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A "Supreme Court" for Bioethics?
The recent decision by President Obama to disband his predecessor's Council on Bioethics raises important questions regarding the role of professional bioethicists in contemporary society. We live, after all, in an age of moral and medical transformation. Advances in technology are occurring at such a rapid clip that scientific professionals and the general public have a difficult time keeping pace with the ethical implications of these developments. Within the past week, British researchers have created human sperm from embryonic material, New York State has authorized cash payments for women's eggs, and the National Institutes of Health has issued new guidelines for the federal funding of stem cell research. Meanwhile, Congress is debating which procedures to cover and which to exclude from whatever national healthcare plan emerges after a summer of negotiation. Hardly a day goes by without headlines predicting mass casualties during a flu pandemic or pundits analyzing a case of religious parents who refuse cancer treatments for their child. The issues are often so complex, and the progress so fast, that even full-time ethicists find these emerging dilemmas to be puzzling. So while an advisory panel might serve the President well in grappling with policy choices, the American people would also benefit from a separate, high-profile body, composed of diverse thinkers, which would inform and guide public opinion on matters at the nexus of ethics and science. One might think of this as a "Supreme Court" for Bioethics.
I do not mean to suggest that we create another judicial panel with legal authority to adjudicate controversies. Instead, I envision a body of eminent bioethical thinkers modeled roughly after the French Academy. Since 1635, that august and widely-esteemed band of forty immortels, devoid of any formal legal authority, has protected the integrity of the French language and steered the French people in linguistic and literary matters. American bioethics cries out for a similar institution.
A Bioethics Court would enable both private citizens and public entities to bring "cases" and conundrums forward for a public hearing, after which the court's membership--arbitrarily set at nine--would issue advisory opinions to the parties. However, since these rulings would be entirely non-binding, far more important than the "verdict" would be the written opinions that accompanied each decision. This framework would force our leading bioethicists to make their arguments on a national stage and to rely solely on intellectual rigor in defense of their conclusions. The general public, as well as scientific researchers and those in the healthcare professions, might benefit enormously from such dialogue. So might state lawmakers, who could look to these opinions for wisdom as they craft their own legislation. The principal goal of such a body, of course, would be to educate the American people on perplexing bioethical questions so that ordinary citizens could develop their own informed opinions. In the long run, with prestige its only source of authority, this panel might serve as a depolarizing and depoliticizing force to counterbalance the sound bites and diatribes that have come to dominate the discussion of bioethical issues within existing political institutions. Without any formal power, the "justices" might be liberated to pursue honest debate and, whenever possible, meaningful consensus.
A Bioethics Court would achieve credibility only if its membership reflected a broad swath of ideological opinion and harnessed a wide array of philosophical approaches. To that end, one might specify that the justices be allotted by political party, as with regulatory agencies such as the Federal Election Commission. Seats might be designated specifically for academics, health care professionals, lawyers, and spiritual leaders. Members would be uncompensated, to avoid any possibility of conflicts of interest. Unlike with the existing federal courts and regulatory bodies, or even with past incarnations of Presidentially-appointed ethics commissions, the success of a Bioethics Court would depend fundamentally upon rejecting political litmus tests and recruiting as diverse a group of participants as possible. The reality is that, despite the media's focus on such hot-button issues as embryonic stem cell research and euthanasia, most issues in bioethics do not divide cleanly along obvious "left vs. right" or "religious vs. secular" lines. Whether to permit dialysis patients to solicit kidneys via newspaper advertisements, and how to allocate ventilators during a swine flu pandemic, are the sorts of questions that defy easy answers or simple classification. But the questions are no less pressing. A Bioethics Court, serving the nation much as an ethics committee serves an individual hospital, might help us find solutions.
To believe that a Bioethics Court will achieve a quick consensus on the moral questions that divide our society would be highly naïve. What we need, in the long run, is a national bioethics curriculum in the public schools that arms all citizens with the philosophical tools necessary to analyze these questions for themselves. However, a Bioethics Court might be a first step toward returning civility and meaningful engagement to public discourse on these highly-fraught issues. If nothing else, nine learned opinions from eminent thinkers, issued side-by-side, might help us to recognize precisely what it is that we disagree about and why. In explaining the Obama administration's decision to disband President Bush's Bioethics Council, White House press officer Reid Cherlin said that the President favored a committee designed to offer "practical policy options" rather than "a philosophically leaning advisory group." If I were President, I imagine that I would want the same. However, the two visions are not mutually exclusive, particularly if two distinct bodies are created.
As a professional bioethicist, I remain confident that no emerging technology has the power to undermine our civilization. The greatest threat that any scientific advances pose is the fiery rhetoric that often surrounds their discussion and implementation. The debate over medical innovations, rather than the technologies themselves, is what threatens to tear us apart. A Bioethics Court--or some similar entity--might go a long way toward establishing a more civil and enlightened public debate of matters desperately in need of wise and careful reflection.
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a smart young man -- I like your thoughts. thank you.
Is it ethical to suggest that we abandon all current public tools for debate, such as democracy, litigation, speech and activism, and centralize instead on a perverse star chamber to settle bio ethical debates?
The main thing I find wrong with bioethics practitioners is their control freak nature. What, trust the culture, can't allow that, now can we? Methods of establishing control seems to be their principle intent.
Bioethics practitioners of this sort are not, in my eyes, very ethical persons, always wanting to substitute their opinion for everybody else' opinion.
I don't think he's suggesting that we do away with democratic debate, I think he's suggesting that we add to it by applying some of the best minds from a number of different philosophical backgrounds, so that people can readily access the thinking behind a wide range of approaches to difficult problems. They are not to control or co-opt the discussion, they are to open it up and make it transparent and also understandable to the average person. I'm not sure how small-d democrats could have a problem with that. Apparently the Bush bioethics folks used a religious perspective exclusively, with a lot of pre-ordained conclusions, which is the complete opposite of what the author is suggesting.
To me, at least, 99% of the bioethic "debate" is B/S. I don't care what happens to a cell or a cluster of cells one can't see without a microscope. I'm more concerned with the ethics of denying medical care, food, and shelter to a living person.
We add to democratic debate? You can only subtract from democratic debate, you cannot add to it.
It this is not an attempt to control or co-opt the discussion, it is moot. What would be the point of such a star chamber if it did not control or co-opt the discussion?
What has small-d democrats got to do with it? This suggestion is nothing that isn't normally practiced in petty campus politics, worthy of a last chance college, writ large. Some faculty seem to think that such politics resemble democracy, but they do not.
I like the idea of a philosophical/ethical body that works on keeping us current. As a philosophy major myself, there would be a world of good in, as you say, giving the general population the tools to think for themselves and base their opinions on reality and a thorough understanding of the concepts behind different ways of approaching difficult problems. My gut reaction as I was reading, though, was the cynical feeling that these people will be bought off by corporate interests just like every other tribunal in this day and age. Maybe not, if they have no salaries and no power to render enforceable judgments, they will be truly dedicated to pursuing the arguments for the end of the betterment of humankind and the condition of individuals. Nice thought. I hope the suggestion gains some traction with the administration.
Readers should take a moment to review the history and accomplishments of the French Academy. I've never been particularly impressed, although the men get to wear swords, which is cool.
It's an odd choice of model for a Bioethics Court. Which isn't really a Court, since findings aren't to be considered binding. The proposal doesn't really describe how such a body would actually produce practical policy, which is what the White House is looking for.
A model for such an endeavor can be found in the various standards organizations that work to solve domain-specific problems using a variety of well-understood techniques. The vastness of the problem of standards in engineering, technology, and science requires great fragmentation of effort and large numbers of professionals working to produce findings that become our next cell phone networks, network protocols, etc.
A framework of forums/committees that examine "bioethical" questions at a fine level of detail, taking the right kind of time to produce proposals, to test hypotheses, to fund research, etc., might serve the greater good than best-effort results of 40 or even 400 immortales.
Hmm.. all hail the Biopontificarisees
The problem with bioethics as I see them is that, just like religion, bioethics lags behind the times when new technology or medicine make advances. Is it really truly practical to use 2,000 year old philosophy and ideology to debate 21st century medicine?? Despite what religious zealots will tell you, there are no absolute rights and wrongs. Everything must be looked at on a case by case basis, and the end result of whatever options are available must be left up to the patient and/or family. Is it really a hospital's or doctor's, or government official's, or even religious leader's place to interfere in the private lives of people who are facing medical issues?
Take the Terri Schiavo case.
Look at how the interference by the religious right and the government has backfired on them and how at least 3 states now have die-with-dignity laws in place. Look at how the Die with Dignity group Compassion and Choices has lobbied congress and apparently (based on a letter I received from C&C) was well received when talking about health care and end of life decisions.
Maybe this is the way things are supposed to be done, but it is simply wrong for anyone, religious organization, government, or medical professional to interfere with the life and death medical decisions of an individual and their family
He's not talking about interfering in individual cases per se, he's talking about making reasonable and intelligent guidelines. I think he's saying that we do need to bring all the rest of ethical thinking to bear on these questions, not to stick with 2000 year old philosophical ruminations which while classic and fundamental to what came after nevertheless in many cases don't hold water in today's world. But people who are not educated in that stream of learning (up to and including the latest advances) don't, as the author points out, have the tools to inform their opinions. As a result, a lot of the debate does stay rooted in outdated religious concepts, ignorance, and fear of the unknown.
How much reasonable and intelligent guidelines does society need than "Make everything in medicine and technology that is potentially available to patients, and let the families decide whether they want to use it or not"? It goes to the religioconservatives fear that someone is going to force them to have an abortion or to pull the plug on their loved one. Which of course NEVER happens. But bioethics does lead to restricting and withholding science and technology from the general populace. Can you imagine how much different this world would be if Bush hadn't implemented the ban on federal funding of stem cell research or implemented the morality clause that allows pharmacists the rights to deny a patient needed birth control or other medical procedure? Where do you think those policies came from? The bioethical council under Bush (which the article states Obama is disbanding)
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