For more than 25 years, Wesley J. Smith of the Discovery Institute has been railing against the Medical Ethics Industrial Complex (my term), pointing out how far left it is as a major force in medicine and public policy. In 2002, I was a newbie to the field, immersed in a conservative, religious bioethics graduate program. When I first heard his critique, naïve as I was, I thought he was overstating his position. Time has proven Smith absolutely correct.

 

On June 18, 2024, Miles Meline highlighted a recent study published in The American Journal of Bioethics called, “Bioethicists Today: Results of the Views in Bioethics Survey,” which confirmed Smith’s, and in general our, worst suspicions.

 

The survey is interesting from several perspectives. First, it notes that the term bioethicist is as yet undefined. Then, it defines the term in order to obtain an appropriate sample from which to perform its survey. In doing so, it begins by using the American Society for Bioethics and Humanities (ASBH) as its benchmark for establishing its pool. It draws from persons who have presented at the 2021 or 2022 ASBH annual conference. The second source they drew from was programs listed with the Association of Bioethics Program Directors (ABPD) Graduate Bioethics Programs database. Other criteria for inclusion in their survey was that the persons sampled were living or working in the U.S. and they spent 20 percent or more of their time engaged in bioethics activities, such as “researching, teaching, clinical ethics consultation, or serving on an ethics committee.” (Just because someone does a lot of something doesn’t mean they do it correctly. As one of my attendings used to say, “Experience may just mean doing the same thing the wrong way many times.”)

 

While these criteria may seem reasonable, they clearly show a built-in bias to favor academic professionals—many from secular settings, and the ASBH, which is well-known for its progressive bent. The secular, academic world is recognized as being significantly left of the U.S. population at large, and, as this survey shows, the academic bioethics community is even further left than the university in general.

 

The study says, “The Bioethicists in our sample are overwhelmingly liberal (87%), while only a small fraction identifies as moderate or conservative; by contrast, only 25% of Americans self-describe as liberal, while 37% identify as moderate, and 36% identify as conservative.” The study further confirms that bioethicists are less religious, less Christian and less conservative politically. It continues, “The social sciences and humanities at major universities have 20 Democratic faculty members for every Republican…While political party affiliation is not the same as political ideology, it can serve as a rough proxy.” Only 22 percent of the study participants hold the MD or DO degree.

 

While 53 percent of respondents were female, only 43 percent were male, with the remainder being “non-binary” or “decline to answer.” Also, 81 percent self-described as white, but 6.2 percent “declined to answer.”

 

The study notes that bioethicists use several different methods of philosophical/ethical problem-solving, including consequentialism, deontology, ethics of care, a feminist approach to ethics, virtue ethics, principlism and other approaches. Despite these differences, they note there is “relative consensus among bioethicists on many ethics issues,” and, as one might expect from the sample pool, these often differ significantly from the general population. They examine several specific areas of ethics controversy:

 

• “Medical Aid in Dying” (which is the new, socially accepted term for assisted suicide that romanticizes the issue): A total of 59 percent of bioethicists report it is “ethically permissible for clinicians to assist patients in ending their own lives if they request this.” The authors quote a Gallup poll and a Medscape survey to state that the public and physicians statistically agree with bioethicists. Unfortunately, they do not delineate exactly what questions were used in these other surveys, or how they might differ from this survey. Some may well believe that medical aid in dying is permissible only with specific extenuating circumstances and guidelines. Thus, it is difficult to know exactly what this means, except to say bioethicists broadly support it.
• Compensating Organ Donors: Methodological differences prevent direct comparisons to the public and physicians in general, but here the bioethicists lean away from compensation. The full reasons are not clear, and the answer to the question seems to hinge on what quality of life means. This has been a difficult issue, particularly among the disability rights advocacy community. How does one define quality of life?
• Treatment Without Parents’ Knowledge or Consent: Bioethicists would advocate for confidential healthcare for adolescents at a higher rate than parents or teens when surveyed. While not fleshed out completely, this would seem to pertain to alcohol and drug treatment, abortion and “gender-affirming” medical interventions.
• Abortion: This is overwhelmingly supported by bioethicists, to a greater extent than obstetrician-gynecologists, who favor it more than physicians in general. Again, polls vary, and depending on the nuances of the questions asked, these numbers likely are much higher than the general population.
• Personhood: Two-thirds of bioethicists believe personhood begins at or after viability, whereas more than half of U.S. adults believe “personhood begins at conception, so a fetus is a person with rights.” A total of 38 percent state this “very well” and 18 percent “somewhat well” characterizes their position. CMDA has long espoused conception as the point in time at which one becomes a person. Recent mainstream media have blindly supported IVF, ignoring the ethical questions of the loss of life of numerous embryos in pursuit of the desires of the parents and the use of embryos as a means to a parental goal as opposed to beings with their own inherent dignity.

 

In the discussion section of this survey, the authors note, “…We urge readers to keep the is-ought fallacy in mind. Just because there is relative consensus on a topic does not necessarily mean it is rightly settled.” Nonetheless, when a major survey like this informs us that a high percentage of experts agree on an issue, it tends to sway public opinion. Federal and state policies, laws and decisions regarding funding for further research are often reflexively referred to purported experts in the field. This survey defines such “experts” conferring authority on their opinions. This study confirms our impression that these identified experts’ opinions are not representative of those of society, religious persons within our society, minority populations or even males.

 

The authors focus on the non-representation of minorities as a factor that “risks retrenching institutional structures that are unfavorable to populations underrepresented in bioethics,” but by this they refer primarily to anti-Black racism. Notably, they do not highlight the major skew of this group of experts against the pro-life movement, religion or conservative political positions. They also do not underscore the fact that this survey only sampled American academics.

 

CMDA has long espoused positions which are contrary to those of general academic bioethicists, and it has successfully advocated for these at a national level. We should continue to encourage these efforts and support Christian healthcare professionals who represent our future generation of Christian bioethicists, particularly young Christian healthcare professionals of African American heritage, international physicians or other under-represented groups. As the late senator Mike Enzi once said, “You’re either at the table or you’re on the menu.” As Christians, we must be part of the public discussion, and we must not withdraw from the fray, or we will be drowned out by secular voices.