WASHINGTON — A proposal to create a coordinated national program for bioethical education and funding is raising red flags among some Catholic bioethicists.
But one academic says the problem addressed in the June issue of Academic Medicine is a real one — and if philanthropists and others take note, there may be a way to increase the influence of Catholic-directed natural law values on research and patient care decisions.
In a set of essays published in June, a top National Institutes of Health bioethicist and a Washington, D.C., think-tank director proposed that NIH initiate a coordinated program for bioethical education for biomedical researchers. Federally funded NIH annually awards $28 billion to research, according to its website. It is the largest funder of biomedical research in the world. At issue is a shortage of scientifically trained bioethics scholars, and thus a lack of substantive bioethical training for biomedical scientists, the bioethicist and the think tank director said.
“NIH … has an abiding interest and a special responsibility to ensure that the research it supports is conducted in accordance with the highest ethical standards, from the protection of human participants to the responsible conduct of research,” wrote Dr. Judith Salerno, executive officer of the Institute of Medicine, a non-profit associated with the National Academy of Sciences. A synopsis of the essays was published by the Chronicle of Higher Education.
Only a small amount of NIH money is applied to bioethics, according to Ezekiel Emanuel, chairman of the NIH Department of Bioethics. He argues for increased federal and private foundation funding of bioethics, “Less than 0.1%, and closer to 0.05%, of the NIH’s budget is devoted to supporting bioethics training and research,” Emanuel wrote in the journal of the National Association of Medical Colleges.
Salerno said she believes that enough money is allocated in the NIH budget for bioethics, but it needs to be pulled together in a coordinated manner with federal leadership. “We need to take resources that are spent in a scattered fashion and put them into a coordinated framework that has clear goals in where we want bioethics to go,” Salerno told the Register. She said many everyday research decisions could be improved if scientists knew more about ethical decision-making.
“We need to map this out as a national initiative.”
The president of the National Catholic Bioethics Center is skeptical.
“What’s key is the approach that’s being talked about,” said John Haas, president of the Philadelphia-based institute. “The dominant approach these days is utilitarianism. It would be dreadful to have more funding to spread more programs that promote utilitarianism.”
The executive director of the Westchester Institute for Ethics & the Human Person said that Salerno and Emanuel are addressing an important difficulty. “The field of bioethics is very new. Only in the past decade have we started getting down to the business of writing and establishing curricula and offering degrees,” said Legionary Father Thomas Berg. “This is still very much a patchwork of programs, credentials and certificates.”
However, the issue is how to incorporate sound moral reasoning in a system that “is generally the product of committee work, consensus-based ‘best practices,’ assuring compliance with arbitrary rules and regulations, and so on,” Father Berg said.
“If we don’t train bioethicists first to be philosophers, to think logically, to apply reason, in a word, to be first and foremost sound ethicists, then I don’t think an abundance of certified ‘bioethicists’ is going to help much in resolving the ever-growing number of difficult moral questions generated by the biomedical enterprise,” the priest said.
There is a need for trained bioethicists who understand both medical science and philosophy, said Dr. Daniel Sulmasy. How to get there and how to make Catholic ethics count is the big question, the Franciscan brother and medical doctor said.
“Are there enough good bioethicists who are well trained? I think the answer is no,” said Brother Sulmasy, Sisters of Charity Chair in Ethics at St. Vincent’s Hospital Manhattan and professor of medicine and director of the Bioethics Institute at New York Medical College. “There are a lot of people who are either clinicians who don’t have a good grounding in philosophy or theology who are, quote-unquote, ethicists at various institutions. Or there are Ph.D.’s who don’t really know an awful lot about medicine or science.”
There are about 200 graduate level science and medical ethics programs at universities and centers around the world, according to a database maintained by the Kennedy Institute of Ethics at Georgetown University.
However, NIH’s Emanuel cites problems scientific institutions have had in fulfilling the requirements for NIH’s bioethics research grants, the Clinical and Translational Science Awards, because “many of the institutions that have won Clinical and Translational Science Awards lack trained bioethical researchers to fulfill this component.”
“I think the future cries out for people who are dually trained,” Brother Sulmasy said.
“We need to raise the profile of bioethics and we need to recognize that it is fundamentally an interdisciplinary issue. It can’t be solved by clinicians or philosophers alone. The public has to be part of this conversation as well,” said Salerno, who recently left NIH to become the Institute of Medicine’s executive director. A graduate of Harvard Medical School, Salerno was deputy director of the NIH’s National Institute on Aging beginning in 2001.
The way medical schools pay their professors is scattershot, with many professors teaching for stipends or as volunteers while making their living from grants and clinical practice, Brother Sulmasy said. In universities, science professors often rely on grants for a substantial portion of their income. Bioethics scholars are unlikely to receive grants from drug companies or to be paid by individual consults in the manner other researchers or physicians are, he said.
Salerno said the impact would be substantial if NIH, as the largest funder of biomedical research in the world, required and funded more bioethical education and scholarship.
The shortage of dually trained bio-ethicists nationally may provide an opportunity to influence development of the field from the inside, said Brother Sulmasy. He floated the idea of Catholics and others funding private grants to support bioethics courses at medical schools and cited the John Templeton Foundation as an example of a foundation that directs money toward secular enterprises to influence thinking and ultimately policy.
“I think in some ways the Church could do a much better job of actually trying to be a part of training people who will take these teaching positions,” Brother Sulmasy said. “Most of the efforts of the Church in bioethics are completely removed from medicine. I think we could do more to have a voice with people inside the profession.”
Brother Sulmasy also suggested directed philanthropy aimed at influencing secular universities. “Instead of giving your money to Harvard, why don’t you donate it to establishing a chair at Harvard with this condition that it be a chair in natural law ethics?” he said. “These are insider baseball strategies that I think would go a long way.”
Valerie Schmalz is based
in San Francisco.
The Westchester Institute:
The John Templeton Foundation:
National Catholic Bioethics Center:
Kennedy Institute of Bioethics,