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In his inaugural address on Tuesday, President Obama promised to "restore science to its rightful place." But his administration will have to do more. It will need to restore our capacity to talk about science and to decide how to use it. It will need to rescue our capacity to do bioethics.
Early in his first term, former President George W. Bush went on television to address the nation. The topic was bioethics. On the evening of Aug. 9, 2001, he restricted federal funding for embryonic stem-cell research to cell lines already created. Obama is widely expected to change that decision. But the new president will have to rescue our very capacity to debate the huge issues posed by biomedicine, from stem-cell research and reproductive medicine to health-care reform. He will need to rescue our ability to do bioethics at all.
The last eight years have seen public bioethics degenerate too often into raw partisanship, inside and outside government. In that August address, Bush promised to create a bioethics council, and in November 2001 he founded the President's Council on Bioethics. But from the start, prominent voices on the council were actually hostile to decades of work in bioethics. Presidential bioethics commissions had produced important work starting in the 1970s, but one council member complained that bioethics "has turned out ... to miss its aim." Another decried "so much bioethics which tends to be reactive and remediative." A third wrote that "the time when governments could deal with biotech questions by appointing national commissions ... with ... bioethicists ... is rapidly drawing to a close." Though many council members were eminent in other fields, even the council chair admitted that "very few of us are trained bioethicists."
Outside the council as well, public bioethics became increasingly partisan. As the nation was gripped by the specter of Terri Schiavo's divided family warring over whether to stop artificial nutrition and hydration, the bioethics questions were often lost in the shuffle. End-of-life issues were already the most-discussed and most-litigated issues in modern bioethics, but few commentators paused to consider the copious literature and many court decisions already on the books. The Florida legislature and governor, the U.S. Congress and Bush all supported legislation to thwart what each successive court found to be Schiavo's past wishes, as best those could be ascertained. In the Schiavo debates, too often the very term "bioethics" was used simply to make a preferred outcome sound more considered.
As public bioethics has moved away from careful and inclusive deliberation and respectful debate to bare-knuckle politics, our capacity for bioethics work has degenerated. When the outgoing administration issued new regulations in December stating that health-care providers with ethical, moral, religious or "other" objections could thereby exempt themselves from rendering care, the failure of bioethics was striking. Law already respected doctors' religious objections to participating in abortions. The new regulations went further. Now any doctor could refuse to participate in any medical procedure, claiming some kind of objection. Lost was the fact that the bioethics literature carefully distinguishes personal preferences from professional obligations. Legitimate exemption from professional obligations due to an objection of conscience is recognized as the exception, not the rule. The bioethics literature has much to offer on this, but had little or no impact on the administration's rule.
Bioethics has fallen far. Instead, partisanship has prevailed. Many commentators have decried the Bush administration's disregard of science in favor of partisanship, a concern that Obama echoed in his inaugural address. But equally concerning is our lost capacity to talk about science to devise sound policy.
That capacity is the essence of bioethics. Without it, we will make no lasting progress on stem-cell research, end-of-life care, genetic discrimination and health-care reform. President Obama and the new administration will have to do more than assert new policy answers. They will have to rescue our ability to talk openly and honestly about the issues we face, especially on contentious questions of biomedicine and science. These are some of the most important questions of the 21st century. We need to trade partisan posturing for real dialogue, to use rather than reject expertise. The new administration faces daunting issues. It will most certainly need a full tool set. That includes bioethics.
Susan Wolf is McKnight Presidential Professor of Law, Medicine & Public Policy at the University of Minnesota and a faculty member in the university's Center for Bioethics.
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