Seeing the Duties to All

Abstract

As biotech revolution hits full stride, one is as likely to find stories on emerging medical technologies in business section as in science section. As New York Times notes, reporting case of academic researcher Kirk Hammond, also founder of company Collateral Therapeutics, With biomedical revolution in full swing, academic scientists who lack industry ties are as rare as giant pandas in wild.[1] Conflicts of interest for clinical researchers have long been seen as an issue in bioethics. Yet bioethicists themselves negotiate with temptations as potent as those faced by research scientists. We are funded not only by universities, but by private donors directly or only once removed from very industries we assess. This article reflects on this emerging problem: conflict faced by a bioethicist who participates as a consultant in research, often in private sector and often on new biotechnology or pharmaceuticals. I will make two claims about conflicts of interest in field of bioethics. The first is that there is and should be a conflict of interest whenever we take a realistic look at any new technology. It is in nature of bioethics that contention is a part of moral reflection, that competing moral appeals call upon our loyalty. Only by a stark appraisal of deep calls to conscience that participation in bioethics consultancy ought to provide can we understand depths of potential breaches of ethics in work. The second claim is that to focus question posed by conflicts of interest on rules about finances is a diversion, a necessary but ultimately simplistic account of temptations of power and influence that are part of work of bioethicist. I hope here to raise some preliminary questions for our further exploration.[2] It is my contention that questions that should animate us are not normative or regulatory ones, but epistemic and ontological ones: How can one know what one needs to know to consult on a new technology? Who does one become by taking part in this consultancy? The Duty to Third To be observant as a consultant is to notice conflict. When bioethicists are invited to consult on biotechnology, their role is to introduce social--implications for future, history of past abuses, and present considerations of justice. Conflict is only meaningful possibility for debate. Every interaction of abstract principles occurs within a narrative context, every boardroom discussion takes place within a larger social and political frame--the marketplace, clinic, public square--and it is role of ethicist to pull narrative frame from private view within institution to larger world that surrounds institution, a world of obligation, of suffering, of injustice, and of potential. It is this ability, this role of narrative construction, that allows for reflection and assessment. It is made possible by presence of what Levinas calls the third, witness to interaction of self and constantly calling other that interrupts self.[3] Because it is presence of third that makes judgment--and hence justice--possible, it is important to see problem of conflict as a radical opportunity, not an avoidable mistake. Only in frank confrontation with an alternative view is it possible to understand total alterity of another and need to include this alternative in our deliberations. Because narrative of poor, uninsured, or marginalized might not be represented at table, ethicist is entrusted with their story. The bioethicist might also hear from a range of more particular communities--disease groups, disabilities groups, patient advocacy groups. In all of this, it is being alive to double-horned dilemma that is useful. We hold things in tension--the reasonableness of a marketplace, realpolitik of private financing, nature of social constraints of our health care funding, and aspirations of justice. …