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c h a p t e r t h r e e The Tyranny of Expertise c a r l e l l i o t t , m.d., p h.d. When I was in medical school and first began seeing hospital patients, there was something about the way the patients behaved that embarrassed me. It was an issue of manners. In South Carolina, where I grew up, we still say “ma’am” and “sir” to our elders. It is a sign of respect. I grew up saying “yes ma’am” and “no sir” to my parents, my grandparents, and all their friends. I said it to my teachers in school, to my professors in college, and to virtually every adult in our hometown Presbyterian church. One of the ways you know you have finally become a grown-up in a small southern town is when children start to say “ma’am” or “sir” to you. What embarrassed me about seeing hospital patients in South Carolina was that older patients, often patients the age of my grandparents, would say “yes sir” and “no sir” to me. These were people to whom I would have been saying “sir” or “ma’am” outside the hospital, and who would naturally have expected it. Yet merely because I wore a white coat and carried a stethoscope, I was the one addressed as “sir.” Eventually I got used to it, of course. If you wear the team colors long enough, you feel like part of the team. The white coat fits, and you feel as if you deserve to be called “sir” or “ma’am.” The point when that happens is the point when you become really dangerous. I wonder if bioethicists have reached this point. After so much time working on hospital consultation services, government commissions, and corporate boards, so many hours producing ethics policies, guidelines, and sound bites for the TV news, I wonder if we have started to take our own expertise for granted. The white coat has begun to feel comfortable to us, and so has the expensive suit. Authority has become something we feel we deserve. The growth of bioethics as an academic field has been remarked upon so often now that it seems superfluous to mention all the bioethics centers, graduate programs, professional journals, and professional societies that it has brought forth. What have received less attention are the various types of social authority that bioethicists have been granted, quite apart from their status as academics. Bioethicists now consult in hospitals, testify as expert witnesses in court, write regulatory policies, appear as expert commentators in the media, and fill positions of bureaucratic authority in pharmaceutical companies, professional bodies , and government organizations. Bioethicists are treated as experts whose judgments on ethical matters must be solicited, quoted, paid for, deferred to, and perhaps occasionally refuted or criticized, but in all cases, given the proper respect . In some ways this is unsurprising. After all, we live in an age of expertise. By virtue of technical eªcacy and a claim to truth, experts are granted a special kind of social authority that they exercise over a particular set of problems (Rose 1998, 86). As professional expertise has expanded into the domain of the self, producing experts in everything from child rearing to marital happiness, it has contributed to the public perception that problems which used to be the responsibility of the individual now fall under the authority of a professional with the proper training. Today experts advise us how to rear our children, achieve sound mental health, improve our personalities, and lose weight in the process. Bioethicists merely extend the reach of expertise even further into the self, claiming special authority over the conscience. “People today hunger not for personal salvation, let alone for the restoration of an earlier golden age,” wrote Christopher Lasch in The Culture of Narcissism, “but for the feeling, the momentary illusion, of personal well-being, health, and psychic security” (1979, 7). The figure of the ethicist helps to satisfy that hunger, but does it in a uniquely late-modern way. In an earlier age, a person might look to external figures for moral authority and guidance—the priest or the rabbi, say, who represented the authority of God. Those external figures of authority have faded in importance, and in modern times people (even religious people) have instead looked inward to the self—to an internal moral compass. What is unique about the ethicist as a figure...


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