Jacob M. Appel
The recent decision by the International Association of Bioethics (IAB) to hold its 17th annual World Congress of Bioethics (WCB) in Doha, Qatar, has been met with considerable backlash over the proposed host country’s record of human rights abuses. Five leading Dutch bioethicists led by Rieke van der Graaf raised concerns regarding Qatar’s long history of abusing migrant laborers, suppressing minority tribes, lack of freedom of expression, and the denial of fundamental rights to women and members of the LGBTQI+ community, arguing that allowing a country with an abysmal human rights records to host such a conference amounts to “ethics washing.” Although not a focus of van der Graaf et al.’s article, Qatar also remains a dictatorship in which the “hereditary emir holds all executive and legislative authority and ultimately controls the judiciary.” Other bioethicists have advocated for boycotting the event. In response, the IAB’s president, Nancy S. Jecker, and vice president, Vardit Ravitsky, emphasized that the 2024 WCB will be the first such event to take place “in the Middle East, the Gulf region, or an Arab country” and noted that the principles van der Graaf et al. seek to impose risk ruling out a significant numbers of nations from hosting such conferences in the future. They argued that “[r]ather than making a country’s human rights record a basis for excluding its people from academic events and collaborations, bioethicists should set their sights on bringing new voices to the table.” The debate over this particular conference creates an opportunity to rethink existing norms regarding biomedical conference venues in a manner that furthers human rights, civil society, and democratic principles.
Most of the world’s population now lives under autocratic governments. Critics of the choice of Qatar as a venue have focused largely on the impact of the location upon potential participants. These efforts are certainly important and considerable progress has been made in addressing these concerns more generally. For instance, the International AIDS Society (IAS) has set forth valuable hosting guidelines for its own conferences—such as ensuring that HIV+ individuals have access to the venue and that participants are able to speak freely. Unfortunately, less consideration has been given to why authoritarian regimes seek to host such international events—whether a bioethics conference in Qatar, soccer tournaments in Chile and Argentina during the “dirty war” of 1970s, or a Summer Olympics in Beijing. The answer is often to “garner legitimacy” on the international stage. Independent of its consequences for would-be attendees, setting biomedical events in authoritarian nations stamps those nations with an imprimatur of legitimacy. Doing so likely makes the tasks of democracy and human rights activists seeking to challenge those regimes only more difficult. In essence, these events represent an egregious form of “whitecoat washing” in which the presence of physicians and scientists is used to distract the world community from the repressive nature and abuses of despotic governments. By treating the hosting of such events in authoritarian countries as routine, the scientific community has to date largely failed to engage with these fundamental issues.
The case mounted by apologists for Qatar as a conference location mirrors those advanced by defenders of hosting other international events in authoritarian nations: that the offending nation’s track record on human rights and democracy is far superior to the condition portrayed by critics or is marked by substantial improvements; that abusive conditions are rampant across the globe and that singling out one nation, such as Qatar, is unjust; that many western democracies also have historically been complicit in human rights abuses; that individual academics ought not to be penalized for political forces beyond their control; that engagement actually furthers the cause of democracy and human rights; and that human rights and moral values are relative and contextual—and different nations, cultures, and societies may either prioritize some values over others, or may simply disagree overtly on whether some phenomena, such as LGBTQ+ rights, are actually rights at all. On this last point, Ghaly et al. ask, “How do we determine which human rights issues should be high on the agenda of the WCB? What about the priority concerns for the vast majority of peoples worldwide that should be high on the agenda of the global bioethics community?”
Many of these criticisms often contain kernels of truth. Western nations should do better in achieving social justice; in some cases, engagement may further democratic goals, which might then justify exceptions in cases where this result appears likely. Most important, care must be taken to expand the opportunities of individual academics outside rights-violating home nations—and under no circumstances should scholars be boycotted or sanctioned for the actions of their governments. At the same time, progress has to start somewhere. Refusing to challenge egregious abuses in non-western nations risks a drift into the madness of an anarchic form of moral relativism in which no judgments can ever be voiced about the conduct of others.
Any policy adopted to address these concerns should prove inelastic enough so that exceptions do not swallow the rule, yet also retain flexibility for extenuating circumstances. At least two such situations are likely to arise with frequency. First, in some situations, human rights activists living under authoritarian regimes may advocate for their own nations to host international events either to reward substantial progress toward freedom and popular governance, as might be the case in hybrid regimes, or, in rare circumstances, to draw attention to the ongoing abuses in the host nation. Second, common sense and efficacy strongly argue for holding conferences and events in locations where the fruits of these endeavors are most relevant. For example, hosting a conference on public health in the Sahel at a location in Scandinavia may avoid human rights pitfalls, but the location is also far removed from the communities impacted by its work. Some flexibility ought to be permitted to allow for these considerations. However, setting a bioethics conference in Qatar at the moment is challenging to justify. In contrast, setting a summit in Qatar to address habitat protections for the Arabian oryx, an endangered antelope of the Arabian Peninsula, might well be a less unreasonable choice.
None of these concerns should absolve democratic hosts from their own obligations to ensure necessary access and protections for international participants. For example, grave concerns have been raised in the past about access of physicians and scientists from the Global South to obtain visas for conferences in Western Europe and North America. Ghaly et al. are fully justified in raising this issue. Conference organizers have an ethical duty to prevent such injustices, even if doing so means that major western democracies are themselves denied events for failures to guarantee access. In fact, by publicly boycotting democratic nations that fail to ensure access, organizations can draw necessary attention to this unacceptable practice. However, hosting conferences under such troubling circumstances in the past does not justify hosting conferences in Qatar today. Rather, international organizations should have boycotted those nations then and Qatar today.
Meaningful autonomy is not possible under authoritarian regimes that severely curtail free expression and consensual conduct. Hosting a conference under such a regime does active harm by stamping that regime as legitimate in the eyes of the international scientific community; in contrast, the potential benefits are often largely theoretical. While a shallow interpretation of justice might rationalize such hosting as a mechanism for ensuring equity for denizens of the host country—and in the case of Qatar, the Middle East more broadly—a more robust sense of justice recognizes that doing so also implicitly suggests that inhabitants of the host country are not as deserving of human rights and self-governance as their peers living in democracies.
The warning of Tocqueville, popularized by United States Supreme Court Justice Felix Frankfurter, not to confound the familiar with the necessary proves particularly relevant to the question of where to host scientific and biomedical conferences. For generations, such events have been held in nations whose autocratic governments suppress dissent, curtail basic human rights, and—in extreme cases—engage in torture, war crimes, and cultural genocide. In most instances, these conferences transpire with minimal objection from the international scientific community. Under the guise of political neutrality, the organizations that sponsor these events lend an imprimatur of legitimacy to the governments of the host countries. Yet doing so is not politically neutral. Rather, hosting a convention under such circumstances is highly complicit in the transgressions from which the host nation’s authorities hope to distract.
Defenders of hosting the WCB in Qatar are correct in arguing that this debate should not be only about Qatar. At the same time, the IAB’s decision affords the scientific community an opportunity to engage in more meaningful engagement with this ongoing challenge and to take a strong stance for human rights and democracy that can be applied more broadly.
Jacob M. Appel MD JD MPH HEC-C DFAPA is Professor of Psychiatry and Medical Education and Director of Ethics Education in Psychiatry at the Icahn School of Medicine at Mount Sinai, New York City, USA. Email: firstname.lastname@example.org
 R. van der Graaf, K. Jongsma, S. van de Vathorst, et al. “The Ethics of Ethics Conferences: Is Qatar a Desirable Location for a Bioethics Conference?,” Bioethics (2023) 37/4: pp. 319-322.
 Freedom House, Qatar: Freedom in the World 2023 Country Report, https://freedomhouse.org/country/qatar/freedom-world/2023 (Washington, 2023)
 “Why Scientists Are Boycotting This Conference in Qatar,” The Daily Beast, May 6, 2023, https://www.thedailybeast.com/qatar-will-host-the-worlds-biggest-conference-on-bioethicsand-scientists-hate-it
 N. S. Jecker and V. Ravitsky, “The Ethics of Bioethics Conferencing in Qatar,” Bioethics 37, no. 4 (2023): 323-25.
 Ibid, 323.
 B. Herre, The World Has Recently Become Less Democratic, One World in Data, 2022, https://ourworldindata.org/less-democratic
 See note 1, 319-322.
 “FIFA Has Long Ignored Human Rights Abuses,” Washington Post, November 21, 2022, https://www.washingtonpost.com/made-by-history/2022/11/21/world-cup-human-rights/
 “Qatar World Cup Comes With Human Rights Abuses And Controversy,” Forbes, October 31, 2022, https://www.forbes.com/sites/samindrakunti/2022/10/31/qatar-world-cup-comes-with-human-rights-abuses-and-controversy/?sh=5b49bdac1657
 J. M. Appel, “Against Whitecoat Washing: The Need for Formal Human Rights Assessment in International Collaborations,” American Journal of Bioethics 22, no.10 (2022):1-4.
 M. Ghaly, M. El Akoum, S. Afdhal, “Bioethics and the Thorny Question of Diversity: The Example of Qatar-Based Institutions Hosting the World Congress of Bioethics 2024,” Bioethics 37, no. 4 (2023): 326-330.
 “Why Visas Are a Hot Topic Right Now at the International AIDS Conference,” NPR, https://www.npr.org/sections/goatsandsoda/2022/07/13/1111135757/the-visa-hurdle-why-conference-applicants-from-the-global-south-cant-always-clea
 Adamson v. California, 332 U.S. 46 (1947); Griffin v. Illinois, 351 U.S. 12 (1956).