Why bioethics? On the anamnesis of meaning in medicine

The history of bioethics rests upon the assumption that, given the growing complexity of medicine, the function of ethics is, first of all, normative: ethics is supposed to help in the solution of concrete problems, and to do so systematically, by relying upon a defined set of principles and rules. The scientific character of such an approach to bioethics complements the very understanding of modern medicine as itself increasingly scientific and technical, that is, as oriented toward the production of effects. Although careful scientific attention to the patho-physiology of disease has unquestionably yielded marvelous advances in modern medicine, its positivist reduction has also created a mind-set that brackets questions of meaning, themselves highly significant to human well-being and to the ethical aspects ofmedicine. The paper claims that, rather than sharing in the "suspension of meaning" pursued by medicine for the sake of scientific objectivity, the main task of bioethics consists in a retrieval, or "anamnesis", of the very questions medicine seems to suspend: the significance of illness and disease, of birth, suffering and death, and of the service to the ethos of generosity that sustains the healing professions. Also, the paper offers a cultural "etiology" of "the suspension of meaning" in bioethics. In addition to a critical integration of positivistic attitudes in medicine and the reduction of moral discourse to the normative, one must mention the basic presumption of a cultural situation that, in the name of post-modernity, raises serious doubts against the possibility of engaging in questions of meaning across moral boundaries. As an alternative, the paper calls for a moral reflection that begins neither with the application of normative principles, nor with an attitude of resignation towards the pursuit of the good; rather with a free and open confrontation with clinical experience that attends to the moral meaning of concrete situations, recognizing that formal modes of logical argumentation are only derivative functions of the moral language, and, thus, cannot exhaust the broad spectrum of ethical discourse in bioethics.