I’ve been reading and discussing Jonathan Baron‘s Against Bioethics (MIT Press, 2006) this semester – with the Faculty Discussion Group at the Wolfe Institute for the Humanities at Brooklyn College. Roughly, Baron’s thesis is that utility-based decision-theoretic analysis would improve the quality and outcomes of decision making in the medical sphere, which is currently bogged down in a morass of poorly understood and specified deontological principles, biases and heuristics.
My disagreements with Baron are extensive, even as ironically, I agree with him that some kind of utilitarian decision analysis might often be useful in some domains of medical decision making. I often find myself experiencing what Baron would very likely dismiss as the ‘yuck factor’ – a cluster of heuristics and biases that make it so that I find certain courses of actions offensive or problematic, even when there appear to be apparently very good consequentialist or utilitarian arguments for them. I agree that the ‘yuck factor’ is often not a useful guide to action and can lead to problematic beliefs – such as homophobia for instance. Still, I wouldn’t know how else to characterize my opposition to organ sales (a topic on which I have written before, here, on this blog, where I worried about whether these would encourage the poorest to sell their organs at very low prices), or to using subjects in poor countries for drug trials.
Here, the objections are familiar: both practices are forms of exploitation; they capitalize on the weak–economic and otherwise–situation of those exploited under the guise of providing them a better life. The responses to these are familiar too; ultimately, what we get is the following:
From a utilitarian perspective, the behavior of the researchers…is still better than not doing the study at all or doing it in a rich country, but perhaps not as good as possible. [Or in the case of organ sales, we get better outcomes with organ markets than we do in a situation with no organ markets.]
If this argument–that the ostensible exploiters are making a bad situation better, not worse, by their ‘exploitative’ behavior–sounds familiar, it should. Because it is the same one used to excuse the use of sweatshops in places such as Bangladesh, which every once in a while kill hundreds of their workers. It should also be familiar because the dichotomy presented in it is an old one: either the exploitative action is taken, or the status quo of poverty–pernicious in all its forms–persists. Perhaps the disruption of the status quo is deadly, but that price comes out in the wash for we have better outcomes in the final reckoning, provided the correct option is chosen.
While the acceptance of the terms of the dichotomy is interesting what is perhaps even more so is the uncritical acceptance of, in the case of pharmaceutical industry, a very particular corporate axiom: if observing the boundaries noted by a particular ethical injunction is likely to effect profit margins adversely (note: not doing away with them entirely) then so much the worse for the ethical injunction. The deployment of these arguments in the case of drug testing shows how well-entrenched this principle has become.