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.
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.