Guest Post: The Moral Imperative for Bioethics

By Daniel K. Sokol
Daniel Sokol, PhD, is a bioethicist and lawyer at 12 King’s Bench Walk, London. He has sat on several ethics committees, including the UK’s Ministry of Defence’s Research Ethics Committee.

In a recent Opinion piece in the Boston Globe, Professor Steven Pinker made the surprising suggestion that the primary moral goal of today’s bioethics should be to “get out of the way”. “A truly ethical bioethics”, he argued, “should not bog down research in red tape, moratoria or threats of prosecution”.

This bold assertion no doubt echoes the thoughts of many scientists whose research requires the approval of an ethics review committee before springing to life. As a PhD student many years ago, I experienced first hand the frustrations of the tedious review process. I spent hours drafting the protocol, revisions and responding to the Committee’s questions, time I would have preferred to spend conducting research. While a popular sentiment, getting out of the way is not the goal of bioethics.

The goal of bioethics is to allow potentially beneficial research while ensuring that the risk of harm to participants and others is proportionate, reduced to the lowest practicable level, and within morally acceptable limits. The risk of harm can never be eliminated, but it can usually be reduced with minimal effort or cost. It may be as simple as testing a new piece of equipment one more time in a laboratory before attaching it to a human for testing.

At times, researchers – who in their enthusiasm may not have considered the risks of harm as carefully as an impartial judge – underestimate or overlook the potential harms to others. In those situations, an ethics committee should ‘get in the way’, point out the problems, and if possible suggest ways of surmounting them. Speaking from personal experience, no ethics committee wants a death under its watch. Academic bioethicists may talk of ‘dignity’, ‘sacredness’, and other nebulous notions in scholarly documents but, in the front line of ethical decision-making, the focus is on the very real physical and psychological harms that may befall participants.

Bioethics is not opposed to research and progress. The search for solutions to the suffering of humankind is, in itself, a moral imperative, but misguided attempts to help can – and have – led to incalculable harm. Examples of harmful research are many. Some of these examples were the triggers to the safeguards, principles, codes and declarations that pertain to contemporary biomedical research.

Knowing what we know about human nature, to let researchers evaluate the ethics of their own research is akin to the police judging other policemen or doctors judging other doctors. Virtually everyone would, in good faith but quite wrongly, consider their research ethically exemplary.

Professor Pinker worries about the threat of prosecution as an obstacle, but it is a legitimate concern. What sensible researcher would not want to know about the risk of being sued? The level and likelihood of risk are best assessed by lawyers, but the matter should be raised by an ethics review committee. Review by a committee may itself reduce the risk of litigation. Professor Pinker sees ethics committees as adversaries of researchers whereas, in fact, they strive to assist them rather than finding fault for its own sake. They are on the same team, or at least they should be.

Bioethics suffers from an image problem. Bioethicists are viewed by some researchers as the ‘ethics police’, as legislators and enforcers of their own moral law. Admittedly, some bioethicists suffer from a kind of ethical hypochondria, prone to catastrophic thinking, the belief that every protocol or project is plagued with ethical boils. Just as surgeons have a natural inclination to operate and lawyers tend to see the ‘worst case scenario’, bioethicists can see ethical problems that are too remote and over-stress their significance.

There are, without doubt, members of bioethics committees whose disposition and judgement are incompatible with their membership. I have witnessed ugly scenes when members of a research ethics committee have questioned researchers with the venom of a cross-examination in a criminal trial, and when researchers have failed to give the process of ethical review the necessary attention, turning up to the meeting unprepared. There are good and bad researchers, and so too bioethicists.

The recruitment, experience and training of members of ethics committees are legitimate concerns; perhaps more members should have direct experience of the type of research they are reviewing.

The idea that research that has the potential to cause harm should be subject to ethical review should not be controversial in the 21st century. The words “this project has been reviewed and approved by the Research Ethics Committee” offers some reassurance that the welfare of participants has been duly considered. The thought of biomedical research without ethical review is a frightening one.