restricted access 7 Democratic Ideals and Bioethics Commissions: The Problem of Expertise in an Egalitarian Society
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c h a p t e r s e v e n Democratic Ideals and Bioethics Commissions The Problem of Expertise in an Egalitarian Society m a r k g . k u c z e w s k i , ph.d. Being a bioethicist is a funny thing. It makes one welcome in polite social conversation in a way that being called a philosopher does not. “Bioethics” immediately suggests some familiar issues to the news-savvy public. Names such as Quinlan, Cruzan, Kevorkian, and Schiavo have each been familiar to many Americans at some time. Issues such as abortion, withdrawing life-sustaining treatment , assisted suicide, cloning, stem cell research, and many others also come and go and come around again. So, when bioethics comes up in conversation, people feel like they know what to talk about, that is, what subjects my job deals with. Of course, shortly thereafter, the conversation is often abruptly interrupted. The enthusiasm for talking about intriguing issues often gives way to a sudden surge of self-consciousness as our interlocutor feels he may have said a bit too much to an expert. He becomes worried that we may be judging him as nonetoo -bright since he is not so sure how his opinions sound to someone who works in the field. Nevertheless, such stumbling blocks in the conversation are generally easily set aside. One simply explains that these are matters that should concern everyone and that it is important that thinking individuals consider the subjects thoughtfully. Of course, as the discussion progresses, the question of what I actually know and do is invariably at issue. That is, the impetus for much of the discussion becomes finding out whether I am not only more familiar with these widely discussed issues but am someone who knows something di¤erent from my interlocutor, even if this is explored in indirect terms and questions. This cocktail-party-like dialogue is a microcosm of a discussion that has been going on between citizens and experts at least since the time of Attic Greece. Moral matters are interesting and attract our attention. However, moral matters can also be surprisingly complicated and can lead to a desire to enlist the aid of experts. No sooner do we consider enlisting such guidance than we become concerned about losing control over matters that deeply concern us. Worse still, we fear losing this control to people who are merely “seeming” experts. After all, is there really any genuine expertise in morality? This fictional conversation mirrors the tension between society and the bioethics community. Namely, the general public can vacillate between a sense that everyone can solve moral matters and a respect for expert solutions. While bioethical issues are of widespread general interest, their complexity can inspire humility in the general public, who would like to see the problems taken care of by experts working in the public interest. At the same time, when it comes to moral matters, Americans have a faith in the common sense of everyman and a suspicion of experts. It is not surprising, therefore, that there should be an ambiguity with respect to the role of ethicists in general, and more specifically, ethicists who work with government, such as bioethics commissions. In general, bioethics commissions in a democracy like the United States raise several kinds of questions: Is there a role for some kind of expertise in regard to what seem to be moral matters? If there is a role for expertise, what might this role be? But the first question is why are these considered collective matters at all? That is, is not morality in health care simply an individual matter? I will attempt to outline answers to these questions. Contemporary biomedicine is a collective enterprise in which the public has invested so heavily that it is diªcult to separate a private sphere from the public sphere. Furthermore, the choices made within the biomedical-industrial complex frame the choices for individuals and their options for achieving the good life. As a result, bioethics must also be a public matter, facilitating public deliberation. Entities such as bioethics commissions assist this process by clarifying policy options and pointing the way to potential consensus solutions that respect the competing values at stake. In this way, bioethics commissions can aspire to perform a public service. bioethics as a public enterprise One way to think about all moral issues, one that is unrealistic in the modern world, is that there should be no community...