Every doctor knows patients who are so disenchanted with the remedies of modern Western medicine that they dabble in an ever-growing range of alternatives: aromatherapy, naturopathy, Chinese herbal medicine, Reiki therapy, iridology, Ayurveda, yoga, homeopathy and on and on. According to a blistering article in the latest Journal of Medical Ethics, the situation in bioethics is not much different.

Leigh Turner, of the University of Minnesota, argues that bioethics has become so diverse that it may have ceased to exist as a serious intellectual discipline. “If bioethics is capacious enough to include libertarians, communitarians, deontologists, neo-Kantians, utilitarians, neo-Aristotelians, virtue theorists, feminists, Rawslians, Habermasians, narrative theorists, interpretivists, principlists, casuists, civic republicans, liberal egalitarians and religious ethicists of every persuasion, does bioethics exist as something other than a loosely connected assemblage of conflicts over norms, principles, practices and policies?”

Over the last 40 years bioethics has swollen into an industry, with centres in hospitals, universities and government departments. Consultant bioethicists make a living out of giving advice to companies. However, Turner writes, “Although an increasing number of individuals make their living as bioethicists, there is no recognizable, widely shared, common moral philosophy that bioethicists draw upon to resolve moral disputes.”

The movement called “principalism” distilled the essential features of bioethics into four priniciples of justice, beneficence, non-malificence and autonomy. These “offered the hope of a common, 'nonpartisan', secular, philosophical language for addressing ethical issues in medicine, health care and biotechnology.” But that dream has been dashed by the proliferation of incompatible approaches.

He concludes -- somewhat ominously -- that ”Practitioners of intellectual disciplines, professions and occupations need to be able to respond to questions about their claims to authority, credibility and legitimacy. If bioethicists cannot provide thoughtful, persuasive responses to such questions, they might find that the expansionist phase of bioethics is replaced by an era of retrenchment and decline.” ~ Journal of Medical Ethics, December