My favorite portion of The Censor’s Hand is Schneider’s invention of Earnest Member, a conscientious gentleman with good intentions but no ethical training until he is appointed to the IRB and handed copies of what Schneider terms the Sacred Texts.
Most Sacred, of course, is the Belmont Report, and here Schneider imagines Earnest Member trying to make sense of that document:
The Belmont principles mean different things among and within fields. “Respect for persons” is a philosophers’ term of art that can mean treating people as ends, not means. Does Earnest Member know that? He treats people and is treated as a means daily, and so much the better. Nor can the philosopher’s special meaning practically be taught to the IRB members, IRB staff, and researchers. And even philosophers disagree about what respect for persons means. Some “suggest that respect incorporates considerations of well-being. Others suggest that concern for well-being lies within the purview of beneficence and nonmaleficence” and that the ambiguity about “well-being is one reason the principle of respect for persons is unhelpful.” This must confuse Earnest Member, especially since there is “a sense in which both are correct.”
Thus the Report’s method is not reason, it is ipse dixit. It does not explain why its principles were chosen, why they are right, what they mean, or how to infer rules from them. It just announces conclusions. For example, one of the “complementary expressions” of beneficence is “do no harm.” But instead of explaining why, the Report says, “The Hippocratic maxim ‘do no harm’ has long been a fundamental principle of medical ethics. Claude Bernard extended it to” research. But Miller and Wertheimer rightly question how far “‘do no harm’ is operative even for medical care.” It can only be “operative” with arduous interpretation, since much care inflicts harm to do good and/or risks doing more harm than good. And who was Bernard, why did he “extend” the rule to research, and why does he matter?