July 10, 2006

The Scientist: The Chief of Bioethics

When I was being recruited to come to Albany Med to form AMBI, the director of New York State's public health labs and I agreed that it would be outstanding to build a bioethics research component for the Wadsworth Center. Before I could do that, though, I had to come up with a title for what it was, exactly, that I would do, so that I could explain it both to those who pay my salary and to anyone from whom we needed to raise money for the research. The title we agreed on was "the Chief of Bioethics," a moniker taken from Paul Root Wolpe, who used a similar title to describe to people in NASA what a bioethicist does there.

At Wadsworth titles matter, and this one was to distinguish the specific components of my role, as the head of Wadsworth had articulated it to me, from that of, e.g., an IRB member or any other regulatory group. What's in a name? Well, maybe not much, but in the early days of "benchside bioethics," the one we chose made it clear that bioethics is one among several critical new areas of research interest for the director of the Wadsworth Center.

What I didn't count on was politics: within weeks, the director told me that pro-life advocates and those who staff New York's once prominent Task Force on Life and the Law were complaining to the Department of Health - perhaps correctly - that there was no way for a bioethics scholar to write and talk in the ordinary way (in journals, talks and in the media) while under the umbrella of a state title about something as controversial as bioethics. The executive director of the task force - a group one of whose reports was actually temporarily embargoed for political reasons by the state - went so far as to say to me that she was the real "chief" of bioethics. At that point I didn't know what to do; should there be rank in state bioethics, and if so should it be given on the basis of party affiliation or publication record?

In this month's column for The Scientist, I explore the increasingly popular idea that bioethics is at best an activity that does not particularly admit of expertise, and at worst is a political football. There are dozens of people who work in bioethics in companies, government, consultancy, law firms, even lobbying. But when it becomes impossible to talk - when holding a title in one arena means you cannot do your job as a scholar - the recent effect has been to scare many of the best people in the field away from even using the label bioethics anymore, so that they will not find themselves unable to do their research:

At a time, however, when political columnists, fundamentalist zealots, and untrained aficionados not only call themselves bioethicists but also are eligible to work on a presidential commission on the subject, many of those who should be calling themselves bioethicists repudiate that label instead. Though tempting, it would be a mistake to recoil in horror as bioethics becomes politicized. A good sign of the health of bioethics in fact is the healthy debate and political action elicited by bioethics scholarship. It would be bad news indeed for the future of debate about ethics in medicine and science if no one cared about the controversial conclusions reached by those who study and write in the area.

I'll admit, there's a certain allure to the idea of a job that my child can understand. But while I hang on to my "chief of bioethics" badge, really it is an artifact of a time when bioethics had to be explained not only to children but also to everyone. Today most leaders in science and medicine know that bioethics, properly understood, isn't a police force, a task force, or the product of a president's commission. All appearances to the contrary, the explosion of interest in bioethics and even the groping to be called a bioethicist represents a recognition that the field of bioethics is coming of age.

It will be some time before anyone in bioethics takes on the role of "chief" of bioethics in a state - of that I am sure, based on my own conversations with others in various states - but the issues are still very much alive. In fact one of our primary areas of interest is the role of the states in bioethics debate. But for the states to really sponsor bioethics scholarship that is meaningful, there will have to be a carve-out for academic freedom. And that is asking an awful lot of state government, private corporations or even non-governmental organizations. Instead of Chiefs, perhaps there will be new badges: for Meter Maids.

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