Bioethics or biopolitics?
On the relationship between academic and public discussion of the "selection" and "manipulation" of human life
Sigrid Graumann Biomedical Ethics, vol. 5, 2000, no. 3
The biomedical techniques which make the "selection" and "manipulation" of human life possible are among the most controversial bioethical topics in public discussion, since they address extremely fundamental differences not only between different interests, but also basic moral convictions, world views, and conceptions of the human being. It often seems impossible to reach a consensus between the representatives of divergent positions; on the contrary, insurmountable disagreements appear to predominate. In other words: a plurality of interests, assessments, convictions, world views and conceptions of the human being stands in the way of a social consensus on the research on and application of these biomedical techniques.
Experts periodically express criticism of the public discussion of biomedical topics. This criticism is directed specifically at the following features: that discussions are in part carried out with primary reference to strategic interests, that "ambiguous terminology" is used (Winnaker 1997), that social acceptance is confused with moral legitimacy, that arguments are used inconsistently (Mieth 1977), that the correct procedure for reaching necessary consensus has not, as yet, been found (Honnefelder 1966), that controversial positions are intentionally polarized (Wiesing 1988), and that some lines of argumentation are extremely emotionally loaded or linked with intense fears (Winnaker 1997). On the other hand, criticism of the ethical discussion is also expressed by the public. This criticism makes the specific claims that the ethical discussion contributes to the de-emotionalising of decisions about human life, that it consciously promotes the legitimation of problematic fields of biomedical research and application, and that it consists of a proxy discussion between parties which are not directly involved and so encourages a way of carrying out the debate which is in principle undemocratic.
It is not intended to resolve here the conflict sketched out above between experts and sections of the public on the way in which bioethical issues are dealt with in different discourses. Nevertheless, this conflict should be taken seriously, and therefore it seems necessary to consider the public debate and the role of experts - particularly that of ethicists - in it more carefully. As a preliminary move in this direction, I want in what follows to present some of the results of my media-analysis of the public discussion with reference to the example of pre-implantation diagnosis (PGD), and then to discuss a number of theoretical aspects of the function and task of the media with respect to such problematic and controversial bioethical issues. I shall conclude with a consideration of the role and function of experts and particularly of ethicists in public debate.
The public debate on in vitro techniques in the media
Discussions about controversial biomedical research programmes and areas of application take place in political institutions, in public by means of the mass media and in everyday communication, and, in the academic world, in specialist publications and specialist conferences. My comments will be concerned in what follows with the public discussion in the mass media, as this is represented by the printed media.
In order to reconstruct the public debate about the "selection" and the "manipulation" of human life, I have carried out research in the archives of twelve national daily newspapers [ 1 ] and weekly journals [ 2 ] with a high degree of distribution, and collated and assessed all of the relevant articles on the topic which appeared between 1995 and 1999 on the basis of a catalogue of main questions.
First of all I want to present a number of general features of the public debate on the "selection" and "manipulation" of human life, and then focus on the discussion of pre-implantation genetic diagnosis (PGD) more specifically.
The authors of the relevant contributions are for the most part well informed science journalists familiar with a wide range of issues relating to the subject. [ 3 ] In some newspapers, a relatively large number of background articles and interviews have appeared, written or contributed to by experts. The Sloterdijk and Dolly debates, for example, were marked by public discussions between experts organised by individual newspapers (the FR and the Zeit). After the symposium on reproductive medicine organised by the German Ministry of Health in May 2000, an expert debate with detailed guest articles on PGD also took place in the FR and the Zeit. Further, it is clear that those who, in addition to the role they play as writers of guest articles, dominate as protagonists, those who are referred to and cited, are experts in the life sciences, in medicine and ethics, alongside politicians. An important role here is played by professional associations such as the Deutsche Forschungsgemeinschaft (German Research Foundation), the Gesellschaft für Humangenetik (Human Genetics Society), and the Bundesärztekammer (German Medical Association), which pursue a specific policy in the media in much the same way as politicians. The Bundesärztekammer, for example, presented their draft of a set of guidelines for the use of PGD at a press conference, which gave the impression that the medical profession stood for a unified position: the application of PGD in individual cases subject to restrictive self-control on the part of the medical profession. The Ministry of Health presented itself in the press as being clearly against PGD, but at the same time allowed the message to percolate through that "despite its personal dislike of PGD, it could assent to a law which would allow the application of this technique under certain, highly restrictive conditions" (Zeit, 31 May 2000).
The voices of other protagonists - representatives of the churches, or of social movements (such as the women's movement or those representing the interests of the disabled) - are under-represented in the press in these discussions. An exception is the statement of the Conference of German Bishops on PGD, in which PGD is rejected on the basis of the right to protection of human embryos and with reference to eugenic tendencies. The positions of other interested parties are usually only heard when they are argued against. (A part of the "bioethics critique" is certainly a result of this.)
Contrary to my own expectations, the assumption that the debate about the "selection" and "manipulation" of human life is sensationalised in black and white terms into a conflict between pessimistic conservative and optimistic progressive views turned out not to be true. Science journalists report for the most part in a deliberately balanced fashion in which, on the whole, the voices of supporters and opponents are relatively evenly cited. Pointedly extreme positions are for their part only given exposure in order that they can be argued against. Guest articles by experts, on the other hand, usually take up explicit and pointed positions (in the expert debates on "Dolly" and "Sloterdijk", for example).
Only comparatively few journalistic contributions (again in contrast to guest articles by experts) concern themselves in detail with a single technique or area of application. The "selection" and "manipulation" of human life is usually addressed in a relatively general fashion with reference to single techniques or areas of application as examples. As far as pre-implantation diagnosis is concerned, the following tendencies can be observed:
- The most important criterion for the presentation of a topic in the media is its degree of currency. In the case of PGD, there have up until now been no spectacular events, such as those which occurred, for example, in the case of the Dolly debate; instead, commission reports have been published, reports on scientific conferences have been presented, and a new law on reproductive medicine has been planned.
- A whole series of points at which different debates overlap are noticeable, for example the discussion on prenatal diagnosis and that on § 218 (the legislation governing abortion in Germany), the debate about the historical experience of eugenics and euthanasia, discussions about IVF in general, about germ line gene therapy, about the cloning of human beings and about the economic interests involved in the issue of biopatenting (see, for example, the Zeit, 24 and 31 May 2000). This overlapping widens the horizon of the debate and thus leads to fundamental questions being addressed, such as the tension between autonomy and social responsibility, the lessons learned from the national-socialist period, and the consequences of an "economic misuse of human life."
- In contrast to the significant role played by the question of the moral status of human embryos in expert discussions on PGD, journalists are extremely reserved about addressing this controversial issue. This dimension of the problem is primarily addressed by politicians. In this context, however, legal-positivistic arguments with reference to the Law for the Protection of Embryos and the constitutionally guaranteed protection of unborn life dominate. Here recourse is had to the authority of the law, and the question of the ethical argumentation on which the right of the embryo to protection is based is, for the most part, not asked. The legal prohibition of PGD, however, is also viewed critically. So, for example, the Zeit asks "whether the Law for the Protection of Embryos is still ethically tenable" (Zeit, 25 October 1996).
- The desire of "genetically 'at risk' couples" to have a healthy child of their own is given high status in the press. "All I want is a healthy child," so a patient quoted in the Welt (28 July 1995). On the level of those directly affected, the so-called assessment contradiction to prenatal diagnosis is raised: "Of course the sick embryos are disposed of when they are only a few days old," argued a future mother in Focus, "but isn't that better than aborting them much later as foetuses?" (14 December 1998).
- In general, paternalistic interventions in individual life choices in the context of family planning are rejected. This position takes on particular significance in its relationship to the "autonomy research" of the women's movement. At the same time, however, the interests of the future parents are called into question. The FR writes, for example, that "children come into being as a means of fulfilling the wishes of their parents to a previously unheard of extent - they are 'instrumentalised'" (FR, 15 November 1999).
- The identification of "the potential for misuse" and the danger of a slippery slope all the way down to "the manipulation of embryos" (letter to the editor, FR, 1 December 1999) plays a significant role in the discussion of PGD in the press. To a certain extent, PGD itself is viewed as a form of misuse: "Ambitious researchers use the experience gained in the work on IVF in order to push ahead with cloning, PGD and genetic therapy of germ line cells," writes the FAZ (25 July 1998). While these kinds of "slippery slope" arguments are used in the media debate as a matter of course, in the specialist discussion they are extremely controversial. An important role here is played by visions of the future. The impression is often given that the "genetic design" of a human being is almost entirely steerable. Only occasionally are the limits of the technical possibilities mentioned. Some ideas about how the technique should be applied are irrelevant, writes for example the FAZ, because "the interaction of the genes is not amenable to analysis" (FAZ, 12 August 1998). PGD is regularly, and for the most part with critical intention, placed in the context of the vision of a "society without suffering" (e.g. the Zeit, 2 March 2000). This is answered, for example, by the statement that "the disabled cannot be prevented" (FR, 1 December 1999).
- The main conflict with respect to PGD as it is presented in the media is between individual freedom with regard to family planning on the one hand, and the responsibility of society on the other. On the one side are the unfair burdens and deprivations for the individual couple caused by a disabled child, supported by the postulate of a "moral duty" to avoid suffering in general. On the other, the moral claim of solidarity with the sick and the disabled are emphasised. So, for example, the FR writes on the subject of PGD (15 November 1997): "But if many make individual decisions to be tested, this will change our way of viewing disabled people and our way of treating them." "Here, the social costs of a disabled child are being weighed up against the possibility to prevent his or her existence." The conflict identified here about the changes taking place in social values and norms is of absolutely central importance in the public debate, in contrast to its role in expert discussion.
In summary, we can make the following claims. In journalistic contributions on the topic of PGD, a trend can be observed towards narrowing the ethical problem down to a conflict between a justified desire on the part of a "genetically 'at risk' couple" to have a healthy child of their own and a dangerous social change, this latter with reference to a society increasingly hostile towards the disabled and the danger of a slippery slope down to a comprehensive instrumentalisation of future children for parental vanity, for research interests, and for the vision of a "society without suffering." In academic ethical discussion, on the other hand, the conflict with respect to PGD is between the right of the embryo to protection, and the rights, wishes, and interests of future parents. This corresponds to a limitation of the problem to an individual-ethical level. In public discussion, however, a considerably broader perspective is adopted, and social-ethical questions addressed. Here, PGD is discussed in a historical (the historical experience of eugenics and visions of the future) and social (discrimination and the danger of a slippery slope) context. The debate about changes in central societal values and norms shows itself in the way in which conflicts between different communities of interest, systems of belief, world views and notions of being human are addressed. That means, however, that the academic ethical discussion, which concentrates on the question of whether the individual use of PGD is morally reprehensible or permissible, does not take adequate notice of the concerns which are expressed in the public arena. I want therefore now to move on to a number of theoretical considerations with reference to the function and tasks of public debate.
Function and tasks of public debate
Biomedical research and its areas of application change social reality. Their legitimation and, when necessary, regulation is one component of political communication. Under the conditions created by the "mass society" (Hannah Arendt), political communication - and political action is essentially communicative action - relies on the medium of the mass media. [ 4 ] The media are ultimately the only forum in which political communication as a public conversation about how common concerns are to be dealt with and ordered can take place. Alongside other functions - such as entertainment and the use of leisure time - this is a necessary and, given the conditions created by the mass society, an irreplaceable function of the media. It obliges journalistic activity to take account of the public interest in the sense of a minimal principle opposed to the naked power struggle between different interests in the political arena. The primary ideal is the political dialogue as a common search for political solutions capable of being extended to a broad range of issues (including, when necessary, compromises), which all affected parties can agree to for good reasons (Hügli, 1992). [ 5 ] From the principle of public interest, itself already a moral principle, essential moral guidelines for the professional practice of journalism are derived, such as the commitment to truthful and objective reporting, the commitment to accuracy in research, balance in reporting controversial positions, the separation of factual report and opinion, and so on, as also institution-ethically based structural conditions which make correspondingly responsible journalism first possible.
It may be controversial in individual cases to what extent, in public discussion about the "selection" and "manipulation" of human life, these ethically based demands are lived up to, on the individual or the institutional level. I would maintain, however, that my investigations of the public debate about PGD can demonstrate that in this case, at least as a general trend, no obviously incorrect journalistic conduct is to be found and that recriminations directed at the press on the grounds that no social consensus on the moral problems of PGD has as yet been reached would be inappropriate.
As it has been shown, the essential difference between the public discussion and the academic ethical debate is that, in the former, a broader perspective is adopted and PGD addressed in its historical and social context, without the perspective of the individual couple affected being forgotten. This raises the question of whether such a difference, from a media-ethical perspective, is appropriate, whether it serves "the public interest." The suggestions made by professional ethicists, that the discussion should be held in a dispassionate and pragmatic manner, are of course all arguments in favour of a narrowing of the perspective (Birnbacher, 1999).
Social reality is the "matrix" within which single individuals accumulate their knowledge about the real world, construct their systems of belief, make decisions and act (Hacking, 1999). Nevertheless, social reality is only to a very limited extent accessible to direct personal experience. It is increasingly mediated through the media. There is a certain sense in which the media "construct" social reality (Debatin 1997). Social values and norms emerge, are changed, or are newly constructed in public discussion. They thus influence the possibilities for future development in the praxis of research and application; these possibilities simultaneously reflect back on the development of social norms. That means, however, that the debate as it takes place in the public arena is not only about the social acceptibility of specific practices, but also - and always - about the social values and norms, world views and perspectives on the human being which shape our decision-making and our actions. And since experts and particularly ethicists play such a central role in public discussion about biomedical issues, they also have a part in the development of the system of values and norms adopted by society and must thus act with the appropriate responsibility. Here the particular authority ascribed to the positions of experts in public debate must be taken into account.
Now one could argue that ethicists should stay out of the public discussion: they are academics, and their job is bioethics rather than biopolitics. But at the same time it is clear that especially in the area of biomedicine there is a great need in society at large for ethical reflection. The increasing institutionalisation of bioethics is of course not least a response to social controversies about biomedical research. That means, however, that bioethics is essentially and unavoidably also biopolitics. One result of this fact is that it is necessary for bioethics to reflect on itself, a process which in my opinion must take place in the tension between the ideals which govern the scientific search for truth, and those which govern political communication.
According to Hans Lenk, the genuinely scientific task of bioethics should orient itself according to the internal responsibility for the best possible objective search for truth and its confirmation on the one hand, and the external responsibility to society on the other (Lenk 1991). The political task of bioethics would in addition need to be directed towards the ideal which governs the political dialogue: that of the joint search of society for political solutions capable of being generalised. In this sense, I argue for seeing the task of bioethics in public discussion in the first place in contributing with the "reflective competence" specific to it as a discipline to the clarity of the positions adopted and thus to better communication between the various opposing parties. That means, specifically, refraining from carrying out proxy debates, and addressing the concerns expressed in the public discussion - in particular the changes in social values and norms - in ways appropriate to academic ethical discourse.
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- The Frankfurter Allgemeine Zeitung (FAZ), the Frankfurter Rundschau (FR), the Neue Zürcher Zeitung (NZZ), the Stuttgarter Zeitung (STZ), the Süddeutsche Zeitung (SZ), the Tageszeitung (taz), and the Welt.
- The Focus, the Spiegel, the Stern, the Woche, and the Zeit.
- E.g. Hans Schuh, Volker Stollertz (Zeit), Wolfgang Löhr (taz), Michael Emmrich (FR), Claudia Ehrenstein (Welt), Reiner Flöhl, Barbara Hobom (FAZ).
- "Political communication" is, however, not diametrically opposed to "entertainment" in the media: both are a part of "cultural praxis" and both take part in the creation and maintenance of cultural hegemony (Gramsci) as a prerequisite for stable political conditions of governance (Dörner, 1997)
- The central idea of a process of shaping public opinion as an appropriate formulation of the morality of public discourse goes back to Habermas, although it is controversial whether Habermas' conception works as a metatheory of ethics (Hügli, 1992; Habermas, 1990 #99).