Who Will Watch the Watchers?

The publication of "Bioethics Consultation in the Private Sector" by the Hastings Center Report marks a unique and we believe troubling moment in the maturation of bioethics. The flagship scholarly journal of bioethics has published, neither a scholarly article nor an argument for a controversial practice, but a "how to" manual for a new guild interested in promoting what it already does. Early in the development of bioethics, Albert Jonsen wrote about bioethicists as "doctor watchers," whose new but socially sanctioned role "allowed" them to observe and criticize the practice of medicine. (1) The justification was that the insights of bioethics would "somehow improve the quality" of medical practice by helping it negotiate its "profound moral paradox"--the incessant conflict between its altruistic ideals and self-interest. (2) Since then, bioethics and bioethicists have flourished, in great measure because they have stepped out of the ivory tower to exert real influence in the real world. Like everyone operating there, bioethicists are influenced not only by a desire to do good but also by a desire to do well by acquiring power, prestige, and money. It is exactly this situation that creates conflicts of interest, defined by Dennis Thompson as a set of conditions in which professional judgment concerning a primary interest "tends to be unduly influenced by a secondary interest." (3) Primary interests are determined by one's professional duties--they are the interests of a scholar, a teacher, a researcher. Secondary interests, as Thompson points out, are not illegitimate in themselves and can be "necessary and desirable." (4) They become problematic when they unduly influence or diminish professional decisions. Financial gain is a prototypical conflict of interest because "it is often difficult if not impossible to distinguish cases in which financial gain does have improper influence from those in which it does not." (5) Disclosure is the simplest and most practical way to deal with the conditions of conflict of interest in an increasingly complicated moral landscape. After writing a report that assumes without discussion that it is a good thing for bioethicists to work as well-paid consultants to private companies, eight of the ten authors reveal that they have chosen to adopt that role. That is all they disclose to the Report and its readers. Yet the Report's written policy calls for complete disclosure to the editor of all affiliations and financial involvements that may compromise the quality or objectivity of the manuscript. Complete? All? The authors did not identify how many relationships each had. Was it one, five, ten? They did not identify the companies for which each worked. And they did not say how much money each one earned. Was it hundreds of dollars a year, thousands, tens of thousands? Stock options? More? Was the money paid directly to them or to their program? The answers to these questions are directly relevant to understanding the "conditions" under which the report was written--letting the editors and their readers make their own judgments about how the authors' secondary interests as paid consultants might or might not have influenced their responsibility as professionals and scholars in commenting on that role. The failure to disclose cannot help but raise serious doubts about the motives of the authors and the objectivity of their report. The authors' relationships to private companies (a secondary interest) are directly relevant to their roles as scholars and professionals who are writing a report that might influence other professionals, junior colleagues, students, and the public who look to them for guidance in ethical matters. …