A Dim Future

Within the recesses of the US Department of Health and Human Services, the President’s Council on Bioethics quietly goes about its work, as it has done, under various titles and different mandates, for over 30 years.

Not related to HHS, but only housed there for administrative reasons, the present council was established by President George W. Bush’s executive order in November 2001. The 18 members were chosen by the president from among a group of leading scientists, doctors, ethicists, social scientists, lawyers, and theologians. The council was chaired by Dr. Leon Kass, MD, PhD for its first four years, and by Edmund Pelligrino, MD during Bush’s second term.

The President’s Council, according to Bush’s executive order, was created to “advise the president on bioethical issues that may emerge as a consequence of advances in biomedical science and technology.” With a new president and administration in the White House now, the present council is finishing up its work and will probably vacate the office in the fall of 2009.

The council’s future reincarnation, if there is one, will depend on the interest of President Barack Obama in continuing the work of the current council members. And obvious questions will arise should the council continue under Obama: Will he be as open to a diverse discussion on bioethical issues as the current members? Or will he simply seek members who mirror his own thinking?

THE MISREPRESENTATION OF BUSH’S COUNCIL

Robert P. George, McCormick Professor of Jurisprudence at Princeton and a member of the President’s Bioethics Council, suggested that during the Bush presidency, the media and others believed the council membership favored Bush’s conservative religious leanings. But George denied that theory, saying that the council chaired by Leon Kass “was the most intellectually and ideologically diverse bioethics advisory body ever constituted.”

Writing in January 2009 for the Witherspoon Institute on its website, Public Discourse, George explained that the notion that the makeup of the council was heavily weighted toward “religious conservatives” under President Bush was a false assumption. In fact, almost half of the 18 members disagreed with many of the president’s stances on key issues; several members had voted for Al Gore in the previous presidential election.

Furthermore, on the issue of embryonic stem-cell research alone, six of the members supported the creation and destruction of human embryos for research purposes, one was in favor of revoking Bush’s funding restrictions on using frozen embryos from fertilization clinics for research, and three other members were unopposed to “therapeutic cloning,” George wrote.

From its inception, according to George, Bush asked that the council offer a variety of views on any given issue rather than try to reach consensus in their deliberations.

Fellow council member Peter A. Lawler, PhD, Dana Professor and Chair of the Department of Government and International Studies at Berry College, says the council’s purpose actually goes beyond informing the president. He believes that the mandate given by President Bush to the council “was not only to advise him, but to educate American citizens on the challenges we face.”

Lawler said that “my real opinion is that some of the council reports—such as Beyond Therapy—will grow in public stature over the years.” Lawler credits President Bush with having “a good understanding of the bioethical issues” owing to his “serious study of the work of Dr. Kass.”

Kass, who served as the chairman of the council from 2001 to 2005, has written numerous articles and books on the subjects of bioethics and medicine. He is the Addie Clark Harding Professor in the Committee on Social Thought and the College at the University of Chicago and Hertog Fellow in Social Thought at the American Enterprise Institute. Kass has been engaged for more than 30 years with ethical and philosophical issues raised by biomedical advance, and, more recently, with broader moral and cultural issues.

Dr. Edmund Pelligrino, who chaired the council during Bush’s second term, is professor emeritus of medicine and medical ethics and adjunct professor of philosophy at Georgetown University. He has served as director of the Center for Clinical Bioethics, as head of the Kennedy Institute of Ethics, and as director of the Center for the Advanced Study of Ethics, all also at Georgetown.

Both chairmen are well-respected among their peers, even those who disagree philosophically with them. According to fellow bioethicist Tom L. Beauchamp—who is a liberal by his own admission—Pelligrino is “scrupulously fair in attempting to understand and react to an opponent’s positions. He will meet the issues head-on, and he deserves the same respect from the bioethics community that I have always seen him accord to others.”

Dr. Kass’ approach to the council’s deliberations was demonstrated in a teleconference in May 2005 with members of the media, in which he discussed the council’s considerations of the controversy over alternative sources of human pluripotent stem cells.

He stated that even though there was a split recommendation on the ethics of doing cloning for biomedical research, the council agreed that all parties in the debate “have concerns vital to defend, vital not only to themselves but to all of us” and that no one “can afford to be callous to the needs of suffering humanity, or cavalier about the treatment of nascent human life, or indifferent to the social effects of adopting one course of action rather than another,” he emphasized.

As members of a national bioethics body, Kass explained, “we are mindful of the need to understand and respect the strongly held ethical views of our fellow citizens even when we do not share them….” He stated that they would be receptive “to any creative, scientific, or technical suggestions that might find a way around this ethical dilemma and ethical impasse we face, [enabling] scientists to proceed with their research in ways that neither raise ethical questions nor violate the ethical principles of many Americans.”

Though varied in its purpose and format, the previous bioethics commissions arose out of a need for the kind of bioethical discussion Kass outlines. There was a sense of urgency that the country faced dilemmas that deserved special attention and reflection, making each commissioned group unique.

The present council was created by a presidential decree, as was the previous commission under President Clinton. But three past bioethics organizations were initiated by Congress, by the Department of Health and Human Services, and by the National Institutes of Health, respectively. The second commission and the most recent council studied a broad range of bioethical issues, whereas others focused on specific topics of concern, namely treatment of human subjects in research and embryonic stem-cell studies.

The present bioethics council is the sixth such deliberative body given the task of discussing and reporting on bioethics issues affecting our nation. The current council has served the longest of all the federal commissions on bioethics.

WILL THE COMMISSION BE AN ECHO CHAMBER?

With its own future in question, the President’s Council on Bioethics held a conference this March to examine its own experience, and learn about the experiences of bioethical national commissions in other countries, with the end result being a report with recommendations, or at least an examination of the questions raised.

One of the invited guests was Marie- Hélenè Mouneyrat, Secretary General Comité Consultatif National d’Ethique, from France. She began by saying that “ethical concerns have become the preferred spiritual nourishment of our contemporary societies…[which are] gradually gaining ground in every sector of human activity.”

There are presently national ethics commissions of some sort in almost every country in the world. In France, the commission’s existence is defined by law and mandated by the French president. Mouneyrat stated that “bioethical reflection could be defined as an exploration of the relationship between scientific progress and social acceptability.”

She said that ethics committees “must be the preferred instrument for the establishment of an unfettered and reasoned debate on bioethical issues by society, firstly, because the existence of this societal debate is an essential condition for society’s willingness to accept normative rules, [an essential] of participative democracy.” In this respect, she believed, “the particularly sensitive role of an ethics committee in such a democracy, on the borderline between representative and direct democracy, becomes very clear.”

As for the next President’s Council on Bioethics, council member Peter Lawler believes that the ideal situation would be for President Obama to have “some continuity with the past council, homily the Pope referred again to the challenge secular Australia, where “in the name of human and not act on the wrong opinion that Bush’s bioethics council was waging some war against science.”

Lawler stated that he believes the reports created by the council “added a genuinely Socratic dimension to public reflection on the problems of technology and biotechnology.” In reviewing transcripts from council gatherings, he said that one couldn’t help but be “amazed at the sustained, smart, friendly disagreement…a real education for me.”

“No previous advisory group even aimed at such a high and sensitive level of public reflection,” Lawler emphasized.

And he wondered, like everyone else, over the possible outcome for the next council, which council member Robert George outlined in his article on the Public Discourse website. If President Obama follows “Bush’s lead and appoints a diverse council…his decision would ratify a certain way, entirely noble, of using bioethics advisory councils to enhance the overall quality of deliberation and debate,” George wrote.

But if Obama “repudiates Bush’s openness to permitting a range of voices on the council” then he will “have established different terms for conducting the debate—terms according to which the role of bioethics councils is to advance the president’s own preordained agenda on bioethics questions [rather than providing] thoughtful argumentation enriched by the inclusion of perspectives that are critical of the president’s beliefs,” George concluded.

At the conference, Mouneyrat finished her remarks by saying that there was one final challenge that concerned her — the “institutionalization” of national bioethics committees. She said: “The danger is letting the consultative role slip away. In other words, losing its soul and paving the way for a society deprived of its capacity for reflection, having handed it over [to a chosen group] to say what is right or wrong.”