The Failure of Bioethics

When in April of 2025 the Hastings Center for Bioethics (the oldest bioethics think tank in this country) revealed its new five-year strategic plan, one of six “values” specified as central to the center’s work was “inclusiveness and diversity.” “We engage with a wide range of perspectives and values with humility,” the plan said, and “we invest in diversifying the field of bioethics.” Were it actually achieved, this investment in diversity would be a significant contribution. I suspect, though, that the center has a steep hill to climb if it is really to incarnate that value in its work, for this would mean encouraging a bioethics that includes diversity of viewpoint—and that, alas, is seldom what those calling for diversity seem to want.

The center is not alone in emphasizing diversity. More recently still, in late June of 2025, in an editorial published in the American Journal of Bioethics (AJOB), nine bioethicists, some of them well known, contend that (as the ­editorial is ­titled) “­Bioethicists Must Push Back Against Assaults on Diversity, Equity, and Inclusion.”

To call the editorial disappointing would be an understatement, though for anyone who has spent years in the academy it is surely not surprising. Trite sentences abound. “Will we be on the right side of history?” we are asked, the assumption evidently being that there is such a side and that we can identify it. And, pulling out a very old playbook, the authors exhort us to “speak truth to power.” Evidently, bioethicists must courageously bar the door against the Nazis taking aim at under-represented groups in America, even if this resolution has more to do with political commitments than with medicine or science.

One need hardly be supportive or fond of Donald Trump to wonder whether bioethics as currently practiced can speak authoritatively about the character of the good life. How strange it is that a bioethics that often underscores the importance of autonomy for patients, the importance of having their persons respected, should set itself against the concerns of so many of these same people when they are not patients but simply citizens. More than a decade ago the sociologist John Evans was already observing that many people had lost confidence in the ability or willingness of bioethicists to represent their values and beliefs. The gap seems to have widened since then. One may reasonably wonder whether bioethicists have any real claim to expertise about the character of the good life, and aggressively asserting what are, in large part, political claims only exacerbates the problem.

The editorial in AJOB is, in many respects, only the culmination of a long process of development. Whe­n what ­eventually came to be called bioethics first emerged from medical ethics and began to garner attention in this country, it had no unified voice and was often marked by disagreement. Those disagreements were about the ends or goals to be pursued in medical care and research. Deep, and sometimes perhaps unanswerable, questions about the meaning of our humanity were involved. Both religious and philosophical visions of human nature were in play, needing to be unpacked, debated, and refined. The scholars writing in this newborn field did not think of themselves as bioethicists. They were grounded in many well-­established disciplines—religion, philosophy, medicine, psychology, law—out of which they approached the humanistic problems being raised by modern research medicine.

One thinks of Willard Gaylin, inviting us to contemplate the idea of “neomorts”; of Daniel Callahan, asking how long we should want to live and what a peaceful death would be like; of Joseph ­Fletcher, suggesting that technological reproduction was more in keeping with our human nature than old-­fashioned procreation; of Paul Ramsey and Richard McCormick, debating the use of children as research subjects; of Renée Fox and Judith Swazey, offering a thick and (to some extent) dissenting examination of developing transplantation technology; of Hans Jonas, exploring what it means to be a living organism; of Leon Kass, unpacking the difference between procreation and reproduction; of William F. May, reflecting on the meaning of the newly dead body; of Loretta ­Kopelman, exploring the meaning of freedom and ­competence for those with ­psychiatric problems; of H. T. Engelhardt, drawing attention to the effect on ­medical care of social pluralism; of Jay Katz and Eric Cassell, reflecting on the relation between patients and physicians.

Perhaps that is enough to make the point. This was a bioethics of which it could truly be said, “We engage with a wide range of perspectives and values with humility.” From various angles, grounded in different traditions of thought, and focused on different issues in medicine, those scholars were reflecting on the meaning of our humanity. They did not begin by assuming that we know what it means for us to live well and flourish. They did not have a common political agenda. They probed and examined their questions from various angles of vision. They did not seem to think that a principle such as justice—thin and undeveloped as it is in the recent ­editorial—could be of much use when abstracted from some deeper understanding of our humanity. In short, they were not just political advocates seeking to speak truth to power. And at least some of them may well have anticipated that they might be on the losing side of history.

Now, however, it seems that we all know what our goals should be and need only become more politically active and effective in order to bring them to fruition. Such activity, especially in the shrill tone one hears in the AJOB editorial, is unlikely to be very helpful in persuading those who hold different views to change course. Nor is the suggestion that opponents of DEI are filled with “racist hatred” or are something like Nazi supporters a very helpful or measured approach (mirroring in its own different register the rhetorical tone adopted too often by Trump). It is political activism, done in a way that is likely to appeal ­only to those who need no reasons or arguments to persuade them. Only that can explain why these bioethicists write to oppose the administration’s attack on DEI initiatives in general, not just on those that may directly affect the work of ­bioethicists. One need not think that the sledgehammer the Trump administration’s Department of Health and ­Human Services has taken to research ­funding is wise in order to be less than impressed with the program for bioethics put forward in the editorial.

Moreover, there is little reason to suppose that bioethicists are uniquely qualified to unpack and clarify what the moral principle of justice means or requires, even if, as the editorial puts it, “justice continues to be a core commitment of bioethicists.” We cannot know what justice means or requires unless, for example, we first know who counts as a person to whom the principle of justice applies. We cannot thoughtfully pursue equity until we have worked through and clarified the relationship between equality and equity. More generally, what justice requires may be different in different spheres of our life, nor need it always produce what looks like simple equality. Merit may rightly be considered in academic institutions when, for instance, we are training physicians or engineers. Democratic elections result in unequal but legitimate distributions of political power. And surely we should realize that a commitment to restorative justice—such as the AJOB editorial announces—is simply that: a commitment, not an argument. 

“Embedding DEI in our research, teaching, and service,” as the AJOB editorial recommends, is likely only to overlook the complexity of justice and narrow the impact of bioethics. It may be, after all, that just treatment of others would include recognizing and making room for the diverse intellectual perspectives they bring to the study of questions at the heart of bioethics.

There are, to be sure, complex and difficult questions embedded in the nondiscrimination principle enunciated in Title VI of the 1964 Civil Rights Act. Programs or organizations receiving federal funds may not discriminate against individuals on the basis of race, color, or national origin. This does not mean that one may not, for example, seek a diverse pool of applicants for a position. But, again, the AJOB editorial passes over the difficult task of articulating this difference. In focusing only on ­equitable representation, it loses the commitment to equal treatment that ­genuine nondiscrimination requires. If this is not a failing of the editorial, we need to see the argument, not just a broadside against those who think differently. Only thus can a diverse range of thinkers and perspectives actually be welcomed within the community of bioethicists.

According to the AJOB editorial, “bioethics emerged in the shadow of World War II.” True as that is chronologically, it is only part of the truth conceptually. Physicians had for a long time understood it to be part of their calling to attend to the thick moral dimensions of care for the ill. And, as David Rothman noted in one of the first accounts of the emergence of bioethics, a wide range of (often secularizing) social changes first made physicians strangers to their patients and then brought new people, other strangers, to the bedside along with physicians. Some of those new strangers became bioethicists, and one might suggest that discerning the meaning of care for those who, in the midst of rapidly changing social circumstances, were facing some of the deepest problems of life, was every bit as integral to the emergence of bioethics as was an underdeveloped principle of justice.

After several decades of growth and development, bioethics as understood today by many who call themselves bioethicists shows little interest in the meaning of our humanity and the ways it is probed from a variety of perspectives and within a variety of disciplines. It has a very foreshortened sense of its own history, missing the ways in which it grew from and expanded upon concerns that had always been internal to the practice of medicine. It assumes that we know where the human good lies and must simply find ways to achieve that good. It assumes that this achievement is largely to be pursued through political activity. And now it even seems to suggest that those who disagree—and certainly those who support the “wrong” political ­positions—are morally corrupt.

What happens to those who disagree? Some may be put off by the self-righteous tone that is ­presented as essential to bioethics. Some may simply lose interest in what ­passes for official bioethics. Some may look elsewhere and turn to other disciplines in search of the kinds of insight once offered by bioethics. But all of us will be the poorer for what we now mostly lack: the sort of probing reflection and civil discourse among a ­genuinely diverse array of voices from different disciplines and different points of view, grounded not in a political program but in a vision (or visions) of human nature, that once made bioethics both interesting and significant.