Françoise Baylis offers her view on what it means for bioethicists to make an impact, and urges innovation, responsibility and accountability.

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It is not unusual for scientists to dismiss (some) bioethicists as bio-Luddites through crosstalk (undesired ancillary conversation) and caricature (distorted representation).

In the category of crosstalk, Jason Scott Robert explains how respectful discussions about the ethics of controversial science can effectively be displaced by divisive ‘us versus them’ debates. In some instances, these debates focus on bioethicists who, all too enthusiastically and uncritically, embrace the sciences to the point of “proselytizing rather than critically probing, in pursuit of victory at the expense of truth”. In other instances, these debates focus on bioethicists who stand in the way of scientific progress.

In the category of caricature, Leigh Turner explains how it is commonplace in social science critiques of bioethics “to characterize bioethicists as servants of established social and economic authorities. Handmaidens, servants, balm, show dogs, institutional graphite—these evocative terms capture the notion of the bioethicist as servant, parasite, shill, and sellout”. Typically, castigating bioethicists serves to uplift social scientists, in particular medical anthropologists and medical sociologists: “While bioethicists nestle comfortably inside the belly of the whale of medicine, social scientists perch uneasily ‘on the margins’ maintaining their critical lenses sparkling, apparently uninfluenced by power, money, and the prospect of influence”.

In the face of such obstacles, the successes of bioethics as a discipline have been few and fleeting. The problem is deeper than disciplinary derision, however. There is also a history of limited bioethics contributions to effective public policy. If bioethics is to make a difference, we need a ‘new’ innovative, responsible and accountable bioethics. We need an “impact ethics” axed on a clear commitment to social justice.

Innovative bioethics exercises the moral imagination, and invites us to rethink our understanding of foundational concepts such as personhood, autonomy, justice and solidarity through a relational lens. This, in turn, draws our attention to the concepts of neighborliness, reciprocity and community. Innovative bioethics is also inclusive, and invites us to explore a new motif for the work of bioethics and bioethicists—that of the kaleidoscope where there are infinite possibilities for new linkages in pursuit of just social policy.

Responsible bioethics serves the public and in so doing earns public trust. It requires integrity and sensitivity to the real world of policy-making and politics. More than 20 years ago, in reflecting on the contributions of philosophers to policy-making, Dan Brock identified “a deep conflict between the goals and constraints of the public policy process and the aims of academic scholarly activity in general and philosophical activity in particular”. The traditional academic follows arguments and evidence wherever they may lead. The challenge for bioethicists is to engage in compromise, without being compromised.

Accountable bioethics requires, at a minimum, transparency and explicit disclosure of the reasons for the policy options on offer. In addition, bioethicists should be accountable for the level of expertise they bring to policy deliberations (which should include a deep understanding of the relevant theoretical and practical issues). Not infrequently, bioethicists have presumed ethics expertise on most if not all topics, thereby failing to appreciate the depth and range of knowledge and experience needed to advise on discrete policy matters. As well, bioethicists should be accountable for the way(s) in which they contribute to the “framing” of policy issues and options. There are structural, economic, social and political injustices that need to be challenged, not taken for granted. For example, it is not a given that human well-being can properly be measured in terms of productivity, material goods, or technological progress.

Bioethicists interested in impact ethics—interested in making a difference—need to reflect critically at the research programs they undertake. We need to question the attention we bring to bear on high-tech issues (such as enhancement technologies) at the expense of low-tech issues (such as clean water and hospice care). We also need to reach out to Canadians and engage them in health policy debates with clear ethical content. There are, for example, two important legal cases winding their way to the Supreme Court of Canada that have serious ethical implications for Canadians. One case is about donor anonymity (Pratten v British Columbia (Attorney General)), the other is about physician assisted suicide (Carter v Canada (Attorney General)). These are not issues for elites to decide… they are issues which present those interested in impact ethics the opportunity to make meaningful contributions to discussion and debate.

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Françoise Baylis, Professor and Canada Research Chair in Philosophy and Bioethics, Dalhousie University

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Photo by H. Pellikka (2005). http://commons.wikimedia.org/wiki/File:Kaleidoscope.jpg