Some doubts about medical ethics, and maybe that Russian vaccine is underrated

By Tyler Cowen

Most major questions in ethics are unsettled, though of course I have my own views, as do many other people.  I take that unsettledness as a fairly fundamental truth, I have been studying these matters for decades, and I even have several published articles in the top-ranked journal Ethics.

Now, if you take a whole group of people, give them medical licenses, teach them all more or less the same thing in graduate school, but not much other philosophy, and call it “medical ethics“…you have not actually gone much further.  Arguably you have retrogressed.

So when I hear people appeal to “medical ethics,” my intellectual warning bells go off.  To be sure, often I agree with those people, if only because I think contemporary American institutions often are not very flexible or able to execute effectively on innovations.  For instance, I didn’t think America could make a go at Robin Hanson’s variolation proposal, and so I opposed it.  “Medical ethics” seems to give the same instruction, though with less of a concrete institutional argument.

Still, the Lieutenant Colombo in me is bothered.  What about other nations?  Should we ever wish that they serve themselves up as medical ethics-violating guinea pigs, for the greater global good?

Medical ethics usually says no, or tries to avoid grappling with that question too directly.  But I wonder.

How about that Russian vaccine they will be trying in October?

To be clear, I won’t personally try it, and I don’t want the FDA to approve it for use in the United States.  But am I rooting for the Russians to try it this fall?  You betcha.  (Am I sure that is the correct ethical view?  No!  But I know the critics should not be sure either.)  I am happy to revise my views as further information comes in, but I see a good chance that  the attempt improves expected global welfare, and I think that is very often (but not always) a standard with strong and indeed decisive relevance.  And all the new results on cross-immunities imply that some pretty simple vaccines can have at least partial effectiveness.

Why exactly is “medical ethics” so sure this Russian vaccine is wrong other than that it violates “medical ethics”?  All relevant scenarios involve risk to millions of innocents, and I have not heard that Russians will be forced to take the vaccine.  The global benefits could be considerable, and I do note that the Russian vaccine scenario is the one that potentially spends down the reputational capital of various medical establishments.

Trying a not yet fully tested vaccine still seems wrong to many medical ethicists, even if the volunteers are compensated so they are better off in ex ante terms, as in some versions of Human Challenge Trials, an idea that (seemingly) has been elevated from “violating medical ethics” to a mere “problematic.”  Medical ethics claims priority over the ex ante Pareto principle, but I say we are back to the unsettled ethics questions on that one, but if anything with the truth leaning against medical ethics.

I find it especially strange when “medical ethics” is cited — often without further argumentation or explanation — on Twitter and other forms of social media as a kind of moral authority.  It then seems especially glaringly obvious that the moral consensus was never there in the first place, and that there is a gross and indeed now embarrassing unawareness of that underlying social fact.  It feels like citing Kant to the raccoon trying to claw through your roof.

I think medical ethics would not like this critique of medical ethics.  Yet I will be watching the Russian vaccine experiment closely.

Addendum: There is also biomedical ethics, but that would require a blog post of its own.  It is much more closely integrated with standard ethical philosophy, though it does not resolve any of the fundamental philosophical uncertainties.