Up from Bioethics

Studying bioethics and the imperative of ethical use of biotechnologies

I am pleased to announce that I have graduated with a Masters in Bioethics from KU Leuven!

I had decided, after 10 years in EU affairs, to study bioethics because I wanted to shift focus more towards biotech and health policies. After taking an excellent online course from the University of Maryland on “Genes and the Human Condition: From Behavior to Biotechnology,” I decided to take the leap and work part-time to be able to study at KU Leuven.

Why bioethics? Health is a supreme human good, one we often take for granted and only notice once we (or a loved one) have lost it. As Schopenhauer said with typical provocativeness: “Health so far outweighs external goods that a healthy beggar is truly more fortunate than a kind in poor health.”

Now, with gene-editing technologies like CRISPR, cheap gene sequencing, and the rise of AI to analyze genomic data, we are achieving unprecedented capabilities to understand and manipulate life itself. As I highlight in my Acumen blog on biotech and European strategic autonomy, biotech has wide-ranging applications for the sustainable circular economy, food, energy, materials, health, and ultimately human enhancement.

At the most fundamental level, biotech enables life to consciously influence its own evolution beyond the semi-random and brutal process of natural selection and its associated blind biological urges.

The courses at KU Leuven provided an interesting taster of different academic subcultures. “Bioethics” is a diverse field with a rather unique institutional setup compared to other academic fields: bioethics is torn between philosophical work and committee.

Bioethics as philosophy

At its most fundamental, bioethics is a branch of philosophy, thinking about the ultimate justification and morality of biomedical interventions. Here one learns about different ethical systems (deontology, utilitarianism, virtue ethics) and the great philosophers associated with them (Kant, Mill, Aristotle…).

Personally, I find the different great ethical systems — e.g. Greco-Roman philosophy, Christianity, liberalism, Confucianism, Islam, and so on — to be quite fascinating. Their ethical and reproductive assumptions are often radically different and this has resulted in the emergence, alongside Western bioethics (which tends to be Christian-influenced and liberal, emphasizing individual autonomy and equality), of Confucian bioethics (emphasizing family and community) and Islamic bioethics (emphasizing divine command and the Islamic scriptural and legal traditions).

I summarize herewith the three main Western schools of morality briefly and illustrate them with appropriate extracts from The Simpsons.

Deontology argues that there are fundamental moral rules or imperatives that one must follow. This is often grounded in the notion of universal and equal human dignity — which has its roots in the West in the notion of humans being created “in the image of God” — and which culminates in the idea of unconditional respect for human rights.

Virtue ethics claim that right action is about doing things with the right, virtuous mindset. For example, a Buddhist might argue that an action is ethical not because it follows some universal law, but because of the way the action was done was with Buddhist virtues, such as Compassion. In the Western tradition, inheriting from Aristotle and Aquinas, an action may be deemed to the extent it was done with virtues such as Moderation, Self-Control, or Constancy.

Utilitarianism is about results. One judges actions’ morality based on their (intended) results and their conformity was some ultimate end, such as human happiness, pleasure, and/or flourishing.

Bioethics as committee work

At its most practical, bioethics is about bioethics committees advising hospitals, health bodies, and governments on biomedical interventions and research. This work is about building consensus that is acceptable colleagues, policymakers, and broader society. These decisions are often controversial and require sensitivity, concerning often divisive issues such as abortion, euthanasia and end-of-life, distribution of inevitably scarce healthcare resources, (mandatory) vaccination, modification of human nature, and so on.

This practical predominance in the field of bioethics is reflected in the fact that, significantly, bioethics departments are often not part of the philosophy departments of universities but, as in KU Leuven, in the school of medicine.

At the risk of being overly schematic, bioethics has a kind of polarization between the pure philosophers — who can afford “ideological purity” and being provocative Socratic gadflies — and the committee members who, more like statesmen, have to be more pragmatic and tactful.

Bioethical principles go all the way back to the Hippocratic Oath and, perhaps most notably, its injunction to doctors to “do no harm” to patients. However, the field really developed after the Second World War in the wake of Nazi medical atrocities and scandals such as the Tuskegee syphilis study.

In post-1945 bioethics, there are sharply distinct (and arguably even contradictory) traditions as concerns clinical bioethics and health policy.

In clinical bioethics (that is, between a doctor and patient, or between a researcher and subject), the emphasis is on autonomy, which has emerged as a supreme value, and therefore of informed consent wherever possible. By contrast, public health ethics is not averse to various forms of influencing and even coercion, as in the case of sin taxes on cigarettes and fatty goods, campaigns against smoking (just look at the packaging), and mandatory vaccination.

KU Leuven’s bioethics MA included an excellent (though quite lengthy given the number of credits!) MOOC on research ethics featuring interviews with many practitioners, namely people sitting on research ethics committees. The goal is not to undermine researchers, but to make sure biomedical research projects really think through their implications beforehand and reflect, to the greatest possible extent, the interests of all.

A point that resonated with me is the need to have multinational research projects — such as ones financed by wealthy Northern countries but taking place in poorer Southern countries — approved by research ethics committees in both jurisdictions. (You can wonder, or instance, what a committee based in, say, Flanders might know about the social and cultural realities of research subjects in, say, Angola.)

Ethics committees are also advising EU policymakers on scientific and biotech issues. For example, the European Group on Ethics in Science and New Technologies published an excellent report on the Ethics of Genome Editing.

With my background as historian, political scientist, and EU affairs professional, I could not help but think a political science approach to bioethics would be relevant. Bioethics committees exist in a dense institutional context — academic institutions, government advisory — and their work is necessarily influenced by factors such as the way bioethical advisers are nominated for office and public or interest group sensitivity to different biomedical issues (such as abortion, euthanasia, or gene editing). In this sense, the work of bioethics is eminently political and would benefit from analysis by political scientists.

I was also able to take some basic first-year courses in Ethics, Epistemology, and Philosophy of Science. This was quite fascinating insofar as we looked at how to really carefully read texts and engage in the “annoying” games of philosophy. Such as, most basically, picking holes in definitions and always finding exceptions that don’t fit. It was amusing to me that in this sense some of the basic work of philosophy has not changed much since the times of Socrates! Even in science, many fundamental concepts are not as clear-cut or well-defined as you might think.

In addition to meeting interesting people and taking time to learn about bioethical philosophies, practices, and institutional cultures, the Masters ultimately helped me achieve my shift towards working on EU biotech and health policy. And for all that I am grateful!