Time to take a fresh look at bioethics

 

The demise of the Irish Council for Bioethics gives us a good opportunity to reflect on the topic and how it is handled in Ireland

THE CHANGING profile of bioethics – the ethics of medical and biological research – in Ireland is fascinating. Of most interest are the transitions: from when the Catholic Church had an inappropriately large influence on all aspects of Irish life, through a marked move to secularism and, increasingly, an evolution to what the philosopher Jürgen Habermas calls the “post-secular” age, in which we are secure enough to embrace a pluralism that makes space for reason, faith and the secular. In this, we are assisted by Habermas’s methodological atheism – the search for the values and intellectual arguments of the major faiths, without bending to dogma.

The recent demise of the Irish Council for Bioethics affords an opportunity for reflection, and future developments would benefit from careful analysis of the experience.

The council was appointed by the Royal Irish Academy at the instigation of the then Department of Enterprise, Trade and Employment, at a point when investment in the life sciences – with attendant ethical issues in areas such as stem cell research – became a major pillar of our industrial strategy. The council’s final report, Compendium of Work 2002-2010, shows impressive activity, with publications on a wide range of areas and novel public outreach programmes, such as commissioned drama.

For those working in ethics in Ireland, the council provided a fresh public focus on the subject. However, its remarkable consensus, most notably on embryonic stem cells, raised eyebrows. Consensus is generally a positive phenomenon in public life but less clearly so in science.

In his celebrated paper, Nonsensus Consensus, renowned Trinity College Dublin academic Petr Skrabanek highlighted the challenges posed to knowledge and science by consensus.

In ethics, blanket consensus is rarely welcome, given the complexities of the issues, knowledge and viewpoints. The passage of policies on stem cells in University College Cork and TCD raised reasoned dissent at both boards.

How might a future national ethics forum incorporate these tensions and the spirit of constructive dissent? A rethink on representation, academic engagement and input of the full range of disciplines might usefully build on an important start.

Although the council stated that it was not a representative body, even the most reasoned ethical debate cannot avoid an element of representation of the backgrounds of those involved – either overtly or without design. Having a more clearly representative body of expertise would ease interpretation, avoiding the need to divine the dynamics of a council made by appointment, or of those who made the appointments.

More emphasis on academic involvement in bioethics might also be helpful. A key yardstick for clinical research activity in medical ethics is authorship of ethics papers on the main medical database, MedLine. Although all physicians on the council were senior and medically experienced (and clearly generous with their time and experience), little evidence of their formal engagement with the academic aspects of clinical ethics was apparent from searching MedLine.

Reflection on structured interaction with other disciplines, such as theology, would be helpful. Although one academic ethicist on the council was also a priest, there was no obvious formal linkage with advances in the theological thinking of the largest faith grouping in the State for this wide programme.

Sometimes the attitude to faith seemed uneasy: artificial dichotomisation in surveys as to whether respondents were religious or not (as if faith excludes the possibility of reason and critique, or atheism diversity) and an unusual assertion on a radio show that the reluctance of Germany to embrace embryonic stem cell research arose because it was a “largely Catholic country”.

The remark seemed to miss out on the role of the most profound historical influence in their national discourse in ethics, the hugely distressing experiences of the mid-20th century. Indeed, the opening words of the post-war German constitution, that the dignity of man is inviolable, reflect these deep-seated themes.

The philosopher George Santayana wrote that progress, far from consisting in change, depends on retentiveness: those who cannot remember the past are condemned to repeat it.

In this sense, a new national forum on bioethics, incorporating relevant academic excellence, appropriately broad representation from disciplines and interests integral to bioethics, and building on active research and education ethics programmes in Irish universities, is a goal worth striving for, especially if we can build constructively on past experiences.


Prof Desmond O’Neill is a consultant in geriatric and stroke medicine