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  • BIOETHICS FORUM ESSAY

Obama’s Bioethics Commission: Providing Practical Policy Options

Last week President Obama disbanded the President’s Council on Bioethics and signaled plans to replace it with a new bioethics commission. A White House press officer told The New York Times that the council was being disbanded “because it was designed by the Bush administration to be ‘a philosophically leaning advisory group’ that favored discussion over developing a shared consensus.” Obama will appoint a new bioethics commission that “offers practical policy options.”

The article quotes Alta Charo as saying that the Bush council “‘seemed more like a public debating society’ and that a new commission should focus on helping the government form ethically defensible policy.”

These are very few words from which to predict what the Obama administration and its bioethics advisors think of past and future bioethics commissions. But, to me it references the debate going back to the 1960s about what public bioethical debate should be.

People largely have defined the first chair of the Bush commission, Leon Kass, and that commission as a whole, by their relative conservatism compared to previous commissions. But what Kass should be more famous for is his vision that bioethics should define societal goals or ends before we decide whether to pursue various types of biotechnology. I think it is this conversation that is considered “philosophical.”

As Kass wrote nearly 40 years ago, we must begin “with a serious deliberation about our ends and purposes” in biomedical technology, because “it is indeed the height of irrationality triumphantly to pursue rationalized techniques while insisting that ends or purposes lie beyond rational discourse.”

As an example, the first sentence of one of the council’s publications asks: “What is biotechnology for?” Debating ends was not a conservative stance in the 1960s, but was shared by leftist critics of science and technology, as well as those concerned with the growing rationalization of society.

The Bush commission’s notion of bioethics returned bioethics debate to its earliest days in the 1960s and 1970s, before what is now called practical advice became paramount. Practical advice was achieved from the 1970s forward by avoiding debates about the ends to pursue, and by using assumed ends – like those articulated through “principlism” – in order to make policies that were actionable by unelected officials. Think of IRBs, which do not debate the ends to pursue, but apply institutionalized ends to specific situations.

Kass was clearly aware of the role that consensus plays in discouraging this discussion of ends. Bush’s executive order authorizing his commission had a passage not seen in the authorizations of previous bioethics commissions – that in pursuit of the goal of striving “to develop a deep and comprehensive understanding of the issues,” the council “shall be guided by the need to articulate fully the complex and often competing moral position on any given issue, rather than by an overriding concern to find consensus.”

Kass recognized, I think, that up to that point, bioethics commissions achieved consensus by not debating the ends to pursue, but rather by assuming a number of very thin, presumably consensual ends.

Now, Obama seems to be returning bioethics commissions to where they were when Clinton left off. But, can anyone say that we are now a society that has somehow achieved consensus about the status of the embryo? And has anybody answered the question: What is biotechnology for? The very fact that ethics seems to depend on whether the Democrats or the Republicans win has made it clear that there is no agreement on the ends to pursue with biotechnology.

How, then, can the new bioethics commission reach consensus over “practical policy options” and not become a “debating society?” The history of bioethics would show that this has previously been achieved by limiting the questions that can be addressed, limiting discussion of ends, or limiting who can deliberate. For example, conservatives would have to be excluded.

I could finish by making a call to return to the Kass vision, perhaps this time with more of an attention to practical details. However, I think that what the Bush commission demonstrated is the irredeemable value of pluralism in the United States. I still think it is critical to define the ends that we are pursuing, but let’s not pretend that these ends are universally held by not talking about them.

Instead, Obama’s group should state the ends that it wants to pursue through biotechnology. It could start with the vision statement of the Progressive Bioethics Group or with the values inherent in principlism. It can then set out to work out the practical details, of which there will be very many.

The Obama commission should explicitly state its ends, or values, because it is only then that good practical advice can be given. Such a statement would also make it clear that presidential politics will determine whose values will be promoted in public bioethics in the future, and the public should be aware of this before they vote.

John H. Evans is associate professor of sociology at the University of California, San Diego. He is the author of Playing God? Human Genetic Engineering and the Rationalization of Public Bioethical Debate.

Published on: June 26, 2009
Published in: Bioethics

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