Bruce Jennings

This chapter engages two issues as they bear on genomic editing and the effects of biotechnology on human well-being: (1) how technology influences a reductionistic and manipulative understanding of biopower and biopolitics, fundamentally at odds with the worldview of bioethical humanism; and (2) how the reconceptualization of human flourishing in capability theories of justice bears on the ethics of biotechnology. The argument of this chapter appeals to a relational or “ecological” humanism that will assist bioethics in developing a critique of the technologies and knowledges of molecular reductionism. In the perspective of relational humanism, human beings are empowered as subjects of value and agents of self-realization, and mutual relations of interdependence and solidarity are affirmed. Along these lines, a reframed debate concerning the governance of biopower and the promotion of just human flourishing in an age of biotechnology can take place.

This chapter considers bioethics in the United States as a political terrain for competing visions of American liberalism. In accordance with the U.S. belief in moral progress, a key social function of U.S. bioethics is to be an agent of progress in respecting individual rights and interests; dedication to reasonable compromise and mutual accommodation; and optimism about individual privacy, free choice, equal opportunity, and liberty ordered by law. U.S. bioethics has become a new discipline and profession because of its ideological service to mainstream American liberalism's public philosophy, advancing the social ideal of the self-sovereign individual.

The field of public health ethics today needs philosophical and methodological self-consciousness and self-scrutiny. In “What is Public Health Ethics,” Angus Dawson clarifies the distinctive identity of this rapidly developing field. Public health ethics must be conceptually well-equipped to address its own social and political legitimacy so as to preserve the progressive, humanitarian values of the public health profession at its best. Public health represents a core health and welfare function of the modern state, and it is at the pivot point of contemporary struggle over the meaning of the two key values of our political and ethical tradition: liberty and equality. The fundamental task of public health ethics is not simply to improve population health, but also to articulate an ideal of human well-being, capability, and development for individuals and within communities and social institutions.

This chapter discusses ethical issues raised by the film _One Flew Over The Cuckoo's Nest_ (1975). The film tells the story of Randle P. McMurphy (Jack Nicholson), who is committed to a state mental hospital locked ward, and gradually becomes entangled by and literally silenced by the bureaucratic coils that rule this institution. The power structure of the ward is dominated by Nurse Ratched (Louise Fletcher), a controlling woman who fosters the dependency of the men on her and exercises total autocratic control of the ward. The chapter considers the power struggle between McMurphy and Nurse Ratched, and argues that the confrontation between them is an allegory of the controversies that continue to swirl around contemporary psychiatry. It also asks: where do we draw the line between ethically grounded therapy, on the one hand, and domination or the exercise of power, on the other?

This is the concluding essay for a special report from The Hastings Center entitled Democracy in Crisis: Civic Learning and the Reconstruction of Common Purpose, which grew out of a project supported by the John S. and James L. Knight Foundation. This essay provides an integrative discussion of various theoretical and practical reform perspectives offered by other essays in the report. It also offers a number of recommendations. It notes that the aim of the special report is not to propose specific reform measures but, rather, to consider larger, more theoretic concerns related to political and economic questions, which are personal and structural—psychological, cultural, and institutional—at the same time. In response, this essay argues that the best relationship between the citizenry and government in a democracy is not one of deference, nor one of contestation, but one that is critically constructive, which in turn is linked to practices of civic learning. To be constructive, citizens need scientific literacy, an understanding of how government and other institutions work, critical thinking abilities, and many open and diverse forums for civic learning to offset the increasingly isolating media “bubbles” that are the only source of information for many. The essay then formulates five recommendations designed to facilitate critically constructive citizenship and civic learning. These are creating a basis for civic participation, acquiring information, talking to each other, designing institutional change, and achieving deliberation.