Bioethics on the bench

by Prof. Jan Helge Solbakk

Three weeks ago I had the pleasure of visiting the Sigmund Freud museum in Bergasse 19 in Vienna. Relaxing on a modern copy of Freud’s famous sofa, I sent an sms to my companion telling her where I in that particular moment was horisontally situated. A couple of minutes into my psychoanalytic meditation a message entered my cell phone: “Write a paper on bioethics and Sigmund Freud”. My instant reaction was of the detached and ironic kind. And I left the sofa for the bookshelves, bought a couple of biographies on Freud, Carl Gustav Jung and on a third literary and medical figure, Arthur Schnitzler. Then I went for a Sunday walk in a shilly Vienna until my wish for a strudle and a hot chocolate led me to one of the famous brown cafés. In the meanwhile the sms from Latin America had started to work my mind, looking for clues that could make creative sense of it. What kind of family relation could there be between the project of bioethics and Freud’s project? My first association brought me back to his sofa in Bergasse 19. Perhaps the Freudian sofa was the clue: Bioethics and analysis? Bioethics and liberation? Bioethics and therapy? Suddenly I had the title for my Freudian paper: Bioethics on the bench!


For the last weeks this title has been floating around in my mind looking for further clues to make bioethical sense of it. The working hypothesis has been this: Freud’s project represented a project of individual liberation; a project the fertility of which is still traceable in our culture. Whether we like it or not, whether we consider Freud a fake or a foe; it is an empirical fact that our perceptions of what it entails to be a self - to be oneself – and morally speaking - to become an autonomous self – cannot be formulated in words that do not in one way or the other bear the fingerprints of Freud’s language.


This brings me to the father figure of academic bioethics, medicine. If we are to believe Stephen Toulmin, medicine actually saved the life of (bio)ethics! [1] This title has been hailed throughout the last 28 years as one of the truest things ever said about contemporary bioethics. From my former teacher in medical ethics and science ethics, professor emeritus Knut Erik Tranøy, I have learnt to appreciate the dictum, “You should not only say, ‘This is true’, you should in addition ask, what else is true?”. This question brings me back not only to Toulmin’s praised article, but also to the sofa in Bergasse 19: From the point of view of academic work possibilities and income Toulmin is evidently right; the different medical research scandals disclosed in the 1970’s and the early 1980’s made it evidently clear to everybody – with the possible exception of the medical communities - that the boundary between correct and incorrect medical behaviour could no longer be perceived as up to the ethical consciousness of the individual researchers and medical practioners to determine [2]. For this reason, and because of the emergence of kidney and heart transplantations, ethics competency started to be requested in medical research and practice, something which in its turn opened up the medical field for ethicists on the search for an academic living. However, viewed from the horisontal vantage point of the bench in Bergasse 19, the following title would be true as well, ‘How (bio)ethics saved the decency of medicine’. In the first fifteen years of its existence academic bioethis may very well be said to have pursued the same goal as the cigar smoking man behind the sofa in Bergasse 19: liberation of the self; because without the noble activities of the pioneers of academic bioethics in the 1970’s and the 1980’s patients’ right to self-determinacy would probably still have been neglected by physicians and other health care professionals. For this reason, I believe, the alternative caption is as true as the one suggested by Toulmin.


What Toulmin, however, could not perceive at the time he wrote his paper was the long-term side-effects of becoming an integral part of the medico-scientific establishment. That is, by embracing medicine in the way (bio)ethics did, its project of liberation slowly but inevitably was transformed into a project of intellectual and moral self-deception. Main-stream bioethics can, therefore, no longer be said to act as a liberator; instead it has become a handmaiden within the medico-industrial complex. That is, while academic bioethics in its infancy was lending ear to the silenced voices in our societies; today’s bioethics is instead using its intellectual and moral skills to serve the interests of the most powerful voices in our societies.


To substantiate these allegations I will turn the attention to one of the founding fathers of genomic research, James Watson. He should not be remembered only for his co-production with Francis Crick of the model- structure of the DNA-molecule, his pioneering work in mapping the human genome or for being the first individual ever to undergo whole-genome sequencing: Watson deserves also remembrance for being the main architect behind the ELSI-programs for human and social science research. This he achieved through the suggestion that 2-5% of the funding allocated to the Human Genome Project should be set apart to adress the ethical, legal and social implications of this project. Thus was born the ELSI-way of doing normative research on genomic science. During the last twenty years this idea has proved very fertile in the sense that it has become the paradigmatic model of funding bioethics research. Undoubtedely, this has provided bioethics with a lot of new funding possibilities and given many scholars in the field the sense of really having an impact on what is going on in science and technology, medicine included. Making bioethics research an integral part of the medico-industrial complex and of big science and technology has, however, come at a cost which needs to be accounted for as well. For a first, by focusing its main attention on pursuing the implications of research questions put on the plate by medicine, science and technology, bioethics runs the risk of loosings its professional autonomy. That is, because mainstream bioethics dedicates most of its time at tracing ELSA/ELSI-funding and investigating the implications of questions formulated by the most powerful stakeholders in the field its intellectual action space has been dramatically reduced. Mainstream bioethics is no longer speaking truth to power; its voice is hardly ever audible as a critical voice. Instead it has become the ‘ancilla’ – the handmaiden - of the medico-industrial complexe. For a second, because mainstream bioethics accepts to work under such funding conditions, it neglects at the same time the need for pursuing its own goals. Bioethics seems no longer to be a discipline acknowledging the need for undertaking basic research pertaining to its own foundation and ‘raison d’être’. Or to formulate this problem in a Freudian way: bioethis is no longer digging into the depths of its own self. In fact, I doubt that it is any longer conscious of its need for returning to its true self. For these reasons I believe (bio)ethics is in urgent need of therapy.

References

• Toulmin S, Perspect Biol Med. 1982 Summer;25(4):736-50.
  
• Solbakk JH, Vidal SM, Research ethics, Clinical, In: Chadwick, R (Ed.) Encyclopedia of Applied Ethics, Elsevier Sciences (forthcoming).