Saturday, June 30, 2012
But not the aftermath everyone is talking about—that’s the aftermath of the Supreme Court’s ruling on ACA. To the extraordinary outpouring of commentary, I really have just two things to say about the decision. The first is enormous relief that most of the statute remains intact. The second is unexpected admiration for the Chief Justice’s opinion, which is a marvelously-crafted reflection on federalism. Whether one agrees or disagrees with its conclusions—especially the limited reading of the Commerce Clause—there is much to praise about the delicate balance struck between federal powers, state powers, and the role of the Court. It’s a magisterial, coherent, deft reading of US federalism, setting out a likely vision for the years ahead.
Instead, this post is about the aftermath of the International Association of Bioethics meeting in Rotterdam. IAB is the organization for bioethics around the world; it meets every two years, with impressive satellite meetings such as FAB (Feminist Approaches to Bioethics). Any health law professor with interests in the intersection between law and bioethics should know about IAB. This year’s meeting was the first back in the Netherlands since the Association’s founding meeting 22 years ago. In addition to the satellite FAB meeting, satellite sessions also included a conference organized by the World Medical Association on possible revisions to the Declaration of Helsinki, a session organized to plan international collaboration for genetics and society research, a session on “nudges,” and a session on personalized health monitoring. In considering revisions to the Declaration, especially touching on issues such as informed consent, the use of placebos, and biobanking, the WMA is conducting open discussions around the world; the next will be held in South Africa during the first week in December. It is expected that a draft of planned revisions will be available for public comment in spring 2013—anyone interested in commenting on the draft should be sure to save a bit of time for that sometime in March or April.
This year’s IAB meeting, however, was far less interesting than the satellite sessions. Surprising and disturbing to me at least (and judging from applause from the audience in one session to many others) was the IAB’s failure to structure a program with plenary sessions that addressed many of the most serious issues of ethics and health today: risks of infectious disease spread and anti-microbial resistance, global inequalities in access to health care, or even questions of inequality and resource-limitation within more affluent economies. Instead, plenary sessions involved such topics as moral enhancement and (unsurprisingly for a meeting in the Netherlands) a session on policy choices in legalized euthanasia—important issues, to be sure, but issues of affluence not constraint. Yes, there was a session on global justice, but it featured only speakers from well-off countries: one speaker from Canada (albeit born in Rhodesia and with a longstanding career in South Africa), and three based primarily in the United States.
To be a truly international bioethics association, the IAB could surely do better. I left the meeting with a sense of irony that just as the United States may have taken a significant step towards justice in health care on its own behalf, the field of bioethics—surely quite relevant to the work of health lawyers—took a step backwards.