What does a bioethicist do?

It’s already been an intriguing question, one that came up a few times over the past year on ‘America’s Lifeline’. But now that President Obama has disbanded the President’s Council on Bioethics and instead, relies heavily on chief bioethicist Ezekial Emanuel, the
debate within that community itself is getting very interesting. And
listening to it, (or reading it), the picture emerges of an internal
evolution of where the increasingly important field of bioethics is
headed. And where Emanuel wants it to head.

Which isn’t where Arthur Caplan believes it should.

At its heart bioethics is an interdisciplinary activity
and knowing how to work with others who do empirical, historical, legal
and normative work is a must.

I had thought that advice to be sound until I heard Zeke Emanuel’s
plenary address to open the most recent annual meeting of the American
Society of Bioethics and the Humanities. Zeke espoused a vision for
future bioethicists that I think is narrow, misguided and wrong. Now I
say that in the spirit that Zeke himself enjoys–vigorous debate about a
matter that both of us consider of the gravest importance.

Zeke Emanuel, a physician with a degree in political science as
well, is one of the best and brightest scholars in the field of
bioethics. His writings are solid and exemplify how best to integrate
empirical inquiry with normative analysis. And the ’shop’ he has run at
the NIH Clinical Center for many years prior to moving into the Office
of Budget and Management to work on health reform has done an
outstanding job training younger scholars in the ins and outs of
bioethical inquiry. These facts are precisely why Zeke’s recent plenary
address to the American Society of Bioethics and the Humanities was so

What did he say?

The only way for bioethics to flourish, to paraphrase
Zeke’s key contention, is if bioethicists spend less time in public
places, more time mastering quantitative methods and publishing
empirically grounded research on topics such as informed consent and
surrogate decision-making at the end-of-life in peer-reviewed journals.

And so on, as Caplan elaborates, until he says…

…let me try to point out why Zeke’s vision about what bioethics should be is severely myopic as well as inadequate.

This is clarifying.

Bioethics, in my view, has a duty to engage the public
with bioethical questions. The topics that bioethics grapples with–how
to manage dying, the use of reproductive technologies, what to do to
maximize the supply of transplantable organs and tissues, how best to
promote clinical and animal research, what information you should
expect to receive as a patient about your diagnosis and treatment–are
of keen importance and legitimate interest to everyone, rich and poor;
young and old around the globe. Part, albeit part, but nonetheless a
crucial part of the bioethicists role is to alert, engage and help to
illuminate ethical problems and challenges both old and new in the
health and life sciences. Note I do not say to solve them nor to be
seen as an authoritative source to whom bioethical issues ought be
assigned. Rather bioethics’ role is both Socratic and
prophetic–challenge, probe, question, warn, chastise, alert, and, as
Zeke appreciates, irritate the powers that be when necessary.

But now, Zeke is part of the powers that be, just about the
highest official one, at that. He shouldn’t be discouraging that
Socratic reasoning and challenging role we need bioethicists to carry
out with vigor.

To engage in the public role that bioethics has and
should enthusiastically continue to play in the media, policy,
education, legislation and the law more tools are needed then empirical
data no matter how rigorous or precise that data and the means used to
generate it may be.

One must be able to present a cogent argument, know the areas of
consensus that have been established about ethical issues over the
history of medical ethics and bioethics, have a familiarity with health
law, the infrastructure of policy and a grasp of political, cultural,
literary, historical and social dimensions of what makes morality tick
in various cultures. In the absence of these skills and knowledge data
is completely and utterly blind, even useless.

In other words, as the title of this piece says, we need more than number crunchers.

For every ethical problem for which sufficient data
exists to point toward an answer a hundred blossom for which the data
don’t. For every ethical problem for which sufficient data have been
assembled to make an answer rational, sensible, or even self-evident
there are many where behavior, policy and practice do not and cannot be
made to conform to that data. Sometimes data alone can point toward an
answer. Almost always, however, it is a prior moral argument that
points toward the use to which data will, could and ought be put
whether that be in medical practice or in medical ethics. And more
often then not moral and value arguments simply moot data and that
situation cannot be rectified by appeals to more data.

This is the best I’ve seen out of Caplan yet. At the end of the argument, he’s the one who deserves an ovation. And
all the attention this piece is evidently getting in the communications
world Emanuel says is less important to bioethicists and the public
they serve.


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