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Researchers who are paid to enrol patients in studies with a not-so-favourable risk–benefit ratio, pharmaceutical companies holding back with data that give rise to concern about patient safety, institutions that provide advanced clinical care to underinsured patients only if they agree to enrol in a trial—conflicts of interest in the medical field have become the subject of increasing scrutiny, leading to codes of conduct as well as to the establishment of processes and rules for the resolution of such conflicts. Bioethics has happily contributed to these developments.
The growing attention to conflicts of interest is to be welcomed indeed. Not only because it helps spell out concrete moral issues that might go undetected by a four-principle analysis of patient–physician encounters but also because it shifts the focus of ethical analysis from conflicting principles, virtues or values to the moral agents themselves, with the roles and responsibilities they themselves or others attribute to them.
But what about the conflicts of interests that bioethicists are experiencing, which are ever more likely to occur with the growing engagement in decision-making, be it in the hospital, in the research ethics committee, or in the drafting of a healthcare policy or law? The classic situation, which readily comes to mind, is the question of sponsorship by the pharmaceutical industry, but there are many other instances in which bioethicists risk losing their voice, their independence, their credibility.
Take the example of a clinical ethicist who is employed by a hospital and who has a contract (of limited duration). What if the job was not easy to come by, was well paid and allowed a perfect arrangement for balancing the ethicist’s work and family responsibilities? Would she really confront the hospital board of directors that is deciding on the prolongation of her contract, even if she was convinced a certain practice was not in the best interests of patients or staff?
Or consider the case of an eager and promising young academic bioethicist who wants to have a respectable list of publications in the foreseeable future. If he was at all smart he would have figured by now that certain topics have more “sex appeal” to high-impact factor journals than others. Writing a snappy paper on how alternative ways to produce stem cells do or do not raise ethical issues is certainly more promising than an—albeit original—paper on the moral status of animals and the need to reduce the number animals being used in research. He might thus put the issues he considers most important to write about on the back burner until he has churned out the five more papers he needs to be promoted. The same problem holds true for the more senior academic hunting for funding. However boring she may think synthetic biology or nanotechnology is, she will find it difficult to resist spending her scarce research time on preparing this huge project proposal, which would send millions into her university’s account, turning her into one of the heavy-weights if not stars of her faculty.
And finally, think of those who have joined the biopolitical arena and have been recruited to help revamp policies to reflect one position rather than another, and are torn between the standards of academic openness and scrutiny on the one hand and, on the other, the excitement of being part of lobbying for political changes that they may in principle be sympathetic with, although they do not appreciate all the arguments put forward by the lobbyists?
If bioethics is supposed to flourish in the future as we hope it will, independence, undiluted energies, the will and the ability to shape the agenda will be primary assets. We can preserve them better if we acknowledge that they are at stake.
Competing interests: None.
Provenance and peer review: Not commissioned; not externally peer reviewed