Rob MacDougall argues the bioethicist’s role is to engage with the whole range of viewpoints and perspectives.
Many bioethicists have misgivings about bioethics scholarship funded by industry. Their misgivings recently came to a head when Glenn McGee, editor of a major bioethics journal, accepted a paid position as president for ethics and strategic initiatives at CellTex Therapies, a Houston-based company selling stem-cell therapies.
These misgivings have led some bioethicists to condemn financial relationships between academic ethicists and industry— arrangements like Glen McGee’s— wholesale. Carl Elliott, for example, lists 6 reasons to avoid pharmaceutical-funded bioethics. He also writes that journals should not accept articles written by bioethicists who receive pharmaceutical funding. Similarly, Dan Callahan has written that bioethicists should avoid consultation with private, for-profit firms.
Others believe that steps can be taken “to minimize threats to independence and objectivity and maximize trust in bioethics consultation.” On this view, industry funding of bioethics is permissible, provided bioethics consultants take precautions to control conflicts of interest. (See here and here).
For bioethicists on both sides of the issue it appears that the primary concern is one of bias. These bioethicists seem to agree that bioethics should strive to be unbiased (or strive for “impartiality,” a word Elliott uses), but disagree about what is required to achieve this impartiality.
But whether bioethics can (or should) aspire to “impartiality” is hotly disputed, and many believe that bioethics inevitably will be, and should strive to be, partial (i.e., take sides). For example, Lisa Parker argues that bioethics is essentially “activism,” and that it has always advocated for those unable to represent themselves. Richard Ashcroft argues that bioethics should take up the cause of a particular class, probably the vulnerable or poor. These authors do not think bioethics should merely advocate for “truth,” “morality,” or “justice.” They also think that bioethics should advocate for particular parties— classes, interests, groups, or individuals— and not others.
When those writing about conflict of interest are concerned that bioethicists will be “biased” or “partial,” their concerns imply that they reject the belief that ethics inevitably will be or should strive to be impartial. It would seem inconsistent, after all, to hold both that bioethics should strive to be partial towards certain classes or groups, and yet fault some bioethicists for accepting funding because it is likely to result in partiality and bias.
Now regardless of who is right in this debate over partiality/impartiality, it is important to see that implementing rules about the conduct of bioethicists, such as limiting the sources from which they take funding, is to take an implicit position on what is still a live debate in bioethics. Designing rules to ensure impartiality among bioethicists only makes sense if we take it for granted that bioethicists should strive to be impartial in some sense, for example. Is it desirable for the field of bioethics to take such a position?
I suggest it is not. Other professions have been successful in drawing up conflict of interest policies to the extent that there is societal agreement about their role. Elliott, for example, compares the bioethicist who takes money from industry to the judge who takes money from one party to a legal dispute, trying to show that both situations represent an unacceptable conflict of interest. There is agreement in society about the role of the judge, enough to result in clear policies preventing judges from taking money from either side of a dispute they are judging. If bioethicists are like judges in this respect, then surely Elliott would be right. But disputes about the role of the bioethicist would seem to indicate that we have little agreement about whether bioethicists are more like judges, who must remain impartial and so cannot take money from either party, or more like public interest lawyers, who are fundamentally partial and so can unproblematically accept funds from the parties they represent.
If we can’t agree on basic matters such as whether bioethicists are more like judges or public interest lawyers in the relevant respects, then I suggest we should probably not implement policies like those suggested by Elliott. Such policies suggest that bioethicists agree about the fundamental character of their role, when we have every reason to believe they do not. Such policies not only make a misleading suggestion about the extent of our agreements, they also threaten to exclude some voices and prevent some debates that will in the long run be beneficial to bioethics.
Of course, someone will say: “Well, we may not know whether bioethicists are supposed to be partial or impartial, but we know they shouldn’t be partial towards industry.”
I don’t have space here to give a full explanation for why admitting partiality in bioethics will likely necessitate accepting all partial voices into bioethics debate. Brown has made this argument, and I agree with him. Briefly, we can just stick with the legal analogy: in legal disputes, both sides get a representative. Even if it were the case that we should generally advocate on behalf of the poor or downtrodden, as many hold, it is always possible that bioethicists could go too far in this respect, and could neglect the legitimate needs of the many citizens that work in industry and the families they support, or even the large number of patients whose lives are improved by the pharmaceutical industry. It is not inconceivable that these might someday need “bioethicist” representatives as well.
But whether we ultimately find this picture of bioethicists as representatives compelling, it seems to me that it is uncontroversially part of the bioethicist’s role to carefully examine and interact with the whole range of viewpoints and perspectives. Artificially constraining our conversations threatens to undermine this one thing that we all agree bioethicists should be doing. We should be wary of policies that would jeopardize this important societal task.
Rob MacDougall is an Assistant Professor of Philosophy at Cape Breton University, Sydney, Canada.