Reconceiving bioethical proceduralism: an ontological perspective.

This year marks the 40th anniversary of the Belmont Report that formally ushered in an era of principlism and proceduralism in the field of bioethics, an era which shaped the form of bioethical debate according to the combination of Enlightenment-inspired dualism and Liberal pragmatism characteristic of the United States. While ostensibly seeking to protect the vulnerable in a pluralistic society, in reality, recent critiques have argued, the development of bioethics has been directed at legitimizing the bureaucratization of ethics into a self-referential and isolated instrument for socio-political control. As a result, bioethical proceduralism often subverts the very values it is supposed to defend. These critiques, while valuable, do not reach the heart of the problem, which is rooted in the ontological level. The philosophical heritage of modern bioethics -the ontological presuppositions about human nature, freedom and the supposed ″neutrality″ towards any claims about the good, among others- must be rectified so bioethics may better achieve its stated goals and uphold its own principles. While recounting the entire ontological vision that would undergird such a renewal is beyond the scope of this paper, reconceiving the presuppositions behind the notions of freedom, consensus, and autonomy through an understanding of the human being as a person-in-community constitutively related to others opens a path through which principles and procedures can be preserved, not subverted, within bioethics today.