Clinical Ethics >
Volume 3, Number 4 >
Pp. 194-198
Papers |
Anglia Ruskin University, Cambridge, UK
E-mail: jensen{at}gatesscholar.org
Beauchamp and Childress (1994) elaborated an approach to bioethical deliberations based on four universalistic principles. This framework of ‘principlism’ has been criticized from within biomedical ethics as insufficient and problematic. However, this article considers a more radical sociological critique by John Evans (2002) that rejects the entire approach of defining ‘principles’ a priori. This sociological critique is based on classical sociologist Max Weber's (1925) distinction between instrumental (‘thin’) and substantive (‘thick’) rationality. As an exploratory assessment of Evans' critique, his conceptualization of ‘thin’ versus ‘thick’ rationalization is applied to a large sample of Anglo-American press coverage (n = 5126) of the bioethical controversy surrounding therapeutic cloning. Given the role of mainstream news media as a key arena for the discursive framing of biomedical research and its ethical implications, the findings raise important questions about principlism and the mediation of bioethical debates on issues such as therapeutic cloning.
Research within the life sciences has lead to a number of high-profile bioethical debates in recent years. Mass media coverage has played a key role in framing the ethical implications of issues such as GM crops, genetic engineering and human cloning.1–5 In both the USA and Britain, research on early human embryos has been a major source of controversy going back to the 1980s.6–8 The present study analyses media-framing of the bioethics of therapeutic cloning. Therapeutic cloning is a putative biomedical technology that would use cloned human embryos to generate genetically-matched tissues for medical treatments. Also known as ‘biomedical’ or ‘stem cell’ cloning research, this scientific sub-field has held out the promise of cures for numerous diseases such as Parkinson's, Alzheimer's and cancer.9,10 However, this research has been criticized by pro-life activists and conservative religious groups for its creation and destruction of early human embryos. This study examines coverage of therapeutic cloning in the Anglo-American press in terms of the modes of ethical rationalization employed by journalists and their sources.
Human cloning has been the subject of extensive ethical argumentation for decades. Indeed, Poon11 notes that cloning was ‘one of the first issues tackled by the emerging discipline of bioethics in the late 1960s and early 70s’. Over the years, this debate has been joined by key bioethicists and theologians including Paul Ramsey, Joseph Fletcher, Ruth Chadwick, Daniel Callahan and Leon Kass. The debate was renewed with the cloning of Dolly the sheep in Scotland in 1996. In the immediate wake of the internationally broadcast news of Dolly's birth, US President Bill Clinton empanelled the National Bioethics Advisory Commission (NBAC) to provide both the President and the nation with expert ethical recommendations on the issue of human cloning. Three months later, the NBAC report was released. It called for a five-year moratorium on reproductive cloning based upon concerns for the safety of any children born using such an untested technology. This instrumental rationale for temporarily blocking human cloning effectively side-stepped the more difficult substantive ethical questions surrounding human cloning.12 Moreover, subsequent arguments by bioethicists such as Glenn McGee and Arthur Caplan13 supporting biomedical cloning research have tended to invoke similarly ‘known and important moral goods’ like safety and beneficence towards suffering patients.
Long-time cloning opponent and bioethics professor Leon Kass14 criticized NBAC and its conclusions as ‘waffling on the main ethical question, by refusing to declare the production of human clones unethical (or ethical)’. Kass14 argues that human cloning, even when used to create early embryos for biomedical research, is ‘deeply repugnant and fundamentally transgressive’. With Kass as chair, the Bush Administration's Presidential Bioethics Advisory Commission (PBAC) came to similar conclusions. Their report declared that human cloning is inherently unethical regardless of safety considerations, and that even biomedical cloning would instrumentalize human life (also see Fukuyama15). However, PBAC also used human cloning to delve into a deeper discussion of both ends and means within the domain of biomedical research.
Significantly, while the argumentation of therapeutic cloning opponents such as PBAC and Kass have included a wide range of concerns about ends and means, proponents have tended to draw upon a much more limited bioethical framework. Specifically, NBAC and bioethicists such as McGee and Caplan call upon one or more sets of principles, most famously elaborated by Beauchamp and Childress.16 On the basis of an averred secular ‘common morality’, Beauchamp and Childress16 propound their four principles of autonomy, non-malificence, beneficence and justice.17 This approach to normative ethical deliberation has become known as principlism. Critics have identified numerous shortcomings in principlism as an ethical framework.18–23 For example, Harris24 argues that limiting bioethical argumentation to the four principles would stifle and sterilize debate into a uniform ‘checklist’. At the same time, McCarthy25 and others have argued for the inclusion of additional frameworks such as ‘narrative ethics’ to complement the four principles. These responses to principlism from within biomedical ethics are extended in this essay through consideration of a sociological critique. This sociological critique bears some resemblance to Harris's thesis,24 but goes significantly further by arguing against any predefined limitations on the range of ends or principles at issue within a bioethical debate. Sociologist John Evans12 calls for a radical re-structuring of normative bioethics, so that professional ethicists no longer prescribe the ends or principles by which a bioethical debate will be decided. Instead, Evans argues that bioethical principles should remain open to public determination. Thus, in Evans' model professional bioethicists would enact the much more circumscribed role of identifying the most efficient means for achieving such publicly defined ethical principles.
In developing this argument, Evans12 uses the concept of ‘rationalization’, which is drawn from one of the founders of sociology, anthropology and political science, early 20th century German social theorist Max Weber. His analysis of public debate points to an inherent bias in professional bioethics favouring ‘thin’ rationalization. ‘Formal’, ‘instrumental’, ‘goal’ and ‘thin’ rationality all refer to the kind of logic wherein a ‘pattern of action is... calculated to be the most efficacious means for achieving predetermined or assumed ends’ (p. 13). Thin bioethical discourses ‘tend to ask, What should a scientist or patient do in this situation, given the universal ends’ of principlism (p. 20), rather than considering a broader range of societal and cultural ends (e.g. humility or inter-generational responsibility). As it has become increasingly dominant and professionalized, Evans12 contends that the field of bioethics has become reliant on the thin discourse of principlism to efficiently produce clear normative conclusions about public bioethical issues. Indeed, this connection between thin rationality and efficiency is well developed in Weber's original work.26 He argues that thin rationality is ‘capable of attaining the highest degree of efficiency...’. It is superior to any other form in precision, in stability, in the stringency of its discipline and in its reliability. It thus makes possible a particularly high degree of calculability of results.
Evans argues against such ethical efficiency because of its antidemocratic and antipluralistic tendencies. Instead, he advocates ‘thick’, value-based bioethical discourse that is based on the assumption that ends are not universally held. Rather, the thick framework allows for a potentially infinite range of ends to be contested within a sphere of agonistic struggle and debate. Evans contends that a thick bioethical debate is more democratic and more legitimate because it does not close down lines of thinking arbitrarily based on purely technocratic criteria. To the contrary, he suggests that thick debates require public participation and lay definitions of the ends at stake for a given issue.
However, a key problem with Evans' argument is that he does not offer a realistic solution to the problem of how publics can supply the ends for bioethical deliberations. He briefly suggests the idea of ‘lay-dominated’ panels or ‘ends commissions’ that could decide such matters (p. 202). But it is not clear what institutions, organizations or individuals could be trusted to act as sponsor and organizer of such commissions. This leaves Evans' normative prescriptions open to fundamental practical criticisms, raising the question: Is thick public bioethical debate an impossible ideal?
In practice, news media are still the main forum for discussion and debate about political, scientific and bioethical issues in most nations.27 Therefore if the thick ideal exists in practice it should be visible in the mediated public sphere. In order to assess the ‘thinness’ or ‘thickness’ of public bioethical debate in the media domain, I have conducted a grounded discourse analysis2 of a large cross-national sample of news coverage of the bioethical controversy surrounding the issue of therapeutic cloning. Specifically, this study assesses the applicability of Evans' ‘thick’ versus ‘thin’ framework to this sample, addressing the research question: Is bioethical debate over therapeutic cloning in the Anglo-American press characterized by thinly and/or thickly rationalized discourse?
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Thin coverage of the bioethics of therapeutic cloning
Bioethical discourse about therapeutic cloning in the Anglo-American press generally favoured ‘thin’ forms of bioethical argumentation, limiting the range of ends included in the debate. For example, in the following journalist interview extract, the scope for continued bioethical debate is constructed as extremely limited in the wake of UK government reports and legislation.
We have had a very lengthy discussion [about the ethics of therapeutic cloning]:
The debates in the Lords and the Commons and there have been long consultations and reports by the Chief Medical Officer and at the end of the day we came to the view that therapeutic cloning as a research – not as a clinical, but as a research application – is an acceptable subject to the law and I don't think there's much argument about that really... I don't think I have anything else to say on stem cells. (Health Editor, elite UK newspaper, ‘Charles’, 2005)
Such narrow and ‘thin’ journalistic constructions of the bioethics of therapeutic cloning are reflected in American and British press coverage throughout the sample frame. In the following US extract, a bioethicist employed by a lobbying organization for the biotechnology industry criticized even forestalling therapeutic cloning research for a two-year period based on the principle of beneficence (i.e. relieving suffering):
‘A moratorium and a ban are indistinguishable. A two-year moratorium is pretty bad. If you're sick, it's a long time to wait,’ said Michael Werner, vice president for bioethics at the Biotechnology Industry Organization, a trade group based in Washington. (Italics added; Staff Reporter, Milligan, Front page news, Boston Globe, 13 June 2002)
The following UK extract quotes Julian Savulescu, a high-profile UK bioethicist, who advocates for therapeutic cloning by characterizing the issue in terms of both the principle of beneficence (i.e. relieving suffering) and non-maleficence (i.e. not causing harm):
Ethicists... said it would be immoral not to proceed. Professor Julian Savulescu, of Oxford University, said: ‘To fail to develop therapies that would save 100,000 people is morally equivalent to killing 100,000 people’. (Science Correspondent, Henderson, Times, 20 May 2005)
Such examples of ‘thin’ bioethical discourse were common throughout the sample frame. However, in order to establish the contrast between thin and thick bioethical argumentation, I now turn to examples of thick framings of therapeutic cloning's ethical implications in the UK and US press.
Thick coverage in the elite UK press
In the present sample, news value typically accrued to sources offering simple, universalistic and ‘thin’ forms of ethical commentary. This was especially true in the UK, where the government-sponsored ethical committees only supported ‘thin’ ethical debate and pro-therapeutic cloning conclusions. However, there were islands of ‘thickness’ even amidst the waves of ‘thin’ rationalization in the UK press and government statements. The following UK press extract is a commentary authored by a retired religious leader, exemplifying the very seldom utilized thick form of bioethical discourse:
One of the tasks of the moralist is to be aware of the gradual changes taking place in the character of our society,... and to spell out their implications. The dominant model of our society is that of an efficient machine. Industrialized society gains its wealth from mechanization, and much of its life is geared to the demands of mechanized processes. Images of nature as a machine have for centuries inspired science, and there are strong pressures on human beings to see ourselves in this way. The latest developments could take us even further in that direction. (Commentary, Habgood, Observer, 2 March 1997)
Such thick bioethical discourse is identifiable by its engagement with ends-related ethical concerns, not just straightforward means-related questions. Mulkay7 argued that such religiously inspired bioethical discourse has dwindled alongside the fragmentation of religious authority in UK society and politics. Indeed, The Guardian and Observer were unusual among elite UK newspapers32 in their willingness to play host to such substantively rational ethical discourse. The following extract is from a ‘news analysis’ article:
How did it get to be like this? How did life – once God's business, or at least Nature's – get to be something you could just play with, like Lego? How did horses' piss and pigs' hearts and mouse gonads get in on the act? What are plant scientists doing, taking an anti-freeze gene from the blood of a flounder (flounders live in freezing polar waters, but their blood doesn't freeze) and putting it into tomatoes to make them frost-proof?... Why are the scientists who are doing all this so calm about it, and how are the rest of us supposed to discuss it? The answer is, with difficulty. (Science Editor, Radford, Guardian, 23 May 1998)
‘Thick’ coverage in the US press
Thick bioethical discourse was much easier to find in the US sample, likely reflecting the greater level of religious influence in the American public sphere. One example of thick ethical argumentation came in a Wall Street Journal commentary by neo-liberal theorist Francis Fukuyama criticizing instrumentally rational arguments in favour of cloning:
There is today a great deal of fatalism about the march of technology. It is conventional wisdom that innovation cannot, and therefore should not, be stopped. Others argue that... a ban on cloning would be rendered ineffective by the fact that we live in a globalized world in which any attempt to regulate technology by sovereign nation-states can easily be sidestepped by moving to another jurisdiction. None of these arguments holds water. (Commentary, Fukuyama, Wall Street Journal, 2 August 2001)
Fukuyama's criticism finishes with the substantively rational suggestion that the ends are not preset with regard to techno-scientific development.
There are many dangerous or controversial technologies... which cannot be freely developed or traded internationally. We have successfully regulated experimentation on human subjects for many decades... A broad ban is appropriate in the case of human cloning because it is necessary to establish... the principle that our democratic community has the authority and power to make science the servant of human ends rather than their master. (Commentary, Fukuyama, Ibid.)
A similarly thick bioethical discourse was repeatedly initiated by Presidential Bioethics Advisory Commission (PBAC) Chair Leon Kass. In the following extract, he explicitly lays out an agenda based upon ‘thick’ discussion of future ends within the context of his leadership over the PBAC.
Kass elaborated at the [PBAC] meeting his view of the council[’s] responsibilities[:]..."To consider not just the technologies ... but also to see how those things which impinge on our humanity, in fact, touch our personal aspirations, our human longings, our duties". (Science Correspondent, Vergano, USA Today, 29 September 2005)
Such thick bioethical discourse was fiercely counter-attacked in other press commentaries. However, even as Kass's opponents attacked his ideas they were nevertheless forced to engage at some level with his thick bioethical argumentation:
‘Leon believes humans put themselves at risk when they deviate from natural patterns – it's natural to make families through sex and procreation, not with embryos in dishes,’ Caplan said. ‘He's cool to stem cell research because to him it's unnatural to make life to destroy it, and not allowing embryos to grow to their potential would be morally dubious’. (Staff Writer, Leonard, Front page news, Boston Globe, 12 August 2001)
Overall, the American coverage of therapeutic cloning showed a far greater affinity for thick rationalization than the UK sample. However, in the same news publications – and even the same stories – there simultaneously appeared quotations from professional bioethicists following in the ‘thin’ tradition.12 Ultimately, these divergent forces yielded an agonistic bioethical discourse, contributing to a more dynamic, pluralistic and highly contested mediated debate in the US press sample.
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The limited nature of much of the bioethical discourse about therapeutic cloning in the Anglo-American press raises doubts about whether Evans' ideal12 of publicly determined ends for ethical debate can be achieved through the existing mechanisms for public debate, the most widely available of which are mainstream news media. Indeed, Evans' ideal of thick bioethical debate may be so unrealistic within the context of contemporary journalism as to be unusable from a practical perspective, at best providing an interesting analytical device or conceptual ideal type. For example, cultural sociologist Pierre Bourdieu33 suggests that journalism increasingly produces a form of ‘cultural "fast food" – predigested and prethought culture’, which would be commensurate with ‘thin’ rationalization (see also Horkheimer and Adorno34). Nevertheless, there is still potential for news media to play a role in fostering thick bioethical discourse about therapeutic cloning and other issues.2,4
Given the structural limitations of journalism and their use of professional bioethicists embedded in principlism as a major source for ethical commentary, one might question whether news media offer a better forum for thick bioethical debate than expert panels such as NBAC. Yet, the present data suggest that news media do not close down issues and limit the range of ends or principles to be evaluated at an early stage as is frequently required within a professional bioethics panel. The result is a messier, agonistic sphere of bioethical discourse where ethical concerns appear, recede and then re-appear at different points in the debate. Certainly, the greater inclusion of religious, in this case ‘pro-life’ perspectives at least in the American Press, comes closer to Evans' ideal of ‘thick’ bioethical debate. Indeed, even if press coverage of bioethics is frequently thin, it still sometimes requires scientific and medical institutions to justify themselves in terms of their net public benefit.35 At a minimum, this can help to construct ‘progress’ as something less than the unquestioned, self-legitimating ideal that it once was.36–39 Moreover, as this study shows, there are instances of mediated bioethics that contribute to substantively rationalized debate. However, it remains unclear of how such ‘thickness’ could be directly utilized within public policy formation. Perhaps, the inclusion of a contingent of lay panellists on existing advisory panels could offer a provisional method of going beyond principlism and ‘thickening’ public bioethical debate.
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