Interview with Professor Jonathan Montgomery

Professor Jonathan Montgomery is Chair of the Nuffield Council on Bioethics and of the Health Research Authority, which protects and promotes the interests of participants, patients and the public in health research and aims to streamline its regulation. He is Professor of Health Care Law at the University College London (UCL).

MHS member Morgan Shimwell asked him about his work and research when he visited the University of Sheffield to give a public lecture for MHS, on 11th February 2015.

Transcript 11/2/15

Professor Jonathan Montgomery

Morgan: I wanted to start by picking up on something you have done in one of your recent articles,[1] when you talked about the differences between, and the challenges of, being an academic on the one hand and then holding a public office (being head of Nuffield Council) on the other. I wondered how easy it is to change between mind sets and occupy these roles in a working day?

Jonathan: I think you have to have a clear a very sense of purpose. It’s not that the roles are completely inconsistent; I wouldn’t be doing Nuffield if I wasn’t interested in that sort of area. But I have a strong sense of when to speak for myself and when to speak in role. I am reasonably comfortable at roleplaying. So I can get my head into saying; on behalf of the Council I would take this decision, and then I can say in the next breath , if I was speaking personally I would say this. An example is the piece I did in the Cambridge Quarterly on ‘Reflections on the Nature of Bioethics’. The longer version I had to cut down had a couple of paragraphs on my own view, that you could defend a conscription model of organ donation.  So, in relation to the Organ Donation Taskforce, we took a view that presumed consent was politically difficult and therefore we thought this wasn’t the right time to defend it. On a personal basis I would have gone still for presumed consent, and said that actually we should move to a reasonably strong opt out system, and say to people you should be a donor unless you have a really clear set of reasons that we respect. It’s not quite mandatory but it’s a bit like military conscription, and conscientious objection, that you require people to articulate. But I think that it is a no-starter in the current political climate, so I would never put that forward with an official hat on, but would have happily argued it in the journal article (but it was too long so I had to take it out).

Morgan: One of the things you mentioned in that article was a ‘public mindedness’ or at least engaging with public discourses of legitimation: the difference between the academic who has the freedom to develop an argument over a couple of years, and a public figure must write punchy lines and slogans. Do you think that academics should be more ‘public minded’ and have an eye to the public thinking or do you think it is OK to keep academic literature and public work completely separate and have these different discourses going on?.”

Jonathan: I think it is a continuum, I don’t think it is a completely separate bit, if you were giving a paper to fellow PhD students, you would take some risks you wouldn’t if you were giving it to experienced academics or doing it on the local evening news, because you are thinking how to communicating effectively with this audience. So I see more in those terms. It’s about understanding what I can bring to the conversation with the audience, if I am standing there representing, whether that is Nuffield council or the Health Research Authority, or the Human Genetics Commission, then you have to speak to the audience in the language that is within the contains  but also with the opportunity that it provides. You have a degree of authority, you have influence that you would not have in an academic debate, but you have to speak a language that can be understood. If I felt I was lacking integrity, if I was being inconsistent, that would be make me uncomfortable and I would reconcile that by being specific,  saying that I was speaking for the council with their view, but if I were giving a personal view it would be like this. But if I felt I couldn’t see this as a position I could accept with dual responsibility it would make me very comfortable, so I don’t think I would say academics should ignore the more public discussion, nor feel obliged to do it. But if academic work is worth doing it is worth sharing, and it is about who is appropriate to share with. I think you learn a lot more in conversation than on your own, so I would never give up an opportunity to talk about my work to those interested, but talk to them with terms I thought they would be interested with.

 “You learn a lot more in conversation than on your own, so I would never give up an opportunity to talk about my work to those interested, but talk to them with terms I thought they would be interested with.”

Morgan: One of the things that interested me in relation to my own work is the idea of the public opinion influencing and being influenced by policy making and ethical discussions.  Do you think it is tempting for academics, or politicians or policy makers to speak on behalf of, or even appropriate, the public opinion in support of arguments?  Do you think that ever becomes worrying to a point?

Jonathan: It’s clearly always worrying that if you make claims about public opinion it may be unfounded, and it varies depending how you do that. In one level people talk about opinion polls, where you make claims that x amount of people think this and packed into that sort of claim is a whole set of problems: how is the information generated, whether they are open or closed questions, who commissioned the poll? If you look at assisted dying, opinion polls will pop up in both sides of the argument, so you think in what sense are they worth it. On the other hand it is incredibly useful to understand how ideas play out in real context, so understanding stories of people being consumers of these technologies, or creating technologies or caring for people with particular problems, enriches understanding enormously, and are interesting ways to understand better how people think. You shouldn’t think of them in one group, there are different segments of publics, in the same way that there are different groups of academics, so you need to do it carefully.  But that idea that one version is better that another strikes me as a bit odd, they are different and good for different things. If you’re making a claim about wherever a particular technology works, I wouldn’t go down to the pub to ask a person, I would ask a scientist to tell me what they understood about what it does. On the other hand if you’re trying to get a sense of if this is making people anxious or concerned or whether an argument seems plausible, then testing an argument of different people and asking if this make sense to you is a useful thing to do. This is slightly different from the legitimacy question, that’s about the process about how you reach positions and reassure yourself that you have got solid positions. For different purposes you need different types of legitimacy. The Human Genetics Commission advising the government didn’t need to worry too much whether recommendations were plausible, because that is a government decision whether to adopt, so they could take more courage about things. But it took the view than it was in a better position to influence government, if it had been through the political processes and gained a good understanding of what the public thought. In other circumstances you might think expertise is very important, you might construct a different group of people. I will talk a lot more about that this evening.

Morgan: Building on what you were just saying about not treating the public as a an homogenous group: there’s obviously going to be diverse opinions on many issues, but I wondered if on certain issues such as public perceptions about risks – risks about medicines or vaccines – if it is possible to identify certain underlying assumptions that you could challenge as being incorrect or falsely held. What comes to mind is the Organ Donation Taskforce and the public support for an opt-out donation system which the Taskforce rejected because such support was founded on a hypothesis that it decided was false. Do you think that the falsely held or the invalid, or even the ignorant argument still has a place in ethical decision-making or ethical deliberation at least?  Or, if an opinion it can be rejected, is that the point it is thrown out?

Jonathan: I am never sure it is ever good to throw things out completely, everything you hear, read, learn is there and part of the data you have to work on, you shouldn’t ignore it, but it is appropriate to think about what its significance is, so when you are getting feedback from public on what is acceptable, which might be that this is not acceptable, you then need to say ok, that is your intuitive response.  If we explain things to you, if we get to talk to the people involved and affected by this, does it not change your response.   And that enables you to tease out if there is more to it, if the intuitive response is based on something that can be explored and addressed. What we did with the Organ Donation Task force was to try to understand the nature of the position that was taken and if it appears that people are building their ideas on particular assumptions then it is worth understanding whether they are true or false. If they are building on something on an attitude of acceptability, or an impact on experience of people they love and care for, then even if other people are different, then that is valuable. So I don’t think it is a question if you can disregard, it is a question of as we understand it better, how does it impact on decisions we might be taking. It is important to understand your responsibility in making the decision and hence if your responsibility is to make a binary choice, i.e.; should we choose a step or not, you weigh up on both sides, but need to come down on one side or the other. But on the other hand you are doing more typically something which Nuffield Council is doing, trying to understand, define, refine and frame discussions that need to be had, well then you would expect to try and be fair to all discussions that you have heard. You would not take regard of some and not of others, you would try to recognise variation and might form view of the thing you were going to recommend, but I don’t think you would be doing your job properly, if you hit some adverse things that came in.

“I think that the idea that you pull resources and see different insights into problems, is the right way forward. If you look at something like Nuffield Council of Bioethics we have very few bioethicists.  What we try to do is collect a group of bright people from lots of different disciplines and experiences, and create an environment to try and work though what they understand, to beat issues and possible ways forward.”

Morgan: As I am sure you are aware, Medical Humanities Sheffield is a collaborative vehicle for the interface between various disciplines that all share an interest in human health whether that is in the past, present or future.  Do you think multi-disciplinary or inter-disciplinary approaches to health are valuable in academia?  Do you think they are becoming the norm? Or do you think there is some work to go?

Jonathan: Well I am intellectually eclectic.  It seems to me that making sense of experience enables you to draw on many disciplines and challenges ways of approaching things.  When I was a student, I made myself read a non-law book every year, and I think I learnt more from that than from my legal studies, because it made me think about my legal studies differently. I have always been interested in philosophy, theology, poetry, literature, history, psychology, sociology, my brother did anthropology, and I have yet to discover something that it was not worth reading.  So I think that the idea that you pull resources and see different insights into problems, is the right way forward. If you look at something like Nuffield Council of Bioethics we have very few bioethicists.  What we try to do is collect a group of bright people from lots of different disciplines and experiences, and create an environment to try and work though what they understand, to beat issues and possible ways forward. So we are absolutely looking at the idea that we get more than just the sum of separate

[1] Jonathan Montgomery, ‘Reflections on the Nature of Public Ethics’ (2013) 22 Cambridge Quarterly of Healthcare Ethics 9.

MHS Public Lecture – Health Care Law: Bioethics and the Public(s)’ Interest(s)

Professor Jonathan Montgomery (UCL)

Find out more about Professor Jonathan Montgomery and The Nuffield Council on Bioethics on his Twitter page.