Last July, an article was published in the Journal of Medical Ethics (JME) by outgoing editors Julian Savulescu, Thomas Douglas and Dominic Wilkinson, in which they reflect on the importance of philosophy in the context of medical ethics, as their term as editors of the journal comes to an end.

Savulescu comments that “When we applied for the editorship of the JME 7 years ago, we said that we considered the JME to be the most important journal in medicine. The most profound questions that health professionals face are not scientific or technical, but ethical”. It goes without saying that we also share this opinion.

“Ethics grows in importance as our technology creates new possibilities. Where there are no options, there are no ethical questions”, an assertion that we share, although we are of the opinion that ethical concerns should be raised before the development of new technological projects, when they start.

“During the last 7 years, issues like the creation of brain organoids, human non-human chimeras, mitochondrial transfer, gene editing of embryos and in vitro gametogenesis have grown in prominence. These raise deep questions about moral status and how it should be determined, the limits of modification of humans, and what is good in life”.

They continue by saying that they are proud of their contribution to thinking about these challenges, and of the journal staff for their hard work, but that there is still much more to do.

One area that must be studied more deeply is the ethical aspects of the empowerment of patients through the internet and the debate about the definition of death, which seemed to have been resolved three decades ago, but which today has been revived. In relation to this, the editors consider that a paradigmatic example of the need for this debate is the recent case of Charlie Gard (see Savulescu’s opinion HERE) and the disputes that took place between Justice Francis and Savulescu himself and his colleague Dominic Wilkinson, in raising questions such as: What was Charlie’s experience of the world? How much […] was he suffering? What was the chance that the experimental treatment that his parents sought would lead to improvement? How should we assess the benefits and harms of the proposed treatment against the alternative of death? After extensive discussion of these matters with other colleagues, divided opinions remained, even with Dominic Wilkinson, a colleague specialized in neonatology and co-author of the paper, whose opinions differed from those of Savulescu himself.

This case, together with that of Alfie Evans, has highlighted the importance of ethical debates in these circumstances, and also the urgent need to have them.

These debates in ancient philosophy are the basis of dialectics, which was undoubtedly the key that made philosophy progress.

Likewise, Savulescu, Douglas and Wilkinson say that, although eminent bioethicists – mainly from the United States — took part in the debate, other biomedical journals should have been more involved.

The importance of finding points of agreement 

The authors continue by saying that, in these types of debates, it is important to find a point of consensus, something that could not be achieved in the Gard and Evans cases, although this dissent was undeniably positive, because it allowed the ethical aspects of these cases to be examined more closely. Further to this, Wilkinson and Savulescu say that they going to publish a book, to be released shortly, in which they will try to delve deeper into both clinical cases, to explore new ways to make progress in bioethics, despite the disparities that exist among the different experts who have professed their opinion on the case.

They continue by saying that some professionals, when they hear the word “ethics” believe that it merely serves to pose bureaucratic and ethical obstacles, which slow down the development of knowledge about life, and even scientific and clinical development; however, with respect to this, Savulescu says that ethics is liberating, to know what we should and should not do in these scientific fields. He goes on to say that they have tried to show should ethics should be constructive instead of obstructive.

The authors end by declaring that this is their last issue as editors of the JME, that they are happy with how the journal has progressed over the last 7 years, in which they have encouraged dynamic debates through the publication of feature articles and commentaries. They continue by saying that they have tried to make the journal an attractive place to publish in-depth ethical analysis.

Several issues on which they have made less progress than they would have liked

However, they also claim that there have been difficulties and that there are several issues on which they have made less progress than they would have liked, referring to three in particular: the first, that they should have done more to bridge the gap between empirical research and normative arguments; the second, that the journal has remained less internationally representative than they would have liked, because they consider that it has little success in attracting contributions from low- and middle-income countries; and third, they have often struggled with the tension between ensuring that they did not censor controversial viewpoints — for example on topics such as abortion and euthanasia, disability, Chinese organ procurement practices, chronic fatigue syndrome and circumcision — and protecting the authors from unfair and harmful publicity.

The authors end by saying that it is now time for a fresh approach and new editorial ideas and that they are delighted to hand over the journal to the new team.

Our bioethical opinion

While we do not agree with some of Savulescu’s positions (see our statement on Principle of Procreative Beneficence HERE) we believe that this article contributes to the enrichment of bioethical debate by basing itself on philosophical principles, not limited to consensus decisions or established laws and protocols.

Justo Aznar. Bioethics Observatory.

Institute of Life Sciences.

 

Read entire article J Med Ethics, June 26,  2018, Savulescu JDouglas TWilkinson D Philosophical medical ethics: more necessary than ever 

Photo Ryan Zaklin, MD, MA