The Bioethicists are (Mostly) Alright

Originally published on 7th Jan. 2022 on the EA Forum. Discuss it there!

Author’s Note: this post is based in part on Discord and Slack rants, as well as various conversations I have had recently, but is largely original

Special thanks to Applied Divinity Studies, for conversation on this matter, as well as commentary on earlier drafts. Some of the wording and sources in the final piece are based on their input

This is my second post on this forum. My co-blogger Nicholas Kross posted my first one here from his account, but it was a little weird to just have him be a proxy for me. I explained my reasons a bit in this comment, but even so, I decided to just get an account of my own this time. Sorry that this is another criticism of Effective Altruists, I swear I don’t hate you guys or anything, I’m an Effective Altruist myself, it’s just a coincidence that the first two pieces I was ready to write and post here are both critical.

It is a recent truism of the circles I run in that you should blog about your career. It is also a recent truism of the circles I run in that bioethicists are crazy and dumb. Bryan Caplan has compared them to astrologers. Robert Wiblin implied it is typical for them to think licking ice-cream in public is wrong. Byrne Hobart made a widely retweeted joke that bioethicists wouldn’t be approved by bioethicists if they were a treatment. Alec Stapp flatly asserted that bioethicists are grifters who stopped us from having challenge trials early in COVID. Scott Alexander even called bioethicists the rationalist “outgroup” along with evil robots back in 2016.

Well I have great news guys, I have infiltrated the enemy. Through clever subterfuge and sheer nerve, I have embedded myself inside a real life bioethics graduate program! And…look, I can’t keep this up. I am in bioethics because it is related to my academic interests. I have always found the reaction to the field prominent in EA/rat/adjacent spaces ¹ pretty weird.

I have had informal conversations about this disparity in impressions several times recently. Twice in the last several months when mentioning my degree to others from my ingroup, once at an ACX meetup and once in correspondence with Applied Divinity Studies, the reaction was relief that someone from their background might be able to add some sense to the field on the margin. I am unusual in my bioethics program, but I am unusual just about everywhere except, to an extent, Effective Altruist spaces. I don’t feel unusually unusual in the bioethics program. I am not sure how to prove that bioethics just isn’t that bad, I am not even certain that it isn’t, but I want to at least register some evidence.

A key issue that I see people from my ingroup berating bioethicists about is challenge trials. Human challenge trials for COVID vaccines are popular with the public, so why do bioethicists oppose them?

This question came up semi-recently in the Rationally Speaking interview with Matthew Yglesias,

Matt: “Like, what is the field of bioethics? I don’t understand how that’s a purported domain of expertise. Because I’ve clashed with bioethics Twitter, on both this vaccine distribution thing and on human challenge trials for vaccines … And, I don’t know, the ethics experts just disagree about the big picture, obvious controversies. The trolley problem, et cetera. I was blown away, on the human challenge trials, that Christine Korsgaard, my former professor – I think the leading Kantian deontological thinker – she had her name on the 1Day Sooner challenge trials thing. And then there’s these, I don’t know who, being like, ‘Well that’s not good ethics.’ And I’m like, ‘Well, according to whom?’ Right? Obviously in consequentialist terms, it’s good ethics. I happened to know the top expert in Kantian ethics, she thinks that’s a good idea. So, who the fuck are you?” ²

This is an interesting question, especially in light of another recent anti-bioethics tweet from Willy in the world, suggesting bioethicists were at fault for not putting out some sort of petition in favor Challenge trials. If only they were more like these 1Day Sooner ethicists. As Yglesias noted, prominent ethicists of every persuasion signed on, not just Peter Singer and Christine Korsgaard, but also Shelley Kagan, Jeff Sebo, Johann Frick, Jeff McMahan, Thomas Scanlon, Julian Savulescu, and Lawrence Temkin. It’s a shame, considering this, no bioethicists signed on…you can probably see where I’m going with this. Some prominent figures who are very specifically bioethicists signed on, like Nir Eyal and Arthur Caplan for instance, but more to the point, many of the cited figures are at least partly bioethicists. If you want to deny that people like Peter Singer, Jeff Sebo, or Julian Savulescu can really count towards the bioethicist scorecard, because they have other academic interests and careers, you will have to exclude other figures like Wiblin’s aforementioned example of Leon Kass. Singer, Sebo, and Savulescu are as much bioethicists as Kass, and Singer at least is almost certainly more influential on the field. The other figures listed often don’t have “bioethicist” listed anywhere explicitly in their title, but a good number of them like Jeff MacMahan and Shelley Kagan have done some of their most influential work on related subjects, while many of the others have at least done some influential work. Nearly everyone I listed is someone I have either been assigned to read something by, or to read something heavily influenced by, in a bioethics class this past semester (the exceptions being Jeff Sebo and Shelley Kagan). This is not an account of everyone on the list who may support my point either, just the really prominent ones who stood out to me reading it. I think there is a bit of a fallacy circulating in the ingroup that bioethicists are these strange aliens removed from academic ethics. On the level of theorists at least, this is flatly false.

There are noticeable omissions from the list, like (the sadly recently deceased) Judith Jarvis Thomson, but my other readings of her work make me think it is fairly likely she would have signed, and there are other noticeable omissions, like Jessica Flanigan, I am so confident would have signed, that this seems to mostly evidence the open letter’s poor circulation. Indeed one bioethics professor I talked to this about hadn’t even heard of the open letter until I mentioned it.

This is some counter-evidence right? Alright, maybe that isn’t very strong counter-evidence. When I recently started talking to ingroupers about this, it occurred to me that I hadn’t personally asked anyone in my program for their opinions about this issue, which meant I had the opportunity to run a test on my theory. I decided to ask the people in my program for their opinion on challenge trials, with the tie breaker for ambiguous answers being whether they would endorse the 1Day Sooner letter. I didn’t get a great response rate, but managed to corner about 10 people from my program (including two professors). One person opposed the letter, one person abstained from answering, the rest supported it. Some with bafflement that anyone could oppose its content, others with more hand-wringing and hedging, but ultimately they thought the letter as it was would be better than nothing (one professor was among the supporters, the other was the abstainer). ³ The rate of agreement here seems pretty consistent with the results among the polled public.

I spoke to one of the professors I polled after getting their answer, and they said they agreed with my impression that most bioethicists are supportive of COVID challenge trials. Additionally, before classes started, our professors circulated a bunch of recommended bioethics readings, one of which was Richard Yetter Chappell and Peter Singer’s defense of challenge trials. It was not very interesting because the case for challenge trials is not very interesting. There was no piece in the packet opposing challenge trials. But…maybe my program is weird, a few of its faculty members came from Singer’s department in Princeton. Isn’t there any stronger evidence?

I’m not sure if this is much stronger, but conveniently for me, the 2020 version of the phil-papers philosopher survey was released around this time, which has a much larger, more random sample. Unfortunately there is no “bioethicist” option for specialties. Still, “applied ethics” may be close enough to get some sense. I have already discussed the overlap in the context of the 1Day Sooner letter, but another factor is that “bioethics” is often used to refer to a fairly large set of issues. In my program for instance, it is not just used to refer to the ethics of medical and research decisions, but is also extended to environmental, animal, and emerging technology ethics. This point may be sort of a semantic difference, but for what it’s worth, arguably, bioethics is one of the biggest subfields, if not the biggest subfield of applied ethics at this point (aside from political philosophy, which got its own tag), and most applied ethicists contribute at some point to bioethics. So it isn’t perfect, but I think this survey can still tell us something, and at the very least it would seem strange if a large subgroup of applied ethicists were so different from the rest on the questions relevant to their own field without having some strong impact on the results in their own weird direction. As it happens, the applied ethics responses just seem too normal for philosophy, and normal for people in general I suspect, for me to find this very plausible.

There aren’t any questions about challenge trials in the survey, but there are some questions pertinent to bioethics. A few of these are arguably just too controversial or hard to figure out the stereotyped answer for them to be very helpful, such as abortion and vegetarianism. Others however might be helpful. I think that most of the people I have cited with outgroupy stereotypes of bioethicists would predict a consensus among bioethicists against human genetic engineering and immortality for instance. Most applied ethicists, however, support both, indeed in both cases a larger proportion of applied ethicists support these things than the proportion of philosophers in general. Is there anything else? Applied Divinity Studies’ comments actually led me to discover this very helpful Less Wrong post by Rob Bensinger attempting to look at the state of the field fairly by sampling abstracts and excerpts from 33 random bioethics papers (drawn from specifically “bioethics” journals). Some of these papers (like #24) seem to be on the side of the stereotypes against bioethicists. Others (like Savulescu’s papers #1 and #23) are in the other direction. Most are not very dramatically in any direction. One of the comments, from supposedlyfun, suggests that these confirmed their impression that what is wrong with bioethics is that you shouldn’t be trying to be original and clever about commonsense ethical decisions. I cannot even begin to relate to this impression, I am from this field, and so many of these papers felt like dull marginal pulls on debates about the specific form of consent people should be asked for in different medical contexts that it took me days to get through this post. This commenter also appeared to walk back their reaction a bit after reading other comments.

Most of the other comments seem to agree that these papers are fairly innocuous on average. From Gwern,

“the actual day-to-day churn of publishing bioethics papers/research… Well, HHGttG said it best in describing humans in general: ‘Mostly Harmless’”,

from tcheasdfjkl,

“I’m sort of surprised that other people are surprised that bioethics is not uniformly trash”,

from Kaj_Sotala,

“after getting used to so many shouting-matches about controversial topics on social media, I’d almost forgotten what it’s like to witness a community of people actually doing careful and nuanced ethical thinking”,

from PeterMcCluskey,

“it looks like the average academic bioethicist is ok (with high variance)”,

from FireStormOOO,

“these papers were mostly unoffensive and not that terrible in contrast to expectations”

…I think you get the point. There was more to the impressions in the comments than this, and I will discuss some of the other sentiments shortly, but overall, my impression mostly matches that of the commenters: bioethicists don’t believe anything super weird and awful on average and most publications on the subject are just pretty okay actually.

Alright, anything else? Well, a quick google search didn’t turn up much in the way of surveys of bioethicist opinions on different issues, but maybe someone better at online research can find something more definitive, but each piece of evidence more or less matches my impressions of the field before I turned said evidence up, and pushes against the stereotypes of it I hear. Meanwhile, I am not aware of a similar evidential grounding for the opposing view of bioethics, mostly just tweets pointing at bioethicists quoted by newspapers, which doesn’t strike me as incredible evidence. Even if this is a robust trend, there are two parties to that piece of evidence, and it is already sort of foregone that journalism has some issues as a field. Still, I don’t want to totally reduce this to Gell-Mann amnesia.

When I spoke to Applied Divinity Studies, they said on this point,

“it’s possible that ‘people are doing X, bioethicists say it’s probably okay’ is just not as good a headline as ‘bioethicists are mad that people are doing X’. But I would still expect to see some headlines of the form ‘bioethicists are outraged that the government isn’t doing X!!’”

If I searched around I’m sure I could find some articles of the latter form, but I still get the point. You can find articles on all sorts of things, it doesn’t explain very well why, when you aren’t looking, the prominent coverage leans so heavily a certain way. The theory that ADS is sympathetic to, that at least a good deal of this is publications incentivized by clicks to generate controversy, has something to it. However after some thought on my part, I think it can often be accounted for more simply through something like this: when a novelish medical decision comes up, as happened in lots of cases related to vaccine research and distribution during the pandemic, publications that normally swear off bothsidism like the plague suddenly feel a desperate urge to find someone who can suggest a flaw with apparently commonsense ideas. If I am correct, bioethicists believe similar stuff to the general public on average, but weird ideas in every direction are also overrepresented among them on the margins. Even those who do not believe an objection are used to, per the norms of analytic ethics, coming up with the most polished, principled versions of the other side. Bioethicists are selected to be the group of people who both have apparent relevant expertise, and who can be harvested for the other, bizarre, side, of any given new medical debate an article wishes to report on.

And what of the other side of this mentioned by ADS? Why aren’t there many pieces arguing that we should be more bullet-biting in the pro-cost-benefit/anti-paternalist direction than is commonsense? I think this winds up breaking the bothsidism for many publications. The similarly contrarian bioethics positions on the opposite end from “maybe giving out vaccine doses about to expire is actually unfair” often look more like “infanticide is fine actually” and “we should harvest living peoples’ organs against their wills”. These are the sorts of pieces that will get a publication accused of platforming someone horrible. Even more modest (and frankly correct) takes in this other direction like “people should be allowed to get prescription medicines without doctor approval” run some risk like this. People with contrarian takes in the anti-doing-anything direction simply don’t generate this kind of fury outside of our relatively tiny and unpopular internet circle.

On the other hand, some anti-bioethics critics seem fairly willing to recognize that bioethical theorists don’t tend to endorse anything too terrible, and still insist on some version of the anti-bioethics position. As has been made brutally clear in recent years, regardless of what most bioethicists are like, most bioethics decisions are terrible (well, at least many of them are ⁴). This seems to gel well with the meat of Gwern’s aforementioned comment,

“The problem with the field of bioethics has never been the papers being 100% awful, but how it operates in the real world, the asymmetry of interventions, and what its most consequential effects have been. I would have thought 2020 made this painfully clear. (That is, my grandmother did not die of coronavirus while multiple highly-safe & highly-effective vaccines sat on the shelf unused, simply because some bioethicists screwed up a p-value in a paper somewhere. If only!)”

A sentiment reflected in a number of the other comments, as well as in this recent piece by Tom Chivers,

“while I’m talking about ‘bioethics’, it’s not clear that it’s actually bioethicists who are the problem. For instance, Peter Singer of Princeton, probably the world’s most famous bioethicist, is on the board of 1DaySooner, the human challenge advocacy group, as is his fellow bioethicist Nir Eyal, of Harvard. Leah Pierson, a Harvard bioethicist who is writing a book about the failings of bioethics during the pandemic, stresses that when the CDC paused the use of the J&J vaccine, lots of bioethicists she knows were appalled at the decision. But the practice of bioethics as it is actually carried out in major institutions, such as the FDA and CDC, often leads to these bad decisions. … Perhaps I should complain about ‘institutionalized public health’ rather than ‘bioethics’ per se.”

This is a perfectly reasonable sentiment. It is also not reflective of many many of the reactions to bioethicists I described at the beginning, such as Wiblin’s, Stapp’s, and Yglesias’, or the stereotypes of the field and its members I have encountered more informally in conversations. This would not be an irrelevant insight to really properly internalize. If this were just the rationalist version of the tedious debate over whether Critical Race Theory is really being taught in schools, I wouldn’t balk nearly as much. The difference here seems to be between cleanly and clearly identifying the problem as standard bureaucratic nonsense, or as a group of insulated crazy people ruining things on purpose. This is not a trivial difference for practical purposes. As discussed in a blogpost linked by its author as evidence that bioethicists are bad, the organizations making these decisions are litigation-averse and regulated through vaguely-yet-strongly worded guidelines, passed down from a federal agency with 22 current staff members working largely off of an old conference report drafted by people who presumably didn’t intend the more absurd consequences of these guidelines in the wake of an incredibly notorious case of human research malpractice. Indeed to the extent people with “bioethicist” in their job titles have impacted these decisions, it is probably in large part in a legal advisory role about what it is safe to do within and what is implied by the terms of these guidelines. Maybe they are better thought of as “biolawyers” in such cases.

Admittedly I know more about the academic field than the specific dynamics of IRBs, so I may be wrong about this. Still, it is worth some eyebrow-raising if it turns out that the ingroup defense is something along the lines of “well, by bioethicists, we mean research ethicists, and by research ethicists we mean research bureaucrats, and by research bureaucrats, we mean research bureaucracy.” It feels like blaming congressional gridlock on political philosophers at a certain point. To summarize my impressions on this matter, if “bioethics” is used to mean theorists, it refers to a broad, not that weird, not that insulated group of philosophers. If it is used to refer to “the thing that makes bioethics decisions bad”, framing the blame as though it has anything to do with a particular group of people believing weird things is about as helpful as trying to say the DMV is unpleasant because of those blasted DMV theorists.

Another version of the anti-bioethics critique that is perhaps more successful is to say that bioethicists aren’t worse than average, but also aren’t nearly good enough. This for instance seems to be reflected in the aforementioned tweet from Willy in the world, complaining that bioethicists really are responsible for bad bioethics outcomes, because they could oppose them more prominently, for instance in petitions. I do not think bioethicists, as a whole, are worse than the general public on these issues. But they are definitely more deontological, less focused on “beneficence” as a factor, than ingroupers. Like your average person on the streets, I don’t see the average bioethicist making a huge fuss about cumbersome medical regulations that cost lives. Indeed when I spoke to people from my department about challenge trials, none had both heard of and thought extensively about the issue. One respondent wished to emphasize that they hadn’t thought about this issue much yet at all when deciding. Bioethicists are no worse than the average person on the streets, but that doesn’t mean they are much better either, and maybe they should be. Still, I am pretty hesitant about this type of argument.

For one thing, if a professional field agrees with the views and priorities of the general public and not your weird ingroup, it becomes hard to make a credible argument, convincing to people on the outside, that the field is actually sick. How much better than the general public should the field be expected to be? Maybe these questions are just hard, and of course any group would rather the consensus on them drifted closer to its own views, and would call that progress. Still, this is the most credible version of the criticism I have seen, and those who hew specifically close to it have my respect. It may well be true that if the composition of views and priorities among bioethicists were different, they might be able to make more of a difference on the bureaucratic institutions currently failing. Most of them won’t have an opportunity to do this directly, and I don’t know for sure that they could even be that influential by signing more of these petitions or berating the relevant organizations more, but they’re at least on the short list of people who have a shot. I contend that most bioethicists do not focus much on this stuff, but if you point out the worst excesses of FDA/IRB/CDC incompetence and poke them with a stick, they will lean towards the apparently reasonable side. If the average composition of priorities among bioethicists isn’t far from that of the general public, the priorities it would be practical for them to have is, and perhaps they can be blamed for that. Still, this is also not how many of the critics I have mentioned come off either, and this point’s influence on ingrouper discourse may prove worryingly close to this motte and bailey recently discussed by Julia Galef.

One of my least favorite online discourse tactics is to point to two different, inconsistent opinions held by some people in a group, and then imply that the group is hypocritical without doing anything to establish that anyone in this group holds both inconsistent opinions at once. This means I will have to be careful not to do it myself when I point out that the responses ingroupers seem to have to bioethicists and what’s wrong with them appear to be all over the place. Are you referring to career bureaucrats enforcing medical policies, or academic theorists? Are you accusing the field of believing bad things, or believing insufficiently good things, or of being insufficiently outspoken against the bureaucracies? And yet, it seems to me that all of these things hang in the air around the ingroup as the same vague shared understanding, referred to in the same ways, that allows for the vague implication that Leon Kass’ weird ice-cream hang-ups have something to do with the failure to efficiently approve Paxlovid. The same atmosphere that prompts Tom Chivers to complain about bioethics and bioethicists throughout an article whose punchline is that maybe we should really just be complaining about “institutionalized public health”. The same atmosphere that leads Willy in the world to link his piece on IRB incompetence as evidence that you should hate bioethicists. It feels like there really is an appetite to scrunch all of these complaints of varying targets and validity into one group understanding. So, what’s the deal with that?

Interestingly one of the best accounts I can think of is suggested by Scott Alexander’s own quip about bioethicists and evil robots being the rationalist outgroup. I don’t know from context whether he was endorsing or merely describing this ⁵, but as a description it fits his account of outgroups very well. Not only is there a weirdly uncharitable partisan hatred towards bioethicists among rationalists, it seems to me, but there are strong grounds for believing this may have something to do with a narcissism of small differences. Bioethics is the field of ethics that focuses on issues like pandemics, human enhancement, AI, global health, animal rights, and environmental ethics. Bioethicists, in short, have basically the same exact interests as us. Given this, maybe it is understandable that their different norms, views, and priorities are exaggerated given this shared space. In Alexander’s own words,

“So what makes an outgroup? Proximity plus small differences.”

On the other side of this, as one of the academic fields most relevant to our interests, it seems pretty bad to alienate bioethicists for no good reason. If there is an especially good reason then fine, but if as I suspect the stereotypes are careless and poorly grounded, or the phrase “bioethicist” is just used as a vague catch-all for the aspects of professional bioethics decisions ingroupers tend to dislike, then this seems like a not very good reason. If we don’t antagonize them, and our arguments for our priorities and norms are good, a productive conversation may be possible.

Additionally, I have no expectation that the result of looking down on bioethicists will be them improving or coming out the worse-off party. If there was a groundswell of people criticizing bioethics, it might move the needle, but I do not know anyone outside of my ingroup who has this strong an opinion on this one field. Indeed many people I have spoken to have never even heard of it. In a war between an apparently reputable academic discipline and a loose assortment of utilitarianish weirdos, the academic discipline is the one that wins. In all likelihood, we need bioethicists if we want to make an appreciable impact on the conversation, and they don’t need us.

There is more that I could say, but this is dragging a bit. Look, none of my observations or suspicions here are super decisive, but I haven’t seen anything similarly convincing put forward in defense of the ingroup anti-bioethics camp yet. Maybe I am wrong, and either bioethicists are bad in some way I don’t know about, or by and large the ingrouper response to them has been perfectly reasonable even given this, and I am misunderstanding or weak-manning it. As I said, I want to register my evidence however, for what it’s worth. The ball’s in your court.

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Tagged:

• philosophy
• discourse
• ethics
• rationality-community
• ported