Gareth Jones wonders how society can debate issues when strongly held views pull in mutually exclusive directions. It's especially challenging on topics like abortion, reproductive technologies, eugenics and euthanasia, he says.
Recently, I have been publicly criticised because of a paper that appeared in the New Zealand Medical Journal of which I was a co-author.
Under the title ''Testing times: do new prenatal tests signal the end of Down syndrome?'' it sought to assess the impact of the new blood tests for detecting Down syndrome in early pregnancy on the Down syndrome community and their families. In writing this piece, my co-author and I were very aware of the tentative ground we were treading, but writing from a bioethics perspective we concluded that public discussion of this very sensitive area was an important contribution to public debate within New Zealand. Neither of us saw it as our role to advocate for any particular position.
We consider society should discuss these issues widely and in an informed manner, at as many levels as possible. And we certainly think families who may be involved directly should be part of these discussions and should have a voice in whatever decisions are made by the appropriate decision-making bodies within society.
It is in this spirit that I have sympathy with organisations that have a stake in these decisions, since they and their families are directly affected by one or other genetic or chromosomal conditions. The one proviso is that any discussions must be held in as open a way as possible, allowing for a variety of perspectives, because that is the reality of a diverse society.
The world of bioethics can sometimes be challenging, especially for those who write on contentious issues where entrenched views are frequently encountered. This is not to criticise the entrenched views because they are usually held for very good reasons and their causes are worthy ones.
The difficulty for bioethicists or anyone in applied ethics is they write as academics, who are engaged in analysing and critiquing positions within society. A distinction always has to be made between the writer's personal perspective and the contribution he or she is making to public debate. The writers' own views generally do not feature.
This can be very difficult for others to understand, especially when committed to a particular perspective. This is particularly the case with issues that touch on deeply human concerns, especially the welfare of children. This is where emotion and academic debate readily come into conflict, since the arguments of academic bioethicists can appear dry and devoid of human feeling. However, there may be no escape from this if they are seeking to weigh up contending positions within society, all of which are legal and represent legitimate moral positions.
As with all of us, bioethicists are functioning within societies that cherish freedom of speech and the freedom to explore a very broad range of viewpoints. Most bioethicists also work within universities for whom academic freedom is a central tenet. This allows, and even encourages, people with expertise in certain areas to argue the pros and cons on contentious matters in peer-reviewed academic journals and books. In the absence of this tenet, universities could not claim to act as the critic and conscience of society.
Bioethics as a discipline does not have the luxury of confining its attention to erudite discussions with fellow academics. If bioethics fails to engage with the outside world, with policy and political issues, with clinical decision-making, and with informing the public of the issues being raised by scientific and technological developments, the question has to be asked ''why does it exist?''
If it fails to advise and inform these various disciplines and professions, an important aspect of its rationale has disappeared. It has to communicate in ways that can be understood by others. It also has to translate complex ideas into language that can be understood and appreciated by the general public. Sometimes of course it gets things wrong, but that applies to all of us.
This might be a worthy goal, but it is a road full of potholes, and from time to time leads to vigorous debate within the media. A high-profile example at the start of 2012 was a paper on ''After-birth abortion'' that appeared in the Journal of Medical Ethics. Numerous commentators were deeply disturbed by its contents.
In defending the publication of this article the editor of the journal contended that the goal of the journal was to ''present well-reasoned argument based on widely accepted premises ... The Journal does not specifically support substantive moral views, ideologies, theories, dogmas or moral outlooks, over others. It supports sound rational argument ... freedom of ethical expression.''
The editor of another journal stated that: ''Good bioethical analyses will continue to challenge and test boundaries we take for granted.''
Bioethicists are aware they do not exist in ivory towers isolated from the murky world of everyone else. The language they use is important and has power, and they have to tread carefully. All their writing should be scrupulously fair, especially when walking through ethical minefields. By all means disagree with what they write; they need feedback. But remember in the end they are human beings who have to contend with the same challenges as everyone else, including illness and the myriad issues raised by the biomedical technologies.
Dr Gareth Jones is an emeritus professor at the University of Otago.
