Do we need bioethics?

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Two counterarguments: Need and Employability

It may be surprisingly annoying to keep defining and defending your speciality every time you are asked about it. To many, including some medical colleagues, I have wasted my time and two dream opportunities: a master at the University of Toronto and a PhD at the University of Birmingham. Instead of ‘being a doctor’, they tell me in full empathy, I chose a ‘theoretical discipline’.

Although I had my masters in bioethics at the University of Toronto Joint Center for Bioethics more than a decade ago, my listeners still get confused when they ask me about my speciality and I quietly utter the word, “bioethics”. They respond, “good, biostatistics is not bad at all”. I try to correct them that bioethics has nothing to do with biostatistics. Some keep this sympathetic look of ‘oh dear, what a waste of time?!’. They believe, consciously or unconsciously, that I should have failed to be a clinician to go to this unknown field. Others openly argue, “why would you specialize in such unneeded, unemployable discipline”. 

This blog is for the latter.

First, Let me start by stating that I will not argue who a doctor is and what his roles are. Perhaps a look at the CanMEDS Framework can save me a lot of time of who is a doctor. Then, here we go.

Let me start by stating by two of my favourite quotes from two colleagues, Dr Wifaq of Sudan and Dr Adlan of Saudi Arabia, which are “people do not miss what they do not know” and “people do not know what they do not know”, respectively. 

One major gap in the development of bioethics in the region is that many people at various levels don’t miss bioethics because they don’t know what it is and how it can help them. This is true both at the clinical bedside decisions related to end-of-life care, informed consent, organ donation, their patients’ rights, telling their patients about their diagnoses, and the list goes on. Public health practitioners and the policy-makers who need to make ethical decisions related to who gets the vaccine first, how to allocate the resources during pandemics, and what are the limits we can impose on the people’s inherent rights to free movement and travel. 

All clinicians and public health practitioners face dilemmas they do not have an answer to, and they don’t know where to find it. Some refer to their faith and decide that a fatwa will resolve the issue, but even the mufti refers to other experts to be able to issue a fatwa. Moreover, this technically means we need a mufti for every hospital because the cases may seem similar but not identical. 

Some prefer to play it safe and follow the rules, policies and guidelines. Unfortunately, these documents are mostly written by and for clinicians for clinical purposes. They seldom provide meaningful ethical guidance. Others prefer to take it on their own and decide by ‘what pleases their conscious’. This is even trickier as it varies widely, depending on what you think the right thing is.

Bioethics is a systematic study of these issues in all the disciplines and fields of healthcare that aims at helping the decision-makers through theoretically-justifiable decisions that can be applied through practical frameworks and tools. Many people do not know that. Hence, they will not miss it. Back to the quotes, I started with.

In that sense, the need argument is void because of the perception of the need to absent. 

The picture is not that dark after all.

To be fair, there is a growing awareness of the field. This is very true during the pandemic. For example, the UNESCO has asked some experts in bioethics to record some video messages for the public about the ethical issues related to COVID-19. Also, the Saudi National Bioethics Committee and the Saudi Health Council have formed expert panels to develop ethical guidelines for the conduct of research and the allocation of scarce resources during the pandemic, respectively.

These initiatives give a tint of hope that the need is growing and the field is progressing, and perhaps more people are becoming interested in it. However, there is a need to move from the era of ‘bioethics by interest’, to bioethics as a discipline. Many people, back to the quotes, think they know bioethics because they have read a few books, and subscribed to a few bioethics journals. They were, then, invited as speakers or teachers of bioethics for undergraduate students and the public. Sorry, this does not make them experts. They just do not know that they do not know. 

As an academic discipline, bioethics should be treated as one. There is no physician, or lawyer, or social worker by interest. Yes, there is no certification for bioethics, yet. But this does not mean anyone should call himself a bioethicist, at least as long as there are postgraduate academic programs that people spend years studying. I need not disclose how biased this sentence is, given that I have spent many years in formal education of the field.

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