Making decisions in the name of science

Cushla McKinney argues that the dissolution of the Bioethics Council of New Zealand is a hasty mistake.

Who, now, will engage the public with the moral and ethical conundrums met at the frontiers of modern technology?

Among the deluge of company closures and job losses, the elimination of a small division within the Ministry of the Environment seems neither here nor there.

But the dissolution of Toi te Taiao, the Bioethics Council of New Zealand, should dismay us all.

There is a common perception that science operates outside the sphere of the "general public", both in terms of morality and discourse.

However, in reality, scientists do not work in a moral vacuum but as members of a community, with a range of social, cultural and spiritual concerns; one in which the outcomes of their work will have wide implications.

If scientists want to earn the respect and trust of the wider society, they have a corresponding duty to engage in ongoing dialogue to better inform non-scientists about their work and to understand the public concerns about the implications of their research.

Similarly, while it is easy to say "I don't understand" and to blame scientists for hiding the truth, this can also be a convenient excuse for avoiding discussions about difficult ethical issues - particularly when they provoke strong emotional responses.

In such situations, it may take a third party to act as a mediator, to identify points of commonality and difference, and to map out a compromise position where tensions exist. The Bioethics Council was formed in 2002 to fulfil just such a role.

It provides independent advice to the Government on biotechnological issues involving significant cultural, ethical or spiritual dimensions, and to enhance New Zealanders' understanding of these matters.

Its nine members are drawn from a variety of disciplines: science, public and Maori health, education, sociology and bioethics, and uses a process of dialogue rather than consultation in its interactions with the public.

Take, as an example, an issue recently considered by the council: our ability to test IVF (in vitro fertilisation) embryos for a variety of different genetic traits - a procedure called pre-implantation genetic diagnosis (PIGD).

This means we can now identify embryos with serious diseases such as cystic fibrosis and Huntington's chorea.

Couples undergoing IVF can potentially screen for disease genes and choose to use only healthy embryos.

Indeed, there are some who would argue that we have a moral obligation to do so.

Others consider this "playing God" and think there should be a complete moratorium on any such selection.

What should we be allowed to test for and what restrictions should be placed on the use of such diagnostic screens? These questions affect all of us, even if we never intend to have children or make use of this technology.

At one extreme, New Zealand could adopt a policy of complete reproductive autonomy, with parents free to choose what tests to use and what to do with the subsequent information.

This raises many questions.

What does testing for disability say about the value we place on those with physical or mental disability in our society?

If it is OK to reject an embryo because it will develop cystic fibrosis, should we do the same if it has blue eyes? A predisposition to obesity? Schizophrenia?

Should the same tests be included in prenatal screening and would the criteria used to reject embryos also justify abortion?

Do we then expect those who refuse to abort a disabled fetus to shoulder the financial and emotional burden of raising that baby unassisted because it was "their choice" to have that child?

Alternatively, we could use genetic testing only so parents can prepare themselves psychologically and physically for the birth of a child who will require special support.

This avoids value judgements about which lives are worth living, but means that some children will be born with such severe disease that he or she will live only a few, painful years with no possibility of any quality of life as we understand it.

How many people would be comfortable with that? And if we are going to curtail the right of people to decide that they are unable or unwilling to care for a child, are we prepared to accept the reciprocal duty of ensuring that all families are supported and cared for adequately - particularly those with additional needs due to genetic disease and disability?

How do we ensure that social and medical services are not strained to breaking point?

In approaching these questions, the Bioethics Council pioneered a new approach to policy-making.

Rather than council members identifying what they felt to be the important ethical issues, a bottom-up approach was used. Groups from a variety of social, cultural and religious backgrounds were introduced to the science and asked to identify key values and concerns.

These were then discussed in public seminars and online in an attempt to reach a consensus position.

The recommendations on pre-birth testing, released last year, have been controversial, but at least they represent the views of a wider group of people than the privileged few who sit on the council.

All of us will be affected if they are taken up by the Government and any changes to the law that result will be driven by the will of the people rather than the whim of politicians.

The Bioethics Council is not the only ethics body that advises the Government, but the council differs from other organisations in many important respects.

Unlike most other ethics boards, which deal with issues on a case-by-case basis, the Bioethics Council can look at the big picture and has played an important role in leading public discussions on issues as diverse as xenotransplantation and nanotechnology.

In its focus on dialogue and public engagement, the council addresses societal issues beyond the science, advising the Government on how technology should be regulated to reflect the genuine concerns of both scientists and the general public.

Finally, even if the Government disregards its advice, such consultation offers us an opportunity to examine our own values and beliefs, and to be exposed to alternative views.

This can be a challenging and uncomfortable process (particularly if we discover that our immediate response to an issue is based on emotion rather than reason), but can also give us the opportunity to consider perspectives that have not occurred to us before, and help us understand the basis for our own moral and ethical beliefs.

Public dialogue directing policy at the start rather than trying to deflect it at the end is, in my opinion, true democracy in action.

Is the social cost of losing the Bioethics Council worth the financial savings its elimination will generate?

•Cushla McKinney is a scientist and ethics student.

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