St. Peter's Square in Vatican City at dawn - Rome, Italy.

Bioethics Forum Essay

Hannah Arendt in St. Peter’s Square

Neither one of us expected to be talking about Hannah Arendt at the Vatican.  We had been invited to give talks at the Pontifical Academy of Sciences on the scientific and ethical challenges posed by personalized medicine.  Walking across the cobblestones of St. Peter’s Square we began to discuss how society regulates biomedical research. Are institutional review boards capable of dealing with innovations like personalized medicine? Are they too bound by regulations? Can they ask larger questions of meaning when simply following the rules won’t suffice? And most worrisome, has their bureaucratic function caused them to mistake regulatory compliance for ethical reflection?

 These questions led us to Arendt’s conception of logicality.  In “Understanding and Politics,” Arendt explains how a false premise can lead to a logical cascade. Without scrutiny, “stringent logicality” leads to deductions from a seemingly self-evident statement. This results in the “ingenious replacement of common sense” and the loss of critical reflection.

Arendt worried that logicality could obscure concerns that should prompt inquiry. Too easily, “. . .  truth becomes indeed what some logicians pretend it is, namely, consistency.” Yet, Arendt urged us to ask, is it true? “[T]ruth,” she countered, “is always supposed to reveal something, whereas consistency is only a mode of fitting statements together, and as such lacks the power of revelation.”

Regrettably, along with scientific advances, we have cultivated a culture of medical, science and engineering education that frames ethics not as a matter for thought and reflection, but rather as passive adherence to IRB and other regulatory directives. Reflexive following of rules, not independent speech or thought, results. This is how good people stand by in the face of transgressions that should prompt protest.

In “Personal Responsibility Under Dictatorship,” Arendt trenchantly observed, “In brief, what disturbed us was the behavior not of our enemies but of our friends, who had done nothing to bring this situation about.” Their silence reflected “the almost universal breakdown, not of personal responsibility, but of personal judgment.”

It is always problematic to draw an analogy to Nazi Germany, but the question remains: what has happened to our capacity to judge? As Arendt asked, why are bystanders “unable to pit their own judgment against the verdict of History?” With the CRISPR-altered babies, why the collective lapse of judgment?

While logicality can allow research to advance that should not, unreflective application of regulatory structures to novel science is also problematic. Nearly two decades ago one of us (JJF) was part of a research team that proposed the use of deep brain stimulation to restore function to patients with liminal consciousness who could not provide consent. While our team had therapeutic intent, from a regulatory standpoint surrogate authorization was pretty close to a nonstarter.

The ethical principle of respect for persons dictates that patients with severe brain injury should be protected from invasive procedures absent their ability to autonomously consent to participate. But then the Arendtian revelation: we were stuck in a false logicality confusing respect for persons with the doctrine of informed consent. Yes, it is impermissible to do something without consent when a subject is competent. But it is quite another matter when the patient is unable to provide consent and the goal is to help restore the ability to participate in decisions.

That deeper analysis, its unbinding of the shackles of logicality, allowed the work to proceed in an ethically sound manner in pursuit of a good: the restoration of voice for patients who might otherwise not be able to speak. Our Nature paper reported on a gravely injured individual who only intermittently communicated with a blink of his eye. With neuromodulation he could articulate short sentences, recite the first words of the Pledge of Allegiance, and eat by mouth for the first time in six years. As recounted by one of us (JJF) in Rights Come to Mind: Brain Injury, Ethics and the Struggle for Consciousness (Cambridge University Press, 2015), the intervention resulted in agency ex machina, the restoration of voice via a neuroprosthetic device.

These two examples reveal the need for deeper ethical reflection. We must neither be seduced by the logicality of new technologies such as CRISPR nor dissuaded by the misapplication of unreflected-upon regulatory barriers? But how?

One of us (JR) in The Postgenomic Condition: Ethics, Justice, Knowledge After the Genome (University of Chicago Press, 2017), has argued that such lapses demonstrate the urgent need to invest in institutions that support the arts of collective judgment. This, as Arendt explained in The Human Condition, will require first and foremost learning the capacities to think and speak in the presence of others who are different from us.

The sciences and the humanities, engineering and the social sciences, must be placed in deeper conversation with one another. Instead of battling for resources, the two cultures  (to invoke C.P. Snow’s well-worn phrase) need to see their fates inextricably linked. Are there any truly interesting one culture problems? In a world where almost all societal challenges require skills that cut across domains, adequate preparation for the twenty-first century requires an admixture of training.

We both teach across the disciplines and appreciate that good normative reasoning cannot be sustained when we split science and engineering off from ethical inquiry. We do students a disservice when we perpetuate siloed thinking. When CRISPR is taught as a technology that simply cuts DNA into pieces the deeper fabric of the act is lost.

Thinking synthetically does not consume scarce curricular time. Interdisciplinarity enhances pedagogy. In our experience, students resonate with an integrative approach that probes larger questions. It is in the interstices between the sciences and the humanities that we effectively evaluate human striving.

In 1961, as Wesleyan University hosted C.P. Snow, professors William Firshein, a biologist, and William Ward, an artist, called for a “common frame of reference . . .  based on the assumption that science and the humanities are concerned with the same world — even though they may look at different aspects of it and observe it with different feelings…”

Their call was prescient decades ago and is even more pressing today given the ubiquity of science and engineering in our daily lives. Synthetic thought, not capitulation to technical or ethical logicality, must guide us.

Joseph J. Fins is the E. William Davis, Jr., M.D. Professor of Medical Ethics and Professor of Medicine at Weill Cornell Medical College and Solomon Center Distinguished Scholar in Medicine, Bioethics and the Law at Yale Law School. He is a member of the Board of Directors and a Fellow of The Hastings Center. Jenny Reardon is a professor of sociology and founding director of the Science and Justice Research Center at the University of California, Santa Cruz. 

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