Challenging the Conventional Wisdom: From Philosophy to Bioethics
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Challenging the Conventional Wisdom
From Philosophy to Bioethics

Philosophy is a core discipline that has contributed importantly to bioethics. In this essay, the author traces his trajectory from philosophy to bioethics, oriented around the theme of challenging the conventional wisdom. Three topics are discussed to illustrate this theme: the ethics of randomized trials, determination of death and organ transplantation, and pragmatism as a method of bioethics. In addition, the author offers some general reflections on the relationship between philosophy and bioethics.

Philosophy recovers itself when it ceases to be a device for dealing with the problems of philosophers and becomes a method, cultivated by philosophers, for dealing with the problems of men.

—John Dewey (1917)

Kierkegaard famously declared that life is lived forwards but understood backwards. The retrospective look at one's career necessarily takes the form of a narrative reconstruction. Our lives are messier than the stories we tell about them. [End Page 3]

I first took up serious study of philosophy as a sophomore at Columbia College in 1967. The extensive core curriculum at Columbia exposes all students to a sampling of classic texts in philosophy. Some inkling of a more than passing interest in philosophy, which I can't now recall, must have induced me take an elective course devoted to that subject. It was taught in the old-fashioned way of detailed examination of classic texts—the way that I believe it is best to learn about, and kindle enthusiasm for, philosophical inquiry. We studied carefully Descartes's Meditations, Hume's Enquiry Concerning Human Understanding, and Mill's On Liberty. I was hooked. And from that time I can trace a lasting influence: Mill's classic text is one to which I returned nearly 40 years later in a collaboration with the late Alan Wertheimer concerning the paternalistic character of the ethics and regulation of clinical research.

My first course in philosophy led to taking others and eventually to majoring in the discipline. But I almost set it aside after graduating college, as I believed then that I was more interested in graduate studies in the history of ideas. I didn't get into either of the programs to which I applied, which prompted me to sheepishly consult with one of my philosophy professors about what I should do next. Taking a properly directive stance, he encouraged me to apply to the graduate program in philosophy at Columbia, and he was instrumental, I believe, in my getting accepted. This was one of a few twists of contingency or fate that set me on the path to becoming a philosopher-bioethicist.

In graduate school I concentrated on moral and political philosophy, eventually writing a dissertation on the moral obligation to obey the law. In the late 1970s, it was especially difficult to land academic positions in philosophy. I count myself lucky that I failed in that endeavor. It is doubtful that I would have found my way to bioethics had I managed to become a faculty member at some obscure college or university. Instead, I pursued alternative career paths from 1977 to 1990. In the latter half of that period I renewed my love affair with philosophy, but in a purely private way. I fancied myself a "closet philosopher," rereading classic texts, exploring areas of philosophy with which I hadn't been much familiar, and writing unpublished essays, dialogues, and even an unpublished book on the theme of philosophy as a way of life. While pursuing philosophy again, I was in rebellion against academic philosophy, which I took to be essentially an ivory tower discipline. Perhaps there was an element of sour grapes in this perspective, given my failed efforts to become an academic philosopher. Nevertheless, I saw moral philosophy in the Anglo-American world as largely isolated from practical issues of moral concern.

My path to bioethics opened up when I met John Fletcher, a theological scholar and one of the pioneers in the field, who now is probably unknown to most bioethicists. Then a solo bioethicist employed at the National Institutes of Health, Fletcher was an old friend of my stepfather. In 1985, Fletcher persuaded me to become a lay...