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  • BIOETHICS FORUM ESSAY

The Past, Present, and Future of Bioethics

The Hastings Center’s 40th anniversary celebration did more than pay homage to its cofounders, Daniel Callahan and Willard Gaylin, and throw a great party – although it did both of those things. The real meat was the Hastings Center Fellows meeting in New York, a day and a half of panel discussions on bioethics – past, present, and future.

Panels consisted of two dozen Fellows and a few others who have used the power of the press to examine dilemmas in medicine and life sciences: William Saletan, who writes the“Human Nature” blog for Slate, and Arnold Relman and Marcia Angell, Editors emeritus of The New England Journal of Medicine.

Panelists cited the ways that bioethics has mattered over the last four decades, as well as some areas where it has fallen short, and new issues that demand its attention.

The first panel discussion was titled, “The Early Years of the Center: Aspirations and Outcomes.” Gaylin described his aspiration as nothing less than to “solve the world’s problems.”

Callahan noted that “The Hastings Center was influenced by the 1960s.” Feminism and the Pill were giving women unprecedented reproductive choices; dialysis and the first intensive care units were prolonging the lives of patients who only a few years earlier would have died.

But the sixties’ influence went only so far. “We were not angry,” Callahan said. “We were not protesting anything. We wanted to understand the power of medicine on ourselves, the way we live our lives, and on society.”

The Center began by asking fundamental questions, recalled Alex Capron, of the University of Southern California: “What is normal? What is a human being? The process might be described as creating the moral taxonomy of health care.”

“Launching the field of bioethics had a remarkable effect on the practice of medicine, not just in the creation of IRBs, but in the expectations of doctors and patients,” he said.

Eric Cassell, of Cornell University Medical College, was a young doctor in the early 1970s when he was invited to give a talk at a meeting of the Center’s Task Force on Death and Dying. It was his introduction to the experience of interdisciplinarity, the Center’s method of bringing together people with different areas of expertise – doctors, philosophers, theologians, lawyers – to parse difficult issues.

“The meeting was so interesting, so fascinating, it was overwhelming,” Cassell said. Among the revelations was that “doctors and patients see death differently,” he said. “Doctors see the process of dying; patients see the state of being dead.”

Robert Murray, of Howard University College of Medicine, came to the Center as a young geneticist. “Race and IQ lead me to be involved with The Hastings Center,” he said. Genetics was a new field in the 1970s, and some people seized on it to try to explain the disparity in IQ between blacks and whites. But Murray – “the only black geneticist at that time, I think” – thought the impact of genetics on human intelligence was limited and focused on a more probable explanation of the racial disparity in IQ test results: flaws in the IQ tests themselves.

The second panel discussion was on interdisciplinarity. Not only did The Hastings Center’s interdisciplinary approach enrich its bioethics research, it also seeded multiple disciplines with bioethics thinking.

It informed the research of Allan Brandt, a historian at Harvard, who wrote on the Tuskegee research atrocities and what might have lead the scientists to violate the norms of their profession. “The single piece of work I’m proudest of is a paper I wrote on this for the Hastings Center Report,” he said.

It was clear from this panel discussion, and the ones that followed, that bioethics has plenty of work cut out for it. Inadequate attention has been paid to racial and ethnic inequalities in this country, as well as to practices and institutions abroad, several participants said.

Arnold Relman discussed the corrosive effect of financial conflicts of interest on medical research, asserting that medical journals’ requirements that authors disclose their industry ties are insufficient. “The best remedy for conflicts of interest is no conflict of interest, not disclosure,” he said.

Susan Dentzer, editor of Health Affairs, bemoaned “the absence of the ethical debate in health care reform today,” including regional variations in spending, population disparities in life expectancy, the large amount of money spent at the end of life, and whether health care is a basic right.

Will Saletan devoted his talk to “ethical issues coming down the pike.” One of those issues was addiction, and the ethical problems that occur when industries get the public hooked on their products.

In but one example of the connectedness between bioethics and public policy, Saletan gave his talk on the day that the U.S. Senate passed a bill – similar to one previously passed in the House and supported by President Obama – that would give the Food and Drug Administration the power to regulate the tobacco industry. The bill would enable the FDA to eliminate harmful chemicals and to reduce, but not eliminate, nicotine.

“The tobacco industry is changing to a nicotine industry,” Saletan said, the idea being that it doesn’t want to kill smokers, “just to addict them.”

The first panel discussion of the following day looked at the challenges of mixing bioethics and politics. While bioethicists and politicians deal with many of the same topics, they see them through different lenses. Citing but one example, Ruth Macklin, of Albert Einstein College of Medicine said, “Many bioethicists argue for a single payer system in health reform, but no politician will; it’s too extreme.”

The lesson for bioethicists who serve on government committees is that while this is an important way to affect public policy, it also requires bioethicists to compromise some of their personally held views. “If you’re not willing to compromise, you shouldn’t be on a commission,” said George Annas.

The last panel discussion was back to the future. Albert Jonsen, of University of Washington, cited neuroethics as the next “transfer station” in the field of bioethics because its study of the intersection of brain and behavior “touches on all aspects of human experience.”

Anita Allen, of University of Pennsylvania Law School, looked at the future of “trait enhancement” – cosmetic surgery, sport doping, cognitive enhancement, and prenatal genetic diagnosis – and characterized the state of affairs as “autonomy gone wild.”
“Bioethics must take a hard look at what people of different cultures are willing to do, with informed consent,” she said

The last words came from Farhat Moazam, of the Sindh Institute of Urology and Transplantation in Pakistan, and they were not congratulatory. She upbraided the panelists for being “parochial” and neglecting to think globally, and especially for failing to consider what American bioethics can learn from developing countries. “It’s not just what American can do for us, but what we all can learn from each other,” she said.

Her suggestion for the future of bioethics picked up on the “bioethics transfer station” metaphor: “Let’s make a tunnel under the Atlantic.”

If that were to happen, it’s anyone’s guess where The Hastings Center’s 50th anniversary Fellow’s meeting might be held.

Published on: June 16, 2009
Published in: Bioethics

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