On Evans' Rather Odd View of Bioethics as a Profession & Bioethicists as Professionals

I recently read John H. Evans’ new book, The History and Future of Bioethics: A Sociological View. On the face of it, this should have been very much my sort of thing. However, I am afraid to say I did not get on with it very well at all [1]. With the (very) honorable exceptions of his ideas regarding (bio)ethical translation, transmutation and, particularly commensuration, I am not sure there is much in it worth taking away. I think this is largely down to the way Evans understand bioethics as a profession and bioethicists as professionals. Of course this is, in turn, down to the fact that he is researching American bioethics. In the USA there are hospital based consultant bioethicists who, it appears, very much look and act like professionals. This gives the claim that bioethicists are professionals a stronger basis than in the UK, where there are no such ‘consultants’.

Given that bioethics is a global enterprise and the fact that there is no equivalent to the American ‘consultant bioethicists’ in the UK and elsewhere and we might question whether the fact that there are such things as hospital based ‘professional’ bioethicists should lead us to conclude that bioethicists and bioethics sui generis constitute a profession and, furthermore, if they are members of the same profession as the consulting bioethicist. For example consider the priest and the academic theologian. The priest is, certainly, a professional and a member of a profession, properly understood. However the academic theologian is not necessarily a member of that profession even if they are of the same religion. We might think the academic theologian is a professional, but this would be to distinguish her from an amateur theologian rather than to suggest that she belongs to a guild. At the very least Evans’ contention that bioethics is a profession needs further support. 

This easy slip into thinking bioethics a profession is facilitated by an unusual mapping of the range of bioethical activity. Evans breaks it down into four Jurisdictions, or Task-Spaces, these being: 

1: Health Care Ethics Consultations

2: Research Bioethics

3: Public Policy Bioethics

4: Cultural Bioethics (Public Sphere)

This characterisation is not unusual for what it includes but, rather, for what it excludes. Oddly there is not any explicit acknowledgement of bioethics as an academic activity. His discussion of each of these spheres is focused on the practical activity of bioethicists. Again this view clashes somewhat when applied to the UK rather than the USA. There is no formal space allocated to the bioethicist on Research Ethics Committees, we are classed as lay members and so ‘Research Bioethics’ cannot be considered our ‘professional domain’ in the way Evans is suggesting it can be in the USA [2]. Certainly the professional (i.e. non-amateur) or academic discourse on research ethics is dominated by ‘bioethicists’: contemporary ‘research ethics’ is a bioethical discourse including, for the most part (and problematically so in my view), the discourse surrounding social sciences research ethics. But, again, Evans does not seem to be concerned with this sort of academic bioethics. This odd position leads to two other omissions. First, there is no concern for what has been called foundational or meta- bioethics, research into the philosophical, historical and sociological foundations of bioethics as an ethical enterprise. Second, bioethics is assumed to be an applied ethical enterprise and bioethicists are assumed to be applied ethicists. Thus there is no consideration of the diverse academic and non-academic contribution to bioethics made by various non-philosophical (or theological) academic disciplines. 

Whilst Evans might not think of himself as a bioethicist his work is clearly ‘bioethical’ and there are many other examples to be found across disciplines such as history, sociology and anthropology. The denial that one is a bioethicists on the part of those non-applied ethicists whose work is, nevertheless, ‘bioethical’ is not uncommon and the degree to which this is seen as valid is a doxic assumption both within and beyond bioethics contributes to the hegemony of a certain sort of bioethical discourse and debate. The degree to which this assumption appears to colour Evans view is even stranger when one realises that whilst he thinks the bioethicists activity in spheres 1 and 2 (Heath Care Ethics Consultation and Research Ethics) is founded on the right ‘applied ethical’ footing he rejects the validity of applied philosophical bioethics in the sphere of public policy. In short he thinks that bioethicists working in this sphere should take up social scientific research methods and, by surveying the public, use them to determine ‘the common morality’ [3] which can then be used in the formation of public policy. Thus Evans appears to think ‘professional’ public policy bioethicists should take up social scientific methods (and remain bioethicists) whilst not appearing to include those who currently conduct bioethical research according to social scientific methods in his definition of the ‘professional bioethicist’. 

It seems to me that Evans is tying himself in knots due as a result of his basic commitment to understanding bioethics as a profession. It appears to force him to obscure the fact that academic bioethics forms the core of the ‘profession’ whilst also construing all professional, non-academic, bioethics as the technocratic exercise of ethical expertise. His acceptance of this in regards the basic jurisdictions of Health Care Ethics and Research Ethics is open to challenge. I do not think that the exercise of technical ethical expertise is the predominant activity of bioethicists in these arenas. To paraphrase what someone who has conducted extensive research on RECs once said to me: One might assume that RECs engage in bioethical discourse, and one might be motivated to conduct research on them based on such an assumption. However, in practice, very little actual bioethical reflection actually occurs. RECs are more bureaucratic instrument than applied philosophical enclave. 

In the case of the bioethics consultant their role has been considered one of ‘facilitating’ the ethical reflections of others [4] or the emotional mediation of fractious relationships between patients, families and healthcare professionals [5]. Furthermore we might think that the ethical determination is not what bioethicists should – ethically – engage in because this would institutionalize a moral division of labour and represents the abdication (if not bioethical abduction) of ethical responsibility on the part of the clinician/ researcher in favour of the bioethicist’s determinations who, themselves, cannot be fully responsibly for the ethical conduct of medical practice or research. 

In regards public policy bioethics Evans appears to be committed to the idea that bioethicists should be technocratic civil servants but rather than offering policy advice based on their own native, (bio)ethical expertise but based on the perspectives of the polity, which public policy bioethicists should become expert in discovering. If this is what public policy bioethics were to become the result would be, presumably, that another route would have to be found for academic bioethical knowledge and expertise to be taken into account in policy making. Evans suggestion would, I think, be that this route would be through the impact bioethics has on the public and iot would, therefore, be ‘democratically filtered’ if you will. However, because Evans conceives of bioethics as a technocratic profession, he recommends that bioethicists not speak in the cultural sphere. Whilst he thinks it is fine for the bioethicists to speak in the public sphere as a philosopher, or under some other designation, they should not do so as a bioethicist. It seems then that academic bioethicists should abandon bioethics per se and, instead, perceive themselves as conducting bioethical research as philosophers, sociologists, historians etc. They should then speak from such disciplinary perspectives, as academics rather than as (professional) bioethicists. 

This seems to me an extremely odd conclusion and whilst there are plenty of other points and perspectives that one could debate and, in so doing, challenge Evans conclusions I think that, in a large part, this view results from his initial restriction of bioethics to a technocratic ‘ethically expert’ profession, and one that is rightly engaged in a process of institutionalizing itself as a expert and technocratic endeavor, and excluding ‘academic bioethics’. Thus he puts the horse before the cart and cuts off the bioethics profession from its foundation as a profession, the academic inter-discipline of bioethics, something he is implicitly reliant on [6].

Bioethics is not a profession in the sense that medicine, law or the priesthood is. Indeed academic research is not professional in the same way as these other activities are [7]. One can be a professional social scientist or physicist but this does not mean that ‘social science’ or ‘physics’ is a profession. If the result of bioethics attempting to become a profession is something like Evans’ view then it seems to me clear me that bioethics should make no attempt. 

[1] Incidentally, if you are looking for something along the lines of a historical and sociological view of bioethics then you should look no further than Fox and Swazey’s Observing Bioethics. At least, you should look no further until you have read it! 

[2] I am actually unsure if bioethicists have formally allocated places in American IRBs. Evans position seems to imply that they must but, regardless, there must be many other individuals on IRBs and I cannot imagine that bioethicists form a predominant cadre of members. Thus how it is that research ethics is the particular domain of professional bioethicists remains unclear. 

[3] The notion of the common morality is, perhaps notoriously, confused and confusing. Evans appears to think that it is, or should reflect, public opinion or the values of the polity. I don’t think anyone could fool themselves that this will be easily determinable or, in any event, produce a coherent singular view. When applied philosophical bioethicists suggest they are working with common morality they might make some concession to the idea of it being related to what (and how) the general public think about moral and bioethical issues. Nevertheless, they will also be committed to the idea that the common morality is given by a professional and philosophical reconstruction of such arguments and perspectives. They are committed to transcendental universalism accessed through philosophical reflection rather than common agreement universalism accessed through democratic means. Finally, if Evans thinks the latter is what public policy bioethics should be based upon it would be better to recommend that public policy bioethics takes up the methods of Habermasian discourse ethics rather than the methods of social scientific pollsters.  

[4] Eriksson, Stefan, Gert Helgesson, and Pär Segerdahl. “Provide Expertise or Facilitate Ethical Reflection? A Comment on the Debate Between Cowley and Crosthwaite.” Medicine, Health Care and Philosophy 9, no. 3 (December 1, 2006): 389–392.

[5] Watkins, L. T., G. Sacajiu, and A. Karasz. “The Role of the Bioethicist in Family Meetings About End of Life Care.” Social Science & Medicine 65, no. 11 (2007): 2328–2341.

[6] He says professions are reliant on and defined by “their systems of abstract knowledge” (p. xxi). In another strange statement he suggests this is a truth given by the sociological approach to the professions. However sociological research on the professions tries to move away from this conception of professions and towards understanding professionalization as a social process marked by institutionalisation, border marking and claims regarding the ethical commitment of members to the client. In this view it is feasible that a profession that has no (real or actual) claim to being founded on abstract knowledge could be socially institutionalised 

[7] One might be able to call academics professionals insofar as they are teachers and educators but this is a different matter.