Biomedical Ethics: Humanist Perspectives of Humanism Today - Hardcover

Radest, Howard B.

Hardcover

ISBN 10: 1591024234 ISBN 13: 9781591024231

Publisher: Prometheus, 2006

Synopsis

Biomedical ethics raises a host of humanistic issues. Among these are human dignity, personal autonomy, quality of life, and access to care for all. Now, more than ever, scientific discoveries and medical technologies prompt us to rethink older perspectives. Humanists have an unprecedented opportunity to shape the moral agenda of the future. In this collection of thoughtful articles from the Humanist Institute, humanist scholars from various fields explore a number of critical issues in bioethics. The moral status of the human embryo, scientific medicine versus Eastern concepts of caregiving, the human genome project, eugenics, contraception, and the economics of healthcare are just some of the topics considered in this enlightening volume. The contributors include: Berit Brogaard, Vern Bullough, Carmela Epright, Faith Lagay, Mason Olds, Howard B. Radest, Philip Regal, Andreas S. Rosenberg, Harvey Sarles, David Schafer, Robert B. Tapp, Stephen P. Weldon, and Michael Werner. For students of ethics, healthcare practitioners and policy makers, and everyone who wishes to participate intelligently in decisions involving cure and care, this work is of great value.

About this title

About the Author

Howard B. Radest (Hilton Head, SC) is an adjunct professor of philosophy at the University of South Carolina, Beaufort, Dean Emeritus of the Humanist Institute, Chair of the Biomedical Ethics Committee of Hilton Head Regional Medical Center, consultant to the Ethics committee of the South Carolina Medical Association, and consultant to the Center for Public Health Preparedness, School of Public Health, University of South Carolina. His most recent book is From Clinic to Classroom: Medical Ethics and Moral Education.

Excerpt. © Reprinted by permission. All rights reserved.

Biomedical Ethics

Prometheus Books

Copyright © 2006 North American Committee for Humanism (NACH)
All right reserved.
ISBN: 978-1-59102-423-1

Contents

Acknowledgments.........................................................................................9Introduction: Humanism and the New Biology Howard B. Radest............................................11SCIENTIFIC PERSPECTIVES ON BIOETHICS1. Twenty-first Century Bioethical Problems Philip Regal...............................................232. Bioscience and the Recovery of Nerve David Schafer..................................................493. Bioethics of the Germline Andreas S. Rosenberg......................................................674. The Moral Status of the Human Embryo Berit Brogaard.................................................815. Exploring the Boundaries Between the Scientific and the Spiritual Harvey Sarles.....................91EXCURSIONS INTO HISTORY6. Humanitas and the Human Genome Faith Lagay..........................................................1097. Joseph Fletcher Revisited Mason Olds................................................................1178. Eugenics and Biotechnology Stephen P. Weldon........................................................139PUTTING BIOETHICS TO WORK9. Biology as a Window Into Therapy Michael Werner.....................................................15310. Bioethics, Contraception, and Business Vern L. Bullough............................................16511. Bioethics and Justice Carmela Epright..............................................................17512. Rationing is Not a Four Letter Word Howard B. Radest...............................................18913. Poverty, Health, and Bioethics Robert B. Tapp......................................................207ADDENDUM14. Before and After Schiavo Carmela Epright...........................................................22115. Prescription Drugs, Medicare Part D Kristy Maher....................................................229Contributors............................................................................................235

Chapter One

Twenty-first Century Bioethical Problems

Where Is Bioethics?

Philip Regal

THE BIRTH OF HIGH-TECH GENETICS

Changes in economic systems have interacted with technological developments throughout history to change people's lives and values. Knowing this, it was predicted since at least the 1920s that new developments in biology and medicine could eventually change human life more profoundly than the industrial revolution.

Aldous Huxley's Brave New World (1932) is a familiar literary landmark that reminds us of the interest in biological futurism early in the 20th century, and one might also recall the utopian eugenic dreams that had generated widespread and notorious enthusiasm by the 1930s. The great biologist Julian Huxley, brother of Aldous, had written a short story in 1926, "The Tissue Culture King." A scientist uses his knowledge to serve his own self-interest and secure his position with a tribe in the jungles of Africa. Huxley prompted the reader to ponder to what ends the foreseeable power of biology would be used. Would it be used largely to cater to old tribal dreams and aspirations, or should we try to figure out better things to do with it?

Meanwhile, the visions of a future dominated by biology involved especially grand predictions for the anticipated "genetic engineering" or "biotechnology" at the great private foundations, notably Rockefeller, and among the scientists they assembled and funded. They set out to do nothing less than create the technical basis for this new chapter in human evolution and economics. The high-tech genetic technologies and the economic/commercial enterprises that were expected to emerge around them would change human society more profoundly than the Industrial Revolution, and would indeed change notions about the definitions of life, nature, and even the human species itself. Their vision, in the spirit of genetic utopia, was completely optimistic, and had no downside.

Then, after decades of intense research, the first genes were spliced together chemically with recombinant DNA techniques in the 1970s. Molecular biologists at the National Academy of Science encouraged government to promote the new technology to private investors and directed agencies to accelerate the development of a publicly funded infrastructure for research and industrialization. Legal, social, and economic incentives were developed to blur the line between basic biology and corporate culture and university scientists were encouraged to become entrepreneurial, and the managers of academic programs in biological and medical research and teaching forced close ties with industry.

Industrial biotechnology was born and its character was shaped as it grew throughout the formative 1980s. By the 1990s the biotech community of entrepreneurial university scientists, life-science corporations, lawyers, and their allies in government agencies had become a major political force in the United States and Europe and indeed globally.

ETHICAL MATTERS

Economic and technological forces historically have tended to change ethical standards of societies. Developments in high tech biology, in basic science, medicine, agriculture, and industry generally have tended to assert pressures on ethical perceptions and standards not simply by working their way into "individual life styles." Nothing like simple "market forces" or consumer demand was asserting the pressures. Rather, pressures from special interests were brought to bear within arenas where, in theory, democratic society as a whole was supposed to have the constitutional power to make choices in policy, funding programs, and law after orderly study and debate. Yet too often the public ethical discussions of these have been intellectually inadequate, detached from the politics of policy formulation, much of which takes place in the shadows and heavily influenced by lobbying, old-boy networks, and expensive public relations campaigns.

"Ethical discussions" have been typically little more than rationalizations about the "greater good." The simplifications, claims and assumptions that the advocates have made and continue to make tend not to be carefully and critically examined. Persuasion and decision are done out of the sight of public scrutiny.

The forced merger between academic biology and medicine and industry in the 1980s, for example, generated many conflicts of interest in government and research and thus raised a number of ethical issues. Could scientists provide the objectivity that society had a right to expect? How would financial involvements impact upon doctor-patient relationships and upon health care systems in general? Could agricultural scientists provide objective technical advice to farmers? When asked how they would deal with such matters, administrators typically tended to give vague answers like, "We will evolve solutions as we go along." "But so much good will come of these changes that whatever price we pay will be worth the costs."

There has been a good deal of frustration with such mergers among involved citizens and scientists who have tried to monitor developments in the biotech/biomedical industries. Personally, I had an opportunity to watch the processes by which policies were developed for nearly 20 years from very close to the centers of power in the United States and Europe. I gained this access during the birth of industrial biotechnology in the critical 1980s. I was invited to dozens of discussions because I was a scientific expert on the technical aspects of risks to the environment and human health from genetic engineering. As a result, my knowledge could help analyze as well the technical feasibility of several types of projects.

I was generally disappointed with any of the ethics discussions that did take place, and even disappointed with the contributions that a developing guild of "professional bioethicists" would make to such discussions, whenever they were invited.

In this essay, I will comment further on the above and on some of the ethical issues that have emerged out of high-tech genetics and related reproductive technologies. It will offer some observations on why such issues have tended and still tend not to get significant attention by mainstream bioethics. And this despite the fact that bioethics grew in the 1990s largely in response to the public's desires to have modern medical and genetic technologies develop only with proper discussion and ethical controls.

It is important to keep in mind that modern biological science is involved not simply in medicine and industry, but in the fate of the biosphere itself. Will we use biological knowledge to contain the human population explosion, embrace ecologically sound agricultural practices, begin to grasp the dangers of the loss of biodiversity, and confront the dangers of unregulated biotechnology and nanotechnology? Or will biological knowledge be generated and used along lines that exacerbate global problems?

THE DEVELOPMENT OF A PROFESSIONAL GUILD OF BIOETHICISTS

Society, the public, the man in the street, is at least vaguely aware that the stakes with the development and use of biological knowledge are enormously high and wants those who have the power to shape, accelerate or impede to consider the ethical, safety and cost implications of publicly funded or otherwise publicly encouraged programs. As a strategy-partly sincere, often for public relations purposes-those in control of the resources, the broad community of biostakeholders if one likes, thus began to hire "bioethicists" and "biomedical ethicists" so that they could assure society that there were indeed professionals assigned to deal with the public's concerns. The "guild" of bioethicists also could provide the stakeholders with talking points. Thus a professional bioethics subculture became an increasing presence at medical schools, hospitals, and on college campuses.

Of course ethics related to biology had long been discussed by scientists themselves, by essayists and theologians, and in literature. Arrowsmith by Sinclair Lewis in 1924 and The Doctor's Dilemma by George Bernard Shaw in 1906 come immediately to mind.

But by the late 20th century the informed public was becoming increasingly concerned with the complex ethical challenges emerging from developments in biology and in medicine. New books were continually appearing on the market that explored questions about the social, economic, and ethical implications of the new technologies. This robust market was one sign that the informed public's concerns were likely to continue and even broaden.

Graduates of philosophy departments were often hired to guide the development of the new bioethics programs. Turning the issues over to philosophers might have seemed logical to a public that had little understanding of academic philosophy in the United States, or of the ethical issues that the new scientific developments were likely to raise. In turn, the philosophers naturally set the agendas for institutional and public discourse in terms with which they were familiar. Most had been trained in the post-pragmatic, "analytical" vogues of early and middle 20th century Anglo-American philosophy; increasingly some benefited from development in feminist and narrative philosophy; others from re-discovered Aristotelianism and "virtue" ethics, still others were influenced by post-modernism and neo-pragmatism.

However varied and not surprisingly given its roots in clinical practice, biomedical ethics discourse often came to revolve around discrete cases-or classes of cases-and around the logic involved in reasoning about case studies. Analysis and decisions and the, language, meanings, and categories that grew out of such considerations lent themselves to the use of the traditional tools of philosophers.

But even if some good could come from such deliberations, the question of who is qualified to be an expert on bioethics or ethics generally was hardly raised. The concepts of "the expert" and a specialized profession suggest possession of special authority and competence with regard to the identification of issues, their analysis, communication to and discussion with the public. But is it so that bioethicists are superior in their abilities to identify, analyze, and communicate the challenges of the new biology? Can they really be the watchdogs that society expects?

What Bioethics Programs Might Instead Have Been

Another strategy might have been to hire investigative journalists, sociologists, and/or concerned scientists and physicians to try to understand the career aspirations, economic interests and the qualifications of the important stakeholders, and indeed to identify the key stakeholders. Ethical issues could be based in empirical studies. Philosophers and theologians might then be brought into the inquiry along with others once the structure of the technological/social institutions, the driving forces for their development, and the human implications became well understood, and philosophical analysis could realistically be assigned its place among priorities.

Philosophers tend not to be empirical investigators. They tend to break empirical phenomena down into conceptual bits rather than to study them and their functions as elements within larger systems or networks. Their habit is to attend to ethical dilemmas and stylized cases. Their questions, no matter how relevant, have a generality that often does not match experience. They tend to ask questions like: "When does life begin; do stem cells have a soul." They discuss the implications of ethical guidelines such as "do no harm" asking whether or not physicians should condemn a family to anguish by keeping a loved one half alive while they experiment on a terminally ill person. Important as such queries may be to the individuals involved, it takes a different kind of mental effort to try to outline and probe complex political dealings such as the national budget for biomedical research, or patterns of malpractice at various hospitals, or false promises made to Congress about time tables for eliminating cancer or mental illness, or high-tech genetic schemes for eliminating starvation. It takes a different kind of mental effort to go on from there and estimate "downstream" social implications of these, outline the ethical questions that they raise, then attempt to map the landscape of alternative policy responses to the predictable social implications these matters raise, and finally outline the ethical questions they pose. And it takes a different kind of mental effort to map the potential landscape of policy responses to such ethical questions.

These issues need to be approached sociologically, cross-culturally and historically. Unfortunately, too many bioethicists confine themselves to more conventional terms of ethical discourse. This narrow approach fails to clarify the larger cultural context in which events occur and the importance of a larger perspective for democratic self-rule. If cultural context were discussed in comparative terms, bioeothicists might well contribute to a broader discussion of social norms, mores, and taboos and to the aspirations of a democratic, multicultural society.

By focusing on topical issues and clinical cases, and by not expanding on the political and economic forces that all too often shape biological and medical research and practice, bioethicists pose minimal threat to the agendas and careers of the policy makers and administrators of programs in biology and medicine. In that way they may even be said to be complicit in generating the very problems they are intended to solve.

To be sure, there have been bioethical critics from various philosophic and religious perspectives but all too few and all too powerless. Secular language has become the most neutral and practical lingua franca for modern pluralistic democracy. Despite the essential role that secular perspectives and language play in pluralistic democracy, large religious factions are legitimate stakeholders in bioethical debates. Ethical matters will necessarily be investigated from religious perspectives. Theological criticisms have brought important basic information together that is relevant even in a secular humanistic context. There have also been critics of bioethicists as a new elite of self-proclaimed experts (for example Smith, Wesley J. 2000. Culture of Death: The Assault on Medical Ethics in America. Encounter Books, San Francisco), But however various or valid the approach, dissatisfaction with the state of bioethics seems justified.

Ultimately, however, it would be more useful to explore the issues by examining their network structure and functions. It should be kept in mind that, as a recent phenomenon, bioethicists are not merely self-constructions and they are not merely self-proclaimed experts. They are the human elements of programs that have been constructed by the university, the hospital, the medical school, and the government bureaucratic guilds. In important respects they are appointed and institutionally proclaimed "experts." Once such a guild has been established, it may well be committed to perpetuating itself ... or it may not. It is simply to soon to tell. But we do know that individuals and groups, more often than not, can be counted on to try to perpetuate themselves and their values and to protect their interests.

Administrators claim that they have established these programs and appointed the leadership of this guild in response to public concerns, and in a sense this is true. However the public may not always be getting what it thinks it is getting, because the general public's concerns and the special interests that determine the career ladders for administrators do not entirely coincide. Administrators are not for example likely to support teams of investigative reporters who might well begin to question the political structure of the institutions that the administrators administer, or the private sector interests that are affiliated with them. Nor are they likely to appoint Socratic gadflies from among the philosophers.

I have watched these developments from many years in the trenches. But I am not the only one who has been uneasy about the formation of a guild of professional bioethicist stakeholders. Yet the concerns from other scientists, physicians, and sociologists go largely ignored by administrators, the media, and politicians. University of California sociologist John H. Evans, for example, in Playing God? Human Genetic Engineering and the Rationalization of Public Bioethical Debate (University of Chicago Press, 2002) has made some of the same observations. The book

explores the social forces that have led to the thinning out of public debate over human genetic engineering.... Disputes over human genetic engineering concern the means for achieving assumed ends, rather than being a healthy debate about the ends themselves.... This change in focus occurred as the jurisdiction over the debate shifted from scientists to bioethicists, a change which itself was caused by the rise of the bureaucratic state as the authority in such matters.

(Continues...)

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Edition details

• Publisher: Prometheus
• Publication date: 2006
• Language: English
• ISBN 10: 1591024234
• ISBN 13: 9781591024231
• Binding: Hardcover
• Edition number: 1
• Number of pages: 236