How Ethics Can Better Anticipate the Consequences of Emerging Biotechnologies

Ankeny et al.’s “Developing a Reflexive, Anticipatory, and Deliberative Approach to Unanticipated Discoveries: Ethical Lessons from iBlastoids” (Ankeny et al. 2022) cites several places in the literature where bioethics has attempted to use anticipatory approaches to address controversies in emerging technologies. The authors state these efforts “have not gained traction specifically in bioethical domains.” Yet ethical imperatives often drive anticipatory states, and the work of anticipating the potential futures of technologies is fueled by concerns about what those futures might look like. Identifying these concerns is the focus of scholarship in speculative and anticipatory ethics: it is not without its detractors. Speculation attempts to foresee the major ethical challenges in an effort to minimize harms that may be caused by new technologies, yet the practice tends to generate hyperbolic or unreasonable scenarios (Racine 2014). By speculating on the ethical outcomes of new technologies, Nordmann warns that “the hypothetical gets displaced by a supposed, actual, imagined future that overwhelms the present.” (Nordmann 2007, p.32) Schick’s exhaustive critique of “anticipatory bioethics” argues that these “imagined future(s) [have] consequences for how agency is structured and how choices are prioritized” (Schick 2017, p.22). To be sure, the hope articulated in support of human blastoid research echoes other “promissory sciences” such as human genome editing, personalized medicine, and stem cell research, where scientists (and ethicists) can generate socio-technical expectations in advance of the actual work.

However, bioethics is not always speculative. The Ethics, Law, and Social Implications (ELSI) program of the Human Genome Project, established in 1990, was implicitly forward-looking in its focus on the societal impact of genetic technologies, a form of bioethics that is both practical and anticipatory. In the 1960’s and 1970’s, prominent scientists and ethicists including Joshua Lederberg, Paul Ramsey, Joseph Fletcher and others presaged the concerns for children born of cloning. It was much later, in 1997, when Dolly the sheep gamboled upon the scene (Orentlicher 1999). In 1982, the President’s Commission on Bioethics debated altering the human germline decades before CRISPR/Cas9 was discovered (President’s Commission 1982). Indeed, various forms of anticipation can operate locally, such as the ethics consultation services described by Harvey and Salter as “anticipatory governance” but probably more properly termed “embedded ethics” (Harvey and Salter 2012).

So, we see that anticipation operates in manifold ways in bioethics, and it is a matter of debate whether anticipatory ethics is too prophetic, too speculative, or in other ways properly useful. Despite a history of forward-looking ethical discourse, it seems we are often left hashing through past deliberations in the national and international policy forums of the present. In our view, (see Nelson et al. 2022) what matters more is how ethical foresight is constructed and enabled in a framework of deliberative governance (two features of anticipation described in Ankeny et al), and how it can address what many major policy reports (NASEM, Nuffield, WHO) and scholars clearly recommend for human genome editing (HGE): that ongoing public engagement and dialogue is required to establish a broad social consensus before various approaches are attempted. To address this challenge, we (Scott and Selin) recently described an anticipatory approach in HGE in this journal (Scott and Selin 2019), and it now forms the basis of an NIH grant (NHGRI 1RO1HG010332–01) that is dedicated to anticipatory governance for HGE.

In order to ground anticipation in plausible futures, we conducted a literature review to identify first authors and prominent figures in the area of HGE, spanning multiple disciplines (e.g. bioethics, law, history, and science). Involving experts from a wide range of disciplines allows for the adoption of a broad perspective in support of a more comprehensive reflection (Racine et al. 2014). We interviewed this purposive sample of experts individually, specifically soliciting their perspectives on the uncertainties and driving forces of HGE technologies. After qualitative analysis of the interviews, we gathered these experts for a workshop to generate a set of plausible future scenarios that would then be tested with publics in deliberation forums. Plausible is different from possible; plausibility is grounded in the current state of technological development, whereas possibility is wide-ranging and not necessarily rooted in those details. Thus, our interviews and workshop with experts served as an exercise in foresight, which is one of the defining activities of anticipatory governance (Barben et al. 2008). Our public deliberation forums were an opportunity to not only educate publics about these technologies and their plausible futures, but also to engage publics in whether such futures were even desired (e.g. whether these technological developments are valued and should continue), thereby avoiding the pitfall of technological determinism that often plagues regulatory bioethics (Schick 2017). By putting forth the expert-derived set of plausible future scenarios to publics, we were able to elicit the values that they prioritize. Such engagement, described in Ankeny et al.’s article, is another foundational activity of anticipatory governance (Barben et al. 2008). We will analyze the qualitative data from these public forums and then bring those results back to our expert group to reflect upon and address major gaps in expert thinking with respect to publics’ concerns over HGE technologies. This interchange builds a long-term reflective capacity and forms the third activity of anticipatory governance, namely integration (Barben et al. 2008). Prioritized areas of concern then will be matched with existing governance mechanisms or the development of new ones to best address them. These governance proposals will then be disseminated to funders, oversight agencies, advisory bodies, and policy-making groups, as well as through our public engagement networks and publication in peer-reviewed journals.

Our model serves as the first end-to-end cycle of anticipatory governance applied to an emerging technology like HGE. First engaging experts, then the public, then cycling these deliberations back to experts can help refine and nudge the trajectory of HGE. Rather than guided by deliberations after the fact, policy can be informed by foresight that is developed in synchrony with public values. These methods can be employed in other venues, such as funding organizations or at the international level, to ensure that the technology’s development considers publics’ concerns and needs.

In conclusion, we believe that incorporating the defining activities of anticipatory governance, a well-established practice in science and technology studies, to be a way forward for anticipatory bioethics. Thus far, efforts at anticipatory bioethics have had mixed results, largely due to acts of speculation that are wide-ranging and unstructured. However, the practice of anticipatory governance provides a structured framework for bioethics—and indeed any discipline striving to grapple with near-term futures. Thus, anticipatory governance assists bioethics in becoming forward-looking and proactive, rather than responsive and reactive to undesirable outcomes.