Who Guards the Guardians? Ian Kennedy, Bioethics and the ‘Ideology of Accountability’ in British Medicine

This article charts the history of bioethics in Britain through the work of the academic lawyer Ian Kennedy. From the late 1970s, Kennedy claimed that external oversight, which he termed ‘bioethics’, was needed to make medicine accountable to patients and the public. I believe these arguments provide a window onto the historical factors that generated the demand for bioethics, and help us determine why it became influential in recent decades. I detail how Kennedy's argument resonated with the Conservative enthusiasm for audit and consumer choice in the 1980s. Contrary to traditional portrayals of bioethics as a critique of medicine, I also show that Kennedy promised it would benefit doctors by improving decision making and maintaining public confidence. This analysis reframes bioethics as an important constituent of the ‘audit society’: fulfilling the neo-liberal demand for oversight and the medical demand for legitimacy.