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.
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.
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 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.