Advice Fit for a President

At the first meeting of the newly assembled President's Council on Bioethics (PCB), Jan. 17-18, members began their consideration of sensitive bioethical issues not with an analysis of the writings of a scientist, nor a bioethicist, nor a legislator, but a novelist. The group discussed Nathaniel Hawthorne's short story The Birthmark, a literary exploration of mankind's apparent aspiration to root out his own imperfections. The story's protagonist, an alchemist named Aylmer, convinces his wife Georgiana that he can safely remove a hand-shaped birthmark from her cheek, the lone blemish of an otherwise perfect physical specimen. Tragically, Aylmer removes the birthmark but unintentionally kills Georgiana in the process. Writes Hawthorne, "the fatal hand had grappled with the mystery of life, and was the bond by which an angelic spirit kept itself in union with a mortal frame." Courtesy of University of ChicagoLeon Kass Hawthorne's tale, says PCB chairman Leon Kass, is a commentary on the implications of "trying to eliminate all signs of our mortality and finitude." According to Kass, who is on leave from the University of Chicago's Committee for Social Thought, the discussion was part of an effort to "develop the terms of a richer and deeper bioethics that does full justice to the issues." This is just one of several difficult assignments that the new panel, with its new approach, plans to tackle during its two-year term. President George W. Bush announced his intention to form a panel last summer, along with his decision to allow government funding only for embryonic stem cell research that utilizes existing embryonic stem cell lines. The appointment of Kass and the PBC's executive director, Dean Clancy, and former senior policy adviser for US Rep. Dick Armey (R-Tex.), were announced last fall, but the remaining committee members were not officially announced until mid-January. Superficially, the PCB has much in common with its predecessor, the National Bioethics Advisory Commission (NBAC), whose third two-year term expired last October. Both are federal advisory committees created by an executive order from the White House; both consist of 18 members with diverse academic and professional backgrounds ranging from religious studies to medicine to law. But unlike the PCB, NBAC had a specific request on its inception: to examine the issue of human subjects' protection. At the behest of former President Bill Clinton, NBAC also notably addressed the ethical and legal issues surrounding cloning humans in 1997 when Dolly the sheep came on the scene, and those surrounding stem cell research in 1998 on the heels of pivotal stem cell findings. Other NBAC reports covered the use of human biological materials, research on persons with mental disorders, and bioethics issues in international research. For now, the PCB, which will meet monthly, has only human cloning and stem cell research on its agenda. At its first meeting, the council had three sessions on cloning: one related to the larger context of technological innovation and reproduction, one on the moral issues related to reproductive cloning and one on the policy questions and the legislative options. The panel is not required to make specific policy recommendations, as was NBAC. "We've been liberated from the obligation to pursue consensus," says Kass. He suggests that the panel will focus more on the "fundamental inquiry into the human and moral significance of these advances" than have previous panels. "In other words," he explains, "not just to say 'is it ethical, is it unethical?' 'Are you for it or not?'" The PCB has not been immune to criticism. For a panel on bioethics, the council actually has relatively few so-called bioethicists within its ranks. "It's going to take a long time for this group to get up to speed," says Arthur Caplan, director of the University of Pennsylvania's Center for Bioethics. "They've got some intellectual heavy-hitters there from the right wing, but they're not people who are necessarily conversant with current developments in biomedicine." Kass, who himself holds an MD and a PhD in biochemistry, points out that several members, though not bioethicists per se, have bioethics-related training. He says that he is convinced that the group has sufficient diversity to handle any topic thrown its way. The council's charter also does not explicitly include members of the public, though one member, Charles Krauthammer, is a Washington Post columnist. Kass notes that the PCB will often hear from members of the public and patient advocates often. "The key issue," comments former NBAC executive director Eric Meslin, "is how the public will be engaged in this council's work whether they will see it only as a group of experts speaking to themselves, or whether they will feel that the deliberations of that group will be relevant and useful to the public conversation." Critics have more seriously charged that the council is little more than a politically conservative mouthpiece for President Bush. "There's no danger of the president getting any advice out of this group that would unsettle him," claims Caplan. Possible proof of NBAC's independence: the Clinton administration embraced the commission's human cloning guidelines but rejected their stem cell research guidelines, which called for federal funding of both use and derivation of embryonic stem cells. "The impression I have been given, and it's more than an impression," says Kass, "is that [Bush] doesn't want just 'yes-men.' He wants people who will make sure that when he has to make a decision, he will have heard the best arguments on various sides of the issue." Kass' own conservative views in particular have made some observers nervous—especially scientists. He, for example, does not believe that the government could enforce a ban on reproductive cloning while simultaneously allowing so-called therapeutic cloning, precisely the goal of the pending Human Cloning Prohibition Act of 2001 being sponsored by US Sen. Dianne Feinstein (D-Calif.) and others. "The hard step is creating the cloned embryos," says Kass. "Putting them in a uterus is easy." But Kass hopes to allay the fears of the scientific community: "I have these personal views, and I'm not going to erase them. But as chairman, I am not an advocate." Eugene Russo (erusso@the-scientist.com) is a contributing editor. Members of President's Council on Bioethics Elizabeth Blackburn, PhD, Professor, Department of Biochemistry and Biophysics, University California, San Francisco Stephen Carter, JD, William Nelson Cromwell Professor of Law, Yale Law School Rebecca Dresser, JD, MS, Daniel Noyes Kirby Professor of Law, Washington University School of Law Daniel Foster, MD, Donald W. Seldin Distinguished Chair in Internal Medicine and Chairman of the Department of Internal Medicine, University of Texas Southwestern Medical School Francis Fukuyama, PhD, Bernard Schwartz Professor of International Political Economy, Paul H. Nitze School of Advanced International Studies of Johns Hopkins University Michael Gazzaniga, PhD, Director, Center for Cognitive Neuroscience, Dartmouth College Robert P. George, JD, D Phil, McCormick Professor of Jurisprudence, Princeton University, and Director of the James Madison Program in American Ideals and Institutions Alfonso Gomez-Lobo, PhD, Ryan Family Professor of Metaphysics and Moral Philosophy, Georgetown University Mary Ann Glendon, JD, LLM, Learned Hand Professor of Law, Harvard University William B. Hurlbut, MD, Consulting Professor in Human Biology, Stanford University Charles Krauthammer, MD, National Columnist, The Washington Post William F. May, PhD, Cary M. Maguire Professor of Ethics Emeritus, Southern Methodist University Paul McHugh, MD, Henry Phipps Professor of Psychiatry and Director of the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, and Psychiatrist-in-chief of the Johns Hopkins Hospital Gilbert Meilaender, PhD, Richard & Phyllis Duesenberg Professor of Christian Ethics at Valparaiso University Janet D. Rowley, MD, DSc, Blum-Riese Distinguished Service Professor of Medicine, Molecular Genetics and Cell Biology, and Human Genetics, Pritzker School of Medicine, University of Chicago Michael J. Sandel, PhD, Professor of Government, Harvard University James Q. Wilson, PhD, The James A. Collins Professor of Management and Public Policy Emeritus at the University of California, Los Angeles

Advice Fit for a President

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