Bioethics Forum Essay
The Next President’s Council on Bioethics: Who Cares What It Does?
President Obama’s announcement that he will replace the members of the President’s Council on Bioethics has led to speculation about appointments and the issues a reconstituted commission might address. White House officials say they favor a commission that is less inclined toward philosophy and more inclined toward practical policy advice. What, then, should a newly constituted President’s Council on Bioethics take as its major tasks?
Our initial reaction to such a query was, who cares? Presidential commissions have historically had no responsibility for, and no control over, presidential bioethics policy. The ethics of human subjects research and the evaluation of gene therapy has long been the province of federal agencies, and President Obama has additionally delegated responsibility for stem cell policy to the National Institutes of Health and oversight of the abortion reduction initiative to the Office of Faith-Based and Neighborhood Partnerships.
Further, the chair of a bioethics commission is ill placed to be an active participant in the policymaking and implementation process. Senior presidential advisors such as the national security advisor and the director of the National Economic Council are organizationally part of the Office of the President. They oversee elaborate institutional machinery that includes representatives from multiple departments and have clear responsibilities for developing, implementing, and marketing the president’s program in their respective areas.
Chairs of bioethics commissions lack any such organizational or political standing. Individual presidents can and have asked bioethics commissions for formal or informal advice on particular issues, and politically sophisticated chairs may be able to leverage considerable influence, but bioethics commissions have typically lacked the institutional ties to the White House or the standing to speak for the president to make them major players in policymaking.
Perhaps more importantly, it is far from clear that much American bioethical policy is made in Washington. In some other countries – England, for example – it is possible to speak of national bioethical policy made and promulgated by national entities with the clear authority to do so.
By contrast, bioethical policy in this country is typically made in a decentralized, market-driven fashion in which state legislatures and courts, professional societies, insurance companies, and individual patients and providers are major players. There are enormous disparities across states in the accessibility of abortion, the scope of legal stem cell research, and laws governing assisted reproduction.
Federal influence over these issues is so limited that it may matter little what a presidential bioethics commission does. To the extent that the commission is tasked with suggesting concrete policies, it will arguably play less of an advisory role to the president than to state and local courts and policy-makers – making “President’s Council” a misnomer.
Just as there is a limited role for the federal government, then, so, too, should the new national bioethics commission be aware of its correspondingly limited role. However, a role that is limited in scope need not be limited in importance. Here’s where our cynical first reaction gives way to our second, “yes we can” response.
A national bioethics commission might in fact be quite helpful in a variety of ways. For instance, as science and medicine become increasingly globalized, so, too, do the ethical issues they raise. Adequately addressing many bioethical issues means attending to international law and policy, and there is bioethical issues means attending to international law and policy, and there is a clear role for a federal commission to play in this regard.
Second, in addition to its global turn, bioethics has taken an empirical turn. Our federalist structure produces a natural experiment in the outcomes of different policy choices, as policy on reproductive and genetic technologies makes clear. Individual states lack the resources, and perhaps the incentive, to take advantage of this natural experiment. A federal commission – staffed more heavily than in the past with empiricists – could usefully collect and analyze data on the results of different state (and perhaps international) bioethical policies, providing policy-makers with outcome-based, empirically supported bioethical guidance.
Finally, a national commission might focus on emerging technologies. State governments and federal agencies have limited resources, requiring them to focus on policy questions that are certain and immediate. A national commission has the leisure of taking on the important task of initiating a national conversation about the bioethical issues that may confront us on the horizon.