Is American Bioethics Lost in the Woods?
Public Library of Science
Vol. 2, Issue 4, April 2005
Reproduced with permission
The debate between a libertarian bioethicist and a communitarian
bioethicist1 illustrates why American bioethics
is becoming increasingly marginalised and irrelevant to the democratic
society that it intends to serve.
Both participants in the debate, Arthur Caplan and Carl Elliott,
explicitly reject the notion of "human nature" as a foundation for
bioethics. But without human nature, on what grounds can advances in
biomedical knowledge be called good or bad, right or wrong, or even harmful
or beneficial? Clearly Caplan and Elliott have to accept something as a
touchstone of their bioethical discourse, or it will lapse into windy
incoherence. Although they approach it from different angles, this benchmark
is informed consent, with Elliott placing the stress on "informed" and
Caplan on "consent".
As a result, their lively disagreement over enhancement technology is
just verbal sparring and not a battle of ideas. Caplan believes that the
consumer-patient is sufficiently mature to weigh up the dangers; Elliott is
more sceptical. Neither appears to think that it makes any sense to argue
that technology should be suited to human nature. This belief seems to be
widespread in the bioethics community. Ruth Macklin, a bioethicist at Albert
Einstein College of Medicine, argued recently, for instance, that "human
dignity" is an empty and meaningless concept.2
However, academic discourse has failed to dislodge from the heads of the
hoi polloi the conviction that the starting point of ethics is not consent
but happiness. The man in the street, the ultimate consumer of bioethics,
still believes in human nature. The notion that human dignity is meaningless
would be regarded by nearly all Americans as not merely absurd but
What I find odd in the writings of many bioethicists is that they skirt
around the question that the average person wants to ask: will this
enhancement make me happy in a deeply satisfying and fulfilling way? He or
she is much less interested in whether all the boxes on the informed consent
form have been ticked properly.
Consequently, as the Caplan-Elliott bunfight demonstrates, bioethicists
are now reduced to arguing that human enhancement is good if people want
it-even if they want it mainly because powerful commercial interests have
persuaded them to, even if it is weird and kinky, even if it won't make them
happy. Elliott's fascinating book Better than Well3
is evidence that exercising a right to enhancement still leaves many lives
hollow and unhappy. Sooner or later people will ask why they hadn't been
warned, and a lot of bioethicists will be looking for jobs.
1. Caplan A, Elliott C (2004) Is it ethical to use
enhancement technologies to make us better than well? PLoS Med 1: e52 DOI:10.1371/journal.pmed.0010052.Find
this article online
2. Macklin R (2003) Dignity is a useless concept. BMJ
this article online
Elliott C (2003) Better than well: American medicine
meets the American dream. New York: W. W. Norton. 357 p.
Competing Interests: The author has declared that no
competing interests exist.
Published: April 26, 2005
Copyright: Â© 2005 Michael Cook.