Bioethics & Vulnerability: Recasting the Objects of Ethical Concern

By Thomson, Michael | Emory Law Journal, January 1, 2018 | Go to article overview

Bioethics & Vulnerability: Recasting the Objects of Ethical Concern


Thomson, Michael, Emory Law Journal


INTRODUCTION

Standard accounts of the emergence of bioethics are typically anchored in the progressive politics of the sixties.1 In these narratives, bioethics is cast as a response to the Nuremberg trials and a series of abuses committed in the name of research in the decades that followed.2 These originary tales position bioethics alongside the civil rights movement. It is a counter-cultural force protecting the rights of individuals, checking the excesses of (some) researchers, and an increasingly technological, commercial, and industrialized health system. As the bioethicist and historian Albert Jonsen argued, early bioethicists were "pioneers" who "blazed trails into a field of study that was unexplored and built conceptual roads through unprecedented problems."3 The pioneers "radically change[d] the practice of scientific research in America."4 Since these early days, bioethics has grown to attain a particular place in the governance of science and technology. It has "spawned a new profession and seeded novel social institutions."5 It acts directly through structural requirements for ethical review, as well as indirectly through the ways in which bioethics has come to shape public deliberation. It has also influenced processes of legal reasoning and governance, with law becoming increasingly undifferentiated from bioethics and both "seen as normative modes that can preempt and control biomedicine."6 As José López concluded over a decade ago, "In little over 30 years, bioethics has managed to position itself as a key node through which a variety of social, political and scientific activities are refracted."7

However, the operation and effectiveness of bioethics has long been questioned, with a "cottage industry of sceptics" keeping pace with the growth of the field.8 Critics have challenged dominant accounts of the emergence of bioethics and its ability-and willingness-to check the "overreach" of science and technology. Here, the bioethics enterprise is cast as a mode of permissive governance rather than a contesting presence and voice. In the most cutting of these critiques, bioethics is the "public relations division of modern medicine,"9 lambasted as medicine's "showdog rather than a watchdog."10 This Article focuses on the important charge within this wider criticism that mainstream bioethics fails to account sufficiently for the social; that is, "the social, political and economic arrangements that simultaneously create and constrain us."11 This is understood as at the heart of bioethics' failure to live up to its originary narratives and sufficiently contest the power and reach of modern biomedicine.

In response, I argue for the mobilization of Martha Fineman's vulnerability theory as a new framework for bioethical analysis and deliberation. Fineman argues for a reorganization of our political discourse to respond to our shared vulnerability, which is "universal and constant, inherent in the human condition."12 The aim of this Article is not to replace mainstream bioethics, but to enrich it with the "embodied and embedded"13 vulnerable subject: a subject whose embodied vulnerability and social embeddedness creates inevitable dependency on others.14 While calls to expand "the matrix of bioethical thought" are not new, there has over the years been little change in the "style of thought, or the ideologies" of mainstream bioethics.15 Nevertheless, it is argued that the "new biosocial moment"16 emerging in the life sciences may provide the conditions of possibility for the reorientation and revitalizing of bioethics. In areas such as neuroscience, epigenetics, and pro-social models of evolution, the body is increasingly figured as responsive at a molecular level to the environments within which it is embedded. As these biosocial knowledge claims proliferate, attending to the social in ethical debate becomes not only more pressing but also possible if strategic alliances are built across diverse disciplines. …

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