What is wrong with "ethics for sale"? An analysis of the many issues that complicate the debate about conflicts of interests in bioethics

Journal of Law, Medicine and Ethics

Volumn 35, Issue 1, 2007, Pages 175-186

  Sontag, David N ^a,b  

^a Health Law Group   (United States)

^b Rutgers Law School   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

CONFLICT OF INTEREST; DECISION MAKING; ECONOMICS; ETHICIST; ETHICS; HUMAN; LEGAL ASPECT; ORGANIZATION AND MANAGEMENT; REVIEW; STANDARD;

CONFLICT OF INTEREST; DECISION MAKING; ETHICISTS; ETHICS CONSULTATION; HUMANS; PRIVATE SECTOR;

EID: 33847403972     PISSN: 10731105     EISSN: 1748720X     Source Type: Journal    
DOI: 10.1111/j.1748-720X.2007.00122.x     Document Type: Review

References (61)

1. B. Brody et al., "Bioethics Consultation in the Private Sector," Hastings Center Report 32, no. 3 (2002): 14-20, at 15.
2. C. Elliott, "Pharma Buys a Conscience," The American Prospect, Sept. 24 - Oct. 8, 2001: 16-20, at 17.
3. V. A. Sharpe, "Science, Bioethics, and the Public Interest: On the Need for Transparency," Hastings Center Report 32, no. 3 (2002): 23-26, at 25.
4. See Brody et al., supra note 1, at 14-15.
5. Id., at 15.
6. Id.
7. N. Boyce and D. Kaplan, "And Now, Ethics for Sale?" U.S. News and World Report, July 30, 2001, at 18;
8. N. Boyce, "A View from the Fourth Estate," Hastings Center Report 32, no. 3 (2002): 16-17, at 17.
9. See Sharpe, supra note 3, at 25.
10. Editorial, "Probing the Ethics of the Bioethicists," Indianapolis Star, August 13, 2001, at 8A.
11. See Boyce, supra note 7, at 17.
12. See Sharpe, supra note 3, at 25.
13. The "practical bioethicist" I will focus on is one who is hired either as a consultant or speaker by private companies because that is the type of practical bioethicist commentators have focused on to date. Bioethicicsts who are hired by non-profit institutions, or even news companies, would fit into my definition of "practical bioethicist," but again, my focus will mirror that of previous commentators.
14. Although the role of accountants will be discussed in greater detail shortly, I believe this brief example will be illuminating here.
15. A general introduction to the fields of law and accounting, including how lawyers and accountants are meant to interact with their respective clients when there is no conflict of interest, can be found in the Appendix of this article. Specific issues concerning conflicts of interests in those fields will be discussed in greater detail throughout the text of this article when such discussion proves useful to the debate about conflicts of interests in bioethics.
16. 107 H.R. 3763 (Jul. 30, 2002).
17. Id.
18. The debate about how "independent" the accountants actually were prior to the enactment of the Sarbanes-Oxley Act will be addressed later in this article.
19. See Boyce, supra note 7, at 17.
20. S. J. Youngner and R. Arnold, "Who Will Watch the Watchers?" Hastings Center Report 32, no. 3 (2002): 21-22, at 21
21. (quoting D. Thomson, "Understanding Financial Conflicts of Interest," New England Journal of Medicine 329 [1993]: 573-576).
22. Whether bioethicists who are employed by biomedical companies full-time would make the same concession is unclear. However, since this type of bioethicist is in the significant minority, and the focus of this article is on those bioethicists who consult in the private sector while maintaining their positions in academia, I will not address this issue further.
23. T. Donaldson, "The Business Ethics of Bioethics Consulting," Hastings Center Report 31, no. 2 (2002): 12-14, at 13.
24. C. Elliott, "Throwing a Bone to the Watchdog: Conflicts of Interest and Bioethics," Hastings Center Report 31, no. 2 (2002): 9-12, at 9.
25. See Sharpe, supra note 3, at 25 (citing Elliott, supra note 2); see also R. De Vries, "Businesses are Buying the Ethics They Want," Washington Post, February 8, 2004, at B02 ("Today bioethicists are part of the landscape.")
26. Despite what some critics have argued, bioethicists do not see themselves as "the arbiters of what is moral and ethical in health care." R. J. Neuhaus, "The Public Square: The Best Bioethicists that Money Can Buy," First Things, March 1, 2001, 71-72, at 71 (quoting W. J. Smith, Culture of Death: The Assault on Medical Ethics in America [San Francisco: Encounter Books, 2000]). More importantly, the American public does not accept the opinions of bioethicists regarding what is right and wrong carte blanche. Rather, the public trusts bioethicists to highlight and clarify issues that arise in biomedicine. Bioethicists' opinions are insightful and therefore helpful, but are not accepted per se.
27. See Editorial, Probing the Ethics of the Bioethicists, supra note 9.
28. D. Callahan, "Doing Good and Doing Well," Hastings Center Report 31, no. 2 (2001): 19-21, at 20 (emphasis added).
29. See Boyce and Kaplan, supra note 7, at 19.
30. Personal communication from Arthur Caplan to author, October 6, 2003.
31. R.M. Green et al., "Overseeing Research on Therapeutic Cloning," Hastings Center Report 32, no. 3 (2002): 27-33, at 29.
32. H. Cohen, "Ethics on the Corporate Payroll," The Scientist, July 22, 2002, at 44 (quoting Virginia Sharpe, Director of the Integrity in Science Project at the Center for Science in the Public Interest).
33. See Green et al., supra note 29, at 29.
34. Id., at 32.
35. See Sharpe, supra note 3, at 25;
36. Neuhaus, supra note 24 (quoting W. J. Smith, Culture of Death: The Assault on Medical Ethics in America [San Francisco: Encounter Books, 2000]).
37. See Editorial, Probing the Ethics of the Bioethicists, supra note 9.
38. See Elliott, supra note 2, at 17.
39. See Elliott, supra note 22, at 9.
40. See Callahan, supra note 26, at 20.
41. See Donaldson, supra note 21, at 12.
42. See Boyce and Kaplan, supra note 7, at 19.
43. See Brody et al., supra note 1, at 15.
44. See Donaldson, supra note 21, at 12
45. See Elliott, supra note 2, at 17.
46. Id., at 17-18.
47. See Callahan, supra note 26, at 20.
48. W. Bower, "A Perspective on Enron/Andersen, MDPS, and Professionalism," Of Counsel 21, no. 10 (2002): at 6.
49. 15 U.S.C. § 78j-1(i)(1)(B).
50. See Brody et al., supra note 1, at 19.
51. See Green et al., supra note 29, at 28.
52. See Brody et al., supra note 1, at 18.
53. See Callahan, supra note 26, at 21.
54. See Elliott, supra note 2, at 20.
55. See Elliott, supra note 22, at 10.
56. I also think Laurie Zoloth has made an excellent argument that prestige associated with certain consulting relationships could create a conflict of interest. See L. Zoloth, "Seeing the Duties to All: Conflict of Interests in Bioethics," Hastings Center Report 31, no. 2 (2001): 15-19. However, due to space limitations, I am not able to address that issue in this article.
57. See Boyce, supra note 7;
58. Youngner and Arnold, supra note 19;
59. Elliott, supra note 2;
60. Cohen, supra note 30, Sharpe, supra note 3.
61. The conflict or appearance thereof also raises concerns about client confidentiality, which will not be addressed in this article.