CELIA B. FISHER: You're very welcome.
MATTHEW HENNESSEY: Tell me a little bit about the history and the mission of the Center for Ethics Education.
CELIA B. FISHER: The Center began as an interdisciplinary faculty seminar that discussed ethical and moral issues. We had people from the hard and soft sciences, theologians and philosophers. It was a wonderful way to do cross-disciplinary thinking on ethical issues. After three or four years we established the Center with the notion that any understanding of these issues needed to be a dialogue between the humanities and the sciences.
One of our first activities was funded by a grant from the National Institute of Health. Around the time when President Clinton was apologizing for the Tuskegee experiments there was an initiative to fund research education workshops throughout the country so that this kind of abuse would never happen again. We received one of those grants and began running workshops for different institutional review boards in different professions.
MATTHEW HENNESSEY: You've done a lot of work on the ethical responsibilities of pharmaceutical companies in the conduct of their clinical trials. In your view, do pharmaceutical companies have an obligation to produce drugs that may not be profitable to the corporation but may be in the interest of public health?
Obviously they are companies, so they have an obligation to be profitable. They have an obligation to protect confidential business information and intellectual property rights. But that does not have to be inconsistent with the obligation to produce useful and safe medications. If there appears to be a conflict then it needs to be resolved with respect to the safety of patients.
For the most part, we all benefit from the drugs that pharmaceutical companies are producing. Unfortunately, along with what they are producing are a lot of costs that may or may not be necessary. The extent to which it's their responsibility to limit their costs is, I think, a very interesting question in a capitalist society. However, there is no doubt that they have an ethical responsibility to be honest, to produce medications that are effective, not to fabricate or falsify data, not to hide data that is contradictory. And they shouldn’t produce medications where the risk/benefit analysis is loaded toward risk. I think it's unethical when a decision about money overrides a decision about safety.
MATTHEW HENNESSEY: You say that they should protect their intellectual property rights. What about in the context of epidemics or emergencies—especially in the developing world? Do pharmaceutical companies have an ethical obligation to relax their copyright protections in those situations?
A lot of the pharmaceutical companies do their initial testing in undeveloped countries. They do that because the costs of paying participants and field workers are a much cheaper. The fact that they are in some sense profiting from the poor economies of these countries can produce an ethical responsibility to balance that asymmetric benefit by providing, when they can, medicines at reduced cost.
MATTHEW HENNESSEY: Can you give me any examples of drugs that have been developed in that way?
CELIA B. FISHER: Well, I think the whole HIV controversy was steeped in that. A lot of drug companies went into underdeveloped countries in Africa and Thailand. For one thing, that's where the populations are. But it's also just cheaper.
What I like about ethics is that it's complex. Pharmaceuticals, stem cell research, just war, end of life issues—there are no easy answers to these questions. We are searching to find out whether the answers to these questions meet a moral criteria.
MATTHEW HENNESSEY: So one of the most complex issues then is the debate over embryonic stem cells. Has the most recent innovation in that area voided that debate?
It hasn't voided it yet. It has the potential to void the debate in the future if, in fact, we find that the skin stem cells are as pluripotent as the embryonic ones. Hopefully that's the case, but there are years of research ahead. It has the potential, but at the same time, for those that champion the use of any kind of pluripotent cell to help with disease, not being able to use embryonic stem cells remains a setback. We ran a conference last year with theologians, religious speakers and biologists that really engaged each other in a respectful way. While some of these issues are, in some sense, irresolvable—you may not have a meeting of the minds in terms of morality—but you may have a meeting of the minds as to whether it’s the government's responsibility to dictate what's acceptable.
What I think is really interesting, is that the debate itself has really moved the field. Although there have been some false notices around alternatives to embryonic stem cells, the debate has sparked innovation in non-embryonic cells. There is the possibility for the issue to go away, but other things will come up.
MATTHEW HENNESSEY: How does being a part of a Catholic university affect the debate? Does it lend itself in any way to the complexity you were describing?
CELIA B. FISHER: Oh, I think so. Especially because we are a Jesuit university. The Catholic tradition, in terms of knowledge and care, I think is wonderful for the study of ethics. The Jesuit tradition of openness to other voices allows us to approach these problems with a respectful, but moral, core. The people that come to our conferences know that we won't let one view—whether religion, science or politics—dominate the others, but rather create a shared moral understanding that may move the dialogue ahead.
MATTHEW HENNESSEY: Sidestepping a little, there are many that don't see a role for ethics when it comes to international policy. This school sees the international system as characterized by anarchy and would argue that an ethical stance is at best naïve when it comes to crafting foreign policy. At worst, it can be self-defeating. What do you say to that?
I can empathize with that argument although I don't agree with it. Morals are principles that we aspire to and we want to guide us—first do no harm, respect people's autonomy and dignity—for me, the moral principles are what makes us human. As a country, I think that if we abandon that humanity we are in danger of becoming an anarchy.
I don't think the threats that other countries provide us are an argument for abandoning morals. The just war metaphor is an example of that. A country that decides to go to war should make certain moral judgments as to whether war is necessary and how to win it while doing the least harm possible.
MATTHEW HENNESSEY: You hinted there at a difference between ethics and morals.
CELIA B. FISHER: Right. Ethics is the practical application of morals within different fields. Business has ethics. Mental health has ethics. Politics and government have ethics—conflict of interest is a big issue within government, for example. So ethics is really about actions taken within a specialty area to fulfill these higher moral principles.
The other issue that I think comes out internationally is whether or not there are universal moral principles. There may not be universal ethics, but I'm from the side that says there are universal moral principles, but they may be articulated or emerge in different ways in different countries.
MATTHEW HENNESSEY: What's your response to the argument that there is a culturally relative basis for unethical practices such as corruption? Often you hear, "Well, that’s just how business is done" in a given country.
There's a difference between ethical relativism—which says ethics is whatever we say it is depending on were we are—and ethical contextualism—which says that how a moral issue emerges is going to be different depending on its context.
What is the purpose of paying people? It is a fair exchange, right? That's what our business model is based on. But the way some countries operate, payments under the table are seen as a fair exchange. It's not a formal policy, it's kind of an informal policy that goes on. Then the question is: Is it unjust? Is somebody being exploited? Is this an accepted part of the system?
So what you want to do is apply the moral principles to it. Not the act itself, but whether or not you’re exploiting or harming a population, or you’re being inconsistent with the distributive justice of that population.
Another example has to do with research. In some countries you cannot approach a woman without asking her husband, or a male relative, whether she can participate first. So the ethical question for Western thinkers that believe in personal autonomy and the right to self-governance is, "How do you recognize and respect this woman’s personhood within the context of a tradition that says the husband has to give permission?" If we did not do research with any of those women because we decided they had no autonomy and they were being exploited, then we might not do research on maternal health that is essential to them. On the other hand, you can also respect their autonomy by getting their husband's permission to speak to them, but then having a policy that no one will be forced to be in a study because their husband says "Yes" They have the right to choose.
These are difficult questions. You're asking, "How do you assume that humanity has similar rights and responsibilities across cultures." But tradition makes an understanding of these basic moral principle sometimes very difficult. How do you act as a moral agent? Where do you draw the line? Some things may be acceptable to the culture, but there may be no way that I can enact my moral principles in engaging with that culture.
MATTHEW HENNESSEY: Thanks for chatting with me.
CELIA B. FISHER: You're very welcome.