Before proceeding, I must indicate what I take the philosophy of medicine to be—namely, philosophical reflection on the epistemological, metaphysical, and moral claims made within or about medicine, the biomedical sciences, and health care generally (including the practice of giving philosophical guidance and advice within those fields). The philosophy of medicine broadly understood encompasses not just elements of the philosophy of science directed toward medicine, such as the exploration of models of explanation and prediction in medicine, but also those theoretical, metaphysical, and moral reflections on health care (e.g., are fetuses persons?) more commonly placed under the rubric of bioethics. I use the phrase “philosophy of medicine cum bioethics” to identify a complex field of philosophical reflection on medicine and the biomedical sciences, a field in which epistemological and moral issues interplay and are intimately tied to applied concerns, which is to say, to clinical and public-policy decision-making.
My claim is not simply that this field has emerged as a cultural resource that provides us with conceptual distinctions, analytic clarifications, geographies of possible understandings, and assessments of competing arguments. I contend that the field has come to be regarded as the source, with respect to health-care policy, not only of moral instruction, but of canonical secular normative guidance. Bioethicists have come to be seen as moral experts that are able, when consulted by physicians, nurses, and patients, to give guidance in health-care contexts regarding what it is to act ethically. They serve on hospital ethics committees and give advice as members of institutional review boards (IRBs) overseeing the use of humans in research; they also provide guidance for policy-making boards. In these various offices, the task of a bioethicist is often strategically blurred between (1) giving an account of the issues at stake in a particular decision, (2) approving of a particular choice, and (3) certifying the acceptability of a particular choice. Along this spectrum, the bioethicist’s role shifts: he moves from being someone who is an authority about moral-philosophical matters to being someone with the social authority to certify a choice pertaining to clinical practice or health-care policy. As bioethicists became secular moral experts—meaning here persons socially ordained to guide a secularized culture in need of direction for its use of new, expensive, and powerful technologies—the philosophy of medicine, and in particular bioethics, became the secular moral and dogmatic theology needed to inform these new secular pundits, these persons acknowledged as authorities who should not only help guide clinical choices as well as serve on ethics committees and national commissions, but should also be recognized by courts as moral experts. Through its legitimation as a guide for health-care policy, the philosophy of medicine cum bioethics has taken on a novel sociopolitical significance: it has been accepted as a source of official medical morality.
(H. Tristram Engelhardt Jr, "The Ordination of Bioethicists as Secular Moral Experts," Social Philosophy & Policy 19 [July 2002]: 59-82, at 61-2)
