IAB Presidential Address: Contextual, Social, Critical: How We Ought to Think About the Future of Bioethics

There are many things that could be said about the future of bioethics. I’ve previously argued in this journal that we ought to see bioethics as having at least two key characteristics. First, it should be thought of as a broad area of disciplinary enquiry, covering all ethical issues in medicine and the life science: hence the term, bio-ethics. For this reason, the focus of discussion in this journal and the discipline of bioethics ought to be not just on issues in medical ethics, but should cover a much broader set of ethical issues related to human, animal and environmental ethics, public health etc. Second, bioethics should be seen as, essentially, a critical discipline, one focused on articulating, analysing and questioning assumptions and evidence related to the ethical issues within this broad domain. I refer to this as the Socratic spirit of bioethics, and I argue that this is something that we should seek to preserve and enhance through a sceptical questioning. With this approach, bioethics can never be reduced to a set of particular principles, nor can it simply involve a commitment to a particular theory or method, nor does it make any sense to think of bioethics as involving the pursuit or creation of a single overarching text or declaration. In this article I begin to sketch out a vision of bioethics that is responsive to context, and is reflective, tolerant but robust. More particularly, I want to explore a set of issues relating to just one aspect of the critical perspective that I wish to defend; namely, the appropriate balance to be struck between the philosophical and the sociological, the descriptive and the normative, the local and the universal. Such issues are not as often discussed in bioethics as I think they ought to be. Perhaps this lack of discussion of deeper, more theoretical issues reflects the nature of contemporary bioethics itself. Bioethics can be seen to be a largely fragmented area of activity, with all kinds of activities, positions and methods. One response might be to just accept this cacophony and to join and even celebrate the throng in the marketplace of ideas. However, such an approach seems to require a commitment to some form of relativism and, whilst this is one option, it needs to be argued for and not just assumed. I don’t think it is a viable option, as I will argue below. However, what I’d like to do is stimulate debate and hope that the issues I raise here will be explored in more depth in the future. My key message is that we can treat other cultures with respect, but that this should not blind us to the potential dangers from inappropriate tolerance. Sometimes practices are wrong, and this is true in our own as well as other cultures. We should not be afraid to say so.