The election is about six weeks away. Though the economic crisis is dominating the news now, the candidates’ positions on other issues, including many that are fundamentally bioethical, should receive attention in the presidential debates and in voters’ decisions.
Here’s a roundup of where Barack Obama and John McCain stand on particular bioethics issues, as stated on their web sites and in responses to questions posed by Science Debate 2008. Following it is a wish list of additional issues that are under their radar for the time being but that deserve their attention.
Abortion: Obama “will make preserving women’s rights under Roe v. Wade a priority as President.” McCain seeks to overturn Roe.
Cloning: Research on cloning could advance scientific knowledge of the genetic basis of diseases and produce therapeutic stem cells. The challenge is how to avoid ethical problems, like cloning a human embryo for reproductive purposes. Obama gives no official position. McCain seeks to ban all human cloning, including for medical research.
Conscience clauses: Doctors and other clinicians have the legal right under federal and state conscience clauses to opt out of performing or participating in abortions. A regulation under review by the Department of Health and Human Services could extend that right to refusing to dispense birth control pills and emergency contraception. Obama opposed the proposed rule in a letter he cosigned to the Secretary of the Department. McCain has no official position.
Family caregiving: With the population aging and most long-term care to the elderly provided by family members, family caregivers need financial and other resources. Obama wants to reform the financing of long-term care to protect seniors and their families and improve the quality of elder care. McCain has no official position.
Genetic testing: Beyond the passage of the Genetic Information Nondiscrimination Act (GINA) this year, what role, if any, should the federal government take in overseeing the use of genetic tests and guarding the privacy of genetic information? Obama told Science Debate 2008 that he is “concerned about the premature introduction of genetic testing into the public domain without appropriate oversight,” noting that he introduced the Genomics and Personalized Medicine Act of 2007 to ensure the safety and accuracy of such testing. McCain told Science Debate 2008: “As genetic research becomes increasingly deployed, the need to ensure privacy of human records will become all the more essential, as will be the rigor to ensure there is no genetic discrimination.”
Health care costs: The U.S. spends nearly twice as much as any other country on health care, and yet it has the worst record in preventable deaths and other unfavorable health statistics. Obama and McCain both propose curbing health care costs by investing in electronic medical technology, allowing American to import medicines safely from other developed countries, increasing the use of generic drugs, and promoting disease prevention. Obama would also lift the ban on the government negotiating prices with drug companies. McCain aims to improve coordination of health care.
Health insurance: With 46 million Americans uninsured, both candidates pledge to reform the health care system. They want health insurance to be portable. Obama’s proposal includes the creation of a national health plan similar to what is available to members of Congress that is affordable and open to all Americans, as well as mandatory coverage for children. McCain’s proposal is market-based, including a $5,000 tax credit for families or $2,500 for individuals to buy health insurance and the freedom to use insurers across state lines.
Medical error: An estimated 44,000 to 98,000 patients die each year in the U.S. because of medical errors. Obama would require health care providers to report preventable medical errors, and he would support quality improvement measures to prevent errors. McCain would bar Medicare and Medicaid from paying for preventable medical errors or mismanagement.
Pandemic planning: What should be done to contain an influenza pandemic or a biological attack? Obama told Science Debate 2008 that he would “help hospitals form collaborative networks to deal with sudden surges of patients” and “expand local and state programs to ensure that they have the resources to ensure that they have the resources to response to these disasters.” He proposes to improve communication between federal, state, and local governments. McCain would also focus on preparedness, communication, and surveillance and detection, as well as on deterring a biological attack through intelligence and counter-terrorism.
Stem cells: What role, if any should the government take in regulating and funding stem cell research? Obama and McCain told Science Debate 2008 that they support federal funding for embryonic stem cell research. Obama would lift the current ban on federal funding of research on embryonic stem cell lines created after August 9, 2001. McCain would make it a federal crime for researchers to use cells of tissue from an embryo created for research purposes.
The Hastings Center scholars have compiled a list of other bioethics questions for the candidates. The questions are unlikely to come up during the presidential debates, but they’re highly likely to face the next president.
1. What will you do to keep politics from biasing tough decisions on climate change, environmental protection, workplace safety, and other science issues?
2. Do you unequivocally condemn torture? Both of you have said so in speeches, but you have eliminated references to torture on your web sites.
3. Should the federal government take a more active role in regulating assisted reproduction (as other developed nations do), such as in protecting egg donors from exploitation and preventing clinicians from denying services based on marital status or sexual orientation?
4. What, if any, government regulation is needed on the use of embryos left over from fertility treatments and stored in clinics?
5. Would you consider legalizing a market for donated organs to reduce the shortage of organs for transplantation?
6. In the event of a public health emergency, such has the SARS outbreaks in 2003, what limits on liberty are justified, such as quarantine of infected individuals or other restrictions of movement?
7. What regulation is needed of the increasing practice of collecting of DNA samples from criminal suspects?
8. More than 300 million biospecimens are stored in U.S biobanks and used for research purposes; how would you oversee the ethical use of this material, including informed consent from donors, privacy, and ownership of intellectual property?
9. What role should the government play in supporting promising new technologies – nanotechnology, synthetic biology, and genetic engineering – while guarding against potential safety and environmental hazards?
10. If your proposals to control health care costs prove insufficient, would you consider rationing health care, such as the availability of costly drugs and technology?