APA Newsletters

Spring 2001
Volume 00, Number 2

Newsletter on Philosophy and Medicine

From The Chair

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Leonard M. Fleck
Michigan State University

All of my readers, I am sure, are familiar with the "terror of the blank page," sometimes known as cognitive impotence. I had an episode of that as I started to write this column. But then I received an e-mail from my son, Jonathan, in Boston, inquiring (worriedly) whether I was one of the High Priests of Bioethics. This is not the sort of question I would normally expect from my son, who has a career in the business world. In fact, he had pasted into his e-mail a column from the Wall Street Journal (Jan. 25, 2001) by Adam Wolfson with the very provocative title "Are You a Person or a Non-Person: The New Bioethicists Will Decide."

The column was about a new book by Wesley J. Smith titled Culture of Death. It is in that book that "Weasley" (sic, following the nickname imperium of the "W" Administration) starts referring to the High Priests of Bioethics. Apparently, Weasley is of the opinion that bioethics represents a movement, a religious ideology that is threatening the most fundamental values of Western civilization. For him this is a movement that rejects the sanctity of life ethic and would put a quality of life ethic in its place, an ethic that would seek to distinguish persons from non-persons, the latter being individuals who are badly disabled or cognitively impaired. Further, Weasley contends that "many bioethicists today are eager to bring about some version of Huxley's 'perfect' society, no matter how morally troubling the means or how questionable the ends." He sees bioethicists as being in the forefront of efforts that "call for loosening safeguards against human experimentation, human cloning, and genetic engineering." The person he identifies as being "The Highest High Priest" of the movement is Peter Singer, who calls for the killing of disabled infants. Weasley finds it especially galling that Singer is a distinguished professor at a distinguished university, and that our nation's best universities and hospitals and medical journals have all been infiltrated with the likes of him. Weasley also rails against all forms of health care rationing. His practical concluding recommendation is that new schools of bioethics be set up to challenge the reigning doctrines.

Why do I bother calling attention to these rantings? I have two reasons in mind. One pertains to the fact that this column appeared in The Wall Street Journal. This is not "must reading" for most philosophers, but this paper does reach a very large segment of the business community. It does contribute to the shaping of public opinion in significant ways. In this case the result could be a gross distortion of public opinion. Second, I believe all members of the APA received a letter in January from J.B. Schneewind, the President of the Board of the APA, regarding the one-hundredth anniversary of the founding of the APA. In that letter Schneewind urged that we all make an effort to restore the "public role" of the philosopher that was much more the case in the early part of the twentieth century when the APA was founded. He suggested in particular that we make ourselves available to speak in a range of public forums where we have an opportunity to address pressing social issues as philosophers. For those of us who are associated with philosophy and medicine there is no shortage of such opportunities. Today we find, literally, daily media attention both to a very large range of ethical issues in health care, often prompted by emerging medical technologies, and to the corresponding policy issues that have been raised as competing interest groups seek to use the policy process to shape an authoritative social. All of us receive numerous requests to address these issues before audiences of health care professionals. We might think of them as a natural comfortable constituency. But if philosophers are to embrace a broad public role in these social debates, then we must also speak before and engage Rotary groups and Kiwanis and Chambers of Commerce. The fact that these issues are discussed (badly) in publications such as The Wall Street Journal necessitates such a response on our part.

If I were addressing a Rotary group this afternoon, what would I say to them about this column and the author whose work is discussed in the column? First, I would express a sense of faux shock that The Wall Street Journal would publish a piece such as this when it could have the effect of eroding investor confidence in the pharmaceutical industry. After all, according to the Weasley Narratives these high priests of bioethics are mostly closet utilitarians who are seeking to loosen onerous restrictions on human medical experimentation so that new drugs can be brought to market more quickly, thereby being able to take advantage of patent protection for a longer period of time and larger profits. Put more graphically, these priestly bioethicists are nothing but whores for the pharmaceutical industry. If this were the case, we would all expect to be more warmly embraced by the business community.

The fact of the matter, however, is that a number of bioethicists have been very strong critics of the increasingly cozy relationship that has developed between medical researchers, clinicians, and the pharmaceutical industry at considerable risk to the well being of sick and vulnerable and trusting patients. I have in mind, for example, the excessively high incentives paid to many practicing physicians for recruiting more quickly patients into a broad range of clinical trials. These bioethicists have pressed several federal agencies for much more stringent oversight of these research practices. [For a full description of the proliferating ethical issues in this area, see Jesse Goldner's essay "Dealing with Conflicts of Interest in Biomedical Research," The Journal of Law, Medicine, and Ethics, 28 (Winter, 2000), 379-404.]

At this point in my addressing members of the Rotary (or some other segment of the business community) I would ask them what they would want in the way of oversight and regulation regarding our research practices. I would want them to think about this issue as investors; this is not an illegitimate perspective. But I would also want them to think about this issue from the perspective of possible research subjects, who might be themselves, or their spouses, or siblings, or parents, or best friends-all very much trusting advice they receive from a personal physician, all very much ignorant of the hidden financial incentives that might tilt the judgment of their physician. This research is medically and morally necessary. It often represents medical hope for otherwise desperate patients. Completing such research more quickly for the benefit of all seems like a reasonable and morally commendable goal, but there are risks. Individuals faced with a terminal prognosis can be made worse off as a result of their participation in this research. My goal throughout is to create in each member of that audience the internal moral conflict that is occurring externally in our society, often as conflict among members of different social groups with different value priorities. If philosophers are to play a more valuable public role in these debates, then having the capacity to generate this sort of internal moral conflict in each of our citizens about such issues ought to be a central part of that role. Being able to generate an outcome such as this is both morally and politically virtuous. At the very least we thereby diminish the likelihood of more ideologically mindless and socially destructive battles such as we have seen regarding the abortion issue. Instead, if we have a community of individuals experiencing that internal conflict, we have the opportunity to contribute to the development of what John Dewey would call social intelligence or to what we might describe today as more rational and more morally imaginative democratic deliberation about these issues. To effectively facilitate such public conversations, to assist our society in steering between the Scylla of ideological hectoring and the Charybdis of platitudinous pontificating, is a worthy social and philosophic task that Socrates and Dewey would both endorse. There is a risk that philosopher bioethicists will themselves become the servants or high priests of an ideology. Daniel Callahan warns us of this in a thoughtful prophetic recent essay. [See "Judging the Future: Whose Fault Will It Be?" The Journal of Medicine and Philosophy, 25 (Dec., 2000), 677-88.] But if we stay faithful to the philosophic ideals that link Socrates and Dewey in a common history, then it is less likely we will be seduced by the Siren songs of any prevailing political ideology. Nor will we be tempted to found new schools of bioethics to produce ideological clones of ourselves, per the recommendation of Mr. "Weasley" Smith.

Some of my readers may be interested to know the rest of the story, how I responded to my son Jonathan's shock that his respected father might be associated with this unseemly band of High Priests. I explained that Weasley's research was flawed, that he probably only interviewed a bunch of Hollywood hip-happy High Priests of Bioethics, with whom I have never consorted. I myself am just a hard-working, beer-guzzling (only American) blue collar sweaty High Priest of Bioethics. I am confident that reassured him of my integrity.

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APA Newsletters

Spring 2001 Volume 00, Number 2

Spring 2001
Volume 00, Number 2