January 1, 1970 (Vol. , No. )
Taralyn Tan Ph.D. Curriculum Fellow Harvard Medical
Science and ethics are inextricably linked, and it is sometimes unclear whether science can be considered friend or foe. Despite a history riddled with examples of destruction at the hands of scientific ingenuity (the atomic bomb) or simple moral disregard through experimentation (various instances of horrific studies involving human subjects), science today seems to generally fall within the “friend” classification. Battle cries of “cure cancer” and “vaccinate against HIV” greet the valiant scientist in shining armor, as he/she rides off to the laboratory. Yet, both the condemnation of scientific missteps of the past and the extolment of scientific virtue today illustrate the fact that conversations regarding science and ethics are all too often consumed with extremes. There is a paucity of discourse in the middle ground.
The oversimplification that scientific research is either obviously detrimental or obviously beneficial to humanity is completely inappropriate in the context of today’s biomedical landscape – a landscape rife with ethical nuances and controversial topics like embryonic stem cells, the ownership of genes, and genetic screenings. While there may be consensus that current goals in biomedical research are noble, there is dissent regarding how to achieve those goals. What is ethical to one person may very well be unethical to another. Thus, we as a society must be more cognizant of bioethical considerations. We must live and breathe in the middle ground, that pesky “grey area” between right and wrong. So, how to begin the discussion?
Last month, President Obama established the Presidential Commission for the Study of Bioethical Issues (Executive Order 13521). This replaces the President’s Council on Bioethics created by President Bush in 2001 (Executive Order 13237). While the Commission and Council are similar in many respects (at least in writing – the executive orders contain identical wording in parts), one distinguishing feature of Obama’s Commission that has been emphasized by the current administration is its focus on practical policy options, as opposed to philosophical discussion. Indeed, this was the reason cited for the premature disbandment of Bush’s Council earlier this year.
I agree with the notion that the identification of a practical course of action is worth more than endless philosophical debate, but I have to wonder why, if we are to have an advisory committee to the President at all, it can’t strive to both generate varied discourse and suggest a number of practical policies from which the President can choose. (It’s all up to the President in the end, after all.) In particular, in describing the function of the new Commission, President Obama’s executive order excludes a paragraph from the previous executive order by former President Bush – a paragraph that I do not think should have been excluded at all:
“The Council shall strive to develop a deep and comprehensive understanding of the issues that it considers. In pursuit of this goal, the Council shall be guided by the need to articulate fully the complex and often competing moral positions on any given issue, rather than by an overriding concern to find consensus. The Council may therefore choose to proceed by offering a variety of views on a particular issue, rather than attempt to reach a single consensus position.”
With the exception of mentioning that the new Commission will “critically examine diverse perspectives,” the charter for Obama’s Commission does not speak at all to the importance of diversity of thought and debate among the Commission’s members. Surely the group need not reach a single consensus position in order to produce practical policy options, right? Shouldn’t an emphasis of the Commission be to critically analyze complex bioethical issues in their entirely, then look for one (or two or three) viable policy options to present to the President?
Maybe I’m just dwelling on semantics, but it seems that instead of looking to create such a chasm between former President Bush’s Council and the new Commission – instead of emphasizing the dichotomy of philosophical discussion versus practical action – President Obama might have sought synergy of the two approaches to create an even more effective advisory group. Take a lesson from science, wherein diverse and conflicting hypotheses foster discovery. You are challenged by competing thoughts, you are driven to achieve deeper levels of understanding, and a more focused vision eventually emerges. In the realm of bioethics, we find ourselves in murky water. If we are ever able to successfully navigate bioethical issues through effective public policies, it will not be a result of a Commission that is narrowly focused on producing those policies. Effective public policies will only emerge through competing perspectives and lively debate, in a system where philosophical disquisition is not viewed as a fault.