“So what is bioethics?”. This is a question that I have been asked many times since working in this field and no doubt will continue to be asked! My initial response is normally to bat it straight back to the person asking the question to see what they make of it. Partly to make the conversation a little more interesting but also to test a long running theory – one that posits that the vast majority of people think bioethics is something to do with saving the environment: biomass, biofuels and the like! It is very rare that we actually get onto the path of medical ethics and the like straight away.
I came to the place of reflecting on this question afresh recently having been invited to participate in an interview for a project looking at bioethics and its role in public policy making. In preparing for the interview I was challenged to think about and reflect on the great endeavour which has become bioethics and where we are destined in terms of the future. This opinion piece seeks to lay out some of my key reflections and is very much a work in progress.
Bioethics: a brief history
First, a brief history lesson. Making its appearance in 1960–70s, bioethics was an American inspired term which has since then matured and established as a field of enquiry traditionally associated with medical care at the beginning and end of life as well as research on human subjects. Yet with this development has come a certain degree of ambiguity in terms of what precisely the term means and how it should be classified. Even within European circles bioethics seems a fairly broad term with our Eastern European friends classifying hospital bed shortages as a bioethics issue, all the way through to genetic discrimination and personalised medicine topics which very much point to the cutting edge issues of the day.
So what of the success of bioethics? Has it been a useful term to use and will it prove useful into the future? Well, I think if we did not have bioethics we would be all the poorer without it. It is has helped to focus our attention on some of the ground breaking discoveries in science as they affect the human project. Giving these issues and some of the profound implications that result, the appropriate ethical reflection is absolutely critical. Bioethics as a discipline has helped to give focus to these issues.
Bioethics & public policy
But I don’t think we can say outright that it has been an all round success. Confusion over the term has not just made introducing myself to people a bit more fun but rather it has caused confusion and ambiguity at the policy level as well. We have to be honest and admit that in terms of helping to shape and direct public policy bioethics the results have varied. Let’s be clear, there has been some very diligent, intelligent and engaged work, both at national and international level, which has helped to articulate and express the range of ethical, legal and social viewpoints on pertinent issues. I think here of various EU organised initiatives, not least the European Group on Ethics in Science and New Technologies (EGEST) and the efforts of United Nations Educational, Scientific and Cultural Organisation (UNESCO) and others.
Nevertheless, very often to pass an issue to a bioethics committee or out to consultation with bioethicists means effectively to put the issue out to graze for a while and to quietly forget about it. Whilst this may be exaggerating a little, there is a point to be made as to the level of importance given to bioethics. The recent debate over the Human Fertilisation and Embryology Act (HFE) Act 2008 in the UK clearly demonstrated the effectiveness of the media and scientists to frame and articulate their perspective on how they wanted to see policy develop. The ethics involved on the other hand seemed to be more of a minefield. The tireless work of many committed individuals and organisations sought to communicate some of the key ethical and social issues surrounding provisions in the Bill which should not be ignored or disregarded. However, the reality was there were varying degrees of success in terms of getting the message out there and debated.
Turning to the example of the USA with its various forms of Presidential Councils and Commissions on bioethics, one can see the extent to which they have (or have not) really been able to shape the direction of policy making. At worse they have been a talking shop, stirring up a variety of opinion, criticism and controversy – great start to a conversation but who takes this on to the next step? At best they have helped to tick a box which confirms we have given the issue – be it reproductive technologies, cloning, synthetic biology or whatever – the bioethical consideration it warrants.
Consequently my take is that rather than bringing a bright light to issues which really are of immense importance, the bioethics tag has actually switched the light off or at least begun to smother the light out. The creation of the bioethics silo has in effect helped to sideline key issues which, although complex and important, have only helped to make the situation even more confusing and incomprehensible.
To add insult to injury it is not even the case that bioethics or even applied ethics is the issue. Much of what runs through the strata of policy making is rooted to the question of values and ethics. Bioethics on the other hand has helped to create its own domain with very little integration in the bigger policy conversation. It is not the case that bioethics does not have a role in public policy; it is rather a case of how we go about engaging with it.
An ‘arranged marriage’?
In more recent years bioethics has entered into a form of ‘arranged marriage’ with emerging technologies. The term “bioethics AND emerging technologies” has appeared as a way of bringing the ethics conversation (which originally focused on new advances in medicine and biotechnology) together with emerging technologies. Yet their “union” seems strained. I have even heard academics working on bioethics and emerging technologies projects make the distinction that “I am working on the bioethics whilst Jim is working on the ethics of emerging technologies”. Maybe this awkwardness offers some explanation as to the rise of terms such as nanoethics, neuroethics, and cyborg ethics as a way of making the distinction far more explicit.
Either way, I am convinced that there is an absolute necessity to engage in ethical reflection as we consider the opportunities and challenges which emerging technologies present to the future of humanity. Building on the progress to date, we need to consider fresh ways of engagement which must surely come from ditching silo thinking. Here’s why:
1) Silo thinking stops bridge building; we need to connect
When we keep the bioethics conversation in its own silo we loose the opportunity to bridge build. I prefer this term as opposed to networking which I think has come to mean more about a forced sense of connection. People are invited to a “networking event” with high expectations to meet x number of new contacts within y minutes.
I have come to the conclusion my best contacts and connections have arisen from simply spending time with people and allowing connections to emerge and flourish naturally. In this vein I think bioethics needs to begin to bridge build and to find ways of connections and synergies with other disciplines. Bioethics does not have the rights on ethics. I have come to realise there are a great many ethically minded scientists, sociologists, engineers and technologists who are keen to talk and think about the same issues as we are. Both parties could be better off for talking with each other.
2) Silo thinking leads to stagnant ways of thinking; we need fresh, creative thinking
I use the term silo thinking not by accident. I like words and finding out their deeper meaning. A silo can be defined as “a pit or underground space for storing grain, green feeds but also as “an underground installation constructed of concrete and steel, designed to house a ballistic missile and the equipment for firing”. Going with the first definition, silo thinking in bioethics has for the large part caused our thinking to be confined and limited. Simply storing ideas or rehearsing old patterns of thinking. On the other hand, I believe bioethics can be about the fostering of ideas and responses than can be as powerful as any ballistic missile.
We therefore, need to engage in creative thought, bridge building with those who we may not necessarily think of engaging with and with whose thoughts and ideas we may not even hold to. However in hearing what the other has to say and giving time to consider their ideas more fully, it might just open up new lines of thoughts and ideas. What we need to avoid is ‘group think’ in bioethics; everyone thinking the same thing in the same way.
3) Silo thinking is restrictive; we need vision and forward thinking.
Very often the ethics consultation or ELSI (ethical, legal and social implications) package gets bolted on either as a last minute phase of a project or something towards the end in some quasi–appraisal role. This only serves to limit the role of bioethics as something to satisfy a certain set of criteria. But how about we actually engage ethics from the start? How about ethics and values shaping the direction and evolution of a project from the beginning?
Far from implying that bioethics is out of dated and not required, I see the ever growing need for ethical reflection and analysis as we look to the future. Moore’s Law continues to drive us up its curve of exponential growth and with it the growing consensus that the compounding character of our knowledge and its application through emerging technologies is getting faster every day. The result is that we must start thinking about and shaping the future today, otherwise the future will shape us. Proactively engaging with the future rather than trying to work out our ethics once the technology has arrived is crucial. We need to start thinking about the future now and what values we want to see as part of our future.
The challenge of new technologies
Very often the challenge of new emerging technologies is met with a response that considers them simply ample fodder for sci–fi literature. However, there is growing sense that societies depicted in films such as The Island or GATACCA are very much upon us.
In 2006 Professor Armand Leroi had a paper published in the journal EMBO. In the article he presented the case for expecting the emergence of neo–eugenics. When you factor in falling costs, new technology and a pervasive eugenic mindset amongst parents in industrialised countries he foresees genetic sequencing and the like decreasing in cost so rapidly that its widespread acceptable is going to be commonplace very, very soon; a fact he was keen to make at a conference in Dublin this year.
From just this one example I would hope we can all see – from whatever perspective you may come at the issue from – that there is a pressing need to consider the ethics and values questions which underpin many of these new advances.
Crucial to this is the question of values and ethics which will shape how government, industry, and science go about making strategic long term decisions. Good practice, trust and accountability are terms which have taken on new importance in recent years and with a growing shift towards collaboration, there is no better place for upholding these terms and linking up both technology and ethical foresight from the start.
Where once the idea of cyborgs, brain implants, artificial intelligence and the like were dismissed as science fiction these ideas are becoming the focus of mainstream discussion. From the front cover of TIME magazine to the business section of some of our daily newspapers; from primetime TV on BBC1 to Channel 4, discussions about human enhancement, our genetic future and the relationship between human and machine show only signs of intensifying. Bioethics needs to undergo a process of re–tooling and engagement that sees it burst out of the silo and become a much needed part of the wider conversation.
