Progress in Bioethics: Science, Policy, and Politics (review)

Once upon a gentler time, bioethics tended to float well above the messy fray of power politics. Its leading topics deserved their prominence for their unmistakable social importance and intrinsic intellectual complexity; its methods of assessment and analysis strove to be available to all deep conceptions of the good. As it was an honest broker in the realm of contested values with practical import, practitioners and policy makers sought its counsels and made them so, because bioethics elevated scholarship over advocacy and preferred ideas to ideologies.

Alas, in the last decade or thereabouts, snakes have gotten into the garden. Conservative ideologues have been degrading the discourse and practices of the public sphere in general, and bioethics has not been spared. The right wing, supported by the Bush administration, a collection of well-funded think tanks, and a core of smart, policy-savvy people, has made a concerted effort to commandeer and politicize this once philosophical discourse, spearheaded by the Dark Master of bioethics, Leon Kass.

Progress in Bioethics presents itself as an effort to help bioethicists become alert to what is at stake in this struggle, and to make more explicit and effective a "progressive" sensibility in the field, allied to a broader countermovement in American politics and society that is not identical to but rather an heir of liberalism. Whereas the kind of social conservative program that has assumed such heft in recent years is enamored of certain threads in our religious and civic traditions while insensible to others, and is dubious about (or disinterested in, or allergic to) Enlightenment visions of science as key to improving human welfare and making the world fairer, progressive bioethics is characterized by a broadly pragmatic orientation, by a respect for science and a "critical optimism" about its social impact, and by deep sympathy with both individual rights and the common good. This collection—fourteen essays, bookended by an introduction by Harold T. Shapiro, former chair of the National Bioethics Advisory Committee, and an afterword by the book's editors—is something of a manifesto of progressive bioethics, albeit one that is rather more internally diverse and thoughtfully motivated than most.

Feminists, of course, will tend to raise a skeptical eyebrow at the backstory motivating this collection. Narratives of innocence lost are almost a priori unlikely, and when one actually looks at the state of the field—with its tendencies toward infatuation with individual impact and techno-glamour that guide the choice of issues to which it has given pride of place, the ways in which its ameliorative tendencies can muffle more exacting criticism of policies and procedures—it is hard to escape the thought that bioethics' social clout flows as much from its strategic affiliations with enormously powerful social forces as from its critical independence from them. In this respect, if no other, there is at least something of a convergence between conservative and feminist approaches to bioethics: they both call for more searching forms of scrutiny of the impact of professional health care and the life sciences on cultures and their practices. If progressive bioethics does little more than repackage standard approaches and marshal them against reactionary trends in discourse about health care, it may be missing out on an opportunity to ask more thoughtful questions about how bioethics might develop in the face of conservatism's challenge—questions about various forms of social power and privilege, for example.

Progress in Bioethics does not seem very keenly interested in what feminist approaches might bring to the table. Perhaps that would seem to violate the pragmatist stricture on "ideology" (a notion progressives might do well to think harder about). Still, feminists are likely to be interested in Progress in Bioethics. For anyone trying to sort out the interplay of bioethics, politics, and power, nearly all the essays are well worth reading; several are quite striking for one reason or another. Jonathan Moreno and Sam Berger, for example, do a very nice job of situating progressive bioethics...