The missing link
By Jessica Ullian
Bioethicist George Annas believes that his field is endangered and that the work of President Bush’s Council on Bioethics proves the point. In questioning whether the government should fund stem cell research, he says, the council is making a mistake that is all too common among bioethicists — focusing on the laws and economics surrounding an issue, instead of considering how it affects the well-being of humans worldwide.
The legislation that was supported by the Bush administration and ultimately passed by Congress, which denies federal funding for new stem cell research, reflects how bioethics has become “extraordinarily narrow,” Annas says. And the fact that the federal restrictions do not affect the private sector — thus allowing any private corporation to conduct the research — is “a classic example of bioethics becoming irrelevant.”
“There is no coherent justification for denying federal funding on that,” says Annas, one of the nation’s preeminent bioethicists and the Edward R. Utley Professor of Health Law, Bioethics, and Human Rights at the School of Public Health. “It’s like saying to the Mafia, ‘We think murder’s wrong, but if you guys want to kill people on contract, go ahead.’”
The diminishing significance of the field of bioethics in the United States is the central theme of Annas’ new book, American Bioethics: Crossing Human Rights and Health Law Boundaries. In it, he argues that American bioethics has been “captured” by legal and economic interests, and as a result bioethicists are not able to consider the issues of health and scientific progress that affect the lives of most human beings. Instead of finding ways to “bless” the activities of biotechnology and pharmaceutical research companies, he says, bioethicists need to shift the focus to human rights.
“What we need are bioethicists who question, who think deep thoughts, and who help society work through really pressing problems that could involve the future of the species,” Annas says. “And they can be much more effective using human rights language and human rights instruments and the human rights activist model than they can using either law or economics.”
The book is framed around Annas’ premise that the concept of bioethics emerged as a result of the 1946 Nuremberg Trials, where Nazi physicians were tried for experimenting on human subjects. The document that emerged out of the trials, the Nuremberg Code, outlines a set of guidelines for doctors that Annas views as “a fundamental human rights document that protects the rights of individuals” and establishes a clear link between bioethics and human rights.
But American bioethicists have tried to distance the field from its association with Nuremberg, Annas says, because of the discomfitting fact that so many German physicians — the world’s most prominent doctors at the time — became tools for the genocidal Nazi government. As a result, he says, American bioethicists frequently overlook the human-rights component of the field, which includes the right of informed consent, the right to choose medical care, and the right to health care in general.
Looking to the Nuremberg Code’s emphasis on patient consent as a guide, Annas’ book explores the ideas of a patient’s right to health through a number of domestic and international issues facing the medical and scientific communities, including the development of biological weapons, cloning, and partial-birth abortion, stressing that on a case-by-case basis, the welfare of the patient must supersede the will of a doctor, a court, or an institution.
He also warns that no major bioethical question can be viewed as simply a medical issue, a law issue, or an American issue, since the scientific developments open a global Pandora’s box. The creation of a human clone or a biological weapon, he says, nullifies the importance of its country of origin or the laws governing it.
“To analyze these questions in any meaningful way, you can’t just be limited to what’s going on in the United States,” he says. “If we don’t do it here, and somebody else does it somewhere else, it has the same impact on the world.”
Annas’ global perspective makes American Bioethics a critical work, says Leonard Glantz, associate dean of academic affairs at the School of Public Health and a professor in the department of health law, bioethics, and human rights.
“The globe is shrinking,” says Glantz. “There will be a greater reach of these sorts of issues, and they will reach into countries and into cultures that have not even thought about these issues. The idea is not to impose American bioethics on other places, but to think about what will be the sort of universal ethical norms and requirements.”
Annas is attempting to put some of his ideas into practice at BU through Global Lawyers and Physicians, the nongovernmental organization he operates with SPH Professor Michael Grodin. The organization enlists doctors and lawyers in a collaborative effort to protect human rights and is affiliated with the Boston Center for Refugee Health and Human Rights, which provides medical, social, and legal services to survivors of torture. The center treated more than 300 refugees from 40 different countries last year — proving, Annas says, that “you can do international human rights work right here in Boston.”
He is also altering the structure of some courses at the School of Law and at the School of Medicine to better reflect his view that bioethics, health law, and human rights are inextricably linked. Beginning in February, the MED first-year lecture series will unite the three for the first time. In addition, the name of the SPH department of health law, bioethics, and human rights, of which Annas is chairman, has already been changed from health law.
By combining the ideas that define bioethics for him, Annas hopes to show his students that bioethics cannot be a tool of law or economics, but must be a study devoted to a better future for the species.
“American bioethics,” he says, “will either move in the human rights direction, or die.”