“SCIENCE without conscience is the ruin of the soul,” wrote François Rabelais, the French monk, satirist and physician. Yet the notion that science operates above or beyond conscience and morality has persisted in the west for nigh on a hundred years. From Max Weber, the German sociologist of the early 20th century, to Lewis Wolpert, the UK’s erstwhile public-understanding-of-science guru, an influential constituency of thinkers and scientists has maintained that science is value-free. It is the politicians, military and corporations that twist science to good or bad ends, not the scientists: or so the argument goes.
A classic example of the “value-free” contention is the development of the Haber-Bosch process in Germany in the early 1900s, whereby nitrogen was fixed from air for the first time. The process became the basis of cheap fertiliser for food production, while also enabling the near-limitless manufacture of explosives, enabling a blockaded Germany to fight the first world war for four years. Put to both good and bad uses by industry and the military, the Haber-Bosch process and its inventors remained morally neutral: or so the argument goes.
Yet when it comes to bioethics, there is a tendency for governments, in the UK at least, to heed the moral opinions of scientists in preference to ethicists, religious leaders and the general public. A current example is the recent U-turn over human-animal hybrid embryos. In December 2006, UK officials signalled a ban on such experiments, citing “considerable public unease”. Just five months later, in April, following intense lobbying from stem cell researchers, a draft bioethics bill sanctioned such hybrids after all.
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“We saw this as an area where these [embryos] could be used for scientific benefit,” says public health minister Caroline Flint – a patently “consequentialist” argument based on prospective biotech revenues as much as the future good of patients. The US faces similar pleas from stem-cell scientists, yet federal funding for such research, with some exceptions, has been blocked by President George W. Bush, whose evangelical enthusiasms sometimes get the better of him.
Consequentialism derives from the early 19th-century utilitarian philosophy of Jeremy Bentham. It is a thoroughly sensible way of judging actions according to their actual or likely effects for the greatest number. Utilitarianism is routinely contrasted with moral considerations that belong more to the realms of metaphysics, religion and sophistry than the daylight world of actual repercussions. A consequentialist might condemn drink driving because it causes accidents whereas a puritanical fundamentalist might condemn alcohol in any circumstances because it sullies the soul.
Consequentialism, however, is not without its problems. Could you justify killing one person, for example, to save the lives of five others? And it faces a striking, non-theological counter-argument, originally presented in the 1970s by the late Bernard Williams in the book he wrote with the philosopher J. C. C. Smart entitled Utilitarianism: For and Against. While Smart argued for the merits of judging behaviour on its effects, Williams insisted that true moral behaviour for an individual also involves what he called one’s “whole life project”. He cites the example of an unemployed, penniless chemist with a large family. The chemist, who detests chemical weapons, is offered a project at a cutting-edge chemical weapons research centre with the assurance that if he does not accept it, a rival candidate enthusiastic for such weapons will complete the project twice as fast. Consequentialists would say “Take the job!” declared Williams, since there is no scope within their argument for the “whole life project” – principles, scruples and standards, developed through a lifetime of experiences, including family influence and education. From the point of view of his “whole life project”, the chemist might well refuse the job, wrote Williams, despite the prima facie favourable consequences of accepting it.
This is all very well for individuals, but what of the actions of governments? The idea of the “whole life project” writ large, on a national scale, is the underlying theme of a fascinating and timely new book, Dark Medicine, based on a conference held at the University of Pennsylvania in 2004, at which the majority of papers were presented by Japanese and German historians and ethicists, all with a focus on the 20th century.
When ethicists survey the annals of history for instances of inhumanity in the name of science, they tend to cite medical experiments at Auschwitz. Less familiar in the west are the horrors of a Japanese wartime facility known as Unit 731, sited near the city of Harbin in occupied China during the second world war. As many as 10,000 Chinese civilians and Allied POWs died at Unit 731. Vivisection without anaesthesia was practised, and prisoners were deliberately infected with plague, anthrax, gangrene and cholera. Victims were bombarded with a variety of weapons, and subjected to unendurable levels of cold, heat and pressure. About 3000 Japanese medical specialists took part in these atrocities and their rationale, according to surviving perpetrators, was that the victims were condemned to die anyway and that their deaths could contribute to useful knowledge for the military.
The Japanese and German contributors to this volume argue that an awareness of their separate, but at points comparable, wartime histories has given rise to a systematic caution in the development of their nations’ biotechnologies – notably human embryonic stem cell research. The German philosopher Gernot Böhme takes the link between history and current ethical dilemmas even further. On the problem of physician-assisted suicide, for example, he argues that it is impossible to decide the matter simply by weighing the Hippocratic code against consequentialist arguments based on avoidance of “a humanly degraded form of existence”. History, he insists, must also be taken into account. “It is quite impossible to decide on this question today,” he writes, “without seeing it against the background of the misuse of the idea of euthanasia – if the practice of the Third Reich can be described as that. What is at issue here, therefore, is not only basic values but our society’s historical understanding of itself.”
The conclusion of the authors of Dark Medicine is that the UK, US and other countries should pay heed to the lessons of German and Japanese history at a time when consequentialist perspectives are increasingly dominated by prospective patient dividends coupled with commercial arguments. Hence, while it is possible to create convincing moral arguments for human embryonic stem cell research on the reasonable basis of benefit to future patients, a major portion of the real consequentialist “case” is the threat of being left behind in race for biotech supremacy.
As the authors put it: “Although this is utterly dubious as an ethical argument to justify any programme in medicine – in today’s world, blatant appeals to scientific nationalism get imported into politics. And even into bioethics.” Sobered by the knowledge of having gone “too far into the dark side of medical research”, Japan and Germany, intensely competitive in most other spheres of technology and industry, are less inclined to seek ethical latitude in bioethics than their Anglo-American counterparts (President Bush’s scruples notwithstanding). This is despite any fear of falling behind in the global biotech race.
The take-home message of the 16 contributors to Dark Medicine is that a nation’s books on past episodes of unethical practice should never be fully closed, and that ethical committees in science and medicine should never neglect the historical perspective of their own and other countries. As one of the book’s editors, William LaFleur of the University of Pennsylvania, writes: “A bioethics trained to detect times and ways in which dark motives for doing certain kinds of research are present will be a bioethics more able to tell the scientist and physician which fruit to grasp and which ones to leave unpicked.”
Dark Medicine: Rationalizing unethical medical research
Indiana University Press
