one wants to explore the entire book everywhere at once. Editors Lisa A. Eckenwiler and Felicia G. Cohn organize the chapters under six themes. Each chapter title points accurately and appealingly to what is offered therein. I skimmed the periphery (table of contents, index, etc.) and a few chapters that particularly called to me, and then settled in for a cover-to-cover read.

Predictably, Part One sets out to situate bioethics historically. Carol Levine maps the "modern American incarnation" of bioethics, which focuses squarely on how the field developed in the United States, with few influences beyond its borders (notably, reaction to atrocities of some German physicians under the Nazi regime). It will be sorely disappointing to many that no attempt was made to acknowledge or situate bioethics internationally. For the global bioethics community, with its larger scope of history, contributions, challenges, and issues, the sting of who speaks for bioethics, and who is unheard, is planted early. With his mapping of some recent history about codes of ethics for bioethicists, Robert Baker raises important questions about the integrity of the field and challenges for its members to recognize common standards and responsibilities. With this point of departure, we launch into a more inward analysis of the modern American incarnation of bioethics.

Going straight to the heart of the field—the people and the legitimacy of their practice—Part Two explores the problems of expertise in bioethics. Carl Elliott reminds us of the dangers of social authority coupled with claims of expertise, particularly for fostering stifling power hierarchies. James Lindemann Nelson's essay "Trusting Bioethicists" is one of the best and most useful in the book. It prepares and leads us to routes that we need to explore, and points out features of a moral landscape that we need to understand and make use of, if we are to have and use moral expertise in the service of others. Bioethicists who have long ignored or under-explored moral psychology should take note.

Parts Three and Four address contributions and conflicts of bioethics in action. Collectively, these essays make plain the considerable challenges that bioethics needs to overcome in service...