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Apr 15, 2010 (Vol. 30, No. 8)

Thinking About Public Bioethics

Approach that Fosters Discussion as Opposed to Consensus Is Worth Considering

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    Gilbert Meilaender, Ph.D.

    We all have a stake in how public bioethical debate is structured. Indeed, it may be that we should care more about how it is structured than about what is decided on any given occasion. The conversation and the arguments never reach a definitive end. But a public conversation that leaves policy making to elected officials  who can be held accountable, a conversation that is designed to focus, not just on means, but also on the ends or goals of biotechnological advance provides all citizens an opportunity to reflect upon who we are as a people and how we may best structure our common life on matters of great moral significance.

    This is the approach to public bioethics that was practiced by the President’s Council on Bioethics, on which I served from 2002 to 2009. It does, of course, run certain risks and face certain difficulties. 

    Not all will be satisfied by an approach that seeks, not a lowest common-denominator policy, but instead, fosters discussion of morally complex questions among people who bring to that discussion quite different normative commitments. If one thinks public bioethics must move toward policy proposals, or if one is made uneasy by the kind of give-and-take this approach entails, dissatisfaction is likely.

    In 2002, during some of the work preparatory to the writing of the Council’s Beyond Therapy report, the Council heard from various experts about research into pharmacological means of enhancing memory and blunting traumatic memories. James McGaugh, Ph.D., director of the Center for the Neurobiology of Learning and Memory at the University of California, Irvine, spoke at length to the Council about the possibility of relieving post-traumatic stress disorder through drugs that hinder the consolidation of memories.

    In the conversation that followed, Dr. McGaugh on several occasions recognized that, although there are obvious benefits to relieving strong memories of remembered trauma, there may also be reasons why we need to remember. That is a “judgment call,” or a “trade-off question,” he noted at several points in the conversation.

    A society eager to forge ahead with publicly supported pharmacological research must also ask itself—in advance—some of the questions that issue raises. Does memory blunting risk falsifying our perception of the world? Does it risk making us too comfortable with some of the terrible things that happen in our world? Does a truthful identity seek to integrate rather than edit out the pain and unhappiness of life?

    Even while stating that there is “little doubt” that some memories are so painful and intrusive that the impulse to relieve them is “fully understandable,” the Council also invited the American public to think about the moral significance of memory and research into pharmacological means of blunting it.

    That is, the Council thought of the task of public bioethics not as protecting scientific research from oversight, but as enriching public deliberation about the place of research in our common life together.

    If researchers do not always appreciate this, neither do bioethicists. So, for example, Ruth Macklin, Ph.D., professor of bioethics at Albert Einstein College of Medicine, criticized the Council’s use of “poetic and metaphoric language” (speaking of children as “gifts,” for example) in place of “empirical evidence and reasoned arguments.”

    To speak of children as gifts is, however, hardly intended to eliminate reasoned argument; on the contrary, without that language, we may be unable to explore the full meaning and significance of procreation as a human activity—in order to go on and argue about it. Describing children as gifts does not make the description true, but it offers a way of thinking that can be discussed and examined as we seek to learn the truth. It helps us know what we should argue about.

    Dr. Macklin’s objection goes deeper, however. She seems to believe that, to speak of a child as a gift is inescapably religious language and, as such, can only be a “conversation stopper” in gatherings that are, not themselves explicitly religious. It may be that, plumbed to its depths, characterizing children as gifts is intelligible only in the context of religious belief. It may be—but not all agree.

    Michael Sandel, Ph.D., professor of government theory at Harvard, observes, reasonably enough, that “we commonly speak of an athlete’s gift, or a musician’s, without making any assumption about whether or not the gift comes from God. What we mean is simply that the talent in question is not wholly the athlete’s or the musician’s own doing; whether he has nature, fortune, or God to thank for it, the talent is an endowment that exceeds his control.”

    Moreover, language that draws on a wide array of humanistic perspectives—including religious—does several important things. It challenges us to ponder whether a world in which we had no sense of our own and others’ “giftedness” would really be a better world.

    It undergirds, as Dr. Sandel notes, a certain humility about our possibilities, it suggests limits to human responsibility, and it encourages us to think of ourselves in solidarity with those less fortunate. But it does more than challenge us. It also offers to enlarge our vision of what it means to be human. It is precisely the function of imaginative language to uncover meanings we might otherwise overlook.

    If this language often has its roots in religious thought, then our public deliberations about bioethics will need to be open to such thought. The desire to fix, in advance, the limits of acceptable argument manifests a kind of nervousness and anxiety about democratic discourse, which almost always—and certainly when important matters are at stake—involves a conflict of visions and wills. That is the very stuff of a shared moral life.

    A body such as the President’s Council, enjoined to eschew consensus and to think through and articulate our disagreements, can make a contribution to public deliberations very different from what is contributed by a consensus (and, very probably, lowest common-denominator) policy recommendation.

    The latter invites only acceptance or rejection; it does not inspire fresh or more expansive reflection, nor does it open up much space for those who would speak out of very different normative traditions.

    To be sure, when we speak out of a particular tradition, even a religious tradition, we do not enter public discussion merely in service of a certain interest group. Rather, beginning from a particular standpoint, we seek to learn and articulate an understanding of what is, quite simply, human.

    An epistemologically particular starting point may be a place from which to see what is ontologically universal. We all begin from such particular standpoints. That is not problematic; it is the human condition. What is problematic is a failure to acknowledge that we do so. We are all well served by a public bioethics that does not fail in that way.



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