Ethic Theory Moral Prac (2007) 10:409 418
DOI 10.1007/s10677-006-9058-y
Eugenics and the Criticism of Bioethics
Ann Kerr and Tom Shakespeare, Genetic Politics: from eugenics
to genome, Cheltenham: New Clarion Press, 2002, ISBN
(paperback) 1 873797 25 7, ISBN (hardback) 1 873 797 26 5
Stephen Wilkinson
Accepted: 21 November 2006 / Published online: 9 January 2007
#
Springer Science + Business Media B.V. 2007
Abstract This article provides a critical assessment of some aspects of Ann Kerr and Tom
Shakespeare's Genetic Politics: from eugenics to genome. In particular, I evaluate their
claims: (a) that bioethics is too  top down , involving normative prescriptions, whereas it
should instead be  bottom up and grounded in social science; and (b) that contemporary
bioethics has not dealt particularly well with people's moral concerns about eugenics. I
conclude that several of Kerr and Shakespeare's criticisms are well-founded and serve as
valuable reminders to the bioethics community. These include the claims: that bioethics
ought not to consist entirely of applying moral theory to cases; that bioethics must take
account of relevant empirical evidence; and that bioethicists should be on the look out for
those subtle social forces which can undermine the voluntariness of people's choices and
consents. However, we should reject some of Kerr and Shakespeare's other criticisms and I
conclude (amongst other things) that even  mainstream bioethics is better able to deal with
difficult issues like eugenics than Kerr and Shakespeare suggest.
. . .
Key words eugenics bioethics moral theory genetics
Ann Kerr and Tom Shakespeare spend much of Genetic Politics: from eugenics to genome
providing an informative, interesting, and accessible account of the history of eugenics. In
this respect, the book is a welcome addition to the literature. As well as the most obvious
manifestations of eugenics (such as Nazi  racial science ) they deal with eugenics move-
ments in Scandinavia, the UK, and the USA.
One interesting theme of the descriptive part of the book is that eugenics can take many
forms and that a wide variety of different means can be, and have been, deployed in order to
achieve the eugenic end of  improving the gene pool. Thus, at one extreme (the most brutal end
of the scale) eugenic ends can be pursued via compulsory sterilisation programmes and the killing
of those deemed  unfit ; while, at the other, relatively innocuous attempts to persuade the middle
classes to have more children have been used to achieve essentially the same ends. Similarly,
S. Wilkinson ( )
Centre for Professional Ethics, School of Law, Keele University, Newcastle-under-Lyme ST5 5BG, UK
e-mail: [e-mail]
410 S. Wilkinson
eugenic ideologies have enjoyed the support of those from across the political spectrum with even
many  progressives supporting eugenics. Kerr and Shakespeare note, for example, that:
Too many feminists and socialists showed little solidarity with the disabled, the poor
and the socially stigmatised ... (Kerr and Shakespeare 2002, p.20)
Chapter 3 of Genetic Politics contains a generally interesting and enlightening discussion
of Nazi  racial science and of the Nazis compulsory sterilisation and  euthanasia programmes.
I do however have one reservation about this chapter, which is Kerr and Shakespeare s accep-
tance of the term  euthanasia to describe actions that, it seems to me, are clearly not euthanasia
 or at least not as the term is generally used by moral philosophers. The distinction I have in
mind here is between killings which are done for the sake of the person who is killed, because
(for example) her quality of life is so bad that death would be in her interests, and killings done
for reasons unconnected to the welfare of the person killed (as in standard cases of murder). Many
of the things that Kerr and Shakespeare call  euthanasia fall into the latter (non-euthanasia) category.
For example, killing people with disabilities because they are seen as a waste of society s resources
(the so-called  useless eaters ) and killing people with disabilities to stop them from reproducing (thus
 improving the gene pool ) arenot cases of euthanasia (Kerr and Shakespeare 2002, p.31). Of course,
it is possible for people to have mixed motives. Someone might, for example, think both that a
person is a waste of society s resources and that her quality of life is so bad that death is in her
interests. But many of the Nazi examples mentioned in Genetic Politics seem not to be of this kind;
they are not, by any stretch of the imagination, benevolent mercy killings, but rather killings
designed to achieve wider social objectives (specifically, eugenic ones). This point merits attention
not least because contemporary bioethical debates about euthanasia are often beset by the failure
to distinguish clearly euthanasia from other types of killing, and indeed by some rather un-
fortunate and inappropriate allusions to Nazism. So, regardless of one s views about the rightness
or wrongness of euthanasia, it is important to maintain a clear analytical distinction between
euthanasia-killings (which are, by definition, attempts to be beneficent) and other killings.
Turning now to the second part of the book, here Kerr and Shakespeare move on to discuss
 the new genetics and provide an often subtle discussion of some of the similarities and dis-
similarities between contemporary genetics and the eugenics movements of the past. During the
course of this discussion they are  highly critical of bioethics, and this particular aspect of their
work (rather than its historical and sociological dimensions) is the focus of the main part of this review
essay (Kerr and Shakespeare 2002, p.188). Their criticisms of bioethics, and the possible responses to
them, should be of interest to all ethicists and moral philosophers who seek to engage with issues of
policy and practice, not just to those with particular interests in bioethics, eugenics, or genetics.
The remainder of my review essay is divided into two parts. In the first, I examine some of
Kerr and Shakespeare s remarks on bioethics methodology looking at, amongst other things, the
role of empirical evidence and of moral theory. In the second, I discuss some of their criticisms
of the way in which bioethics deals with eugenics, taking the work of Caplan, McGee, and
Magnus as an example.
1  Top Down and  Bottom Up Bioethics
1.1 The Attack on  Top Down Bioethics
The first of Kerr and Shakespeare s criticisms is that bioethics is generally too  top down ,
involving normative prescriptions, whereas it should instead be more  bottom up and
grounded in social science.
Eugenics and the Criticism of Bioethics 411
... bioethics from the ground up, based on careful consideration of how morality is
enacted in society  from the boardroom, to the clinic, to the high street  instead of
normative prescriptions about choice and progress, would also be essential to more
sophisticated policy making (Kerr and Shakespeare 2002, p.188).
We should start by drawing a distinction between descriptive and normative ethics.
The former consists of describing people s moral beliefs and practices. It is essentially a
form of empirical social (and/or psychological) science and crucially does not involve
the evaluation of beliefs and practices. The descriptive ethics project is to say what it is
that people do and believe. It may also seek to explain why people have the moral beliefs
that they do and act as they do, but does not seek to justify or to critique actions and
beliefs.
Normative ethics, on the other hand, has fundamentally different aims. It seeks to
discover which actions are right or wrong and which moral beliefs are true or false.
Normative ethics engages at different levels of abstraction. At the  top (the most abstract)
there is normative ethical theory; here, the issue is which general account of right action, or
of the good life, is best. Is, for example, Utilitarianism more defensible than Kantianism or
Virtue Ethics? At the  bottom (the most concrete) there is practical ethics which deals with
what we ought to do in particular situations. Practical ethics may be about the actions of
private citizens or about questions of law and public policy. Fundamental to normative
practical ethics is that the questions it addresses, as it were, contain an ought; they are about
whether certain actions or policies are right or wrong, good or bad, ought or ought not to be
carried out.
What then are we to make of Kerr and Shakespeare s claim that bioethics should be
 based on careful consideration of how morality is enacted in society ... instead of
normative prescriptions about choice and progress ? (Kerr and Shakespeare 2002, p. 188)
First of all, we need to dispose of the  choice and progress point, which is a bit of a red
herring, or a case of straw manning, if the supposed target is bioethics generally rather than
a minority of  autonomaniac bioethicists. All sensible ethicists are going to admit that there
is more to morality than choice and progress and, although there might be some bioethicists
who are overly preoccupied with these concepts, clearly much of the bioethics literature is
about neither; indeed, many bioethicists, notably those with  conservative views and some
feminists, are enamoured of neither choice nor scientific progress (Donchin 2001; Holm
1995; Mackenzie and Stoljar 2000; O Neill 2002).
Kerr and Shakespeare s more fundamental and interesting point is that bioethics should
be less  top down, less concerned with making normative claims, and more concerned with
empirical data, especially people s moral beliefs and behaviour ( how morality is enacted in
society ). What does this claim amount to and how seriously should we take it? It seems to
be a compound concern about a number of different things. First, there is a worry about
bioethics being  top down meaning that it is seen by some of its practitioners as merely the
application of normative ethical theory to cases. This seems a legitimate concern and I shall
discuss it further in Section 1.2. Second, there is the (trivially true) claim that bioethicists
ought not to ignore relevant empirical evidence conjoined with the (substantive) empirical
claim that they often do so. I will say nothing more about this point, not least because
addressing it properly would require a comprehensive review of all the ways in that
bioethicists use (or fail to use) relevant empirical data, not something that I can attempt
here. Thirdly and finally, there is the strong claim that bioethics ought to be entirely, or
almost entirely, descriptive. This latter claim seems to be false for reasons explored in
Section 1.3.
412 S. Wilkinson
1.2 Theory-driven Bioethics
Would there be something wrong, as Kerr and Shakespeare s remarks suggest, with a
bioethics which consisted wholly or primarily of applying normative ethical theories to
practical issues?
As Eve Garrard and I have argued elsewhere, moral theory has an essential role within
bioethics and there is often value in applying normative ethical theories to cases, teasing out
the diverse implications of different theories, explicating (for example) what the Aristote-
lian, the  Ethic of Care Feminist, the Kantian, and the Utilitarian would, or should, say
about a particular case or policy (Garrard and Wilkinson 2003). Perhaps the main value of
this process is that it makes clearer the nature of the theories themselves, showing what their
implications are, and whether they are conservative or revisionary, plausible or counterin-
tuitive, when it comes to people s ordinary moral beliefs about practical ethics. In bioethics
however (as distinct from  pure moral philosophy) our aims are often more practical and we
often seek guidance about how to act. Can applying normative theories deliver this?
The answer is a qualified no. The main qualification is that obviously particular nor-
mative ethical theories (or at least specific and fully fleshed out versions of some particular theo-
ries) do have implications for actual cases. Thus, it may well be that  Utilitarianism Version 17 (or
whatever) entails that we should prohibit euthanasia (or whatever). So, in this limited sense,
theories can (sometimes) deliver action-guiding outputs. However, there is a fundamental problem
with this approach: namely, which theory should we apply? If moral philosophy (specifically
normative ethical theory) were not a contested area, if there were widespread (and justified)
agreement about which moral theory is best, then perhaps the theory-driven approach could work.
But there is widespread disagreement about which normative ethical theory is best, and indeed
about whether a general normative ethical theory is possible or desirable. Hence, unless and until
the moral philosophers can deliver an ultimate answer to the  which moral theory? question (and I
fear that we are in for a long wait!) a bioethics that proceeds by simply applying theory to
practice will be close to useless as a guide to action, since we will typically have numerous
answers to practical ethical questions, each corresponding to a particular theory.
None of this is meant to imply (or depend on the view that) moral theory is not rationally
assessable, or simply a matter of subjective taste, or unknowable. Rather, the underlying claim
(a more modest and practical one) is that ethical theory is, as things stand at present, a contested
area and a matter about which rational and well-informed people can and do disagree.
Some philosophers will of course disagree with this and hold that one particular moral
theory is demonstrably the most justified; these people reject one of the premises of this
section s argument and thus will reject the argument. I believe that they are wrong but cannot
argue for that here as it would require a lengthy discussion of all the extant moral theories.
1.3 Descriptive Bioethics
Turning to Kerr and Shakespeare s next claim: should bioethics be entirely (or mostly)
descriptive? There are at least two fairly obvious reasons for answering no.
First, one of the aims of bioethics, even of purely academic bioethics, is to provide
guidance about what we should do. Admittedly bioethics may often fail to deliver on this;
like questions in moral philosophy, many questions in practical ethics are fundamentally
contestable and no consensus from the bioethics community is likely in the foreseeable
future. (Classic cases of intractable moral disagreement such as abortion and euthanasia
spring to mind here.) Second, philosophical bioethics (like philosophy generally) aims not
Eugenics and the Criticism of Bioethics 413
merely to describe but also to assess the quality of ethical arguments. Thus, even when not
directly involved in first-order moral judgement, moral philosophers are often involved in a
normative enterprise of a different kind: the project of determining which arguments ought
to be seen as compelling. If bioethicists were permitted only to make descriptive claims
then they would be incapable of engaging in either of these normative enterprises, both of
which are central to bioethics as we know it. Thus, the view that bioethics should be
entirely (or even predominantly) descriptive seems flawed.
One objection to this line of argument is based on scepticism or subjectivism about these
normative projects: on the view that first-order moral claims and claims about the quality of
arguments are either merely  matters of taste (and not amenable to rational assessment) or
else unknowable. If the subjectivist s and/or the sceptic s claims were true then it would
follow from this that normative bioethics is fundamentally flawed, consisting of people
merely expressing their subjective and/or unjustified opinions. However, it would also
follow that most, if not all, academic work is similarly flawed. This is true especially in
relation to scepticism and/or subjectivism about the assessment of arguments. For if
 anything goes when it comes to assessing the quality of arguments then  anything goes
for nearly all academic work since all research uses argument of one sort or another. So it is
not just bioethics that has a problem!
At this point someone may suggest that even though the assessment of arguments is not
subjective, making moral judgements is. Obviously, this raises one of the biggest issues, if
not the biggest issue, in moral philosophy and I cannot hope to tackle it here. What I can
say however is that, even if this more limited subjectivist claim were true, normative
bioethics may still not be completely doomed. For normative-philosophical bioethics could
still engage in the assessment of arguments, looking (amongst other things) at questions of
consistency and validity, and at the logical relations between different moral claims and
positions. Obviously however, if the limited subjectivist claim were true, then much of the
point and interest of practical ethics would be lost since there would be no prospect of
finding ( objective ) moral truth; but to say this is just to say that moral subjectivism has
unpalatable implications, which of course it does.
Finally, before proceeding to Part 2, I should make it clear that none of these
considerations tell against supplementing normative ethics with descriptive ethics and my
aim here is not to criticise social scientists or to argue that bioethicists should refuse to work
with or ignore them. On the contrary, I agree with Levitt that:
Together philosophical and sociological bioethics can widen the bioethical perspective
by setting an issue or problem in its historical, social, cultural, and political context
(Levitt 2003, p.17).
However, I have defended (to some extent here, and in more detail elsewhere) the view
that the function of the social sciences is what Haimes terms the   handmaiden role of
simply providing the  facts  along with the view that sociology is (therefore) peripheral
rather than central to bioethics  like natural science, a supplier of empirical premises which
can be  plugged in to bioethical arguments (Garrard and Wilkinson 2005a; Haimes 2002).
2 Regulatory Bioethics
In a section called Regulatory Bioethics, Kerr and Shakespeare are critical both of bioethics
generally and specifically of Caplan, McGee, and Magnus s paper  What is immoral about
414 S. Wilkinson
eugenics?, which they take to be a good illustration of some of the flaws in contemporary
bioethics (Caplan et al. 1999). I shall start this section by briefly summarising the main
points of Caplan et al. and then proceed to outline and evaluate Kerr and Shakespeare s
criticisms.
2.1 Caplan et al. on Eugenics
It is almost universally assumed, Caplan et al. tell us, in discussions of the ethics of genet-
ics,  that no sensible person can be in favour of eugenics (Caplan et al. 1999, p. 1284).
Three main objections are levelled at eugenics. These concern:
...the presence of force or compulsion, the imposition of arbitrary standards of perfec-
tion, [and] inequities that might arise from allowing the practice of eugenic choice
(Caplan et al. 1999, p. 1284).
Caplan et al. argue that these objections can be met. They deploy two main argumenta-
tive strategies to establish this. One is to show that eugenics objectionable features are merely
contingent and can be avoided. The other is to highlight similarities between genetic engineer-
ing or selection and other widely accepted social practices. For instance, they say that:
... it is not clear that it is any less ethical to allow parents to pick the eye colour of their
child or to try and create a fetus with a propensity for mathematics than it is to permit
them to teach their children the values of a particular religion, try to inculcate a love of
sports by taking them to football games, or to require them to play the piano. (Caplan
et al. 1999, p. 1285)
The view of Caplan et al. is that while it is, admittedly,  morally objectionable for
governments or institutions or any third party to compel or coerce anyone s reproductive
behaviour, nonetheless  the goals of obtaining perfection, avoiding disease, or pursuing
health with respect to individuals need not involve coercion or force (Caplan et al. 1999,
p. 1284). In other words, it is possible for people to pursue  individual eugenic goals
without being on the receiving end of coercion; individuals can do such things voluntarily.
Thus, in this respect at least, eugenics may be morally unproblematic.
2.2 Kerr and Shakespeare s Critique
The first criticism of Caplan et al. is that they:
... ignore the subtle and not so subtle ways in which individuals decisions in favour of
enhancement and selection would be influenced by stigma and discrimination in so-
ciety ... (Kerr and Shakespeare 2002, p.164)
While it is true that Caplan et al. say very little about subtle societal influences in their BMJ
paper, I wonder if their view is as different from Kerr and Shakespeare s as this quotation sug-
gests. Kerr and Shakespeare s worry is that people may be pressured into using enhancement and
selection technologies by stigma or discrimination. This seems however to be a concern about the
voluntariness of people s choices, one which in principle Caplan et al. would share. After all, they
do provide this strong statement of principle against compulsion and coercion, whatever the source:
... it is morally objectionable for governments or institutions or any third party to
compel or coerce anyone s reproductive behaviour (Caplan et al. 1999, p. 1284).
Eugenics and the Criticism of Bioethics 415
So, if it could be shown that a community was pressurising parents into using
reproductive technologies by stigmatising people with disabilities (or without enhance-
ments) then Caplan et al. would, it seems, want to condemn this along with other forms of
coercion. So the error of Caplan et al. is not a fundamental problem of principle but rather
just the fact that they fail to mention the possibility of subtle forms of coercion in their BMJ
paper (which, it should be noted, is short, coming in at less than 2,000 words). And it seems
likely that, if subtle societal coercion was brought to their attention that they would
condemn it and support something close to Kerr and Shakespeare s view of it.
So, as regards this first criticism, Kerr and Shakespeare are right to say that bioethics
should pay careful attention to the less obvious ways in which the voluntariness of consents
and decisions can be threatened. This does not however expose a fundamental flaw with
(many) bioethicists commitment to the value of autonomous choice, but rather shows that
they need (perhaps together with social science colleagues) to take account of the complex
social contexts in which choices are made.
Kerr and Shakespeare s second criticism is that Caplan et al.:
... give scant regard to the intensification of discrimination that these decisions would
engender (Kerr and Shakespeare 2002, p. 164).
This criticism is somewhat misdirected because Caplan et al. do address arguments of
this kind, albeit without using the term  discrimination :
Another objection to allowing eugenic desires to influence parenting is that this will
lead to fundamental social inequalities. Allowing parental choice about the genetic
makeup of their children may lead to the creation of a genetic  overclass with unfair
advantages over those whose parents did not or could not afford to endow them with
the right biological dispositions and traits. Or it may lead to homogenisation in society
where diversity and difference disappear ... (Caplan et al. 1999, p. 1285)
Caplan et al. have three responses to arguments of this kind. The first is a  companions
in guilt move. This says roughly that, even if eugenic biotechnologies are bad in this
respect, they are no worse than lots of other widely accepted practices:
It is hard to argue in a world that currently tolerates so much inequity in the
circumstances under which children are brought into being that there is something
more offensive or more morally problematic about biological advantages as opposed
to social and economic advantages (Caplan et al. 1999, p. 1285).
The second is to point out that the correct reaction to potential inequality problems may
be not to prohibit or discourage eugenic selection but rather to make it freely available to
all: levelling up, as it were, rather than levelling down. Finally, their third response is to
claim that a strong obligation may exist  to try and compensate for any differences in
biological endowment with special programmes and educational opportunities (Caplan et
al. 1999, p. 1285).
These responses may or may not ultimately work, and it may well be the case that more
attention should be paid to the likely social consequences of allowing individual eugenic
choice. Nonetheless, it is harsh to accuse Caplan et al. of paying  scant regard to issues of
inequality and discrimination since clearly they have thought about and responded to these
concerns.
Kerr and Shakespeare s third and final criticism is that, although bioethics  has been
important in excluding some of the most extreme forms of eugenics, it has helped to open up
416 S. Wilkinson
what Troy Duster calls the  backdoor to eugenics (Duster 2003). The paper of Caplan et
al. is (Kerr and Shakespeare believe) a good example of this  backdoor eugenics approach
and, at this point, they criticise the work of Caplan et al. quite forcefully describing it as
 not only naïve and misleading [but] ...dangerous, because it justifies eugenics by appealing
to a burgeoning neoliberal doctrine of rights and choice (Kerr and Shakespeare 2002,
p. 164).
To object to the paper of Caplan et al. on the grounds that it  justifies eugenics seems
rather odd because justifying (some sorts of) eugenics is precisely what they set out to do.
So how can this qualify as a criticism, rather than merely a description of the paper s aims?
Lying behind this critique, seems to be one of the following views: either that eugenics is
always wrong (or alternatively that being eugenic is a universally wrong-making property
of actions) and so any attempt to justify it is misguided, or that although some eugenic acts
are permissible, we ought not to defend even these because this will lead to the social
acceptance of other wrongful kinds of eugenics (via a sort of  slippery slope ).
The first of these (that eugenics is always wrong) may or may not be true but, even if it
is true, it is not capable of underpinning an argument against Caplan et al. (Wilkinson
2006). For what they are doing is providing arguments for the acceptability of (certain
forms of) eugenics and it cannot be a response to these to assert that eugenics is wrong,
since this begs the question, assuming the very thing that is at issue. What is needed rather
is specific engagement with the arguments of Caplan et al.
The second approach seems more promising and does not suffer from this question-
beggingness problem. The argument goes like this. Some forms of eugenics are
permissible; some are not. Let us grant, just for the sake of argument, that Caplan et al.
have got the distinction about right: that the bad forms of eugenics are those which are
coerced or cause unfairness. Thus we have  free and fair eugenics, which is basically okay,
and coerced and/or unfair eugenics, which is not. At this point, one (or both) of the
following empirical claims can be made: (1) that if we permit  free and fair eugenics this
will cause coerced and/or unfair eugenics to occur; and (2) that if we argue publicly for the
moral acceptability of  free and fair eugenics this will cause people mistakenly to believe
that coerced and/or unfair eugenics is acceptable. If such claims are true then arguing for
and/or allowing even those forms of eugenics which are (intrinsically, considered in
themselves) morally permissible might be wrong because of the bad consequences of doing
so (in terms of promoting wrongful eugenics).
Arguments of this kind are commonplace in bioethics. For example, it is sometimes
argued that while voluntary euthanasia is not intrinsically wrong, it should not be permitted
or supported because it would lead to involuntary euthanasia, and similar things are said of
passive and active euthanasia (Garrard and Wilkinson 2005b, p. 67).
One problem with, or at least a challenge for, all such arguments is that they involve
conjecture about long-term social effects and so these arguments are only as good as the
empirical case that is presented in defence of the argument s central premise (e.g. that
voluntary eugenics or euthanasia will lead to involuntary eugenics or euthanasia). Such
empirical cases can, in principle, be mounted but doing so in a convincing fashion is often
very difficult given the complex and novel social phenomena and long timescales involved.
A second worry about such arguments is that they (or rather the conclusions they
support) involve dishonesty. For the central claim is that, even if we were to discover
(perhaps through a process of philosophical argumentation) that some forms of eugenics are
morally unproblematic, we should keep quiet, or lie, about this fact because  the masses
are incapable of telling the difference between permissible and impermissible eugenics and
Eugenics and the Criticism of Bioethics 417
would take our sanctioning of acceptable eugenics as a reason to practice wrongful
eugenics. Structurally this argument resembles one that is sometimes used in debates about
the legalisation of drugs. An expert committee might make the case for legalising cannabis
(for example) and be met with the response that, even if its arguments are correct, cannabis
should not be legalised because this would  send out the wrong message (that drugs are
okay) to a population incapable of distinguishing cannabis from less acceptable drugs.
This deceptive approach may or may not ultimately be justified depending, amongst
other things, on how powerful the consequence-based argument for deception is. None-
theless, it is worth at least noting that this position involves deception, something that is
sometimes overlooked and which many of us will be uncomfortable with.
A similar worry arises if we turn our attention to arguments for legal prohibition. The
form of these arguments is that it is okay to ban x, even if x is (considered in isolation)
permissible, provided that:
(A) Banning/preventing y is justified;
(B) Many people are not capable of distinguishing x from y (and so);
(C) Allowing x will cause people to do y.
Possible applications of this style of argument are: that we should ban boxing because it
will lead to people thinking that street fighting is okay; that we should ban mobile phones
altogether because people are not capable of distinguishing permissible from impermissible
uses (e.g. while driving or during lectures); and that we should forbid consensual extra-
marital sex because it will lead to people thinking that rape is okay.
The worry about arguments of this kind is: is it fair and reasonable to disadvantage those
people who want to do x (by banning x) essentially because of other people s cognitive
failures (some might say  stupidity ), because of their inability to tell the (moral) difference
between x and y? Thus it seems iniquitous to criminalise and punish those who enjoy
consensual extramarital sex, who can see a clear distinction between this and rape, and who
are not rapists, on the grounds that some other people are incapable of making this
distinction. Whether the ban is ultimately fair and reasonable is a complex and context-
dependent question, one which depends (amongst other things) on how reasonable or
unreasonable the population s failure to distinguish x from y is, and on how bad the
consequences of allowing x would be. The worse the consequences, and the more
reasonable the failure to distinguish, the more justifiable a ban on these grounds will be,
although I should add that strategies other than prohibition should usually be tried first,
notably using public education to teach people the difference between x and y. Thus, if
permitting extramarital sex really was going to cause a lot of rapes then perhaps banning it
could be justified on harm-avoidance grounds, but only after we had tried (and failed) to
teach people the moral difference between consensual extramarital sex and rape.
3 Conclusion
Several of Kerr and Shakespeare s criticisms are well-founded and serve as valuable
reminders to the bioethics community. These include the claims: that bioethics ought not to
consist entirely of applying moral theory to cases; that bioethicists must take account of
relevant empirical evidence; and that bioethicists should be on the look out for those subtle
social forces which can undermine the voluntariness of people s choices and consents.
However, we should reject a number of Kerr and Shakespeare s other criticisms and I have
418 S. Wilkinson
argued (amongst other things) that bioethics should not be wholly (or even predominantly)
descriptive and that even  mainstream bioethics is better able to deal with difficult issues
like eugenics than Kerr and Shakespeare suggest in their book.
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