Last month, Steven Pinker, cognitive psychologist and public intellectual, argued in a Boston Globe op-ed that bioethicists—those who weigh the ethical implications of biological research—had a moral imperative to "get out of the way" of research. Pinker's assertion was nothing short of a live grenade lobbed into the field of bioethics. While perhaps harsh, there is a sizable kernel of truth in his case.
"A truly ethical bioethics," Pinker wrote, "should not bog down research in red tape, moratoria, or threats of prosecution based on nebulous but sweeping principles such as 'dignity,' 'sacredness,' or 'social justice.' Nor should it thwart research that has likely benefits now or in the near future by sowing panic [about] Nazi atrocities, armies of cloned Hitlers, or people selling their eyeballs on eBay." We must not succumb, in other words, to science-fiction scenarios that have little likelihood of materializing.
Pinker's disquisition was spurred by calls for a moratorium on research involving a new technology called CRISPR, a revolutionary gene editing method that is cheap, quick, and easy to use. With the ability to modify small segments of the DNA of eggs and sperm or of the embryo itself—the so-called germ line—scientists hope to eventually use CRISPR to cure certain genetic diseases, by replacing the genes that cause them. But some bioethicists fear that the technology will work too well, thus raising the specter of "eugenics." Such research, they claim, is "contrary to human dignity" because "the human germ line should be treated as sacred."
Bioethicists' arguments are often weak, resting on outlandish hypotheticals, unanalyzed "yuck" reactions, and thinly disguised religious rationales.
Pinker finds such rationale flimsy, based less on an argument than on the gut feeling that gene modification must somehow be wrong. Worse, he says, it's a potentially deadly view. Because biomedical inquiry saves and improves lives on a massive scale, judgments about its conduct must factor in the good that full-speed-ahead research can likely deliver, and weigh all interventions against that good.
Pinker's commentary in turn prompted a round of condemnation. Mildred Solomon, director of bioethics think tank the Hastings Center, quickly criticized Pinker for "painting those who seek to consider the ethical implications of genetic engineering as Luddites who disdain science." Members of the Public Responsibility in Medicine and Research (an education and advocacy group for research overseers) stipulated, "Our ethical oversight system may be imperfect, but that's not a reason to jettison ethical examination of new scientific developments." Matthew Beard, a philosopher at the University of New South Wales, faulted Pinker for implying we should "sacrifice ethics on the altar of scientific progress."
But Pinker does not claim we should sacrifice ethics on the altar of scientific progress. Rather, he's saying that we should not sacrifice ethics on the altar of the "bioethics" establishment, because it does a poor job of ethical analysis. Bioethicists' arguments are often weak, resting on outlandish hypotheticals, unanalyzed "yuck" reactions, and thinly disguised religious rationales. Logic is shoddy, supporting evidence often lacking, and a cost-benefit perspective is either absent or biased against the alleviation of human suffering at the expense of abstract principles. Pinker doesn't trust ethics to the bioethicists. These are fighting words, no question.
But does any of this matter? How much real world power do bioethicists actually have? Answering this question is difficult; it is hard to gauge their influence. Still, Pinker's confrontation with them is important—it prompts us to consider, more broadly, the proper role of bioethicists in society.
Optimally, when bioethicists are asked to advise, their role should be to objectively delineate value conflicts intrinsic to the ethical dilemma at hand. They lay out the assumptions behind different positions, evaluate the soundness of arguments according to standard rules of logic, and reflect upon the potential consequences of various courses of action. Ultimately, they present a dispassionate analysis, a moral map, to the designated decision-makers—physicians, administrators, patients, and the public.
To be sure, no one needs an expert to verify that Dr. Mengele was a monster. But there are medico-ethical deliberations residing in the gray zones: whether students should be allowed to use cognitive-enhancing drugs; whether to sell organs; whether to conduct research on unconscious patients who cannot give consent. When debating these matters, soliciting the wisdom of others is typically a good thing to do.
Any bioethicist who can help responsible decision-makers frame arguments and discredit illogical claims is a boon to thoughtful deliberation. But when it comes to judgments about what is to be done, about what is right or wrong, why should bioethicists' judgments be given greater weight than other stakeholders—physicians, scientists, legal scholars—who consider the same issues carefully and come to different conclusions? After all, ideological sway, quirks of intuition, and tolerance of risk play significant roles in what bioethicists, like the rest of us, deem ethical.
The answer is that bioethicists' normative views should not be given greater weight. The problem is that they sometimes are. Health-care administrators, politicians, and members of the media too often hold the input of bioethicists as a moral authority, thereby giving special, even exclusive, weight to their claims of how the world ought to be.
Any bioethicist who can help responsible decision-makers frame arguments and discredit illogical claims is a boon to thoughtful deliberation.
In fairness, many bioethicists actively do their part to disavow this mantle of moral authority endowed to them by medical professionals and members of the media. But others—including some of the disavowers themselves—present themselves as arbiters of right and wrong ("Wizards of Oughts," as Giles Scofield of the Centre for Clinical Ethics in Toronto puts it). Media coverage of almost any biomedical controversy is almost sure to contain a quote from a bioethicist, the unmistakable message of which is clear: Anyone who disagrees with me is either thoughtless or unethical.
Such arrogance discomfits some of colleagues in the science community. Erik Parens of the Hastings Center, located just outside of New York City, rejects the popular view of ethicist as "priggish or foolish enough to lay claim to how other people should lead their lives." Fed up with Homo bioethicus, Carl Elliott of the University of Minnesota has remarked:
Many people working in and around bioethics wince if someone called them a 'bioethicist' ... Some resist the aura of professionalism and moral expertise that the term bioethics seems to imply. Others are just embarrassed by the incivility and glibness of our public spokespeople. Others just don't want to be viewed as the ethics police.
How did bioethics come to be known as a field for glib and woolly moralizing? During the early days, in the late 1960s and early '70s, bioethics was less a distinct enterprise than a collegial network of scholars and learned professionals, all of whom shared a mutual interest in applying moral theory to medical quandaries. These physicians, legal theorists, philosophers, historians, anthropologists, and sociologists were members of established academic disciplines with distinct bodies of knowledge, full of time-honored theories and methods of inquiry.
They brought those intellectual traditions to bear on questions of value-conflict within medicine and science. But when, in the late 1960s and early '70s, the zone of intersecting interests promoted itself into a primary, semi-autonomous field of its own called bioethics, the field became increasingly estranged from the rigorous scholarly disciplines from which it was spawned.
Many students nowadays aspire to become "bioethicists" without any other disciplinary background. One can be employed as a bioethicist by simply having a master's or Ph.D. in bioethics. Many of these individuals see bioethics as primarily a practical, rather than a scholarly, discipline. At the far end of the practical spectrum is the administrative wing of the profession, which deals with regulation compliance, mainly surrounding research on human subjects.
I believe that the moralizing spirit animating applied bioethics is the discipline's preoccupation with being relevant. The philosopher Daniel Callahan has said that he and his colleagues founded the Hastings Center in 1969 because they wanted to give philosophy "some social bite, some relevance." The Center was the nation's first bioethics think tank, an august training ground for scholars interested in the ethical problems in medicine and biology. In his book, the Birth of Bioethics, A.R. Jonsen explains that many post-1970s bioethicists saw their academic work as inseparable from their commitment to political and social activism.
The primary role of bioethicists in our society is to illuminate debates, not to settle them.
The impulse lives on a 2008 book, Observing Bioethics, by Renée C. Fox, a highly distinguished sociologist, and Judith P. Swazey, a respected historian of medicine. They urge bioethicists to take on "inequalities in health and in access to health care in American society ... [global] suffering and ... issues of social justice." It is not hard to see how partisanship can get smuggled in here, advancing a political agenda while taking advantage of the public's tendency to confuse bioethicists' expertise for authority.
For a person with an activist spirit, it must be frustrating that so much of one's work is done at the behest of others. "Politicians may want [bioethicists] in order to postpone decisions on controversial matters," writes G. Madison Powers of the Institute of Ethics at Georgetown, "or [to] burnish their own conclusions with the imprimatur of like-minded academics." Corporations and the media often engage and quote bioethicists, respectively, to "demonstrate their due-diligence," according to Powers. And surely many university administrators are happy to outsource sticky issues to new bureaucracies helmed by bioethicists, where they are no longer responsible for them.
To be sure, bioethicists can have much to offer those seeking to clarify their own thinking about a problem. At their best, bioethicists are experts in making good arguments for and against certain practices and in knowing how to distinguish between tight and sloppy arguments. They have educated themselves in the relevant history, and bring a deep knowledge of the cultural background of controversies, including the conceptual schemes that have been used to resolve them, as well as relevant legal decisions.
Bioethicists are free, of course, to advance and publish arguments of their own—what direction they would take, and what policy should look like. Some will make better cases for why their view should prevail, and perhaps they'll emerge victorious in the marketplace of ideas. But a view should not win or be given added weight by virtue of it being offered by a bioethicist. What's more, bioethicists advocating for a particular view must make clear that they are engaging in debate, rather than pronouncing moral truths.
The primary role of bioethicists in our society, then, is to illuminate debates, not to settle them.
To the extent that bioethicists have power to determine the outcome of a moral impasse, it is because administrators, committees, politicians, and the media mistakenly look to them as having special expertise in Moral Truth. In the parlance of medicine, bioethicists shouldn't have prescribing privileges: those are to be reserved for the decision-makers.
Optimally, bioethicists are experts in the intellectual and social histories of value controversies in medicine and biotechnology. They know about the technical and cultural antecedents of modern debates, and show us, in an impartial fashion, how to engage in disciplined moral inquiry. Their skill at drawing conceptual maps of the dilemma at hand while enumerating various ways to resolve it is a great service. But the knee-jerk naysayers and finger-wagging moralizers should, indeed, "get out of the way."