Director’s Corner

Quotidian Mysteries in Bioethics

In her book, The Quotidian Mysteries, poet and author Kathleen Norris examines the everyday routines of ordinary life as sources of spiritual insight, and finds them as rich as any religious ritual. Bill Bryson, in his History of the Private Life, shows how the commonplace contents of his own home resonate with as much historical significance as most major tourist sites. And ever since Hannah Arendt wrote Eichmann in Jerusalem: The Banality of Evil, it has been widely accepted that the psychology of ordinary citizens can teach us as much about the social dynamics of genocide as the psychopathology of their monstrous leaders. Behind the mundane, the normal, and the garden variety in any human sphere lie deep veins of tacit meaning. As the sayings go, “the Truth is in the nuance,” and “the Devil is in the details”.

It is certainly true that there are everyday ethical problems in health care and research continue to bedevil Bioethics. Exotic questions from the frontiers of science and technology may capture the headlines, but just as vexing are commonplace issues that researchers, clinicians, patients, and the public must face routinely. For example, we may all embrace the ideal of “treating patients as persons,” but how does that translate into extended stay decisions involving complex patients? Pathology specimens are routinely collected and stored for research use, but against a growing dissensus over what rules should apply. Babies are born every day into an environment fraught with malpractice claims, but what understanding of the “good birth” informs their delivery? A good bit of effort is being devoted to improving the ways in which biomedical research is being conducted in the developing world, but the ethical issues involved in actually implementing what we learn go largely unaddressed.

Even in the definition and doing of bioethics, everyday mysteries abound. We take for granted that the best work in bioethics is “interdisciplinary,” yet stumble over mixed methods in research proposals and tenure reviews. We claim bioethics must take scientific and clinical realities seriously, yet teach it as a set of abstract quandaries, as if it were merely an exercise in illustrated logic. We want bioethics to affect practice and policy, but resist the notion of bioethical expertise when called upon for help.

Both of these kinds of day-to-day issues in bioethics are easy to despair over in hallway conversations, and easy to neglect as topics for serious inquiry. Unexamined assumptions are hard to articulate, common problems are often embedded in contextual concrete, and aspirational academic goals are easy to compromise in the rush of business. Bioethics has always been an anticipatory field, oriented to new advances in research and heath care, and keeping up with that novelty leaves little time for ruminating on stubborn issues. Everyone already knows these are problems, and they take research in complicated directions. Moreover, there is no money in pursuing them, as long as the field’s funding sources prize innovation over persistence in the investigations they reward.

Nevertheless, if bioethics is to live up to its original mission as a “bridge to the future,” its quotidian mysteries deserve more robust attention. Monitoring the scientific horizon for the new questions it raises remains critical. However, without circling back around to continue the field’s unfinished inquiries, identifying the issues is all that bioethics will be able to do. Without pain-staking empirical work on the social determinants of contemporary health disparities, we will have no foundation for addressing “enhancement”-driven inequalities in the future. To make sound policies regarding the engineering of “humanized” transgenic primates, we will need to headway towards a robust philosophical account of non-human animals’ moral status. Until we get a better grip on what we mean by “risk assessment,” for the risks of synthetic biology will remain imponderable. Similarly, without better articulations of interdisciplinary research design, grant reviewers will continue to be bewildered by our proposals. And without viable models for “teaching the teachers,” bioethics will continue to see talented students and trainees unprepared to meet the challenges of the field.

The strength of the UNC Center for Bioethics is our faculty’s special concern for and focus on the field’s chronic problems, stalled conversations, and untested assumptions. This concern frames our service and educational partnerships, from the daily work of the UNC Hospital Ethics Committee and the Ethics Core of the North Carolina Translational and Clinical Science (NC TraCS) Institute, to our capacity building projects in research ethics with colleagues around the world. But even more unusually, this concern also animates our intellectual and scholarly interests. All of the specific inquiries that have illustrated this essay are projects pursued by our Center’s Faculty Associates, including the meta-level concerns with the dynamics of interdisciplinary scholarship and teaching. This does not mean that we do not end up at exotic destinations, both intellectually and geographically.  But we do so in the service of the ‘orphan issues’ in bioethics; issues prosaic and careworn enough to be easily overlooked, but critical nevertheless to the next generation of work in the field.