After the Genome: A Language for Our Biotechnological Future

10. Bioethics, Economism, and the Rhetoric of Technological Innovation

177 Howard Brody Bioethics, economism, And the rhetoric of technoloGicAl innovAtion 10 The topic of this volume, “A Language for Our Biotechnological Future,” invites us to explore the rhetorical system within which biomedical technology is depicted, and to reflect upon what the rhetoric reveals about ourselves and our society. However, we do not talk about biotechnology in a vacuum. Other discourses are already in place and shape the way we think about both ourselves and the technology. i want to explore in this chapter the relationship between the rhetoric of biotechnology and one of those background rhetorics, which i call economism and others call neoliberalism.1 i begin by describing how my major field of study, bioethics, has addressed technology in medicine since the 1960s. i then describe the rhetoric of economism and identify some of its salient features and the impact it has on society. Finally i describe how the background rhetoric of economism shapes the rhetoric of biotechnology, using the current debate over medical cost containment as a case study. Bioethics And medicAl technoloGy One could say that bioethics emerged as a new way to think about the ethical issues raised by medicine and health care, in the mid- to late 1960s, in large part as a response to technological advances. Hans Jonas, one of the most thoughtful philosophers to help shape the new field, argued that the new technology of that day posed novel ethical questions for which traditional ethics offered no answers. The old ethics might address uses of technology that affected the people and things in its immediate surroundings 178 g After the Genome in the present. But the new biotechnology threatened to reach well beyond those limits. Technology seemed capable of altering the earth and all life on earth in new ways, whose effects stretched far into the future. Technology also seemed to offer means to significantly alter living things themselves, including the human species. Jonas argued that only a new way of thinking about ethics would suffice to address these concerns.2 Others engaged in the new bioethics were less apocalyptic, and less willing to dispense with traditional ethical theory, than Jonas. But a common view emerged that new technologies presented us with novel ethical problems. There also arose the assumption that technologies had attached to them a sort of ethical window of opportunity. Presumably there was a magical time early in the life of a new technology when one could ponder its ethical implications and, if the risks seemed to substantially outweigh the benefits, call a halt to its use. However, if one waited beyond that window, the proverbial genie would be out of the bottle for good, and all one’s ethical pontificating would be in vain.3 At the time, few questioned the hubris associated with this view of bioethics . To get one’s ethical conclusions to fit into the magic window, one needed to be extremely prescient as to what impacts the technology would have on human life, both now and in the distant future. in hindsight, the idea that one could decide on the basis of such preliminary data and considerations that a technology ought or ought not be used, for all time henceforth , seems silly. But that did not matter very much, as i am not aware of a single biomedical technology that was put aside simply because a bioethicist warned of its dangers. A technoloGy cAse study, 1900–1920 An instructive example of the difficulties in assessing any new technology from an ethics standpoint is provided by Joel Howell’s study of the entry of new medical technologies into U.S. hospital practice during the first two decades of the twentieth century. Howell focused on two technologies, X-rays and routine laboratory tests of blood and urine. He found that both were hardly ever used in hospitals, despite the technology being available, around 1900 but that both were in widespread use by 1920.4 Howell next asked what explained the difference, and made a good case for implicating other technologies that made their way into the hospital during these same years. But the other technologies were not at all of the sort we usually classify as “medical.” The responsible technologies were typewriters, Bioethics, economism, And the rhetoric of technoloGicAl innovAtion f 179 adding machines, and standardized paper forms that could be pasted into the medical chart. Without these enabling technologies, physicians lacked a good...