Neuhaus got in so many great jabs in this piece I was nearly rolling on the floor. Though published in 2002, it is as timely today, and the players are the same, too! Enjoy.
The Best BioethicistsThat Money Can Buy
Richard John Neuhaus
“A bioethicist is to ethics what a whore is to sex.” That judgment by a friend who was once viewed as a pioneer of bioethics may seem somewhat harsh, but it is not entirely off the mark. This really happened: Some years ago I was on a panel at the big annual economic conference in Davos, Switzerland. Also on the panel was Nobel Laureate James Watson, then head of the Human Genome Project. I and a few others—well, I think it was one other—were pressing moral questions about the technological manipulation of human nature. Impatient with that line of inquiry, Dr. Watson—who seems not only to subscribe to but to devoutly celebrate what Jacques Ellul called the Technological Imperative—explained that nobody should worry about the morality of what they were doing since the project had allocated millions of additional dollars “to get the best ethicists that money can buy.”
A number of publications have in recent months raised sharp questions about the biotech industry and its connections with the sub–industry of bioethics. For the most part, bioethicists are in the business of issuing permission slips for whatever the technicians want to do. After all, they are in their pay. Arthur Caplan, director of the University of Pennsylvania’s Center for Bioethics and perhaps the most quoted bioethicist in the business, thinks that criticism is unfair. He says that possible conflicts of interest can be “managed.” He funnels money from companies such as Pfizer, DuPont, and Celera into his center, and says he is amazed by colleagues who suggest that bioethicists should do pro bono work for wealthy corporations. Why do it free when they’ll pay good money for it? U.S. News & World Report says that the biomedical industry is pouring millions into bioethics centers, and rewarding academic bioethicists with stock options worth many thousands of dollars. The same ethicists are quoted daily in the media, testify in Congress, and generally assure the public that there’s nothing to worry about so long as scientific innovations are accompanied by appropriate expressions of concern by professional handwringers. “It’s an odd development,” says U.S. News, “for a profession that has no formal education or licensing requirements.”
Wesley J. Smith is author of Culture of Death: The Assault on Medical Ethics in America. He writes, “The bioethicists have set themselves up, almost like Napoleon crowning himself emperor, as the arbiters of what is moral and ethical in health care.” Daniel Callahan is cofounder of the Hastings Center, an institution that laid the groundwork for bioethics back in the sixties. “This is a semi–scandalous situation for my field,” he says. “These companies are smart enough to know that there are a variety of views on these subjects, and with a little bit of asking or shopping around you can find a group that will be congenial to what you are doing.” Carl Elliott, who succeeded Arthur Caplan at the University of Minnesota’s Center for Bioethics, says, “Personally, it seems too much like bribery. If it’s not bribery, it becomes the perception of bribery.” Caplan, on the other hand, says that apparent conflicts of interest are comparable to the problems of magazines that accept paid advertising. The main problem with corporate money in bioethics, he says, is that there’s not enough of it. Eli Lilly stopped funding the Hastings Center when its publication criticized Prozac, a Lilly product.
“There’s a risk that this kind of funding could reduce the critical edge of the field,” says Dartmouth’s Ronald Green, who chairs the ethics board at Advanced Cell Technology (ACT). ACT knows all about the cutting edge, having been at the center of recent “breakthroughs” in human cloning. As does Professor Green, who, in his extensive writing, has “redefined” death, birth, life, and the meaning of the universe, among other things. Like Prof. Caplan, he recognizes that there is a risk, but is sure it can be managed. He has, by his lights, managed very successfully. Minnesota’s Carl Elliott says the big danger is not that bioethicists get rich from companies but that they are, whether they know it or not, used. “Bioethics boards look like watchdogs,” he says, “but they are used like show dogs.”
Nigel Cameron, a bioethicist working with Charles Colson’s Wilberforce Forum, notes that bioethics is not what one would ordinarily call a discipline or profession. “Most bioethicists don’t train in bioethics. They move sideways from other disciplines—law, theology, medicine, philosophy.” The field is “perfectly designed to be the midwife for the birth of a whole posthuman future.” He notes that ethics as ordinarily understood—classical ethics, if you will—works from rules or principles to guide moral judgment. “Bioethics doesn’t like being locked into any kind of framework that would involve predictability. From a Christian or traditional perspective, it isn’t ethics at all, but uses items from the ethics toolbox so it can do what it wants in any situation.” William Saletan, a writer for the online magazine Slate, sums it up: “The slickest way to make yourself look ethical is to narrow the definition of ethics so that it won’t interfere with what you want to do. But that won’t make you ethical. It’ll just make you an ethicist.”
So what is to be done? Certainly biomedicine and biotechnology call for the most careful moral scrutiny. But whose scrutiny is to be trusted? Nobody comes to these questions, or any questions of importance, with a value–free or value–neutral perspective. But some are free of clear conflicts of interest, unlike the ethical pipers who sing the tunes of the companies that pay them. Their promiscuously issued permission slips would license almost anything, and the slips are typically accompanied by promissory notes that this innovation or that will lead to a cure for everything from Alzheimer’s and cancer to the heartbreak of psoriasis. Such promises are powerfully appealing, including, as proposed at a recent University of Pennsylvania conference, the promise of immortality.
Never mind that extravagant promissory notes have been issued for decades and are almost never redeemed. Those at the cutting edge assure us that the decisive breakthrough is just on the other side of the line that it was previously forbidden to cross. The biotech industry is driven by scientific curiosity, no doubt, but most importantly by the prospect of wealth beyond the dreams of avarice. How many people of great means would be willing to pay how much for an extra ten, twenty, maybe fifty years of life? How much for the promise of immortality? And what moral lines would they, and those who make such promises, not be prepared to cross?
In real ethics, there are some things that must never be done. Bioethics is “procedural.” Where it can, it leaps ahead, and where it cannot, it inches ahead, enticed onward by the question, Why not? If it can be done it should be done, or in any event it will be done, and, if it will be done, why not by us rather than by the competition? This is ethical reasoning of a very low order. There is no sure way of protecting society against it. But we might begin by asking the experts who advocate the crossing of the next moral line, What’s in it for you?