When I was researching Consumer’s Guide to a Brave New World, it hit me that the ethical values of many scientists cut against the grain of most of the citizenry. Actually, that didn’t just hit me–I quote a major scientist making that very point. From my book (citations omitted):
…[T]he scientific establishment seems to be increasingly insular from the rest of society. It is thus unsurprising—if disturbing—that Bruce Alberts, president of the National Academy of Sciences hubristically told a reporter for the National Journal, “We [scientists] care a lot about how other scientists think about us, and we don’t care a lot about others who are not scientists.”…
Making this even more worrisome, the moral views of the scientists who are supposed to decide these issues on our behalf often do not comport with the general moral sensibilities of society. “Most scientists adopt utilitarian perspectives on ethical and political questions, and they use their values to estimate costs and benefits.” Thus, the NAS’s Alberts admitted that the moral views of the general public sometimes prevent research that scientists’ general utilitarian outlook would cause few qualms. For example, in the 1970s, a public outcry halted the practice of using condemned prisoners in experiments, whereas according to Alberts, “If it was purely up to the scientists, they might accept the idea of doing experiments on death row [because] the person will be dead in six months anyway.”
And now the science journal Nature provides further proof to the point by supporting the utilitarian rationing board NICE, that is doing so much harm to the weak and vulnerable in the UK. From the Nature editorial:
In the highly polarized debate over US health-care reform, opponents of increased government involvement in the system frequently caricature Britain’s National Health Service (NHS) as the disaster they want to avoid — an impenetrable snarl of red tape that keeps ailing pensioners on years-long waiting lists for even the most essential procedures. And at the heart of their nightmare is the UK National Institute for Health and Clinical Excellence (NICE), portrayed as a bunch of callous government bureaucrats ruling life-saving medications as off-limits to dying patients.
Globally, however, NICE is widely regarded as a world leader in comparative-effectiveness studies: research that aims to show which of the available medical options is most effective at treating any given condition, and which is worth the money — what US reform opponents might call ‘health-care rationing’. Faced with an overwhelming yet incomplete medical literature, most medical professionals welcome NICE’s best-practice guidelines on everything from early testing for breast cancer to child nutrition.
I doubt that–at least in the USA. But notice: NICE explicitly adopts a quality of life ethic in making its rationing decisions. That is a view that rejects human equality by definition, not to mention human exceptionalism, views that I don’t think the American people are willing to swallow–as illustrated by the resistance to Obamacare and its supporters many pretenses that the plan would not impose a rationing regime. Excuse me for not being surprised that the Science Establishment thinks that this is a splendid approach.
Sure the big brained and the bioethics community are hot to trot for rationing, since many–I would say most–accept explicit or implicit utilitarian approaches as the best way to provide for the greater good. But I can’t help but think that NICE-type boards, the foundations for which are being laid in Obamacare legislation, would also mean greater power for bioethicists, which, as I reported previously, is already being advocated in high places like the Hastings Center blog.
Add this as just one more reason why we can’t let “the experts” have the final say.
September 17th, 2009 | 11:18 am
Does it strike anyone else as funny that this thing is called “NICE” — just like the scary “scientific” institute in Lewis’ That Hideous Strength?
September 17th, 2009 | 12:39 pm
GregK,
You might be interested in this:
http://www.davidalton.com/2007/10/That%20Hideous%20Strength.html
Also, you may recall a Chapter in which Mark Studdock writes fictitious media reports twisting public opinion.
Well, that’s what happened last year here in the UK over the hybrid embryo debate. You couldn’t have made it up – but Lewis came close.
September 17th, 2009 | 1:12 pm
Utilitarianism is most definitely not the scientific consensus and any scientist that claims this is the case is speaking without authority or is speaking to convince the public that “since most respectable and authoritative believe this ‘fact’, you would be a fool to believe otherwise”.
If it is propaganda, it must be shot down quickly and repeatedly with the facts. As the “Asch conformity experiments” show, a non consensus is required if you the general public is ever to express its true opinion.
I don’t have numbers, but it’d say that the “consensus” is evenly split between:
(1) Utilitarianism
(2) Minimize suffering
(3) Individual doctor and patient choice
(4) Cost accounting (if it costs too much, you’re on your own)
(5) Triage first (i.e. if you’re not sick enough, go away and come back if you get worse and have a hope of living)
(6) A combination of (3), (4), and (5)
Besides being evil, (1) is nonsense that means whatever the elites want it to mean. Utilitarianism only works if you know the utility of a person and no world view has an adequate definition that’s usable for medicine (other than Darwinism which would have reproduction even if you live only a day as the ultimate goal).
Criteria (2) is insidious and must be opposed strongly. Taken to its logical conclusion, it says that anything is okay as long as it doesn’t hurt and anything that increases pleasure is a moral imperative. The Holocaust would be okay and even admirable if the Jews were given happy pills during their internment and surgically altered to experience the greatest possible ecstasy imaginable when they we killed. The “Brave New World” where people live a meaningless life of pain-free pleasure is not only desired, it is a moral imperative for medicine and society as a whole. It’s also insidious because it makes pain more important than the treatment. I don’t care how painful a sure fire permanent cure for cancer is, if I have cancer I want it.
(3) is okay as long as there is understanding that the patient is vulnerable (especially to duress), the doctor is in the superior position, and the patient has to live with the consequence of any decision the doctor makes.
IMO, (4) and (5) and necessary to some extent, but if they become the dominant way of making medical decisions, something is seriously broken (as is in the case in brutal totalitarian and war conditions and extreme capitalism which morality is defined purely in terms of profit).
So obviously, I personally think that (6) with an emphasis on (3) is the most rational choice.
September 18th, 2009 | 1:27 pm
Currently in the US we have (4) – cost vs.benefit calculation. What is the cost of rescinding a person’s health coverage ($1 million) vs. honoring it and paying about $5 million to treat her cancer. That’s how health insurers in the US work. The un and the under-insured go by (2) Minimize Suffering. The working poor – many of whom can’t afford even the junk high deductible health-plans use pain killers till their body gives out and they can use emergency services. And yes we follow (1) Utilitarianism as well in the US. Right now although about 65% are covered by employer paid goldplated low deduc. health plans and almost an equal % want the public option, we would rather go with the information peddled by misleadingly named lobbies like “Patient’s Rights Organization” or some such thing that is bankrolled by a big time health insurer, because they have the money to buy media time, while the working poor don’t. And isn’t it some Heritage Foundation expert who said the poor don’t vote, so they don’t count. The law permits health insurers to classify Domestic Violence as a “pre-existing” condition in 7 states and deny coverage. Wow! And did you that in some states pregnancy coverage is valid only if the policy is maintained without such claims for two years? In France (which with Germany and Japan has arguable the best health coveage in the world) illegal aliens receive 100% coverage – no questions asked. Once again sanctimonious US based big business proponents show themselves to have not even a fraction of the compassion of a European country they love to criticise.
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