The Imperative of Expanded Bioethics Investigations

In the January 2022 issue of the American Journal of Bioethics, an editorial by Joel E. Pacyna and Richard R. Sharp of Case Western Reserve University highlights the importance of "big bioethics" research in shaping the future of healthcare.

The editorial underscores the ongoing efforts by healthcare institutions to support large-scale studies that evaluate access to healthcare services, costs of medical care, strategies for increasing cost-effectiveness, and characterizing contributions to health disparities. These initiatives are fueled by both federal funding and institutional investments in implementation science, artificial intelligence, and translational research.

Big bioethics research can identify atypical patient experiences and less common ethical perspectives on healthcare. By employing empirical methods to collect and analyze data from large numbers of people, it can examine subtle differences in psychosocial and behavioral outcomes between subgroups, including historically under-represented groups. This research has the potential to illuminate new areas of bioethical inquiry that merit further exploration.

However, the authors note that bioethicists may be hesitant to embrace "big bioethics" due to concerns about de-personalizing reductionism and the difficulty of publishing qualitative research findings in high-visibility medical journals. They argue that bioethics would benefit greatly from increased methodological diversity among its practitioners, including the addition of research specialists who can work with large datasets.

The long-term impact of bioethics scholarship is highly dependent on its practitioners' capacity to recognize systemic biases within the field and make adjustments to the aims of their research. Pacyna and Sharp challenge bioethicists to reassess their topical priorities and financial structures, and to consider the methods they employ and their impact on marginalized patients. They also encourage bioethicists to consider whether sources of funding for bioethics scholarship are helping to mitigate health inequities or contributing to them.

The success of bioethics programs has prompted closer scrutiny of their impact and relevance to medicine. Many universities and academic health centers host bioethics programs that support various educational and translational research activities. These programs, however, may not be well-positioned to conduct "big bioethics" research due to their focus on scholars with expertise in qualitative research.

Data sharing arrangements and applications of machine learning in healthcare are using "big data" to improve health outcomes. Pacyna and Sharp argue that bioethics programs should collaborate with these efforts to ensure that the ethical implications of these advancements are considered. They conclude by issuing a challenge to the bioethics community: to embrace "big bioethics" and to use it as a tool for promoting equity and justice in healthcare.