Threats to the common good. Biochemical weapons and human subjects research.

Chemical and biological weapons are rightly regarded with a special sense of horror. Their effects can be both devastating and indiscriminate, taking the harshest toll on the most vulnerable classes of noncombatants. A biological attack may not even be discovered until long after a disease has spread through a population. Moreover, chemical and biological weapons are especially attractive alternatives for groups that lack the ability to construct nuclear weapons. The 1995 release of sarin gas into the Tokyo subway by the Aum Shinri Kyo group suggested that effective delivery devices may be harder to procure than the chemical agents themselves, but the 2001 anthrax attack in the United States, which used the postal service as a delivery device, showed there could also be surprisingly low-tech solutions to delivery and dispersal. All this makes chemical and biological weapons uniquely potent tools for insurgency and destabilization. (1) Responding to the threat of chemical and biological weapons raises complex but important ethical questions. In a very real sense, the bulwark of last defense against such agents must be mounted, not atop a wall or in a distant trench, but within the very bodies of military and civilian personnel. Questions about the limits of what can be justified in the name of defense were raised during the first Gulf War. (2) The controversy surrounded a waiver that the Department of Defense sought from the Food and Drug Administration that would allow it to administer pyridostigmine and botulinum toxoid vaccine to U.S. military personnel without their consent. The consent waiver was granted, but the vaccine was made available only on a voluntary basis. As the possibility materializes that chemical and biological weapons could be used as instruments of terror in a domestic context, similar questions are being raised for civilian populations as well. (3) Smallpox, for example, was eradicated from the world in 1980, and there has not been a case within the United States since 1949. The United States ended routine vaccinations against it in 1972. Since there is no accepted treatment for the disease once it has been acquired, the possibility that it might return to the world in a more virulent, weaponized form has prompted a new though limited vaccination program, with its own risks. (4) Yet as public health countermeasures are implemented, the logic of escalation naturally leads those seeking weaponized forms of the smallpox virus, or other agents, to enhance them to known countermeasures. (5) This raises the prospect that a protracted war on terror will require ongoing research to develop new countermeasures, or to assess the effectiveness of existing measures, against new variants. (6) All this raises basic questions about how aggressive such programs may be, given that there are no disease populations in which treatments and vaccines that target chemical and biological weapons can be readily tested. These questions take on special urgency in light of the insistence of the current U. S. administration that we are engaged in what will be a long and far-reaching war against terrorism. To paraphrase Cicero, law is often muted by the exigencies of war. Indeed, some have openly speculated about the fate of such traditional bioethical principles as informed consent in a social climate that is increasingly preoccupied with "homeland defense" and social solidarity. (7) Perhaps a climate that privileges public well-being and the professionals and institutions that protect it will be more tolerant of exceptions to such principles. These worries represent building tensions between the imperative to safeguard and protect the common good and the justification for accept ed safeguards for individual research participants. In times of peace, lingering tensions at this fault line do not generally pose a special challenge. However, in times of crisis, when group cohesion, patriotism, and themes of civic responsibility take on renewed meaning, appeals to the common good provide a natural way of expressing and justifying plans for collective action. …