The word is now going out from last week’s Bioethics & Politics conference, organized by Glen McGee at the Alden March Institute in Albany. (I am so sick that I couldn’t attend!) Wesley Smith’s take on it is interesting. He was a prominent representative of the conservative side at the meeting, and participated in a panel discussion. He comments that he views the field of bioethics as a kind of public policy debating ground, in which competing societal visions vie for social influence:

I suggested that (macro) bioethics [bioethics "which tries to impact public policy, culture, and the methods by which {clinical} bioethics is conducted"] is not a discourse and not a matter of bioethicists being “neutral arbiters” of complex moral dilemmas. Nor, is it a profession, as there is no specific training required to become a bioethicist, no state licensing, no professional discipline, etc. Rather, mainstream bioethics is a political and social movement, and like all such movements, seeks to implement policy based on a distinct ideology. . . .

The cause of the divide is fundamental: Mainstream bioethicists reject the intrinsic value of human life and instead have embraced personhood theory. Those of us perceived to be in the other camp, accept the intrinsic value of human life. This divide is too wide for the two sides to reach accommodation. Thus, we will always be in conflict.

But, this is good. These conflicts are how democracies decide important issues. Moreover, we will not decide how it all turns out. The people will through our democratic institutions. Thus those of us in the fray owe it to society to vigorously and energetically debate these matters. But how we do that is important. The people have a right to make informed decisions based on accurate information.

Without accusing Smith of being disingenuous, it seems to me there is a great deal of that is both wrong and highly politically convenient (to the conservative side) in these remarks.

First, I am both puzzled by his claim that bioethics is “not a discourse” and strongly in disagreement with his claim that it is “a political and social movement . . . based on . . . ideology”. I’m not sure what he means by “discourse” (surely there’s no lack of discursive rhetoric in bioethics), but he appears to have in mind either “scholarly field” or “profession” – as witness his evidence against its status as as profession. As to its being a profession, that is neither here nor there; for one thing, the definition of “profession” is famously contentious, and the term is widely misused (often, today, synonymously with “white collar”, or merely “anyone who doesn’t want to be considered working class”). Status as a profession is largely a question of one’s role in professional practice, which has nothing to do with Smith’s main point, that bioethics is merely a matter of practical politics driven by ideology.

As to whether bioethics is a field of learning, it’s hard to imagine that it is not. Bioethics is grandly interdisciplinary, which makes it harder to define a clear demarcation for the field, but its methods are just those of ordinary scholarship in the humanities (mostly), and its content, by acclamation, is the ethics of biomedical science and practice (some would add environmentalism as well). If ethics is a “discourse”, how can bioethics not be?

Smith seems to be attempting to remove any claim to scholarly authority from the field. Of course, it is bioethicists themselves who have been in the forefront of disavowing the imputation of decision-making authority to their own field: one of the impetuses for bioethics in the US was revulsion at the “God committees” who decided unilaterally who would get scarce kidney dialysis in the 1960s; today, clinical ethicists play strictly advisory roles, and even when sitting as boards of approval for proposed procedures, invariably act as members of large committees, working under public scrutiny, on which a single professionally-trained ethicist is vastly outnumbered by numerous clinicians as well as lay people and others. There is no federal ethics body with regulatory authority, nor any at state level that I am aware of (the VA has an ethics program with some policy-making authority, but it is deeply embedded in their overall managerial structure). And most ethicists want it kept that way.

In declaring that ethicists are not “neutral arbiters”, if he means by that judges or unilateral decisionmakers then he is merely denouncing a role that ethicists have never sought to play. But he appears to imply also that they are not trustworthy sources of knowledge – that they are merely advocates playing games of political interest, and that what they have to say about their subject is no more reliable as information or knowledge than the pronouncements of a politician or political lobbyist. In this he is wrong, and in a revealing way.

He goes on to make his point more explicit: bioethics really is nothing more than politics and ideology, he claims. It is the clash between two “camps”, which he calls “mainstream” and “conservative” (though he puts the term “conservative” in scare quotes, which is odd; there is no better – polite – word for it). In places his language is inconsistent: he calls the non-conservative bioethical beliefs “mainstream”, but also says “mainstream bioethics is a political and social movement . . . seek[ing] to implement policy based on a distinct ideology”. If by this he means that bioethics in general today has become a big political contest, that’s surely true, but if he means that only “mainstream” (not conservative) bioethics functions in this way, he is delusional or dishonest.

“Mainstream” – which I think is an apt word – bioethics is grounded on traditional philosophical ethics and related disciplines, as applied to the biomedical sciences and practice. It offers arguments for its positions, and grounds its theories on well-known and widely-used works from respected scholars. (Beauchamp and Childress, by far the most influential workers in the first 30 years of the field, go to lengths to tie their theory to Hume, Kant and medical tradition. Fletcher was a Utilitarian. Engelhardt is a Libertarian. Some have tried to build Rawlsian theories of medical ethics. The respectable conservatives – Pellegrino, notably – are Hippocratics. These are respected and weighty schools of thought.) There are some conservatives doing serious work in bioethics, but the bulk of conservative thought in the field is mere religious assertion, and most of the rest of it is far worse. In the policy arena, invariably, progressive positions are justified by reference to foundational principles of ethics, while conservatives have abandoned reasoned discourse for public demonstrations, harassment, violence, and the most empty-headed and embarrassing slogans and emotional displays.

A Colorado State House member was all the rage in right-wing circles recently for arranging for a handicapped woman to sing the national anthem in the legislature. She got a round of applause, naturally, because what else would you do? – then he revealed that she had once been the subject of a late-term abortion. And . . . ? What? To the right wing, the fact that this had happened on “Planned Parenthood Day” was some kind of coup. To anyone thinking carefully about abortion, it’s incomprehensible. Someone underwent an abortion and survived. It happens. That’s an argument? No – but to the right wing, it’s good enough for them to accept as proof that abortion is wrong. During the earlier debate over stem cell research funding, some clown brought his twin sons onto the floor of Congress, revealed that they had been gestated from frozen IVF embryos, and then asked plaintively “Which one of my children would you kill?” Apparently he didn’t realize his 9-month-old sons were no longer frozen embryos, or believe that anything about them at that stage – their developing personalities, their self-awareness, their consciousness and experiences – is in any way morally significant (a fact that ought to make them pretty mad when they get a bit older). But this was supposed to tell us something about stem cell research. What, exactly? That it’s wrong because babies are cute. It would be regarded as mean to point out that that’s asinine. I know it would, because when I did, lots of people blogged extensively about how mean I was. But none of them, I’m certain, ever had the presence of mind to be embarrassed by the stupidity of these displays.

And never mind the activists, terrorists, and harassers – the “pro-life” movement’s leaders are just as clueless, and just as shameless. In state after state, lawmakers have enacted crippling restrictions on abortion, virtually none of which is honestly intended to do what it actually says. Nobody really believes women need a “waiting period” to make up their minds about abortion; nobody cares how wide the hallways are in a gynecological clinic; the “informed consent” statements doctors are required to read in some states are grossly false, and the people who wrote them knew that full well. All the restrictions – every one of them – are intended merely to create logistical hassles that will block as many women as possible from exercising the rights they legally and morally hold. The think tanks are just as bad – virtually unanimously they tout the “breast-cancer/abortion link” and “post-abortion trauma” that have been disproven and discredited over and over and over; it makes no difference to them. All this is part and parcel of the right-wing’s approach to the subject in general. “Discourse”, to that side of the debate, does not require saying things that are actually true, or even things that you really mean or believe.

In contrast, a woman’s right to abortion is invariably justified by “mainstream” ethicists and activists by reference to one simple, profound, and quintessentially ethical-philosophical principle: the woman’s right (autonomy, self-determination, bodily integrity, call it what you will) to make her own choices about her own body. The right to refuse or to terminate medical treatment is grounded on the same essential principle – and it was academically-trained philosophers who played a central role in establishing the legal right to exercise that moral right, with clear and eloquent arguments (many of them still standard content in bioethics textbooks) based on recognized moral principles, not with bombs, or slogans, or lurid photos, or underhanded legislative steamrolling.

Of course there are bad thinkers on the left as on the right, and in public activism you see protests and slogans and banners – some of them ill-chosen. But these irrelevances are the content of right-wing bioethics, not its substance. (Substance? “The wisdom of repugnance”? Please.) And this brings us to the heart of Smith’s post.

In declaring that “mainstream” (i.e., progressive) ethics is ideological, he accuses his opponents of the crimes of his own fellows. (To his credit, Smith is far from the worst on the right wing – which is not to say he does not engage in frequent wild and groundless accusations, as this post alone gives evidence.) By claiming that all of bioethics is merely a poltiical fight between idiosyncratic dogmas, he tries to bring bioethics down to the level of his own ideological pandering. In fact, mainstream bioethicists consistently engage in careful, often heated, but painstaking and sincere discussion of ethical issues in light of the best thinking known on those subjects from over the years. Right-wing religious writers also often engage in detailed Biblical jousting, but that is an infight for believers only – it is by definition not rationally-grounded discourse. Aside from that, most right-wing bioethics is, simply, exactly what Smith says it is: self-consciously self-interested political manipulation, employing emotional appeal and deliberate obfuscation. Consider the “debate” over gay marriage as a case in point – the tactics used by the right wing in that travesty are precisely those used on ever other major social issue they attack, and it couldn’t be more different from the approach used by their opponents.

Smith seems to be making a deliberate attempt to invalidate bioethics as an intellectual discipline, in order to claim that one need not take reasoned conclusions seriously – they are, after all, just as empty and politically motivated as those of the buffoons on the right wing. But this is false. I am glad to see Smith admit that right-wing bioethics is naked ideology, political posturing, and fighting for political influence. We should make sure that admission is widely known. But his insinuation that there is no other way to do bioethics at all is simply false as a question of fact – the counterevidence is to be found in the last 30 years of progressive bioethics. Smith is engaged in political “framing”, to strip actual intellectual discourse and ethical reasoning from bioethics and reduce it entirely to what his side is good at: sloganeering, power politics, mob psychology, and political tricks. But his insistence that there is nothing more to the field is really a hopeful bid that no one will remember where that real substance lies.

(Does Smith really claim that Tom Beauchamp and James Childress were just ideologues seeking political influence? That the widely read, magisterial article on abortion by J.J. Thomson – former President of the American Philosophical Association – has exactly the same intellectual credibility as some Jesus-freak jackass waving a photo on a stick at a terrified patient outside a women’s clinic? That the original National Commission for the Protection of Human Subjects, which produced the Belmont Report that became the groundwork for all federal research safety legislation, has no more claim to respect than the current President’s Council on Bioethics under its discredited Chair Leon Kass, who is widely regarded as a loon and who fired two of his own members for publishing a dissenting opinion? That Ron Cranford, a vastly admired central figure in most of the groundbreaking end-of-life cases and issues over the years, is on the same plane, in professionalism, intelligence, or integrity, as his counterpart in the Terri Schiavo case, William Hammesfahr, a nutcase who touts himself entirely falsely as a “Nobel Prize nominee” for a completely unproven treatment so groundless he is listed on “Quackwatch” for it, and who testified that Terry Schiavo was not in PVS and that he could cure her – after the majority of her brain tissue had actually decomposed? [Smith is constantly critical of Cranford, who did more than anyone in the profession to bring end-of-life care from the 1960s to today - but look at the best the right wing could put forward on the opposite side of one of his last cases!])

His final appeal to “democracy” (recall again the gay-marriage pogrom – that’s the kind of democracy right-wing bioethicists practice) is heartwarming but misguided. There are some things not open to democracy, in a democracy – fundamental human rights are among them. You cannot properly vote someone’s rights or autonomy away, no matter how large a mob you can assemble to picket and harass them, no matter how successfully you can demonize them. This is why the sneering about “activists judges” and the Roe decision is so much empty rhetoric: the Roe case was, in its central holding at least, rightly decided and for precisely the reasons Brennan articulated: because freedom at all in this country requires the freedom to choose your most central values, and to control your most vital interests. The freedom-giving amendments to the Constitution cannot work at all if a large enough cabal of right-wing yahoos can take your body away from you – and so, to have any freedom, we must have the most basic freedoms. That includes at the very least, the freedom to control your own body by your own values alone, and thus the freedom to determine what happens to your body and what you will do about it.

Smith wants to put women’s bodies, and dying people’s bodies, and gay people’s private lives, and, really everything about every one of us that some right-winger doesn’t like, to a vote. Ethics, properly understood, won’t let him. So he’s out to change that.