Monday, November 29, 2010

Ambiguous bioethics messages from high places

The two of the biggest bioethics news items in the media this past week have formal similarities: they first raise interest, and end in puzzlement. First, the words of the Pope. The Catholic church, as is well known, is against the use of contraception, because it is said to sever the natural connection between sexuality and procreation. However, condoms -- when used and used properly -- are very effective at preventing the spread of HIV infection. This is why the Church's principled prohibition against condoms looks sinister in the context of the HIV/AIDS epidemic. It makes the Church look indifferent to (if not complicit in) the spread of HIV infection and the sickness, suffering and death that often accompanies it. Last week, the Pope floated a few ideas around that suggested that the use of condoms could be morally permissible in exceptional circumstances. And his example of such an exceptional circumstance was quite striking:

There may be a basis in the case of some individuals, as perhaps when a male prostitute uses a condom, where this can be a first step in the direction of a moralization, a first assumption of responsibility, on the way toward recovering an awareness that not everything is allowed and that one cannot do whatever one wants.

If the male prostitute is a gay sex worker, then the condom is not being used anti-procreatively, for obvious reasons. Hence, male prostitute condom use is not against Church doctrine -- not that this particular topic has been a rich source of doctrinal debate, to my knowledge. So the exception is not particularly helpful for regions like, say, sub-Saharan Africa, where male prostitutes are not the drivers of the HIV epidemic, God-fearing (and often married) heterosexuals are. And here is where it gets murkier: a Vatican spokesman claimed that the Pope was not talking about the use of condoms among male sex workers alone, but also with any "man, woman or transexual." (Gay sex workers and transexuals: since when did the Vatican get so racy?) The use of condoms could be regarded as a moral act if the intention is to prevent grave risk happening to another person. But is the spokesman really speaking for the Pope? Why were the Pope's comments part of some obscure interview? Is the Pope seriously considering a U-turn on condoms, or just floating something out there, testing the conservative waters?

The secular state has its own ways of being obscure. President Obama ordered a review of the ethics of research sponsored by the US government involving human participants. According to the press release, the review was provoked by the recent revelations that the US government funded and helped to conduct dubious syphilis research in Guatemala in the 1940's. The new (and newly renamed) Presidential Commission for the Study of Bioethics Issues is to lead the review. But, on reflection, this does not make much sense. The scandal in Guatemala happened sixty years ago. In the meantime, we had the infamous Tuskegee syphilis studies, the Belmont Report, the creation of the Common Rule, the proliferation of IRBs, the rise of bioethics centers, programs and scholarly journals, and much more besides. Why would an event which pre-dated all this trigger a review of all this? The only reason I can see is ... that there must have been calls to review the system of ethics protections already, and the news of the Guatemala scandal came at an opportune time for reformers. What sort of reforms are being contemplated, what is really driving the changes, and who is leading the charge? For the moment, the answers are shrouded in mystery, and the huddled masses have no way of telling.

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