American bioethics was born out of a desire to be relevant. The philosopher Daniel Callahan has said that he and his colleagues founded the Hastings Center—the premier bioethics think tank—in 1969 because they wanted to give philosophy “some social bite, some relevance.” Whether bioethics has achieved its goal is the urgent question at the core of this useful book, co-authored by Renée C. Fox, a highly distinguished sociologist, and Judith P. Swazey, a respected historian of medicine. Between them, Fox and Swazey have spent many decades as participant observers in the house of medicine. Their intensive involvement with physicians, theologians, and philosophers has given them ringside seats to the development of modern bioethics. Through enjoyable interviews with major figures in the field and a rich trove of personal observations, the book perceptively, if densely, chronicles the growth of bioethics as a profession.

If success is measured by breadth of institutional footprint, then bioethics has indeed succeeded. Major universities house bioethics centers that offer a plethora of both graduate and undergraduate programs. Bioethicists serve on hospital ethics committees and on research review boards. In many hospitals, bioethicists are “on call” to offer guidance on whether certain life-prolonging treatments should be initiated or withdrawn. In the public policy arena, bioethicists are appointed to presidential commissions and state and federal task forces that formulate guidelines and advise politicians.

By other measures of relevance, however, bioethics certainly falls short. Though clearly fond of the bioethicist-physicians, bioethicist-philosophers, and bioethicist-legal scholars they interviewed, Fox and Swazey describe themselves as “critical of what we regard as the field's deficiencies and blind spots.” They identify these as the use of dumbed-down teaching formulae, an insensitivity to cultural differences, and the tendency of American bioethicists to emphasize “individual rights, and rationality” instead of “community, and common good,” which are the values that Fox and Swazey favor.

The matter of ethical expertise—what it looks like, who can claim it—is a profound one. Bioethics’ place in the academy, in the clinical realm, and in society turns on it. For most of us, the very idea of “right” answers to complex moral and philosophical dilemmas such as euthanasia, embryonic stem cell cloning, or organ remuneration is absurd on its face. After all, deriving an “answer” depends upon which type of moral theory one favors.

Fox and Swazey have faith that expertise in ethics does exist, but they believe that such expertise will not be fully realized until bioethicists take on matters of social justice. Disconcertingly, they are not concerned that a social justice agenda risks blurring the lines between disinterested ethical analysis (the authentic expertise of bioethicists) and outright political activism. This oversight is made even more peculiar because the authors seem quite appropriately exasperated by some of the day-to-day perversions of ethics “expertise.” Ask almost any hospital physician about bioethicists and you will get, in reliable sequence, an eye roll, a sigh, and then an earful of anecdotes about swaggering cowboys posing as arbiters of right and wrong (“Wizards of Oughts,” as one critic put it). In the media, the coverage of almost any biomedical controversy is sure to contain a quotation from a bioethicist with oracular pretensions. The unmistakable message of ethics punditry is clear: anyone who disagrees with us is thoughtless or unethical.