Penn on the World after COVID-19 Bioethics, COVID-19, and the Changing International Order

Penn on the World after COVID-19 is a joint project of Penn Global and Perry World House. We've asked some of Penn's leading faculty, fellows, and scholars to imagine what the global pandemic will leave in its wake.

Jonathan D. Moreno is the David and Lyn Silfen University Professor at the University of Pennsylvania where he is a Penn Integrates Knowledge (PIK) professor. He is also Professor of Medical Ethics and Health Policy, of History and Sociology of Science, and of Philosophy. Moreno’s most recent book is Everybody Wants to Go to Heaven but Nobody Wants to Die: Bioethics and the Transformation of Healthcare in America, co-authored with Penn president Amy Gutmann.

The controversy surrounding a Chinese scientist’s use of the gene editing tool CRISPR-Cas9 in 2017 to modify the genes of three human embryos that were brought to term illustrated the way that emerging issues in the ethics of biotechnology will be thought about in the world after the COVID-19 pandemic. That Chinese scientist’s creation of new products using living organisms, especially in the control of the human genome, represented a stress test for the norms inherent in the liberal international order created after World War II. As COVID-19 has already done with other parts of the world order, today’s pandemic will further stress the foundations of western bioethics.

Although not as explicit or well understood as arms treaties, trade arrangements, or monetary institutions, biotechnology norms were very much a product of the post-World War II liberal consensus.  Modern bioethics is in part a response to the biotechnological capabilities that were opened up with the decoding of the human genome in 1953, leading quite directly to the new genetic engineering technologies. Bioethics can also be viewed as part of the human rights aspect of the liberal order, although bioethical values may also inform and guide economic development (e.g., global pharmaceutical research endeavors and public health programs) and security (through the laws of armed conflict and the treatment of prisoners of war).

Most importantly, in the years immediately following the war, an ethical document was produced by the judges at the medical war crimes tribunal at Nuremberg.  What became known as the Nuremberg Code was the result of the judges’ dissatisfaction with international recognition of ethico-legal standards for the conduct of human experiments. These themes found their way into the foundational documents of the postwar international order. The U.N. Charter reaffirmed in 1945, “faith in fundamental human rights and dignity and worth of the human person” and committed member states to promote “universal respect for, and observance of, human rights and fundamental freedoms for all without distinction as to race, sex, language, or religion.” Article I of 1948’s Universal Declaration of Human Rights, meanwhile, stated that “[a]ll human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood.”

These themes and norms run like a red line through bioethics in the decades since World War II.  Such values have been institutionalized in countless advisory bodies that govern biomedical research and practice, from national ethics commissions to research ethics boards for human subjects research to biosafety committees.  Other entities too numerous to mention have had bioethics as a secondary rationale for their missions, such as the conventions for biological, toxin, and chemical weapons and the World Health Organization itself. 

Unfortunately, despite a theoretical commitment to public health and “benefit sharing,” bioethics has too often been focused on exotic and philosophical issues, like the implications of edited embryos for human personhood. The outbreak of the coronavirus pandemic, however, suggests the limits of this academic focus.  Western bioethics have devoted far too much attention to protecting the rights of individual patients, and far too little to the questions now vexing governments everywhere: how much individual autonomy must be sacrificed for the common good to prevent the spread of a pandemic?  Moreover, this tension goes beyond COVID-19. Anti-vaccination movements have since the 1970s been handled mostly with relative indulgence and minimal use of state police power. 

Another dimension of the current crisis is the increasingly fraught relationship between the Chinese and U.S. scientific communities due to official investigations of intellectual property theft.  This was bad timing. One important and perhaps unanswerable question of today’s pandemic is whether those bad feelings influenced the suppression of early information about the infection on the Chinese side in relation to U.S. inquiries?

What is clear today is that the pandemic is sure to further strain all aspects of the liberal international order, including bioethical norms, by contrasting the approach taken by many Asian countries, most notably China, and the western democracies – each informed by their respective understanding and practice of bioethics. The choice between emphasizing bioethical principles that protect individual autonomy and those that stress collective responsibility seem stark. For the moment, the latter seems to have the upper hand, with subversive implications for the foundations of the liberal international order in the world after COVID-19.   

The views expressed in Penn on the World after COVID-19 posts are solely the author’s and not those of Penn, Penn Global or Perry World House.