Is a Publication Boycott of Chinese Science a Justifiable Response to Human Rights Violations Perpetrated by Chinese Doctors and Scientists?

By Doug McConnell

Recently the editor-in-chief of the Annals of Human Genetics, Prof David Curtis, resigned from his position, in part, because the journal’s publisher, Wiley, refused to publish a letter he co-authored with Thomas Schulze, Yves Moreau, and Thomas Wenzel. In that letter, they argue in favour of a boycott on Chinese medical and scientific publications as a response to the serious human rights violations happening in China. Several other leading journals, the Lancet, the BMJ and JAMA have also refused to publish the letter claiming that a boycott against China would be unfair and counterproductive.

This raises two separate ethical issues: 1. Should journals refuse to publish a letter arguing in favour of a boycott on Chinese medical and scientific publications? 2. Should journals actually establish a boycott on Chinese medical and scientific publications?

 

The letter

The letter is concerned with three kinds of practice happening in China: unjustified mass DNA collection without consent, forced birth control, sterilisations, and abortion, and organ harvesting from prisoners.

“The practices described require the active cooperation of many doctors and scientists and the passive compliance of many more. We note that this complicity may not be voluntary and that protest or dissent would not be tolerated. We understand that because of censorship some practitioners may be genuinely unaware of these abuses. Nevertheless, it seems inescapable that a substantial proportion of doctors and scientists in China are complicit in practices which we regard as profoundly unethical.”

The authors don’t directly take issue with other human rights abuses, such as the unjustified detention and forced labour of Uighurs (see here, here and here), presumably because doctors and scientists aren’t complicit in those practices.

The authors of the letter recognise that unethical research occurs in other countries but claim that the “nature and scale” of the problem is different. In other countries, professional standards are enforced and there is some protection for whistle blowers, both of which limit unethical practice. So you might, for example, have “two rogue psychologists advise the CIA on torture techniques” but there isn’t widespread complicity with unethical practices.

The letter considers vetting individual publications for whether they meet ethical standards but suggests that the problem with vetting contributions is that it is difficult to trust or verify claims that the research was conducted ethically. This leads them to ask:

“Should we go further and say that we regard the Chinese medical and scientific establishments to be so intrinsically involved in these abuses that we are not willing to consider hosting any of their outputs in our journals? … Our own view is that it is very difficult to see how we can claim to uphold our own values, such as are embodied in the Nuremberg Code, the Declaration of Helsinki and the Convention on the Prevention and Punishment of the Crime of Genocide, if we continue to maintain normal professional relations.”

So their main argument in favour of a boycott is deontological in flavour – to continuing to publish scientific research coming out of China is to be complicit in the abuse of human rights going on there.

They also briefly refer to a consequentialist argument – pressure from international medical bodies could be effective in curtailing those abuses, as they claim it was when it was when the Soviet Union was pressured into reducing the use of psychiatry against political prisoners.

The authors recognise that many researchers in China are “bright, committed, and ethical” but characterise them as also being “victims of the very regime we criticise.” This glosses over the fact that a boycott would potentially harm the careers of these blameless scientists and that a more complete consequentialist analysis might weigh against a boycott, but I return to that below. First, let’s consider the ethics of publishing the letter.

 

1. Should these journals block the publication of a letter arguing in favour of a boycott on Chinese medical and scientific publications?

One of the letter’s co-authors, Prof Schulze, claimed that the refusal to publish the letter indicated that “freedom of speech in western science is under threat because of Chinese influence.” “We were turned down because all these journals are heavily invested in China with business and editors there.” It isn’t clear, however, that these authors’ freedom of speech is being limited. There are, presumably, other means of publishing the letter (indeed, it is now getting significant attention online). Interestingly, Curtis has himself used this argument in an editorial to justify rejecting submissions to the journal on ethical grounds – “we do not consider that declining a submission on such a basis would amount to censorship. If we declined to consider a submission, it might still be published elsewhere”. Of course, other vehicles for disseminating the letter won’t come with the authority of those journals, but the right to freedom of speech doesn’t entail a right to publication in authoritative journals.

The situation is somewhat different regarding Curtis’s freedom of speech, however, because he was the editor in chief of the journal he was attempting to publish in. He claims that “the publisher has no business telling the editor what they can and can’t publish because of strong interests in China.” Wiley’s publisher of the Annals, Mark Paalman, says that publication of the letter was not refused outright but that he asked for it to be made less provocative. But perhaps even this represents unethical meddling in the editor in chief’s discretionary space.

In general, we should favour a high degree of editorial independence because scientific journals should publish high quality science, not just the science that happens to align with the commercial (or political) interests of the publisher. The editor is selected, in part, for their expertise in recognising high quality science. Similarly, editors shouldn’t use scientific journals as their personal mouthpieces, e.g. to push a biased conception of the science in their field. The role of the editor is presumably to pursue the purpose of the journal, in this case – “The principal aim of the Annals is to increase understanding of the causes and consequences of human genetic variation, particularly in relation to health, disease and evolution.”

The contested letter was not a scientific publication but an ethical argument about how journals should behave. Does editorial freedom extend to publishing such ethical arguments? Well, it would be naïve to think that human genetic research can proceed in a value-neutral way. Editors have an obligation to ensure that the journal pursues its aims ethically. In the interests of transparency it seems right that the editors should communicate the ethical stance the journal will take . In fact, Curtis and Balloux do just this in their February 2020 editorial. The most relevant section for us is the following on mass genetic sampling: “We would not consider submissions whose major aim seems to be to facilitate the identification of individuals or minority groups to facilitate repressive measures. Additionally, we will have a high threshold for assurance that DNA samples used for population studies have been freely donated with full informed consent.”

However, the letter arguing for a boycott of Chinese research doesn’t explain or justify the journal’s ethical position; rather, it argues for a potential ethical position that this journal and others might take. Given that most of the Chinese research the letter refers to would never be suitable for the Annals of Genetic Research anyway, the scope of the letter might seem overly broad for the journal. Nevertheless, affecting a blanket ban on Chinese research would require cooperation – the Annals could only police its own submissions so, for a blanket ban to take effect, the Annals would have to convince other journals to police their own submissions. Presumably, it is morally permissible to communicate an argument for a collective course of action; it would be up to the other journals whether to accept or reject the argument. So, in short, it isn’t obvious that the content of the letter is contrary to the goals  of the journal.

A further consideration, however, is that there are ethical limits on the normative positions that editors can give their journals. It would be right, for example, for a publisher to block an editor from publishing an outright racist or sexist editorial or to prevent the editor from preferencing the publication of research that directly enables the oppression of minorities. Presumably the publisher would also be justified in blocking the editor’s actions if they were likely to seriously damage the journal’s standing. The journal itself has some value and should only be put at risk for something of greater value. So, does a letter arguing for a boycott on Chinese publications amount to a serious ethical infringement or risk such damage to the journal that the publisher would be justified in intervening?

To answer this we need to address the second ethical issue:  Should journals actually establish a boycott on Chinese publications? Before discussing this, however, it is worth reflecting on a closely related precedent. Efforts over the past ten years have resulted in a boycott of a narrower range of Chinese research on organ transplant research.

 

Precedent

In 2011, the Lancet was prepared to publish a letter calling for a boycott on organ transplant research coming out of China. The letter stated:

“The time has come to bring normal scientific and medical interchange with China concerning transplantation to a halt. We call for a boycott on accepting papers at meetings, publishing papers in journals, and cooperating on research related to transplantation unless it can be verified that the organ source is not an executed prisoner.”

In 2016 and 2017, the journal Liver International published two letters (here and here) to the editor urging the journal to retract research published by Chinese scientists on the grounds that it almost certainly used the livers of executed prisoners in the research. In 2018, Rogers et al. published a paper in BMJ calling for the retraction of 445 organ transplant papers for the same reason. These researchers arguing for the boycott and retraction of Chinese organ transplant research provide a similar argument to Curtis’s: “Banning publication of new research and retracting published research are actions that express condemnation of the underlying human rights abuses while avoiding complicity. It is our hope that such actions will contribute to change in China.” Since then the journals PLOS ONE and Transplantation have retracted 27 papers.

It seems, then, that there is a relatively strong consensus that organ transplant research should not be published (and even retracted) unless researchers can convincingly show that they have not relied on the organs of executed prisoners. This narrower boycott is less controversial because the scientists whose work is being boycotted are those acting unethically, i.e. providing and enabling the transplant of organs from prisoners. The more controversial move in Curtis et al.’s letter is clearly the extension of a boycott to a much wider range of science which is only very loosely connected to unethical practices.

 

2. Should journals actually establish a boycott on Chinese medical and scientific publications?

One deontological reason in favour of extending a blanket ban on Chinese scientific research might be that it would communicate disapproval of the human rights abuses more strongly. There is a sense in which the boycott and retraction of just transplant science seems a disproportionately small reaction to serious, systematic human rights abuses.

People with deontological leanings would feel uncomfortable, however, about the fact that a blanket ban would unfairly impinge on the careers of thousands of Chinese scientists who could barely be considered complicit in human rights transgressions.

There is also a concern about the threshold being used here. What exactly do we have in mind when we say the “nature and scale” of human rights violations are at the point where a blanket boycott is justified? In the US, Homeland Security has authorised mandatory DNA sampling of immigrants and some physicians participate in carrying out the death penalty (sometimes on the wrongly convicted). Perhaps this is not sufficient to justify a boycott on US research because the number of immigrants or complicit physicians is too low or perhaps capital punishment is not sufficiently wrong, but we should be clear about the threshold being used before a boycott is implemented. Without a principled justification for a specific threshold, a boycott on Chinese science remains open to the charge that it is racist or merely an attempt to exert political power.  Assuming an ethically justifiably threshold for a blanket ban on research can be found, journals would have to be prepared to boycott other countries now or in the future if they met that threshold.

When assessing the moral problem through a consequentialist lens, much comes down  to how much a blanket ban might encourage the Chinese government to stop their human rights violations. A blanket ban would certainly exert more pressure than the relatively limited boycott on transplantation scientists. However, it is unclear whether the added pressure would change Chinese policy, it might only serve to diplomatically isolate China, essentially making the problem worse. Finally, a blanket ban would reduce the significant Chinese contribution to global scientific progress. This would entail significant harm to many innocent bystanders as medical and scientific breakthroughs would take longer to eventuate than without the ban.

Perhaps a blanket ban on Chinese science (and other countries who meet the threshold) could be justified in the eyes of a certain kind of deontologist but for consequentialists or pluralists it seems to me that the weight of reason counts against such a ban.

Regarding whether Curtis should have been allowed to publish his co-authored letter arguing for a blanket ban in the Annals, is less clear. I don’t think it is clearly unethical to present an argument for such a ban in the Annals, so it shouldn’t have been blocked by the publisher on those grounds. However, the publisher may have been justified in thinking that the journal’s reputation shouldn’t be risked to promote a controversial ethical position.