venerdì 21 ottobre 2011

The irrelevance of libertarian bioethics

"The political and moral ideas of most men are adopted by them inasmuch as they satisfy their emotions, nor their reasons; that they are only popular inasmuch as they satisfy pride; that ideas which satisfy pride are as barbarous as they are necessary".
Julien Benda

Even a casual observer would not fail to notice the pervasiveness of bioethics in contemporary society. How did bioethics come to take on such significance in Western societies? This is a rather puzzling phenomenon given that, in a pluralist society, philosophy cannot deliver incontrovertible moral verdicts and the philosophers’ views are no more binding than those of the man in the street (Maclean, 1993). As logician Charles S. Peirce noted long ago, absolute certainty, absolute exactitude and absolute universality cannot be attained by reasoning and, in a world in which human reason and knowledge are socially, culturally, and historically embedded, it would be misguided to expect bioethicists to provide objective and rigorously codified precepts and indications. Their speculations can only tell us what they believe is right and fair, and their logical demonstrations must be first evaluated against the empirical evidence. Thus far, libertarian bioethicists do not appear to be willing to concede this point, and yet their resolve does not make their arguments any more compelling.

The libertarian bias

The cultural climate of a country exerts a powerful pressure on the judiciary and the legislative power. In the United States, as elsewhere, the doctrine that human beings are driven by their instincts and self-interest fed a cynical distrust in human nature which infiltrated the debate on the Constitution, because it was generally assumed that the masses were ignorant, selfish and did not possess the natural virtues required by a vital democracy. James Madison’s illuminating passage in Federalist No. 10, 1787, which encapsulates the inherent tension between liberty and equality and the fundamental class-bias of the American Constitution, clarified that the first object of government would be “the protection of different and unequal faculties of acquiring property” and the securing of this property. It followed that in the newly independent states only white male property owners, namely those who could be trusted as basically virtuous, were allowed to cast their vote and make their voice heard on crucial issues. Thomas Jefferson and John Adams maintained that the rise of a natural aristocracy of men, an aristocracy of virtue and talent that would select the best political leadership, was hindered by the existence of an artificial aristocracy of men. This line of reasoning was later employed to sanction an elitist understanding of human nature and human affairs. An entrenched sense of pre-eminence would translate into the propensity to turn a blind eye to social, occupational and economic disparities which undermined those very same fundamental rights that the Founding Fathers themselves so forcefully advocated.
If one interprets the term “equality” rather narrowly, as equality before the law, and regards the principles and laws of market economy as the guiding hand of social and economic growth, the resulting social contract will define the promotion of equal opportunities and the reality of wide disparities as compatible. As German-British sociologist Ralf Dahrendorf discerningly put it, “all men are equal before the law but they are no longer equal after it.” The notable omission of political equality and social justice in the drafting of the Constitution cannot be explained simply in terms of class relations. The notion of cosmic retribution was another factor at play. It was held that a correlation existed, between virtue and happiness, vice and misery and that, because there were no insurmountable barriers to hinder upward social mobility, individuals could rose just as far as their skills and determination would enable them to. In other words, wealth was always earned and, with few exceptions, the poor deserved their station in life, owing to chronic, and possibly inheritable, flaws in their character, leading them to moral failing and economic destitution. Thus, following Locke, citizens without property were not as fully entitled to constitutional rights because it was doubtful that they would live up to the moral and rational demands of modern society. I contend that this outlook is common, if at an unconscious level and not always explicitly stated, among mostly Anglo-Americans libertarian bioethicists, who maintain that the right to reproductive liberty extends well beyond the right to safe contraception and abortion and not to be subjected to sterilization without an informed consent and includes the right to control one’s ‘reproductive destiny’, i.e. choosing what kind of children to have, even if that means determining the life course of someone’s offspring through genetic enhancement and cloning. Within this ethical formulation freedom is valuable for its own sake.
We need to make clear that this ideological posture has nothing to do with genuine liberalism. A more correct definition is ‘libertarian eugenics’. As Samuel Freeman has forcefully and eloquently demonstrated, “correctly understood, libertarianism resembles a view that liberalism historically defined itself against, the doctrine of private political power that underlies feudalism. Like feudalism, libertarianism conceives of justified political power as based in a network of private contracts. It rejects the idea, essential to liberalism, that political power is a public power, to be impartially exercised for the common good” (Freeman, 2002). The essence of libertarian eugenics thus lies in its pursuit of an enhanced State of Nature typified by free market selfishness, that is, by unaccountable private tyranny. Its stress on ‘procreative autonomy’ necessarily conflates the meaning of autonomy with that of consumer demand. When John Harris or Julian Savulescu maintain that we all have a moral obligation (!) to enhance ourselves and our children, they reflect the collectivist thrust of libertarian intense individualism – an ideology that binds them together, as a vicarious religious experience – and they make it patently obvious that the total freedom they want for themselves is paired with the right to deny freedom of choice to those who are not equally competent at exercising freedom and would not go along with their ‘rational’ choices. The new eugenicists believe that everyone is free to act as they please, so long as they do as they are told (for their own good). After all, why should the self-made and self-sufficient successful feel that they owe anything to those who, allegedly, cannot make rational decisions and thereby cause their own misery? Thus, paradoxically, but in accordance with Albert Camus’ warning that absolute freedom mocks at justice, and absolute justice denies freedom, the libertarian pursuit of absolute reproductive freedom is likely to end in absolute subjugation and in greater levels of inequality.
This is dangerous ground to tread, not only because modern societies in order to function and to be societies in a significant sense need solidarity, but also because the libertarian undermining of liberalism is likely to open the door to authoritarianism. Saying that individuals are free to do what they like, provided that they do not harm others, begs the question of what constitutes “harm” in the first place. If my decisions affect other people but I am not required to answer to them for my actions, then the definitions of “harm” and “responsibility” become too fluid and arbitrary to serve any meaningful legal, scientific, ethical, and political purpose. This is the essence of authoritarianism.
Civil liberties are what the English jurist William Blackstone (1723-1780) described as “the great end of all human society and government…the state in which each individual has the power to pursue his own happiness according to his own views and of his interest, and the dictates of his conscience, unrestrained, except by equal, just, and impartial laws.” This implies that civil liberties may sharply contrast with the self-interest of the majority, which is required to refrain from arbitrary actions. When a majority of citizens strongly believe that their views and reasons are so logically compelling and morally persuasive that everyone in their right mind should agree on a given course of action, the consequences for civil liberties can be devastating. The checks and balances of liberal democracies have been devised precisely with the aim of averting this danger. Antonio Gramsci correctly stressed the point that discipline as such does not compromise freedom, it is the arbitrariness and impunity of the power behind discipline that we should be most concerned about. States must, to some extent, be coercive because their function is to establish and secure civil liberties by overriding individual and group coercion. However, and most unfortunately, individual coercion, whether it is acknowledged or not, lies at the core of the libertarian doctrine, which systematically subordinates positive liberty – the freedom to do something – to negative liberty – the freedom from something –, that is, social justice to economic freedom and private property. All too often, and for far too many, this translates into the negation of liberty (Newman, 1984). It is the kind of antidemocratic individualism that, according to political philosopher George Kateb, “rests on the notion that only a select few deserve the opportunities of individualism, and society ideally exists for the purpose of allowing them to develop themselves to the fullest and then to assert themselves with impunity, typically but not exclusively at the expense of others” (Kateb, 2003, p. 289). It is important to stress that this is not a new phenomenon, far from it. It is simply a latter day manifestation of the aristocratic radicalism of the Romantic self-styled genius and of the Nietzschean Übermensch, who lie beyond good and evil, having overcome bad conscience, the mark of slave morality. They regard themselves as unique and therefore deserving of complete freedom to express their creative energy and talents. Searching for the ultimate moral justification for selfishness, they set the stage for the final clash between “conventional freedom” and “creative freedom”.
When John Harris (Harris, 2007) counts Marx, Plato, Rousseau, and Bentham, among the thinkers who have proven most influential in his recent work it becomes immediately clear that the line between libertarianism and anti-liberalism is very thin indeed and that the rejection of any legitimate authority often goes hand in hand with the rather petulant and self-indulgent assurance of the self-righteous paternalist, which is beautifully portrayed by Fyodor Dostoevsky in “The Legend of the Grand Inquisitor”: “If there’s only one like my old inquisitor, who had…made frenzied efforts to subdue his flesh to make himself free and perfect. But yet all his life he loved humanity, and suddenly his eyes were opened, and he saw that it is no great moral blessedness to attain perfection and freedom, if at the same time one gains conviction that billions of God’s creatures have been created as a mockery, that they will never be capable of using their freedom, that these poor rebels will never turn into giants to complete the tower, that it was not for such geese that the great idealist dreamt his dream of harmony. Seeing all that he turned back and joined the clever people.”


It seems that, at times, libertarian bioethicists feel somewhat insecure about the conceptual foundations of their field and, as a result, about their own authoritativeness and authority. And rightly so, given that logical consistency is no proof of wisdom and veracity. When it comes to critics, several of them display a startling lack of the cool, detached, rational style of reasoning that should underpin bioethics theory. Witness the indignant reactions to the legitimate criticisms of bioethics made by prominent philosophers, anthropologists, sociologists, historians of medicine, and even by some bioethicists (Hermitte 1990; Wolf, 1996; Cooter 1995, 2004; Fox 1999; Bosk, 1999; Berlinguer & Garrafa, 2000; Stevens 2000; Campbell, 2000; Benichou, 2002; Ashcroft, 2004; Hedgecoe, 2004, Stephen 2004; Koch, 2006). This is most unfortunate, for democracies thrive on the questioning minds of professionals and lay-people alike, and this means that specialized expertise cannot be exempted from public scrutiny lest, to paraphrase Blaise Pascal, we should make an idol of truth itself.
On the other hand, Troy Duster is spot-on when he opines that the notion of “trained incapacity”, due to customary professional biases, may well apply to many bioethicists, who don’t always have a good grasp of the social and cultural ramifications of technoscience (Duster, 2003). Personally, I am under the impression that some of the leading libertarian bioethicists are sometimes blinded by their own ostensibly progressive reformism and do not see that through their aggressive argumentation and rigorous, but occasionally simplistic analyses they somehow compel people to freedom (Glover, 2001). Perhaps prompted by an underlying substratum of anthropological pessimism, they tend to reason the public into believing that human life can and should undergo unlimited changes and that the needs and expectations of the well-to-do must not be restrained, even if this means raising the bar of what passes for a decent life and promoting a lifestyle that is not environmentally and socially sustainable. In this sense, many bioethicists who pose as iconoclastic thinkers really are in tune with the core values of a postmodern consumerist society and with the logic of market segmentation and emulative spending. Perhaps the most serious flaw in the vigorous libertarian strand of Anglo-American bioethics is the inability to understand that change is less a free, rational choice than the end result and function of social and economic coercive power-relations.
Unfortunately, the haste with which common sense is waved aside as an inconsequential distraction, together with a rather strong measure of technological determinism, can only reinforce the impression that bioethics has the justificatory function of bringing the public around to the way of thinking of the most enlightened and glamorous elite and, by extension, of the bio-pharmaceutical industry. The fact of the matter is that a thin bioethics confronting the market and powerful professional and corporate interests is bound to be either crushed or to lend itself to the endorsement of an ideology of unbridled competition and rampant consumerism. Bioethicists would therefore be well advised to pay heed to the words of Jean-Baptiste Henri Lacordaire, who once said that “between the weak and the strong, it is freedom which oppresses and the law which sets free.”

Agar, N. (1998), Liberal eugenics, Public Affairs Quarterly, 12(2), 137-155.
Benichou, G. (2002). The advent of the genetic quotient. Diogenes, 49(3), 20-26.
Berlinguer, G., Garrafa, V. (2000). Il nostro corpo in vendita. Cellule, organi, DNA e pezzi di ricambio. Milano: Baldini & Castaldi.
Bosk, C. L. (1999). Professional ethicist available: logical, secular, friendly. Daedalus, 128(4), 47-68.
Campbell, A. V. (2000). “My country tis of thee” – the myopia of American bioethics. Medicine, Health Care and Philosophy 3(2): 195-198.
Cooter, R. (1995). The resistible rise of medical ethics. Social history of medicine, 8(2), 257-270
Cooter, R. (2004). Bioethics. The Lancet, 364(9447), 1749.
Duster, T. (2003). The hidden eugenic potential of germ-line interventions. In A. Chapman and M.S. Frankel (Eds.), Designing our descendents: The promises and perils of genetic modifications (pp. 156-178). Baltimore, MD & London: The Johns Hopkins University Press.
Fox, R.C. (1999). Is medical education asking too much of bioethics? Daedalus, 128 (4), 1-25.
Freeman, S. (2002), “Illiberal Libertarians: Why Libertarianism Is Not a Liberal View,” Philosophy and Public Affairs, 30(2): 105-151.
Glover J. (2001), A moral history of the twentieth century. London: Pimlico.
Habermas, J. (2003), The Future of Human Nature. Cambridge: Polity Press.
Harris, J. (2004), On Cloning, Routledge, London.
Harris J. (2007), Enhancing Evolution: the Ethical Case for Making Better People. Princeton University Press: Princeton.
Hedgecoe, A. M. (2004), Critical Bioethics: Beyond the Social Science Critique of Applied Ethics. Bioethics, 18(2), 120-143.
Hermitte, M-A. (1990), L’embryon aléatoire. In J. Testart Le Magasin des enfants (pp. 238-265). Paris: Gallimard.
Kateb, G. (2003), “Democratic individualism and its critics,” Annual Review of Political Science, 6: 275-305.
Koch T. (2006), Bioethics as ideology: conditional and unconditional values. Journal of medicine and philosophy, 31(3): 251-267.
Maclean, A. (1993), The elimination of morality. Reflections on utilitarianism and bioethics. London & New York: Routledge.
Newman, S. L. (1984), Liberalism at wits' end : the libertarian revolt against the modern state, Ithaca Cornell University.
Savulescu, J. (2002), Deaf lesbians, ‘designer disability,’ and the future of medicine. BMJ, 325(7367): 771-3.
Savulescu, J. (2006), Genetic Interventions and the Ethics of Enhancement of Human Beings. In The Oxford Handbook on Bioethics, ed. Bonnie Steinbock, 516-535. Oxford: Oxford University Press.
Ashcroft, R. E. (2004), Bioethics and conflicts of interest. Studies in history and philosophy of biological and biomedical sciences. 35, 155-165.
Stephen, J. (2004), Titanic ethics, pirate ethics, bioethics. Studies in History and Philosophy of Biological and Biomedical Sciences, 35, 177-184.
Stevens, M. L. T. (2000), Bioethics in America: Origins and Cultural Politics. Baltimore: Johns Hopkins University Press.
Stock G. and Campbell J. (Eds.) (2000), Engineering the Human Germline. Oxford: Oxford University Press.
Stock, G. (2002), Redesigning Humans. Our inevitable genetic future. Boston, New York: Houghton Miffling Company.
Wolf, S. M. (Ed.) (1996), Feminism & bioethics. Beyond reproduction. New York & Oxford: Oxford University Press.

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