Letters
- Bioethics with Blinders
To the Editor:
Ruth Macklin and Eric Cohen have written eloquently and passionately about the bioethics wars in the United States (January-February 2006). While their arguments are of great interest, what is notable to bioethicists from beyond the U.S. borders is their narrow perspective. In a world in which medicine and bioethics should play a critical universal role in relation to human health, American bioethics, despite its claim to universalism, is oriented to an American "world view." The narrow focus reflected by the bioethics war described here exposes some of the weaknesses and inadequacies of bioethics, particularly as it has been developed in the American context.
Macklin claims that "so-called liberals" have paid attention to justice issues but that these concerns are "largely absent" from conservative agendas. Cohen asserts that conservatives who care most about civic morality are often critics of modern capitalism and "care deeply" about the plight of the poor. Their positions are framed within the context of a broader culture war that arises out of a peculiar blend of American cultural and religious phenomena and the nation's unique constitutional and judicial system. They appear to agree, though, that the significant issues that sharply divide them relate to human reproduction (abortion, embryos, assisted reproduction, and fetal tissue research). Controversies focus on conflicts between the rights/dignity of embryos and fetuses and the responsibilities of individuals and societies to treat all equally, particularly the most vulnerable among us—those at the "edges of life."
While these are universal concerns, this largely American-oriented debate places heavy reliance on a civil rights discourse that, as Audrey Chapman once noted, is "characterised by hyper-individualism, exaggerated absoluteness, and is silent about personal, civic, and collective responsibilities." This narrow, impoverished concept of rights overlooks or even ignores the rights of the poor, vulnerable children and women, and the disabled—in the United States itself as well as in poor, developing countries. Although both authors nod in the direction of pursuing a search for justice, they fail to link their views in a meaningful way to issues of social justice. A bioethics enterprise that expends so much time, space, and resources debating issues that are narrowly cast in a provincial United States framework is ethically insensitive to the claims of hundreds of millions of poor who lack meaningful rights or access to even minimal health care.
A first step to broaden this perspective would be for American bioethicists, whether liberal, conservative, or uncommitted, to join others around the globe in advocating, as a matter of fundamental morality, that the United States sign and comply with the Covenant on the Rights of the Child and agree to the Statement of Common Understanding on Human Rights.
Solly Benatar and Theodore Fleischer
University of Cape Town
- Ruth Macklin replies:
Professors Benatar and Fleischer are largely correct in their assessment of the concerns that have occupied much of the bioethics literature in the United States. As they also know, my own contributions to that literature argue against allowing "double standards" in medical research—one standard for the industrialized countries and a lower standard for developing countries. Along with Norman Daniels, Dan Brock, Dan Wikler, Dan Callahan, and other prominent bioethicists, I have addressed questions of social justice in my writings. However, I think the stem cell debate, the moral status of embryos and fetuses, and the ethics of genetic manipulation are not the topics on which to address collective social responsibility. Nevertheless, if stem cell research does eventually yield the promise for the many cures that its proponents hope for, there will surely arise a question of social justice if such therapies are accessible only to people in industrialized countries or to the very wealthy people in poor countries.
Benatar and Fleischer call upon the United States "to sign and comply with the Covenant on the Rights of the Child and agree to the Statement of Common Understanding on Human Rights." Surprisingly, they do not mention the Convention on the Elimination of All Forms of Discrimination against Women...
