The Future of Bioethics

On November 11, Andrea Vicini, S.J. the Gasson Chair professor at Boston College, presented the annual Gasson Chair lecture on “The Future of Bioethics.” Vicini has a unique vantage point in presenting a lecture on such a topic. He possesses two doctorates, one from Boston College in moral theology, and one from Italy, and he is also an M.D. Moreover, he possesses a larger global perspective that many North American bioethicists lack.

Vicini first identified three major areas of concern for contemporary bioethical inquiry. The first, health care, is an obvious concern, but Vicini pointed out the global dimension of this issue, noting that 70% of the world’s population cannot afford health care.

The second concern, research, is a familiar topic for bioethical inquiry, and developments in biomedical and biotechnological research always raises new moral dilemmas that ethicists need to be aware of. Vicini pointed out specifically the ethical challenges raised by the new discipline, synthetic biology, which combines elements of engineering, chemistry, biology, and computer science to redesign life as we know it at the molecular level. The immediate implications of this new discipline were described in a New Yorker article documenting how synthetic biology is changing the face of malaria treatment. Artemisinin, an herb, when taken with other drugs, is the only consistently successful treatment for malaria. However, this plant is difficult to cultivate. Using the tools of synthetic biology to create a new metabolic pathway that did not exist naturally by inserting artemisini genes into E. Coli bacteria, scientists were able to create organisms that produce the drug necessary to treat malaria, potentially saving millions of lives. While the language that accompanies such advances is often triumphant, as Vicini pointed out, we need to also be aware how these new advances are impacting human evolution, and potentially creating new biological and ecological threats for future generations.

The third area of concern Vicini addressed is the problems created by global emergencies like HIV, which have not only biological and medical dimensions, but also social dimensions. Does bioethics have a future in addressing such complex issues?

Vicini thinks that bioethics, a relatively new discipline, historically a branch of applied philosophical ethics, does have a future in addressing these and other issues, but to do so, the discipline must evolve. First, bioethics can no longer be seen as a mere area of philosophical inquiry with implications for policy, but must be understood as a practice. Quoting Baruch Brody, Vicini noted that the future of bioethics must be regarded as a “working practice, not solely a collection of arguments and ideals.”

The practice-oriented vision of bioethics has three dimensions, according to Vicini. First, it is interdisciplinary in mode. Everydaythomist has written about the necessity of interdisciplinary work in both the sciences and the humanities, a point Vicini confirmed. “Interdisciplinary work makes us grow morally and intellectually,” he noted. Moreover, interdisciplinary work has a theological foundation. God in the Christian understanding is triune, and thus eminently in relationship. So too must God’s creation be in relationship, recognizing and reaching out to the other in order to forge relationships on both a practical and a scholarly level that are themselves foundational for truth.

More practically, interdisciplinary work demands that science acknowledge its limits and that the humanities acknowledge their dependence on the sciences. While the natural sciences like neuroscience and medicine can provide a strong empirical foundation for the future of bioethics, a necessity especially emphasized by bioethicist Ezekiel Emmanuel, such empirical foundations are necessary but not sufficient to achieve the telos of the bioethics discipline. Understanding what it means to be human requires not only empirical data, but also narrative from literary studies, an understanding of causation from philosophical studies, an understanding of sociality and group dynamics from sociology and economics, and an understanding of grace from theology. Because human beings cannot possibly master all of these disciplines, the task of bioethics is necessarily collaborative, both on a scholarly and a practical level.

The second dimension of Vicini’s vision of the future of bioethics is the discipline’s prophetic nature. By “prophetic,” Vicini is referring to a human capacity to “speak truth to power.” Bioethicists have to be ready to make ethical proposals, to challenge the status quo, and to have the courage themselves to live out their ethical beliefs. A prophet is inspiring not only in word, but also in example. Future bioethicists have an extraordinary responsibility to live in a way worthy of their calling.

Finally, Vicini’s vision of the future of bioethics sees the discipline as transformative, not only on the level of public policy, but on an individual level. Genetic developments are allowing us to transform human nature on a biological level, but Vicini also thinks that bioethics has the power to transform on an ontological and existential level. Bioethics allows us to see concretely the relational dimension of human nature, and the discipline should proceed in such a way according to Vicini that strengthens those relationships, allowing us to extend those relationships to a universal level, whereby human beings see their connection not only with other human beings, but also with the natural world around them. Bioethics should help human beings identify their place in the cosmos.

Of course, a lecture at this level is necessarily vague, but Vicini’s overall point I take it is that bioethics should transform the way people live. Bioethicists have typically worked on a grand scale, working to transform public policy and weighing in on controversial moral quandaries like the Terri Schiavo debate. While there is a place for such ethical reflection, we must ask ourselves how transformative this mode of bioethical practice really has been. Leon Kass, when asked if bioethics makes a difference in people’s lives, answered in the negative. Vicini’s point is that if bioethics is to have a future, it must find its power on an individual level.

What Vicini neglected in his lecture is the necessity of an adequate moral psychology for his vision of the future of bioethics. Until we can learn how to translate an intellectual ideal into an appetite and an action, bioethics, and all ethics, will fall short. I currently teach a bioethics class for nursing students and we most recently raised the question of the morality of in vitro fertilization (IVF). I had my students read an article from the NYTimes on the larger societal implications of IVF, especially on the cost of health care for children born prematurely due to fertility treatments.

Surprisingly, almost all of my students concluded that from a utilitarian perspective, IVF was not a morally sound practice. There were various comments about how the benefits of IVF are limited to the rich while the burdens more strongly affect the poor, a violation of the principles of beneficence and justice. However, when asked if they themselves would undergo IVF if unable to conceive naturally and practically every student said that she would. The understanding of an ethical ideal was not strong enough to change the actual practices of those holding this ideal.

So without such a moral psychology, bioethics will still fall short of its goals. It will find it easier to get bogged down in quandaries than transform people’s lives. It will find it easier to talk big and act small. Without an adequate moral psychology, bioethics will, I think, become obsolete.


3 comments so far

  1. Michael Rubin on

    The reason why bioethics will never go away is because new issues will occur in the future in which doctors and scientists will have to question the morality of certain medical advancements.

    I agree that Vinici was being very vague. The discussion of bioethics should include more detailed examples of issues that may have ethical questions, and discussions from both sides of the debate.

    A Pro-Life person I know is against stem-cell research. I argue that being against stem-cell research is preventing cures from being discovered. As long as the zygote is not implanted inside of a woman, it cannot turn into life.

    But I asked the person, “If you are against stem-cell research, and that research finds a cure for Cancer, are you going to turn down any medical advancements that are discovered from stem-cell research? She said that she cannot answer that. I argue that if a person is against something that may save lives, that person should commit him or herself to refusing the cure. That is an ethical question.

    I think instead of using complicated terms to discuss bioethics, it is more useful to discuss specific topics in everyday language.

    The views on bioethics sometimes are settled by human beings in politics who do not have medical degrees. That is why it is more important to have common discussions of bioethics than to leave the discussions just in the hands of the medical elite.

  2. everydaythomist on

    You raise excellent points. I agree that the use of everyday language is imperative, but the job of scholars is to sort out the difficult language regarding topics like moral psychology in order to translate that language to people like my students–future nurses–and to make that language transformative for people’s lives.

    Interestingly on the question of stem cell research, the same ethical questions arose following the Nuremberg Trials about whether or not the conclusions of the Nazi researchers could be used by the scientific community, despite the immoral ways in which this research was conducted. I don’t think there is a good answer to this question in the abstract. Rather, I think it is the job of bioethicists to train researchers to be virtuous individuals who can decide for themselves whether they want to use such research or not. With embryos that are already dead, I think the same–we need researchers who can ask and answer for themselves honestly, “Am I the kind of person who does research on fetal tissue obtained in ways I find morally questionable or unsound?” I don’t think there is just one way to answer that question ethically.

    Teaching bioethics to nursing students has been both eye-opening and humbling. I have realized that it is not on the level of policy that the real work of bioethics is occuring–it is in hospital board meetings, doctor-patient relationships, and bedside care. The real task of bioethics is teaching a doctor how to communicate with a patient in such a way regarding her disease that the patient really can grant informed consent to a medical procedure; it is in nurses and doctors developing emotional relationships with patients so that the patient’s very person is cared for, not only her body; it is in the ability of health providers to help a patient and that patient’s family come to terms with the realities of handicaps, finitude, and death.

    And this is why bioethics must be concerned about personal transformation and character because merely knowing the jargon does not translate into ethical action.

    I admire how thoughtful you are, Michael, regarding these issues. Thanks for reading.

  3. An Episcopalian Professor on

    Wow. Talk about speaking truth to power, your blog talks him up then takes him down (but gently and within bounds).
    Great job. I heard more through your summary than I did in his horribly measured, drained expression in person. He does summarize a lot, doesn’t he, and show where the problems lay.

    I guess my scruple is that, being a Roman Catholic, he brushed under the rug the rather huge conflicts between that community of reflection and the others he urges us to be in dialogue with. The talk seemed unrealisticallly optimistic, and your blog critique takes him directly and reasonably to task on the matter.

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