For years, and rightly so, bioethics has wrestled with the "technological imperative." The phrase has characterized the excessive use of technology at the end of life, or the rush to unnecessary tests and procedures. Did you really need that sigmoidoscopy? But there is another neglected imperative now, the research imperative.

Try a taste of it. The Nobel laureate Joshua Lederberg once said of research that "if we do not pursue new medical knowledge, the blood of those whose lives could be saved will be on our hands." Al Gore, touting the economic benefits of research, has spoken of the "sacred circle of progress and prosperity." And the present Congress, tight-fisted about welfare but exuberant about biomedical progress, gave the National Institutes of Health a 10 percent increase this year, bringing its budget to $15 billion. It is hard to argue against a highly profitable enterprise, backed by a supposed moral duty, and filled with the drama of scientific progress.

Yet increasingly the research imperative has provoked ethical controversy and, here and there, strong resistance-but so far, not enough resistance. The first struggle took place in the 1960s when, to combat the abuse of human subjects in medical research, the government established an elaborate system of institutional review boards. Many scientists of that era complained bitterly at this interference in their freedom, predicting the end of research.

That didn’t happen, of course, but a series of later research initiatives provoked a series of no-less-heated debates. There was the struggle over fetal-cell research in the 1980s, aimed in particular at finding a cure for Parkinson’s disease (and now, with some results coming in, showing fair promise of working); then a battle in the 1990s over embryo research, sought by many scientists as a possible route to the cure of cancer and infertility. More recently, the cloning debate broke out, with many calls for a ban-which has yet to happen-on research aimed at cloning a human being; and, shortly after that, still another set-to over stem-cell research, seen as a promising way into the creation of human organs and tissue. In each case, proponents of the research invoked visions of enormous gains in scientific knowledge and splendid possibilities for the relief of suffering; and the biotechnology industry could see only more dollar signs.

Many of those initiatives have provoked the ire of anti-abortion groups. Most of the fetal tissue, embryos, and embryonic stem cells would come from aborted fetuses. But other challenged research initiatives have not touched on abortion issues. The National Bioethics Advisory Commission stirred up anger among mental-health researchers when it recently called for more stringent regulation of research on the mentally ill and incompetent. Reports of schizophrenics and other seriously ill people being taken off their medications, with no informed consent, to see what would happen, is just one of many reported abuses. For some years there have been complaints about social psychologists using deception in their research, but it still goes on.

Three questions require more reflection. The first is this: Is biomedical research a moral imperative, such an overriding good that it must be pursued, and so valuable that some moral risk should be taken in its behalf? I would answer "no" to that question. It is a moral good, but not a moral duty. Call it a desirable, though optional, good. There are many other competing social and individual needs and the possible benefits of biomedicine are not necessarily greater than other goods (such as improved education, relief of poverty, job creation, and so on).

The second question is this: Should researchers be deferential to the values of those with moral objections to the research? More specifically, should prochoice researchers defer to the repugnance of anti-abortion groups simply because those groups are morally offended-and defer even if they could win legislatively, as they almost surely will in our science-loving culture? I would give a hesitant "yes" in response to that question, much as I would say that those with antigay beliefs should defer to the moral convictions of homosexuals on occasion, such as with the passage of antihate crime laws. Serious pluralism can require deference to our neighbor’s moral sensibilities.

Here is my third question: Can anything be done to tame-not to cripple, much less kill-the research imperative? Probably not much, but it is worth a try. Begin by denying that research is a moral demand, flatly rejecting such claims. Next, treat claims by scientists that some proposed research direction (for example, embryo research, research without consent) is necessary for the cure of disease as nothing other than self-interested pleading by a group that wants to go one route rather than another. Not only is there almost always more than one way to pursue medical research with targeted goals, and usually many more, there are almost always also plenty of scientists eager to get money for some other, competing line of research.

Still another step is to demand of those who want to carry out morally problematic work to bear the burden of showing that it has (1) a high probability of success; (2) that it will make a genuine contribution to human welfare, not just scientific progress; and (3) that no other approach can make such a claim. One of the great strengths of scientific methodology is the skepticism it brings to claims of new knowledge. It demands stringent proof. High hopes and enthusiasm don’t count. The same kind of skepticism is appropriate when claims of great human benefit from controverted lines of research are put forward. Much infertility, for instance, is caused by sexually transmitted disease and late procreation, both of which are behavioral problems. Embryo research to relieve infertility medicalizes what is heavily a social problem, and one that might just as well be studied by behavioral as biomedical research.

Finally, it should be asked of all biomedical research these days what it will do to the future cost of health care. While some new technologies lower costs, most of them increase it. The reigning killer diseases are rarely cured. They are just kept a bay by expensive drugs or other technologies, as with the AZT AIDS "cocktail," as it is called, or new drugs to cope with Alzheimer’s disease. Will we be better off with technologies that increasingly only the affluent can afford, and which will (and already are) wreaking havoc with health-care systems? An unpleasant question.