Remaking Bioethics Together

Abstract: This workshop aims to expand bioethics’ horizons of political possibility. Bioethics positions itself as a neutral arbiter; indeed, ASBH bylaws forbid the association from taking “positions on substantive moral and policy issues.” This puts bioethics at odds with institutions like the World Health Organization and United Nations, which advocate universal healthcare as a right. Bioethics’ neutrality prevents it from engaging in movements to build the healthcare system that most in the field say is needed – one which is equitable along lines of race, class, gender, and sexuality; redistributes resources towards the elimination of disparities; and ensures access. Bioethics also contributes to the institutional reproduction of academic medical centers (AMCs), which generally make profits by maintaining exploitative relationships with communities which provide them research subjects, patients, workers, and revenue. Clinicians at AMCs must then treat patients in desperate straits without adequate support, while being told by employers to center social determinants of health in their practices and to further the aims of patient safety and equity. However, rarely are these commitments reflected in AMCs' behaviors toward patients, communities, or employees. Instead, burdens are borne by healthcare workers and clinical ethicists, who address issues related to patient safety, quality, and equity for some of the most marginalized. Though the clinical ethicist’s job is often to disambiguate issues for individual patients, they have a valuable potential role in advancing systems-level equity. We propose to re-envision bioethics’ mandate to include advocacy to address the root causes of inequities, which requires courage and consensus.