What even is Bioethics?
Emma Nance reflects on her first year of the One Health Models of Disease PhD
“What even is bioethics?”
This is the most common question that people ask when I say that I am studying bioethics and biosciences on the Wellcome Trust One Health Models of Disease: Science, Ethics, and Society PhD programme (OHMD).
Like most, if not all, questions posed in the realm of ethics and philosophy, there is no definitive answer.
According to Wikipedia, bioethics is concerned with ethical questions that arise from the fields of “life sciences, biotechnology, medicine and medical ethics, politics, law, theology, and philosophy”. According to the NIH, bioethics is the “study of ethical, social, and legal issues that arise in biomedicine and biomedical research”. But rather than rattle off a seemingly never-ending laundry list of disciplines and abstracted adjectives, the best way I’ve found of answering the bioethics question is by asking people what they think about the COVID-19 pandemic.
COVID-19 and Bioethics
If there is one vaguely positive thing that has happened as a result of COVID-19, it is that people have the language to talk about bioethics, perhaps without knowing that they already have the tools.
When we talk about restrictions that limit personal freedoms (like lockdowns), when we discuss how to allocate scarce resources (like vaccination prioritisation and hospital bed shortages), when we talk about end-of-life care for people who are dying from COVID-19, we are talking about bioethics.
However, not everyone has the same reaction to the same situation; for example, some people might be happy that legal restrictions on social distancing ended 19th July in England, while this might make others anxious. Conversations like this have become part of our daily interactions with acquaintances, colleagues, friends, partners, and family, and are so important to have and continue having.
It can be difficult, uncomfortable, perhaps even polarising to speak with others who do not share the same position about a topic, whether the topic is COVID-19, abortion, gene editing, physician-assisted suicide, etc. People often have instinctive reactions to complex topics and sometimes become defensive and emotional, perhaps failing to listen to other perspectives in the process.
Especially now, conversations about COVID-19 are increasingly politicised and contentious. It is easy to develop a selection bias, interacting only with those who already agree with our own opinions on a topic and deliberately ignoring those who don’t. Also, these conversations are often technologically mediated through social media – and platforms’ algorithms further exacerbate the echo chamber effect.
So how should we have conversations about Bioethics during the pandemic?
To paraphrase Maggie Little from the Kennedy Institute of Ethics at Georgetown University, what if we reframe complex conversations away from the defensive position towards a more inquisitive stance? Maybe we should ask questions like:
- Do you have an instinctive reaction to a polarising topic? Why or why not?
- What do you think someone on the opposing side is afraid of regarding your position?
- What are you afraid of regarding the opposing side?
Little suggests that, instead of instantly disagreeing with someone whose position is different from your own, it is more constructive, but initially more difficult, to compare why you and someone with a different view feel uncomfortable, to compare why you have formed different conclusions from the same information and situation.
To overcome our own selection biases, we must hold dialogues with people from different backgrounds, with different experiences, with different opinions. Bioethics can only benefit from interdisciplinary interactions, from respectful disagreement, from difficult conversations.
The importance of difference and interdisciplinarity
This interdisciplinarity is what I value most about bioethics and why I chose the One Health Models of Disease PhD programme. Fundamentally, the One Health model recognises that animal, human, and environmental health are intrinsically interconnected and works to foster interdisciplinary collaboration across multiple levels, including locally, nationally, and internationally.
As a microcosmic example of this, my cohort and I are all from different places: Greece, Italy, England, Palestine, Qatar, Scotland, USA. Our experiences range from microbiology and virology, cardiovascular sciences, genetics and genomics, infectious disease, bioinformatics, to English literature and law. These differences between us lead to fascinating and varied conversations, with our perspectives being supplemented, challenged, and refined over time.
My background is the only non-scientific one, which has made for a challenging but very rewarding first year. I studied English Literature for my undergraduate, taking courses in Medicine in Humanities in my last two years that changed my career course and led me to apply for a Master’s of Law in Medical Law and Ethics. Last year during my LLM, I took courses such as: Public Health Ethics and Law; Biotechnology, Bioethics, and Society; and Contemporary Issues in Medical Jurisprudence. I really enjoyed analysing important legal cases as well as debating bioethical issues and knew I wanted to continue studying these topics at the postgraduate level, which led me to apply for the OHMD programme.
What is the OHMD PhD like?
This is the first year of the programme and it has been a great opportunity to give dynamic feedback to the organisers for future cohorts. OHMD is a four year programme: Year 1 consists of taught courses while Years 2-4 consist of the main PhD project, which is selected at the end of the first year. This first year, I have learned and explored so much, including:
- used CRISPR/Cas9 gene editing technology (including cell transfection, gene mutagenesis)
- watched a post-mortem sheep dissection,
- written essays about how animal models are used to recapitulate human diseases,
- had lectures on One Health and the implications for animals, humans, and the environment,
- presented to my classmates about the One Health approach to understanding, controlling, and eradicating rabies
- and earned my rodent handling licence!
I have also completed two rotational projects. The first was in bioethics, writing about the ethics of using human challenge trials to research COVID-19 disease progression. And the second in bioscience, working with the bacteria, Staphylococcus aureus, to make genetic knockout mutant strains to study its effects on milk curdling.
Specialising in Bioethics
Now that I have finished Year 1 of the programme, the core taught programme, I am looking ahead towards the next three years of my PhD research project. Though I really enjoyed my three-month rotational project in microbiology at the Roslin Institute (yes, where researchers cloned Dolly the sheep!), my main project is in bioethics. I will be specialising in pandemic ethics and global health justice, asking questions such as:
What have been the impacts of health policy on racial, gender, and socioeconomic justice, specifically in relation to the COVID-19 pandemic?
- What responsibility do high income countries have in supporting low and medium income countries’ vaccination efforts and how should this responsibility be shared out globally
- What powers have public health boards been granted in emergency situations and how should such powers be limited, if at all?
- Have laws and policies which have been introduced under the justification of public health emergencies been unjust and/or had a disproportionate impact on minorities and/or subpopulations?
How has COVID-19 impacted public awareness of and responses to global healthcare?
- How can and should we prepare for the next pandemic or next crisis?
- How have the effects of COVID-19 on minority ethnic groups been reported and discussed?
What does species justice or One Health justice look like? Would adopting a One Health justice approach enable us to understand how animals are positioned in relation to public health?
- Should animals be considered recipients of public health rather than simply as instruments which help humans or as viewed as sources of disease?
- How has the narrative around the COVID-19 pandemic given rise to xenophobic and othering narratives (like invasion biology) and can this discourse be altered?
As this blog post has demonstrated, from the foundational question of ‘What is bioethics?’ to the specialised questions on pandemic ethics, there are no easy answers. And that’s the best part: since there are no straightforward answers, we can all contribute to and explore interdisciplinary solutions. In true philosophical form, to answer a question with a question, really, what isn’t bioethics?