Bioethics, ideology and the market

The issue of whether and to what extent market forces and private property in the means of production provide appropriate mechanisms for controlling the production and distribution of biomedical resources is a 'standard' component of the bioethical syllabus. But it is seen as just one issue amongst many others. Typically it is pursued in depth only towards the end of the course and the text-book - under the heading of 'social justice and health care policy'. There, the parameters of the discussion are generally circumscribed by liberal political and economic ideas of 'efficiency' and 'respect for individual private property rights' versus 'equity' and public health. The old debate between Rowls and Nozick, interpreted in terms of interventionist versus non-interventionist public policies is often a central focus of attention, with very limited consideration of the broader ethical consequences or possible irremediable contradictions of capitalist market relations. This segregation of 'economic issues' is very much in keeping with the currently dominant neoclassical or 'economic rationalist' ideology, which sees 'legitimate' economics as a 'positive' science, separate from sociology, politics and history and essentially value-free. But there are good grounds for arguing that the bioethical significance of capitalist market forces extends well beyond the appropriate 'balance' of public and private' in a 'mixed economy' of health care; that such forces profoundly influence all other areas of bioethical concern - including research, technology, treatment and the obligations and rights of professionals. Most importantly, so too does their bioethical significance extend beyond the established syllabus to areas - like the social causes of ill-health - that are all too often ignored or marginalized in courses and textbooks on bioethics. At the same time, neoclassical and right-wing liberal theory are used to direct and legitimate policies of accelerated privatization and deregulation of health care and biomedical research around the world. Here, then, is one major area of 'silence' in the discipline; the area of critical analysis of the neoclassical economic ideas that condition much of contemporary discussion of the economics of health care; and the application of such critical analysis in consideration of the brooder bioethical implications of capitalist market relations. Hopefully, with the opening up of this area, so too can we open up a range of new policy possibilities for biomedical theory and practice. In this context there is a strong case for an active role for critical political economists in speaking for bioethics, alongside of health professionals, philosophers, politicians and patients. And in what follows I will begin to apply some such critical political economic ideas in examining general issues of the covert morality of neoclossicol economics and the brooder bioethical implications of capitalist market relations.