1. A Foundation for Bioethics: Van Rensselaer Potter’s Legacy

How to live on a damaged planet? This was the question that the contributors to Arts of Living on a Damaged Planet asked themselves, a volume that was edited by Anna Tsing, Heather Swanson, Elaine Gan and Nils Bubandt and that appeared in 2017 (Tsing et al., 2017). At the time of writing, it is 2022, and a pandemic has thrown humanity off guard. COVID-19 serves as a wake-up call for many ethicists and policymakers. How do we go forward? How to prevent, mitigate or live with even more challenging disasters yet to come? What methods do we use? What should be the guiding ethical principles? What technologies are appropriate? How will they change us? What about possible future health crises related to environmental pollution and climate change? Bioethics is the discipline deeply invested in questions related to technologies, health, and biology. Today, in 2022, bioethical reflections on responsibility towards future generations, our position as human animals in the biosphere, and the limitations of medicine in the face of human health crises are more needed than ever. At the same time, mainstream bioethics has still to rise fully to the occasion when facing possible future calamities.

First, bioethicists like me may have ignored the situatedness of knowledge and ethical reflection. We have assumed that a toolbox of Anglo-Saxon principles such as autonomy and beneficence (Beauchamp and Childress, 1979), or more continental ones, including dignity, would suffice in maintaining an ethical biomedical practice. We have sometimes missed opportunities to engage with other value systems and marginalized standpoints. As Henk Ten Have writes in Bizarre Bioethics:

It [bioethics] is too distanced from the values of ordinary people and too far from the social context in which problems arise. Ethics should be ‘resocialized’ (i.e., located into specific contexts; for example, considering the setting of poverty with the lack of access to treatment). (ten Have, 2022)

Second, our perspectives were perhaps too fringe, too easily seduced by the lure of fantastic new technologies. Maybe disproportionally too much attention has been paid to the ethics of designer babies when the world as we know it is at risk of ceasing to exist. At the same time, the challenges humanity is facing are unprecedented. As I am writing these lines, most scientists and politicians acknowledge that it will be tough to keep the global temperature rise below 1.5 degrees Celcius. It is almost certain that generations after us will face unprecedented difficulties. Bioethics has a pivotal role as health, the environment, and new technologies have been the topics of our enquiry long ago. Still, until recently, environmental or engineering ethics have played a marginal role in bioethics conferences. Questions about environmental justice and where the world should be headed are often overshadowed by discussions about genetic privacy and the risks of genetic modification. Indeed, Arts of Living on a Damaged Planet contains contributions of artists, writers and academics working in anthropology, history, humanities, biology, feminist philosophy, botany, ecology, literature and genetics, but no bioethicists.

Since the second half of the twentieth century, bioethics has been heavily influenced by Georgetown professors Beauchamp and Childress’ book Principles of Biomedical Ethics (Beauchamp and Childress, 1979). This book laid down what would become the four principles of bioethics that every beginning bioethics student has to learn: autonomy, beneficence, non-maleficence, and justice. Since its publication, many have criticized it for valid reasons that will make their way into this book: the principles are too Anglo-Saxon, too Global North, too abstract and should be supplemented with situated knowledge and context-sensitive information, facts that Beauchamp and Childress themselves wholeheartedly agree with. What has not often been questioned is the task of bioethics with regard to science. Bioethics and the science it relates to are seen as two separate endeavours. Although bioethicists thinking about research ethics have thought about how to do science ethically, as in not committing fraud and protecting the privacy and integrity of research participants, we have often taken for granted the starting points and the aims of science itself. According to Henk ten Have, this has led to a reduced critical potential. As such, the agenda of bioethics accommodates ‘the social and cultural context in which it has emerged’ without querying the underlying values that guide science (ten Have, 2022, pp. 26–29). We do not often comment on what science there should be, what science we should want, or what future such science should create. Bioethics and exact science are seen as practices with fundamentally different methods and finalities. As if they, in the words of PC Snow, belong to two cultures (Snow, 1993).

Bioethics has not always been conceived as a handmaiden to science and medicine. It is worth going back into the history of ‘bioethics’. One of the first people to think about ethics and science and the inseparability of health and environment was the American biochemist and professor in oncology Van Rensselaer Potter (1911–2001), as is described in Henk ten Have’s book Wounded Planet (ten Have, 2019). Potter wrote two books: in the first, his focus was on bridging the gap between biology and ethics, and in the second, he developed a global bioethics that encompasses both societal concerns and more individual concerns, the latter being more readily associated with mainstream bioethics as we know it today. His first book Bioethics: Bridge to the Future, was written in 1971 (Potter, 1971). At that time, there was a need to think about a liveable future for human beings. Rachel Carson had described the potentially disastrous consequences of pesticides in her 1962 book Silent Spring (Carson, 2002).

Potter aimed to ’contribute to the future of human species, by promoting the formation of a new discipline, bioethics’. We now tend to forget to mention his work in bioethics courses. Potter’s idea that ’ethical values cannot be separated from biological fact‘ is now often considered naive and potentially even dangerous. For Potter, ethics that can help us live and survive on a damaged planet should be based on biological knowledge, hence bioethics. However, for him, such biological knowledge cannot be reductionist or determinist. Potter argues that the biology he thinks our knowledge should be based on is holistic, not mechanistic, as was the predominant view in the twentieth century. Such a view of life makes it self-evident to see nature and life as objects that can be manipulated and tampered with. Biological ethics should be based on ecological and ethical holism. According to Potter, life is full of chance, feedback loops, and disorder. This disorder is the raw material for creativity, for the potential of ethical biology to imagine and create a future for humanity. We need educated leaders who are trained in both science and humanities. He describes a Council on the Future, quoting Margaret Mead, to use ‘The future as a basis for establishing a shared culture’. Such an interdisciplinary council can function as a fourth power, independent from the legislative, executive, and judiciary powers, and needs to safeguard the future.

In his second book, Global Bioethics, Van Rensselaer Potter is disappointed that the bioethics he envisages has not taken flight (Potter, 1988). Instead, he writes, bioethics had become synonymous with medical ethics. According to Potter, there are two types of bioethics, medical bioethics, which has a short-term view, and environmental bioethics, with a long-term perspective. Both are part of ‘global’ bioethics, which considers different viewpoints, including the feminist viewpoint. His views in this book, especially his insistence on tackling overpopulation, are sometimes ableist and do not systematically consider the global south’s perspectives. Still, the idea of global bioethics that extends beyond the individual relation between practitioner and patient and has a long-term view of humanity’s survival as a goal is refreshing and sorely needed, especially now. So is the idea that life, science, and ethics are entangled. For Potter, ethics is based on science, as is evident from this quote: ‘As concerned humans, we “ought” to consider the “is” of earth’s carrying capacity and how it can be enhanced and preserved’. There may be wisdom in biology. At the same time, scientific practice should be guided by ethics and a desire to preserve humanity. Science and ethics are entangled in a non-hierarchical way.

With this book, I want to take to heart the hopes and dreams of Potter.¹ Following Potter, I argue that bioethics and biology are fundamentally entangled and show that bioethics should claim its position at the science table from the design phase of research. Bioethics is not merely an afterthought. I also argue that bioethics can and should extend beyond medical practice or fringe cases such as genetically edited embryos and confront urgent cases such as the environmental crisis heads on. I use ideas from different thinkers, recent and less recent, that corroborate this idea. At the same time, I believe Potter’s framework needs some rethinking. I have found inspiration in feminist posthumanist thinking and standpoint epistemology. Speculative bioethics, a bioethics for the future of humankind, is necessarily also an intersectional bioethics. It is forward-looking but not utopian and takes the trouble and messiness of the present as a starting point to develop something better. For example, I shall not follow Potter’s somewhat problematic suggestion that restricting population growth is the main answer. In fact, I will not offer ‘solutions’ at all. I advocate for bioethics that stays with the trouble, in the words of Donna Haraway (Haraway, 2016). Quick fixes and simple solutions that strip arguments of all the ballast that may obscure them are counterproductive.

At the same time, it is not my aim to attack a ‘straw man’ bioethics. The book at hand is more a reflection on my readings of the last decade and a critique of my own earlier work than it aims to caricature bioethics as a field altogether. In fact, during the last decades, more and more voices have advocated for a more critical bioethics, often mentioning Potter’s foundational ideas. This book is as much a description of a personal journey as it is an academic work. As I shall argue that also in bioethics, situated knowledges (and thus a critical reflection on one’s own situated knowledge) matter, I think this approach is warranted. I am indebted to many great thinkers that have formulated similar ideas. For example, in her brilliant book Bioethics in the Age of New Media, Joanna Zylinska has pinpointed and criticized three main characteristics of ‘traditional’ or ‘mainstream’ bioethics: a sense of normativity, or being able to pinpoint what is the ‘good’, the rational human subject that can make a decision and is the source of this decision as a starting point, and the need for the universalization and applicability of the moral judgment (Zylinska, 2009). Zylinska offers an alternative: she is inspired by Levinas to advocate for a posthuman bioethics of ‘responsibility for the infinite alterity (i.e., difference) of the other, as openness and hospitality’, while at the same time offering insights from cultural and media studies. Her view on life is deeply relational:

What we are dealing with, however, is not so much a ‘human being’ understood as a discrete and disembodied moral unity but rather a ‘human becoming’: relational, co-emerging with technology, materially implicated in sociocultural networks, and kin to other life forms (Rogers, 2022)

I will also argue for a kind of posthuman bioethics that embraces entanglements of all levels of life, although I start from different thinkers than Zylinska.

Feminist bioethicists such as Hilde Lindemann have argued for situated knowledge and the inclusion of care perspectives and understanding experiences² (Lindemann, 2006; Lindemann, Verkerk and Walker, 2008). Scholars such as Jackie Leach Scully and Rosemarie Garland-Thomson have convincingly argued for including a disability perspective in bioethics (Scully, 2008, 2012; Garland-Thomson, 2012).

Moreover, many colleagues have suggested that bioethics should not solely be about individual relations and responsibilities. It should question the system it operates in. These colleagues suggested that we should marry bioethics and political philosophy. For example, Joseph Millum and Ezekiel J. Emanuel argue in their volume Global Justice and Bioethics that bioethics must move away from parochialism:

The facts of globalization mean that a responsible bioethics must address problems of international scope. But the expansion of the scope of both theories of justice and the problems of bioethics into the global arena means that the concerns of the two now intersect to an unprecedented degree. Consequently, it is now impossible to engage with many of the most pressing problems of bioethics without also engaging with political philosophy (if, indeed, it ever was possible) (Millum and Emanuel, 2012).

In Global Bioethics, Henk ten Have advocates for bioethics that acknowledges the impact of globalization on health and also questions the social, economic, and political context that is producing the problems at a global level. In Wounded Planet ten Have is inspired by the works of Van Rensselaer Potter to argue for bioethics that extends beyond biomedical ethics to include environmental ethics (ten Have, 2019). In Naturalizing Bioethics, the editors, Hilde Lindemann, Marian Verkerk and Margaret Urban Walker, advocate for a new interpretation of naturalism in Bioethics that includes situated knowledges and analysis of power structures rather than assuming that knowledge can be produced from an Archimedean perspective:

Our naturalism, however, does not privilege institutionally organized natural and social scientific knowledge but also embraces the experience of individuals in personal, social and institutional life. Our naturalism is also wary of idealizations that bypass social realities and of purely ‘reflective’ approaches to ethics that are apt to reflect only some, and usually the socially most privileged, points of view regarding the right, the good, and moral ideals such as autonomy, respect, beneficence and justice (Lindemann, Verkerk and Walker, 2008, p. 5).

In this book, I want to stand on the shoulders of these giants who have laid the foundation of rethinking bioethics to make it relevant to the challenges we are facing. In the words of Potter and Joanna Zylinska, I believe it is possible to reclaim bioethics as proper ethics of life. Such ethics of life includes thinking about the lives and health of humans and other-than-human beings, the macrocosmos and the entanglements of all these entities. In what follows, I investigate how to imagine bioethics as a discipline in times of superwicked problems,³ using ideas from process philosophy, biology, and feminist posthumanism.

Such an approach implies that bioethics is a grand project that focuses on interpersonal and interspecies relations but that at the same time is political and, to use Isabelle Stengers’s words, cosmopolitical (Stengers, 2005). The description of bioethics as a ‘meeting ground’, as Onora O’Neill has called it, is more than ever accurate (O’Neill, 2002). It also means that we take Van Rensselaer Potter’s idea of bioethics seriously as a foundational approach permeating all scientific practice levels. Next to positioning bioethics in relation to other sciences, exact sciences, philosophy, and humanities, I also use a specific concept of life that I think should guide bioethics. I have borrowed this concept from systems thinkers such as Stuart Kauffman, Donna Haraway and Lynn Margulis and developmental systems theory and process philosophy. Arguing that there should be more dialogue between the sciences and bioethics and philosophy, also on very conceptual and fundamental issues, and at the same time already committing to a particular processual view on life and the universe may look contradictory. Perhaps this need not be the case. For one, process views on life offer us a way of looking at science in a way that both acknowledges the historicity of particular thought and the idea that such acknowledgement does not mean that we have to buy into the idea that everything is relative. At the same time, a new materialist or process view on matter and life also entangles ethics and science at its core. Science is as much about world-making as it is about describing the world, and describing is also world-making. Getting science right is not separated from imagining what future we want. It is at this nexus that the bioethicist is at home.