The dominant view of bioethics frames issues in terms of autonomy and individual rights. A retrospective in the Cambridge Quarterly of Heathcare Ethics, by Daniel Callahan, one of the grand old men of American bioethics, is a reminder of a broader and more communitarian view of the discipline.
Callahan is a restless thinker who did his undergraduate study at Yale and his PhD at Harvard. But the academic life did not suit him and he turned to journalism and for several years edited Commonweal, an influential Catholic journal. After splitting with the Church over abortion, in 1969 he co-founded The Hastings Center, a leading bioethics think tank.
Here are a few paragraphs:
I became known as an autonomy-basher, not because I objected to autonomy as an important human value but because I objected to an undercurrent trend that seemed to reduce ethics itself to nothing but individual free choice disconnected from an even more important question: what counts as a good or bad choice, a good or bad person, or a good or bad society? Those questions seem to make Tea Party–like autonomy zealots acutely uncomfortable …
I wanted to directly challenge what I take to be the present “reigning goals” of medicine, its de facto working agenda: (1) that death is an inherent evil to be pursued relentlessly and without limits—and by this I mean the search for cures for lethal disease, not end-of-life care when a cure is no longer possible (an important distinction); (2) that the royal road to curing disease is medical research and technological innovation; (3) that meeting healthcare needs trumps other societal needs when they clash; (4) that the notion of limits to progress and innovations is heretical, a threat to all the values bequeathed to us by the Enlightenment; (5) that nature is to be dominated and manipulated to human ends; and (6) that it is individual good and autonomy that takes priority over the common good …
My latest book project, and probably my last ambitious one, is a comparative study of five global crises (so labeled by the World Health Organization): global warming, food shortages, water quality and shortages, obesity, and chronic illness. I call them the five horsemen, and I chose them for their unique common feature: after some 30–40 years of international government and private efforts and research, and after the spending of billions of dollars, they are all getting steadily worse, with little progress of any serious kind being made. Perhaps there is a certain masochism (or maybe hubris) in going after such a difficult and often depressing topic, but there was another reason for my choice as well: in every case there is agreement that dealing with the problem requires massive changes in deeply embedded cultures, behavior, and ways of life. It is our industrial societies that have given us prosperity but also global warming, our extended life spans that have brought with them huge increases in chronic illness, and the improvements in our diets that, ironically, have brought about the cheaper food that also gives us obesity, which is on the rise in poor countries (where citizens can now afford meat). How do we change the ways of life that turn the initially good into the bad?
Is that a bioethics problem? Not quite, by the usual notions of what bioethics is all about. But if bioethics is what people in bioethics do, and I am in bioethics, then why not? Some of us who started the field can perhaps introduce some new possible directions. The fact that I am utterly over my head, with no background at all in the case of three of my five horsemen, is part of the charm for those of us who seek variety and adventure.
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