The Care of Life: Transdisciplinary Perspectives in Bioethics and Biopolitics

by Miguel de Beistegui (Editor), Giuseppe Bianco Dr (Editor), Marjorie Gracieuse (Editor)

Overview

This interdisciplinary collection of essays demonstrates how the ethical and political problems we are confronted with today have come to focus largely on life. The contributors to this volume define and assess the specific meaning of life itself. It is only by doing so that we can understand why life has become an all-encompassing problem, why all questions, especially ethical and political, have become vital questions. We have reached a moment in history where every distinction and opposition is no longer in relation to life, but within it, and where life is at once a theoretical and practical problem.

This book throws light on this nexus of problems at the heart of contemporary debates in bioethics and biopolitics. It helps us understand why and how life is understood, valued, cared for and framed today. Taking a genuinely transdisciplinary approach, these essays demonstrate how life is a multifaceted problem and how diverse the origins, foundations and also consequences of bioethics and biopolitics therefore are.

Product Details

ISBN-13:	9781783480395
Publisher:	Dutton Penguin Group USA
Publication date:	12/22/2014
Sold by:	Barnes & Noble
Format:	eBook
Pages:	332
File size:	1 MB

About the Author

Miguel de Beistegui is professor of philosophy at the University of Warwick, UK. His many publications include Aesthetics After Metaphysics (Routledge, 2012), Proust as Philosopher (Routledge, 2012), Immanence and Philosophy: Deleuze (Edinburgh University Press, 2010) and The New Heidegger (Continuum, 2005).

Giuseppe Bianco is a postdoctoral Leverhulme research assistant at the University of Warwick, UK. He is co-editor of Badiou and the Philosophers (Bloomsbury, 2013).

Marjorie Gracieuse is a postdoctoral Leverhulme research assistant at the University of Warwick, UK.

Contributors: Katherine Angel, Leverhulme Trust Fellow (Queen Mary, University of London); Robert Bernasconi, Edwin Erle Sparks Professor of Philosophy (University of Pennsylvania, USA); Giuseppe Bianco, postdoctoral Levehulme research assistant (University of Warwick, UK); Florence Caeymaex, Professor of Philosophy (Université de Liège, Belgium); Lorenzo Chiesa, Professor of Modern European Thought (University of Kent, UK); Miguel de Beistegui , Professor of Philosophy (University of Warwick, UK); Piergiorgio Donatelli, Professor of Philosophy (Sapienza University of Rome, Italy); Steve Fuller, Auguste Comte Chair in Social Epistemology (University of Warwick, UK); Marjorie Gracieuse, postdoctoral Leverhulme research assistant (University of Warwick, UK); Hector Kollias, Lecturer in French (King’s College London, UK); Guillaume LeBlanc, Professor of Philosophy (Université Michel de Montaigne, Bordeaux 3, France); Paul-Antoine Miquel, Professor of Philosophy (Université de Toulouse, France); Julien Pieron, Research Associate (Université de Liège, Belgium); Aaron Schuster, Research Fellow (Institute for Cultural Inquiry, Berlin, Germany); Patrick Singy, Fello (Columbia University, UK); Claudia Stein, Associate Professor of History (University of Warwick, UK); Sander Werkhoven, PhD candidate (University of Warwick, UK); Charles Wolfe, Research Fellow in Philosophy (University of Ghent, Belgium); Andy Wong, PhD candidate (University of Ghent, Belgium); Frédéric Worms, Professor of Philosophy (Ecole normale supérieure, France)
Miguel de Beistegui is Professor of Philosophy at the University of Warwick, UK.
Marjorie is an affiliate member of the ERRAPHIS research laboratory (Toulouse, France) and teaches Philosophy and French literature at the Institut Florimont in Geneva, Switzerland.

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The Care of Life

Transdiciplinary Perspectives in Bioethics and Biopolitics

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By Rowman & Littlefield, International

Rowman & Littlefield International, Ltd.

Copyright © 2015 Miguel de Beistegui, Giuseppe Bianco, Marjorie Gracieuse and contributors
All rights reserved.
ISBN: 978-1-78348-039-5

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CHAPTER 1

A Brief History of Bioethics

Guillaume Le Blanc

WHY BIOETHICS HAS NOT ALWAYS EXISTED

I want to begin by stressing that we did not always think the questions of disease and health in terms of bioethics. There were days, not so far from us, when human life was not reflected in the vocabulary of bioethics. It seems that we already know everything about bioethics. Where does it come from? Why has it appeared as a peculiar way of questioning the power of medicine? Bioethics is everywhere and seems to be a new way of governing human life within medical power and biology. A very strong explanation consists in the claim that bioethics is an effect of the transformation of life produced by medicine. In particular, because of the disappearance of frontiers between nature and culture, and so far as life can be modified by science, the medical is disoriented and, it would seem, in need of a new moral discourse, on which new points of reference could be grounded. Also, bioethics is viewed as a new moral consciousness which, like every event, has historical roots. In every book of bioethics, we find this first chapter, which speaks of glorious fathers and mothers. For example, Florence Nightingale Pledge, written by the English nurse Lystra Gretter in 1893; the professional ethics of the American Medical Association, published in 1847; and even Thomas Percival's Medical Ethics, published in England in 1793, are most often viewed as the first utterances of a bioethics. I believe this view of history to be misled. In fact, we are dealing with a myth according to which bioethics has always existed. In my view, we need to approach the question of bioethics from another angle, and understand that a genuine history of bioethics means that there is a birth certificate of bioethics.

Bioethics does not belong to an earlier history because it is a new and radical event in the way of treating life. Foucault has helped us problematize a history based on abrupt changes. I would like to refer to a specific page of Birth of the Clinic, in which Foucault identifies a break between the old medicine of the eighteenth century and the new medicine of the nineteenth century. Medicine is no longer characterized by the value of health, but by that of normality. If there is such a break between two kinds of medicine, how could we claim that they belong to a same space of knowledge? How could they belong to a same form of power? There are, in fact, important transformations in the spaces of both knowledge and power. The birth of the clinic is a new event in the order of knowledge and power. It signifies a new experience of power based on a new knowledge, biology. The bodies are auscultated, individualized within a new framework, that of the hospital. To be sure, the aim, in treating patients, remains the recovery of health. But the value of health now unfolds in the medicine of normality. And as a result of the emergence of normality, a new meaning of health appears. According to Georges Canguilhem's seminal The Normal and the Pathological, Broussais, followed by Auguste Comte, elaborated a new way of conceiving of diseases, according to which there is no qualitative difference between the normal and the pathological. The pathological is a simple variation of the normal, an excessive reaction or, on the contrary, a failure to react. This means that health can no longer be annulled by a merely external entity. Health is henceforth threatened by a dysfunction of the normal itself, and the pathology is located at the heart of the normal. It is no longer an external threat; it becomes an internal possibility. In this context, the reference to health ceases to have the same meaning. It ceases to be a common value that lies outside the field of medicine, and becomes a medical construction underpinned by the identity of the normal and the pathological.

Thanks to the reversibility of the normal and the pathological, the field of medicine can henceforth conquer an appropriate space. Medicine is all the more successful that it is fixed within the limits of nature: normality, which, evidently, signals an abstraction, nonetheless indicates a natural frequency. The medicine of normality is then one in which the identity of the normal and the pathological testifies to the unity of life in its different manifestations, and fixes the medical intervention within the limits of a restoration of the natural norms, for the body as well as the mind. We need to pay specific attention to the fact that the birth of the clinic reveals a strange paradox: where it is carried out at the bedside of the patient, it remains that the medical glance is interested in an individualized body only to the extent that it can conquer the pathology that lives inside it. In addition to the clinical relation between the doctor and the patient, there is in fact another, more hidden medical relation — namely, that between the doctor and the pathology itself. This, in turn, means that the existence of the patient is bracketed. As René Leriche puts it in Philosophie de la chirurgie, the patient as such is someone who can only give false clues about his or her body and thus compromise the purity of the diagnosis. We should keep in mind that, under such conditions, bioethics can't even exist, since it's supposed to be connected with the consciousness of the sick person, and particularly with the consciousness of the dangers inherent to medicine.

TOWARDS AN ARCHAEOLOGY OF BIOETHICS

If we want to witness the birth of bioethics, we need to pay close attention to the Nuremberg Code, which was written in 1947 with the explicit purpose of avoiding the inhumanity of the experiments led by the Nazis during the Second World War. It introduces the category of consent, which became extremely influential. Its first article stipulates that "The voluntary consent of the human subject is absolutely essential". Furthermore, it must be informed. Before agreeing to the experimentation, the person must know the nature of the experiment, its length and its purpose. The experiment should benefit the person, but also society as whole (Article 2). Bioethics seems to originate from this new consciousness that someone might have about the dangers of a given experiment, and that a population might also have about the benefits of the experiment in question. The reference to consent creates a bridge between the interests of the patient and the interests of medical research, and involves a new logic in which the dangers of medicine itself are recognized. In this new history, marked by the reference to consent, a new character comes to light: the sick person herself. This promotion of the sick person is an event, when compared with the earlier history, described, for example, by Foucault in Birth of the Clinic. But we can give two interpretations to such a promotion. On the one hand, we can claim that each sick person is an individuality, and one who, as such, medical power must respect, and in relation to whom it needs to disappear qua power, and exist only in order to restore the health of a given life. On the other hand, we should also realize that we can be threatened by the medical art itself: medical power can kill or damage bodies.

There are, in fact, two different episodes. In the first one, medicine is viewed as a clinic — that is, as a kind of relation between the doctor and the patient, in which the most important thing is to preserve the singularity and the dignity of the patient. In the second one, medicine is viewed as a strong power that has the ability to turn against the patient himself. In fact, in the second type of episode, it seems that the medical practice not only fights against the dangers of illness but also generates specific dangers that are due to the extension of the medical world. Each episode has, so to speak, its author. Canguilhem's reflections belong to the first one and the critic of the medical power proposed by Foucault to the second. I consider that an archaeology of bioethics refers to the second episode, and not the first. Let me explain.

What are the features of the first sequence? Contrary to Broussais and Comte's assertions, the normal and the pathological are not phenomena of the same order and are placed in two different experiences of life. Furthermore, the sick person needs to be attended to before, and ahead of, the illness. As Canguilhem asserts, "It is always the relation to the individual patient through the intermediary of clinical practice, which justifies the qualification of pathological". It's always the relation to the sick person which, by means of the clinic, involves the diagnosis of a pathology. We feel sick first, before we are diagnosed as really sick, and this feeling comes from the loss, whether partial or total, of our normativity. Thus, being ill consists in the loss of normativity, and absolutely not in the loss of normality. In addition, that which, according to Canguilhem, limits medical power is, in a way, nothing other than a philosophy of life, according to which by life as such is described in terms of its own creativity.

By contrast, in the second sequence, the use of medicine is no longer thought to be entirely beneficial for the patient. It becomes clear that medicine is not only a clinic but also a power. And such a power can be used against the patient himself. From another point of view, the relation between the normal and the pathological plays a minor role when compared to the extension of the pathological field. Such an extension can no longer be viewed as an experience of life led by the patient, but needs to be interpreted as a generalization of the pathological risks. In 1974, Foucault gave three talks entitled "Crisis of Medicine or Crisis of Anti-Medicine?" Initially, they were meant as a review of Illich's book, Medical Nemesis. In those lectures, Foucault points out that our societies are regulated by the generalization of pathology, so that medicine is now everywhere and has penetrated every sphere of life. This generalization can be attributed to the end of the clinical model and to the construction of a new category, that of "the medicalizable". As a result of this medical expansion, Foucault claims, the traditional boundaries defined by the sick person and his pathologies tend to disappear. What we have instead is an economic field of health, in which medicine is required to produce health. The status of life has changed in this second scenario. Life is not only the life of someone but also, and above all else, a reality in itself. We therefore expect a certain valorization of life and we know that Foucault gives it a name: biopolitics. In this new context, life has become an economic challenge. Medicine is required to maintain life in all its forms. As a result, new kinds of risks arise, which have to do with the medicalization of life as a whole and the multiplication of therapeutic interventions. Every form of life, every organ becomes a target for medicine. Today, it's impossible to imagine a single aspect of life that's not represented by a medical domain. By definition, medicine has no field outside itself.

Let me now say a few words about the archaeology of bioethics. First, bioethics is a kind of reaction against this extension of medicine. Second, if every single field of life falls under the control of medicine, and if a certain therapeutic relentlessness belongs to modern medicine, it becomes necessary to erect limits in order to deny medicine an absolute power over life: we need bioethics to formulate moral arguments against all kinds of medical interventions on life. Third, it is particularly tempting to understand bioethics as an extension of biopolitics. But I think this would be a mistake, since bioethics would then be nothing other than a reaction against biopolitics. But the question we're confronted with is the following: how can bioethics operate as a critique of biopolitics if it does not speak under the first scenario — that is to say, under the figure of the respect of the patient's dignity and integrity? Fourth, something more important than the dignity of the patient is at stake in bioethics, and that is the promotion of life as a value: the defence of the dignity of the patient tends to be the strongest argument in favour of the value of life itself. From this point of view, and contrary to what I seemed to be saying at the beginning of this chapter, the bioethical gesture does not simply involve a strong break between natural life and artificial life. Rather, it contributes to the valorization of some forms of life as natural, and to the rejection of some other forms of life as artificial.

THE TWO BIRTHS OF BIOETHICS

We have to pay attention to both conditions, the absolute value of life and the absolute value of the patient, if we want to understand the two births of bioethics, which in fact refer to two different origins. To begin with, the word "bioethics" has an ecological meaning. It was used by Van Rensselaer Potter in a famous article from 1970, "Bioethics, the Science of Survival", and developed in a book the year after: Bioethics: A Bridge to the Future. But it is also, and at the same time, used in a medical context, and with the creation of the "Joseph and Rose Kennedy Institute for the Study of Human Reproduction and Bioethics" in 1971. One of its three sections received the name of "Center for Bioethics". Let me note, in passing, that this medical turn was already prepared by Paul Ramsay in 1970 when he published his The Patient as Person. From the start, the word "bioethics" was the site of a conflict between an ecological meaning and a medical one. How can we interpret this conflict within bioethics? Van Rensselaer Potter himself acknowledges it an article from 1987, called "Aldo Leopold's Land Ethic Revisited: Two Kinds of Bioethics". In that article, he deplores the reduction of the original meaning of bioethics and its strict application to the field of medicine. By contrast, he pays attention to the two different meanings. Although medical bioethics is addressed to human persons in order to protect their existence against medical power, bioethics in the second sense concerns every living person, and even the ecosystem as a whole. Furthermore, ecological bioethics involves a strong discussion about the interdependency of all living beings and is concerned with protecting the future. By contrast, medical bioethics argues in favour of the independence of every person and takes place in the present.

It can seem surprising that, at the beginning of its history, bioethics was an ecological concept. As such, it amounted to a new government of nature, and the regulation of medicine was just a part of a general regulation of life on earth. In fact, Van Rensselaer Potter was truly inspired by Aldo Leopold and his idea of a "land ethic". In the third part of A Sand County Almanac, first published after his death in 1949, Aldo Leopold wrote a speech for the defence of an ethics, the main function of which was to define the correct relation that we can develop with other living beings, and even the earth itself. In reality, this ethics should enable us to gain a new perspective on life, and on the earth. The earth does not belong to human beings. On the contrary, we should realize that human beings belong to the earth. The love of this belonging is the main idea behind Leopold's "land ethic". On one level, we are faced with the earth as a community: that's the main idea of ecology. On another level, we are faced with the idea that we should love the earth and treat her with respect, and that's the main idea of an ethics.

We understand now why there is a conflict between different forms of bioethics. According to Potter, if bioethics is an extension of ecological ethics, how is bioethics, understood in that sense, compatible with medical bioethics, understood as the government of human life, which tends to forget the reference to nonhuman nature?

(Continues...)

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Excerpted from The Care of Life by Rowman & Littlefield, International. Copyright © 2015 Miguel de Beistegui, Giuseppe Bianco, Marjorie Gracieuse and contributors. Excerpted by permission of Rowman & Littlefield International, Ltd..
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Table of Contents

Acknowledgements / List of Contributors / Introduction / Part I: ‘Bioethics’ and ‘Biopolitics’/ 1. A Brief History of Bioethics, Guillaume Le Blanc / 2. Between (Bio)-Politics and (Bio)-Ethics: What Life?, Luca Paltrinieri / 3. What is Vital?, Frédéric Worms / Part Two: Norms and Normality / 4. The Return of Vitalism: Canguilhem, Bergson and the project of a biophilosophy, Charles T. Wolfe and Andy Wong / 5. Life and Objective Norms: Canguilhem in the Context of Contemporary Meta-ethics, Sander Werkhoven / 6. Critical and Political Stakes of a Philosophy of Norms. Part I: Towards a critical philosophy of norms, Julien Pieron / 7. Critical and Political Stakes of a Philosophy of Norms. Part II: Theory of Norms and Social Criticism, Florence Caeymaex / 8. The Racial Politics of Life itself: Goldstein, Uexküll, Canguilhem, and Fanon, Robert Bernasconi / 9. History and the Politics of ‘Life’,Claudia Stein and Roger Cooter / Part Three: Pathology and Ageing / 10. Life of Pain. Remarks about Negativity and Effort in Georges Canguilhem, Giuseppe Bianco / 11. Human Life and Subjectivity. Learning from Foucault, Piergiorgio Donatelli / 12. Ethics of Care and Face Transplant. After Levinas, Deleuze and Guattari, Marjorie Gracieuse / 13. Ageing and Longevity, Paul-Antoine Miquel / 14. Generational Change as a Vehicle for Radical Conceptual Change: the Case of Periodic Rejuvenation, Steve Fuller / Part Four: Desire and Pleasure / 15. Sexuality and liberalism,
Patrick Singy / 16. Desire Within and Beyond Biopolitics, Miguel de Beistegui / 17. The Pragmatics of Desire and Pleasure: Rethinking Somatic Powers with Foucault, Deleuze and Guattari, Marjorie Gracieuse and Nicolae Morar / 18. Revenge of the Tender Pervert: On A Troubling Concept that Refuses to Go Away, Hector Kollias / 19. Jouissance in Lacan’s seminar XX: Proglomena to a New Reading of Strange Enjoyement and Being an Angel, Lorenzo Chiesa