Bioethics and its Discontents

Anyone who has been broadly dissatisfied by the bioethical response to human biotechnologies will  want to check out sociologist Amitai Etzioni's penetrating critique [PDF] of the field’s failure to deal adequately with the the essential tension these technologies raise. Etzioni, who is University Professor at The George Washington University, argues in a recent issue of the Journal of Medical Ethics that by focusing almost exclusively on the individual patient’s autonomy, bioethics marginalizes the inescapable second element that must be addressed in contemporary medicine—the wider interests of society. Etzioni calls for bioethics to expand its framework and advances the case for a “responsive communitarian” approach that has as its goal balancing autonomy against the collective good without privileging either a priori.  

Those who study, report on, and engage in activism regarding reproductive medicine and reprogenetics can readily recite a litany of headline cases that have highlighted the nature of the individual-collective tension: Should women or couples be allowed to contract for other women to gestate and bear their biological offspring? Should couples with a hereditary disability be allowed to attempt genetic selection that might increase chances that their children will have the same disability? Should families be able to screen for embryos of a certain gender or genetic makeup? Should couples be able to travel offshore to avail themselves of services that are expensive in their own countries, or banned?  Virtually every use of human biotechnologies involves not only normative ethical conundrums, but also the political question of whether, and to what degree, states have a compelling interest to regulate such choices.

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