I’m a bit surprised this didn’t get more play. From what I hear, Pinker has some beef with bioethics.
Biomedical research, then, promises vast increases in life, health, and flourishing. Just imagine how much happier you would be if a prematurely deceased loved one were alive, or a debilitated one were vigorous — and multiply that good by several billion, in perpetuity. Given this potential bonanza, the primary moral goal for today’s bioethics can be summarized in a single sentence.
Get out of the way.
A truly ethical bioethics should not bog down research in red tape, moratoria, or threats of prosecution based on nebulous but sweeping principles such as “dignity,” “sacredness,” or “social justice.” Nor should it thwart research that has likely benefits now or in the near future by sowing panic about speculative harms in the distant future.
This path leads to very dark places. I’ll quote a summary I wrote of Blumenthal (2004).[1]
Booker T. Washington had an ambitious plan around the turn of the century, of rapidly advancing the health and welfare of African Americans in that city. His Tuskegee Institute revived agriculture in the South, build schools and business alliances, created a self-sustaining architectural program, and developed a Black-owned-and-operated hospital.
It also took a keen interest in health issues, and after World War I it faced a major crisis in syphilis. Soldiers returning home led to a dramatic spike in cases, and as of 1926 as many as 36% of everyone within the surrounding Macon County were infected. The best cure, at the time, was a six-week regimen of toxic drugs with a depressing 30% success rate. Something had to be done.
A short study of six to eight months was proposed, the idea being to track the progression of the disease in African-Americans and learn more about it, then administer treatment. It got full approval of the government, health officials, and local leaders in the African-American community. Substantial outreach was done to bring in patients, explain what the disease was, and even give them free rides to reach the clinic.
But then… circumstances changed. The newly appointed leader of the project, Dr. Raymond Vonderlehr, became fascinated with how syphilis changed people’s bodies. The Great Depression hit, and as of 1933 there wasn’t a lot of money available for treatment. So Vonderlehr decided to make the study longer, and provide less than the recommended treatment. He also faced the problem of getting subjects to agree to the toxic treatments and painful diagnostic tools, but that was easily solved: stretch the truth, just a bit. Those spinal taps they used to diagnose syphilis spread to the neural system became “free special treatment,” even though no actual treatment was done. Disaster struck when other scientists discovered the first effective cure, penicillin; elaborate “procedures” were developed to keep the patients from getting their hands on the drug, even if other infectious diseases threatened their lives.
And the entire time, the project had the full support of the government, and published their results openly.
After the entire incident exploded in the press, a commission of experts were formed to advise the US government on bioethical legislation. The result was the Belmont Report, and one of the three core principals it rested on was
Justice. — Who ought to receive the benefits of research and bear its burdens? This is a question of justice, in the sense of “fairness in distribution” or “what is deserved.” […]
Questions of justice have long been associated with social practices such as punishment, taxation and political representation. Until recently these questions have not generally been associated with scientific research. However, they are foreshadowed even in the earliest reflections on the ethics of research involving human subjects. For example, during the 19th and early 20th centuries the burdens of serving as research subjects fell largely upon poor ward patients, while the benefits of improved medical care flowed primarily to private patients. […]
Against this historical background, it can be seen how conceptions of justice are relevant to research involving human subjects. For example, the selection of research subjects needs to be scrutinized in order to determine whether some classes (e.g., welfare patients, particular racial and ethnic minorities, or persons confined to institutions) are being systematically selected simply because of their easy availability, their compromised position, or their manipulability, rather than for reasons directly related to the problem being studied. Finally, whenever research supported by public funds leads to the development of therapeutic devices and procedures, justice demands both that these not provide advantages only to those who can afford them and that such research should not unduly involve persons from groups unlikely to be among the beneficiaries of subsequent applications of the research.
Ignoring social justice concerns in biomedical research led to things like the Tuskegee experiment. The scientific establishment has since tried to correct that by making it a critical part. Pinker would be wise to study the history a bit more carefully, here.
But don’t just take my word for it. Others have also called him out, like Matthew Beard…
Let’s put aside the fact that one paragraph later Pinker casts doubt on our ability to make accurate predictions at all. Because there is an interesting question here.
Let’s assume that hand-wringing ethicists slow progress that cures diseases. As a result, animals aren’t subjected to painful experiments, patients’ autonomy is respected, and “justice” is upheld. At the same time, lots of people died who could otherwise have been saved. Surely, Pinker suggests, this is unethical.
Only under a certain framework, known as utilitarianism, in which the right action is the one that does the most good. And even then, only under certain conditions. For instance, although some research might have saved more lives without ethical constraints, Pinker wants all oversight removed.
Thus, even bad research will operate without ethical restraint. For each pioneering piece of research that saves lives there will be much more insignificant research. And each of these insignificant items will also entail ethical breaches. This makes Pinker’s utilitarian matrix much harder to compute.
… and Wesley J. Smith.
These general principles [than Pinker excludes] are essential to maintaining a moral medical research sector! Indeed, without them, we would easily slouch into a crass utilitarianism that would blatantly treat some human beings as objects instead of subjects.
Bioethics is actually rife with such proposals. For example, one research paper published in a respected journal proposed using unconscious patients as “living cadavers” to test the safety of pig-to-human organ xenotransplantation.
The best defences of Pinker I’ve seen ignored the bit where he dismissed “social justice” and pretended he was discussing less basic things. It doesn’t reflect well on Pinker.
[1] Blumenthal, Daniel S., and Ralph J. DiClemente, eds. Community-based health research: issues and methods. Springer publishing company, 2004. pg. 48-53
