Death panel dudgeon

Dr Ezechiel EmanuelBack in August, the American Society for Bioethics and
took the unusual step of publicly
about “unfair attacks” upon bioethicists.
The ASBH was incensed at the shellacking its members has been
receiving in the media over the “death panels” issue.

vice-presidential candidate Sarah Palin was the first to ring alarm
about "death panels" of bioethicists who would
have divine powers of life and death in President Obama's health care
plan. Palin highlighted the "Orwellian thinking" of
President Obama's chief health care adviser, Ezechiel Emanuel, and
basically accused him of introducing euthanasia by stealth. If she
didn't name other bioethicists, the media did.

This infuriated the
ASBH. Portraying the work of these thoughtful people as an attempt to
hasten the deaths of patients was "a heinous form of
intellectual violence" and contemptible dishonesty. This
inflammatory rhetoric not only defamed individuals, but also
"denigrate[d] bioethics as a profession," the ASBH said.
The “death panels” – however absurd they were –
became a public relations nightmare for the bioethics industry.
"Bioethics" had become something sticky and malodorous on
the sole of your shoe.

Weeks later, the
situation hasn't changed much. Dr Emanuel is still in the cross-hairs
of critics of Obamacare. Earlier this month the head of the Southern
Baptist Convention Ethics & Religious Liberty Commission had to
apologise for bestowing an
imaginary "Dr Josef Mengele Award"
upon him in a
rabble-rousing speech.

But the most recent
attack on Dr Emanuel, who is also the head of bioethics at the
National Institutes of Health and the brother of President Obama's
chief of staff, came not from the right-wingers, the tabloid press or
the internet wackos, but from a leading bioethicist colleague.

This was sparked by an
address by Dr Emanuel to the annual conference of the ASBH. He argued
that what bioethics needed was more statistics. Without a solid
grounding in quantitative methods, bioethicists simply aren't much
good. Ideally, aspiring bioethicists should study behavioral
economics, psychology, decision theory or sociology. There should be
less public discussion and more number-crunching. And, he implied, it
is number-crunching bioethicists who will be getting the precious
government funding which enables them to stay in business.

America's best-known
bioethicist, Arthur Caplan, of the University of Pennsylvania, was so
irritated that he almost immediately posted an
open reply
. He responded that a bioethicist must be a "moral
diagnostician". "A crucial part of the bioethicist's role
is to alert, engage and help to illuminate ethical problems and
challenges both old and new in the health and life sciences."
Empirical data are just one tool in the bioethical toolbox.

Emanuel's address has
not been published on the internet yet. But this very public dust-up
provides more ammunition for those who believe that the field of
bioethics is in crisis. When the most quoted US bioethicist says that
the philosophy of the most powerful US bioethicist is "narrow,
misguided and wrong", what are laymen to think? It certainly
gives them no confidence whatsoever that President Obama is getting
the right bioethical advice.

The problem is deeply
rooted in American bioethics, at least the kind represented by Dr Emanuel, and to some extent, Dr Caplan himself. Americans have every
right to think that bioethics is about clarifying and defending human
dignity. But to their surprise, when these mysterious seers emerge
from their academic caves, all they hear is talk about statistics,
efficiency and quality-adjusted life years.

There's a reason for
this. Bioethics is meant to be a practical philosophy, but the brand
represented by Dr Emanuel has become so practical that it is no
longer philosophy. This is a tragedy. Without philosophy, bioethics
becomes detached from human dignity.

Here's why.

For so familiar a word,
"bioethics" has a short history. It entered our
dictionaries as late as the 1970s. The English word cobbles together
the Greek words for life, Bios,
and for moral character, or custom, Ethos.
So huddled under the umbrella of a single term are two related but
distinct intellectual disciplines, metaphysics and ethics. Bioethics
is inexplicable without them, just as biochemistry is inexplicable
without biology and chemistry.

Let's look at
metaphysics first. The ancient Greek philosopher Aristotle coined the
word. He wanted to investigate whatever underlies or lies beyond
(meta) the physical world of what we can see and touch
(physica). So metaphysics deals with the most fundamental
questions of experience: what is reality? what does it mean to be?
what does it mean to be a person? what is life? Bioethics "works"
only if its metaphysics is correct, that is, if its understanding of
life, humanity and personhood corresponds to reality. An
astrophysicist who bases all of his calculations on the equation
e=mc³ will ultimately reach the wrong conclusions, no matter how
sophisticated his mathematics.

This is not just
airy-fairy, pie-in-the-sky theorising, either. Many bioethical issues
which hit the front page are fundamentally metaphysical. Is a human
embryo a human person? Did Terri Schiavo have a right to life? When
does a person with Alzheimer's become so disabled that she no longer
has human dignity?

Bioethics also depends
upon the ethical systems which underlie them. Is what I do ethical
because I have a good intention? Or is it good because God says so?
Or is it good because a majority says so? Or is it good because its
consequences are good? Or are questions of right and wrong
meaningless and is all ethics basically a waste of time? Should
bioethicists give up and get PhDs in behavioural economics?

many American bioethicists give the impression that they have never
given the philosophy or ethics which underpins their work much
thought. One
British philosopher has even complained
that they are simply too

... it
is all too evident that very many, perhaps the majority, of
bioethicists are, to put it frankly, less than competent. I believe
that this is a view a good number of philosophers share. The
bioethics industry is, unfortunately, populated by many individuals
whom one might even call second-rate philosophers. They have found
themselves unable to grapple with the more technical or abstract
areas of philosophy--or at least to make a name for themselves in
such areas--but have found that it is relatively easy to forge a name
for oneself in the bioethics business.

If this
is true of second-rate philosopher-bioethicists, what about
decision-theory bioethicists?

No one
should subscribe to the reasoning of a bioethicist, even one as
eminent as Dr Emanuel, without kicking the tyres. He should be
asked two questions: what makes us human and what makes right right
and wrong wrong. If we can agree on the philosophical bits, it is
much more likely that we will agree on the practical consequences
which flow from them.

say that your mother has Alzheimer's and breaks her hip. Let's say
that all the bioethicists on the hospital ethics committee have
degrees in behavioral economics, psychology, decision theory or
sociology. Would you find that reassuring? When tough decisions have
to be made about her future, would you expect them to treat your
mother as a unique human being with inalienable dignity? Probably
not. Probably the thought would cross your mind that these guys may
know a lot about quality-adjusted life years, but not a lot about how
precious a human life is. In fact, the thought might cross your mind
that this looks more like a death panel than an ethics committee.

doubt the ASBH would respond, “Trust us! We are honourable men.
Decent people like us would never ignore your mother's dignity.”
Hopefully this is true of most members of the ASBH. But “trust
us” is not a very persuasive argument. (Just watch this
hilarious Apple attack on Windows 7
to see why.)

Caplan's stoush with Dr Emanuel is more than an academic bunfight.
It has exposed the shallow foundations of American bioethics. If
American bioethicists really want to put a stop to the hysteria about
death panels, they will have to return to bioethics' roots in human

Cook is editor of MercatorNet and the bioethics newsletter BioEdge


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