Culture & Ethics
Why Bioethics Should "Fail"
Julian Savulescu represents all that I find so objectionable about the mainstream bioethics movement.
Rejecting the sanctity/equality of human life, utilitarian in outlook, embracing a eugenics point of view, the Oxford professor — what does that tell you? — would lead society in a way opposed by most of the very people bioethics claims to serve.
Savulescu "gets" that the field has not swept all before it — to which I would add, not for lack of trying. But he is clueless as to why that should be the case.
He writes that the alleged problem can be cured by somehow improving the "philosophy." From his article "Bioethics: Why Philosophy is Essential for Progress," published in the radical Journal of Medical Ethics, which he edits:
Ethics is not peripheral to medicine and research — it is central. What you study will determine what you will find. It is an ethical decision, as is when you will start treating, or whether to stop treatment. One excellent example of hidden ethical values is the concept of futility used to limit treatment. There are many definitions. Some are quantitative, such as a treatment with a <1% chance of a beneficial effect.
But this is not futile. Imagine that you have had a massive stroke and will die, but there is a treatment that has a 1/10,000 chance of saving your life and returning you to full health. Such a treatment is not futile in the way that trying to sew a decapitated head back on is futile (that is, being incapable of achieving the desired result); it is just very unlikely to achieve the desired result.
What people who deploy ‘futility’ arguments usually mean is the treatment is cost-ineffective. Such judgments are most justifiably made as resource allocation and distributive justice decisions.
The example he gives of "futile" is known as physiological futility, and contrary to Savulescu, bioethics has pretty clearly delineated what medical futility means — a combination of the cost/benefit value system he identifies, mixed with a disdain for life of perceived low quality.
Thus, the futility question is one of raw power: Whose values prevail, the patient and/or family, or the Julian Savulescus?
People get that: Medical futility hasn’t (yet) become the rule in health care, not because it hasn’t been philosophically masticated enough, but because patients and families who would be victimized by the policy want no part of it!
We also know that, despite its claim to high regard for autonomy, as an essentially utilitarian enterprise — whether explicitly or in outcomes — the field would eventually include coercion. Thus, Savulescu believes the state should require organ donation (which would not make it "donation" at all):
There is a basic moral obligation to donate organs. Why? Because this is not just an easy rescue, it is a zero cost rescue.
Organs are of no use to us when we are dead, but they are literally lifesaving to others. Nonetheless, most people choose to bury or burn these lifesaving resources, and are allowed to.
Yet the state extracts death duties and inheritance taxes, but not the most important of their previous assets — their organs. [My emphasis.]
I agree we should generally be organ donors after death.
Why aren’t we? Lack of trust, for one thing — easily understood when you read bioethicists urging that doctors be permitted to kill for organs or pushing "presumed consent" that all patients are organ donors — and then in the next breath urge that doctors and bioethics committees be empowered to unilaterally withdraw life-sustaining treatment.
Connect the dots!
And, of course, Savulescu wants policy dominated by the "experts," e.g., people like him:
But for many people working in bioethics or medical ethics, or formulating guidelines or policy, ethics is a ‘hobby’. They have no formal training in ethics. Imagine that I was to sit on a cardiological research funding panel, or review a paper in cardiology, or stem cell science. It would be laughable. Yet I have seven years formal training in medicine and research. Many people ‘doing medical ethics’ have nothing like that training or experience.
Sorry, a corner barber has as much right to a voice in these subjective issues of public policy as the highest Oxford don. Moreover, who wants Julian Savulescu philosophical clones dominating medical ethics? I sure don’t.
Savulescu grouses that in his entire career he has rarely accomplished any good:
From time to time, we ought to ask how well we are doing. In my own career, apart from promoting people’s careers, I am only aware of two instances where my work did some good…
It is hard to know how much good or harm we have done. But I think we should at least reflect. Modern medical ethics, as a field, seems to me to have failed in many important respects.
May it continue to be so!
Considering what he perceives to be "good," if Savulescu succeeds, society will be less moral, the weak and vulnerable will be at greater risk, and a bioethics authoritarianism will be loosed upon the land.
Image: Julian Savulescu, Oxford Centre for Neuroethics.