Bioethicists and Activism: Should They Rock the Boat?
We are all bioethicists because we all have views and opinions about things bioethical in our country and world. And with these opinions we set our behavior about those things. But there are bioethicists and there are bioethicists. There are bioethicists who have studied philosophy and ethics and are actively participating within the discipline of bioethics through consultation and teaching. It is with regard to these people who spend their lives immersed in bioethical thought and investigation that I find something missing in their role and goals.
That missing function is the lack of a spirit of activism. Activism represents the need and desire, not just to sit and contemplate but to act on their ethical conclusions. If a bioethicist finds that his or her view is the ethical path for change that would benefit both the individual and/or society, that ethicist should join others with like views and actively try to change things in the most appropriate and effective manner. What things are going on in the world that should be considered? How about inadequate healthcare in the United States and other countries, inadequate nutrition and water for people in many parts of the world, misuse of resources, pollution, torture and many more?
But is that happening in bioethics? No. Why not? I think it is because the discipline is still relatively new and I guess bioethics has been derived from a more academic, sedentary, introspective discipline of philosophy and bioethicists are still caught in that environment.. think things out, give advice but don’t rock the boat. On the other hand, maybe the true value of a bioethicist’s conclusion is, along with others, to rock the boat.
What do you think? ..Maurice.
posted by Maurice Bernstein, M.D. @ 11:50:00 AM
13 comments
13 Comments:
Hi Maurice -
I'm all for rocking boats, but as long as bioethicists want a home in academia, they can't very well make boat rocking an integral part of the discipline -- and I don't think very many self-styled bioethicists would be willing to cut their ties to academia.
Bob, it is interesting that the academic institutions would claim that freedom of thought and expression is part of the underpinnings of their structure or constitution. And yet at the same time their scholars are denied, without penalty. an opportunity, in an appropriate and civil manner, to act based on those thoughts and expressions.
It would be as though those bioethicists who participate in academia or other institutions are treated as monks who study and write but remain isolated and restricted in their activities.
And yet, I understand that these institutions have profound and complex conflicts of interest because of the manner in which they are financially supported and fear actions on the part of their faculty which might antagonize the supporters.
And yet, isn't society missing something important by bioethicists not actively contributing to making beneficent change but simply and quietly expressing their personal view and hoping someone else will take on the activist job? ..Maurice.
I'm a little confused.
You've said on your blogs, at least the modesty thread that you don't want to be an activist, you want to moderate discussions and not take sides. That's why I opened a separate blog with your encouragement. Isn't this thread contradicting that, or am I missing something?
Joel, you brought up a good point. But this blog, covering many different areas of bioethics and medical education and practice is a "discussion blog". Activism, in the most direct and potent sense, tends to defeat any discussion. As a moderator, to be seen as regularly taking and promoting any side would be not in the best interest of me nor the blog. Go to the political blogs for an example of the activist blog function. I contribute to organizations meeting my views and I have supported a bylaw which would have encouraged the American Society for Bioethics and Humanities (ASBH) to take stands on social issues but was defeated by the members several years ago. ..Maurice.
Maurice, I think I see your point, but I think it's a very fine distinction. I have no trouble in my patient privacy blog taking an active role for patient privacy rights, yet I hope maintaining an open discussion without being doctrinaire. I welcome other viewpoints which I don't necessarily fully agree with.
I don't think that activism and moderation are necessarily opposing or contradictory stands.
Returning to the response that Bob Koepp made to the issue of why bioethicists in an academic environment might hesistate becoming activist, I posed the question to an ethicist, familiar to me, who wrote:
"As someone who was fired from her hospital for making a speech about just war about a month before we invaded Iraq, I am here to say there is a heavy price for speaking one's mind. Bioethics is in the ludricrous position of being by the institutions who represent the establishment that bioethicisits by definition should be critiquing. Yes, I think this is part of the resistance to taking political stands.
There is something more. It's the old Vietnam war argument of professionalism staying aloof from the politics of the time to retain it's professionalism. As I tell my students, Socrates did die of eating hemlock and ethicists should think of that before they enter the profession."
Taking risks may be part of the responsibilities of those who call themselves professional bioethicists. ..Maurice.
The isssue of whether activism should be a part of the professional bioethicist and bioethics can be spoken of in terms of whether bioethics as a discipline should have a soul. Steven Miles, M.D. who has contributed a number of times to my blog and who is a physician ethicist at the University of Minnesota wrote the following paper "Does American Bioethics Have a Soul?" in the Summer 2002 issue of University of Minnesota "Bioethics Examiner". I have pasted a pertinent excerpt below but I would advise reading the entire article at the link above.
In what shape is Bioethics’ Soul (if it exists)? There
is no point in discussing Bioethics’ soul if Bioethics
is simply analytic work. By so defining itself,
Bioethics would be limited to teaching, technical
analysis, mediation, and research. This would be
an ironic limiting for a discipline with such an
ostentatious name. It would certainly seem to stifle
the articulation of new commitments. It may even
erode Bioethics’ canonical commitment to respecting
autonomy if a skepticism about new commitments
is taken to mean that prior commitments were
improperly taken. Bioethics’ sense of its mortality
may lie in awareness of this kind of finitude. Can a
cautious middle-aged profession enter the new
millenium in hope of articulating a moral vision
without trying to found a church?
The profile of Dr. Miles career, as noted in the journal, included:
... bioethics work focuses on end of life care,
reducing restraints in nursing homes, and
improving access to health care. He is most proud
of the role he played as President of Minnesotans
for Affordable Health Care, a group instrumental
in passing MinnesotaCare: the model for the federal
CHIP program that expanded insurance for working
people and children. He has worked in refugee care for
twenty years with the American Refugee Committee
for whom he directed medical services at a Cambodian
refugee camp of 45,000 persons. He is currently cocoordinating
an HIV prevention program in Sudan, and
chairs the research committee of the Center for Victims
of Torture.
And in the most recent years he has written, lectured and documented questionable treatment of Guantanamo Bay prisoners and unethical physician participation there.
Certainly, Dr. Steven Miles is the perfect example of an ethicist who,beyond just talking the talk, walks the walk of activism . ..Maurice.
Maurice -
Steve Miles certainly is an activist, but he doe these things as an individual. He doesn't claim to represent the field of bioethics, and he doesn't claim to represent the academic institution where he works.
Of course I don't know the facts (Steve should explain here if he desires)BUT if the University of Minnesota is aware of his activism and appears to accept it, one could infer that indeed his public comments are at least acceptable to that institution and then could one further infer representation? ..Maurice.
Sure, high muckety-mucks at the U of Minnesota are aware of Steve's activism, as are his colleages in Bioethics. Even if they disagree with Steve's positions, so long as he doesn't claim to represent them they have no grounds for objecting to his activism. He does, after all, have the legal right to express his personal views and try to persuade others to those views. But the fact that they don't interfere with Steve's right to self-expression doesn't support any inference to the effect that they agree with him and accept him as their representative in these matters.
One more point, Bob, without belaboring Steve's position further. His relation to the University of Minnesota, therefore, might be an exception to your proposition " but as long as bioethicists want a home in academia, they can't very well make boat rocking an integral part of the discipline." I would assume that you would think that generally the experience of the anonymous ethicist which I posted above would be the more likely probability and outcome. ..Maurice.
A. Academics regularly engage in social activism and boat rocking, bioethics is noticeably reticent.
B. My major heresy in the U was stating that I would not seek tenure because I did not believe that it was morally consistent to value free speech and to simultaneously argue that academics should have more protected free speech than anybody else. For this I was punished but not fired.
c. As for bioethics being a speculative endeavour, its time to reread Toulmin's "How Medicine Saved the Life of Ethics."
D. Although there are bioethicists have been punished for activism, most bioethicists are sidelined for timidity--incremental papers on the minutae of DNRs, not publishing or teaching at all, reiterating the mantra without seriously expanding the canon of mode of analysis or the domain of issues.
Bye
Maurice -
I don't see how activism on Steve's part, or on the part of other bioethicists, can be viewed as an "integral part of the discipline" so long as activism is not a requirement for being included in the tribe of bioethicists. And if it were to become a requirement, what level of activism, regarding what issues, taking what positions, etc., would be appropriate?
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