New cynics will never flourish

A Question of Trust - Autonomy and Trust in Bioethics
August 30, 2002

Our 'trust no one' culture leads to bad behaviour, says Mary Warnock.

Onora O'Neill (Baroness O'Neill of Bengarve) delivered the Gifford lectures in 2001, and the Reith lectures in 2002. These two books are the outcome of the two series of lectures. The Gifford lectures, delivered in alternate years in Edinburgh and Glasgow, must, according to the terms of the trust, touch on matters related to morals or theology, and they must be published, though not necessarily in exactly the form in which they were delivered. There is a chance for their author to reflect on the series as a whole, to expand the scope of individual lectures and to profit from the discussions held after each lecture, whose audience will have been not exclusively but predominantly academic. The Reith lectures, on the other hand, are published just as they were delivered (as they used to be, week by week in the much-lamented Listener ). The audience for these lectures will have been enormous and mixed, and, though I am sure that O'Neill will have had numerous letters from listeners after each lecture, there will have been nothing that the audience specifically contributed.

Hence the difference between the two books. Autonomy and Trust in Bioethics is more professionally philosophical than A Question of Trust . They are alike, however, not only in dealing with the topic of trust, but also in their sharp intelligence, their refusal to accept received opinion without examination and their humane common sense. The combination of serious philosophical discussion with journalistic presentational skills has been brought to a fine art by O'Neill.

She has been chairman of the Nuffield Foundation since 1998. She was a member of the Nuffield Council on Bioethics from 1984 until 1998, and a member of the Human Genetics Advisory Council from 1996 until 1999. Her practical interests have been largely in the field of medical ethics. But bioethics is a wider topic than medical ethics, and she begins Autonomy and Trust by contrasting medical ethics with the ethics of the environment. She argues that, while in medical ethics the idea of individual autonomy has come to be central - everyone supposedly having the right to accept or refuse treatment, to undergo treatment only after consenting to it and to decide for themselves whether to seek infertility treatment or abortion - in the sphere of environmental ethics, no one supposes that the decisions of an individual, still less his mere wishes, carry any weight against the common good. Yet the notion of an individual's right to choose may bring the two spheres closer together: though I may not claim the right to decide for myself whether or not to dispose of chemical waste in a river, or to dump my refrigerator by the side of the road, I may claim a right to choose whether or not to eat genetically modified food, and thus, for example, to demand that all GM foods be labelled as such. And in both spheres, medical and environmental, the greater the belief in an individual's right to choose, the greater the mistrust of those who would seem to strip the individual of this right, by concealing or distorting the facts. The common element in the loss of trust in both these areas is the fear that we are being taken for a ride; we cannot exercise the choice to which we believe we are entitled if we are being systematically deceived.

So there are elements common to different spheres of bioethics. But most of O'Neill's arguments in the first book are concerned with the ethics of reproduction. She examines the claim, frequently made, that the concept of human rights can be made the basis for proper decisions in bioethics, and especially in the use of reproductive technology. Most of those who make such a claim adopt a vaguely Mill-derived idea of rights: that everyone has a right to choose whatever they want, provided that others are not harmed. One objection to such a theory in the matter of reproduction is that someone else, who will one day have his own interests and rights, is inevitably involved, namely the child who will be the outcome of the choice. Her argument against the idea of rights as a starting point for ethics is masterly.

People often bleat that if you have rights, you must also have obligations. But, as O'Neill points out, this is not the relation that holds between rights and obligations: it is rather that if I claim a right, someone else must have an obligation to secure that right for me, or not to prevent my exercising it. Thus if a woman claims that it is a human right to have a child, then it must be someone's duty to ensure that she shall. An obligation, as O'Neill argues, is an obligation on a specific person or body to do something or desist from something - whereas rhetorically to claim a right, for instance to life or to healthcare or to choice, is not to pin down anything specific. Rights are therefore too imprecise to form a foundation for morality. The right to choice, or autonomy, is therefore an insufficient guide to the problems that may arise in reproductive medicine.

Instead, O'Neill reintroduces a properly Kantian idea of "principled autonomy", an autonomy not of individuals but of reason, and duty, shared by all human beings, who are all capable of forming such a concept. This and this alone, she suggests, can provide a basis for trust, not only between individuals, but between individuals and institutions. In the last chapters, she looks at alternative ways of restoring trust, through democratic legitimisation of public policy decisions, or through the media, and unsurprisingly finds that neither is likely to do much more than to reinforce the damaging culture of suspicion in which we now live.

It is this culture of suspicion to which O'Neill turns in A Question of Trust , her Reith lectures. First she raises the question of whether there really is, as is often asserted, a "crisis of trust"; and she points out that though people responding to opinion polls tend to say that they trust no one, not doctors, not politicians, not lawyers, not estate agents, not research scientists - they in fact place their trust in them perforce. Actions might be thought to speak louder than words. If we want to draw up a contract we have to trust a solicitor. If we have appendicitis, there is nothing for it but to go to a surgeon. But to have recourse to professional help when we only half believe that the professionals are worthy of trust is uneasy and, I at least would contend, ultimately destructive of a good or flourishing society. To be forced to take as truth what is offered as truth by the media, or by our political masters, when we have no way of knowing whether we are being deceived, is to turn us into a society of cynics, who in the end may be ungovernable. Good behaviour, whether in the City or on the streets, depends on non-cynical trust.

The subject of these lectures is thus of enormous and immediate importance. O'Neill takes us, lightly and engagingly, through various possible means that are attempted these days to restore our trust. Of these she herself is suspicious. There is the human-rights movement; there is the new insistence on accountability; there is "transparency"; and there is our "public culture" of communication.

She goes through these new suspicions one by one as the lectures proceed. If we think of ourselves as the passive holders of rights, we shall simply sit by, waiting for someone else to act when we feel we have been deprived of what we deserve. Active citizens, she argues, take a serious view of their duties. And, even in times of terror or threat, their duties include refusing to succumb to political pressure, refusing to use the language of deception, even in a small way rejecting the politically correct, refusing to endorse slogans and half-truths.

As one would expect from a professional academic, O'Neill has extremely harsh words for the new accountability, the "unending stream of new legislation and regulation, memoranda and instructions guidance and advice", that streams into all public institutions and overwhelms them with bureaucracy. There is nothing here to restore trust. Transparency fares no better. "The very technologies that spread information so easily and efficiently are every bit as good at spreading misinformation and disinformation. Some sorts of opennessI may be bad for trust." Public mistrust has grown more and more in the very years in which openness has been ever more avidly pursued.

Finally she comes to the media, the one-way communication of what is supposed to be the truth, but whose truth we can in no way assess. Her most excoriating language is reserved for newspapers. A free press, she argues, is not an unconditional good; it is good only insofar as it genuinely informs and makes debate and discussion possible. Above all, the press has no licence to deceive.

Her conclusion is that the ways in which society, and especially government, hopes to increase trustworthiness, and therefore trust, are, on the whole, failing. Indeed the intrusiveness and constant checking and double-checking on performance and adherence to codes of conduct, the insistence on calling everyone to more and more detailed account may in fact make people behave worse, and therefore be less worthy of trust. It is a gloomy note on which to end; but we can recognise its truth. If anything is transparent, it is the truthfulness and good sense of this most admirable lecturer.

Baroness Warnock was formerly mistress of Girton College, Cambridge.

A Question of Trust: The BBC Reith Lectures 2002

Author - Onora O'Neill
ISBN - 0 521 82304 8 and 52996 4
Publisher - Cambridge University Press
Price - £25.00 and £9.95
Pages - 100

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