Tod Chambers

As many in the United States feel a need to take a side in the ongoing culture wars, the people who make up the field of bioethics have an obligation to directly engage with those who hold different political views. If bioethics is an academic field, it must also affirm the overall values of the academy to continually challenge central assumptions. If the field wishes to be a part of the development of public policy, it must be able to construct such policies that in some fundamental manner honor the values of the opposition.

Can one publish a bioethics case ethically? I suspect that most in bioethics would feel comfortable publishing a case if the subject—the patient—gave explicit permission, the amount of biographical information revealed was under the control of the subject, and the subject fully understood the benefits and risks of publishing the case. Some might add that the subject should have a chance to approve the final representation. I think that the ethics of publishing cases needs to be rethought. And this rethinking needs to be focused not on the way publishing a case might harm a patient (that is, nonmaleficence) but, rather, on how a case presentation does not convey the patient’s own voice in the narrative (that is, respect for autonomy). Bioethics needs a new model of case presentation: the polyphonic case, which demands that the subject be a part of the case’s construction.

When I heard that a laboratory in China had cloned two long‐tailed macaques, I thought of Mary Shelley's novel Frankenstein. When academics write about the novel, many point out that the reason the creature becomes a “monster” is not that he has any inherently evil qualities but that Victor Frankenstein, the creature's “mother,” immediately rejects him. All later problems can be traced to the fact that Frankenstein does not take responsibility for his creation. While I do not disagree with this, we need to think beyond (or before) Frankenstein's rejection to the reason he rejects it. I would like to suggest that this reason reveals something about how bioethics judges new biological technologies. I suggest that what causes Frankenstein to feel revulsion toward his creation is its unsettling mix of the beautiful and the ugly.

The authors of “A Conceptual Model for the Translation of Bioethics Research and Scholarship” argue that bioethics must respond to institutional pressures by demonstrating that it is having an impact in the world. Any impact, the authors observe, must be “informed” by the goals of the discipline of bioethics. The concept of bioethics as a discipline is central to their argument. They begin by citing an essay that Daniel Callahan wrote in the first issue of Hastings Center Studies. Callahan argued in this 1973 piece that bioethics had yet to attain the status of a discipline, and he lauded the freedom of being able to define a new discipline. Callahan's essay shares with Mathews and colleague's a peculiarity: neither ever defines what it means to refer to something as a “discipline.” To define a discipline does mean attending to the intended end product of scholarly activity, so I concur with Mathews et al.’s focus on outcomes. But I am concerned that in their argument they confusingly entangle their understanding of an academic discipline's internal goals, its telos, with its potential to have an impact on the external world, its praxis. The confusion that this can bring exposes what I believe is a profound problem within bioethics, the discipline's peculiar and at times intellectually hazardous relationship with its institutional hosts.

It is pictures rather than propositions, metaphors rather than statements, which determine most of our philosophical convictions. Bioethics has been particularly attentive to the role of metaphors in the discourse on moral issues in medicine. In The Physician’s Covenant, William May discusses how the various metaphors of the physician influence the manner in which we analyze problems in clinical ethics. Meaghan O’Keefe and colleagues have argued that particular metaphors dominate and in turn mediate the representation of genetic modification to the public’. Craig Klugman has analyzed the power of various metaphors used in the discussion of...

Recently, bioethics has become interested in engaging with narrative, but in this engagement, narrative is usually viewed as a mere helpmate to philosophy. In this precis to his book The Fiction of Bioethics, Tod Chambers argues that narrative theory should not be simply a helpful addition to medical ethics but instead should be thought of as being as vital and important to the discipline as moral theory itself. The reason we need to rethink the relationship of medical ethics to narrative is that ethicists test their ideas by applying them to cases, and cases are a narrative genre. Recognizing the importance that cases have for the way medical ethicists do ethics is essential in order to appreciate the field as a form of applied philosophy. Like other forms of representation, narrative has distinct and defining features, which ethicists, in order to understand the data of their field, must learn to recognize and differentiate. Ethicists need to attend to the way decisions about the discourse of a narrative influences the kind of moral theories judged relevant to it. The author briefly examines six features of narrative discourse that rhetorically condition the way we understand medical ethics cases: filter, reportability, closure, characters, chronotope, and gender.