(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 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.
(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.