Foucault’s genealogical method is the best approach with which to examine how the subfield of bioethics (1) contributes to the production of the problem of disability (and its naturalized foundation)–that is, contributes to the production of disability as a problem; and (2) is designed to hasten its elimination, that is, to resolve the problem that the production of of disability (and impairment) poses for the (neo)liberal control and management of societies. Indeed, a broad range of critically engaged philosophers and theorists attest to the value of Foucault’s genealogical method for social movement and transformation. In Abolition. Feminism. Now., for example, Angela Y. Davis, Gina Dent, Erica R. Meiners, and Beth E. Richie identify Foucault’s genealogical method and claims about subjugated knowledges as among the best critical devices with which to advance an abolition feminism that both refuses naturalized—and hence, ahistorical—assumptions about carceral institutions and eschews reformist approaches to them that advocate for their putative improvement.[1]

In my work, I rely on the reflections of these abolition feminists both to reinforce my critique of reformist responses to the eugenic impetus of bioethics[2] and to outline the “prefiguration”[3] that requires us to abolish this subfield of philosophy altogether. As Harsha Walia explains: “Prefiguration is the notion that our organizing reflects the society we wish to live in—that the methods we practice, institutions we create, and relationships we facilitate within our movements and communities align with our ideals.”[4] For Walia, decolonization is a framework that exemplifies a “positive and concrete” prefigurative image of the future. I maintain that as we must prefigure a decolonized future for society without prisons or police, so, too, we must prefigure a just and inclusive future for philosophy without bioethics. As Davis and coauthors state, it is crucial that we forge a critical space for “what we have not yet been able to imagine.”[5]

Historians of the subfield of bioethics generally place its emergence around the early 1960s. A combination of cultural events precipitated this development, it is claimed, one of which was the Doctors’ Trial that took place in Nuremberg immediately following World War II. In that twentieth-century trial, Nazi doctors who had performed grisly experiments on disabled, Jewish, Roma, and gay people (among others) in Nazi concentration camps were tried and convicted of crimes against humanity. As evidence presented at the trial made abundantly clear, medical and scientific practices, as well as the medical and scientific personnel who perform them, can be put in the service of ghastly political ends, even in societies with so-called highly developed intellectual communities. The verdict read at the Doctors’ Trial included ten ethical principles—now known as the “Nuremberg Code”—that the jurists maintained should subsequently govern research on human subjects internationally.[6] In fact, the principles of the Nuremberg Code are widely regarded as precursors to the growth of the fields of research ethics, medical ethics, and bioethics, especially the first principle of the Code, which requires the informed consent of research subjects and, by association, respect for their autonomy. Historians of bioethics and bioethicists themselves acknowledge, nevertheless, that throughout the twentieth century the principles of the Nuremberg Code were repeatedly breached as scientists, doctors, and bioethicists engaged in practices that demonstrate that science, medicine, and the subfield of bioethics itself are politically interested domains and by no means value neutral. That the principle of informed consent is itself a technology of government has thus far remained largely unexamined.

With the high-profile exposure of scientific and institutional abuses and the rise of feminism and the women’s health movement in the mid-twentieth century, as well as other sociopolitical trends, the authoritarian tradition that had at one time conditioned interactions between doctors and their patients has to some extent been undermined, augmenting the production of neoliberal forms of self-management and self-governance in medical contexts. The narrative that historians of bioethics and bioethicists themselves tell is that their academic discipline emerged in part as a safeguard against abuses of the past and a rejection of paternalism in favor of patients’ rights, framed (as I have indicated) as respect for the principle of autonomy embodied in the doctrine of informed consent.[7] By contrast, I understand the emergence of bioethics and the doctrine of informed consent as historically specific institutional responses to the demands of (neo)liberal subjectivity, that is, as institutional responses to the relatively recent social and cultural production of a new kind of individual who is self-directed and self-legislating, endowed with the capacity to make autonomous choices that can be put in the service of power to advance certain political ends. Power is neither external to the subject’s autonomy and freedom nor antithetical to these values, but rather contributes to their constitution and operates through them.

Critically astute prefiguration (to use Walia’s term) of a just society for disabled people identifies bioethics as an agent of institutionalized ableism rather than a field of inquiry in which instances of systemic ableism occasionally occur. Hence, a prefigurative philosophy of disability aims to unmask the mystique of bioethics that facilitates the persistence and veneration of this subfield and its discursive instruments. The term mystique of bioethics refers to: first, the technology by which the eugenic impulse of bioethics is concealed; second, the structural gaslighting that enables this concealment whereby the field of bioethics is cast as the domain of a distinct specialist knowledge that renders bioethicists uniquely qualified to evaluate a purportedly distinctive set of questions and concerns; and third, the technology of this supposedly specialist knowledge whereby, through practices and strategies of mystification—which are constitutive of the apparatus of disability—social and political problems are constituted as natural, individual, and medical in origin, or at least, most appropriately studied in the domains of medicine and science.[8]

Furthermore, critical prefiguration of a just society for disabled people eschews reformist approaches to the subfield of bioethics that bolster this mystique. As Davis and coauthors point out, the history of the prison and the police illustrate that “reforms sold as ‘progressive’ all too often function to mask expanding mandates, logics, and budget lines.”[9] In this context, I want to point out that the MAiD regime‒which the Liberal Government of Canada (and the Canadian bioethicists to whom it defers and appeals) claims to champion because it purportedly upholds individual autonomy and self-determination‒is projected to save the Canadian federal government an estimated $34.7 million to $136.8 million annually in health-care spending. Thus, an abolitionist prefiguration of a just society for disabled people would aim to incorporate a full-blown genealogy of the eugenic impetus of bioethics and its material effects, a genealogy that shows how the naturalization, individualization, and medicalization of the apparatus of disability, which this mystification facilitates, occur across a broad range of historical, economic, social, and cultural contexts through an array of technologies of normalization, disciplinary techniques, and discursive practices—including the artifactual distinction between theoretical philosophy and applied philosophy. This discursive and institutional artifact and the asymmetry of status in the profession of philosophy and academia that it prescribes have contributed to the concealment of the eugenic motivation for bioethics and provide the methodological rationale for and rationalization of the very existence of this subfield. Hence, a prefigurative discipline of philosophy that is genuinely committed to justice for disabled people would be grounded in an understanding that philosophy is not external to the history of eugenic normalization but rather is structured and conditioned by the legacy of these operations of power and enables their reproduction.

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[1] Angela Y. Davis, Gina Dent, Erica R. Meiners, and Beth E. Richie, Abolition. Feminism. Now. (Chicago: Haymarket Books, 2022).

[2] I elaborate this argument in various contexts, including in Shelley L. Tremain, Foucault and Feminist Philosophy of Disability (Ann Arbor: University of Michigan Press, 2017) and Shelley Lynn Tremain, “Disaster Ableism, Epistemologies of Crisis, and the Mystique of Bioethics,” in The Bloomsbury Guide to Philosophy of Disability, ed. Shelley Lynn Tremain (London: Bloomsbury Academic, 2024), 19-48.

[3] Harsha Walia, Undoing Border Imperialism (Chico, CA: AK Press, 2013).

[4] Walia, Undoing Border Imperialism.

[5] Davis et al., Abolition. Feminism. Now., 26.

[6] George J. Annas and Michael A. Grodin, The Nazi Doctors and the Nuremberg Code: Human Rights in Human Experimentation (Oxford: Oxford University Press, 1995; The Hastings Center Bioethics Timeline Committee, “The Hastings Center Bioethics Timeline,” The Hastings Center (blog). https://www.thehastingscenter.org/bioethics-timeline/

[7] For example, Alicia Ouellette, Bioethics and Disability: Toward a Disability-Conscious Bioethics (Cambridge: Cambridge University Press, 2011). See Tremain, Foucault and Feminist Philosophy of Disability, especially chapter 5.

[8] Tremain, “Disaster Ableism, Epistemologies of Crisis, and the Mystique of Bioethics,” 22.

[9] Davis et al. Abolition. Feminism. Now, 59-60.