The case for population bioethics
The field of bioethics is growing. More and more universities are incorporating bioethics into their programs and the exposure of major bioethical issues in the media is now a regular occurrence. Prenatal testing, new life-saving technologies, clinical testing of pharmaceuticals–these are just a few of the bioethical issues that we in the West hear about every day.
But Sarah Alsamarai of Boston College wonders: Are these the most important issues? Sarah emphasized that case-based bioethics often “applies primarily to wealthier, insured communities.” If people feel that both local and global bioethical issues are important, why is there so much focus on what Paul Farmer, American anthropologist and physician at Harvard, calls “quandaries of the fortunate?” The fact is that while there are many public health issues that are discussed within the bioethical community, they are often overtaken and overshadowed by topics that are more “popular” but an impact on far fewer lives–for example, preimplantation genetic testing.
As Sarah repeatedly noted, this tension does not imply that such case-based bioethical issues are not worth attention. Mainstream bioethics issues such as pharmaceutical testing need to be discussed. But collective bioethical issues, such as global health disparities, need to be brought to light. But journalists face the problem of a lack of interest on the part of media consumers.
Is this inequality of attention even something that can be fixed? What’s truly important to us, and what is there to be done about it?
–Richard Blissett
March 15th, 2009 at 6:51 am
Part of the said “lack of interest” probably arises from a fundamental difference between “medicine” (which I’m taking to include all forms of treatments like PGI above) and “public health” (which is the basis for a lot of the cheaper, more widely applicable global health interventions). Aside from the novelty of a snazzy new technology, I think medicine generally treats or cures a known problem, whereas public health measures are much more preventative in nature. It’s the problem that vaccines face – everyone takes vaccines for granted, but the moment there’s a single death or handicap from side-effects, the news is up in arms. It’s just much harder in our minds to quantify lives saved when there’s no clear ‘before-and-after’ rescue of an individual, perhaps.
At the same time, I think that it’s a profoundly human trait to want to hear about ourselves, and (I’m generalizing) countries that do have well-established, independent media traditions are the ones that are in “wealthy insured communities”. It’s been said that investigative journalism has fallen by the wayside in recent years, and I think that is related to the lack of reporting around complex problems like global health.
March 17th, 2009 at 5:07 pm
I think the appeal of so-called “First-World” problems in bioethics lies in their ability to highlight strange and striking moral quandaries.
For example, there is more disagreement about whether and how an IVF embryo is human than about whether it is a good idea to send medicine to an impoverished country. The former is a philosophical question that is controversial because of shifting definitions from cutting-edge research. The latter is an ethical no-brainer, at least at first glance — instead the difficulty comes from the logistical and collective action problems inherent in redistributing resources between countries.
Clearly, though, public health problems also lead to moral gray areas, and more important ones if your concern is the overall wellbeing of all people everywhere. But I think that is a separate dimension of bioethics than the academic, (unfortunately) less compassionate aspect of “here’s a strange technology, let’s ponder its implications.”
March 26th, 2009 at 12:26 pm
Those who are REALLY interested in population-level bioethics (read Dr. Dan Wikler’s several papers on this topic) may wish to take his summer intensive research ethics course [http://www.HSPH.Harvard.edu/bioethics/] called “Ethical Issues in Global Health Research (June 8-12, 2009) at HSPH in Boston.
An intensive Harvard professional research ethics course running for 5 weekday days, the illustrated global research lectures are taught by Harvard ethics and regulatory leaders, and include an applications overview and discussion, with meals, snacks, and many ‘extras’ (including professional networking with previous, present, and future students and lecturers).
Developing nation health research raises ethical issues reflecting different cultures, politics, wealth, care standards, individual/group rights, and priorities. Ad hoc ethical codes may be insufficient for broad problems faced by researchers, global health research funders, ERB/IRB members, and government. The annual summer course sizes up ethical and strategic situations where ethical problems are embedded, then students analyze moral and strategic difficulties and competing interests, learn how to protect vulnerable persons involved in research, reduce medical and pharmaceutical errors, and search for better immediate and long-term outcomes for all.
Over 2000 professional students have taken already various versions of this Harvard intensive course in 20 different nations, including Bangladesh, China, India, Mexico, Nigeria, Pakistan, South Africa, UAE, and the USA. It is part of Harvard’s global research ethics education that prepares medical research ethics teachers worldwide. Many of our graduates have found that this course is both sufficient and terminal for their needs.