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PERSPECTIVES IN BIOLOGY AND MEDICINE Volume 27 ¦ Number 2 ¦ Winter 1984 THE BUREAU OF BIOETHICS: FORM WITHOUT CONTENTIS MEANINGLESS COLLEEN D. CLEMENTS* Thoughts without content are empty, intuitions without concepts are blind. [Immanuel Kant, Critique ofPure Reason] Introduction to the Misuse ofEthics The attempt to combine biology and ethics within a procedural or formalist definition of ethics has not only been mistaken but has been detrimental to the life sciences. That such a definition of ethics as the form or procedure for dealing with value issues is actually an arbitrary and problem-filled definition needs to be stated and stressed, or medical ethics can do serious harm. If the reader can tolerate the necessarily abstract groundwork of the next section, I will show the more practical, concrete results of this incorrect ethical hypothesis for medical and biological issues—where politics frequendy carries the specious label of "bioethics." Finally, I will be able to make some workable suggestions for preventing further harm from bioethics. Fake Assumptions ofProcedural Bioethics The true agenda of current medical ethics and bioethics has finally been expressed indirectly by Engelhardt [I]. It needs to be taken quite The author expresses her appreciation to Dr. Roger C. Sider for essentially initiating this paper, to Dr. Norman J. Pointer for his continued discussion of ethical issues and clinical common sense, and to Drs. Carl Wood and Richard McKee. ?Assistant professor of psychiatry, University of Rochester Medical Center, 300 Crittenden Boulevard, Rochester, New York 14642.© 1984 by The University of Chicago. All rights reserved. 0031-5982/84/2702-0388$01.00 Perspectives inBiology and Medicine, 27, 2 · Winter 1984 | 171 seriously for its bad consequences for both ethics and medicine, and it certainly requires careful examination of its doubtful assumptions. While Engelhardt is more specific in defining bioethics as procedure and bureaucracy, this has been a working definition for many in the field. Using John Rawls's procedure for arriving at principles (the construction of a social contract), Veatch also implicitly sees ethics as procedure. He believes people would contract or covenant together to agree on the basic relationships of a moral community: "notions of freedom and responsibility that are the fundamental basis of morality in the community " [2]. The actual content of this social contract is, by the very nature of the contract, left open. Neither medical ethicists nor physicians can articulate the definitive content of such contracts that Rawls's reasonable people would make, though Veatch paradoxically does describe a content of autonomy, honesty, contract keeping, and so on. The ethically important primary activity is the social contracting, however, not content , which is, of course, procedural and seen by Veatch as basic. Beauchamp and Childress's discussion of the criteria for moral action-guides gives some clue to the source ofthis formalism in bioethics. They list two ofthree conditions for such action guides which are purely formal, referring to the form and not the content of moral judgments, rules, and principles [3]. These are the conditions ofoverridingness and universalizability, described by them as necessary conditions for moral thinking. It is becoming apparent how rationalistic this view of ethics is, with its emphasis on the a priori, the analytic, and the necessarily true tautology; and how far removed this is from the method of forming working hypotheses and empirically testing them. Callahan also talks of our time requiring more, not less, rules [4]. These will not be new rules (for some reason that remains vague) but those procedures tested by time, which, predictably enough, turn out to be parliamentary procedures of civility and due process of law democratically established. The Hastings Center, along with the Institute for the Medical Humanities at Galveston, has, in addition, made a significant commitment to procedural public policy planning as equivalent to bioethics. But Engelhardt is clearest about all this. He proposes a medical ethics ofprocedure rather than content, since in a pluralistic society, he argues, such content cannot be agreed on. He even explicitly supports this "bureaucratic and procedural character of modern bioethics" [1, p. 70] which is nonpartisan with respect to moral viewpoints. In fact, he sees the futility of a search for content as even more fundamental than the plurality of...


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