email Dr Kerns
Our poor frustrated reader, now
bewildered by such a large array of complex ethical quandaries,
can be forgiven for desiring, and hoping to find, a Great Simple
Solution. Perhaps, hopes our struggling reader, there might be
found some Great Simple Solution that only the practical minded
person, the person with little learning but much good sense will
be able to see, the Great Simple Solution that can be seen only
by a simple person of great wisdom who is able to think more clearly
than all the learned people and bureaucrats put together.
I find it difficult to chastise this hope. I even share the hope
myself sometimes, when my mind is overly fatigued. Three metaphors
come to mind that richly express this hope: the metaphors of the
egg, the knot and the empty stadium.
i. The egg
According to legend, Christopher Columbus once challenged all
the noble men and ladies at the court dinner to see if they could
balance a hard-boiled egg on the table so that it would stand
upright on its small end. Everyone tried, no one succeeded. They
then passed the egg back to Columbus and asked him to show them
how it was done. He picked up the egg, tapped it lightly against
the table on its small end to dent the shell, then set it gently
and easily on the table. It stood. The problem was solved. All
the learned men and ladies of the court could not solve the problem
with all their trying, but Columbus, the practical man of simple
wisdom, solved the problem easily.
ii. The knot
The ancient Greek legend of the Gordian Knot tells of a great
knot that was so large, so complicated, and so tightly tied that
no one, not even the greatest of heroes, could untie it. Legend
had it that whoever could loosen the knot would rule Asia. Great
men from all over the world tried to untie the knot, but none
succeeded. Finally young Alexander the Great, encountering the
problem of the great knot, simply drew his sword and cut right
through the middle of the knot severing it in two. The knot was
undone. It was loosened. He had provided the simple solution that
none of the others had even thought of.
iii. The empty
stadium
The ancient Greek philosopher Zeno ( in the fifth century BC),
arguing in defense of the philosophy of Parmenides, argued that
it was impossible for a man standing at one end of an empty stadium
to walk across the open field to the other end of the stadium.
The man could not walk across the stadium, said Zeno, because
he would first have to walk half way across the stadium. But he
couldn't walk even that distance because he would first have to
walk half way there. But he couldn't walk even that far because
he would first have to walk half way to that point. And he couldn't
walk even that far because he would first have to walk half way
there. And to get even that far he would first have to walk half
way there. There would, of course, be an infinity of these half
way points. The man would have to traverse an infinity of half
way points in order to walk anywhere. No one can traverse an infinity
of anything, no matter how small. Therefore, it was impossible
for the man to walk anywhere, said Zeno.
Philosophers had tried for centuries to find an adequate answer
to Zeno's stadium paradox. Finally one practical minded mediaeval
philosopher answered thus: you solve the problem by simply standing
up and walking across the stadium. That is, you quit trying to
think out an answer like all the learned scholars had done. Instead,
you simply stand up and walk. "It is solved by walking!"
he said. "Solvitur ambulando," he said in Latin.
He was a practical minded man with little patience for intellectual
problems and complexities. He solved the problem of how to walk
across the stadium by simply standing up and walking.
iv. Solvitur
vaccinando?
I can imagine our frustrated reader, or our frustrated, practical-minded
activist, or even our frustrated vaccine researcher, believing
that the solution to these multi-faceted ethical quandaries is
to simply start doing the experiments. "Let's just start!
Solvitur vaccinando," he or she might say. "It is solved
by vaccinating! We are wasting our time with all this thinking
and fretting. The pandemic is racing out of control. The thesis
position is correct. We must act. The problems will work themselves
out as we get into the trials. We cannot afford to wait any longer!"
I have personally spoken with activists who feel this way. I have
personally spoken with cooler-headed academics, even, who feel
this way. Whenever and in whatever forums I have presented some
of the ideas in this book, I have been able to watch members of
my audience struggling to find some answer, some solution, some
Great Simple Solution to all these ethical complexities. None
of the proffered simple solutions, unfortunately, has yet been
adequate.
Cast about as I may, I cannot see
any solutions to these difficulties that are both simple and ethical.
I suspect that whatever solutions we do find to these ethical
complexities will not be simple ones. I suspect that any successful
solutions that are developed will probably end up being just about
as complex as the problems they are trying to solve.
For that reason, I am deeply encouraged and heartened when I hear
WHO vaccine expert, and now director of the new United Nations
Programme on HIV/AIDS (UNAIDS), Dr Peter Piot, imply that every
one of these ethical problems must be faced squarely and in their
full complexity and must not be oversimplified, "because,
with the urgent need for an effective vaccine, we cannot afford
a failure due to scientific or ethical problems". Failure
of a trial due to scientific or design difficulties would be tragic,
but even more tragic would be failure of a trial due to ethical
difficulties. The discussion among ethicists of what to do with
data garnered from ethically defective experiments has tended,
as we saw earlier, in the direction of completely disallowing
either the publication or the use of any data obtained from ethically
improper research. If this policy turns out to be part of the
operative ethical guidelines governing the use of research data
- and it may well turn out to be - then publication or use of
any data from ethically defective HIV vaccine trials would be
completely disallowed. The trials would have been a failure.
It is for this reason that I am encouraged to see Drs Heyward,
Esparza, and Osmanov, who are leading the WHO AIDS vaccine development
efforts, as well as Dr Piot, say that the whole goal of their
pretrial deliberations is to "ensure that scientifically
and ethically sound Phase III HIV vaccine efficacy trials can
be conducted successfully".
I am heartened to hear, especially from the top, such an appreciation of the importance of the ethical.