Had one of those Delphic moments this morning where I began to despair about the number of medical ethics, and bioethics, departments situated within medical schools. Lo and behold, my worries happened to coincide with the news that the bioethics centre at my neighbourhood university is about to be subsumed under the School of Medicine. It’s an insidious move, and one that suggests that the hegemonic privilege of medicine shows no sign of loosening its grip. Setting aside any considerations of whether academic disciplines must justify their practical utility, the current ethos in higher education demands that disciplines demonstrate ways in which they will be useful (to students, policy makers et cetera). And, clearly, if medical ethics is to have any useful function, it is as a guide to the practice of medicine and healthcare. When its role is subordinate to medicine–when it is a sub-speciality–it is, at best, a secondary consideration, or ignored altogether. At worst, it becomes a vessel for harm.
If medical ethics is situated within medical schools, it runs the risk of being a reactive discipline, waiting for situations that its practitioners can comment upon, mouths for hire whenever someone wishes to die, programme a robot to kill Arab kids or give great blowjobs, or genetically engineer intersex folk out of existence. This is not what medical ethics should be. It is also not about finding justifications for things that medical practitioners and researchers want to do. It is about finding–and teaching–ways to think about healthcare in broad ways. It is about synthesising all that we understand about the structural issues of communities, administrations, society and environment, individuals, and those we share our worlds with, with the issues faced in healthcare service provision. It is a rigorous examination of values, and an attempt to resolve the issues that arise when those values clash.
When it becomes nothing but a compulsory bolt-on to medical training or research applications, and a chortling justification of trauma, misery and suffering in the name of ‘science’, medical ethics becomes the vehicle for the very things it is intended to prevent.