It is now three weeks since the UK voted to leave the European Union. This period has been filled with a great deal of anxious and often vituperative debate about the political, economic and social consequences of that decision. What, though, might it mean for bioethics?
Implications of Brexit for relationships with our regional neighbours
In significant ways the position of the UK has always been anomalous in the way it governs developments biomedicine and biotechnology. The British regulatory state, which grew up under both Conservative and Labour governments from the 1980s (and which the current government is committed to dismantling), has provided us with amenable – if not unproblematic – approaches to a number of public ethical problems (for example around assisted conception and human embryo research via the HFEA). These approaches, which have been widely envied, if not emulated, have arguably been enabled by a characteristically 'normal' distribution of British public opinion, the central mass of which tends to be cautiously progressive in outlook so long as it is reasonably confident in the probity of regulators (or deferential to them).
The UK has also enjoyed a number of historical advantages: the globally prominent and, in some cases, pioneering position of the UK research base in biology and biomedicine has meant that we have already had to confront many ethical challenges here before they arrive in other countries. This, in turn, has meant that the UK has provided either a template that other countries have been able to adapt or examples from which they have been able to learn. UK leadership in science and in bioethics have, therefore, gone hand in hand. The existence of a nationalised health service, again viewed with a mixture of pride and deference, has also insulated the UK from moral concerns that have affected countries that rely on private insurance-based health and care provision (concerns about of social justice and discrimination, for example, as a result of the use of genetic information). Of course, the safety of the NHS itself is another question.
Many in the research community are clearly now concerned about the impact of Brexit on the UK research sector, including the loss of funding and close collaborative opportunities. And the fantasy £350 million a week that was promised to the NHS has disappeared in a puff of smoke. Nevertheless, the discourse of contemporary scientific research remains international, even if its governance is largely national. And its lingua franca remains English, perhaps our greatest cultural export (albeit largely as a result of past colonial activities). Many of the concerns expressed may have more to do with UK competitiveness and technonationalism than the production of knowledge per se. So the ethical questions will remain; whether we generate innovations domestically or merely implement them in our laboratories, clinics and fields, we will still have to confront them on home soil. Regardless, therefore, of the effects of Brexit on UK science, whether we retain the capacity to do so effectively, via government institutions where the capacity among officials, already severely diminished, may be effectively decimated by the challenges of managing a Brexit, or in academic and charitable institutions suffering funding cuts or economic impacts, must be a cause for concern.
Implications of Brexit for institutional bioethics
As with scientific research there is an international bioethics infrastructure that operates through a number of professional societies, international organisations and NGOs. The Nuffield Council was a major sponsor and active participant in the recent International Association of Bioethics 13th World Congress, held in Edinburgh. We are also engaged in a number of initiatives at the Council of Europe: as expert participants in work on emerging technologies (using the experience of our work on Emerging Biotechnologies), and organ donation (making use of our work on Human Bodies). We also provide UK representation on the Council of Europe Bioethics Committee, the group that elaborates international law and guidance around the Convention on Human Rights and Biomedicine (Oviedo Convention), which is part of same legal architecture as the European Convention on Human Rights (ECHR). The fact that Brexit may entail extrication from the ECHR was, of course, a popular canard during the referendum campaign: while adoption of the ECHR is a condition of membership of the EU, withdrawing from the EU does not entail either a repudiation of the human rights Convention or withdrawal from the Council of Europe, although these are questions that may fall to be addressed in due course.
However, there are a number of other debating chambers from which the UK may now become distanced. The place of the UK in the European National Ethics Committee Forum, sponsored by the European Commission’s Directorate General Research and Innovation (which, ironically, the UK was due to host when it assumes the rotating Presidency of the European Council of Ministers for the second half of 2017) must now be compromised. The European Group on Ethics, which informs the Bureau of European Policy Advisors, who advise the President of the European Commission, will no longer accommodate British representation. At a global level, the involvement of the UK in UNESCO committees (the International Bioethics Committee and Intergovernmental Bioethics Committee) should be unaffected by the disalignment (the UK does not currently have representation at the IGBC in any case), although the effect of Brexit on political alignments among committee members, which can make a significant difference to the built-in scope for interpretation of their instruments, is hard to predict.
Nevertheless, as scientific research, social change and bioethical challenges continue to be indifferent to national boundaries, there is no reason for the Nuffield Council to alter the established arrangement to hold annual trilateral meetings with the French and German bioethics committees, or to cease to maintain and develop the many fruitful bilateral relationships we have with other groups and institutions around the world.
The problem for democratic governance.
In Homo Sacer, sovereign power and bare life, the philosopher Giorgio Agamben concludes that "Western politics is a biopolitics from the very beginning, and that every attempt to found political liberties in the rights of the citizen is, therefore, in vain." Agamben’s work is principally orientated as a genealogy of sovereign power and a critique of its practices. Nevertheless, inasmuch as the outcome of the recent referendum turned on issues of immigration and national sovereignty it is tempting to see it as biopolitics at its most distilled: as being essentially about the movement, control and inscription of bodies, and about an act of exclusion as the foundational moment of a simulacrum of sovereignty.
Biopolitics concerns the normative exercise of organised power over human bodies and life processes; bioethics concerns normative judgements about the practices and uses of biotechnology and biomedicine. Now, biomedicine and biotechnologies act, directly or indirectly, on human bodies and are, in many cases, determined by decisions at a public level. So it is worth reflecting on what this ur-political or anti-political – and, perhaps (therefore?), biopolitical – act of Brexit might mean for the modes of bioethics more fundamentally.
The referendum result is undoubtedly a problem for those committed to democratic forms of political governance but who nevertheless find the result difficult to accept. And it is similarly a challenge for those of us who would put forward an approach to public moral questions that rejects Enlightenment humanism but, equally, refuses the embrace of aseptic utilitarianism. I would argue that the challenge that emerges, though, arises not because the referendum process was undemocratic (though undemocratic it may have been) but because it was, seemingly, antipolitical.
It is churlish to say that the referendum produced the 'wrong' result (although not so to say that the referendum was an unforced moral error in the first place). The virtues, difficulties and dangers of relying on procedural approaches to resolving contested questions of collective decision making are well rehearsed, and the poverty of aggregative approaches – like a referendum on a single, simple question – likewise. Public-level bioethics often performs a conjuring trick by which ‘morally perverse’ outcomes are proscribed by higher-order principles that are ‘bootstrapped’ into the process: supposedly more-or-less implied in, and therefore more-or-less inferable from, the existence of the state itself. Human rights, especially, are customarily used as a guard rail, a cordon around the abyss. Despite appeals to intergenerational justice and how that might bear on the franchise, no such cordon circumscribed the Brexit vote.
The implications of belonging to or leaving the European Union are complex, and the absence of a positive prospectus for departure, evident in the aftermath, should always have been a warning. To speak in another register: it is doubtful that the referendum result would represent the informed consent of the British people to Brexit. Sovereignty, for a country as much as autonomy for a person, depends less on having a choice than on having options – better, on being able to create the options through concerted, organised will. The political crisis has produced a fissure in the relation between the public sphere and sections of the citizenry, and the frantic archeology of its conditions of possibility has revealed a molten core of unmediatised negativity in place of a ground of possible engagement. In raising the question of withdrawal from the EU in this way, the British state is broaching a 'zone of indistinction' between politics and its outside, a singularity marked by the collapse of politics, extreme unpredictability, and the spectre of a reign of terror. If Agamben is right, this is the site both of the abolition and foundation of politics: what is important now is not the position we have reached but the orientation by which we move through it.
Bioethics relates to many different areas and it is a mistake to think events such as Brexit will have an equal influence on issues as diverse as human embryo research, end-of-life care, use of personal data, or involvement of children in research etc. etc. The impact will be felt differently and in some cases may be negative and in some cases positive.
For those who have a concern for the protection of the human embryo in biomedical research, the French and German models have always been more appealing than that of the UK. Indeed, the UK has been a very assertive and, from this perspective, a malign influence on ethics and funding decisions in the EU. Its influence is analogous to (and arguably an expression of) the promotion of free market economic models by successive UK governments.
In this area at least the lessening on UK influence within the EU could have a great impact and encourage forms of cell and tissue research that do not presuppose destruction of human embryos. This would get my vote.