The Bioethicists are (Mostly) Alright
Edit 5/25/24: There is now a survey of bioethicist views on many issues out. I highly recommend it, and it has updated me somewhat more towards the position “bioethicists agree less with ingroup views than the general public”, though not by very much.
This is a linkpost for https://www.thinkingmuchbetter.com/main/the-bioethicists-are-mostly-alright/
Author’s Note: this post is based in part on Discord and Slack rants, as well as various conversations I have had recently, but is largely original
Special thanks to Applied Divinity Studies, for conversation on this matter, as well as commentary on earlier drafts. Some of the wording and sources in the final piece are based on their input
This is my second post on this forum. My co-blogger Nicholas Kross posted my first one here from his account, but it was a little weird to just have him be a proxy for me. I explained my reasons a bit in this comment, but even so, I decided to just get an account of my own this time. Sorry that this is another criticism of Effective Altruists, I swear I don’t hate you guys or anything, I’m an Effective Altruist myself, it’s just a coincidence that the first two pieces I was ready to write and post here are both critical.
It is a recent truism of the circles I run in that you should blog about your career. It is also a recent truism of the circles I run in that bioethicists are crazy and dumb. Bryan Caplan has compared them to astrologers. Robert Wiblin implied it is typical for them to think licking ice-cream in public is wrong. Byrne Hobart made a widely retweeted joke that bioethicists wouldn’t be approved by bioethicists if they were a treatment. Alec Stapp flatly asserted that bioethicists are grifters who stopped us from having challenge trials early in COVID. Scott Alexander even called bioethicists the rationalist “outgroup” along with evil robots back in 2016.
Well I have great news guys, I have infiltrated the enemy. Through clever subterfuge and sheer nerve, I have embedded myself inside a real life bioethics graduate program! And…look, I can’t keep this up. I am in bioethics because it is related to my academic interests. I have always found the reaction to the field prominent in EA/rat/adjacent spaces [1] pretty weird.
I have had informal conversations about this disparity in impressions several times recently. Twice in the last several months when mentioning my degree to others from my ingroup, once at an ACX meetup and once in correspondence with Applied Divinity Studies, the reaction was relief that someone from their background might be able to add some sense to the field on the margin. I am unusual in my bioethics program, but I am unusual just about everywhere except, to an extent, Effective Altruist spaces. I don’t feel unusually unusual in the bioethics program. I am not sure how to prove that bioethics just isn’t that bad, I am not even certain that it isn’t, but I want to at least register some evidence.
A key issue that I see people from my ingroup berating bioethicists about is challenge trials. Human challenge trials for COVID vaccines are popular with the public, so why do bioethicists oppose them?
This question came up semi-recently in the Rationally Speaking interview with Matthew Yglesias,
Matt: “Like, what is the field of bioethics? I don’t understand how that’s a purported domain of expertise. Because I’ve clashed with bioethics Twitter, on both this vaccine distribution thing and on human challenge trials for vaccines … And, I don’t know, the ethics experts just disagree about the big picture, obvious controversies. The trolley problem, et cetera. I was blown away, on the human challenge trials, that Christine Korsgaard, my former professor – I think the leading Kantian deontological thinker – she had her name on the 1Day Sooner challenge trials thing. And then there’s these, I don’t know who, being like, ‘Well that’s not good ethics.’ And I’m like, ‘Well, according to whom?’ Right? Obviously in consequentialist terms, it’s good ethics. I happened to know the top expert in Kantian ethics, she thinks that’s a good idea. So, who the fuck are you?” [2]
This is an interesting question, especially in light of another recent anti-bioethics tweet from Willy in the world, suggesting bioethicists were at fault for not putting out some sort of petition in favor Challenge trials. If only they were more like these 1Day Sooner ethicists. As Yglesias noted, prominent ethicists of every persuasion signed on, not just Peter Singer and Christine Korsgaard, but also Shelley Kagan, Jeff Sebo, Johann Frick, Jeff McMahan, Thomas Scanlon, Julian Savulescu, and Lawrence Temkin. It’s a shame, considering this, no bioethicists signed on…you can probably see where I’m going with this. Some prominent figures who are very specifically bioethicists signed on, like Nir Eyal and Arthur Caplan for instance, but more to the point, many of the cited figures are at least partly bioethicists. If you want to deny that people like Peter Singer, Jeff Sebo, or Julian Savulescu can really count towards the bioethicist scorecard, because they have other academic interests and careers, you will have to exclude other figures like Wiblin’s aforementioned example of Leon Kass. Singer, Sebo, and Savulescu are as much bioethicists as Kass, and Singer at least is almost certainly more influential on the field. The other figures listed often don’t have “bioethicist” listed anywhere explicitly in their title, but a good number of them like Jeff MacMahan and Shelley Kagan have done some of their most influential work on related subjects, while many of the others have at least done some influential work. Nearly everyone I listed is someone I have either been assigned to read something by, or to read something heavily influenced by, in a bioethics class this past semester (the exceptions being Jeff Sebo and Shelley Kagan). This is not an account of everyone on the list who may support my point either, just the really prominent ones who stood out to me reading it. I think there is a bit of a fallacy circulating in the ingroup that bioethicists are these strange aliens removed from academic ethics. On the level of theorists at least, this is flatly false.
There are noticeable omissions from the list, like (the sadly recently deceased) Judith Jarvis Thomson, but my other readings of her work make me think it is fairly likely she would have signed, and there are other noticeable omissions, like Jessica Flanigan, I am so confident would have signed, that this seems to mostly evidence the open letter’s poor circulation. Indeed one bioethics professor I talked to this about hadn’t even heard of the open letter until I mentioned it.
This is some counter-evidence right? Alright, maybe that isn’t very strong counter-evidence. When I recently started talking to ingroupers about this, it occurred to me that I hadn’t personally asked anyone in my program for their opinions about this issue, which meant I had the opportunity to run a test on my theory. I decided to ask the people in my program for their opinion on challenge trials, with the tie breaker for ambiguous answers being whether they would endorse the 1Day Sooner letter. I didn’t get a great response rate, but managed to corner about 10 people from my program (including two professors). One person opposed the letter, one person abstained from answering, the rest supported it. Some with bafflement that anyone could oppose its content, others with more hand-wringing and hedging, but ultimately they thought the letter as it was would be better than nothing (one professor was among the supporters, the other was the abstainer). [3] The rate of agreement here seems pretty consistent with the results among the polled public.
I spoke to one of the professors I polled after getting their answer, and they said they agreed with my impression that most bioethicists are supportive of COVID challenge trials. Additionally, before classes started, our professors circulated a bunch of recommended bioethics readings, one of which was Richard Yetter Chappell and Peter Singer’s defense of challenge trials. It was not very interesting because the case for challenge trials is not very interesting. There was no piece in the packet opposing challenge trials. But…maybe my program is weird, a few of its faculty members came from Singer’s department in Princeton. Isn’t there any stronger evidence?
I’m not sure if this is much stronger, but conveniently for me, the 2020 version of the phil-papers philosopher survey was released around this time, which has a much larger, more random sample. Unfortunately there is no “bioethicist” option for specialties. Still, “applied ethics” may be close enough to get some sense. I have already discussed the overlap in the context of the 1Day Sooner letter, but another factor is that “bioethics” is often used to refer to a fairly large set of issues. In my program for instance, it is not just used to refer to the ethics of medical and research decisions, but is also extended to environmental, animal, and emerging technology ethics. This point may be sort of a semantic difference, but for what it’s worth, arguably, bioethics is one of the biggest subfields, if not the biggest subfield of applied ethics at this point (aside from political philosophy, which got its own tag), and most applied ethicists contribute at some point to bioethics. So it isn’t perfect, but I think this survey can still tell us something, and at the very least it would seem strange if a large subgroup of applied ethicists were so different from the rest on the questions relevant to their own field without having some strong impact on the results in their own weird direction. As it happens, the applied ethics responses just seem too normal for philosophy, and normal for people in general I suspect, for me to find this very plausible.
There aren’t any questions about challenge trials in the survey, but there are some questions pertinent to bioethics. A few of these are arguably just too controversial or hard to figure out the stereotyped answer for them to be very helpful, such as abortion and vegetarianism. Others however might be helpful. I think that most of the people I have cited with outgroupy stereotypes of bioethicists would predict a consensus among bioethicists against human genetic engineering and immortality for instance. Most applied ethicists, however, support both, indeed in both cases a larger proportion of applied ethicists support these things than the proportion of philosophers in general. Is there anything else? Applied Divinity Studies’ comments actually led me to discover this very helpful Less Wrong post by Rob Bensinger attempting to look at the state of the field fairly by sampling abstracts and excerpts from 33 random bioethics papers (drawn from specifically “bioethics” journals). Some of these papers (like #24) seem to be on the side of the stereotypes against bioethicists. Others (like Savulescu’s papers #1 and #23) are in the other direction. Most are not very dramatically in any direction. One of the comments, from supposedlyfun, suggests that these confirmed their impression that what is wrong with bioethics is that you shouldn’t be trying to be original and clever about commonsense ethical decisions. I cannot even begin to relate to this impression, I am from this field, and so many of these papers felt like dull marginal pulls on debates about the specific form of consent people should be asked for in different medical contexts that it took me days to get through this post. This commenter also appeared to walk back their reaction a bit after reading other comments.
Most of the other comments seem to agree that these papers are fairly innocuous on average. From gwern,
“the actual day-to-day churn of publishing bioethics papers/research… Well, HHGttG said it best in describing humans in general: ‘Mostly Harmless’”,
from tcheasdfjkl,
“I’m sort of surprised that other people are surprised that bioethics is not uniformly trash”,
from Kaj_Sotala,
“after getting used to so many shouting-matches about controversial topics on social media, I’d almost forgotten what it’s like to witness a community of people actually doing careful and nuanced ethical thinking”,
from PeterMcCluskey,
“it looks like the average academic bioethicist is ok (with high variance)”,
from FireStormOOO,
“these papers were mostly unoffensive and not that terrible in contrast to expectations”
…I think you get the point. There was more to the impressions in the comments than this, and I will discuss some of the other sentiments shortly, but overall, my impression mostly matches that of the commenters: bioethicists don’t believe anything super weird and awful on average and most publications on the subject are just pretty okay actually.
Alright, anything else? Well, a quick google search didn’t turn up much in the way of surveys of bioethicist opinions on different issues, but maybe someone better at online research can find something more definitive, but each piece of evidence more or less matches my impressions of the field before I turned said evidence up, and pushes against the stereotypes of it I hear. Meanwhile, I am not aware of a similar evidential grounding for the opposing view of bioethics, mostly just tweets pointing at bioethicists quoted by newspapers, which doesn’t strike me as incredible evidence. Even if this is a robust trend, there are two parties to that piece of evidence, and it is already sort of foregone that journalism has some issues as a field. Still, I don’t want to totally reduce this to Gell-Mann amnesia.
When I spoke to Applied Divinity Studies, they said on this point,
“it’s possible that ‘people are doing X, bioethicists say it’s probably okay’ is just not as good a headline as ‘bioethicists are mad that people are doing X’. But I would still expect to see some headlines of the form ‘bioethicists are outraged that the government isn’t doing X!!’”
If I searched around I’m sure I could find some articles of the latter form, but I still get the point. You can find articles on all sorts of things, it doesn’t explain very well why, when you aren’t looking, the prominent coverage leans so heavily a certain way. The theory that ADS is sympathetic to, that at least a good deal of this is publications incentivized by clicks to generate controversy, has something to it. However after some thought on my part, I think it can often be accounted for more simply through something like this: when a novelish medical decision comes up, as happened in lots of cases related to vaccine research and distribution during the pandemic, publications that normally swear off bothsidism like the plague suddenly feel a desperate urge to find someone who can suggest a flaw with apparently commonsense ideas. If I am correct, bioethicists believe similar stuff to the general public on average, but weird ideas in every direction are also overrepresented among them on the margins. Even those who do not believe an objection are used to, per the norms of analytic ethics, coming up with the most polished, principled versions of the other side. Bioethicists are selected to be the group of people who both have apparent relevant expertise, and who can be harvested for the other, bizarre, side, of any given new medical debate an article wishes to report on.
And what of the other side of this mentioned by ADS? Why aren’t there many pieces arguing that we should be more bullet-biting in the pro-cost-benefit/anti-paternalist direction than is commonsense? I think this winds up breaking the bothsidism for many publications. The similarly contrarian bioethics positions on the opposite end from “maybe giving out vaccine doses about to expire is actually unfair” often look more like “infanticide is fine actually” and “we should harvest living peoples’ organs against their wills”. These are the sorts of pieces that will get a publication accused of platforming someone horrible. Even more modest (and frankly correct) takes in this other direction like “people should be allowed to get prescription medicines without doctor approval” run some risk like this. People with contrarian takes in the anti-doing-anything direction simply don’t generate this kind of fury outside of our relatively tiny and unpopular internet circle.
On the other hand, some anti-bioethics critics seem fairly willing to recognize that bioethical theorists don’t tend to endorse anything too terrible, and still insist on some version of the anti-bioethics position. As has been made brutally clear in recent years, regardless of what most bioethicists are like, most bioethics decisions are terrible (well, at least many of them are [4]). This seems to gel well with the meat of gwern’s aforementioned comment,
“The problem with the field of bioethics has never been the papers being 100% awful, but how it operates in the real world, the asymmetry of interventions, and what its most consequential effects have been. I would have thought 2020 made this painfully clear. (That is, my grandmother did not die of coronavirus while multiple highly-safe & highly-effective vaccines sat on the shelf unused, simply because some bioethicists screwed up a p-value in a paper somewhere. If only!)”
A sentiment reflected in a number of the other comments, as well as in this recent piece by Tom Chivers,
“while I’m talking about ‘bioethics’, it’s not clear that it’s actually bioethicists who are the problem. For instance, Peter Singer of Princeton, probably the world’s most famous bioethicist, is on the board of 1DaySooner, the human challenge advocacy group, as is his fellow bioethicist Nir Eyal, of Harvard. Leah Pierson, a Harvard bioethicist who is writing a book about the failings of bioethics during the pandemic, stresses that when the CDC paused the use of the J&J vaccine, lots of bioethicists she knows were appalled at the decision. But the practice of bioethics as it is actually carried out in major institutions, such as the FDA and CDC, often leads to these bad decisions. … Perhaps I should complain about ‘institutionalized public health’ rather than ‘bioethics’ per se.”
This is a perfectly reasonable sentiment. It is also not reflective of many many of the reactions to bioethicists I described at the beginning, such as Wiblin’s, Stapp’s, and Yglesias’, or the stereotypes of the field and its members I have encountered more informally in conversations. This would not be an irrelevant insight to really properly internalize. If this were just the rationalist version of the tedious debate over whether Critical Race Theory is really being taught in schools, I wouldn’t balk nearly as much. The difference here seems to be between cleanly and clearly identifying the problem as standard bureaucratic nonsense, or as a group of insulated crazy people ruining things on purpose. This is not a trivial difference for practical purposes. As discussed in a blogpost linked by its author as evidence that bioethicists are bad, the organizations making these decisions are litigation-averse and regulated through vaguely-yet-strongly worded guidelines, passed down from a federal agency with 22 current staff members working largely off of an old conference report drafted by people who presumably didn’t intend the more absurd consequences of these guidelines in the wake of an incredibly notorious case of human research malpractice. Indeed to the extent people with “bioethicist” in their job titles have impacted these decisions, it is probably in large part in a legal advisory role about what it is safe to do within and what is implied by the terms of these guidelines. Maybe they are better thought of as “biolawyers” in such cases.
Admittedly I know more about the academic field than the specific dynamics of IRBs, so I may be wrong about this. Still, it is worth some eyebrow-raising if it turns out that the ingroup defense is something along the lines of “well, by bioethicists, we mean research ethicists, and by research ethicists we mean research bureaucrats, and by research bureaucrats, we mean research bureaucracy.” It feels like blaming congressional gridlock on political philosophers at a certain point. To summarize my impressions on this matter, if “bioethics” is used to mean theorists, it refers to a broad, not that weird, not that insulated group of philosophers. If it is used to refer to “the thing that makes bioethics decisions bad”, framing the blame as though it has anything to do with a particular group of people believing weird things is about as helpful as trying to say the DMV is unpleasant because of those blasted DMV theorists.
Another version of the anti-bioethics critique that is perhaps more successful is to say that bioethicists aren’t worse than average, but also aren’t nearly good enough. This for instance seems to be reflected in the aforementioned tweet from Willy in the world, complaining that bioethicists really are responsible for bad bioethics outcomes, because they could oppose them more prominently, for instance in petitions. I do not think bioethicists, as a whole, are worse than the general public on these issues. But they are definitely more deontological, less focused on “beneficence” as a factor, than ingroupers. Like your average person on the streets, I don’t see the average bioethicist making a huge fuss about cumbersome medical regulations that cost lives. Indeed when I spoke to people from my department about challenge trials, none had both heard of and thought extensively about the issue. One respondent wished to emphasize that they hadn’t thought about this issue much yet at all when deciding. Bioethicists are no worse than the average person on the streets, but that doesn’t mean they are much better either, and maybe they should be. Still, I am pretty hesitant about this type of argument.
For one thing, if a professional field agrees with the views and priorities of the general public and not your weird ingroup, it becomes hard to make a credible argument, convincing to people on the outside, that the field is actually sick. How much better than the general public should the field be expected to be? Maybe these questions are just hard, and of course any group would rather the consensus on them drifted closer to its own views, and would call that progress. Still, this is the most credible version of the criticism I have seen, and those who hew specifically close to it have my respect. It may well be true that if the composition of views and priorities among bioethicists were different, they might be able to make more of a difference on the bureaucratic institutions currently failing. Most of them won’t have an opportunity to do this directly, and I don’t know for sure that they could even be that influential by signing more of these petitions or berating the relevant organizations more, but they’re at least on the short list of people who have a shot. I contend that most bioethicists do not focus much on this stuff, but if you point out the worst excesses of FDA/IRB/CDC incompetence and poke them with a stick, they will lean towards the apparently reasonable side. If the average composition of priorities among bioethicists isn’t far from that of the general public, the priorities it would be practical for them to have is, and perhaps they can be blamed for that. Still, this is also not how many of the critics I have mentioned come off either, and this point’s influence on ingrouper discourse may prove worryingly close to this motte and bailey recently discussed by Julia Galef.
One of my least favorite online discourse tactics is to point to two different, inconsistent opinions held by some people in a group, and then imply that the group is hypocritical without doing anything to establish that anyone in this group holds both inconsistent opinions at once. This means I will have to be careful not to do it myself when I point out that the responses ingroupers seem to have to bioethicists and what’s wrong with them appear to be all over the place. Are you referring to career bureaucrats enforcing medical policies, or academic theorists? Are you accusing the field of believing bad things, or believing insufficiently good things, or of being insufficiently outspoken against the bureaucracies? And yet, it seems to me that all of these things hang in the air around the ingroup as the same vague shared understanding, referred to in the same ways, that allows for the vague implication that Leon Kass’ weird ice-cream hang-ups have something to do with the failure to efficiently approve Paxlovid. The same atmosphere that prompts Tom Chivers to complain about bioethics and bioethicists throughout an article whose punchline is that maybe we should really just be complaining about “institutionalized public health”. The same atmosphere that leads Willy in the world to link his piece on IRB incompetence as evidence that you should hate bioethicists. It feels like there really is an appetite to scrunch all of these complaints of varying targets and validity into one group understanding. So, what’s the deal with that?
Interestingly one of the best accounts I can think of is suggested by Scott Alexander’s own quip about bioethicists and evil robots being the rationalist outgroup. I don’t know from context whether he was endorsing or merely describing this [5], but as a description it fits his account of outgroups very well. Not only is there a weirdly uncharitable partisan hatred towards bioethicists among rationalists, it seems to me, but there are strong grounds for believing this may have something to do with a narcissism of small differences. Bioethics is the field of ethics that focuses on issues like pandemics, human enhancement, AI, global health, animal rights, and environmental ethics. Bioethicists, in short, have basically the same exact interests as us. Given this, maybe it is understandable that their different norms, views, and priorities are exaggerated given this shared space. In Alexander’s own words,
“So what makes an outgroup? Proximity plus small differences.”
On the other side of this, as one of the academic fields most relevant to our interests, it seems pretty bad to alienate bioethicists for no good reason. If there is an especially good reason then fine, but if as I suspect the stereotypes are careless and poorly grounded, or the phrase “bioethicist” is just used as a vague catch-all for the aspects of professional bioethics decisions ingroupers tend to dislike, then this seems like a not very good reason. If we don’t antagonize them, and our arguments for our priorities and norms are good, a productive conversation may be possible.
Additionally, I have no expectation that the result of looking down on bioethicists will be them improving or coming out the worse-off party. If there was a groundswell of people criticizing bioethics, it might move the needle, but I do not know anyone outside of my ingroup who has this strong an opinion on this one field. Indeed many people I have spoken to have never even heard of it. In a war between an apparently reputable academic discipline and a loose assortment of utilitarianish weirdos, the academic discipline is the one that wins. In all likelihood, we need bioethicists if we want to make an appreciable impact on the conversation, and they don’t need us.
There is more that I could say, but this is dragging a bit. Look, none of my observations or suspicions here are super decisive, but I haven’t seen anything similarly convincing put forward in defense of the ingroup anti-bioethics camp yet. Maybe I am wrong, and either bioethicists are bad in some way I don’t know about, or by and large the ingrouper response to them has been perfectly reasonable even given this, and I am misunderstanding or weak-manning it. As I said, I want to register my evidence however, for what it’s worth. The ball’s in your court.
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Often just shortened from here on out to “ingroup”, even if it isn’t strictly accurate to Scott Alexander’s original use of the word.
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This interview made me genuinely curious what “bioethics twitter” is. Seriously, it seems relevant to my analysis here, and I have no idea what he’s talking about. From his description, I guess I might be lucky.
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I want to anonymize the respondents, but when I asked if it was alright to share the anonymized results, one of the respondents actually said he wouldn’t mind being identified, so uh, shout out to Woodley Brown for responding!
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Based on his use of the title “bioethicist” for the child torturing demon in his notorious Hell chapter of Unsong, I have to at least default to leaning towards the former. Edit, 1/6/22, I dug around a bit on a whim, and it seems he explains this part in a comment. Also, I probably should have emphasized this from the beginning, but please read the content warning first if you are going to read the chapter.
I think that there is a difference which is being elided here between “bioethicists have bad opinions” (they mostly don’t,) and “bioethics as a field is bad for the world1.” I’m going to try to make at least part of the case for the second, which I don’t think you addressed clearly.
In my view, one key problem is that bioethics functions almost entirely as a veto, as it relates to medicine, public health, and policy2. Even when individuals argue for something, the field doesn’t have the ability to push something forward. And checks and balances are important, but they can be take too far. I think it’s very obvious that this is the case, where abuses are rare, or not addressed by where bioethics actually focuses. Bioethics informs IRBs, which slow research—sometimes for good reason, but at a very high implicit cost. And because there are legal requirements and potential legal threats that come from failing to fully address bioethical concerns, the shadow of bioethics looms larger than the field itself. So even when ethicists wouldn’t oppose anything, the existence of the field is a barrier to research which imposes huge costs in research or treatments not pursued3.
So it’s not the fault of bioethics as field, necessarily, that there are such huge systemic barriers and institutional barriers—but the barriers emerge from the field, so pleading that the institutional dynamics are the real problem just means blaming immoral mazes rather than the participants who are building and reinforcing them, instead of fighting it.
And if so, people should fight back, or at least not participate.
The field does other things. They just don’t intersect with what EA cares about, in general.
To counter this criticism, you’d need to find something the field does that contributes positively to a greater extent than it contributes to slowing down medical research and the practice of medicine that saves lives.
This is an interesting question, and you’re right that I don’t really address it directly. That said, I’m not sure I totally understand how your criticism applies to the issue of whether bioethics as a field is worthwhile. Are you saying that the IRB system is bad for research, and if it weren’t for the presence of bioethicists this system wouldn’t be in place? As I said in the piece, I’m not an expert on IRBs myself, but this seems implausible to me. The IRB system is in place because of unclear and excessive guidelines, and the strong risk of liability they bring, if bioethicists disappeared, I just don’t think it would solve that. Indeed I expect IRBs themselves would march on, populated by lawyers or doctors or applied ethicists we don’t call bioethicists.
First, I think that working within a broken system know you can’t fix is bad, especially when it lends authority to the system. And second, the IRB system as it exists isn’t being condemned or opposed by bioethicists, and in fact was put in place by the Belmont Report, which was written by a bioethics expert group.
I have heard the claim that there were no professional ethicists among the authors of the Belmont Report.
Per HHS, “The Belmont Report… is the outgrowth of an intensive four-day period of discussions that were held in February 1976 at the Smithsonian Institution’s Belmont Conference Center supplemented by the monthly deliberations of the Commission that were held over a period of nearly four years.”
Not sure who was part of the four-day discussion, but per that site, the commission included, among others:
Albert R. Jonsen, Ph.D., Associate Professor of Bioethics, University of California at San Francisco.
Karen Lebacqz, Ph.D., Associate Professor of Christian Ethics, Pacific School of Religion.
A similar position to David’s might be that bioethics institutions are bad for the world, while being agnostic about academia. I don’t know much about academic bioethicists and you might be right that their papers as a whole aren’t bad for the world. But bioethics think tanks and NGOs seem terrible to me: for example, here’s a recent report I found pretty appalling (short version, 300-page version).
“so pleading that the institutional dynamics are the real problem just means blaming immoral mazes rather than the participants who are building and reinforcing them, instead of fighting it.”
I don’t follow. We should blame the participants even though we realize the institutions cause the flawed behavior? I don’t think this has a good track record. Seems like an argument similar to blaming corporate greed for rising prices.
My suggestion is we invest more in the optimal design of collective decision making institutions.
If the participants as a class first built and still reinforce the flawed system, yes, we assign a small part of the blame for the system on them.
That makes sense, and I agree they are not totally without blame. But I think their role in building the flawed system (the vetocracy, the fear of litigation) is very limited, as is their capacity to unilaterally change those problems which affect societies in general.
I love this. I think it’s really important to contradict important misunderstandings floating around in the EA community, and I found the conversational style really engaging, although some subheadings might have made it easier to skim
Thanks so much! Applied Divinity Studies deserves a good deal of the credit for the style though, they really pushed me to make the tone more engaging/bold, and even gave me suggested rewrites in some places. I have gotten the subheading suggestion a couple of times now on different pieces, so you’re right that I should look into doing that more going forward.
Yeah, I likewise appreciated this post and think this sort of pushback on common but under-justified or oversimplified views seems a useful service to provide.
I’d recommend not just subheadings but also a summary / key takeaways section, ideally in the style used in Open Phil and Rethink Priorities posts and described in the post Reasoning Transparency.
This is a suggestion I very often make (i.e., it’s not like a weird rare issue with just this post). One reason I make it here is that I can imagine wanting to point people to this post in future but not really wanting to say “you should definitely spend 23 minutes reading the whole thing” and instead wanting them to be able to see the key conclusions and reasoning in condensed form right away and then make their own choices. See also Honesty about reading, in particular this passage:
(I collect other potentially useful thoughts on writing here. Though to be clear, I mostly found the writing in this post good already, and the only key thing I felt was missing was a summary section.)
Agreed (I shoulda done that when editing it :P
You can still edit the post to include them! I agree with Khorton that you’ll probably get more engagement that way.
Actually I’m the one who posted this one, Nick edits all of my posts because they are published on his blog (though this one won’t be there until he gets back to RIT). I’ll be busy the next couple of days, but I’ll take it under advisement!
I think creating a system to contradict misunderstandings, is the important and difficult question (which I will do nothing to solve at this moment). I read the essay sampling the research papers, so I’ve known at least since then that actual ‘bio-ethicists’ are not the group we are talking about. But in my head angry rants about bioethicists would still sometimes pop up. And certainly the general discourse in the community didn’t digest that result.
I’d very much like to see a system that helps for us to call out these sort of issues.
An idea I encountered in a different discussion recently that might get at that is encouraging funding groups to fund research into the Devil’s advocate case against ideas popular in the community. That would obviously not be sufficient but it could be a good step in the correct direction.
You raise a bunch of good points and you’re 100% right that when I write “bioethicists” on twitter I should really write “institutionalized research ethics”. Not doing do so is sloppy of me. I think I do a better job showing the institutional dynamics bioethicists work under in my blogposts, so I think those hold up okay. But I’ll look at those posts again and see if I think they need some edits.
Mostly agree with: “worth some eyebrow-raising if it turns out that the ingroup defense is something along the lines of “well, by bioethicists, we mean research ethicists, and by research ethicists we mean research bureaucrats, and by research bureaucrats, we mean research bureaucracy.”
Your survey data on actual bioethicists’ opinions was slightly surprising to me, so I should update on that.
My criticism of bioethics is aimed at bioethics-as-practiced-by-institutions, which does seem bad and deserve criticism, but you’re right that the causal story here is definitely not [bioethicists are the sole reason big institutions are risk-averse] and so blaming only them doesn’t make sense. My own posts basically argue that institutions use IRB’s as a means of reputation/PR control, so in some sense I should exonerate bioethicists per se and focus on the institutional dynamics and laws that led to that equilibrium.
Incidentally, this does lead me to two points of possible (not sure of your views) disagreement:
I think you’re right that practically speaking, engagement with bioethicists is good. But if we take your point that institutionalized research ethics per se is the problem, not bad bioethicists, that suggests we should pay a lot of attention towards changing institutional dynamics, instead of just the opinions of the people inside them. In the case of institutional research ethics, that would look like advocating for specific changes in legislation or federal directives, so that institutional incentives change. In other words, arguing/discussing with bioethicists is good, but we should also try to change the law that leads to bad research ethics. It might be the case that institutional caution is the inevitable consequence of societal risk-tolerance declining and/or older institutions being cautious, but there still might be changes we can make at the margin.
I’m not sure that some vaguely EA-ish/ EA-curious people criticizing bioethics is properly characterized as a “war”. Even if it is, my really vague historical sense of political change is that reforming entrenched institutions (like research ethics) often requires relatively strong public disagreement and criticism. So I’m personally really unsure if your instrumental argument holds up. But this is pretty subjective, so I’m happy to mostly drop this because your other points on more accurate terminology and institutional dynamics are spot-on.
I really appreciate you replying to this, and I read (I think) all of your blog posts on IRBs, and they are all to the best of my knowledge informative and accurate. My point is much more just that “bioethicists” seem to be a bad way of framing a bunch of these issues. As for:
I think this is correct, but I still think it can be useful to try to get along, all else equal. As I briefly mentioned, it is possible that if bioethicists had better priorities they could make some indirect difference at least, and this is probably the best criticism of the field as it is now. Aside from this, I guess I just also don’t like it when a group gets what I see as unfair criticism, even if it doesn’t backfire. I focused more on that issue in the first draft, but wound up cutting it for brevity.
War is maybe a bit of a dramatic word for it, but I guess what I more mean is if it comes down to a very public “it’s us or them” between EAs and bioethicists on important issues, I see the EAs losing. If the public largely agreed about the foibles of bioethicists it would be another story, but our group is weird in both our priorities, and our apparent vitriol against “bioethicists”.
Glad you didn’t see any factual error in the posts!
#1, Yeah, you’re totally right that “bioethicists” is the wrong target. Will try to use “institutionalized research ethics” going forward. It is much more explicit about what the problem is and more fair to bioethicists.
re #2, sort of agreed. I tend to think the public doesn’t like weird ideas in general, but there was a recent paper showing higher public support for challenge trials than traditional trials. So I’m not sure what counts as weird to the public as a whole. It might be the case that the public has surprisingly EA-ish ideas on medical ethics, at least on this specific issue. Not sure.
I appreciate it!
I hope the public is generally receptive to EA-style thinking, and there is some indication of it at least. I do still worry that when it comes to appeal-to-authority type reasoning, the public will find “bioethicists” more trustworthy, even if they are relatively disposed to agreeing with our ideas. I could be wrong on that, it is a fairly speculative harm.
This:
has been roughly my impression of the curious EA bioethics hate, which I have tried to push back on when I’ve seen my friends expressing it. I liked the Rob Bensinger piece Thirty-three randomly selected bioethics papers that you linked.
My sense is that there are institutions making dubious, hyperconservative, and omission-biased “ethical” judgments for reasons that are more to do with liability than ethics. I think many USA-based researchers don’t really interact with “bioethics” except when asked to fill out extremely onerous forms for their institution (e.g. “what are the risks of asking people to look at differently-coloured triangles on a computer screen?”, where an insufficiently-detailed response means your project can’t go ahead).
I agree, the Bensinger piece was very helpful, and wasn’t in my first draft. Credit to Applied Divinity Studies for linking me to something that linked to it, or I wouldn’t have found it at all.
Fair enough, I’m happy to talk less about bioethicists and talk more about institutional review of research ethics.
For what it’s worth I and other critics do regularly/constantly refer people to the classic dissection of the problem caused by IRBs (The Censor’s Hand).
We also talk about the misaligned incentives faced by bureaucrats about as ad nauseam as we talk about bioethics.
And when I’ve seen IRBs in action they have worked to keep their decisions and the reasons for them secret and intimidate researchers into not speaking out, while philosophers publish their ideas in journals you can read (and their arguments can then be used as cover for IRB decisions). So as a practical matter it has been easier for folks to scrutinise bad thinking from philosophers than IRBs even if the average quality of the latter is much worse.
This is all fair, and I appreciate the response. I don’t mean to say that you and other critics overall have bad takes on the issue of research oversight, I agree with most of the criticisms, and think they are important. It’s just on the topic of bioethicists specifically that I find a good deal of the discourse weird (I should also add that there are plenty of particular bioethicists, like Leon Kass, who are worthy of the criticisms, I just don’t think they are representative, or the root of the problem).
Cool yeah. I just want to provide another more boring reason a lot of us have piled on to bioethics that doesn’t even require ingroup-outgroup dynamics.
Basically all of the people you’re citing (like me) have an amateur interest in bioethics as it affects legal policy or medical practice or pandemic control (the thing we actually follow closely).
You and I agree that harmful decisions are regularly being made by IRBs (and politicians), often on the basis of supposed ‘bioethics’. We also both agree there are at least a handful of poor thinkers in the field who do offer up low quality moral philosophy to support these bad decisions. It’s only natural then for me and my fellow travelers to see these bad decisions, and these writings classified as bioethics justifying them, and suppose that the latter are an important cause of the former.
And these decisions come week after week for years, progressively infuriating me more and more.
I could see I’m making a mistake to judge bioethics as a field by sampling a representative bunch of papers (weighted by citations maybe), reading them, and deciding how reasonable they typically seem. Unfortunately that’s an involved process that few people with an amateur interest are going to have time for. Each person can only go down a few rabbit holes like that each year in between our normal work, personal commitments, staying healthy, and so on.
So I appreciate you and other people doing that heavy lifting and then sharing the results — it’s the only way it’s practical for our mistake to be corrected!
Thanks! I’m glad you found it useful.
Tl;dr: Bioethicists are too quiet when people appeal to an illusory “bioethical consensus” in order to justify conventional medical norms that are causing widespread harm.
The Bioethical Illusion
Others here have reframed their opposition to “bioethics” as gloss for opposition to biomedical institutional decision-making. I want to express my qualms with the field of bioethics per se.
The field of bioethics is taken seriously by biomedical decision-makers and practitioners. In non-medical domains, few people feel the need to rationalize their moral judgments and decisions on the basis of a consensus academic ethical position. By contrast, in the medical world, it is relatively common to appeal to a consensus bioethical position as a crucial component institutional decision-making.
As you point out, such a consensus bioethical position may be illusory in many cases. Yet the illusion persists, driving significant real-world outcomes. Let us call this problem “the bioethical illusion.”
The bioethical illusion makes it difficult to put actual bioethical thinking into practice. As long as people subscribe to the bioethical illusion, actual bioethicists and divergent bioethical thinking will come across as “pseudoethics,” the work of cranks.
This makes for an intractable problem, in which the norms of the medical field stem not from a centralized authority (which can be overcome), nor from a cultural norm (which can be changed via healthy debate), nor from consensus academic principles (which can be grounded in a traceable line of argument), but from the bioethical illusion.
The best analogy I can think of is the Latin Bible. The Bible used to be written and read exclusively in Latin, so that common people could not understand it. This allowed the chuch to pretend that church laws and religious doctrines had a Biblical basis, when they in fact did not. But over time, the idea that these features had a Biblical justification became normalized, and questioning whether that Biblical justification itself existed became a form of heresy. While religious authorities did not have a true consensus on many important religious matters, the notion of an illusory Biblical basis for certain rules, and that this could not be discussed, served to greatly inhibit discourse or change.
Likewise, the bioethical illusion functions to establish a false bioethical consensus. One part of the bioethical illusion is the idea that bioethics is the exclusive domain of bioethicists, a subject on which people who are not professional bioethicists cannot reason effectively. To question the bioethical consensus risks compromising a person’s professional standing, and creates political problems for their colleagues. This allows any biomedical norm that is covered by the bioethical illusion to resist challenge or change, or even debate and discussion. They become matters of biodoctrine, not matters of bioethics.
I’m a biomedical engineering grad student at a major US research university. Students in our program are required to take an ethics seminar. No bioethicists and no papers on ethics or bioethics were included in the ethics seminar. The overwhelming impression I had was that students were being impressed with biodoctrine and politics. This is how the bioethical illusion works. Future practitioners in the field are required to an “ethics” class with no ethical content whatsoever—only political and norms-reinforcing content delivered by a non-ethicist.
The Bioethical Illusion Relies on the Complicity of Bioethicists
The bioethical illusion wouldn’t work nearly as well, if at all, if it weren’t for the existence of an actual field of bioethicists. My problem with bioethics is that the field isn’t activist enough. It needs to loudly and consistently point out that:
a) Non-bioethicists are posing as experts in an illusory academic bioethical consensus, while in fact ignoring the field of bioethics.
b) That everybody has a right to consider and participate in bioethical discourse. Medical providers, scientists, regulators and administrators don’t just have a right, but a responsibility to do so.
c) Challenging public misconceptions about the state of bioethical discourse.
d) We need a more ethically-grounded discussion of political/medical issues,with bioethicists being the group primarily responsible for facilitating this shift.
Until the field of bioethics starts working to dismantle the bioethical illusion, it is unintentionally complicit in maintaining the bioethical illusion.
This sounds like a similar argument to “all Muslims are complicit in terrorism unless they loudly and publicly condemn terrorism” or “if your dad’s Facebook account gets cloned, he’s responsible for anyone gets scammed”.
On the one hand, people whose identity is being co-opted to do bad things have a unique ability to fight back. On the other hand, it’s pretty unfair to say that all professional researchers of bioethics need to suddenly pivot into PR because you hold them responsible for the actions of people they’ve never met.
It may sound that way, but it’s not the same argument, and I wish you’d take more time to consider before you make such an uncharitable and contentious interpretation.
Here’s why my argument is different.
The general form of the “all Muslims must denounce Islamic terrorism or be complicit in it” is:
Sharing label X with perpetrators of bad act Y causes good group X1 to have a moral obligation to take a stand against bad group X2.
In my comment, however, I am not accusing the medical establishment (X2) of intentional or uncontroversially bad acts (Y).
Instead, I am identifying a complex coordination problem in which incentives are skewed. Bioethicists are also affected by this situation. However, they have a unique opportunity to take steps toward correcting this situation, by taking the steps I outlined.
Furthermore, a key difference between Muslims, my dad, and bioethicists is that being a Muslim or a dad is a personal avocation or form of cultural participation. Understood in a culturally specific context, being a Muslim or father entails certain duties, but these are limited mainly to personal conduct, certain observances, specific acts in defined conditions, and generally virtuous behavior.
By contrast, occupying a professional role is widely understood to come with an increased social responsibility, both for rendering the services of that role in a competent manner, and for aligning that role in its social context in a proper way. Professional bioethicists can be said to have an obligation to prevent harm and work toward good outcomes in matters related to their profession. This is a widely understood responsibility of many jobs, and is what I’m calling for here.
This responsibility is increased by the fact that many bioethicist salaries ultimately come from the taxpayer. They have a duty to the citizens who fund their work to make improvements in the ethical aspects they purport to be experts on in the medical system.
The cases do seem somewhat different to me as well, but I don’t think this necessarily contradicts my thesis. If the key criticism is something like “bioethicists should make their actual leanings more well-known and influential” I would agree with that. It’s just this seems more modest and less unique than many of the criticisms I have seen.
I think that many of the people you quote are articulating the bioethical illusion. Take Matt’s quote, for example:
He’s saying:
a) It’s not clear who these supposed “bioethicists” are.
b) Whoever they are, they’re misrepresenting their own controversial views as professional consensus.
c) They are also exaggerating their professional standing, and it’s not clear that they do or should have any standing as moral authorities at all.
It seems to me that a primary skill of a competent professional ethicist is to be able to articulate arguments and counter-arguments in their field, and to be able to roughly articulate the professional consensus as well as popular opinion on the subjects they are most expert in. While people are entitled to their personal opinion, if a professional (bio)ethicist speaks out in their professional capacity to politicians or the media, they ought to qualify the strength of their statements based on an accurate representation of the state of the discourse and professional and popular views. This doesn’t have to be done perfectly or in a uniform fashion, but a real attempt should be made.
In turn, bioethicists ought to either work hard to organize their profession around this principle, and to invite the public, journalists, and lawmakers into a more open-minded view of the most pressing bioethical issues of our day. They don’t have to fix PR problems or instill a particular viewpoint on specific bioethical issues, but they need to try to create a perception that bioethics doesn’t have many universally-held conclusions on particular ethical issues in biotechnology. I don’t hold them responsible for failing to restrain their loudmouthed colleagues, but I do feel resentment for their not trying harder to spread a more nuanced and representative view of unsettled debates.
In fact, I think this is perhaps the primary responsibility of an ethicist. It’s not to craft a conclusive argument to settle an ethical issue, but to make strong efforts invite the public and providers into a more refined dialogue in their public communications. If the public doesn’t accept that invitation, it’s not the bioethicists’ fault. I’d like to see more active efforts from bioethicists, and since I don’t—but do see the tails of the field as indirectly contributing to bureaucratic rigidity and journalistic nonsense, with little pushback from the center—I see the field as having net negative value at present. This is the frustration that I read into some of the quotes you’re referencing.
No one is accusing your dad of bad acts if his Facebook is cloned, AFAICT.
I do accept that there is a difference between a taxpayer-funded profession and a personal/religious/cultural role, but that seems to be the only difference—they really do seem like very similar arguments and I’m a bit surprised to be called uncharitable for bringing it up.
In addition to the what AllAmericanBreakfast said, the issue with “all Muslims are complicit in terrorism unless they loudly and publicly condemn terrorism” is that
a. not all terrorism is committed by Muslims.
b. The shared notion between a) Islamic terrorist and b) normal guy who happens to be Muslim is that they share a belief in the “the will of God”, and they have deferring notions about what the will of God tells them to do.
c. In contrast, (at least in AllAmericanBreakfast’s telling)”the establishment” specifically appeals to the bioethics illusion in their choice to be conservative and allowing people to die by omission. The appropriate comparison might instead be a Muslim imam [1]whose teachings were specifically cited by terrorists as a justification for terror and who chose not to condemn terror (or alternatively, blaming God himself, assuming God is real).
I think this is reasonable. I think it’s also reasonable to assign partial blame to Karl Marx (and contemporary Marxist scholars and firebrands) for the failures of the Soviet Union, and it’s reasonable to assign a small amount of blame to Nietzsche and Kant (as well as contemporary scholars who did not disavow such actions) for the harms of Nazi Germany. Or closer to home, if animal rights terrorism are conducted in the name of Peter Singer, it’s reasonable to assign partial blame to Singer for his speech acts, and especially if he does not disavow such terrorism.
Though that comparison is not exact either, since the illusion is not propagated by individual bioethicists so much as the field overall. So perhaps it’s closer to whether Muslim imams overall have a duty to disavow terror, and I think this is also reasonable (I’d say the same thing about contemporary Marxist scholars re: Stalin and Nietzsche scholars re: Hitler).
In particular, the religious example you gave has political associations I am eager to avoid. Implying such associations can be used as a rhetorical tactic. Furthermore, you read an extreme statements into my comment that simply is not there:
These things together caused me to read your comment not as a rebuttal, but as a low blow, combining outgroup signaling and weak-man tactics. This is why I called your comment uncharitable. I am explaining this to you because you said you were surprised at this reaction, which indicates to me that you may be unaware of these associations and may not have been reading me very closely.
Holding your dad responsible for anyone who gets scammed would be equivalent to accusing him of negligence—a bad omission rather than a bad act, but it is in fact a discussion of omissions that we are focused on here.
Given that you didn’t notice this important difference the first time you examined my argument, are you sure you want to trust your impressions of how things “seem” to you the second time around? This is not, after all, the only difference I outlined—the other being that we are dealing with coordination and communication problems rather than intentionally destructive or criminal actions.
Of course, it’s also important to note that it’s not just the number of distinct differences between the argument I’m making and the words you’re putting into my mouth, but the magnitude of each individual difference. A single important difference is enough to robustly distinguish the ethical argument I’m making from the one you’re worrying about.
I’m guessing a lot of the disagreement comes from looking at different time-slices of ‘bioethics’, and different parts of the field. From Luke Muehlhauser:
Luke quotes Baker’s Before Bioethics:
This is a possibility, admittedly my evidence doesn’t say much about the old state of the field. If so I think that would be a good reason for optimism, so I kind of hope you’re right. That said, I think some of the state of research has to come down to unintentional consequences as well. The Belmont Report is too strict even as intended for instance, but I think a great deal of its harm comes from the vagueness of the guidelines it inspired.
Just some quick feedback that I didn’t find it very convincing to say that people like Peter Singer, Julian Savulescu, Jeff McMahan and Jeff Sebo have supported things like 1DaySooner, since they’re pretty affiliated with EA and consequentialist ethics. I don’t think anyone is claiming that consequentialist or EA-affiliated bioethicists have silly views. The review of randomly selected bioethics papers seems more convincing.
Strong agree. All of the evidence cited in this post is about philosopher-bioethicists, and my experience working in bioethics (including at the NIH Department of Bioethics) says that philosopher-bioethicsts are much more progressive than bioethicists with a health background. And unfortunately, bioethicists with a health background have much stronger ties to the medical community and health care policy. One major piece of evidence for this is that none of the “bioethicists” mentioned in this post (other than Art Caplan) are members of the American Society of Bioethics and Humanities, the main professional organisation in bioethics which “represents nearly 1,800 physicians, nurses, social workers, members of the clergy, educators, researchers, and other healthcare professionals interested in the specialty of bioethics and the health humanities.” (Evidence: I know most of them personally, have been to the ASBH conference three times, have a strong sense of who is there + what the conversations are like.) My experience attending the ASBH conference three times in the past suggests that most members of the ASBH see the philosophers mentioned as excessively radical, and they’re routinely ignored by the core bioethics community.
As I’m revisiting this post, I’m going to break with my no-comment policy again. This time I don’t have a very good excuse, this comment just sort of sits in my head rent-free, and I keep wanting to address it.
On the one hand, I think your broad point is right, my evidence is more weighted towards the philosopher bioethicists than the medical bioethicists, and I don’t really distinguish the two in my post. This might full well make an important difference to several of the points in my piece, though I’m not sure what sort of difference in particular you think it makes (do you think the medical bioethicists are more bioconservative on average than the general public as well as the philosophers? Do you think this is the primary reason for current problems in the bioethics bureaucracies?).
On a somewhat more petty level, I’m bothered by how you say all of my evidence is specific to philosophers. The philpapers survey certainly is, and the figures I cite from the 1DaySooner letter, but the two pieces of evidence I bring up that I consider strongest don’t seem to be. The program I surveyed (my MA) has a mix of students from both a medical and philosophical background, and is even in NYU’s School of Global Public Health rather than its philosophy school. As for Bensinger’s literature review, if I had time I would go through all of the authors to check how many are from more of a philosophy versus medical background (and I encourage anyone interested to report the results back to me), but I think they are a mix.
I don’t want to lean on this too much though. Again, your basic point holds, that my evidence is philosophy leaning, and it is fully possible to me that the split is characterized by above average philosopher bioethicists canceling out below average medical bioethicists in the aggregates, and the medical ones having more influence. I just don’t know personally.
On the one hand I agree that that piece of evidence is my least systematic and convincing. I mostly raise it because of Willy in the world asking for a bioethicist petition on challenge trials and Matt Yglesias citing the 1Day Sooner letter in claiming that bioethicists seem out of step with regular philosophers. In this context I thought it made sense to dig a little bit into the contents of the letter. On the other hand, I do think that Sebo and Singer and McMahan and Savulescu (and for that matter Jessica Flanigan and Anders Sandberg and others) should count towards the bioethicist scorecard, and if some bioethicists are consequentialist/EA-affiliated, that doesn’t mean they are in some separate category, it should instead undermine some of the stereotypes.
Thanks for writing this! I run 1Day Sooner (and have a lots of thoughts about bioethics), so I have a special interest.
I really agree with the point that complaints about bioethics are less about the positions of individual bioethicists than the outcomes of bioethical institutions. So I think it’s worth asking why these institutions lead to frustrating outcomes. Some briefly sketched out, somewhat simplistic thoughts:
Conservatism: Structurally, bioethical scrutiny adds friction to accomplishing whatever action it is being applied to. Providing a justification takes time and effort (as does reviewing the quality of that justification and suggesting and making remedial measures). That friction reduces unethical action but it also reduces action of all types, and the cost of that general inaction is not accounted for in bioethical review. One line I like to use about IRBs/RECs is that they’re like a driver who has only a brake and no gas pedal. But I think more broadly the academic act of ethical inquiry problematizes decisions into potential mistakes, which increases the complexity of the decision being made and therefore the difficulty in making it. (To be clear, one could argue this tradeoff of fewer ethical abuses for reduced dynamism is worthwhile)
Parochialism: Because bioethical institutions often exist to translate legal regulations into practice, they are embedded in local concerns and are not cosmopolitan. They are more likely to focus case-by-case (and have insufficient incentive to create rules that would apply globally), and they also are unlikely to take the lives of people outside of rich countries seriously (which matters particularly in a research context).
Illiberalism: In many cases, bioethicists are partially acting as agents for subjects (like research participants) who do not choose them and have no ability to appeal their judgments. Because bioethicists are (1) in fact different from the people on whose behalf they are making decisions and (2) (unconsciously) motivated to maintain their power/resources, their decision-making is imperfect and paternalistic.
What Are Bioethics For? I think retreating to the safety of the academy (i.e. separating the generally reasonable intellectual arguments of bioethicist academics from the practical decision-making of translating biomedical regulation into practice) is not a tenable move for the bioethics field to make. Bioethics exists (i.e. is largely funded) to help solve problems in medical and biological spaces. If in practice, those problems are being solved poorly, that seems like something the bioethics field needs to take up and solve. Otherwise, what’s the use? We could just have philosophers, biolawyers, and doctors.
Fwiw when I see criticisms of a field, especially in a technical/semi-academic setting, I rarely assume the criticisms are about individuals and generally assume it’s about institutions.
This is possibly epistemically unwise/to our detriment, see Dan Luu’s article, and I do think maybe EA currently pays too much attention to ideas and institutions and not enough to people, at least publicly. But I think at the very least, the broad trend in public conversations is for e.g. a criticism about CEA to be more about the institution than specific individuals in it, or a criticism of the US CDC to be more about the inputs and outputs of their decision-making and less about the personal foible of the director of the US CDC, or specific bureaucrats within it.
Perhaps EA critiques of the bioethics profession shed more heat than light, but that’s a different claim than whether individual bioethicists have good opinions or not.
I think there’s a ton to criticize in the institutions, don’t get me wrong, I just disagree that that’s how lots of the criticisms I see come off.
(Caveat: Due to space and time constraints, this comment aims to state my position and make it somewhat plausible, but not to defend it in depth. Also, I am unsure as to whether the goal of bioethicists is to come up with their own ethical positions, or to synthesize the ethics of the public in a coherent way)
For most of the post, I draw on decisions made by (bio)ethic committees that advise governments around the world. I believe those are a great basis for doing so, because they are generally staffed by researchers and independent. My cursory searching has found such committees in France and Austria; the members of the Austrian committee are mostly either high ranking bio-ethics professors, or are at least working in the field in some capacity. Their reports and votes are public. The info for the French members is less transparent. I have not looked into the various US ethic commissions because their appointments seem much more influenced by politics.
You make a great disambiguation of different levels of criticism against “bioethics”. The strong version of the view is that bioethicists as academic researchers reach bad conclusions, even compared to the general population.
I believe there is good justification for holding this view. In particular, many of the decisions made by ethic commissions are highly counter-intuitive to me:
Many of the provisions of informed consent differ from what the general public would consider reasonable. For example, in challenge trial protocols, even those created by proponents, payment of participants beyond time compensation was discouraged in order “not to take advantage of the poor”. I believe most people would disagree with that (depending on the framing), as would most EA-types.
The bioethics committee of Austria explicitly speaks out against surrogate motherhood: “In view of the manifold and complex social, mental and legal problems connected with “surrogate motherhood”, the Bioethics Commission recommends that methods of reproductive medicine be denied to male homosexual couples.” (I could not find a poll of the public for Austria, but the public in France is supportive)
The commission in France recommends against physician assisted suicide and euthanasia, the commission in Austria recommends only against the latter. (p.61)
The WHO advisory committee on Covid-19 challenge trials was split on whether it would be ethical to conduct one if there was no available treatment (p.9). Most of the members are however not bioethicists.
No strong evidence, but in reading these reports I have not seen them actually making a cost-benefit calculation or referring to one. I think doing so would be very unusual.
If one accepts these decisions as bad, then I do not believe that the defence of institutional dynamics is sufficient to explain them away. The members are not appointed by a politicized process, but seem to just be experts in their field, and certainly not career bureaucrats.
But they themselves and their decisions are sometimes public, so maybe they fear backlash over some decisions? However often there is a minority opinion advocating for more permissibility, so presumably holding such positions is both possible and does not lead to huge backlash.
This is interesting, and I’m glad to see some pushback in the direction of the stronger thesis as well. Again, the evidence I have seen leans the other way and I have not seen evidence I consider as strong in the anti-bioethics direction, but each piece of my evidence is also fairly weak on its own. A first pass at these cases leaves me with the following reactions (the numbers don’t correspond to each of your numbered points, they’re just there for organization):
My evidence is, I think, pretty anglocentric, and may leave room for the situation to be different in for instance France and Austria. It is my (not very well researched) impression that countries with a history of Nazi occupation are more bioconservative on average for instance. I was also disappointed to learn when looking into this, that surrogacy is actually banned throughout a large part of continental Europe: https://en.m.wikipedia.org/wiki/Surrogacy_laws_by_country and even if those selected for these committees are sincere and not just bureaucrats, there may be a selection effect for them to have views closer to the government than the public.
As I said, my evidence isn’t overwhelming, but with the exception of the 1Day Sooner letter, I tried to make it fairly systematic. I would expect some of these decisions to get through regardless of whether they are on average the more common types of judgements, so I don’t want to assume too much based on them without a better understanding of how each example was chosen. Leon Kass for instance, mentioned earlier, is a parody of bioconservativism in many ways, but he was highly influential on the Bush administration’s recommendations, and that is in America, where my samples are most relevant.
On the point of recommending not paying for challenge trials, I think this is in part due to an unfortunate asymmetry. There are some bioethicists who are concerned about vague notions of “exploitation” and don’t think participants should be payed, and those who think it is more ethical to pay them, in my experience, still think it is alright to hold challenge trials if you don’t pay the participants (denying this would entail overt paternalism, which in this context I have run into few defenders of). Therefore challenge trials are often recommended without payment for coalitional reasons, from my experience.
This surprises and concerns me. Challenge trials seem like a textbook bioethics topic, and even if they weren’t, I’d expect that people trained to think carefully about the ethics of related problems would arrive at substantially more good-maximizing opinions. Economists are more skeptical of price controls than the public, physicians are more supportive of vaccines, and so on. Bioethicists have power in their institutions, and I think we should hold them to an accordingly higher standard.
I appreciate you sharing data on your experience, but I have to say it didn’t change my view that society would be better off with a weaker bioethics field.
I’ll propose a new term that gets closer to the actual heart of the problem.
Bureauethicist: a person in a major institution making public health (or other ethical) decisions in such a way as to avoid blame for themselves or their institution, instead of prioritizing the best public outcomes.
Quick PSA, I’m interacting in the comments pretty actively right now. If the comments section keeps growing, I will slow down on this in a bit. Please don’t think it means I don’t think your comment is worth some interaction as well, I’ve been very happy with the comments I’ve been getting so far! I just wanted to make quick note of this since I’m pretty new to the forum and a bit self-conscious about how I engage.
So, I didn’t do a very good job sticking to this statement. I’m still new to the forum format, and getting a much bigger response than I had expected. I’ve therefore decided to just make a clean break and hold myself to it. Feel free to continue interacting in the comments, I will read all of the comments unless they really pile up, but I’ll stop responding unless one of them is a direct question or something like that. If I figure out a way to, I’ll pin this message at the top of the comments section.
This makes me wonder, what makes someone an “expert” in ethics whose ethical views should be taken seriously? Is it knowing the nuances of an ethical system?
FWIW, I didn’t major in ethics but I did take a few ethics classes, and I found that every professor I saw had basic, obvious misunderstandings of utilitarianism.
Could you give some examples?
The most common type is various instances of “utilitarianism endorses doing this thing that clearly decreases utility, therefore utilitarianism is wrong.” Hard to remember specifics because this was 6 to 10 years ago. I just remember being struck by how these supposed experts had such basic misunderstandings.
Taking what you said at face value, what’s going on here, institutionally? Philosophy is a nontrivially competitive field, and Stanford professorships aren’t easy to get.
They don’t compete for jobs in “Philosophy,” they compete for jobs in a specific department which specializes in, say, deconstructionist readings of Nietzsche’s later work. (OK, I’m exaggerating slightly. But the point stands—they don’t need to know anything about Philosophy as a whole to do their research and get papers published, or even to teach most of their classes.)
This is odd. I audited/freeloaded at a perfectly mediocre university math department and they seemed careful to assign the prof who’s dissertation was in functional analysis to teach real analysis, and the prof who’s dissertation was in algebraic geometry to teach group theory. I guess I only observed in the 3rd/4th year courses case. For 1st/2nd year courses, intuitively you’d want the analysts teaching calculus and the logicians teaching discrete, perhaps something like this, but I don’t expect a disaster if they crossed the streams, in the way that I sort of think learning the basic deontology vs. utilitarianism distinction from a nietzsche expert, a deleuze or derrida expert, etc. is a disaster.
(Thankful I learned both calculus and discrete from a professor who dropped out of a high-energy particle physics PhD to do a topoi theory PhD in the math department—maybe the optimal teachers fit a description like that, interdisciplinarity and so on)
I actually agree with this part of the Galef/Yglesias discussion, in that I think for major public health decisions they should generally be more a matter of public endorsement than ethical “expertise”. As for what expertise might look like, I guess it would be understanding different well-known distinctions (hedonism versus desire satisfaction, act/omission versus intention) and well known dilemmas (totalist population axiology sounds no good, but neither does anything else) which can make a difference to how you think about the issues.
What do real existing bioethicists think of compensation for kidney donors?
I’m going to break my usual policy of not replying to comments anymore because I think this counts as a direct question.
So, my guess is that bioethicists, on average, believe similar things to what the general public believes, on average, but that either extreme is overrepresented (there will be more bioethicists in favor of a fully privatized kidney market, and also more bioethicists against all kidney donation), just based on my experience on other issues. I also suspect much of the controversy will be in the fine details rarely discussed by the public. As an example, if the purpose of payment is supposed to be reimbursement, should this be weighted by someone’s income in order to directly reimburse their lost wages, or should it be a flat rate to avoid the inherently regressive nature of the weighting policy? If the latter, how should one decide which flat rate counts as the correct one for “reimbursement”? That said, I really don’t know, the topic hasn’t come up much in conversation or readings, and I haven’t informally polled anyone in the way I did with challenge trials. I know someone currently working on trying to set up a philpapers-like survey of bioethicists, so I hope that will shed some more light on issues like this if/when it comes out. Still, I hope this helps.
Yoooo, senpai noticed!
We’ll also mirror this on our collaborative blog TMB soon.