New Year ruminations on global bioethics

The New Year is a good time to reflect on where one has been and where one is going. What have I accomplished or failed to accomplish? What can I do better? It is hard to know whether Julian Savulescu wrote his recent essay in the Journal of Medical Ethics (‘Bioethics: why philosophy is essential for progress’) in a bit of a fin d’annee funk. But it certainly sounds like it: his conclusion is that bioethics and medical ethics as fields have largely failed, and he seriously doubts that he as a bioethicist has made much of a positive impact over the past two decades. What is the malaise, and what is the antidote?

According to Savulescu, bioethics and medical ethics have failed because the philosophical engine that powers ethics has been allowed to wither. In fact, much of his article is devoted to deftly exposing what he considers crappy ethical reasoning. While one may not be a fan of Savulescu’s brand of consequentialism, and/or why he thinks certain positions are untenable, you cannot fault him for failing to present clear ethical arguments in support of his views. This is part of his point: bioethics is being overrun by intellectual laziness in the form of unreflective adherence to ethical-sounding catch phrases (‘humans have dignity’), slavish appeal to existing codes and regulations, or failures to distinguish empirical claims from normative ones. The paragraph that really struck me was the following:

I left a promising career in medicine to do bioethics because I had done philosophy in 1982 and attended Peter Singer’s lectures in practical ethics. The field was new and exciting and there were original proposals and arguments. Singer, Glover, Parfit, Lockwood and others were breaking new ground, giving new analyses and arguments. Now medical ethics is more like a religion, with positions based on faith not argument, and imperiously imposed in a simple minded way, often by committees or groups of people with no training in ethics, or even an understanding of the nature of ethics.

The remedy for this, according to Savulescu, is to go back to basics. Bioethics is a branch of ethics. Ethics is a philosophical discipline, and philosophy (certainly in its Western, Socratic form) is all about critically examining claims and offering the best arguments one can. 

To the extent that Savulescu’s diagnosis is right, bioethics may be in globally rough shape. To make my own start-of-the-New-Year confession, I have been involved with initiatives to strengthen bioethics in sub-Saharan African countries for a decade now. One of the greatest challenges faced by those initiatives is to stimulate critical philosophical thinking. Trainees often expect the ‘right answers’ or ‘correct values’, which are then to be applied mechanically to particular problems.  This may be due to educational systems that elevate professors high above students, and encourage learning by rote while downplaying critical engagement with what is being taught. In addition, I have found that much of the interest in ‘bioethics’ in developing countries too often boils down to the (institutional) interest in establishing and sitting on research ethics committees. Whatever the causes of the trend may be, the net result may be the globalization of a diluted bioethics that ‘is more like a religion.’ Those of us involved in such initiatives need to seriously reflect on this phenomenon, to what extent we contribute to it, and what can be done to minimize or counteract it.

HIV cure of the month

Over the last two decades, there has been two tracks on HIV cures: the scientific track, which has not been very successful, and the ethno-religious track, claiming a long series of successes, none of which  have been substantiated. Africa is a leading producer of faith-based and herbal remedy HIV cures. The BBC reports this week that faith healers in England -- apparently of African origin -- have been claiming to make HIV-positive persons test HIV-negative through prayer. One of the groups involved is the Synagogue Church of All Nations (SCION) in Nigeria, whose website includes YouTube videos of believers being healed of various diseases and conditions through the miraculous workings of faith healers. In England, these sorts of groups are accused of telling HIV-positive persons to stop taking their antiretroviral therapy; three deaths were attributed to these practices of Evangelical Christian groups last year.

The relationship between ethno-religious cures and Africa is an curious one. Africa is the origin of HIV,  and though it is not rational, there is some sense of shame there, that this should not be seen as an 'African product'. I remember people in the DR Congo claiming that HIV could not have come from their country: it must have been snuck in from Rwanda or Cameroon. There is also a persistent rumor in Africa that HIV came totally from the outside, from the leading powers of the world, as a diabolical plot to depopulate the African continent. In this context, the idea of an indigenous, non-scientific African cure for HIV becomes very tempting, a delicious thought. After all the high-tech, heavily funded biomedical struggles of powerful and affluent nations to find a cure, the answer comes from something local, homespun, either natural in the form of herbal concoctions, or supernatural in the form of African religiosity. If that was the case, it would be an incredible coup.

Unfortunately, that is not the way it is. In the English case, it looks much more like religious quacks taking advantage of and endangering the well-being of HIV-positive persons, as well as those with other illnesses. British health authorities are unwilling to comment on the matter for fear of alienating religious sensibilities. But they should. Religious organizations, just like secular ones, should come under the scrutiny of the law if their practices seriously threaten the health of its adherents.