The Occasional Human Sacrifice: Research Abuses, Whistleblowing and Honor
Carl Elliott, MD, PhD, University of Minnesota, Minneapolis, MN
In popular culture, whistleblowers are conscience-driven heroes who triumph against the odds. Yet in the world of medical research, the experience of most whistleblowers turns out to be much darker. Medical institutions deny wrongdoing even when it is glaringly obvious, and rarely do mistreated research subjects or their families get any real justice. Whistleblowing is the exception, not the rule. In many scandals, doctors and other staff members remain silent for years while unwitting research subjects are abused. If abuses do come to light, the researchers are usually protected by the medical establishment while dissenters are punished. Often the researchers are celebrated by their peers with honors and awards. In the rare cases when whistleblowing succeeds, it often leaves deep scars that mark whistleblowers for the rest of their lives.
Why do whistleblowers do it? Over the past six years, that was the question I asked individuals who exposed some of the most notorious research scandals of the post-war era, from the Tuskegee syphilis study to the lethal synthetic trachea experiments at the Karolinska Institute. Initially I found their answers puzzling. Rarely did they give a moral argument or appeal to foundational principles. Instead, they said things like, “How could I say nothing and still hold my head up?” or “How could I look in the mirror?” or “That’s just the kind of person I am.”
Fred Alford, the author of Whistleblowers: Broken Lives and Organizational Power, calls this “narcissism moralized.” When Alford interviewed whistleblowers, he was struck by how often whistleblowers turned a moral question about the well-being of others into a moral question about themselves. He argued that whistleblowers are admirable people obsessed with their own moral purity. So when they find themselves in organizations that are cruel or corrupt, they are driven to push back against the expectation that they are like everyone else.
As much as I admire Alford’s book, I believe he is mistaken. When I spoke to whistleblowers, what I heard was neither narcissism nor an obsession with moral purity, but the ethic of honor and shame. It is true that whistleblowers talk about themselves, but that is what honor and shame are all about. Honor is fundamentally about respect and self-respect. That is why whistleblowers say things like, “If I said nothing, how could I hold my head up?” Honor is not just about getting respect from others. It is also about deserving respect. The honorable person wants to be the kind of person who is worthy of the respect they get. If they fail, they feel ashamed. That’s not wounded narcissism. That’s what happens when an honorable person fails to measure up to the honor code.
To many people, the concept of honor sounds archaic. In a classic essay, “On the Obsolescence of the Concept of Honor,” Peter Berger argued that honor was rooted in the pre-modern world of social hierarchies, where a person’s rights and obligations depended on their social station. So when social hierarchies began to collapse in the 18th century, the concept of honor gave way to that of dignity. Dignity extends to all people, regardless of their social station. Yet it is arguable that honor has not disappeared so much as evolved. The locus of honor has shifted from a person’s social station to their standing as an individual. Today, when whistleblowers explain their moral choices, it is not about upholding their reputation or status, but rather about staying true to themselves and their personal moral code despite intense social pressure to do otherwise. In this way, honor has become harnessed to moral dissent.
The oversight of medical research works on an honor code. It is this way by design. Research is not formally regulated, like a business. Nobody from the government or a university is standing over the researcher’s shoulder and watching what they do. We simply trust medical researchers to be honest. But like any honor code, this oversight system depends on bystanders to speak out when they see abuses. That this happens so seldom is a mark of professional and institutional failure.
To point out the ethic of honor is not to defend it, of course. Honor does not necessarily lead people in the right moral direction, not any more than other moral systems. It is simply to point out something crucial about the way whistleblowers often conceptualize their actions. If we want to encourage people to speak out when they see abuses of research subjects, honor is a concept we need to understand.
Why do whistleblowers do it? Over the past six years, that was the question I asked individuals who exposed some of the most notorious research scandals of the post-war era, from the Tuskegee syphilis study to the lethal synthetic trachea experiments at the Karolinska Institute. Initially I found their answers puzzling. Rarely did they give a moral argument or appeal to foundational principles. Instead, they said things like, “How could I say nothing and still hold my head up?” or “How could I look in the mirror?” or “That’s just the kind of person I am.”
Fred Alford, the author of Whistleblowers: Broken Lives and Organizational Power, calls this “narcissism moralized.” When Alford interviewed whistleblowers, he was struck by how often whistleblowers turned a moral question about the well-being of others into a moral question about themselves. He argued that whistleblowers are admirable people obsessed with their own moral purity. So when they find themselves in organizations that are cruel or corrupt, they are driven to push back against the expectation that they are like everyone else.
As much as I admire Alford’s book, I believe he is mistaken. When I spoke to whistleblowers, what I heard was neither narcissism nor an obsession with moral purity, but the ethic of honor and shame. It is true that whistleblowers talk about themselves, but that is what honor and shame are all about. Honor is fundamentally about respect and self-respect. That is why whistleblowers say things like, “If I said nothing, how could I hold my head up?” Honor is not just about getting respect from others. It is also about deserving respect. The honorable person wants to be the kind of person who is worthy of the respect they get. If they fail, they feel ashamed. That’s not wounded narcissism. That’s what happens when an honorable person fails to measure up to the honor code.
To many people, the concept of honor sounds archaic. In a classic essay, “On the Obsolescence of the Concept of Honor,” Peter Berger argued that honor was rooted in the pre-modern world of social hierarchies, where a person’s rights and obligations depended on their social station. So when social hierarchies began to collapse in the 18th century, the concept of honor gave way to that of dignity. Dignity extends to all people, regardless of their social station. Yet it is arguable that honor has not disappeared so much as evolved. The locus of honor has shifted from a person’s social station to their standing as an individual. Today, when whistleblowers explain their moral choices, it is not about upholding their reputation or status, but rather about staying true to themselves and their personal moral code despite intense social pressure to do otherwise. In this way, honor has become harnessed to moral dissent.
The oversight of medical research works on an honor code. It is this way by design. Research is not formally regulated, like a business. Nobody from the government or a university is standing over the researcher’s shoulder and watching what they do. We simply trust medical researchers to be honest. But like any honor code, this oversight system depends on bystanders to speak out when they see abuses. That this happens so seldom is a mark of professional and institutional failure.
To point out the ethic of honor is not to defend it, of course. Honor does not necessarily lead people in the right moral direction, not any more than other moral systems. It is simply to point out something crucial about the way whistleblowers often conceptualize their actions. If we want to encourage people to speak out when they see abuses of research subjects, honor is a concept we need to understand.