Oration Annelien Bredenoord
Can ethics save biomedical sciences? This question was posed today by Annelien Bredenoord, professor of Ethics in Biomedical Innovation at UMC Utrecht and Utrecht University, in her inaugural lecture. ‘We aim for ethics that guide biomedical innovations from the inside from laboratory to society.’
In the 1960s, academic ethics were withering away, according to Annelien Bredenoord. Ethics were too abstract, too theoretical and too parochial. This all changed when medical science experienced one breakthrough after another – from prenatal diagnostics to the contraceptive pill, from mechanical ventilation technology to organ transplantation.
Bredenoord: ‘Although great optimism reigned regarding the unprecedented possibilities afforded by technology, the possible drawbacks of technology were also acknowledged.’ This led to a new discipline – bioethics – which currently has been flourishing like never before.
In recent years it has been the medical sciences which have come under strong criticism. The list of criticism goes on and on: many studies cannot be reproduced, publication bias abounds, the pressure to publish leads to quantity dispelling quality, and the questions being addressed have low priority. Another issue is the ‘valley of death’, referring to the fact that few studies ever make it out of the laboratory to contribute to new treatments.
‘It seems as if the biomedical sciences and medicine are experiencing the same things that ethics did seventy years ago: it is too parochial, it is not focused on the major issues, and patients and the outside world are not consulted enough about the research agenda’, says Bredenoord. ‘I think that medical ethics – which thanks its existence in part to medical innovation – can now return the favour by helping medical sciences to recuperate.’
The solution lies in part in what Bredenoord refers to as ethical parallel research. This entails that the medical ethicist is involved in the very first stages in the process of medical or biomedical research. The ethicist works together with the researcher in the lab, the data scientist at the computer, with patients and test subjects, and with the physician who wants to begin a clinical trial. ‘We need to aim for co-production, where science, biomedical technology, ethics and society shape one another. This is the counterpart of the classical view, where science and ethics and society are all strictly separate worlds, with separate distinct roles. The question shouldn’t be: “Are you for or against a certain type of new medical biotechnology, such as genetically changing embryos?” A better question would be: “How can new biomedical technology be given an ethically responsible form?” Co-production is the only way that we can address questions that relate to the desires and needs of parties such as patients. And in society today, this is the only solution for what we refer to as the Major Issues we are struggling with. An ethicist can assist in this process.’
In addition – Bredenoord explains – an ethicist conducting ethical parallel research will be able to unearth any implicit value judgments in the study or study design at an early stage, while an ethicist also ensures a natural connection between academia and the outside world, for instance by giving public lectures or using social media. Can ethics indeed thus rescue the biomedical and medical sciences? ‘In any case we can provide the first aid which currently is so sorely needed’, says Bredenoord.