I often told my students of the connection between comedy and philosophy, noting that many popular comedians have an academic background in philosophy. [Editor’s note: insert generic list of philosophical comedians here.] Hoping to validate my statement and gain interest points for himself, one student approached me to say he went to the comedy club and the comedian joked that he started doing comedy after graduating with a philosophy degree and learning that “all the big philosophy firms” were not hiring.
It is a good joke, but I’m assuming this comedian was not a bioethicist. According to the prominent and well-paid bioethicist Arthur Caplan (whose comments appeared in this article by Sheila Kaplan for STAT), for-profit review boards complete almost all institutional review of research ethics. He is quoted as saying, “If you want to work in research ethics,” he said, “you work with them.’’
In other words, institutions developing research protocols, farm out the review of the protocols to for-profit ethical review. If you’ve ever reviewed research proposals, you know that it is a little bit mechanical, anyway. You ask basic questions: 1. Is there a consent form? 2. Is the consent form complete? 3. Are appropriate disclosures included? And so on. Most people involved in review, tick through a checklist to make sure everything is in order.
The work is tedious and mostly clerical, if we are honest. It makes sense to just pay someone to go through and make sure everything is in order. Leave it to the professionals. It saves time and may ensure nothing is overlooked. It is worth the investment to make sure nothing slows down your project or results in embarrassment down the line. The professionals know exactly what they are doing, and you want it done right.
While it makes perfect sense to hire a professional review of your protocol to ensure it meets all legal and regulatory requirements, I fear a professional reviewer will work to find ways to make the protocol successful rather than questioning whether the whole venture passes ethical muster.
The problem is that I’m not sure how you move from “How can we do this according to established ethical standards?” to “How can we act ethically in the pursuit of the good?” Is it possible to seek the good life for hire? Or, is it possible for competent ethicists to exist if they are not paid for their work? How do we create space for genuine soul searching among ethicists?
Of course, ethicists need to be paid for their expertise and work, but it raises problems when how much they earn is tied to what answer they give. A commercial IRB won’t get much businesses if it tells all its customers their research is unethical, so at least some ethicists need to be free to comment on research and all other areas of life and work without their specific answers affecting their income.
Further, the work of such independent ethicists must not be disregarded specifically because they are outsiders. Ethicists working within a system are necessary and their expertise is valuable, but only outsider ethicists are able to comment freely and honestly.
At some point, you have to ask how your work looks to outsiders. People within a system are often amazed that anyone outside the system could possibly doubt their motives, but it may be the outsider who sees your motives most clearly.
Privatization eliminates spaces for free inquiry. While private enterprise certainly has a role in medicine and research, it is imperative that we preserve or create public spaces for ethical discourse. It isn’t a question of experts versus non-experts. It is a question of ethicists with something to gain compared to those with nothing to lose. Sometimes, you have to listen to the voices of those with nothing to lose.