The Logic and Legitimacy of American Bioethics By Mary R. Leinho ...

However, in spite of its past victories, steady growth,² press coverage and political attention, bioethics has been criticized or dismissed by many. Chambliss (1993) charged that “Traditional bioethics, at least according to the latest sociological research in medical settings, is rapidly becoming irrelevant” (p. 649). Commentators fault bioethics for disregarding the social contexts of ethical issues, decision making, and ethical theory (e.g., Bosk, 1999; Callahan, 1999; Churchill, 1999; Fox & Swazey, 1984; Light & McGee, 1998). Several observers of bioethics decry the predominant “principlism” ethical approach, which invokes four universal ethical principles (beneficence, nonmaleficence, respect for autonomy, and justice) to resolve ethical dilemmas (see Beauchamp & Childress, 1994). Principlism is faulted for being too idealistic (Chambliss, 1993), as well as “acontextual, ethnocentric, reductionistic, and sterile” (Muller, 1994, p. 451; see also Light & McGee, 1998), especially in favoring the quintessentially American principle of respect for individuals’ autonomy (Wolpe, 1998).

Worse still, critics charge that the biomedical establishment has assimilated bioethics, rendering bioethics not only impotent, but even a hindrance to critical social reform. This state of affairs has been attributed to the couching of bioethical debates in medical and scientific terminology (Ettorre, 1999; Flynn, 1991a), and to the selective provision of funds to only “suitable” bioethics projects (Bosk, 1999; Evans, 1998; Stevens, 2000). Some argue that as bioethicists accepted scientific ideology (Stevens), forged a “jurisdictional alliance” with scientists over moral authority (Evans), and became professionalized, bioethics came into service legitimating biomedical progress. The biomedical establishment was thus able to defuse and redirect potent challenges from consumer and patient activists, diminishing public controversy by removing debate to an expert arena (Bosk; Kelly, 1994; Stevens; Wolpe & McGee, 2001). Furthermore, by focusing on the ethical conundrums of the affluent (e.g., managed care, assistive reproductive technology), bioethicists may reinforce interests of wealth and power, delaying progress on the pervasive social problems of the disadvantaged (Bosk; Churchill, 1999).