Absent virtues: the poacher becomes gamekeeper

Area of Science:

• Bioethics
• Medical Ethics
• Applied Ethics

Background:

• Bioethics initially advocated against paternalism and elitism, promoting inclusivity.
• The professionalization of bioethics, particularly in North America, has led to internal conflicts.
• Practitioners who once opposed paternalism now face institutional pressures.

Purpose of the Study:

• To analyze the shift in bioethical perspectives due to institutional influences.
• To critique the current state of medical decision-making accountability.
• To propose a revised framework for ethical responsibility in bioethics.

Main Methods:

• Review of the historical development of bioethics principles.
• Analysis of the conflict between early bioethical ideals and current practices.
• Conceptual re-evaluation of professional and public responsibilities.

Main Results:

• Bioethicists, once critics of paternalism, now often align with institutional or employer interests.
• This shift mirrors the very perspectives bioethics initially opposed.
• A disconnect exists between the public accountability espoused and current professional practice.

Conclusions:

• A return to a hierarchical ordering of responsibilities in bioethics is necessary.
• This ordering should prioritize individual and citizen roles before professional roles.
• Revisiting this ethical framework can restore inclusivity and accountability in medical decision-making.