By Bill Peckham
Sally Satel has a review of Observing Bioethics by Renee C. Fox and Judith P. Swazey, posted on The New Republic's new website the Book. Beginning over 30 years ago Fox and Swazey have study bioethics, through an in depth study of organ transplantation and chronic dialysis first in in their seminal book the Courage to Fail and then in Spare Parts.
Satel's review, The Right (and Wrong) Answers, is striking in its dismissiveness of bioethics:
American bioethics was born out of a desire to be relevant.
Ah, no. Bioethics was born out of a desperate need.
While bioethics has been around for as long as humans have been sentient, in the sense of how to treat the dead and dying, bioethics really came to the fore with the advent of chronic dialysis and the decisions faced and made by Belding Scribner, in the early '60s. This is thoroughly documented in Fox and Swazey's earlier books and informs their concerns about modern efforts to use bioethics for political advantage and co-opt the hardest cases to create culture war cause célèbres (see Schiavo, Terri). And one should remember that it is Fox and Swazwey's early work that overlaps Satel's well developed interest in creating an organ market.
The underlying problem Satel has with Fox and Swazey's work is the "Gift Exchange" that Fox and Swazey first document in '70s. The Gift Exchange is as relevant today as it was then and then as now, it undercuts the supposed moral imperative of establishing remuneration for kidney's, something which Satel is wholly in favor (optimal dialysis also undercuts the supposed imperative, but Satel has never addressed that point). In her review Satel offers:
Though clearly fond of the bioethicist-physicians, bioethicist-philosophers, and bioethicist-legal scholars they interviewed, Fox and Swazey describe themselves as “critical of what we regard as the field's deficiencies and blind spots.” They identify these as the use of dumbed-down teaching formulae, an insensitivity to cultural differences, and the tendency of American bioethicists to emphasize “individual rights, and rationality” instead of “community, and common good,” which are the values that Fox and Swazey favor.
Here is Satel's core libertarian beef with bioethics, the idea that when society's collective needs are weighed against an individual's right to act as they wish, the individual is not given more weight.
As recently as the Monday before Christmas Satel wrote:
Sadly, the transplant establishment insists that sick people languish on dialysis for years or die waiting for a kidney. They fear, on one hand, that the patient might remunerate someone for saving his life and, on the other, that any donor in financial need can’t possibly make a rational decision about his own best interest.
The problem isn't with the transplant establishment or bioethics, which holds the myopic in check, the problem Satal has is with libertarianism's inability to make her case.