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Does Bioethics Hinder Medical Progress?

A recent opinion piece by Steven Pinker, a Harvard psychologist often referred to as a “public intellectual,” called on bioethicists to “get out of the way” and allow biomedical research to proceed without the red tape and interference that allegedly slow the path to medical breakthroughs.

Man showing stop gesture with his handThe trigger for Pinker’s attack on bioethics appears to be the moratorium proposed for CRISPR-Cas9, the technique that enables genomes to be edited. Pinker argues that “a truly ethical bioethics should not bog down research in red tape, moratoria, or threats of prosecution based on nebulous but sweeping principles such as ‘dignity,’ ‘sacredness,’ or ‘social justice.’ Nor should it thwart research that has likely benefits now or in the near future by sowing panic about speculative harms in the distant future.”

Pinker’s critique fails for two reasons: First, not all bioethicists speak with one voice. Some are champions of biomedical progress and others are more cautious, critics of the notion that biomedical progress is a goal to pursue relentlessly. Second, although it is true that red tape and bureaucratic requirements can slow the approval and implementation of biomedical research, such requirements are not what bioethicists promote and defend as ethically necessary protections of human subjects.

Scientists Urging Caution
Interestingly, in this case, it was not bioethicists who called for a moratorium on gene editing. It was a group of scientists, led by Jennifer A. Doudna, who, along with other prominent scientists, invented the new gene-editing technique. This is not the first time that scientists, not bioethicists, urged a moratorium on a particular type of research. In 1975, a group of prominent scientists urged a moratorium on research using the newly developed techniques of recombinant DNA. After the scientists developed rules, primarily geared toward public safety, recombinant DNA research resumed and is a robust scientific field today. This should remind us all that a moratorium is not a ban.

Not All Bioethicists Agree
As one who has criticized dignity as a “useless concept” in a BMJ editorial some years ago, I do agree with Pinker’s critique of appeals to dignity and sacredness as reasons for forgoing certain types of research. Again, Pinker’s attack on bioethicists lumps together a heterogeneous group of philosophers, physicians, lawyers, scientists and other scholars who populate the field of bioethics.

In his controversial 1987 book Setting Limits: Medical Goals in an Aging Society, the prominent bioethicist Daniel Callahan began a series of writings that call for setting limits to medical progress. I have just finished reading Callahan’s 2012 memoir, In Search of the Good: A Life in Bioethics, where he makes reasoned arguments for his position, never appealing to concepts such as dignity and sacredness or invoking science-fiction dystopias of the kind depicted in novels and movies such as Brave New World and Gattaca, and “freak-show scenarios like armies of cloned Hitlers”—tropes that Pinker claims bioethicists use to support their attack on scientific progress.

It is not, for the most part, bioethicists who have created and apply the red tape and meaningless barriers to innovative or ongoing research. These generally originate with various regulatory agencies worldwide.

In a previous post in this space, I concurred with the scientists who called for a moratorium on gene editing. Referring to a gene-altering experiment conducted by Chinese researchers, I wrote: “The experiment itself was a spectacular failure in achieving its intended aims. None of the 85 embryos whose genes were edited fulfilled two basic criteria: precisely altered genes in every cell with no accompanying DNA damage. Either the genes were not altered or the embryos died.”

The whole point of a moratorium is to prevent the technique from being used to alter human genomes until scientists can get it right. The failure of the Chinese experiment poses an ethical question that has nothing to do with dignity, sacredness or cloning Hitler. That question is: When is a novel scientific intervention ready for use in human beings?

Scientists themselves may disagree about the answer to that question. These are the types of questions that bioethics seeks to shed light on. As for bioethicists, one has only to look at the many articles in journals addressing controversial issues to conclude that no unanimity exists and any restraint in research cannot be laid solely at the feet of bioethics.

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