The Corner

Health Care

Nature: Bioethics Is Obsolete

(Pixabay)

I have been covering the bioethics movement since the late 1990s, writing several books (one award-winning) on the subject.

When bioethics began, there was a great internal intellectual struggle for dominance between Paul Ramsey’s traditional Christian-focused sanctity-of-life thought and the lapsed Episcopalian priest Joseph Fletcher’s crassly relativistic autonomy utilitarianism. Alas, Fletcher won that battle and the mainstream movement became, if not strictly utilitarian, certainly utilitarianish.

Bioethics also veered sharply left politically with ambitions of leading the technocracy in which movement luminaries would be the new high priests establishing public health policies, funding priorities, and determining the ethics of medicine (such as obliterating the rights of medical conscience). You certainly saw that paradigm in action in the administration of Obamacare, although the law’s most dangerous technocratic threats were blunted by subsequent events, such as the repeal of the Independent Payment Advisory Board (IPAB).

For a time, it looked like bioethics would assume broad societal power. But now, Nature — perhaps the world’s most prestigious science journal — has published a long, and I must say surprising, piece concluding that at least with regard to biotechnology, bioethics is obsolete. From, “Ethical Research–The Long and Bumpy Road from Shirked to Shared,” by Sarah Franklin, the chair of sociology and director of the Reproductive Sociology Research Group at the University of Cambridge.

Just as the ramifications of the birth of modern biology were hard to delineate in the late nineteenth century, so there is a sense of ethical bewilderment today. The feeling of being overwhelmed is exacerbated by a lack of regulatory infrastructure or adequate policy precedents. Bioethics, once a beacon of principled pathways to policy, is increasingly lost, like Simba, in a sea of thundering wildebeest.

Exactly true. For example, rather than push hard for international regulatory controls of CRISPR germ line genetic engineering techniques in humans, bioethicists mostly wrung their hands and advocated a non-binding self-restraint until the technology becomes “safe.”

Franklin says bioethicists have ceased being thought leaders but merely so many PR professionals in the service of Big Biotech:

The field no longer relies on philosophically derived mandates codified into textbook formulas. Instead, it functions as a dashboard of pragmatic instruments, and is less expert-driven, more interdisciplinary, less multipurpose and more bespoke.

In the wake of the ‘turn to dialogue’ in science, bioethics often looks more like public engagement — and vice versa. Policymakers, polling companies and government quangos tasked with organizing ethical consultations on questions such as mitochondrial donation (‘three-parent embryos’, as the media would have it) now perform the evaluations formerly assigned to bioethicists. Journal editors, funding bodies, grant-review boards and policymakers are increasingly the new ethical adjudicators.

And here I thought the power of bioethics was alarming! But the virtual moral anarchy dictated by the “golden rule” (he who has the money makes the rules) Franklin describes is even worse.

In a social-media-saturated age wary of fake news, the new holy grail is the ability to create trustworthy systems for governing controversial research such as chimeric embryos and face-recognition algorithms. The pursuit of a more ethical science has come to be associated with building trust by creating transparent processes, inclusive participation and openness to uncertainty, as opposed to distinguishing between ‘is’ and ‘ought’...

The result is less reliance on specialized ethical expertise and more attention to diversity of representation…The implication of this new model is that the most ethical science is the most sociable one, and thus that scientific excellence depends on greater inclusivity. We are better together — we must all be ethicists now.

In such a milieu in which there really is no “right” and “wrong,” who needs bioethicists?

The huge problem Franklin ignores is that we are not having the kind of democratic discourse about the future of biotechnology that Franklin envisions. Good grief, these issues barely break into the news. All that matters today is love or hate Trump!

Franklin is right that bioethics has lost substantial influence in biotechnology, which is a distinction without a substantial difference as the movement has mostly served as a rubber stamp for approving controversial research in the media and halls of government anyway.

But it is much too early to put the movement into hospice care. Bioethics still exerts tremendous influence in the public policy of healthcare. So, we are stuck with the worst of both worlds. We stand helpless before a biotechnology sector creating inventions of almost limitless power beyond substantial ethical or legal control — as our medical system is dominated by so-called “experts” who deny the sanctity and intrinsic dignity of human life.

Unless there is a great ethical awakening, this will not end well.

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