Whilst Colin Parker and I are in broad disagreement we would nevertheless agree that RECs have both political and ethical functions, albeit to differing degrees, and that a proper account of ethical expertise needs to be given. The uses RECs make of ethical experts and expertise and the way in which this might be recognised remains, from my perspective, open for debate. My only conclusion is that it should be recognised.
References
1.
I also suspect we have differing conceptions of both the nature and the relationship between ‘ethics’ and ‘politics’. I would see the border between them as being both theoretically and practically blurred. Parker makes much of the political nature of the REC and I have not engaged with this here. I have also not engaged with his discussion of the engineering model. I would however like to draw on my expertise in this area and bring his attention to Caplan's (1980) consideration of the relevance and limits of the metaphor [2].
2.
CaplanAL. Ethical engineers need not apply: the state of applied ethics today. Science, Technology, & Human Values1980; 6(33): 24–32.
3.
It is of course perfectly reasonable to assume that my argument was ultimately aimed at providing ethical experts with places in RECs although I would note that this was not how my suggestion of the existence of expert patients was understood. Nevertheless one may quite legitimately ask if I am not advocating for ethical experts to be accorded such REC positions what then am I advocating for ethical expertise? I thus attempt to give some form to what I would imagine as being appropriate.
4.
EmmerichN. On the ethics committee: the expert member, the lay member and the absentee ethicist. Res Ethics Rev2009; 5(1): 9–13.
5.
On a related point Parker appears to suggest I think the necessarily related definition of lay and expert is, in itself, pejorative of the laity. This is not the case. I suggest that promoting the idea of a particular idea of ethical expert, that of a moralist, is pejorative of the laity which stands in relation to the notion of the moralist as an ethical expert. If, as Parker suggests, the moralist is indeed present on the REC then it came as no surprise that some of the things he says certainly seem pejorative of lay members of ethics committees. Parker appears to think lay members presence is required merely so that REC are not in danger of becoming a ‘branch of government’ although I am not sure why this might be a danger and as he later says that lay members are used by the government to achieve public acceptance of medical research it would seem that RECs, or at least their lay members, are indeed a branch of government. They are certainly a form of governance. He furthers that lay members are in some way ‘informal’ like ‘the public’ and ‘ethical standards’, by which he means ‘acceptable public standards’ and certainly not like formal medical ethics or standards which, he thinks, Doctors are the proper proprietors.
6.
Parker restricts his comments to medical Doctors but I assume he does not wish to exclude other medical professionals, particularly nurses, from gaining the contextualised insight from their own particular experiences of the medical field.
7.
McCulloughLB. John Gregory and the invention of professional medical ethics and the profession of medicine. Kluwer Academic Publishers, 1998.
8.
VeatchRM. Disrupted dialogue: medical ethics and the collapse of physician/humanist communication, 1770–1980. OUP USA, 2004.
9.
It is worth noting that Rothman offers a differing interpretation of the past 50 years of bioethics in his work ‘Strangers at the Bedside’ [10]. Whist Rothman and Veatch's interpretations are not diametrically opposed the certainly give rise to differing perspectives.
10.
RothmanD. Strangers at the bedside: a history of how law and bioethics transformed medical decision making. Aldine Transactions, 2003.
DyerSE. Applying bioethics: Local Research Ethics Committees and their regulation of medical research. Unpublished PhD Thesis: University of London, 2006.
18.
Interestingly Parker alludes to the knowledge one gains from participating in RECs and the importance of this for understanding what it is RECs do. Perhaps this and Dyers transformative process are related particularly when she says that lay members ‘certainly develop expertise through sitting on the committee’ [p.208].
