Why Is it so Difficult to Challenge the Bioethics Status Quo?
My effort to add critical thinking to bioethics, a choppy path at best, sparked me to question some fundamentals about academic publishing. From long ago on the Urban Law Journal at Fordham Law School to my current position at Voices in Bioethics, Columbia University’s journal, I have encountered and managed viewpoint discrimination.
In training peer reviewers, I created a workshop to explain the purpose of peer review, especially in the context of philosophy and the humanities. We have nine qualities we evaluate objectively in a process that eliminates viewpoint discrimination, ensures that reliable sources are used in context, evaluates arguments for originality, soundness, and clarity, and in our case, ensures that articles adhere to our specific writing and style guidelines. The guidelines avoid unsubstantiated conspiracy theories, but we do publish articles that project viewpoints with which I disagree. Our system has an added layer to provide a new peer reviewer if one challenged only the point of view rather than the quality or scholarly aspect of the work. We also make every effort to help first-time authors have their voices heard, ensuring more viewpoints are added to the public discourse.
Bioethics as Doctor-centric?
A lot of bioethics pieces by those in academics or medicine project ideas that are rampantly expressed and remain “inside the box”. In my extensive research on pediatric refusals, it was rare to find articles challenging the paternalistic status quo compared the vast number of articles that begin by assuming the doctor is right and look at ways to get parents to “comply” albeit while “empowering them”. The growing use of empirical research in bioethics seems to further detract from the thought pieces. I hope that bioethics articles will increasingly challenge common assumptions and principles. Those most affected by ethics committees, laws, and practices are generally not part of the elite who write the journal articles.
Bioethics may prefer followers to leaders. There can be an expectation that four principles are enough, that doctors are usually right, and that bioethics committees are a valid and positive development. In a pediatric bioethics class, I found my challenges dismissed or condemned because rather than applying principles differently, they challenged principles, considerations, assumptions, and analytical frameworks. The parenting experience did not fit the medicalized narrative. And my legal and professional background spark me to apply critical theory and challenge the status quo when it leads to unjust results. Competition among ideas can exist within required frameworks or can challenge people to think beyond or outside of those frameworks to find a better approach.
I also challenge processes for identifying bioethical issues. New issues with bold approaches are less likely to be published in traditional journals compared to papers offering tweaks on other arguments already in the bioethics discourse. In the typical trajectory, attention to bodily or individual decisions (will preimplantation genetic diagnosis further a moral good?) and benefits of new scientific discoveries (will facial recognition in health care be a positive development?) quickly shifts to access and justice (if the tech comes to fruition, how will those seen as marginalized access the new discovery?). We spend time discussing access to something that does not exist yet while people do not have access to healthcare basics. Some articles address access to clinical trials on behalf of those whom I sense would have not much interest or benefit. There are endless issues and not enough platforms willing to project the viewpoints less heard.
Some nonissues like therapeutic misconception tend to become an assumed bioethics problem, with devoted solutions. Scholarly journals should be increasingly open to challenges to the assumed problems and identifying more pressing issues.
Challenging the Status Quo
Writing a post (now posted on this website) challenging the status quo about mental health care, I received an uncomfortable ad hominem criticism with highly intrusive personal questions suggesting that I should explain what special personal knowledge or experience I had. The recommendation that I share more personal information to strengthen my position left me uneasy. It has never dawned on me to compel authors to provide personal testimony in public policy or clinical ethics articles. I encounter many impersonal professional policy posts on the blogs I read. Was it a sign of viewpoint discrimination or simply advice to make a juicier post? Constructive feedback is helpful to anyone wanting to convey their argument. I wonder (and am truly uncertain) if I had written the very same post but favored the medicalized approach whether I would have faced similar scrutiny from the editor.
Peer Review Processes Can Control Whose Voices Are Heard
Beyond blog posts, the concept and methods of peer review and whose voices are amplified in the public sphere of academic publishing are ripe for challenge. At Voices in Bioethics we take measures to be open to well-researched viewpoints with which we disagree. I have quite a few examples. Yet many journals do not have policies like ours to prevent viewpoint discrimination. There is also a competing important need to ensure accurate and complete factual representations, coherent logical arguments, and to eliminate invalid arguments as some could even be harmful and dangerous.
Bioethics should welcome the opinions of the many people wanting a say in largescale societal health matters (the kind of society we want to have) or simply a say in what goes into their own bodies. That welcome should not be contingent on going along with the status quo. Well-researched, scientifically accurate, important arguments by those outside of medicine, tech, and science are the most worthwhile check on industry. Those articles must come from patients, parents, ethicists, social workers, lawyers, consumers, and others with key insights. Otherwise, critical theory will take a backseat to convenient principles and self-regulation.