Government For The People, By The People Does Not Obviate Use Of Political Litmus Tests

"... We may safely pronounce that the true test of a good government is its aptitude and tendency to produce a good administration." -- Alexander Hamilton, The Federalist, No. 68. Since the majority of government employees, including the director of the National Institutes of Health, are appointed in some fashion, the establishment of selection criteria is unavoidable. The question is what will the criteria be and how will they be weighed? The need for a director of NIH is apparent on several levels. The direction of NIH, as well as its review process and funding priorities, have been called into question from a number of different quarters. However, initial screening of candidates for this position generated controversy when it was revealed that some candidates had been questioned concerning their position on induced abortion and on the use of aborted fetal tissue for research purposes. Considerable outcry arose from a number of individuals and organizations who contended that these were simply "political" issues of no relevance to the NIH directorship. But is this true? If the director of NIH believes that prenatal individuals are not human beings with protectable health interests and, therefore, are excluded from public health policy, NIH's approach to setting priorities for health research would be different from its approach if he or she believed that such individuals are included (in spite of the parents' having the authority to kill the fetus). The priority of studying issues such as occupational hazards on fetal development, for example, would be affected by the extent to which the developing fetus is believed to have protectable interests. A different, but related, issue is the question of whether tissues derived from aborted fetuses should be used for medical therapy or research. The administration has banned the use of federal funds for therapeutic use of human fetal tissue derived from induced abortions, and special- interest groups have opposed it. But if the director of NIH holds a clear opinion on this issue it would be expected to manifest itself in related NIH policies. Much of the outcry against the use of the so-called litmus test has arisen from groups who oppose the ban on the use of aborted tissue. Consequently, it is difficult to determine whether such groups believe the issue is truly irrelevant or whether they want a director of NIH who shares their own political perspective. In fact, declaring a candidate's views on these issues as "irrelevant" provides a new litmus test, since those who believe that a candidate's views on abortion or the use of aborted tissue are relevant would presumably be excluded on that basis. Regardless of where one stands on these issues, a candidate's personal opinion is relevant if it affects the way government policies are interpreted or executed. To this end, relevant litmus tests are not limited to issues relating to prenatal health and life. Examples of other issues are euthanasia, the distribution of health services according to age or wealth, and the inclusion of women and minorities in clinical trials. One would like to believe that decisions can easily be divided into those that are strictly scientific and those that involve politics, but such distinctions have historically been unreliable. Consider the "scientific evidence" used to justify past governmental policies affecting racial minorities. Such justifications included anthropological "evidence" for the inferiority of certain ethnic groups based on "scientific" data, not only in the case of Nazi Germany but also in the practices of slavery in the United States. One wonders whether a candidate for an administrative health post around the time of the Supreme Court's Dred Scott decision, which legalized the doctrine of racial inferiority in the United States in the mid-19th century, would have been excluded from consideration because he felt that blacks were worthy of study or improved health care delivery. A common response to these examples is that the data underlying the prejudiced policy were not reliably or properly obtained. However, this begs the question, since any scientific conclusions are open to debate and may require some time to be supported or falsified. The fact is that there are biological differences between racial groups. The issue is not whether such differences exist, but whether they should be used as the basis for discriminatory policies. One hallmark of an enlightened society may be that oppression based on racial characteristics is not tolerated. Even though this position is primarily a political one, it does not make it irrelevant. If the director of NIH believed that one racial group was less deserving of research or health care because he or she felt the group did not deserve inclusion in the NIH mission, there should be little question that the government would apply the litmus test of "nonprejudice" to exclude such candidates--even though they might otherwise be suited to the task. Few would be willing to put an individual into a position of authority when it was clear that some citizens would be negatively affected by that individual's "personal" view on civil rights. Another example of a personal belief and its impact on health administration is that of "animal rights." A nominee who believed that the use of animals for medical research is unethical might be submitted to a litmus test on this issue even though the test would be labeled by some, namely those who object to animal research, as politically motivated. But it is clear that such a belief would seriously limit the nominee's ability to carry out the current health mission of the NIH. Application of this political litmus test would occur even though there is nothing illegal in objecting to animal research, an objection held by a significant minority of the population who benefit from the health advances made through NIH support. To conclude that litmus tests are necessary is not to conclude that the acquisition of scientific information cannot be separated from its application. It certainly can. However, in selecting individuals for government positions, it becomes necessary to identify those who are qualified not only by virtue of their scientific and administrative backgrounds but also by virtue of their adherence to the fundamental principles on which the government is founded and to which the present elected administration adheres. It is in this context that a candidate's views can, and should, be established. Since there is currently much debate on these topics, the government shows prudence in clarifying candidates' views before appointing them to positions of influence and authority. Perhaps some of the opposition to the use of certain litmus tests is the politically or philosophically based opinion that the mysterious boundary between church and state will be crossed when personal beliefs are considered. But since all government is founded on philosophical principles, such as the self-evident principles listed in the Declaration of Independence, we cannot exclude consideration of an individual's belief simply because it may stem from theistic or atheistic premises. Even the concept of justice, upon which this nation founded its legal system, is based on philosophical, if not religious, principles. The founders of our republic adhered to the concept of freedom of religious belief and expression. Under the rubric of "pluralism" this has come to mean freedom from religious beliefs and expression. Such a view is not deleterious to government function unless it questions the existence of the government or the principles on which the government is established. Individuals who maintain prejudiced views are free to believe what they wish, but the government is judicious in seeking to bar such individuals from holding public office. If the government is truly to represent and carry out the interests of the people it serves, it is necessary to identify individuals who will both carry out the mission of the office in question and adhere to the fundamental principles on which the government is founded. If, in the process, a "litmus test" must be applied, this simply represents a normal function of a good government; that is, to establish, as Hamilton said, a good administration. Keith A. Crutcher is a neuroscientist and an associate professor of neurosurgery at University of Cincinnati Medical Center, Cincinnati, Ohio.

Government For The People, By The People Does Not Obviate Use Of Political Litmus Tests

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