Is corporate money bad for bioethics?

E-mail address

1369-8486/$ - see

doi:10.1016/j.shps

: [email protected] (J. McMillan).

front matter # 2003 Elsevier Ltd. All rights reserved.

c.2003.12.012

Stud. Hist. Phil. Biol. & Biomed. Sci. 35 (2004) 167–175

www.elsevier.com/locate/shpsc

Is corporate money bad for bioethics?

John McMillan

Department of History and Philosophy of Science, University of Cambridge Free School Lane,

Cambridge CB2 3RH, UK.

Abstract

Some bioethicists are concerned about other bioethicists being paid by corporations.These concerns make sense if you have a particular view about what the most important roleof a bioethicist should be. If you believe that a bioethicist should be a moral critic, attempt-ing to expose wrongdoing, then being paid by corporations might compromise this role. It’splausible to suppose that this can be a role for bioethicists but it’s unreasonable to insistthat all bioethicists should be moral critics.# 2003 Elsevier Ltd. All rights reserved.

Keywords: Bioethics; Commercialisation; Conflicts of interest; Corporate money

1. Introduction

The commercialisation of bioethics has attracted a significant amount of schol-arly attention in North America. This debate has left those of us working in theUnited Kingdom a bit puzzled and perhaps even a little envious. Instead of beingworried about the temptations offered by large corporations, it’s more worryingthat those with large wallets are not interested in buying what the UK bioethicisthas to sell. In any case this debate is relevant because it raises questions about therole of bioethics. Most of the objections to corporate payment rely upon the viewthat ethics advice differs from other kinds of service that might be provided to cor-porations. Whether or not corporate payment is a bad thing for bioethics dependsupon whether there is anything about bioethics that distinguishes it from con-sultancy that might be offered by a historian, accountant or philosopher. Somepeople believe that the primary role of bioethics is moral criticism, whereas othersbelieve that it is moral analysis. I will suggest that what you think about the

J. McMillan / Stud. Hist. Phil. Biol. & Biomed. Sci. 35 (2004) 167–175168

primary role of bioethics will influence what you think about corporate paymentand bioethics.While I am not aware of any UK bioethicist accepting corporate money, a well-

known British philosopher found himself under attack for publishing moral argu-ments in exchange for money. Roger Scruton wrote columns for The Wall StreetJournal, The Financial Times, The Times, The Daily Telegraph and The Inde-pendent. These publications were less than pleased when The Guardian disclosedthat Scruton had been receiving over £50,000 per annum from Japan Tobaccoallegedly to write pro-smoking articles.1 Needless to say it is hard to construct atougher test case for someone who believes that it is always right to sell ethical opi-nions. This example involves a very substantial amount of money, from what mustbe one of the most dubious sources, with the effect that the interests of companieswho do much more harm than good are promoted. However, it’s still an openquestion whether Scruton did anything seriously wrong.In the seventeenth century Francis Bacon pleaded guilty to charges of bribery

and corruption after it became known that he was accepting backhanders. In hisdefence he claimed that he didn’t let bribes interfere with his judgement. Scruton islikely to make a similar kind of response. He has argued a consistent line on theright to smoke for a number of years and it seems highly likely that he didn’t claimto believe anything that he does not in fact believe. However it seems reasonable tosuppose that he might have published prosmoking columns that he wouldn’t haveif it weren’t for the fact that he was being paid to do so.Given that Scruton has a high public profile for a British philosopher there

might be cause for concern about the impact of his actions upon the standing ofphilosophy. If there was ever a case which would damage the ethical credibility ofphilosophy this is it. However, I have not read or heard a single comment to theeffect that this has damaged the reputation of philosophy or philosophers. Peoplethat are critical of Scruton’s actions are only critical of him, so perhaps we mightexpect a similar response to a bioethicist in the same position.

2. All bioethicists are moral critics

It is the impact of corporate payment upon the status of the academic or pro-fessional ethicist that is addressed by Carl Elliott in a number of recent publica-tions.2 He thinks that part of the resistance to the growing corporatisation ofAmerican bioethics is due to aesthetic reasons, but he also thinks that it raises ser-ious questions about the credibility of bioethicists; he says, ‘How can bioethicistscontinue to be taken seriously if they are on the payroll of the very corporationswhose practices they are expected to assess?’3

1 See Allison (2002); Kmietowicz & Ferriman (2002).2 See Elliott (2001a,b; 2002).3 Elliott (2001b), pp. 16–20.

169J. McMillan / Stud. Hist. Phil. Biol. & Biomed. Sci. 35 (2004) 167–175

One response is to point out that assessing corporations is not the only role ofthe bioethicist. Whereas some bioethicists are very interested in criticising theactivities of drug and biotechnology companies, not all, nor probably even amajority of bioethicists do this.A related problem is that this begs a question about the role of the professional

ethicist. A list of the bioethicist’s roles would include things such as educating,facilitating moral discussion, analysing moral problems and being a moral critic.This may not be a complete list and there is likely to be disagreement about therelative importance of each of these roles. It may also be that not all of these rolesare necessary in order to be a bioethicist. In particular there is room for significantdisagreement over whether we should think of the moral critic and analyst roles asbeing central functions and this will have a bearing upon what we think of corpor-ate payment for bioethics.Like philosophers, moral analysts test arguments for their soundness; they inves-

tigate the meaning, assumptions and validity of moral claims. They will often lookfor relevant analogies, invent thought experiments or attempt to find counterexamples. They might also investigate the evidence for the empirical premises of amoral argument.Moral critics are moral policemen or investigators, assuming that there are

wrongs to be uncovered and addressed. Some people believe that a bioethicist isdoing their job if and only if they are actively attempting to expose wrongs. Oneexemplar of this view is Laurie Zoloth who says:

When bioethicists are invited to consult on biotechnology, their role is to intro-duce the social—implications for the future, the history of past abuses, and thepresent considerations of justice. Conflict is the only meaningful possibility forthe debate.4

Of course it’s not obvious why a bioethicist should consult presuming guilt on thepart of biotechnology companies. Why not consult while being aware of the‘‘social’’ but also aware of the great potential of biotechnology and the benefitsthat it has produced in its short history?The critic/analyst distinction does not, as it might first appear, amount to mak-

ing or not making moral judgments. The nature of moral argument is such that anattempt to give a solution to a moral problem involves making a normative claim.A normative claim implies that action, practice, or policy is right or wrong. Even ifa moral analyst always argues that present actions, practices, or policies are right itstill implies that a change to any of these might constitute a wrong. So this distinc-tion does not simply amount to giving or not giving moral prescriptions. It is theinvestigative, critical and wrong-seeking aspects of the critic role that distinguishesit from that of the analyst.Hard questions can be asked about the possibility of being an effective moral

analyst, for it comes close to implying that it is possible to be an expert about

4 Zoloth (2001), p. 15.


morality. This kind of expertise would imply that bioethicists have knowledge anda methodology that can place them in a special position with respect to moraljudgment.5 Of course those who think that we can never reach sensible conclusionsto difficult moral problems or think that it is futile to attempt solutions are likelyto think of the moral analyst role as futile or of lesser importance.6

Most bioethicists perform both of these roles to some extent but there are inter-esting differences in the weight that is attached to them. Elliott thinks that ethicsconsultants are problematic because ‘they look like watchdogs but can be used likeshow dogs’7. If, as appears to be the case with Elliott, you think that the primaryfunction of the bioethicist is to be a moral critic then it’s not hard to see how itcould be bad to receive significant amounts of money from corporations. On theother hand if you are in the business of analysing moral problems then it is lessobvious how advising a corporation on an ethical question is a bad thing.8

Perhaps thinking about an individual bioethicist who is not a moral critic missesthe problem. I mentioned earlier that philosophers were not troubled by Scruton’sactions. One explanation for this is because he no longer holds an academic post.Although he continues to be a well-known and respected figure in philosophicalcircles, he is no longer the employee of an academic institution. This might meanthat his actions don’t reflect as directly upon the profession or a specific institutionas they might have done if he were still a Professor at Birkbeck College. A secondexplanation could be that the role of moral critic is not essential to philosophy.The bioethicist who is more interested in analysing moral problems would have toconcede that the critic role is an important part of bioethics even if they confinedthemselves to an analytic role. It is compromising bioethics in a more general waythat is at the heart of Elliott’s worries. He gives a list of well-known and respectedAmerican bioethicists along with details of corporations from which they receivemoney. The problem with this is that if enough senior people are seen to be on thepayroll of big corporations then it could undermine the way in which the wholeenterprise of bioethics is viewed.Perhaps corporate payment for ethics is analogous to accountants being paid by

large corporations to audit their activities. We are not concerned about accoun-tants being paid by the companies that they audit and the bioethicist who providesan ethical audit for a corporation is in a similar position.9 Elliott’s response is thatwhereas there is a methodology for the accountant, when it comes to bioethicsthere is a distinct lack of objectivity and it will be very difficult to tell when an

5 For more on this problem see Crosthwaite (1995).6 While I think that this claim can be countered, doing so would take me too far from my central

point here.7 Elliott (2001b), p. 7.8 Although it’s worth noting that Callahan (2001) believes that the point of bioethics is to improve

moral reasoning and that this will be compromised by corporate payment.9 Of course we are more concerned about the independency of accountants and audit after the activi-

ties of Enron and other corporations were revealed, but the response to this has been to work towards

greater transparency and accountability rather than abandoning financial audit.


ethicist has changed their view because of a financial incentive.10 It might be that

Elliott overstates the importance of the imprecision or lack of objectivity that is a

feature of bioethics. While there are very significant differences in the starting

assumptions of ethicists this gives a consulting bioethicist a reason for being

especially scrupulous in their reasoning. All that one can ever do in ethics is to give

an opinion and give your reasons for believing it. This has to be done in the

knowledge that a bioethicist with different commitments may very well reach a dif-

ferent conclusion. This means that an opinion that is offered in return for money

that departs from the standards expected of the professional ethicist is as serious a

crime as that of an accountant who cooks the books. Any bioethicist who enters

into an advisory role with a corporation needs to be extremely careful not to

depart from good scholarly standards. By this I mean the things that we ordinarily

take to be sufficient for academic quality—such as being motivated by and direct-

ing intellectual inquiry towards knowledge.Elliott thinks that a more appropriate comparison would be with a judge or a

policeman. Even if a bribe doesn’t result in any change in a policeman’s behaviour

it is still wrong. Likewise a judge cannot have a financial interest in the decisions

that she makes. Both of these professionals must be trusted in order to be effective

and an incentive to act inappropriately even if it is not acted upon cannot be toler-

ated. By comparing the bioethicist to a judge or policeman Elliott is again stressing

the ‘bioethicist as moral critic’ view. If you think that the bioethicist must be a

kind of moral critic then a comparison with judges or the police seems reasonable.

If you think that the moral analyst role is more important then this analogy might

be strained. If you hold the latter view then the bioethicist more resembles a his-

torian who conducts research for a corporation. Of course if a bioethicist or his-

torian were paid to come up with specific recommendations or allowed financial

incentives to cloud their judgment then this function would be compromised, but

this would be to commit a kind of academic suicide. Given that the people Elliott

cites are well-known and respected bioethicists it’s unlikely that they would take a

risk of this order with their reputations.Elliott is concerned about the motives that corporations have for putting bioe-

thicists on the books. Arguably the ultimate responsibility of big companies is to

maximise returns for their shareholders. The value of having a pet bioethicist will

have more to do with appearing ethical than actually doing the right thing. While

this is very likely to be the case, it’s not obvious why it should be a cause for refus-

ing to engage with corporations. While the ideal world might be one in which cor-

porations know what the right thing, to do is, do the right thing, and are motivated

to do it for moral reasons, the actual world can only approximate this standard.

It’s not unreasonable to suppose that corporations often want to know what the

right thing to do is, and the bioethicist might be able to help here. Once they have

this knowledge they may even do the right thing—and while it might be better if

10 Elliott (2001b).


they do this for moral reasons, doing the right thing when it will increase yourprofits is better than nothing.The bioethicist who does offer advice to corporations or for that matter to other

agencies with influence over public life does need to think carefully before doingso. Dan Brock has noted that philosophers must think carefully about the con-sequences of providing advice or arguments and that this goes beyond what mightbe thought of as the usual scholarly virtues.11 Suppose that a company that is pol-luting a waterway employs a bioethicist as a consultant, along with a team of law-yers and other consultants. The bioethicist sticks to the moral analyst role andprovides the company with a range of arguments that can be used for and againstbeing able to pollute the waterway. These arguments might be used as part of acampaign against a small group of environmentalists who in fact have a reasonableobjection to the company’s actions. It would be irresponsible, even if the bioethi-cist were only an analyst, to enter into this consultancy arrangement. This is not acompelling reason never to consult for corporations, but it is, however, a reason tothink about the consequences of giving ethical advice.

3. Professional capture

More subtle kinds of worry are articulated by Zoloth, Elliott and Callahan. Ithink they can all be described as forms of ‘professional capture’. By that I meanthat there are worries about the ability of bioethics as a discipline to be a source ofmoral criticism without being corrupted by involvement with large corporations.Zoloth is concerned that bioethicists may be seduced by the epistemic privilege

that can be a feature of consulting with large companies. She thinks that the lureof access to ‘inner secret knowledge’ and the importance that this can have forcareer advancement might create an incentive that is tricky for people to manage12.At first reading this appears an odd claim because it’s reasonable to suppose thataccess to knowledge should always be a good thing for scholarly inquiry. Howeverthis claim makes more sense when Zoloth’s views about the duties of the bioethi-cist are taken into account. She thinks that the bioethicist must always seek to rep-resent those without a voice in debate:

Because the narrative of the poor, the uninsured, or the marginalised might notbe represented at the table, the ethicist is entrusted with their story. The bioethi-cist might also hear from a range of more particular communities—diseasegroups, disabilities groups, patient advocacy groups.13

If you believe that representing the marginalized is what bioethics ought to beabout then it’s not hard to see that corporate consultation might lead to this dutybeing neglected. Whereas it is very hard to deny that the impact of corporate

11 Brock (1993), p. 409.12 Zoloth (2001), p. 17.13 Zoloth (2001), pp. 15–16.


activities upon the marginalized is a crucial part of an ethical opinion about many

things, it is hard to see why all bioethicists need to take this as their primary duty.

Zoloth assumes that the bioethicist must be a moral critic while failing to acknowl-

edge that there might also be a role for the moral analyst.Dan Callahan has a different objection. He thinks that bioethicists should ‘avoid

being part of a culture of money that can force bad choices on us so that we end

up . . . aiding and abetting a potentially corrupt culture’.14 For Callahan the point

of bioethics is to help other people and society more generally make good moral

judgments. Furthermore he believes that making good moral judgments involves

more than just the ability to think critically. It involves having a number of charac-

ter traits or virtues, in particular the ability to avoid self-deceit. Callahan’s worry is

that when the profit motive enters into bioethics this will undermine the ability of

bioethicists to be effective moral guides.Elliott’s underlying worry is quite similar. For a number of years he has been

critical of the direction that North American society is taking with respect to dis-

ease and the medicalisation of any minor ailment.15 His concerns stem from more

general worries about rampant consumerism and the drive to eliminate all minor

suffering. The belief that much of North American life is driven by the almighty

dollar lies behind his fears about what increased corporate involvement might

mean for bioethics. He thinks that bioethics should remain outside of this corpor-

ate world so that it can be an effective critic.Clearly, these worries rest upon a diagnosis of what is wrong with North

American society and upon the role of bioethicists as social critics, so they are not

easily rebutted. But it might be that they are unduly worried about the possibility

of bioethics being bought out by big companies. There is no shortage of bioethi-

cists who share these concerns and so long as this continues there will be people

who can take a broader critical view.Even if what Elliott and Callahan say about North America is true, it isn’t obvi-

ous that there is as much to worry about when we consider the United Kingdom

and Europe. While there have been similar trends towards consumerism and medi-

calisation, the corporate dominance that is a feature of Elliott and Callahan’s con-

cerns is much less obvious on this side of the Atlantic.‘Professional capture’ might be an issue for those of us who do not work in

North America even in the absence of corporate money. By determining the ques-

tions and starting assumptions of an ethical consultation a corporation may be

able to ‘‘capture’’ an ethicist. But this is not unique to corporate involvement, for

there are other ways in which ethicists might be captured. Institutional settings can

influence the questions that the bioethicist pursues. An ethics centre that is part of

a clinical school may not be able to express the same kind of objections to medi-

cine or medical technology as a centre that is in a philosophy department.

14 Callahan (2001) p. 20.15 See Elliott (2003).


The biggest problem with the Elliott, Callahan, Zoloth view is its generality.They think that if a bioethicist is not a moral critic then she is not a bioethicist, orat least not a good bioethicist. Whereas it reasonable to insist that some bioethi-cists should be critics, it is unreasonable to insist that all must be so.

4. What should be done?

Some potential pitfalls of corporate payment apply to both the critic and theanalyst. For both roles bioethicists need to know why it is that a corporationwants them as a consultant and what the consequences of giving ethical advice arelikely to be. Whereas the critic is unlikely to think this sufficient, an analyst is morelikely to think that this will make consultancy acceptable. To a significant extentthe ‘‘badness’’ of being a corporate consultant depends upon whether you think ofthe bioethicist as a critic or an analyst. The professional capture and professionaldamage objections rely upon a particular view of what bioethics is for. The objec-tion that bioethics will be tempted away from good scholarly standards does applyto both roles. However this temptation will be resisted by many because of thedamage it might do to their reputation. Furthermore relatively simple measuresexist for managing financial links between bioethicists and corporations. The WallStreet Journal stated:

Our long-time standard is that such financial ties should be disclosed, so readerscan make up their own minds.

Mr Scruton had an obligation to tell us and his readers about his tobacco finan-cing when he was writing about tobacco issues: he didn’t, and so he will be tak-ing a holiday from our pages.16

This position is similar to that taken by the major medical journals, The BritishMedical Journal, for example, requires authors to declare whether or not they havea potential conflict of interest. I’ve already mentioned that significant payment forwriting about ethics is largely a US phenomenon and that the Scruton example isan unusual case. If significant payments do become more common then there is noreason why bioethics journals couldn’t introduce a similar strategy. Some, such asthe leading bioethics journal The Hastings Center Report have recently introduceda requirement for authors to disclose conflicts of interest.17 These measures will bevaluable for both analysts and critics. If a financial interest is declared it might givethe former a reason to be more critical of an author’s arguments and the latter areason not to read the article at all.Roger Scruton’s writing conveys both conviction and sincerity but even though

this may be a property of all of the pro-smoking columns he has written it will bemore difficult to read them in this way. If bioethicists have to disclose potential

16 Wall Street Journal, European edition, 4 February 2002, cited by Allison (2002).17 See Kaebnick (2001).


conflicts of interest then they risk their credibility in a similar way. This is a power-ful sanction that should be sufficient to protect bioethics from the potential harmsof corporate money.Those who think that this is not going far enough also think that the bioethicist

must be always be a moral critic and while this is an important role for some bioe-thicists, it’s not clear why it is an essential role for all.

Acknowledgements

I’m indebted to Richard Ashcroft, Tim Lewens, Kathleen Liddell and NeilManson for their comments on this paper.

References

Allison, R. (2002). Wall Street Journal drops Scruton over tobacco cash. The Guardian, 5 February,

p. 11. (Available at http://media.guardian.co.uk/tobaccoads/story/0,7521,645180,00.html)

Brock, D. (1993). Truth or consequences: The role of philosophers in policy making. In D. Brock (Ed.),

Life and death: Philosophical essays in biomedical ethics (pp. 408–416). Cambridge: Cambridge

University Press.

Callahan, D. (2001). Doing good and doing well. Hastings Center Report, 31(2), 19–21.

Crosthwaite, J. (1995). Moral expertise: A problem in the professional ethics of professional ethicists.

Bioethics, 9, 361–379.

Elliott, C. (2001). Throwing a bone to the watchdog. Hastings Center Report, 31(2), 9–11.

Elliott, C. (2001). Pharma buys a conscience. The American Prospect, 12(17) (Available at http://

www.prospect.org/

Elliott, C. (2002). Diary. London Review of Books, 28 November, 36–37.

Elliott, C. (2003). Better than well: American medicine meets the American Dream. New York:

W.W. Norton.

Kaebnick, G. (2001). Is disclosure helpful?. Hastings Center Report, 31(2), 3.

Kmietowicz, Z., & Ferriman, A. (2002). Pro-tobacco writer admits he should have declared an interest.

British Medical Journal, 324, 257.

Zoloth, L. (2001). Seeing the duties to all. Hastings Center Report, 31(2), 15–18.

Documents

Is corporate money bad for bioethics?