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Bioethics Forum Essay

A Trump Bioethics Commission?

The smoke and the Sturm und Drang haven’t cleared from the greatest upset since Harry Truman defeated Tom Dewey in 1948 but it’s still possible to read some tea leaves about the role of bioethics in the new administration. To start at the top, one feature of bioethics that has set it apart from other emerging fields and helped to give it legitimacy has been a series of presidentially appointed commissions.  Beginning with the National Commission in 1974 to the current Presidential Commission, every presidential administration save that of George H.W. Bush has had such a body. Two presidents took special interest in certain issues that they sent to their bioethics panels, President Clinton on human radiation experiments and cloning and President George W. Bush on stem cells.

None of these issues were apparent when the respective presidents ran for office. All emerged during their administrations and amid public demand for answers when there was no obvious place to put the questions, hence the bioethics commissions were useful. This fact makes prediction perilous. Will some issue emerge that will stimulate the Trump administration to create a bioethics body? Or, (less likely), will the administration decide to create one at the outset without a particular trigger?

The answer must lie in some combination of factors, especially the relationship between the governing philosophy — or, if you prefer, the ideological orientation — of the senior members of the administration and the matter that focuses their attention. (Excluded from this calculus is the president-elect himself, who doesn’t seem to have a governing philosophy, but that very absence must play into the assessment.) Among the senior members of the president-elect’s circle Ben Carson, often mentioned as a potential Department of Health and Human Services secretary, is the only one who has a special interest in bioethics. Not only does he profess a strong pro-life orientation, he was a member of the President Bush’s bioethics council and last year found himself ensnared in a briefly embarrassing disclosure of his role in a study involving stem cells in the early 1990s. Vice president-elect Mike Pence is the bridge to the establishment Republican Party and a staunch conservative. Expect him to be supportive of Carson if he champions a bioethics council.

A number of experiments involving human reproductive material could stimulate a reaction from the new administration, especially if Carson is in charge of that policy territory. For example, the development of gametes from somatic cells has recently been reported, potentially facilitating male-only reproduction. And next year the National Academies will release a consensus study on gene editing, a discussion into which the new administration might also wish to insert itself.

There is, however, a potential tension in the attitudes of Trump administration officials toward such matters that did not apply to the Bush administration. Strongly pro-life and culturally conservative officials like the new vice president and, say, Carson, might very much want to pursue restrictive policies in certain cutting-edge research, policies that could both constrain federal funding and hamper privately sponsored research. But there are also hints that the incoming administration has an even less regulatory attitude than the last Republican presidency, and the bulk of gene editing applications are in agriculture, not in human reproduction.

As well, much of the Trump constituency cannot be assumed to hold the same culturally conservative views that galvanized the supporters of George W. Bush. Especially on cloning and stem cells under Bush 43, a neoconservative policy elite saw bioethics as important territory for them to express their philosophical views, and that group had the president’s ear.  Since 2008 many of those socially conservative neoconservatives took more of an interest in immigration reform and economic inequality than in bioethics issues (with “fixing” Obamacare a significant exception). Crucially, many of them were “Never Trumpers” who found the GOP candidate anathema to their core values.  It is possible that at least some of them will reconcile themselves to the new reality and be persuaded by figures like Carson to help the new administration and re-engage in bioethics, but it is too early to say.

How this plays out will depend in part on whether the early hints of a deregulatory orientation to government extend into the ethics of the life sciences. If it does, there will be less of an interventionist tendency. If it does not (and that’s my guess), then we can expect the stridently ideological voices to have much to say about activities in science labs that appear to conflict with their core values.

There are, however, a couple of other jokers in the deck. The president-elect has repeatedly claimed he would do more for veterans. The crises of traumatic brain injury, post-traumatic stress disorder, and dementia are undiminished. Basic and applied neuroscience efforts that might help address those problems will have a strong constituency, even if they involve otherwise ethically suspect lab technologies. Look to continuing strong support for neuroscience.

And then there is infrastructure. With bridges and tunnels collapsing and airports unimproved for decades this is one of the few national problems that both parties agree must be addressed. In science comparisons might well be drawn to the state of research infrastructure. A president sympathetic to less regulation and who believes that everyone is beating us in just about every field might be persuaded that scientists, too, need better facilities and a free hand.

And by the way, there is still a Democratic Party, though one that has less power than it has for about 90 years. In the process of rebuilding it will want to appeal to the millennials, who mostly did vote for Hillary Clinton but not in the numbers hoped. Younger people generally have an aggressive attitude toward advances in science and technology. If the Democrats can be identified as the party that advocates for new and better applied science, that can be an important part of their demographic strategy.

In the end, of course, there is more abject speculation going on than has ever been the case in a prospective administration since perhaps FDR’s first term. With the important exception of policies specific to abortion, bioethics is less likely to be on the radar in the early going than it has been since Nixon. But hints may emerge during the transition. They should be closely watched.

Jonathan D. Moreno is the David and Lyn Silfen University Professor at the University of Pennsylvania and a Fellow of the Hastings Center.

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  1. I wonder if “end-of-life” decisions are also something on which the middle American non-college graduate, cornerstone of Trump voters, thinks differently from the more sophisticated backers of the democrat candidate. Fear of discontinuation of care, committees deciding on futility, and so forth were among the arguments given by “Obamacare’s” opponents. Will all the rules about when to make decisions to terminally exterbate, who can make a patient DNR, be open to review by a chief executive with a new take on such issues?
    This brief comment simplifies a topic, but we should be aware of how empowering a different part of the electorate could allow expression of different attitudes to medical decision making.

  2. President Obama’s Bioethics Commission recommended that human clinical trial participants be “compensated” (i.e. receive care) for any research-related injuries sustained in a government run clinical trial. That administration failed to implement the recommended policy, leaving human clinical trial participants in US gov run clinical trials without a safety net. I underwent 11 hours of experimental brain surgery knowing that if I had a stroke on the operating table, the NIH would provide 30 days in hospital and then discharge me; my family would have been ruined by the cost of Long Term Care. I nearly didn’t go through with the trial. Should clinical trial participants have to face this kind of decision?

    Here is hoping the Trump administration will respect the lives of human clinical trial participants and provide care for reseach-related injuries including Long Term Care.

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