Bioethics Consultation in the Private Sector
Brody, Baruch, Dubler, Nancy, Blustein, Jeff, Caplan, Arthur L., Kahn, Jeffrey P., Kass, Nancy, Lo, Bernard, Moreno, Jonathan, Sugarman, Jeremy, Zoloth, Laurie, The Hastings Center Report
Bioethics consultation is flourishing in the private sector. The corporate clients are aware that their work raises substantive ethical issues, and often they are concerned about how their response to these issues may affect their public image and their financial standing. Many are prepared to compensate ethics consultants at substantial rates.
This is a new phenomenon for the field of bioethics. Traditionally, most requests for comment and analysis arose within the academic setting, where compensation for consultation is generally modest, if it is offered at all. But consultations are not new. Bioethicists have provided clinical consultations on individual cases and on policy development within academic medical centers, health care delivery systems, and community health care institutions. (1) They have consulted about the design and conduct of clinical trials for public and private funding agencies and have participated on institutional data and safety monitoring boards for those trials. (2) They have also participated as consultants for governmental, quasi-public, and private-foundation working groups developing guidelines for the ethical practice of medicine, biomedical research, and health policy. (3)
What distinguishes this newest form of bioethics consultation are several features:
* the consultation is sought by a for-profit client, not by an academic institution (although this distinction loses force as patents, profits, and biotechnology come increasingly to characterize the academy);
* the issues have potential financial implications for the clients;
* the consultant is offered a substantial fee and perks for the consultation; and
* the consultant is not a full-time employee of the client (full time consultancy relations raise still other issues, beyond the scope of this report).
Examples of the types of arrangements considered in this report include:
* serving as a member of an ongoing bioethics board such as the Geron Ethics Advisory Board or the DNA Sciences Ethics Advisory Board; (4)
* serving as art ad hoc advisor about a company's research programs or product development, as in the AbioCor Independent Patient Advocacy Council and Pfizer's Advisory Panel on Viagra; (5) and,
* developing background analyses that identify ethical issues and possible corporate responses, as has been done for Framingham Genomic Medicine and by Dupont's Advisory Panel on Biotechnology. (6)
Educational sessions, public performances, and agent-negotiated after-dinner speaking engagements fall outside this list and are not reached by this text. But as academic institutions anti not-for-profit corporations begin acting more like for-profit firms, they will fall within the guidelines suggested below.
There are those who have thoughtfully and seriously challenged this new role of bioethicists. (7) In part, these commentators are concerned about the appropriateness of ethicists who should have broader interests, such as concerns about social justice, serving clients whose primary interest is profit-maximizing. This concern is heightened when it is suspected that the consultation is not a genuine request for advice, but rather just an effort to justify what is planned anyway.
In part, too, the critics are concerned about the increased conflicts of interest created by the substantial fees available in the private sector. Finally, they are concerned about the effect that these new consultations may have on both the integrity of the field and its reputation for objectivity, independence, and impartiality. Some are worried about the effect that even the appearance of a conflict might have on the reputation of the field. While some might regard these concerns as inherent in the process of bioethics consultation, others see these problems as unique to this new type of consultation. …