Dawn of the Biocrats

“Bioethics,” says Art Caplan, “is a little bit like geology. There are shifts going on, but you have to really watch them over time to see them.”

In the 40-odd years since the term bioethics was coined, the field has shaped the practice of medicine in some substantial ways.

“Truth-telling was a big issue when I first got into this,” Caplan recalls. “Do you tell the patient the truth about their diagnosis? Nobody argues about that anymore … The default shifted from tell[ing] a few elite people that we think could understand, to: you will be given full, complete information on your miserable disease and your fatal future, unless you say, I don’t really want to know that. So truthfulness between doctor and patient shifted enormously.

“The ability to stop care,” he continues, is another sea change. “So DNR [do-not-resuscitate orders], do-not-treat, the willingness to write a living will and pay attention to it, the willingness to listen to a surrogate and stop—that wouldn’t have happened 30 years ago.

“Part of the reason bioethics has grown is that bioethics has succeeded,” Caplan says. “It delivered on the challenge to solve certain problems.”

On the whole, solving those problems has entailed minimal controversy. (In hindsight, the case of Terri Schiavo represents the exception that proves the rule.) But consensus has its limits, especially in a country where adding one shot to the childhood-inoculation schedule is enough to touch off a new skirmish in the culture wars.

Caplan thinks Moreno is right in his observation that “a new biopolitics is emerging and has been doing so for some time.” He believes that it is in fact bioethics’ “rare success in finding some way to talk cross-culturally” that accounts for that emergence.

“Bioethics, because it is a way to talk across the aisle, has evolved into a lot of biopolitics,” Caplan reckons. “The experts can have opinions or try to shape the debate. I do. But it’s ultimately politics where bioethics gets settled.”

Does that mean that the Zeke Emanuels of the world are destined to be supplanted by the Bachmanns and Santorums? On the contrary, there’s every reason to believe that the influence of bioethicists will grow.

One of the clearest statements of that case comes from a commentator who does not exactly welcome their influence, the conservative New York Times columnist Ross Douthat.

“There are three broad camps in contemporary debates over bioethics,” Douthat wrote in 2011. “In the name of human rights and human dignity, ‘bio-conservatives’ tend to support restricting, regulating and stigmatizing the technologies that allow us to create, manipulate and destroy embryonic life. In the name of scientific progress and human freedom, ‘bio-libertarians’ tend to oppose any restrictions on what individuals, doctors and researchers are allowed to do. Then somewhere in between are the anguished liberals, who are uncomfortable with what they see as the absolutism of both sides, and who tend to argue that society needs to decide where to draw its bioethical lines not based on some general ideal (like ‘life’ or ‘choice’), but rather case by case by case.”

Moreno might hasten to add that those three camps don’t map neatly onto the American political spectrum. “‘Green’ progressives harbor deep doubts about the implications of science for social justice, often striking a distinctly bioconservative tone,” he points out in The Body Politic. Meanwhile, there’s a natural affinity between traditional business conservatives and the bioprogressives who, in Douthat’s telling, always “find reasons to embrace each new technological leap while promising to resist the next one.”

But Moreno would agree with—and endorse—Douthat’s emphasis on the evolution of mainstream bioethics into a discipline driven by a case-by-case approach. After all, merely identifying the ethical fault lines of practices like “human-mouse bone marrow transplants” (which, lest you mistake them for science fiction, “have been performed since the 1980s and have been part of studies of AIDS and leukemia”) requires a level of technical mastery to which broad Presidential or Congressional edicts are ill suited. 

As Caplan puts it: “We don’t have a Taliban or a Sanhedrin or the Pope to say, ‘Well, this is how we are going to do this.’”

And as long as we don’t, bioethicists will likely occupy a growing role as enlightened bureaucrats. Indeed, when asked how the University aims to impact society by expanding its bioethics footprint, President Gutmann highlighted faculty and alumni who have served in government-advisory capacities.

“True to Penn’s strong commitment to public service,” she said, “our strength in bioethics is represented by no fewer than eight Penn students, alumni, and faculty who have served as high-level staff on the Presidential Commission for the Study of Bioethics, and six Penn faculty members publicly testifying for the Bioethics Commission on topics as diverse as synthetic biology, neuroethics, and protections for human volunteers in research studies.”

They, and the generation Penn aims to train in their footsteps, will face an ever-more-complicated set of challenges.

“The first intellectual who really talked about biopolitics,” Moreno reflects, “was Michel Foucault, who died in 1984—probably the first famous person to die of HIV/AIDS. Foucault talked about biopolitics in terms of the control over bodies and populations. And he said that one of the things that happened in Renaissance Europe was that you had this clustering of populations, especially during and after the Black Plague. And what the plague taught people was that when you start putting a lot of bodies together in a small place, interacting, that a lot of funky things can happen, not only crime and violence, but disease.

“So Foucault’s general argument is political systems develop to try to control the interactions of bodies,” Moreno goes on, getting to the crux of it. “If Foucault had lived, he would have seen that the next step for biopolitics is not only control over bodies and populations, but also over the parts of bodies that provide new sources of wealth and knowledge and power—and that’s cells, tissues, organs, genes.”

Those terms are foreign to the common-sense intuitions our species has developed over millennia to help us pursue the greatest good. The men and women who develop and refine supplementary modes of thought have a weighty task. 

“The ways we respond to the implications of modern biology,” Moreno puts it in The Body Politic, “are of great importance for the country at many levels: for the future of our economy, our place in international technological innovation, our sense of national purpose, the social and ethical choices that await us, and our self-understanding as a people.”
 


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