Everyone Can Be Better Off
It’s been another chilly day in Santa Fe, New Mexico, where strangers are kind and beauty is overflowing.
The UK is just starting to tinker with COVID-19–themed human challenge trials. The rest of the world remains insouciant. Who is responsible for this indecision in the face of the pandemic?
One is tempted to credit the practical ethicist who somehow manages to insert himself (not unlike Tom Hanks’s character in Forrest Gump) into one life-and-death decision after another: FDA’s vaccine approval, NIH’s challenge trial (dis)approval, and every IRB decision. But to blame the ethicist may be to ascribe rather too much agency to a rather poorly understood entity.
Do practical ethicists even exist? Or are they akin management consultants, brought in by a company’s management to recommend the unpopular decision that the management itself wishes to take but wants no responsibility for? That is, are ethicists just conduits for someone else’s initiative? If so, whose? Of a bureaucrat eager to justify his existence and to grow his power?
A bureaucrat has a rulebook to follow and, so, can exercise power in one of two ways: by judiciously flouting a rule or by working to rule. The former is the compassionate, professional way, but also a risky one, for it endangers the bureaucrat’s survival by undermining the raison d’être for his office. The latter way — which consists in maximally delaying any decision — is the safe way to exercise one’s power.
What prevents a politician from overruling the bureaucrat or shaming him into reason? This is a bit of a mystery. While body bags do not vote, they have families who do. In a democracy, the buck always stops there, with the voter, liable not to notice disaster prevention but ready to smile appreciatively at disaster relief.
But suppose, for the sake of the argument, that full-time, professional ethicists exist and operate within organisations. Then, the questions is: What do they stand for, and on whose behalf?
An appropriate analogy here is the Antitrust Division of the Department of Justice. Lawyers and economists research, invite expert witnesses, and build cases. They stand for low prices and against collusion injurious to the consumer. These goals are noble and transparent (even if oblivious to the welfare of firms’ shareholders). But what do the ethicists at the FDA and the NIH stand for exactly? No one knows.
It appears that practical ethicists stand for the tastes that they happen to hold, and for the ethics of imposing these tastes on others. (E.g., Michael Rosenblatt asserts: “An important principle in human challenge studies is that subjects must give their informed consent in order to take part. That means they should be provided with all the relevant information about the risk they are considering. But that is impossible for such a new disease.” The assertion calls for forcing Alice to act as if she were exceedingly risk averse and cared little about saving others’ lives, even if these characteristics describe Alice poorly.)
Practical ethical tastes are rarely widely agreed upon: some donate a kidney to a stranger and some don’t, some support their local opera and others wish they could withdraw money from it, some work pro bono and others spend time playing with their kids. Indeed, broad agreement on ethics is likely an impossibility. (Even something so simple as maximising the number of lives saved — aka effective altruism — is an ethically controversial proposition.)
Perhaps, all the ethics that we all can be reasonably expected to agree on is the ethics implicit in the Declaration of Independence: the sanctity of life, liberty, and the pursuit of happiness. Therefore, in practical problems, it would seem wise to ensure that everyone is at liberty to act upon his own ethics, as long as this ethics does not endanger another’s life, liberty, or pursuit of happiness. (That is, it is wise to let people volunteer for vaccine trials, try experimental treatments, and live in a shabby house instead of a van.) If this is not what some government agency’s ethics is, it may be so for a good reason, but then it would be becoming of this agency to divulge its ethics and its reasons.
Most would probably agree with the Department of Justice that low prices following a merger is good and price fixing is bad. The Department of Justice is given a lot of power because these are powerful principles, with broad support. It is hard to infer similarly powerful and broadly acceptable principles from the choices that the FDA, the NIH, and the EMA make. “Of course, you can make everybody better off if you are prepared to ignore ethics,” the apparent working principle behind vaccine approval and distribution, does not cut it. Is this really the underlying principle?
Thank you kindly.
