Tag Archives: professional ethics

Blogging and recycling: thoughts on the ethics of reuse.

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Owing to summer-session teaching and a sprained ankle, I have been less attentive to the churn of online happenings than I usually am, but an email from SciCurious brought to my attention a recent controversy about a blogger’s “self-plagiarism” of his own earlier writing in his blog posts (and in one of his books).

SciCurious asked for my thoughts on the matter, and what follows is very close to what I emailed her in reply this morning. I should note that these thoughts were composed before I took to the Googles to look for links or to read up on the details of the particular controversy playing out. This means that I’ve spoken to what I understand as the general lay of the ethical land here, but I have probably not addressed some of the specific details that people elsewhere are discussing.

Here’s the broad question: Is it unethical for a blogger to reuse in blog posts material she has published before (including in earlier blog posts)?

A lot of people who write blogs are using them with the clear intention (clear at least to themselves) of developing ideas for “more serious” writing projects — books, or magazine articles or what have you. I myself am leaning heavily on stuff I’ve blogged over the past seven-plus years in writing the textbook I’m trying to finish, and plan similarly to draw on old blog posts for at least two other books that are in my head (if I can ever get them out of my head and into book form).

That this is an intended outcome is part of why many blog authors who are lucky enough get paying blogging gigs, especially those of us from academia, fight hard for ownership of what they post and for the explicit right to reuse what they’ve written.

So, I wouldn’t generally judge reuse of what one has written in blog posts as self-plagiarism, nor as unethical. Of course, my book(s) will explicitly acknowledge my blogs as the site-of-first-publication for earlier versions of the arguments I put forward. (My book(s) will also acknowledge the debt I owe to commenters on my posts who have pushed me to think much more carefully about the issues I’ve posted on.)

That said, if one is writing in a context where one has agreed to a rule that says, in effect, “Everything you write for us must be shiny and brand-new and never published by you before elsewhere in any form,” then one is obligated not to recycle what one has written elsewhere. That’s what it means to agree to a rule. If you think it’s a bad rule, you shouldn’t agree to it — and indeed, perhaps you should mount a reasoned argument as to why it’s a bad rule. Agreeing to follow the rule and then not following the rule, however, is unethical.

There are venues (including the Scientific American Blog Network) that are OK with bloggers of long standing brushing off posts from the archives. I’ve exercised this option more than once, though I usually make an effort to significantly update, expand, or otherwise revise those posts I recycle (if for no other reason than I don’t always fully agree with what that earlier time-slice of myself wrote).

This kind of reuse is OK with my corporate master. Does that necessarily make it ethical?

Potentially it would be unethical if it imposed a harm on my readers — that is, if they (you) were harmed by my reposting those posts of yore. But, I think that would require either that I had some sort of contract (express or implied) with my readers that I only post thoughts I have never posted before, or that my reposts mislead them about what I actually believe at the moment I hit the “publish” button. I don’t have such a contract with my readers (at least, I don’t think I do), and my revision of the posts I recycle is intended to make sure that they don’t mislead readers about what I believe.

Back-linking to the original post is probably good practice (from the point of view of making reuse transparent) … but I don’t always do this.

One reason is that the substantial revisions make the new posts substantially different — making different claims, coming to different conclusions, offering different reasons. The old post is an ancestor, but it’s not the same creature anymore.

Another reason is that some of the original posts I’m recycling are from my ancient Blogspot blog, from whose backend I am locked out after a recent Google update/migration — and I fear that the blog itself may disappear, which would leave my updated posts with back-links to nowhere. Bloggers tend to view back-links to nowhere as a very bad thing.

The whole question of “self-plagiarism” as an ethical problem is an interesting one, since I think there’s a relevant difference between self-plagiarism and ethical reuse.

Plagiarism, after all, is use of someone else’s words or ideas (or data, or source-code, etc.) without proper attribution. If you’re reusing your own words or ideas (or whatnot), it’s not like you’re misrepresenting them as your own when they’re really someone else’s.

There are instances, however, where self-reuse presents gets people rightly exercised. For example, some scientists reuse their own stuff to create the appearance in the scientific literature that they’ve conducted more experimental studies than they actually have, or that there are more published results supporting their hypotheses than there really are. This kind of artificial multiplication of scientific studies is ethically problematic because it is intended to mislead (and indeed, may succeed in misleading), not because the scientists involved haven’t given fair credit to the earlier time-slices of themselves. (A recent editorial for ACS Nano gives a nice discussion of other problematic aspects of “self-plagiarism” within the context of scientific publishing.)

The right ethical diagnosis of the controversy du jour may depend in part on whether journalistic ethics forbid reuse (explicitly or implicitly) — and if so, on whether (or in what conditions) bloggers count as journalists. At some level, this goes beyond what is spelled out in one’s blogging contract and turns also on the relationship between the blogger and the reader. What kind of expectations can the reader have of the blogger? What kind of expectations ought the reader to have of the blogger? To the extent that blogging is a conversation of a sort (especially when commenting is enabled), is it appropriate for that conversation to loop back to territory visited before, or is the blogger obligated always to break new ground?

And, if the readers are harmed when the blogger recycles her own back-catalogue, what exactly is the nature of that harm?

Is how to engage with the crackpot at the scientific meeting an ethical question?

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There’s scientific knowledge. There are the dedicated scientists who make it, whether laboring in laboratories or in the fields, fretting over data analysis, refereeing each other’s manuscripts or second-guessing themselves.

And, well, there are some crackpots.

I’m not talking dancing-on-the-edge-of-the-paradigm folks, nor cheaters who seem to be on a quest for fame or profit. I mean the guy who has the wild idea for revolutionizing field X that actually is completely disconnected from reality.

Generally, you don’t find too much crackpottery in the scientific literature, at least not when peer review is working as it’s meant to. The referees tend to weed it out. Perhaps, as has been suggested by some critics of peer review, referees also weed out cutting edge stuff because it’s just so new and hard to fit into the stodgy old referees’ picture of what counts as well-supported by the evidence, or consistent with our best theories, or plausible. That may just be the price of doing business. One hopes that, eventually, the truth will out.

But where you do see a higher proportion of crackpottery, aside from certain preprint repositories, is at meetings. And there, face to face with the crackpot, the gate-keepers may behave quite differently than they would in an anonymous referee’s report.

Doctor Crackpot gives a talk intended to show his brilliant new solution to a nagging problem with an otherwise pretty well established theoretical approach. Jaws drop as the presentation proceeds. Then, finally, as Doctor Crackpot is aglow with the excitement of having broken the wonderful news to his people, he entertains questions.

Crickets chirp. Members of the audience look at each other nervously.

Doctor Hardass, who has been asking tough questions of presenters all day, tentatively asks a question about the mathematics of this crackpot “solution”. The other scholars in attendance inwardly cheer, thinking, “In about 10 seconds Doctor Hardass will have demonstrated to Doctor Crackpot that this could never work! Then Doctor Crackpot will back away from this ledge and reconsider!”

Ten minutes later, Doctor Crackpot is still writing equations on the board, and Doctor Hardass has been reduced to saying, “Uh huh …” Scholars start sneaking out as the chirping of the crickets competes with the squeaking of the chalk.

Granted, no one wants to hurt Doctor Crackpot’s feelings. If it’s a small enough meeting, you all probably had lunch with him, maybe even drinks the night before. He seems like a nice guy. He doesn’t seem dangerously disconnected from reality in his everyday interactions, just dangerously disconnected from reality in the neighborhood of this particular scientific question. And, as he’s been toiling in obscurity at a little backwater institution, he’s obviously lonely for scientific company and conversation. So, calling him out as a crackpot seems kind of mean.

But … it’s also a little mean not to call him out. It can feel like you’re letting him wander through the scientific community with the equivalent of spinach in his teeth while trailing toilet paper from his shoe if you leave him with the impression that his revolutionary idea has any merit. Someone has to set this guy straight … right? If you don’t, won’t he keep trying to sell this crackpot idea at future meetings?

For what it’s worth, as someone who attends philosophy conferences as well as scientific ones (plus an interesting assortment of interdisciplinary conferences of various sorts), I can attest that there is the occasional crackpot presentation from a philosopher. However, the push-back from the philosophers during the Q&A seemed much more vigorous, and seemed also to reflect a commitment that the crackpot presenter could be led back to reality if only he would listen to the reasoned arguments presented to him by the audience.

In theory, you’d expect to see the same kind of commitment among scientists: if we can agree upon the empirical evidence and seriously consider each other’s arguments about the right theoretical framework in which to interpret it, we should all end up with something like agreement on our account of the world. Using the same sorts of knowledge-building strategies, the same standards of evidence, the same logical machinery, we should be able to build knowledge about the world that holds up against tests to which others subject it — and, we should welcome that testing, since the point of all this knowledge-building is not to win the argument but to build an account that gets the world right.

In theory, the scientific norms of universalism and organized skepticism would ensure that all scientific ideas (including the ones that are en face crackpot ideas) get a fair hearing, but that this “fair hearing” include rigorous criticism to sort out the ideas worthy of further attention. (These norms would also remind scientists that any member of the scientific community has the potential to be the source of a fruitful idea, or of a crackpot idea.)

In practice, though, scientists pick their battles, just like everyone else. If your first ten-minute attempt at reaching a fellow scientist with rigorous criticism shows no signs of succeeding, you might just decide it’s too big a job to tackle before lunch. If repeated engagements with a fellow scientist suggest that he seems not to comprehend the arguments against his pet theory — and maybe that he doesn’t fully grok how the rest of the community understands the standards and strategies for scientific knowledge-building — you may have to make a calculation about whether bringing him back to the fold is a better use of your time and effort than, say, putting more time into your own research, or offering critiques to scientists who seem to understand them and take them seriously.

This is a sensible way to get through a day which seems to have too few hours for all the scientific knowledge-building there is to do, but it might have an impact on whether the scientific community functions in the way that best supports the knowledge-building project.

In the continuum of “scientific knowledge”, on whose behalf scientists are sworn to uphold standards and keep out the dross, where do meetings fall? Do the scientists in attendance have any ethical duty to give their candid assessments of crackpottery to the crackpots? Or is it OK to just snicker about it at the bar? If there’s no obligation to call the crackpot out, does that undermine the value of meetings as sources of scientific knowledge, or of the scientific communications needed to build scientific knowledge?

Could a rational decision not to engage with crackpots in one’s scientific community (because the return on the effort invested is likely to be low) morph into avoidance of other scientists with weird ideas that actually have something to them? Could it lead to avoidance of serious engagement with scientists one thinks are mistaken when it might take serious effort to spell out the nature of the mistakes?

And is there any obligation from the scientific community either to accept the crackpots as fully part of the community (meaning that their ideas and their critiques of the ideas of other ought to be taken seriously), or else to be honest with them that, while they may subscribe to the same journals and come to the same meetings, the crackpots are Not Our Kind, Dear?

Reading “White Coat, Black Hat” and discovering that ethicists might be black hats.

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During one of my trips this spring, I had the opportunity to read Carl Elliott’s book White Coat, Black Hat: Adventures on the Dark Side of Medicine. It is not always the case that reading I do for my job also works as riveting reading for air travel, but this book holds its own against any of the appealing options at the airport bookstore. (I actually pounded through the entire thing before cracking open the other book I had with me, The Girl Who Kicked the Hornet’s Nest, in case you were wondering.)

Elliott takes up a number of topics of importance in our current understanding of biomedical research and how to do it ethically. He considers the role of human subjects for hire, of ghostwriters in the production of medical papers, of physicians who act as consultants and spokespeople for pharmaceutical companies, and of salespeople for the pharmaceutical companies who interact with scientists and physicians. There are lots of important issues here, engagingly presented and followed to some provocative conclusions. But the chapter of the book that gave me the most to think about, perhaps not surprisingly, is the chapter called “The Ethicists”.

You might think, since Elliott is writing a book that points out lots of ways that biomedical research could be more ethical, that he would present a picture where ethicists rush in and solve the problems created by unwitting research scientists, well-meaning physicians, and profit driven pharmaceutical company. However, Elliott presents instead reasons to worry that professional ethicists will contribute to the ethical tangles of the biomedical world rather than sorting them out. Indeed Elliott identifies what seem to be special vulnerabilities in the psyche of the professional ethicist. For example, he writes, “There is no better way to enlist bioethicists in the cause of consumer capitalism than to convince them they are working for social justice.” (139-140) Who, after all, could be against social justice? Yet, when efforts on behalf of social justice takes the form of debates on television news programs about fair access to new pharmaceuticals, the big result seems to be free advertising for the companies making those pharmaceuticals. Should bioethicists be accountable for these unforeseen results? This chapter suggests that careful bioethicists ought to foresee them, and to take responsibility.

There is an irony in professionals who see part of their job as pointing out conflicts of interest to others that they may be placing themselves right in the path of equally overwhelming conflicts of interest. Some of these have to do with the practical problem of how to fund their professional work. Universities these days are struggling with reduced budgets, which means they are encouraging their faculty to be more entrepreneurial — including by cultivating relationships that might lead to donations from the private sector. To the extent that bioethics is seen as relevant to pharmaceutical development, pharmaceutical companies, which have deeper pockets than do universities, are seen as attractive targets for fundraising.

As Elliott notes, bioethicists have seen a great deal of success in this endeavor. He writes,

For the last three decades bioethics has been vigorously generating new centers, new commissions, new journals, and new graduate programs, not to mention a highly politicized role in American public life. In the same way that sociologists saw their fortunes climb during the 1960s as the public eye turned towards social issues like poverty, crime, and education, bioethics started to ascend when medical care and scientific research began generating social questions of their own. As the field grows more prominent, bioethicists are considering a funding model familiar to the realm of business ethics, one that embraces partnership and collaboration with corporate sponsors as long as outright conflict of interest can be managed. …

Corporate funding present a public relations challenge, of course. It looks unseemly for an ethicist to share in the profits of arms dealers, industrial polluters, or multinationals that exploit the developing world. Credibility is also a concern. Bioethicist teach about pharmaceutical company issues in university classrooms, write about those issues in books and articles, and comment on them in the press. Many bioethicists evaluate industry policies and practices for professional boards, government bodies, and research ethics committees. To critics, this raises legitimate questions about the field of bioethics itself. Where does the authority of ethicists come from, and why are corporations so willing to fund them? (140-141)

That comparison of bioethics to business, by the way, is the kind of thing that gets my attention; one of the spaces frequently assigned for “Business and Professional Ethics” courses at my university is the Arthur Anderson Conference Room. Perhaps this is a permanent teachable moment, but I can’t help worry that really the lesson has to do with the vulnerability of the idealistic academic partner in the academic-corporate partnership.

Where does the authority of ethicist come from? I have scrawled in the margin something about appropriate academic credentials and good arguments. But connect this first question to Elliott’s second question: why are corporations so willing to fund them? Here, we need to consider the possibility that their credibility and professional status is, in a pragmatic sense, directly linked to corporations paying bioethicists for their labors. What, exactly, are those corporations paying for?

Let’s put that last question aside for a moment.

Arguably, the ethicist has some skills and training that render her a potentially useful partner for people trying to work out how to be ethical in the world. One hopes what she says would be informed by some amount of ethical education, serious scholarship, and decision-making strategies grounded in a real academic discipline.

Elliott notes that “[s]ome scholars have recoiled, emphatically rejecting the notion that their voices should count more than others’ on ethical affairs.” (142) Here, I agree if the claim is, in essence, that the interests of the bioethicists are no more important than others’. Surely the perspectives of others who are not ethicists matter, but one might reasonably expect that ethicists can add value, drawing on their experience in taking those interests, and the interest of other stakeholders, into account to make reasonable ethical decisions.

Maybe, though, those of us who do ethics for a living just tell ourselves we are engaged in a more or less objective decision-making process. Maybe the job we are doing is less like accounting and more like interpreting pictures in inkblots. As Elliott writes,

But ethical analysis does not really resemble a financial audit. If a company is cooking its books and the accountant closes his eyes to this fact in his audit, the accountant’s wrongdoing can be reliably detected and verified by outside monitors. It is not so easy with an ethics consultant. Ethicists have widely divergent views. They come from different religious standpoints, use different theoretical frameworks, and profess different political philosophies. Also free to change their minds at any point. How do you tell the difference between an office consultant who has changed her mind for legitimate reasons and one who has changed her mind for money? (144)

This impression of the fundamental squishiness of the ethicist’s stock in trade seems to be reinforced in a quote Elliott takes from biologist-entrepreneur Michael West: “In the field of ethics, there are no ground rules, so it’s just one ethicist opinion versus another ethicist’s opinion. You’re not getting whether someone is right or wrong, because it all depends on who you pick.” (144-145)

Here, it will probably not surprise you to learn that I think these claims are only true when the ethicists are doing it wrong.

What, then, would be involved in doing it right? To start with, what one should ask from an ethicist should be more than just an opinion. One should also ask for an argument to support that opinion, an argument that makes reference to important details like interested parties, potential consequences of the various options for action on the table, the obligations the party making the decisions to the stakeholders, and so forth — not to mention consideration of possible objections to this argument. It is fair, moreover, to ask the ethicist whether the recommended plan of action it is compatible with more than one ethical theory — or, for example, if it only works in the world we are sharing solely with other Kantians.

This would not make auditing the ethical books as easy as auditing the financial statements, but I think it would demonstrate something like rigor and lend itself to meaningful inspection by others. Along the same lines, I think it would be completely reasonable, in the case that an ethicist has gone on record as changing her mind, to ask for the argument that brought her from one position to the other. It would also be fair to ask, what argument or evidence might bring you back again?

Of course, all of this assumes an ethicist arguing in good faith. It’s not clear that what I’ve described as crucial features of sound ethical reasoning couldn’t be mimicked by someone who wanted to appear to be a good ethicist without going to the trouble of actually being one.

And if there’s someone offering you money — maybe a lot of money — for something that looks like good ethical reasoning, is there a chance you could turn from an ethicist arguing in good faith to one who just looks like she is, perhaps without even being aware of it herself?

Elliott pushes us to examine whether the dangers that may lurk when the private-sector interests are willing to put up money for your ethical insight. Have they made a point of asking for your take primarily because your paper-trail of prior ethical argumentation lines us really well with what they would like an ethicist to say to give them cover to do what they already want to do — not because it’s ethical, necessarily, but because it’s profitable or otherwise convenient? You may think your ethical stances are stable because they are well-reasoned (or maybe even right). But how can you be sure that the stability of your stance is not influenced by the size of your consultation paycheck? How can you tell that you have actually been solicited for an honest ethical assessment — one that, potentially, could be at odds with what the corporation soliciting it wants to hear? If you tell that corporation that a certain course of action would be unethical, do you have any power to prevent them from pursuing that course of action? Do you have an incentive to tell the corporation what it wants to hear, not just to pick up your consulting fee, but to keep a seat at the table where you might hope to have a chance of nudging its behavior in a more ethical direction, even if only incrementally?

None of these are easy questions to answer objectively if you’re the ethicist in the scenario.

Indeed, even if money were not part of the equation, the very fact that people at the corporations — or researchers, or physicians, or whoever it is seeking the ethicists’ expertise — are reaching out to ethicists and identifying them as experts with something worthwhile to contribute might itself make it harder for the ethicists to deliver what they think they should. As Elliott argues, the personal relationships may end up creating conflicts of interest that are at least as hard to manage as those that occur when money changes hands. These people asking for our ethical input seem like good folks, motivated at least in part by goals (like helping people with disease) that are noble. We want them to succeed. And we kind of dig that they seem interested in what we have to say. Because we end up liking them as people, we may find it hard to tell them things they don’t want to hear.

And ultimately, Elliott is arguing, barriers to delivering news that people don’t want to hear — whether those barriers come from financial dependence, the professional prestige that comes when your talents are in demand, or developing personal relationships with the people you’re advising — are barriers to being a credible ethicist. Bioethics becomes “the public relations division of modern medicine” (151) rather than carrying on the tradition of gadflies like Socrates. If they were being Socratic gadflies and telling truth to power, Elliott suggests, we would surely be able to find at least a few examples of bioethics who were punished for their candor. Instead, we see the ties between ethicists and the entities they advise growing closer.

This strikes close to home for me, as I aspire to do work in ethics that can have real impacts on the practice of scientific knowledge-building, the training of new scientists, the interaction of scientists with the rest of the world. On the one hand, it seems to help me to understand the details of scientific activity, and the concerns of scientists and scientific trainees. But, if I “go native” in the tribe of science, Elliott seems to be saying that I could end up dropping the ball as far as what it means to make the kind of contribution a proper ethicist should:

Bioethicists have gained recognition largely by carving out roles as trusted advisers. But embracing the role of trusted adviser means forgoing other potential roles, such as that of the critic. It means giving up on pressuring institutions from the outside, in the manner of investigative reporters. As bioethicists seek to become trusted advisers, rather than gadflies or watchdogs, it will not be surprising if they slowly come to resemble the people they are trusted to advise. And when that happens, moral compromise will be unnecessary, because there will be little left to compromise. (170)

This is strong stuff — the kind of stuff which, if taken seriously, I hope can keep me on track to offer honest advice even when it’s not what the people or institutions to whom I’m offering it want to hear. Heeding the warnings of a gadfly like Carl Elliott might just help an ethicist do what she has to do to be able to trust herself.

Health care provider and patient/client: situations in which fulfilling your ethical duties might not be a no-brainer.

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Thanks in no small part to the invitation of the fantastic Doctor Zen, I was honored this past week to be a participant in the PACE 3rd Annual Biomedical Ethics Conference. The conference brought together an eclectic mix of people who care about bioethics: nurses, counselors, physicians, physicians’ assistants, lawyers, philosophers, scientists, students, professors, and people practicing their professions out “in the world”.*

As good conferences do, this one left me with a head full of issues with which I’m still grappling. So, as bloggers sometimes do, I’m going to put one of those issues out there and invite you to grapple with it, too.

A question that kept coming up was what exactly it means for a health care provider (broadly construed) to fulfill hir duties to hir patient/client.

Of course, the folks in the ballroom could rattle off the standard ethical principles that should guide their decision-making — respect for persons (which includes respect for the autonomy of the patient-client), beneficence, non-maleficence, justice — but sometimes these principles seem to pull in different directions, which means just what one should do when the rubber hits the road is not always obvious.

For example:

1. In some states, health care professionals are “mandatory reporters” of domestic violence — that is, if they encounter a patient who they have reason to believe is a victim of domestic violence, they are obligated by law to report it to the authorities. However, it is sometimes the case that getting the case into the legal system triggers retaliatory violence against the victim by the abuser. Moreover, in the aftermath of reporting, the victim may be less willing (or able) to seek further medical care. Is the best way to do one’s duty to one’s patient always to report? Or are their instances where one better fulfills those duties by not reporting (and if so, what are the foreseeable costs of such a course of action — to that patient, to the health care provider, to other patients, to the larger community)?

2. A patient with a terminal illness may feel that the best way for hir physician to respect hir autonomy would be to assist hir in ending hir life. However, physician-assisted suicide is usually interpreted as clearly counter to the requirements of non-maleficence (“do no harm”) and beneficence. In most of the U.S., it’s also illegal. Can a physician refuse to provide the patient in this situation with the sought-after assistance without being paternalistic?** Is it fair game for the physician’s discussion with the patient here to touch on personal values that it might not be fair for the patient to ask the physician to compromise? Are there foreseeable consequences of what, to the patient, looks like a personal choice that might impact the physician’s relationship with other patients, with hir professional community, or with the larger community?

3. In Texas, the law currently requires that patients seeking abortions must submit to transvaginal ultrasounds first. In other words, the law requires health care provider to subject patient to a medically unnecessary invasive procedure. The alternative is for the patient to carry to term an unwanted pregnancy. Both choices, arguably, subject the patient to violence.

Does the health care provider who is trying to uphold hir obligations to hir patient have an obligation to break the law? If it’s a bad law — here, one whose requirements make it impossible for a health care provider to fulfill hir duties to patients — ought health care providers to put their own skin in the game to change it?

Here’s what I’ve written before about how ethically to challenge bad rules:

If you’re part of a professional community, you’re supposed to abide by the rules set by the commissions and institutions governing your professional community.

If you don’t think they’re good rules, of course, one of the things you should do as a member of that professional community is make a case for changing them. However, in the meantime making yourself an exception to the rules that govern the other members of your professional community is pretty much the textbook definition of an ethical violation.

The gist here is that sneakily violating a bad rule (perhaps even while paying lip service to following it) rather that standing up and explicitly arguing against the bad rule — not just when it’s applied to you but when it’s applied to anyone else in your professional community — is wrong. It does nothing to overturn the bad rule, it involves you in deception, and it prioritizes your interests over everyone else’s.

The particular situation here is tricky, though, given that as I understand it the Texas law is a rule imposed on medical professionals by lawmakers, not a rule that the community of medical professionals created and implemented themselves the better to help them fulfill their duties to their patients. Indeed, it seems pretty clear that the lawmakers were willing to sacrifice duties that are absolutely central in the physician-patient relationship when they imposed this law.

Moreover, I think the way forward is complicated by concerns about how to ensure that patients get care that is helpful, not harmful, to them. If Texas physicians who opposed the mandatory transvaginal ultrasound requirement were to fill the jails to protest the law, who does that leave to deliver ethical care to people on the outside seeking abortions? Is this a place where the professional community as a whole ought to be pushing back against the law rather than leaving it to individual members of that community to push back?

* * * * *

If these examples have common threads, one of them is that what the law requires (or what the law allows) seems not to line up neatly with what our ethics require. Perhaps this speaks to the difficulty of getting laws to capture the tricky balancing act that acting ethically towards one’s patients/clients requires of health care professionals. Or, maybe it speaks to law makers not always being focused on creating an environment in which health care providers can deliver on their ethical duties to their patients/clients (perhaps even disagreeing with professional communities about just what those ethical duties are).

What does this mismatch mean for what patients/clients can legitimately expect from their health care providers? Or for what health care providers can realistically deliver to their patients/clients?

And, if you were a health care provider in one of these situations, what would you do?
_____
*Arguably, however, universities and their denizens are also in the world. We share the same fabric of space-time as the rest of y’all.

**Note that paternalism is likely warranted in a number of circumstances. However, when we’re talking about a patient of sound mind, maybe paternalism shouldn’t be the physician’s go-to stance.

The Research Works Act: asking the public to pay twice for scientific knowledge.

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There’s been a lot of buzz in the science blogosphere recently about the Research Works Act, a piece of legislation that’s been introduced in the U.S. that may have big impacts on open access publishing of scientific results. John Dupuis has an excellent round-up of posts on the subject. I’m going to add my two cents on the overarching ethical issue.

Here’s the text of the Research Works Act:

No Federal agency may adopt, implement, maintain, continue, or otherwise engage in any policy, program, or other activity that–

(1) causes, permits, or authorizes network dissemination of any private-sector research work without the prior consent of the publisher of such work; or

(2) requires that any actual or prospective author, or the employer of such an actual or prospective author, assent to network dissemination of a private-sector research work. …

In this Act:

(1) AUTHOR- The term ‘author’ means a person who writes a private-sector research work. Such term does not include an officer or employee of the United States Government acting in the regular course of his or her duties.

(2) NETWORK DISSEMINATION- The term ‘network dissemination’ means distributing, making available, or otherwise offering or disseminating a private-sector research work through the Internet or by a closed, limited, or other digital or electronic network or arrangement.

(3) PRIVATE-SECTOR RESEARCH WORK- The term ‘private-sector research work’ means an article intended to be published in a scholarly or scientific publication, or any version of such an article, that is not a work of the United States Government (as defined in section 101 of title 17, United States Code), describing or interpreting research funded in whole or in part by a Federal agency and to which a commercial or nonprofit publisher has made or has entered into an arrangement to make a value-added contribution, including peer review or editing. Such term does not include progress reports or raw data outputs routinely required to be created for and submitted directly to a funding agency in the course of research.

(Bold emphasis added.)

Let’s take this at the most basic level. If public money is used to fund scientific research, does the public have a legitimate expectation that the knowledge produced by that research will be shared with the public? If not, why not? (Is the public allocating scarce public funds to scientific knowledge-building simply to prop up that sector of the economy and/or keep the scientists off the streets?)

Assuming that the public has the right to share in the knowledge built on the public’s dime, should the public have to pay to access that knowledge (at around $30 per article) from a private sector journal? The text of the Research Works Act suggests that such private sector journals add value to the research that they publish in the form of peer review and editing. Note, however, that peer review for scientific journals is generally done by other scientists in the relevant field for free. Sure, the journal editors need to be able to scare up some likely candidates for peer reviewers, email them, and secure their cooperation, but the value being added in terms of peer reviewing here is added by volunteers. (Note that the only instance of peer reviewing in which I’ve participated where I’ve actually been paid for my time involved reviewing grant proposals for a federal agency. In other words, the government doesn’t think peer review should be free … but a for-profit publishing concern can help itself to free labor and claim to have added value by virtue of it.)

Maybe editing adds some value, although journal editors of private sector journals have been taken to task for favoring flashy results, and for occasionally subverting their own peer review process to get those flashy results published. But there’s something like agreement that the interaction between scientists that happens in peer review (and in post-publication discussions of research findings) is what makes it scientific knowledge. That is to say, peer review is recognized as the value-adding step science could not do without.

The public is all too willing already to see public money spent funding scientific research as money wasted. If members of the public have to pay again to access research their tax dollars already paid for, they are likely to be peeved. They would not be wrong to feel like the scientific community had weaseled out of fulfilling its obligation to share the knowledge it builds for the good of the public. (Neither would they be wrong to feel like their government had fallen down on an ethical obligation to the public here, but whose expectations of their government aren’t painfully low at the moment?) A rightfully angry public could mean less public funding for scientific research — which means that there are pragmatic, as well as ethical, reasons for scientists to oppose the Research Works Act.

And, whether or not the Research Works Act becomes the law of the land in the USA, perhaps scientists’ ethical obligations to share publicly funded knowledge with the public ought to make them think harder — individually and as a professional community — about whether submitting their articles to private sector journals, or agreeing to peer review submission for private sector journals, is really compatible with living up to these obligations. There are alternatives to these private sector journals, such as open access journals. Taking those alternatives seriously probably requires rethinking the perceived prestige of private sector journals and how metrics of that prestige come into play in decisions about hiring, promotion, and distribution of research funds, but sometimes you have to do some work (individually and as a professional community) to live up to your obligations.