Kanter, Steven L. MD
I am worried about Aristotle. Since scientists synthesized his genome and brought him to life as a sentient being a few weeks ago, he still is not able to understand current thinking in the natural sciences, mainly because things have progressed so rapidly since his time. Of course, I am even more worried that he already understands current thinking in ethics because things have progressed so slowly. My recent conversation with him only confirmed my anxiety.
“I don’t mean to sound overly critical,” he said to me, “but have you folks really spent the better part of 2,300 years advancing my ideas about the natural sciences while finding little time to advance my ideas about ethics?”
I replied, “Well, Aristotle, there are a lot of ways to look at what happened over the last two millennia, but I think we got into this predicament because important advances in the natural sciences have, for example, fostered economic growth, enabled the development of increased military might, and led to a longer lifespan. Scientific progress has catalyzed the automation of everything from agriculture to weaponry. Since advances in the natural sciences have ensured a society’s dominance as an economic, military, and political power, there has been a lot of money available for this kind of research. There just hasn’t been the same financial incentive to advance research in ethics.”
Being unusually perceptive, he said, “Have leaders been telling their peoples, Steven, that economic, military, and political advantages will ensure that they will have a better life?”
“Yes, Aristotle, that is so.”
“You do realize, Steven, that it is not the power alone that science brings that will lead to a better life for all—it is greater understanding of what one should and should not do with that power that will truly help humanity. That will require the ongoing, advanced study of ethics. And I don’t have to tell you about the importance of research in bioethics. You need to support bright, young individuals who wish to devote their professional careers to understanding what you should and should not do with the biological power you are developing—for example, the ability to create entire genomes from off-the-shelf chemicals. I mean, the scientists who reconstituted me also have the ability to grow a limb, and that is great for someone who lost one. But what is the right thing to do when someone wants a third limb as a means to gain a certain advantage? The answer to that question cannot be found in a basic laboratory.”
We both marveled at the benefits that have accrued to humanity as a result of the dedication, creativity, and commitment of those who have worked, and now work, in the natural sciences, and we spent considerable time talking about specific remarkable advances in biomedical science over the last 100 years. We agreed that a good society should continue to foster such progress, but that it also must foster matching progress in ethics. We both felt a particular urgency about bioethics.
“But,” I protested, “there is just not enough money to pursue studies in bioethics in such a way that it keeps pace with advances in biomedical science and technology.”
Aristotle replied, “You must change that. You must convince friends, colleagues, and anyone who will listen of the dangers of the present imbalance in research and the great benefits of altering that! You must help them understand that they are encumbered by their own technological advances, and the only way to proceed responsibly is to become enlightened through a better understanding of bioethics.”
I nodded in agreement, too impressed by his brilliance to speak.
Then Aristotle said, “Hey, Steven, I have a great idea!”
You can imagine how I waited with unbelievable anticipation. Here I was about to hear a new idea from none other than the founder of the school at the Lyceum. He continued, “The way to raise awareness of the importance of bioethics in your culture is through a catchy slogan—how about ‘Better living through bioethics’?” He was crestfallen when I told him that this slogan was already used by the chemical and electrical industries.
We stared at each other awhile when, all of a sudden, he exclaimed, “Ok, I’ve got it now, Steven. Isn’t one of the important roles of government to step in and fund activities that fundamentally advance the public good, such as research in bioethics?”
“Well, you may be on to something,” I replied. “That is exactly what Drs. Emanuel and Salerno call for in their commentaries in this issue of Academic Medicine.”
He was pleased, and he really liked the commentaries. But he emphasized that we had waited far too long—that it was a serious error not to have pursued the development of ethical thought with the same energy and passion that has been used to advance the natural sciences.
“But,” I countered, “we are doing a lot in bioethics today and we know we need to do much more.” I told him that the U.S. National Institutes of Health has funded the development of several educational programs designed to improve the bioethics knowledge of researchers who study human participants. I then referred him to the article by DuBois et al in this issue of the journal; the authors describe a program specifically tailored to the needs of researchers who study human beings with mental health or substance abuse disorders. I could see that Aristotle was pleased. Also, I told him that modern-day universities have committees called institutional review boards that provide or withhold ethical approval for any research involving human participants. I referred him to the article by Dyrbye et al also in this issue, that reports the experiences of clinician educators in obtaining ethical approval for educational research.
And while I was on a roll, I told Aristotle that organizations that conduct or review research on human participants could receive accreditation from the Association for the Accreditation of Human Research Protection Programs (www.aahrpp.org). He liked the idea that ethics bodies themselves would undergo accreditation. I am pretty sure I heard him say, “Ah, yes, Quis custodiet ipsos custodes?”
Aristotle pulled his robe around him and explained: “Steven, by pursuing science and technology without adequate pursuit of ethical reasoning, you engage in a dangerous game of brinksmanship—you bring yourselves and your children to the edge of a cliff without fully thinking through all of the potential consequences or what it means to fall off the edge. To put it another way, would you drive a race car at full speed with your eyes closed? If you did, you would know you could go fast, you could feel the thrill, but you would not be able to see whether or not you were going in the right direction, and you would have no way of knowing if you arrived at the right place or not. That is precisely what you are doing if you advance biomedical science and technology without developing a comparable sophistication in bioethics!”
I could see why Aristotle was such a good teacher! While discussing his superior didactic techniques, including his uncanny ability to employ metaphors from beyond his time, we agreed that we should apologize to anyone listening to our little dialogue for the fun we had with some anachronisms and a little historical inaccuracy.
Straightening his robe once again, Aristotle said, “Steven, this conversation has been most interesting. I want to emphasize that when biomedical scientists develop new capabilities, especially when those capabilities have the potential to do harm as well as good, your culture must support research to thoroughly develop the understanding of aims, purposes, and ends, and then must be guided by that understanding. It is not easy. And you can’t do it in isolation. That’s why you need a strong bioethics research community. It will cost some money, but the guidance it will provide to humankind is priceless.”
Steven L. Kanter, MD