This piece was originally published on Bill of Health, the blog of Petrie-Flom Center at Harvard Law School.
The financial barriers associated with becoming a bioethicist make the field less accessible, undermining the quality and relevance of bioethics research.
Because the boundaries of the field are poorly defined, credentials often serve as a gatekeeping mechanism. For instance, the recent creation of the Healthcare Ethics Consultant-Certified (HEC-C) program, which “identifies and assesses a national standard for the professional practice of clinical healthcare ethics consulting” is a good idea in theory. But the cost of the exam starts at $495. There is no fee assistance. Given that 99 percent of those who have taken the exam have passed, the exam seems to largely serve as a financial barrier to becoming an ethics consultant.
A related problem arises with Masters of Bioethics programs. These degrees can cost more than $80,000 just for tuition — often more than the tuitions of medical schools at the same universities. And although many programs entice students with partial scholarships, these degrees likely still cost tens of thousands of dollars. Students who earn these degrees may correspondingly come from advantaged backgrounds or take on substantial debt pursuing them. We don’t actually know, as most of these programs provide little information about their students’ backgrounds, graduates’ debt burden, or the proportion of students who attain jobs in bioethics after earning their degrees. It is possible that some of these programs do provide substantial support for disadvantaged students, but because few programs publicize this information, it is impossible to tell. This lack of transparency is worrisome given that many humanities masters programs enrich universities while driving students into debt they cannot escape from.
These financial barriers aren’t unique to bioethics: students routinely take on significant debt to pursue careers in other humanities disciplines. But financial barriers in bioethics are particularly concerning for three reasons.
First, the pervasiveness of financial barriers is hypocritical. Bioethics is a field that is supposed to be concerned with inequities. Many bioethicists conduct research on the fair distribution of health resources, health disparities, and barriers to healthcare access. If bioethics itself is inaccessible to people who aren’t wealthy, this is at odds with the field’s core tenets. People who want to pursue careers in bioethics should be able to do so, regardless of their financial backgrounds.
Second, people’s backgrounds influence what they choose to work on. Bioethics has long been criticized for focusing on “issues of affluence,” or niche problems that affect only a handful of advantaged people. But if bioethics is primarily comprised of wealthy people, then it is unsurprising that the field devotes too little attention to the problems of people who are not wealthy.
Finally, bioethicists often adopt paternalistic attitudes towards people who are poor. For instance, many bioethicists have argued against allowing risky research (e.g., human challenge studies) or compensating people who take on certain risks (e.g., by donating kidneys) because poor people would feel pressure to participate. But it’s odd for bioethicists — most of whom are advantaged — to make claims, usually without citing empirical evidence, about how poor people would feel about or react to policies pertaining to them. Putting aside the strength of the arguments on both sides of these debates, we should be concerned that the people affected by the policies bioethicists help shape are not well represented in bioethics.
These problems are entrenched, but they are solvable. A first step would be to provide fee assistance for all bioethics exams, conferences, applications, and events. For instance, students can attend the American Society for Bioethics and Humanities (ASBH) Annual Conference for only $60 and should similarly be able to take the HEC-C exam at a discount.
A second step would be to create greater financial transparency around bioethics training programs, and in particular, Masters of Bioethics degrees. Programs should publicize information about their students’ backgrounds, how students finance these programs, how much debt students typically incur because of these programs, and the job prospects of graduates. This would put pressure on programs with few disadvantaged students to recruit and support those students. Bioethics organizations — like ASBH and the Hastings Center — should ask universities to release financial information about their Masters of Bioethics programs and should consolidate this information so students interested in bioethics can make informed decisions about where to pursue training.
Finally, there are several paid fellowships that provide excellent, hands-on training for people interested in bioethics. The field should work to create and fund more programs like these. Large hospitals — which often have ethics committees and revenues in the billions — could help finance them.
Ultimately, bioethics will be a better field if it becomes a more accessible one. Bioethics should thus work to address financial barriers to entry.
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