Bioethics faces a rocky but navigable road


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Tag(s): Legacy post
Topic(s): Clinical Trials & Studies Genetics Politics Reproductive Ethics Research Ethics Science

by Arthur Caplan, Ph.D.

Academic bioethics has never been popular with Republicans. Libertarians dislike academic bioethics because it seems too elitist and anti-free market. Religious thinkers worry it is technocratic, soulless and crassly utilitarian. Now with Trumpism add a populist disdain for expertise, experts and the scientific method and you have a stew that means few of you reading this will find a rapt audience in Washington for many years to come.

Trump needs to appease the paleocons and religious righ to get things done. This makes it likely that bioethics will be swept back into the culture wars of the Bush era — Abortion. Contraception. Sexuality. Embryo research. Gene engineering. Enhancement issues. Chimera formation. Gender reassignment. All are back on the table.

Existing oversight of human research—FDA, OHRP, ETC., will be strongly challenged as too restrictive and inimical to autonomy. “Conscience” will be very much in vogue. The vaccine wars will heat up in terms of mandates and choice. Individual rights will dominate arguments favoring the public good. Public health ethics will become hugely contentious.

Trump and a GOP congress mean the end of the ACA. Academic bioethics will be more ‘oppositional’, more concerned for the vulnerable while being accused of being both elitist and overtly partisan.

In policy there will be more disrespect in government for science, ‘facts’ and scientific expertise. Worries about COI will wane.

This means a rejection of scientific consensus about climate, vaccines, evolution. The need for clinical trials to gain access to drugs or devices will be challenged—hard. The role of pollution in spoiling health will be disputed and since bioethics is not tightly connected to environmental ethics it had better rethink that gap. Scientific findings about race, ethnicity, homosexuality and gender are all likely to carry less weight. Conservative ideology and religion will be heard loudly; scientists less so. Dr. Oz will flouriah. Alternative medicine will gain in influence.

A Trump presidency means the American economy will be less stable with a smaller tax base so government funding for biomedicine will slow. Government funding for bioethics will shrink even further.

Attracting the best and brightest from the world to a nation with a regime seen as hostile to scientific expertise and to diversity will be harder. Oddly, business may be a greater friend to bioethics than government.

I see tougher times for a scientifically grounded public policy in the USA. Respect for empirical methods and evidence will further slide and weaken. The notion that facts ought guide policy is now just a point of view not a moral presumption.

Since Trump is a triumph of, like it or not, a set of values, bioethics is in for some self-assessment and tough hand to hand combat. If we are to endure then there is no room for elitism, snobbery, pretense or moral superiority in our future.

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