Bioethics Forum Essay
Warp Speed Bioethics
When I began my career as a bioethics scholar in 1990, it was a different era technologically. I spent a great deal of time doing research in medical libraries. (There were no search engines to locate relevant articles or books.) Ideas were exchanged with colleagues by snail mail; draft manuscripts were circulated via fax machines. Submissions to journals and the communication of editorial decisions were also by snail mail. It took several months to a year or more from submission to print publication, after which one received a glossy reprint in the mail.
Fast-forward to 2020. Sitting in my home office under a strict regimen of physical distancing during the Covid-19 pandemic, I can go through all the steps of research and writing at my desk. I access articles online via a university library or Google Scholar and download them to my computer desktop. I use email to exchange ideas with colleagues, send electronic articles to be used in research, and attach draft papers. Modifications of the papers are made in track changes, with comments and queries inserted into the margins. Final versions are submitted to online portals; editors respond by email. Initial publication is online. Recently, it took less than five weeks from floating an idea for a paper with a colleague to online publication of the article by a medical journal, and this was after the paper had been rejected rapidly by three other medical journals. No doubt, other bioethicists have completed this process in considerably less time. Much more rapid dissemination of bioethical thinking is available on blogs, like this one, and in op-eds.
The efficiency and productivity now facilitated by digital technology is impressive—indeed, mind-boggling for someone who grew up in a pre-digital world. But how about the quality of bioethics scholarship produced at warp speed? This is a question I address to myself—I have done my share of rushing to produce publications on some of the myriad ethical issues posed by the pandemic—and to my colleagues.
The urgency of the pandemic, and the emotionality it evokes, is a powerful stimulus to ethical thinking. Advocating and arguing in favor of an ethical position on an issue of practice or policy is an important part of what bioethicists do. But coupled with digital technology, the pandemic environment may be conducive to half-baked or simplistic ethical analysis. Additionally, topics such as rationing of ventilators and the use of coronavirus infection challenge studies to expedite vaccine development—both of which I have been working on—may be commanding more attention than they deserve, as compared with other pressing ethical issues relating to population health. There is reason to be skeptical about whether a coronavirus challenge trial, which deliberately infects a small number of research volunteers with the virus to initially test the efficacy of a candidate vaccine, can in fact facilitate and speed access to a safe and effective vaccine, in view of the complex set of vaccine development efforts already underway. But assuming that an effective vaccine will be developed, how should it be allocated locally among members of the country that has funded its development and to populations around the world? This is an important issue of ethics and of politics in the classical formulation of the focus of politics by political scientist Harold Lasswell: “Who gets what, when, and how?”
Bioethics is, and ought to be, a reflective field of scholarship. The manifold uncertainties associated with the Covid-19 pandemic—a threat to humanity–highlight how much we do not know and need to learn. At the same time that bioethicists are so strongly induced to jump in with ethical analysis and commentary, it also behooves us to query, to stand back, to stop and think, to cogitate and ponder, to entertain skepticism about mainstream bioethical thinking, to identify and correct biases and blind spots. It is a time not only to do bioethics, but to reflect on what bioethics has to offer and how that can best be accomplished.
Franklin G. Miller, PhD, is a professor of medical ethics in medicine at Weill Cornell Medical College and a Hastings Center fellow.