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c h a p t e r t h i r t e e n Ethics on the Inside? d e b r a a . d e b r u i n , p h.d. It is, in practice, simply not possible to adopt such a critical attitude towards an employer and at the same time provide good service. (Kazuo Ishiguro, The Remains of the Day) Bioethics has become “an accommodating handmaiden” (Callahan 1996, 3) to the biomedical sciences, and in so doing, has “sold out” (Loewy 2002, 388). So goes the concern, raised by a number (albeit a small one) of passionate voices in the field. It is a very troubling worry, one that merits serious consideration. In this chapter, I shall describe this criticism and assess its legitimacy. I shall address the responsibility of individual bioethicists for responding to this concern. However, I shall also insist that the institutions within which we work must share this responsibility . the charge: bioethics has “sold out” Erich Loewy argues that bioethicists tend to cater to privilege: The development of bioethics has been mainly focused on those who had good access to healthcare. Those with a lack of access have been given short shrift. Basic healthcare provided to all within a given society has been the case in virtually all industrialized countries except for the United States since at least World War II, and even longer in most cultures. Here in the United States, our main bioethics soci- eties, and bioethicists as individuals, have tended to concentrate on individualistic ethics and its problems (euthanasia, abortion, termination of care, IVF, etc.) and have, to a large measure, practiced “rich man’s ethics.” The lack of access to healthcare as well as many other faults have been labeled “system errors” and are in general considered to be beyond the responsibility of the bioethical profession. (Loewy 2002, 396) Steven Miles agrees, and suggests a parallel between bioethicists’ relative neglect of social justice concerns and the failure of Kitty Genovese’s neighbors to raise the alarm despite their knowledge that she was being brutally murdered on the street outside their homes (Miles 1997, 97). Indeed, one of the most striking criticisms of bioethics that I have ever seen is currently displayed on Miles’s office door. The display includes a poster captioned “One Week of U.S. Gun Deaths (excluding nine not reported when poster was made)” that includes the photos of more than 450 victims of gun violence, along with a list compiled by Miles of all of the articles written by bioethicists on gun deaths in the past decade. The list is three items long. These critics admit that some work in bioethics attends to issues of social justice . Their complaint concerns the degree of attention paid to certain types of topics rather than others. As Miles explains, “This selectivity suggests a partial moral vision” (Miles 2002, 5). To protest the partiality of our vision is not to deny the importance of what we do see; it is to affirm the importance of the things we tend to overlook. A simple review of the bioethics literature reveals that it does, indeed, selectively attend to topics in individualistic ethics that tend to presume access to care rather than to social justice issues (Miles 2002, 2). Daniel Callahan suggests bioethicists should be chastised not only for their neglect of certain types of topics, but also for the commentary they provide on the topics they do address: While bioethics creates problems now and then for mainstream, right-thinking trends, it mainly serves to legitimate them, adding the imprimatur of ethical expertise to what somebody or other wants to do. It is hardly likely that the National Institutes of Health (NIH) Human Genome Project would have set aside 5 percent of its annual budget for the Ethical, Legal, and Social Implications program if there had been even the faintest likelihood it would turn into a source of trouble and opposition ; and it indeed hasn’t. (Callahan 1996, 3) Pandering constitutes a sell-out, indeed. Yet it is also difficult to establish that such pandering occurs; no simple literature search will suffice here, it seems. I shall not attempt to establish the charge in this chapter. Even Callahan admits that 162 c o n t r i b u t i o n s a n d c o n f l i c t s : c o n s u l t a t i o n his...


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