Field Notes

The Ethics of Facilitating Sausage-Making.

You know the saying: There are two things you don't ever want to watch being made—sausage and policy. The saying assumes that both sausage and policy are everyday parts of our lives, that we consume them regularly, that we might wonder what goes into them, and that observing this process will shatter any illusions we might have concerning the purity of the constituent parts. As the nineteenth century English journalist Walter Bagehot famously wrote, "We must not let daylight in upon the magic." He was referring to the doings of the British royal family, but the principle is the same: there are some things you don't want to know too much about or see too clearly.

Sausages (and kings) are simple, really, compared to policy. First, there's the matter of definitions. By "policy," do we mean public policy, such as the laws and regulations that protect public health or promote social welfare? Do we mean the internal policies that apply to members of professions and employees of institutions? Do we mean almost any activity of any branch or member of government: increasing or cutting the budget of the National Institutes of Health; capping malpractice awards; reversing a position on stem cell research? Do we mean advocacy, or even lobbying? Do we mean something that is related to but distinct from ethics, as in "ethics and policy," or do we regard policy as always having an ethical basis of some sort? We might not be in favor of a policy that would permit people to sell their own organs for transplant, but we can discern the problematic ethics underlying such a policy.

Once we have settled on our definition of "policy" while acknowledging that others may use the word very differently, we are confronted by the question of the proper role of bioethics with respect to policy-making. Can we bear to watch? Or do we want to help policy-makers do a better job of making ethically sound policy? Bearing in mind that bioethics is already "applied" ethics, and that we are always applying our work to fields replete with policy of various kinds, it's hard to imagine a bioethics that managed to be relevant while averting its gaze from the quotidian reality of rules and regs in the clinic and the lab. To help policy-makers do their jobs better is not to become policy-makers or political players ourselves, but it's part of our obligation as a field, because we have signed on to study issues in which policy of some kind is invariably a factor.

At The Hastings Center, as at other bioethics centers and programs, we're having conversations and conducting experiments aimed at strengthening our ability to meet the educational needs of policy-makers, and of those who report and reflect on policy relevant to bioethics. Part of this task is simply to learn how to think about policy-makers as part of the audience for all of our projects—rather than despairing when we read about new legislation, new guidelines, and new regulations that seem to work against the interests of those members of society who are affected by advances in medicine and biotechnology. In other words, us.