|See, Hear and Speak No Evil courtesy of Identity Photogr@phy’s Flickr photostream.|
Why should students study bioethics at a university plagued with bioethical scandals? That’s the uncomfortable question here in Minnesota, where our bioethics graduate program is housed in an academic health center seemingly intent on making its way into the Guinness Book of World Records for Disgraceful Behavior. Research death, corruption, scientific fraud, invasion of privacy, nepotism, double-dipping, employment discrimination, manipulation of research data, improper industry influence, a U.S. Senate investigation into hidden conflicts of interest: As soon as the shock of one revelation begins to fade, the press uncovers another one. Which raises the question: Wouldn’t being admitted to study bioethics at the University of Minnesota be a little like winning a fellowship to study ethics in the Nixon White House?
The problem is not unique to Minnesota. Like parasites in the bowel of a large animal, bioethics centers seem to thrive at scandal-prone universities. Bioethics has flourished at the University of Pennsylvania, despite Albert Kligman’s notorious research at Holmesburg prison, the death of Jesse Gelsinger in a controversial gene-therapy trial in 1999 and an ongoing medical ghostwriting affair; it has thrived at Johns Hopkins, despite the death of Ellen Roche in a healthy-volunteer study and the Kennedy Krieger Institute lead-paint litigation; and it has thrived at Emory University, despite the Nemeroff corruption scandals and the events described in Tom Harbin’s alarming book, Waking Up Blind. In fact, a good dose of shameful behavior seems to be a prerequisite for a well-funded bioethics program.
Many university administrators seem to think that leaving a stack of cash on the table for the bioethicists is a good way to make amends for wrongdoing. Bioethicists don’t usually complain. When the Presidential Commission for the Study of Bioethical Issues looked at the issue of making reparations to victims of unethical research, it suggested that reparations do not necessarily have to mean monetary compensation to victims. Instead, they may mean more funding for bioethics. For example, when the Clinton administration apologized on behalf of the federal government for the Tuskegee syphilis study in 1997, it also announced a grant initiative to establish a bioethics center at Tuskegee University. Whether the victims of unethical research see a bioethics program as fitting compensation is not for me to say. But if the point is to prevent future wrongdoing, there is not much evidence to suggest that that ramping up a bioethics program helps. The tacit agreement at most institutions seems to be: “We will fund bioethics generously as long as the bioethicists pledge to keep their mouths closed.”
That arrangement seems to work out just fine. When a bioethics scandal erupts at a university, you can generally count on the bioethicists to clam up. They usually don’t write about the wrongdoing, and they rarely talk to the press. This is not to say that faculty members at a troubled university don’t have good reasons to keep quiet: Maybe they don’t have enough information about the issue or sufficient expertise to make a judgment. And it may well be that the bioethicists are working diligently to improve things on the inside — you know, developing “ethics consultation services” and “educational modules,” or even writing a Strongly Worded Memo. None of this justifies keeping information away from prospective students, of course. Students need to know exactly what kind of sewage lies at the bottom of the lake before they dive in.
Twenty-five years ago, the question of what to tell prospective students would probably not have arisen. Most graduate students interested in bioethics migrated into the field from departments of philosophy or religious studies, or maybe a law or divinity school. When medical scandals occurred, everyone observed them from a distance. Now, however, many graduate programs in bioethics are located squarely within centers of medical power, where the scandals are taking place. Sometimes, in fact, the bioethicists are directly involved. The justification bioethicists have traditionally given for embedding themselves in academic medicine has been to get an up-close, inside look at the way medical practice really works. But the view from the inside can be ugly. These days, in fact, it is a lot like looking in the mirror.
It has been over fifteen years since my friend and colleague at McGill University, the late Benjamin Freedman, asked in the Journal of Clinical Ethics why it was so rare to find a bioethicist taking a principled stand about ethical wrongdoing at his or her own institution. The answer is no mystery: It is because that person would probably be punished. Most bioethics programs are built in a way that makes retribution easy. The programs are often funded with soft money; many faculty members work in contract positions; and tenure, if it is granted, usually has to go through other schools or departments. Besides, academic medicine is notoriously hierarchical, authoritarian, and intolerant of dissent. Bioethicists serve at the pleasure of whatever monarch happens to be in power.
The real danger of housing a graduate bioethics program at a scandal-plagued institution has less to do with the curriculum than with the hidden curriculum. And the hidden curriculum for bioethics seems to be: Don’t speak up. Keep your counsel. If you feel compelled to do something about wrongdoing, work quietly on the inside. Be a good soldier. Respect your superiors. Submit, conform, obey.
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