Editorial: Not Just How, but Whether: Revisiting Hans Jonas

It is probably not an exaggeration to say that bioethics as a discipline is more the child of research ethics than clinical ethics. From Nuremberg to Jesse Gelsinger, the threat to human life and dignity posed by the temptations of using human subjects as experimental fodder has produced some of the deepest bioethical musings and most important contributions of bioethics to human welfare. Informed consent standards, the development of IRB review, the establishment of OHRP and FDA oversight, and the (albeit tardy) consolidation of the Federal Policy for the Protection of Human Subjects (the "Common Rule") are all non-trivial advances that promote greater protections and ethical treatment of human subjects.

The American Journal of Bioethics offers within these pages (or a click away from this screen) two major articles on research ethics: one about the permissibility of placebos in surgical clinical trials, and the other about the rights of children to assent to treatment. The articles fit squarely in a traditional thread of bioethical discourse on research ethics; given the current system of human subjects research, what types of research design are permissible, and how do we assure the full and most dignified participation of all subjects in medical experimentation? Both also clearly reflect the need to reassess issues as times and circumstances change. The use of sham surgery can only be seriously considered once surgical techniques and anesthesia reach a point at which their administration as a placebo arm can be considered low risk. The reassessment of the role of minors in decision-making around research participation seems prompted, in large part, by the call to improve clinical testing of pharmaceuticals on pediatric populations and our increasing ability to keep children with significant disease and disability profiles alive.

However, a second traditional thread of bioethical discourse on these issues also needs periodical reexamination, so that our attention to the particularities of cases does not derail us from the overall vision of ethical human subjects research. What are our goals for medical research, and what are the (often unrecognized) assumptions behind those goals? A close reading of the articles and commentaries within shows that you cannot separate a discussion of particular issues from the overall goals of research as an enterprise. Yet, as circumstances change—both in terms of the technological sophistication of our research efforts and our institutional situating of them—we must revisit our old friend Hans Jonas and ask ourselves once more: exactly why are we doing this? And, given our answer to that question, are our methods and our priorities true to the values we claim to espouse?

Jonas posed these questions eloquently over thirty years ago. While his answers were astonishing even at the time, they particularly rankle us today, because Jonas tries to make problematic the very idea of medical progress. Medical progress as a sufficient rationale for (at least some level of) research risk has become so embedded in our thinking that it is rarely deemed necessary anymore to take it out, dust it off, and explicitly justify it. Jonas, on the other hand, was clear: medical progress is not itself necessary for human flourishing. "If cancer, heart disease, and other organic, non-contagious ills, especially those tending to strike the old more than the young, continue to exact their toll at the normal rate of incidence, society can go on flourishing in every way" (Jonas 1969). Jonas understood how discordant this claim sounded; he acknowledged that "we expect from organized society no longer mere protection from harm and the securing of the conditions of our preservation, but active and constant improvement in all the domains of life." Future generations, suggested Jonas, have a right to have passed down to them a planet unsullied by our pollutions and exploitation, but have no "right" to new technologies created by the sacrificing of human dignity:

The destination of research is essentially melioristic. It does not serve the...