The Concept of Community in Bioethics

Abstract

On the 27 July 2010, the Wellcome Trust sponsored a satellite meeting of the 10th World Congress of Bioethics in Singapore focused on the concept of community in bioethics. This was a collaboration between the International Network for Public Health Ethics (InterPHEN), and the International Network for Philosophical Approaches to Bioethics (Inpab), coordinated by David Hunter, Angus Dawson and Jacob Leveridge. In recent years, the notion of ‘community’ has assumed an increasingly important role in ethical discourse. Discussions of individual informed and community consent, and of community engagement and participation in research, have taken centre stage in international research ethics, and increasingly research ethics in general. Another arena in which the notion of ‘community’ has assumed particular significance is of course public health ethics. Two threads running through much discourse in public health ethics are the extent to which the interests of the community might justify state interventions that impose limits upon the freedom of individuals and the extent to which individuals have moral obligations to contribute to or protect the community. Clearly, different understandings of who or what constitutes a ‘community’ and the relationship between the individual and the community will be crucial to advancing these discussions. With these discussions in mind, this meeting aimed to explore different understandings of the concept of ‘community’ and the role it might play in normative decision making from different philosophical and cultural positions, using four case studies, two from the world of research ethics—biobanking and genomics research, and emergency health-related research—and two from the world of public health ethics—vaccination and resource allocation. The principal focus of the meeting was the different sets of assumptions that different conceptions of ‘community’ and its role carry and the implications of these assumptions. We also hoped to use ‘community’ as a focal point for broader discussions around the plurality of different approaches to doing normative bioethics. Dr Jane Kaye kicked off the meeting with a discussion of the frameworks that are applied to biobanks and Professor Terence Hua-Tai followed up with an exploration of the question of democratic legitimacy in large-scale biobanking in Taiwan. A panel made up of Dr Sunita Bandewar, Professor Aasim Ahmad and Professor Jerome Singh took us to lunch with a broader discussion of the concept of community in disaster-affected settings. After lunch, Dr Angus Dawson and Dr Anant Bhan talked about the relationship between community engagement and trust in the context of vaccination programs. Dr Martin Wilkinson and Professor Ellen Zhang then closed off the proceedings with a look at the utility of the concept of community and the related concept of the common good under conditions of resource constraint in public healthcare. With the kind agreement of the editors, we invited both the speakers and the audience to submit papers analysing the concept of community in bioethics and its role in normative decision-making in greater depth for Public Health Ethics and four papers have thus far been published, two in the previous issue and two in this issue. ‘Western’ bioethics is often criticized for placing too great an emphasis on an ‘atomistic’ notion of the individual and paying too little attention to the relations between individuals and their wider community. Yet, the concept is often picked up and used with little reflection on its philosophical underpinnings. As Timothy Wilkinson put it in his paper in the previous issue of Public Health Ethics, ‘bioethics, like political theory, is prone to outbreaks of communitarianism’. Wilkinson (2010) criticized appeals to the concept of community within healthcare resource allocation, arguing that the role of the concept is at best of minimal use, perhaps in efficiently delivering services to specific groups, but it does not play a central role in the answers commonly offered to the significant challenges of debates in relation to fair resource allocation. PUBLIC HEALTH ETHICS VOLUME 4 NUMBER 1 2011 12–13 12