Bioethics - the latest fashion in lab smocks

CERTAIN debates go on and on, like badly staged sword fights in grade-B movies. Economists, for instance, make a career these days out of arguing how the United States can become ``competitive'' with Japan. The answer may be nowhere in sight, but we sure recognize all the thrusts and parries. So, too, with the campaign of '88 shaping up between Bush and Dukakis, otherwise known as ``I am not a wimp'' vs. ``I am not a robot'' - an endless thumping of nicked blades that nobody can figure out how to stop.

By contrast, significant decisions are made by default on topics where, for one reason or another, there occurs little or no discussion. Even to bring the subject up, one has to invent a dialogue. Here is an imaginary life-and-death (no less!) debate between a bioethicist and - what shall we call him? - a layman.

Layman: What is a bioethicist?

Bioethicist: I think the term, and the role, are self-explanatory.

Layman: Not at all. The term implies that you function as a kind of middleman between the ``two cultures,'' bringing traditional humanistic values to bear upon the new frontiers of science - genetic engineering, in vitro conception, etc.

Bioethicist: That's not a bad definition - for a layman.

Layman: So you're sort of an ombudsman - an in-house representative of the interests of us ordinary citizens?

Bioethicist: Right.

Layman: Wrong. If the Pentagon created a Department for Humane Warfare to prove they ``cared'' about civilians, you'd be comparable to the general placed in charge - chest covered with battle stars. In your heart of hearts, you're a member of the scientific establishment, dedicated to the credo of ever more knowledge, ever more capability. OK - that's the scientist's vocation, that's the scientist's destiny. But you're pretending to be a brakeman when you're really one of the hands on the throttle. You're the latest in lab smocks, pretending it's a layman's Palm Beach linen suit.

Bioethicist: That's not fair. I really am a philosopher and a moralist. It's just that life and death aren't the simple terms they used to be ...

Layman: Aha! Now we're getting down to it. When is an embryo human? When is the brain dead? Call in the specialist. By making life and death technical questions requiring sophisticated laboratory equipment to define and measure, you not-so-subtly take the matter out of the layman's hands.

Bioethicist: Now wait a minute! I'm sensitive to how the revolution in biological capability disturbs the layman - that's why I'm here, acting as mediator.

Layman: I don't doubt your sincerity. But I do worry about your self-awareness. You don't see your own prejudices because you don't think you have any - being a scientist. You play at saying, ``Now wait a minute, what would Plato think?'' But all your impulses say, ``Go for it - whatever it is - all the way.''

Bioethicist: Not true. I really do agonize over the moral questions of consequence and responsibility.

Layman: Maybe. But Hamlet you're not. You're too efficient at getting on with the job - and towing us along with you. The layman, to you, is a confused, ignorant child, scared of learning ``The Truth.'' He's too lazy or dumb to become scientifically ``literate,'' so you have to take him by the hand and lead him out of his superstitions into the 21st century, and the way you do this is by ``speaking his language'' - sort of moralistic baby talk.

Bioethicist: Now you're really being outrageous. I and my children live on Spaceship Earth, too, and I'm just as concerned as you are about the quality of life. Who's being patronizing to whom here?

Layman: Oh yes. The ``quality of life.'' How you nudge the little phrase around - not very scientifically, if I may say so. You seem to want both the right to legislate compulsory health care to perpetuate the ``quality of life'' and the right to pull the plug when you decide the ``quality of life'' is not up to standards. You have this dialogue - really a bioethicist's monologue - so well under control that Nat Hentoff, writing in the Village Voice from the perspective of constitutional rights, is about the only layman to challenge consistently your inconsistency.

Bioethicist: We're dealing in difficult areas where nothing is clear cut - abortion, babies with AIDS, old folks on life-support systems. Give us a break.

Layman: Give us a break. Unless life is sacred - as poets, philosophers, and saints have assumed - it becomes a brain wave, a pulse beat. Without a ``sense of the sacred,'' the philosopher and historian Theodore Roszak has noted, ``there can be no ethical commitment that is anything more than superficial humanist rhetoric ... which therefore collapses into embarrassed confusion as soon as a more hardheaded inquirer comes along and asks, `But why not?''' This, I take it, is where bioethics - or just plain ethics - can be found today, pretending to a judicious balance without really practicing it.

Bioethicist: I protest. Whoever is writing this dialogue is giving you all the long speeches.

Layman: Maybe that's because in the real world you're the one having the last word.

A Wednesday and Friday column

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