The Berlin Wall

A disclaimer at the outset: according to current NIH guidelines, I am classified as a white, non-Hispanic male. Presumably my speech, clothing, attire, and lifestyle could be categorized accordingly. What about my bioethics? According to Catherine Myser (2003), the answer is an emphatic "Yes." If she is right and this is a problem that needs to be redressed, will decreasing the "whiteness of bioethics in the United States" improve how bioethics is practiced in this country? Will this enhance the clinical outcome when bioethics is applied to actual scenarios that occur in hospitals and doctors' offices?

To live the good and moral life has always been difficult and fraught with conflict. The purpose of ethics is to help people recognize the moral dimension of problems that arise in their life, to delineate the individual components and competing interests in these complex situations, to define priorities, and to provide guidance on how to act in these circumstances. Underlying the whole concept of ethical conduct is the idea that people are autonomous individuals who have free choice and, thus, are responsible for the consequences of their actions. There can be no ethics when people are ignorant of the facts, constrained in their options, and not held accountable for what they decide to do. By most accounts, these features describe a free person; by implication, without freedom there is no ethics. This formulation is no less true for bioethics.

There has been much discussion in the past two millennia about freedom and what political and social conditions are needed to foster its development and survival. According to Berlin (1969), the most durable form of freedom is not active liberty; that is, the right to do whatever an individual wishes. Instead, the form of freedom that has proven the most resilient in modern open societies like the United States is negative liberty. This concept signifies the assurance that each person is entitled to the opportunity to make major life decisions such as where to live, what to wear, how to earn a livelihood, and what to think or believe without interference from outside forces. Under these circumstances we consider to be genuine the choices that a person makes, and we feel entitled to hold him or her responsible for the consequences of these life selections.

In Freedom and Its Betrayal: Six Enemies of Human Liberty (2002), transcriptions of radio lectures given on the BBC in 1952, Berlin identifies six historical personalities whose ideas he considers dangerous assaults on the concept of liberty. Helvetius, a forerunner of utilitarianism, considered as the highest good the pursuit of pleasure by the largest possible number of people conditioned to do only what is of benefit to them. Rousseau created the mythology of the real self that can be defined by someone outside the individual and used to coerce people to do things against their will. Fichte and Hegel defined individual and national wills that justified and empowered the impersonal use of people in the interest of larger causes. Saint Simone, in the name of science, advocated the creation of an elite ruling group to define and bring about the best interests of humanity. Finally, Maistre argued on behalf of the strict authority of the church and state to control the destructive forces within man. Each of these ideas has been used in the service of a variety of national causes during the nineteenth and twentieth centuries. However, despite the intentions of their proponents, these ideas ultimately restricted the liberty of individual citizens. Each ideological plan curtailed the ability of the individual to make choices freely based on individual preference and capacity, for the good or for the bad, and diminished the responsibility of each person to act ethically and bear the consequences of their actions.

I suggest that Myser's proposal to diminish the whiteness of bioethics and to broaden the language and application of the discipline to include the perspectives of other constituent ethnic, racial, and class groups in the United...