Reviewed by David Belde, Ph.D., VP, Mission & Ethics, Bon Secours Richmond Health System
Howard Brody,
The Future of Bioethics (New York, Oxford University Press, 2009).
In The Future of Bioethics, Howard Brody argues that "[b]ioethics ought to be concerned with power disparities within society … " (114). Furthermore, he argues that in its past, bioethics has "relied especially on one tool to address power disparities — appeals to the principle of respect for autonomy" (114). But autonomy, he claims, has not been as successful as some think in empowering the voiceless (115). The future of bioethics, therefore, must resort to other conceptual tools — tools residing outside the sphere of traditional ethics discourse — for doing the work of the future of bioethics.
Based on this argument, Brody takes a stand on two important areas that impact the meaning and significance of bioethics. First, much in the same way that Judith Andre has defined bioethics, Brody maintains that bioethics is a "practice" — a set of activities aimed at achieving certain specific and distinctive ends.1 In this sense, bioethics is not simply a discursive discipline. While it undoubtedly has an important and varied intellectual grounding and trajectory, it also has an undeniably pragmatic and real life sensibility that should guide conclusions and outcomes on the behalf of the powerless. Second, given Brody's understanding of bioethics as a practice, he is, not surprisingly, willing to argue openly and honestly that bioethics is a form of social advocacy. Though he develops this theme
most explicitly in chapter 12, it is implicit throughout the text.
Brody wants to utilize "new" conceptual tools in the future of bioethics — other than the principle of respect for autonomy — to create a discipline that mediates the power disparities that arise in the very scope bioethics. He uses "feminist" thinking in ethics as his basis for changing power disparities in bioethics (105-116). From such a view, ethics generally, and bioethics more specifically, is more about "learning to see" the perspective and experience of others. A "very large swath of life," Brody argues, "consists of important human relationships, in which the pertinent tasks are, not to reason from rules and principles, but rather to understand each other and treat each other responsibly" (112). These new conceptual tools in the future of bioethics can help uncover moral blindness and promote equality in relationships and structures (105-106).
What conceptual tools does Brody use to enhance bioethics discourse? At least three bear mentioning. First, he endorses, in its various iterations, the process of grassroots "community dialogue" to help the public at large engage more directly in issues that will inevitably impact them (88-104). Second, he promotes the continued use of empirical and descriptive work in bioethics as a means of, among other things, understanding and addressing assumptions about race and ethnicity that give rise to health disparities (135-157). Third, he argues that confronting the wider issues of social change and practice, e.g., globalization, will help us realize that "local" bioethics issues "pale in comparison" to international injustices in bioethics (177-192). While these three conceptual tools may not be new to bioethics, they are representative of a broader set of tools that Brody maintains will help bioethics give voice to the voiceless in a way that is more effective than the principle of respect for autonomy.
The reader will benefit from Brody's analysis of whether bioethics is principally about inquiry or advocacy. There appears to be no vacillation on Brody's part: "I propose that [bioethicists] should, as a general rule, do more to speak up on behalf of those who lack power, especially when we can find ways to assist them to speak for themselves. This in turn suggests, as we move from theory to practice, that bioethics ought to adopt a more activist sense of its mission" (217). His book concludes with what this activism in bioethics might entail.
In a creative and humane manner, Brody advances a more social agenda for bioethics. Perhaps most importantly, he advances his argument without recourse to ideology or authoritarianism. Readers will benefit from its scholarship, scope, and sincerity.
NOTE
1. Judith Andre, Bioethics as Practice (Chapel Hill, NC: University of North Carolina Press, 2002), esp., 14ff. Andre's concept of "practice" is grounded in Alistair McIntyre, After Virtue: A Study in Moral Theory (Notre Dame, IN: University of Notre Dame Press, 1984), esp., 181-203.
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