By Wesley J. Smith, J.D., Special Consultant to the CBC

So, which is it? Is ” mainstream bioethics” a “come let us reason together” learned discourse in which respected colleagues explore differing views and ethical outlooks, as some in the movement suggest? Or, is it actually, as I opined in Culture of Death: The Assault on Medical Ethics in America, more of an ideology–or at least, an orthodoxy–that seeks primarily to persuade society to accept its overarching philosophical principles (at least those bioethics without a modifier in front of the term, e.g. “conservative” bioethicist”), and public policy, hospital protocol, and medical ethics recommendations? (As in my satirical cartoon embedded above, in which “the bioethicist’s” lines almost all come from the world’s most notable bioethical thinkers, written in the world’s most respected bioethical journals.) Perhaps, it is both.

Beyond that, I think the movement is looking for a purpose and means for its members to gain employment. Toward this end, it also seeks to become what could be described as secular pastors and ethical life coaches. Evidence of this ambition came to my attention this morning in a Hastings Center email advertisement announcing a new series of booklets designed to help people deal with difficult life issues. From the announcement of “Hard Questions: Turn to the Hastings Center When Life Throws You Curves:

Beloved parents with Alzheimer’s disease who no longer recognize you. Beloved children who can’t focus and are failing in school. Infertility. New genetic tests that give you information you don’t know what to do with. Advanced cancer and questions about coping with it. There are facts to gather when confronted with such challenges, and it is important to do so. We have a mantra at The Hastings Center: Good ethics begin with good facts. But sometimes—-often—-facts can only take you so far. That’s because the “facts of life” do not tell you how to live—-or how to die. This is where bioethics comes in. It can provide moral guidance on common medical dilemmas that individuals face in the beginning of life, at the end of life, and in between.

Really? Bioethics is the new church and synagogue? A secular priesthood, as some have claimed or charged?

So, what bioethical value should a reader follow? Autonomy? Beneficence? Non Maleficence? Distributive Justice? Those are the supposed bioethical principles–although I believe they are more outcome determiners, e.g., choose the result you want and pick the principle that best achieves it. In any event, how do those outlooks get translated into every day guidance?

Apparently, they don’t. I checked out the Center’s booklet Patients and Care Partners. A care partner is not a formal role, but one in which a person–a spouse, child, friend, pastor, etc.–hand holds someone going through a difficult medical situation. What can bioethics tell us about that? Not much that a good magazine article wouldn’t also suggest apparently, or indeed, the kind of common sense guidance of the kind I offered in The Doctor Book: A Nuts and Bolts Guide to Patient Empowerment way back in 1987. From the booklet:

  • Recognize the patient and the care partner as individuals whose lives are not limited to the experiences of illness, medical treatment, and caregiving.
  • Talk candidly about the patient’s values and preferences including any specific preferences about treatment.
  • Patients should introduce their care partners to their health care providers and explain their role. (If the patient has designated a health proxy, this information should also be shared with health care providers.) Clarify whether and to what extent the care partner may, with the patient’s consent, communicate directly with health care providers.

And here’s a typical quote from the question and answer format booklet, Troubled Children: Ethical Questions About Diagnosing and Treating Pediatric Psychiatric Disorders:

That said, even extreme stress does not necessarily lead to depression in all children. Some children who live in highly stressful conditions do not develop depression or other mental illnesses. Furthermore, it seems that not all depression results from exposure to extreme stress. Some children who live in stable families with relatively stress-free lives nevertheless become clinically depressed. What all this means is that there probably are genetic or other biological factors that predispose some children to develop depression and there probably are environmental factors, including exposure to trauma, that increase the likelihood that a particular child will develop depression.

Where does this leave parents? Depression is a complex disorder. Parents can help their child by learning as much as they can about depression and its treatment options. Some children are mature enough to participate in that decision-making process.

Again, pretty innocuous and certainly not offensive. But frankly, not very helpful in figuring out the “right” thing to do–other than to perhaps laying out some initial considerations from which to more deeply explore options, which is fine.

I think these well meaning booklets illustrate an important point: “Bioethics” can’t actually tell any of us what is “right” or “wrong” in any particular situation–either individually or societally–because that determination depends on the first moral principles that are applied. In our morally polyglot society, all the movement can offer to individuals is “to thine own self, be true,” and to society, democratic advocacy for implimenting policies based on the what I view as either or both implicit and explicit utilitarian value judgments.

Me? I prefer human exceptionalism, which mainstream bioethics generally disdains. Which is why rarely the twain shall meet.