Alice Dreger has a new post up discussing How to be a Bioethicist. She admits, upfront, that she sort of sucks as one, and not for reasons the snarkier or more vindictive readers of this blog might assume. Rather, she sucks as a bioethicist because she has a penchant for naming names and citing her work, because she is concerned about principles, and because she hasn’t figured out how to get a staggeringly high salary, regardless of currency. (Of course, she missed the fourth reason she makes a bad bioethicist: her unfortunate affliction with XX Syndrome.)
Sarcasm, and even personal issues aside, I think Dreger raises a very interesting point about North American bioethics as a whole: what I rather jokingly referred to as the advent of “power broker bioethics” before I realized that this, indeed, was actually and precisely the correct phrase.
A power broker, for those of you who missed the 80s or anything to do with Wall Street, is “a person who is important by virtue of the people or votes they control; a power broker who does you a favor will expect you to return it.” It, in many ways, describes the behavior Dreger details: attempts to suppress dissent via appeals to authority; trading favors for benefits; obfuscating financial details in an effort to hide paper trails; and always, always looking for ways to inflate one’s sense of self via title and position.
Specifically, and something that Dreger misses clarifying while connecting the dots in her analysis, is that power broker bioethicists are focused on themselves. How do they benefit? Dreger’s post is replete with examples that stood out — in part, I suspect, because I came up through the excellent medical history and ethics program at the University of Washington. On virtue of history and location — home of the Seattle God Squad, go Swedish! — there was always a strong emphasis placed on the role of patient advocacy rather than personal advancement. Of course, one should try to be successful in one’s career, but we were never allowed to forget that first and foremost, our role was that of advocate, of communicator, of troublemaker. We, the bioethicists, were the jesters in the courts of kings.
I’ve been outside Seattle long enough to see just how sheltered that view was. And the further back I step from the subsequent spin zone I was in, the more I see how the jester has stolen the king’s crown.
Completely independent of Dreger’s prickliness on being identified as a bioethicist, I recently took on a casual project simply asking those people that I would identify as a bioethicist how they identify themselves. The results were surprising, in that none of these people, all of whom I quite respect as bioethicists, self-identified as one. Oh, sure, bioethics is something that they do, but that’s not what they are. They’re patient advocates, researchers, teachers, philosophers (grudgingly), historians, technologists, anthropologists — they contain multitudes. A physicist even snuck in there. Bioethics is simply something that they do as a small part of a greater whole; being called a bioethicist, aside from a connection to both a history and a group that maybe they weren’t so thrilled to be connected with, was akin to being called an algebrist rather than mathematician.
Now admittedly, this was a self-selecting field of people, in that they’re people who still talk to me with a modicum of politeness and respect.1 However, I’m not sure it’s quite so self-selecting once you look at Dreger’s list of examples. Her division lies very strongly upon her own experiences with bioethicists, and in particular the fetal dex misadventures — thus, a strong division of “with” or “not with” the American Journal of Bioethics, the journal that dominates the field, at least in so far as impact factor is concerned. While my division has strong overlap with hers, I’m a bit more interested in recent arguments being made by these folks who, regardless of self-identification, are considered bioethicists by the public at large. Where is the “I” in relation to the “patient”? Where is the focus, internal or external? Is the concern on the sound bite or the issue at hand? Is it on SLAPPing2 others or on working despite threats?
Much of the field this year has been tied up, whether via direct involvement or popcorn in the bleacher seats as spectator, in watching the collision of the American Journal of Bioethics, the stem cell industry, and advocates and antagonists for both. Regardless of if you were in the sandbox or the stands, it did provoke what David Cyranoski called “a period of soul-searching.” For some, this resulted in public renunciation of association. Some people became Spartacus. Others reiterated their support privately, citing self-interest if nothing else. And an awful lot of people were simply silent.
Of course, silence is certainly an option, but silence also makes a statement, and in this case, certainly shows support if not approval.
Why does this matter? Well, the issues Dreger points out create a good starting point: issues of accountability; conflicts-of-interest; and concerns about funding; compounded by attempts to silence people — be they colleagues or journalists or just curious — who ask questions. This lack of transparency and lack of accountability then turns in to a lack of integrity, for both the group and the individuals associated with the group. Removing yourself from the group can rescue your own integrity, but at the same time, that further damages the remaining group and individuals.
Bioethicists are – or at least should be – very sensitive to reputational loss. Those entrusted to make prudent decisions with policies, law and decisions that do directly affect other people’s lives, particularly within medical and technological areas, are inevitably heavily dependent upon a good reputation.
Much like the power brokers of Wall Street have done significant damage to the public trust in banking and finance, the power brokers of bioethics have begun to harm the reputation and perceived integrity of the field. But ethical attitudes and behaviors cannot simply be regulated – or shamed – in to existence, and thus we reach the current stalemate.3
Self-interest is always going to be present; it’s a natural outgrowth of being human, but also of being driven enough to achieve success, especially as it is defined in academia. However, much like autonomy should not become the sole focus of individual ethical decision-making, self-interest shouldn’t become the sole motivator in a field that is at least historically predicated upon being a whole lot more. Rather than closing rank to protect reputation and integrity, which in many ways undoes the last forty years of the point, when controversies come up in bioethics, and between bioethicists,4 the move needs to be towards transparency and accountability5 — not towards those who are already within the ranks, but those on the outside. Those who would question. Those who ultimately, regardless of self-identity, have opted to utilize the tools of bioethics towards service to more than themselves.