Against Bioethics

Governments, health professionals, patients, research institutions, and researchsubjects look to bioethicists for guidance in making important decisions about medical treatment andresearch. And yet, argues Jonathan Baron in Against Bioethics, applied bioethics lacks the authorityof a coherent guiding theory and is based largely on intuitive judgments. Baron proposes analternative, arguing that bioethics could have a coherent theory based on utilitarianism anddecision analysis. Utilitarianism holds that the best option is the one that does the most expectedgood. Decision analysis provides a way of thinking about the risks and trade-offs of specificoptions. Like economics, utilitarian decision analysis makes predictions of expected good in complexsituations, using data when possible, and focusing human judgment on the issues relevant toconsequences. With such a guiding theory, bioethics would never yield decisions that clearly goagainst the expected good of those involved, as some do now.Baron discusses issues in bioethics thatcan be illuminated by such analysis, including "enhancements" to nature in the form of genetics,drugs, and mind control; reproduction; death and end-of-life issues, including advance directives,euthanasia, and organ donation; coercion and consent; conflict of interest and the reform ofinternal review boards; and drug research. Although Baron opposes current practice in bioethics, heargues that by combining utilitarianism and decision analysis, bioethics can achieve its aims ofproviding authoritative guidance in resolving thorny medical and ethical issues.

Jonathan Baron is Professor of Psychology at the University of Pennsylvania. He is the author of Morality and Rational Choice, Thinking and Deciding, Judgment Misguided: Intuition and Error in Public Decision Making, and other books.