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The international growth and influence of bioethics has led some to identify it as a decisive shift in the location and exercise of 'biopower'. This book provides an in-depth study of how philosophers, lawyers and other 'outsiders' came to play a major role in discussing and helping to regulate issues that used to be left to doctors and scientists. It discusses how club regulation stemmed not only from the professionalising tactics of doctors and scientists, but was compounded by the 'hands-off' approach of politicians and professionals in fields such as law, philosophy and theology. The book outlines how theologians such as Ian Ramsey argued that 'transdisciplinary groups' were needed to meet the challenges posed by secular and increasingly pluralistic societies. It also examines their links with influential figures in the early history of American bioethics. The book centres on the work of the academic lawyer Ian Kennedy, who was the most high-profile advocate of the approach he explicitly termed 'bioethics'. It shows how Mary Warnock echoed governmental calls for external oversight. Many clinicians and researchers supported her calls for a 'monitoring body' to scrutinise in vitro fertilisation and embryo research. The growth of bioethics in British universities occurred in the 1980s and 1990s with the emergence of dedicated centres for bioethics. The book details how some senior doctors and bioethicists led calls for a politically-funded national bioethics committee during the 1980s. It details how recent debates on assisted dying highlight the authority and influence of British bioethicists.
1 Ethics ‘by and for professions’: the origins and endurance of club regulation Doctors and scientists successfully argued that they should be left to determine their own conduct during the nineteenth and much of the twentieth centuries, in a form of self-governance that Michael Moran terms ‘club regulation’.1 They portrayed medical and scientific ethics as internal concerns in this period – produced ‘by and for’ colleagues and mainly concerned with limiting intra-professional conflicts.2 This view of ethics functioned as what Harold Perkin calls a ‘strategy of
decisions does not fit that well with broader historical changes to UK regulation which, according to Moran, have moved away from the cosy, professional self-regulation (‘club regulation’) to more formal, centralised approaches. While at the level of organisational rules, with its guidance documents, mandatory training and standard operating procedures, the REC system resembles this modern approach, in terms of actual decisions – centring on interactional assessments of researchers’ trustworthiness – RECs are decidedly old-fashioned. This ambiguous relationship between
of governance, which Michael Moran terms ‘club regulation’, stemmed not only from the professionalising tactics of doctors and scientists, but was compounded by the ‘hands-off’ approach of politicians and professionals in fields such as law, philosophy and theology.66 I outline how these attitudes persisted into the 1960s, ensuring that club regulation survived a ‘backlash against professional society’ and criticism of medical research by the ‘whistleblower’ Maurice Pappworth. Chapter 2 examines why outsiders increasingly joined debates on medical procedures such
called ‘ethics experts’.18 Thanks to escalating mistrust of club regulation, both in public and, crucially, in government, they derive their authority from being ‘expert outsiders’ who are independent from the profession or procedure under scrutiny.19 Their portrayal as ‘ethics experts’ confirms that bioethicists have indeed contributed to a shift in the location and exercise of biopower in Britain. The days of ‘club regulation’ are a thing of the past and we no longer believe that expertise in medical and scientific ethics is inscribed solely within doctors or
’, characterised by its highly cooperative nature where ‘resort to sanctions was rare; and there developed an overwhelming stress on fostering trust between regulator and regulated’. 18 This form of ‘club regulation’, at least as far as medicine and other professions was concerned, was not ignored by the state, but rather acknowledged and devolved, since the: state endowed regulatory institutions with authority, but then practised the lightest of light touch controls; the self regulatory institutions themselves, in turn, adopted collegial regulation – a style that presumed
underpinned political support for club regulation in Britain. But this was not quite the case. GMAG was certainly not comparable to American bodies such as the National Commission for Protection of Human Subjects and the later President’s Commission for the Study of Ethical Problems in Medicine, which was established by President Jimmy Carter in 1978.191 This was clear when civil servants stressed that ‘working scientists must be the backbone’ of GMAG.192 Secondly, and in a more telling contrast, the lay representatives were the least influential members of GMAG and had
, sociability, etc.) from their past. 71 A copy of the rules and bylaws is still given to every new member, and the basic categories of club regulations remain consistent, although the rules themselves have expanded with the passage of time. Once simple documents, the articles of association have now become lengthy, complex treatises on club legalities. The opening passages of rules and bylaws today are much the same as they were in the