Cracks in the Foundations of Engelhardt’s Bioethics

Abstract

H. Tristram Engelhardt’s work on the foundations of secular bioethics can be divided into two major projects: (1) a critical project that challenges the prevailing methods and values of thick, content-full bioethical discourse, and (2) a constructive project that seeks to fashion a minimalistic, content-less bioethics anchored by default in a principle of bare permission-giving. Engelhardt’s aim, then, is to establish a bioethics that avoids both moral nihilism, on the one hand, and a thick content-full moral grounding, on the other. In this chapter, I argue that the internal tension between these critical and constructive projects is unstable and ultimately pushes Engelhardt’s bioethics to one side or the other. In making this argument, I identify numerous “cracks” in the foundations of Engelhardt’s bioethics that arise from fundamental assumptions that are taken for granted in his work. These cracks already surface when Engelhardt’s framework treats paradigm cases in bioethics (i.e., interactions between fully mature, independent, and autonomous individuals), but expand dramatically when this same framework is applied to non-paradigm cases, including standard cases in pediatric bioethics.