What Do Bioethicists Do?

Want to make your life better with the help of medical technology? It might be between you, your doctor, and the President’s Council on Bioethics.

Bioethics has become a booming industry, and it goes way beyond conventional medical ethics. But what exactly do bioethicists do? Are they just a bunch of self-appointed moralists who want to tell everybody what to do? Are they representatives of particular churches or religions?

A year or so ago was asked to review a book called The Case Against Perfection, written by a Harvard philosopher named Michael Sandel. It was all about how people today are getting out of hand with their desire for perfection–better SAT scores, better genes for their babies, better hormones for athletic events, better face-lifts, better breasts.

Speaking of which, Professor Sandel was beating his own breast in a tirade against all this. At first I thought it was original, so I was intrigued by the question of what made the sage professor tick. Then, having learned that he formerly served on the President’s Council on Bioethics, I looked them up. Lo and behold, Professor Sandel had largely recycled one of their official reports.

Now, we all need to publish or perish, but I guess I had naively thought a professional ethicist would want to write a more original book. Truth be told though, I didn’t like the arguments much more when the President’s Council made them in yawn-grabbing bureaucratese than when the learned man recycled them for a wider audience.

It’s not that I can’t see any problems in the pursuit of perfection. As much as the next guy, I’d like to think that the Tour de France, the Major League Baseball home run statistics, and the forthcoming Beijing Olympics are safe from steroids, growth hormone, and other forms of fakery. And I pity the people so addicted to plastic surgery they can never accept themselves no matter what.

But this after all was the same Council on Bioethics that Elizabeth Blackburn–one of the most distinguished biological scientists alive–was forced out of, because she dared to publicly criticize the President on the issue of stem cell research.

If your memory needs jogging, the President made his first major speech–this was before 9/11–explaining why he was vetoing legislation to fund stem cell research, in spite of the fact that almost all knowledgeable scientists and physicians were in favor of it. Not to mention victims of Parkinson’s Disease, like actor Michael J. Fox, and widows of Alzheimer’s Disease victims, like Nancy Reagan.

Republican California Governor Arnold Schwartzenegger, along with his counterparts in New Jersey and other states, soon stepped up to the plate, in effect thumbing their noses at the President and appropriating billions to fund the research that he refused to pay for.

So I guess I have to wonder what makes the members of the President’s Council on Bioethics so special. I understand that where human embryos are concerned, there are serious religious scruples. I may not agree with them, especially when I think back on the horrible suffering of the patients I treated in medical school. Or my wife who died of cancer at 51. Or my mother who was laid low by two devastating strokes. But I do understand.

When it comes to enhancement strategies that have nothing to do with embryos, I confess I have a little more trouble.

Why exactly should we reject cosmetic surgery and SAT prep classes? Because we need to embrace imperfection. That’s the philosopher’s argument, a retread from the report of the President’s Council. It’s a sin against nature to try to escape the imperfection we are handed. Better reproductive roulette, whatever comes, than testing fetuses for genetic diseases.

Perhaps these watchdogs of right and wrong medicine don’t know that once upon a time it was a sin against nature to vaccinate against smallpox. Or so certain preachers, the bioethicists of the nineteenth century, told all who would listen.

I was against breast augmentation until one day in medical school when I had to start an IV for a young woman who was about to have one. She was gentle, shy, and pleasant looking. She had no breast tissue at all that I could see. She had dreamed of this day all her life, and she said that she couldn’t wait to see the look on her husband’s face.

I saw a meticulous surgeon implant two globes of fluid into her chest and I became a believer.

A young friend of mine had a breast reduction operation, a high school graduation present. Her breasts were exceptionally large; they embarrassed her and interfered with her participation in sports. I saw her the other day; she is still full-chested but she is no longer exceptional, and she is happy.

In my view, the question is not what is “ethical” according to some philosophers musing under the aspect of eternity. And it is also not what would be best for America, or humankind, or the planet. The question is the one I learned to ask in medical school: what is best for the person sitting in front of you?

The woman who is pregnant and wants to know if the baby she is carrying will have the devastating disease that killed one of her uncles. The twelve-year-old boy whose shortness has made him an object of ridicule since he can remember and who wants you to make him an inch taller before he finishes growing. The fifty-year-old whose husband has dumped her for a trophy wife and who wants a botox injection to give her a fighting chance at finding a man.

The question is, should the question of what do do for these people be between them, their families, and their doctors? Or should a philosopher with a Ph.D. or the President’s Council on Bioethics be called in to tell them right from wrong?

I know my answer.


  1. Jack Davis says:

    Dr. Konner,
    A very thoughtful, serious post. I was wondering if you have read Undermining science : suppression and distortion in the Bush Administration by Seth Shulman. He talks about stem-cell research, among other subjects.

    You summed up the dilemma succintly when you said: “Or should a philosopher with a Ph.D. or the President’s Council on Bioethics be called in to tell them right from wrong?” No, of course not. having a Ph.D is a fine thing, but it doesn’t ipso facto make one an expert on ethics or morality.

    This is unrelated, but I had to share this book review of Unsettled with you: (from Amazon.com)

    Dr. Konner has an electrifying personality. As a former student i know this.
    During the middle of a lecture on adaptive strategies and evolution, a light fixture swung down from the ceiling. konner grabbed the metal casing and pulled with all the strength in his body.
    he pulled a couple structural beams out of the ceiling, along with a white cloud of building materials. there was a large, bloody laceration on his palm that required first aid.

    Not much of a book review, but interesting nonetheless

  2. Melvin Konner says:

    Thanks, Jack, but I think you exaggerated the incident a bit. 🙂 It was dangling, I thought it might fall on someone, so I pulled it down to prevent that. Display of strength and injuries both very minor, but I guess it was one of my more memorable illustrations of adaptive behavior. Sort of.

  3. Rosalynn A. Vega says:

    I agree with many of the points that you make in this post. Nearly every bioethical rule set in place will be inappropriate or just downright wrong under certain conditions. One of the interesting things about medicine is that it never fails to surprise us. EVERY situation is out there and bioethics has a hard time preparing for all the “possible”–especially since sometimes the “impossible” becomes “possible.” (Take the man who just gave birth.) In a perfect world, doctors, patients and patients’ families should be the only persons involved in medical decisions since, in a perfect world, all of these people would be honorable and have good judgment. In our world, home to the imperfect, does the President’s Council have any place at all? What issues can they rule on and which issues should they stay out of? Who draws that line?

  4. Melvin Konner says:

    Roslyn, Thanks for your thoughtful comment. As you say, medicine never fails to surprise, which is why clinical judgment is so important, and the more experienced the doc, the more she will take the surprise in stride. However, I can’t quite agree that in the ideal world it would always and only be the doc, the patient, and the family, since there are some unscrupulous doctors who will mislead people for their own gain. So there have to be rules and supervision of some kind. But not the kind supplied by the President’s Council.

    You remind me that the guy who gave birth would make an interesting subject for a blog. Hmm. Thanks again, Mel

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