Bioethical Issues in the Concepts of Public and Private

In the history of Western political thought, public and private imperatives, concepts, and symbols have been ordered in a number of ways, including the demand that the private world be integrated fully within the public arena; the insistence that the public realm be "privatized," with politics controlled by the standards, ideals, and purposes emerging from a particular vision of the private sphere; or, finally, a continued differentiation or bifurcation between the two spheres. Bioethics is deeply implicated in each of these broad, general theoretical tendencies that often touch on the private and the public, as in a case, for example, where a couple decides to conceive a child through artificial insemination by donor (AID). What happens to a society's view of the family and intergenerational ties if more couples resort to artificial insemination? What is the effect on the psychosocial development of donor children? What are the responsibilities, if any, of the donor father beyond the point of sperm donation for a fee? Do contractual agreements suffice to "cover" not just the legal but also the ethical implications of such agreements? Does society have a legitimate interest in such "private" choices, given the potential social consequences of private arrangements? Should such procedures be covered by health insurance, whether public or private?

Questions such as these pitch us into the world of social and political theory and the ways particular ideals are deeded to us. Thus, the social-contract liberal endorses a different cluster of human goods than the virtue theorist or the communitarian. Political and social theory yield ethical debates about these competing ideals of human existence. Moral rules—and whether they are to be endorsed or overridden—are inescapable in debating human existence and the human imperative to create meaning. "Public" and "private" and the relations of politics to each exist as loci of human activity, moral reflections, social and historic relations, the creation of meaning, and the construction of identity.

The ways in which our understanding of public, private, and politics plays itself out at present is dauntingly complex. Contemporary society is marked by moral conflicts. These conflicts have deep historical roots and are reflected in our institutions, practices, laws, norms, and values. For example, the continuing abortion debate in the United States taps strongly held, powerfully experienced moral and political imperatives. These imperatives are linked to concerns and images evoking what sort of people we are and what we aspire to be. The abortion debate will not "go away" because it is a debate about matters of life and death, freedom and obligation, and rights and duties.

Perhaps the intractability of many of the debates surrounding bioethics can best be understood as flowing from a central recognition that language itself has become a preoccupation for theorists and ethicists because of our growing concern for establishing norms, limits, and meanings in the absence of a shared ethical consensus. A persistent theme of contemporary social and political theory is that language helps to constitute social reality and frames available forms of action. We are all participants in a language community and hence share in a project of theoretical and moral self-understanding, definition, and redefinition. Our values, embedded in language, are not icing on the cake of social reasoning but are instead part of a densely articulated web of social, historical, and cultural meanings, traditions, rules, beliefs, norms, actions, and visions. A way of life, constituted in and through language, is a complex whole. One cannot separate attitudes toward surrogacy contracts, in vitro fertilization (IVF), use of fetal tissue for medical experimentation, sex selection as a basis for abortion, or genetic engineering to eliminate forms of genetically inherited "imperfection," from other features of a culture. These bioethical dilemmas do not take place in isolation but emerge from within a culture and thus engage in the wider contests over meaning that culture generates.

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