The Pandemic: Lessons for Bioethics?

Abstract

Seeking useful ways to respond to the Covid‐19 pandemic, bioethicists have been tempted to claim for themselves what Alasdair MacIntyre characterized in After Virtue as the moral fiction of managerial expertise. They have been eager to offer a wide range of policy prescriptions, presenting themselves as bureaucratic managers and suggesting an expertise that bioethics may not in fact be able to offer. This was evident, for example, in the petition published by The Hastings Center in March 2020. The pandemic could foster a more hopeful future for bioethics if it were to focus attention less on policy decisions that belong to all citizens and more on some of the most basic moral questions that life presents and with which bioethics has always dealt—including, surely, the virtues needed in order to live well in a time of pandemic.

perspective

It has become commonplace to ask how our world will have changed once this pandemic has passed (a thought that includes an uncertain sort of optimism). Questions of that scope, intriguing as they may be to some, almost never admit of a genuine answer, and few of us would want our answers to them revisited a decade from now. But there is a related, much narrower, question that might usefully be considered: what can we learn about the shape that a newly instructed bioethics might take?

In After Virtue: A Study in Moral Theory, one of the most important, influential, and provocative books of moral philosophy written within the last fifty years, Alasdair MacIntyre observed, “[O]mniscience excludes the making of decisions. If God knows everything that will occur, he confronts no as yet unmade decision…. This way of putting the point has one particular merit: it suggests precisely what project those who seek to eliminate unpredictability from the social world or to deny it may in fact be engaging in” (p. 92).

MacIntyre aimed to offer a critique of what he called the “moral fiction” of managerial effectiveness. Claiming value‐neutrality and the ability to make lawlike generalizations about society, bureaucratic managers are all too confident that they know how a society should order its common life. They forget that the proper shape of a people's common life cannot simply be discovered by “experts.” That requires not discovery but decision—always made in the midst of uncertainty, with consequences not wholly predictable.

Surely our attempts to deal with the coronavirus pandemic should have reminded us of this. We lack clarity. The Centers for Disease Control has changed its recommendations on the need to wear masks in public. The need for ventilators in New York was said to be extreme, but Governor Cuomo has now given some of New York's to other states. Even Anthony Fauci, whom we have all learned to admire, was, as late as mid‐February, describing the risk to Americans as “relatively low.” And no one has a scale on which to weigh the need to prevent transmission of the virus against the need to sustain a large market economy on which the livelihoods of countless numbers of people—many of them already far from wealthy—depend.

In such a world, what has bioethics to offer? Not, I think, what John Evans—in his otherwise thoughtful and instructive book The History and Future of Bioethics: A Sociological View—suggested: that “bioethicists have a form of expertise in weighing and balancing societal values concerning scientific and medical issues, and that this expertise should be useful to government officials” (p. 129). Claiming that kind of expertise, turning bioethics into MacIntyre's moral fiction of bureaucratic management, is the surest road to irrelevance.

How strange—and unfortunate—then was a petition published by The Hastings Center this March and signed by almost fourteen hundred of, as the Center's website put it, “the nation's most prominent bioethicists and health leaders.” The petition noted—quite rightly, I think—the existence of “a large bioethics literature on how to approach triage decisions,” and it suggested that bioethicists were well positioned to offer guidance for such choices to health care workers. But it also offered this: “However, as bioethicists and health care leaders we do not prefer to guide these decisions. We prefer to prevent or reduce the need for them.” That is, not content to offer the expert knowledge that was truly theirs, they preferred to claim a kind of expertise they do not possess: MacIntyre's moral fiction of managerial expertise.

Thus, they offered recommendations about the manufacture and distribution of medical supplies; about sharing resources with other, poorer countries; about strategies for communicating information about the virus; about government funding to cover needed medical treatment; about provision of sick leave. In short, about all sorts of issues they should certainly address as citizens with their fellow citizens when shaping our common life, but on which being a “bioethicist” provides no special expertise.

It is worth asking what a post‐pandemic bioethics should look like. It could continue to offer policy advice clothed in the garb of claims to expertise. Perhaps, though, it should return to its roots, focusing less on policy decisions that are the province of all citizens and more on some of the fundamental moral questions that life always presents: Just how important is my survival? Are there other goods that have at least as strong a claim on me? How can we learn to talk about the value of life on a horizontal plane (the natural life cycle) and at the same time of that plane intersected vertically at every moment by our relation to the Eternal? Do we have special, preferential duties to those who share our political community? Or are we just citizens of the world? What virtues do we need if we are to live well in the face of such a pandemic? How might we inculcate them? What do we mean by a “crisis,” and how can we recognize one when we actually face it?