Absolutely Essential by Jonathan D. Moreno explores how bioethics emerged from the postwar rules-based international order and what its decline could mean for the future of science. This groundbreaking book argues convincingly that a truly global bioethics must move beyond its Western foundations, writes Yelena Biberman.
What happens to science when the global system that has defined the boundaries of its use and abuse begins to unravel? This is the question Jonathan D. Moreno tackles in Absolutely Essential: Bioethics and the Rules-Based International Order. As the post-World War II liberal international (or “rules-based”) order enters crisis, so too does the ethical framework governing medicine and the life sciences (or “bioethics”). Deeply rooted, for Moreno, in Enlightenment values such as individual rights and the consent of the governed, bioethics is inseparable from the political order that shaped it. This is the book’s central argument.
Moreno warns of a crisis not only for science itself, but also for the relationship between science and the state.
As with his previous work, Moreno’s book makes a distinctive and ground-breaking contribution. A number of scholars, such as Sheila Jasanoff, Jennifer Hochschild, and Henk ten Have, have explored the political debates surrounding bioethics, and Annie Jacobsen’s Biological War: A Scenario (2026) takes the reader inside a biological attack. Moreno’s book, however, brings bioethics squarely into the study of international politics and international politics into bioethics.
Antagonism between science and the state
Moreno warns of a crisis not only for science itself, but also for the relationship between science and the state. Bioethics, he shows, has always been both a moral and a political project. It has helped legitimise scientific authority while sustaining a tacit bargain between the state and the life sciences: scientists enjoy broad autonomy as long as they do not “embarrass” political authorities or jeopardise national security. As the rules-based order weakens, Moreno argues, both scientific authority and the state-science relationship face growing uncertainty.
Scientific autonomy depends not only on expertise, but also on public confidence and institutional legitimacy.
Recent debates in the United States suggest that these tensions are already visible. The highly politicised scrutiny of Anthony Fauci – who invoked the Fifth Amendment over 100 times before a GOP-led Senate committee investigating COVID-19’s origins – reflects a growing strain between scientific experts and political authorities. Rising vaccine scepticism points to a broader erosion of trust in scientific institutions. Together, these debates reveal the fragility of the bargain Moreno describes. Scientific autonomy depends not only on expertise, but also on public confidence and institutional legitimacy.
Nuremberg and the history of bioethics
If Moreno’s book is a story of collapse, it is the collapse of an unfinished construction. It is the story of a system that gave rise to bioethics while never fully institutionalizing its principles. The history Moreno recounts was shaped by lofty ideals and the heroic efforts of individuals like Leo Alexander, the psychiatrist who helped expose Nazi Germany’s medical atrocities and drafted the ethical principles, including informed consent, that became the foundation of the Nuremberg Code. But it was also shaped by outsized egos, self-serving bureaucracies, and the overprioritisation of national security. Much of the responsibility lies with the very actors credited with building the postwar order. Yet blaming them alone misses a larger point: bioethics is not a purely Western project, and its future cannot depend on Western states alone.
The contradictions were present from the very birth of modern bioethics. The Nuremberg Trials produced the Nuremberg Code, which established voluntary consent and the protection of human subjects as fundamental principles for scientific research. However, these principles were never fully embedded in the international system. The same powers that prosecuted Nazi physicians for atrocities committed in the name of science made strategic compromises elsewhere. After World War II, the United States granted immunity to Japanese physicians involved in the Imperial Japanese Army’s biological warfare program, including the infamous research facility Unit 731, in exchange for access to their research. Many of these scientists escaped prosecution because Washington viewed their findings as valuable during the emerging Cold War. Many later assumed influential positions in Japan’s medical and public health establishment, including at the National Institute of Health, where some served for decades.
The challenge of global bioethics
The problem was not only selective accountability. It was also the failure to create a genuinely universal bioethical order. Although Moreno does not discuss the 1949 Khabarovsk Trial, in which Soviet authorities prosecuted Japanese officials for biological warfare crimes, the episode suggests that alternative approaches to accountability existed, or at least were attempted. During the Cold War, however, the United States viewed the Soviet Union primarily as a strategic rival rather than as a partner in shaping shared scientific or ethical norms. Geopolitical divisions, along with the West’s reluctance to recognise alternative sources of ethical authority, prevented such experiences from contributing to a broader international conversation.
Rather than evolving through a genuinely global conversation, bioethical principles remained anchored largely in Western institutions and assumptions.
In this sense, the postwar order missed the kind of dialectical exchange across political and cultural boundaries that Nobel laureate economist and philosopher Amartya Sen describes adaptation, and the refinement of ideas as essential to mutual critique. Rather than evolving through a genuinely global conversation, bioethical principles remained anchored largely in Western institutions and assumptions. By failing to cultivate wider international ownership, the “rules-based” order asked others to accept norms they had little role in shaping.
None of this absolves other states of responsibility. Moreno shows how countries with different political systems have struggled to reconcile scientific ambition with bioethical constraints. Moscow’s state-driven biological research and controversies surrounding its COVID-19 vaccine development reveal how political priorities shape scientific practice. China’s experience with human subjects research in genetics highlights similar tensions. The case of He Jiankui, the Chinese scientist whose 2018 CRISPR experiment resulted in the birth of gene-edited children, demonstrates the challenges of enforcing ethical boundaries amid intense scientific competition. He was sentenced to three years in prison, but the episode exposed broader questions about oversight, accountability, and the pressures driving biomedical innovation.
A framework for the next frontier of science
The challenge, then, is not simply to preserve a Western-created bioethical order. It is to build a genuinely universal one: a system capable of confronting past failures while strengthening commitments to human dignity, accountability, and responsible scientific advancement.
Perhaps what most constrains global bioethics is not the system’s erosion or failure, but its partial success. It created a workable consensus without fully building the institutions needed to sustain it. In an era when biotechnology is becoming central to global competition, a “good enough” bioethics will not be enough. The moment demands a more ambitious vision: one that moves beyond preserving past achievements to creating a truly global framework capable of guiding science’s next frontier.
Such a goal may appear lofty, even unrealistic. Yet history shows that ambitious visions can inspire agency. The Nuremberg Code itself was born from a seemingly impossible aspiration: to transform the horrors of wartime medical experimentation into universal principles governing scientific responsibility. The lesson is that a grand vision is not a barrier to change but often a necessary condition for it.
Note: This review gives the views of the interviewer and author, not the position of the LSE Review of Books blog nor of the London School of Economics and Political Science.
Image: Sergey Nivens on Shutterstock.
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