My colleagues in bioethics like to depict themselves as critical thinkers capable of skeptically examining the claims of physicians, scientists, and executives of pharmaceutical and biotechnology companies. Over the last 30 years we have made ourselves responsible for assessing the potential ethical, legal, and social implications of such new developments as stem-cell research, cloning, and xenotransplantation. Bioethicists today are quoted in major newspapers and newsmagazines, regularly appear on news programs and talk shows, and make presentations on the college and corporate lecture circuit for hefty fees.
And yet, despite their visibility, many bioethicists are not particularly insightful critics of contemporary medicine and biotechnology. They do not seem to be especially adept at sorting through hyperbole and corporate public relations. Much of the work of bioethicists has a breathless, gee-whiz tone. When geneticists report that they can extend the life spans of fruit flies and worms, bioethicists immediately begin to debate the ethics of making humans immortal. When engineers develop crude prostheses and computer links for amputees, bioethicists start discussing cyborg bodies and our bionic, posthuman future.
Genetics in particular seems to have a talismanic effect on many bioethicists. Announcing that the technological sheep have left the barn and the regulatory foxes are guarding the henhouse, they promote themselves as the solution to the problems they have in part fabricated.
Some bioethicists command speakers’ fees exceeding $15,000. They sit on corporate ethics-advisory boards, consult with companies, offer banal public commentary -- all with a relentless display of self-promotion and an excessive emphasis on ethical issues related to genetics and biotechnology. They risk turning their field into a farce. More important, they are deflecting public attention from matters of greater significance.
The President’s Council on Bioethics encourages that narrow emphasis on ethics associated with genetics and biotechnology. With more than 40 million uninsured Americans; with several states threatening to order prescription drugs in bulk from Canada and other countries that cap prices for medicine; and with poverty, homelessness, and violence constituting major public-health problems in many American cities, the council chooses to focus on topics like muscle enhancement in the biotechnological production of “the superior athlete,” and the use of genetic interventions to produce “ageless bodies.”
True, our society might one day have to confront difficult moral questions about controlling the aging process in humans. However, if you live in one of the poorer, more violent areas of Los Angeles or Detroit, you are probably more concerned with avoiding physical harm on the streets and getting access to a physician. The members of the council, like many leading bioethicists, are focusing on trendy issues connected to the biotechnology revolution, rather than addressing social issues that demand prompt, careful analysis.
The problem is not that bioethicists are considering ethical issues related to biotechnology; clearly, topics here are worth exploring. Rather, the cause for concern is that bioethicists see so many other topics as marginal to their work.
How can bioethicists make a meaningful intellectual contribution to public debate about medicine, health care, and biotechnology?
First, bioethicists need to reconsider what should be the core of their work. We live in a world of incredible inequities in access to health care, clean water, housing, nutritious food, and other necessities of life. Instead of contributing to the media circus surrounding genetics and biotechnology, bioethicists ought to pay more attention to those inequities and -- following the lead of scholars in economics, international development, and public health -- work on practical solutions. If the President’s Council on Bioethics is interested in issues related to human longevity, its members might want to look at the effects that poverty, homelessness, and lack of access to health care have on mortality.
Yes, developments in the life sciences are important, and topics like gene therapy raise important ethical issues. However, government agencies have provided generous financial support for research on those issues, and genetics-related topics will inevitably attract enough interest from bioethicists. Receiving much less notice are the astonishing disparities that exist between developing and developed societies, and even between wealthy and poor regions of developed countries. Bioethicists ought to have more to say about the relations among urban poverty, homelessness, disease, and unemployment -- issues that are connected to medicine, illness, and health care, and that are just as relevant to bioethics as are questions about therapeutic cloning and genetic enhancement.
Second, bioethicists ought to be more concerned about their role in exaggerating the significance of developments in genetics and biotechnology. Scientists are nowhere near conquering aging and making humans immortal. Do we truly need to worry about what would happen should we become posthuman immortals, when so many other pressing issues face us today? Bioethicists should be less cavalier about using terms like “wonder genes,” “cyborg bodies,” and “virtual immortality” when they worry about the possible perils of biotechnology.
Finally, bioethics needs to retain close ties to related academic fields -- including philosophy, law, sociology, anthropology, religious studies, and medicine. Now it is floating away from those disciplinary moorings as it threatens to mutate into part of the entertainment industry or join the management-consulting industry.
If bioethicists continue to cultivate ties with drug and biotechnology companies, the inevitable conflicts of interest that follow will greatly undermine the integrity of the field. And while I support the desire of many scholars to contribute in an accessible manner to broad public debates, some bioethicists seem to be more interested in providing sound bites than in the traditional academic role of addressing complex issues in depth. Becoming a celebrity bioethicist is all too easy: You need only a sense of indignation, a willingness to wear makeup, a presentable outfit, and a repertoire of clichés.
Unless bioethicists want their field to lose all credibility, they need to rethink what they study, how they frame complex ethical issues for public debate, what their public role should be, and what it means to do their work with integrity.
Leigh Turner is a member of the School of Social Science at the Institute for Advanced Study in Princeton, N.J., for 2003-4 and an assistant professor of the social studies of medicine at McGill University.
http://chronicle.com Section: The Chronicle Review Volume 50, Issue 35, Page B18