By Ann Neumann
The field of bioethics—and the important social and policy contributions it makes to our democracy—will be profoundly affected if authoritarian populism displaces constitutional democracy. —Mildred Z. Solomon, Bruce Jennings, “Bioethics and Populism: How Should Our Field Respond?” The Hastings Report, March 16, 2017
As the sun came up on Easter Sunday, I was standing in a sprouting, dew-wet cornfield in Lancaster County with 60 others who had gathered to celebrate the resurrection and spring. The crowd was a hodge-podge, made up of members of my family, members of the nearby Community Mennonite Church, members of a neighboring, sprawling Amish family, and a smattering of activists (local and national) who have been camping on the site for several weeks, their objective to stop the Atlantic Sunrise pipeline which will slice through the county, jeopardizing the lives and health of everything in its path.
Since the election of Donald Trump, questions about health and safety are no longer rhetorical. All around us, individuals have been making rich, ramshackle communities and loudly parsing the difference between partisanship and morality: non-believing people (like me) are joining churches of all stripes, tapping into existing communities of all types to raise a louder voice. Alarmed mothers are marching and running for office, millennials and minority groups are gathering to protest and make friends, students and teachers are walking out of classrooms. Within disciplines, too, vocal debates are taking place about members’ responsibilities for what many have qualified as the rise of authoritarian populism and the endangerment of public health.
Recently, contributors to a listserv I read, a heap of otherwise non-religious political scientists, policy wonks and journalists, waxed on about their renewed participation in local churches and synagogues, their need for community heightened by the election. Like our Easter Sunrise service in the path of a pipeline, resistance to unhealthy policies is making rich and diverse new communities in which moral actions are the collective purpose, an embrace of the longstanding but often muted morality of the liberal American church.
Churches embody community by, at the most local level, providing social support to those who will most benefit from it: housing, food, child care, care for the disabled, and even health care. The voices of activist groups like Lancaster Against Pipelines and inclusive churches like Community Mennonite are made more relevant and necessary in the current political environment when they work together. Such disparate groups are increasingly finding themselves as allies. Which is only natural; we are all members of more than one group in our communities and professions.
A recent debate in the field of bioethics, a discipline predicated on balancing the health needs of individuals with those of the public, highlights the ways in which discourse about moral obligation to community has bloomed since the election. In the March-April issue of The Hastings Center Report, Mildred Z. Solomon, a professor at Harvard Medical School and president of The Hastings Center, and Bruce Jennings, a professor at Vanderbilt University and a senior advisor at The Hastings Center, co-wrote an essay that’s garnered a host of telling commentary. Their essay, “Bioethics and Populism: How Should Our Discipline Respond?,” is a kind of rallying cry for bioethicists to see the centrality of their role, as members of an interdisciplinary field long predicated on the study of justice and equity in public health, in this political moment.
Solomon and Jennings spend the first third of the essay defining America’s current form of populism. They argue that “In the discourse of constitutional democracies, ‘the people’ is an inclusive, egalitarian, and culturally and religiously diverse conception, while in today’s populist discourse, the people are defined as an exceedingly selective and antipluralistic entity.” This redefining of “We, the people” has further marginalized the concerns of all but an elite group of people, threatening the health and well being of vast demographic categories of residents.
The rest of the essay answers the question, “Why and How Should Bioethics Respond?” Bioethics, they explain, embodies the very same “values and norms of discourse” as constitutional democracy because bioethics “has been concerned with the age-old communitarian question, how should we live together?” Who should have access to new and expensive medical technologies and drugs? What health resources are we all entitled to? How can the costs and benefits of public health best be distributed? What health services violate human morality or medical ethics? How can the autonomy of individual patients be protected and defined within supportive communities?
Science, like the Church, has taught us that we are all in this together, that “We, the people” must mean everyone. The health of all, as medical science tells us, is determined by the health of individuals, and vice versa. Herd immunity, for instance, provides health safety to individuals who are not inoculated against deadly viruses, thus demonstrating the reliance of all on community. While protecting the health of the nation may involve politics, our collective obligation to do so should not be a partisan debate.
Solomon and Jennings make the case that the interdisciplinarity of bioethics, its moral weight in discussion of health justice, and its process of debating equitable structures and distribution, put bioethicists squarely at the forefront of the debate about the politics of health. The authors broadly (and rightly) include issues of the environment, the justice system, immigration, education, and food and drug safety in the realm of bioethicists’ concerns. And while they acknowledge that they are engaging in politics (it’s absurd but frequently claimed that the profession – any profession – is apolitical) they deny any partisanship. The equitable distribution of health care and resources protects and elevates the health of all Americans. What’s controversial about that? Yet, history tells us that disciplines and organizations of all types have been complicit in atrocities.
Chillingly, the essay notes how the medical industry had, in the past, been “coopted for state purposes”:
Academic medicine and practicing health care professionals played key roles in the early twentieth-century eugenics movement, assisted the U.S. government with human radiation experiments during the Cold War, and most recently were involved in the support of torture.
Complicity in immoral state actions, they warn, lies in ignoring democratic values and failing to publicly work for them. Indeed, bioethics in part grew out of this history of state-sponsored eugenics (as well as the ethical challenges created by rapid development of medical technologies). The authors are warning that the field should remember its roots.
Yet, Solomon and Jennings have received ample criticism which falls into two categories: polite admonitions that everyone should please calm down (‘cause, you know, Trump’s not so bad); and hand-wringing warnings that bioethics, the discipline, will be damaged by taking a moral stand. As Franklin G. Miller, a professor at Cornell Weill Medical College, writes in his response (also published in The Hastings Center Report):
Solomon and Jennings give the impression that bioethicists all do, or should, subscribe to a stance of liberal progressivism. Evidence for this view is the way that they advocate for “a greater focus on justice” as one of the ways in which bioethics should respond to populism. The section of their essay devoted to this position gives no attention to competing conceptions of justice; rather, their discussion of distributional and “structural” dimensions of justice provides a liberal progressive perspective, as filtered through a communitarian lens.
I stifled a giggle when reading Miller’s response. “Justice,” as he would have it, is a kind of dirty word, a dog whistle for leftists, a concept and objective that cannot be defended without partisan leanings. Trump’s administration—and his supporters—have long been on a campaign of making “justice for all” the enemy. As this conversation plays out in bioethics, it more clearly and accurately represents the health discrimination Americans have long struggled with. That Miller so publicly concedes this is stunning. Michelle Bayefsky’s response, also a criticism of Solomon and Jennings, drives Miller’s point home:
While Solomon and Jennings may have intended to appeal to fundamental democratic values upon which all civic-minded people can agree, their emphasis on human interdependence and structural and distributional injustices, as Miller points out, would likely appeal more to those with a progressive, communitarian approach.
Bayefsky worries that when bioethicists advocate for justice it could convince “those who disagree with those views” that they “do not belong in the field of bioethics.”
With new emphasis on community and justice, it’s gratifying to imagine that Trump’s election has renewed the power and persuasion of community, not only in the professions, like bioethics, but in the nation’s moral and organizing bedrock, the church. For decades, the power of liberal churches has been usurped and out-shined by the prosperity and political dominance—the partisanship—of the religious right, their purpose maligned as a relic of organized religion’s past. It is bewildering that some would try to rewrite the history of bioethics to erase its foundational purpose of health equity.
Religion has forever granted authority to moral positions on health equity (its own prejudices notwithstanding); it is seen as the keeper and legitimizer of right behavior toward one another. The role that liberal churches are playing today —and the backdrop they provide for local and national organizing—is that of moral authority. If the liberal church—with its embedded community infrastructure both physical (here is the church, here is the steeple) and social (look inside and see all the people)—can demonstrate ways to include those Trump and his henchmen have singled out, the moral conviction and license of like-minded activist groups are made stronger. The religious right has long influenced unjust moral, legal and scientific laws. But an opportunity now exists for a renewed moral voice to usurp that influence.
That the religious left is experiencing new authority in political and social America has been the topic of much discussion in the past several weeks. Daniel Schultz (pastor and, in the past, contributor to this publication) was joined by a host of conservative voices in denouncing the liberal church’s influence—on anything, let alone the health sciences. Schultz writes:
Most people on the left aren’t hostile to faith, but they’re only willing to cede it so much authority. That’s not because liberal clergy deal away the moral (or even revealed) content of their faith, as the stereotype often has it. In fact, I and many colleagues across denominations struggle mightily to know God and to understand where our faith is leading us. But we take pluralism seriously, and we are painfully aware of how faith has been used to control, hurt, and oppress the vulnerable.
I’m not denying Schultz’s well-made points—that the left is a plurality of voices whose power is affected by its acceptance of a multitude of faiths and nonfaiths. My point is more pragmatic and along the lines of Solomon and Jennings’s distinction between politics and partisanship. The religious left in the US cannot alone counter the greed and individualism that this administration is hell bent on enacting, but its voice, when amplified by activist movements and disciplines in need of moral authority and organization, perhaps can.
A multitude of positions then is not a weakness but a strength, contributing what it can to the cause of equity. I have only these slim evidences: members of a non-religious listserv extolling the benefits of right-minded, inclusive churches; and a motley but righteous Sunday Sunrise service in a Pennsylvania cornfield. The call within bioethics for a unified voice for public health makes bedfellows of the American religious left and the scientific community—and a driven smattering of movements across the country. That’s more than the recent American past can boast. And given the vagaries of the near future, enough to place one’s hopes on.
 Community is itself in need of some bit of reclamation. As Kate Reed Petty recently wrote at the Los Angeles Review of Books, “community is overused by nonprofits and has been co-opted by corporations, used as a synonym for ‘consumers.’ What hasn’t capitalism yet coopted?” (Petty directs us to this helpful discussion of the use of community in technology.) But as the word is used among burgeoning anti-Trump movements today, so has it also long been used to identify not only affinity (senior and youth centers) or proximity (the 400 block of Main Street), but a group’s organization around the practice of identifying and caring for people in jeopardy. This is where churches, the more inclusive the better, have prevailed in leveraging moral voices against injustice.
Past “The Patient Body” columns can be found here.
Ann Neumann is author of The Good Death: An Exploration of Dying in America (Beacon, 2016) and a visiting scholar at the Center for Religion and Media, NYU.