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THURSDAY, February 2, 2006

Session 3: Moral Obligations to Children

Council Discussion

CHAIRMAN PELLEGRINO:  What we hope to do in this session — it's an open one, and we can use it as we see best — is to get your responses to what you have, the material you have, and what has been done thus far on this question of children and the ethical issues related to our responsibilities to children, get your reactions to what we have, get your reactions to the readings that were prepared by Eric Cohen from the literature, do they pose questions that you consider to be important that we ought to pursue, what are those questions, how should we pursue them, how far should we go, where are we, really a general discussion on questions on children's ethics.

As you know, we decided to take a look at this as a bookend to the last large report you gave on aging.  And it may or may not be a wise thing to do.  The dignity issue, as you know, will move along because we have decided we will do an anthology.  We are very, very thankful to many of you who have agreed that you would do a paper or commentary.  And that would be the best way we think to embrace the breadth of that concept, as you heard this morning.  It has many dimensions.

We must begin, rather, on the question of the children's issues and children's ethics, what have we left out?  What should we do?  You have several more coming this afternoon and tomorrow on specific issues.

I'm talking because I don't see any red lights going on.  And that's one way to change my verbosity into quiet silence.  I always like to observe the advice of the Talmud, which says that silence is a fence around wisdom.  If you don't open your mouth, they won't know how much you don't know.  Talmud is a very wise book, and I've made use of it many times.

How about a red light here?  Thank you very much.

DR. KASS:  If you are looking for a fool, I will volunteer.


CHAIRMAN PELLEGRINO:  I'm looking for an interpretation of the Talmud, please.

DR. KASS:  First let me say that I welcome at least this preliminary exploration of the subject of children.  I think it, at least for me, remains to be seen what piece of this, if any, is worth our time.

We have in previous efforts touched upon the subject of children, especially in the, say, "Beyond Therapy" report, where the question of better children, of course, raised questions of what is a child and what is better.  We at least touched on them, though we didn't do much more than that.

I thought that, at least some of the beginning discussions of the last meeting from our expert presenters, raised some interesting questions worthy of our attention, if not further study.

I also like the fact that we are beginning in this session with the questions that Eric Cohen has invited us to think about.  I mean, before getting down to the question of what you should think about, genetic screening of newborns or experimentation on children, it would be useful to try to sort out, as Eric puts it right in the very beginning, what kind of a person or a human being is a child and what follows from that account as to what it is that we owe children, both those that are our own and those that are members of our community and ultimately to children around the world.  It's a subject dear to Janet's heart and not only to Janet, around the table.

I guess, I mean, I would be presumptuous, I think, to try to say what I think a child is, though I would maybe open up with a couple of observations that I think shouldn't be lost sight of.  A child is not only an immature being, but compared to the young of other species, a remarkably immature being in that, as Adolf Portman pointed out, the human animal is the only animal that is born very premature andhe coined this term of the "social womb" for the first year of life, in which the other mammals are born and walk almost immediately.  These things have to be learned.  And they are learned in the social context.

The first thing I think to notice is that this immature being stems from and is enmeshed in a series of very particular relations, both of natural origins but also of cultural and social relations.  Often these are the same, not always, as the case of adoption, I would point out.  And somehow attending to those primary sort of elementary facts is a place to start.

To say that a child is an incomplete being, especially incomplete being, means that what it is and becomes depends largely on others.  I mean, to be sure, nature contributes but whether a child gets to realize any of these possibilities depends upon there being a nurturing environment and that people take responsibilities for it to begin with.

This leads to a peculiarity.  Bill May, I think, has spoken beautifully on this subject.  On the one hand, a child is supposed to be, by virtue of its being here and being ours, the recipient of unconditional love.  Mother love is supposed to be like that.  Fathers may have to learn it.  But that's the expectation, that the child is loved for who he or she is right here and now.

Yet, almost everything that the parents do with respect to the child is to coax it and encourage it to be different.  On the one hand, you're absolutely loveable here and now, which means that you somehow warrant this kind of unconditional love.  And, yet, everything that we do to you is to say become somewhat other than you now are, which is to say grow up.

And one of the things that one is — that the trick is somehow to be the coach or the teacher of the process of growing up without disparaging or treating as merely instrumental to some later end the very goodness of the being of the creature who is here. Easy to say, hard to do.  Lots of people do it, on the whole not bad, and some people have a great deal of trouble.

Only one other comment.  It strikes me as odd in the bioethics literature to lump children in with vulnerable populations as if that is somehow their defining characteristic.  They are vulnerable, to be sure, but they are not vulnerable the way the prisoners are vulnerable or for the same reason.  Their vulnerability consists, in part, because of this special kind of immaturity and the special kind of relations that they have and the special obligations to that kind of not mere vulnerability but to their possibility.  It's the unrealized possibility as well as the weakness and dependence that seem to be terribly important when you think about them.

And if you see them merely as weak and vulnerable and at our mercy, one doesn't see the positive obligations to shape, to form, to encourage, to develop, including — and this will come up maybe in the session that we have next — to shape their desires and their longings, not just the intellectual skills, the whole question of helping them grow up so that they can somehow flourish and exhibit what Dan Sulmasy called derivative dignities of the human person.

So that would be a long-winded start.  And if speaking a long time proves one's lack of wisdom, I have served your purpose.

CHAIRMAN PELLEGRINO:  It was a good choice of words, no matter what.  Thank you very much, Leon.

Opening up the issue.  Please?

DR. ROWLEY: Well, I will continue on.  And, as Leon was speaking, I thought that describing children as incomplete — and then he used the word "immature" or "maturity."  I think that's a better way.  You have a child whose functions even are partly formed but not completely formed, and they will mature.

So I look on parents as not so much changing the child but helping to shape that pattern of maturity.  And one does that both in the physical sense in terms of helping children to learn to walk and talk and other functions, but then also as children get older, trying to provide them with the kind of intellectual and ethical environment in which they learn to be the best that one thinks of as all of the human virtues.

My concern and the thing I keep pushing at is that this is the ideal and that our society, the American society, and other societies as well fall far short of that.  And in many respects, some families do.  They do that for lots of complex reasons:  Single mothers, abusive parents, abusive adults other than parents.

And I don't see how one can be dealing with ethics and bioethics, particularly with regard to children, without saying that there are certain populations — and here I would characterize children and infants as vulnerable — that society really has to step in and provide resources and caring and nurturing where parents, for a whole variety of reasons, are unable to do that.  I think we just shirk that task.

And, of course, it's exemplified in the news today, in today's papers, that the budget has been passed, the budget includes cuts.  And who are those who are most affected by those cuts?  The poor and the elderly; whereas, we're about to then embark on making permanent tax cuts for the top one percent wealthiest in our country.  I think that is absolutely unconscionable.

If somebody — and this Council is one potential body — doesn't point out the immorality of the political actions going on in this city, I think we have shirked our duty.

CHAIRMAN PELLEGRINO:  Thank you very much.

Dr. Dresser?

PROF. DRESSER:  Thank you.

I don't want to put a damper on a wide-ranging discussion, but I have a series of questions I wrote down as I was reading this that, at least I am confused and wondering about and, might help the discussion or help me.

So we need to construct a framework for bioethical analysis.  Why this topic?  What about this topic is pertinent to bioethics?  What can bioethics analysis contribute?  What is the proper approach or analysis?   What literature and approaches should we adopt?

As I was just reading this and the other materials for today, I was struggling with that.  And I know we want to go from the general to the specific, but going from specific sometimes helps us think about general.  And so I thought I would throw those out.


Other?  Gil?

PROF. MEILAENDER:  Yes.  I am not sure how what I want to say relates to anything that has been said.  I only know that I have always thought growing up was overrated, Leon.


PROF. MEILAENDER:  But I want to start from these readings that Eric so nicely collected for us because I do think that they make a nice point about vulnerability, though it's not the child, actually, who is vulnerable in the readings.

If you start from the Tolstoy reading, what Levin feels is a new and distressing sense of fear.  It was the consciousness of another vulnerable region.  That is to say, to have a child, unless there's something wrong with you — and, of course, alas, there are people with whom there is something wrong in that way, but to have a child is to become vulnerable.  It's the parent who is vulnerable.  You can now be hurt in a way that you could not be hurt before.  Your happiness is bound up with the child's happiness.

And the most natural reaction to that and in some ways an appropriate reaction — and this gets to one of Leon's issues that he raised.  In some ways an appropriate reaction but also a dangerous reaction is to try to be the guarantor of the child's happiness and well-being, to see yourself simply as a protector, developer, and so forth.

Now, that's a natural reaction.  It's good in some ways because the child does need protection in certain respects.  It's a natural reaction that's dangerous in other ways because it's not just a response to the child's needs.  It's in response to my own vulnerability now.

I then learned to think of myself as the kind of possessor of this other person's future.  That's where the Gilead reading is so nice, the narrator reflecting on this poor guy Abraham, who has to sacrifice both of his sons, realizes that any father must finally give his child up to the wilderness, I mean.

So yes, there are responsibilities.  Yes, the child has needs.  But we also react to our own vulnerabilities.  And I think that that is not irrelevant to some of the bioethical issues, Rebecca, that you raise.  We won't think these things through carefully if we think only of the child as vulnerable or incomplete or immature or whatever the best word is.  We have to understand the distortions that can enter into the way we treat children when we don't realize that we're not the guarantors of their future.

So, to me, the readings, though not, of course, bioethical in any ordinary sense of the term, raise some very important questions about who is really vulnerable here and what the effects of that are on the way we relate to our children.


As the father of seven children, I recognize this question of parental vulnerability with a certain degree of acuteness.  But we'll talk more about that later.

Are there other comments on this question?  I'll open it up.  Vulnerability of a child and the — I'd like you to think — Robby?

PROF. GEORGE: Yes.  I just don't want my friend Dr. Rowley's comments to go unchallenged.  I don't think we should conclude, at least in advance of hearing evidence and analysis, that funding cuts in programs that are designed for children or other worthy recipients are immoral or that tax cutting is immoral.

I think, rather, if we are to make such judgments and if we as a Council were to be invited to make those sorts of judgments, we should have before us critics and supporters of programs that are in line for cuts and competent economists on the competing sides who are prepared to debate before us the question of the impact of tax cuts, making the current tax cuts permanent, for economic growth overall and for the welfare of people across the economic spectrum.

I don't want to prejudge that question because I'm not myself an economist.  And I'm not competent to judge and I wouldn't want to try to reach any judgment in advance of hearing the evidence and arguments on the competing sides.  But I would certainly resist declaring these proposals to be immoral before hearing that evidence and those arguments, particularly as a Council.

DR. ROWLEY: Well, I would certainly support that.  And I think part of my impassioned plea was that as we look at this issue — and I guess part of this is a question of if one takes up the issue, that, in fact, a component of an adequate assessment of this whole area would include just what Robby is proposing.  And I would support that wholeheartedly.

CHAIRMAN PELLEGRINO:  I think we are moving into the realm of what the obligations of a society should be.  Among them would be the kinds of things you're talking about.

We would have to establish what are our moral obligations to the next generation, to children, what are the moral obligations of our stewardship of the next generation, the kind of moral question that would be duty to the specific question, the economics and the politics that go with it.  That should be given consideration as well.


DR. MCHUGH:  Just to press on on the topic Gil was bringing up, I think that one of the issues about our obligation to children comes from our recognition of their vulnerability within us but also perhaps some recognition that they seem to thrive best under certain circumstances.  We are going to talk about that tomorrow and the other circumstances.

The government has to come in, particularly in relationship to the breaking up of those circumstances.  Those circumstances aren't simply financial, although financial can play a role in it.

One the major protectors, as we know, of children and the place where they seem to thrive the best is in a family.  And I've been involved in lots of discussions as to whether the American family is a dead thing now or whether there are so many kinds of families that you can't even talk about what is a better family than another.

I hope I am going to hear from the people who are going to talk with us about why it is that the family seems to be the best arena to bring the children up.  Even a family that has troubles and is poor brings kids up a lot better than state systems seem to do and why that is and in what way we can encourage policies and processes in actions to make sure that the family continues a healthy thing.  So that is one side of it.

The other side of it is, again, just a stirring side.  And it relates a little bit to what Gil is saying and what you're saying, too, Dr. Pellegrino.  And that is that those of us who are parents and who have been parents often discover that we have done things, some good things and maybe some bad things, that amazed us that we did that.  We didn't even know we were doing it.

And something happens later in life.  And the kid says, "You know, that was this."  And that can't happen unless there is a family structure.

I've told Leon this story.  Stories are really good about things like this.  And I'll tell you this story.  It's about a son of mine, who is a most successful banker now and in this business of derivatives.  About two or three years ago, I was taking care of some patients on the psychiatric ward tied up with cocaine who came out of the derivatives business.  And I said to them, "Hey, listen," —

CHAIRMAN PELLEGRINO:  It's better than going into it.

DR. MCHUGH:  — I said, "how did you get into this?  I mean, how did you get into the cocaine?"

And they said, "Well, you don't understand.  We derivatives guys, we are rich as Croesus."  My son doesn't share those things with me.  That's good.  And he said, "But we've got so much money we're vulnerable to taking up this stuff."

So a week later I am talking to my son on the phone.  And I say to him, "Hey, listen, I hear this is a vulnerability of you people.  You've got so much money you're blowing it and killing your brains.  I know you're okay.  I talk with you.  You don't seem to be using it.  What's the story here?"

"Well," he said, "there's something behind that."  He said, "I'll tell you."  And here is the story.  He said, "Do you remember back when I was a freshman in high school?  We got a new machine in the house, one of these tape machines.  And one day you were there and I was there after school.  And you just got this new tape of a reading of F. Scott Fitzgerald's "Babylon Revisited."

"Yeah, I remember that."

"And we put it on.  And, Dad, you are like F. Scott Fitzgerald.  You said I should listen to this."

I said, "I remember that."

He said, "Well, you know what the story is?  The story is this man who had really broken up with his wife, who was trying to regain his child, who was being raised by fundamentally his in-laws in Paris.

"And he comes back.  And this is in the early 1930s.  He comes back to the Ritz bar, where he is going out to get the girl.  Through a series of unfortunate acts, he meets the girl, has some fun.

"Things seem to be going okay.  But then it blows up, and he loses the chance to bring the child.  He goes back to the Ritz bar.  And the guy in the Ritz bar he sees says, 'Well, hi, Mr. Wales.  It's nice to you see.  I haven't seen you for a long time.  Like everybody else, I guess you lost it in the bust.'  And the guy turns to him, and he says, 'Well, no.  I lost everything that was important in the boom,'" to which my son said, "And, Dad, I'm not going to lose it in the boom."

Now, you know, whoa.  This was such a telling experience.  I didn't have him listening to F. Scott Fitzgerald to get this message.  We were just filling in a little afternoon there in Baltimore.  So keeping him off the streets is something.  But, you know, that only happens in families.  And it's scary.  Suppose I put something else on.  What other message could I have given?

CHAIRMAN PELLEGRINO:  It might have gone the other way.

DR. MCHUGH:  What's at stake?  So all I'm saying is reiterating I think what was said before.  We need to know and talk about and hear from people who know something about children about what and why certain kinds of relationships seem to be the best for children and how those seem to happen for their flourishing and bringing them to the next step.

We also need to appreciate that we parents are on spec all the time.  The very times when you don't think you're doing anything — I mean, I have given my sons and daughters regulations and rules and "do it this way." Nothing.  Don't lose it in the boom.  That's what happened.


I have Dr. Carson and Dr. Lawler.

DR. CARSON: Okay.  I think there are probably few more  important questions that we could possibly tackle than children raising children, how vulnerable they are, and what our responsibilities are toward them.

You know, as a pediatric neurosurgeon, I have an opportunity to get involved with children frequently the first day of life and follow them for many years, right up through adulthood.

It's fairly easy to determine what kind of people they are going to be based on their environment, based on the people who are raising them.  Very seldom are we wrong about that, which seems to indicate that there probably are some basic tenets to raising children and to the environment in which they should be raised.

That's on a family level.  On the societal level, we have to recognize that in a city like the one we're in right now, we're looking at a 50 to 60 percent dropout rate in high schools.  What happens to these young people?  You know, they end up in prisons, in the penal system, where we have to pay for them.  We have to be afraid of them when we walk down the street.  We have to protect our families from them.

And, as a society, we have to recognize at some point that for every one of them, that we can keep from going down that path of self-destruction.  That is costing us less money.  And maybe that's the next person who is going to discover the cure for cancer or new energy source.

And we really just can't afford not to do it.  And we need to make it I think into a high moral priority, but also it's a logical fiscal priority.

DR. LAWLER:  Well, I am reluctant to speak after these eloquent physicians, but, nonetheless, let me introduce an elementary political science point.

This morning Robby was talking about the great Declaration of Independence and speaking of the equal dignity of all human beings, but it doesn't really.  It speaks of the equal liberty of all human beings.

And if you think about it, the great offense against equality and liberty in America, in a way the great injustice, is the persistence of the family. A long as we have families, as Walzer points out, there will be great injustice because the most important determinant, as Paul pointed out, to how you turn out in life is the quality of your parents.

And you have no responsibility for that.  There's no justice there.  We shouldn't do away with the family because communism doesn't work at all, but we should distribute parents by lot.  Otherwise it's pretty unfair.

So when I say that in class that the main reason you nice kids with good manners who can sit there silent while I babble on for an hour are sitting here is because you have good parents.  In 88.7 percent of the cases, that would be it.  You're not so responsible for it yourself.  You have good parents.  All right.

And so the family is very unequal.  Parents are an unequalling capability and in a more troubling way, unequal in love for their children.  And there is no greater barrier to liberty, as Walzer points out, than children.  He says — this is in a remarkably conservative article — "Children are obviously a threat to the absolute freedom of the affair."  So there are affairs.  And then there are sexual relationships that might produce children.  So the great demand of our time is for safe sex; that is, sex disconnected from the risky business of birth and death.

So it would seem that the progress of America down the fond roads of equality in liberty inevitably poses, in effect, a challenge to the family.  So in terms of our optimistic or happy presentation this morning, we can say in many ways, things are better, but it would be hard to say, I think, that families are better in America than ever before.  And we have to take seriously the question that the great principles of equality and liberty may only be ambiguously good for families or have good and bad effects on families.

Yet, as Ben just said so well and Walzer says, too, the family is a kind of welfare state.  If the family is a kind of a welfare state, to speak in a corny way, you pay in love.  Right?  And if the family as a welfare state stops existing, then the welfare state as a welfare state will have to come in.  And it will cost us a lot more.

And so as we talk about in our report on aging and care-giving, because the family in some respects is weaker than it has been, we're going to have a lot of lonely, old, dependent people who can't rely on their families.  And no one has any substitute for the government stepping in in a big way the government has not stepped in before.

So I'm not talking about these.  I'm not giving — I am giving a lecture, but I'm trying not to give a polemical lecture here except to lay these things out as political problems, which I think exist prior to the problems Janet brings up and Robby defended our administration against.


PROF. MEILAENDER:  I want to come back to Paul's and Ben's comments.  I mean, yours is a different angle, Peter.  And I won't try to comment on that at the moment.

This is an uncharitable thing to do after Paul says he is sort of agreeing with me and now I am going to add a sort of caveat to what he said.


PROF. MEILAENDER:  At one level, it seems right to say, as Paul did, that we need to know more about what sorts of structures really conduce to rearing children well.  And Ben said, you know, you look at the different structures and you can predict and see how things are going to work out because you know that certain things are what children need and so forth.

I certainly don't wish to deny that.  That's true.  I think what I want to say is that it's only safe to make those claims if you say another thing as well than the thing that I thought came out of the readings because, you see, you also Paul, in addition to saying that we need to know kind of what the best ways to raise children are and so forth, you also said in telling your story "We don't know what we're doing."  Okay?

And I think it's only safe to make these other claims about the best way to raise children if you simultaneously always remind yourself that we don't know what we're doing, by which I mean there is a great mystery here, the mystery of the human person, on which we're laying hands as we try to rear children.

And so there is a sense in which you see you are always giving the child up to the wilderness in terms of giving it.  The question is whether you know it or not because you may do everything right and life turns around in terrible ways on you.  And you may not do things very right at all.  And somehow the mystery of the person in that child turns out well.

So, of course, that's not an argument for saying "No matter.  Pay no attention," you know, "Just let children raise themselves."  But it is an argument for saying there is something dangerous about thinking about that unless we constantly remind ourselves that there is a mystery here that we're not just shaping and forming.  And our forming is only safe when we remember that.


PROF. HURLBUT:  Well, listening to these two comments, there is one little thing to add.  It seems as though we don't know what we're doing more broadly than just with our children and that our children help align us with our deep lives.

I know it's an ancillary point, but it does strike me that part of justice to children and dignity, the dignity of children, is to be found — how do I say this properly? — in the dignity of the adult being properly aligned with life.

I thought the Tolstoy reading was really wonderful.  And a couple of points in it struck me as very strong.  Running through the whole thing was how this event was transforming the man whose child was born.  And you could just feel that it was drawing him back down into a life that is — I don't know what the right word is — authentic, real, more full, true to his dignity.

And it was broader than the child itself.  One of the lines I really liked was where it says "That feminine world, which since his marriage had received a new and unsuspected significant form, now rose so high in his estimation that his imagination could not grasp it."

In other words, this process of bringing the child into the world had taught him what the affair won't teach you and drawn him into a coherent whole where he speaks of tears of tenderness, unreasoned joy.  His heart was bursting with both pity and fear, a sense of purity, a sense of hope, a piece of his soul soaring.  These are all things we all want for our lives.

I teach at a university where a lot of the students have great potential and, therefore, have been stirred to a lot of high goals in terms of career.  And I keep wanting to say and do say to my students that, whereas, not everybody will have children, most people do and don't forget to at least consider doing it, having children, because it's the central unifying theme of human existence for the vast majority of humanity.

And it's amazing how next to children cocaine seems so trivial and so undesirable in my experience.  I have no experience with cocaine.


CHAIRMAN PELLEGRINO:  I was going to say you shouldn't either.

PROF. HURLBUT:  But I do have experience with children.  And I think what it does is it lures you away from so many of those selfishnesses and degrading qualities that prosperity seduces you into.

Well, maybe I've said enough about it.  My main point is that it seems to me the dignity of children is inextricably wrapped up in the dignity of the adults.

DR. GAZZANIGA:  This is directed to Leon.  The bureaucrats talk about something called mission drift.  I'm wondering if we're drifting here in that I remember in the first days of the Council, when you were soliciting ideas for discussion, one of the caveats you always threw back was that this Commission, this Council was supposed to put its teeth into ethical issues that were borne of biotechnological advancements.  And now we're into a quasi-political discussion of the ethics of this or that social program, which is an area of discourse.  But is it the one that we have been assigned to examine?

If anybody can draw a thread between the original executive order for why we are here and what we are currently talking about, it's got to be you.

DR. KASS:  Mr. Chairman, may I?  I don't know where this particular topic is going.  It's an exploratory beginning.  The first charge to this Council under its duties of advising the President was, you're quite right, to not pronounce this or that right or wrong but to explore the human significance, the human and moral significance, of advancements in biomedical science and technology.

Point three, in everything that we have done to this point, we have tried not to simply be driven by the technology as if the technology were somehow first in human life, but we have tried to begin with those things in human life that we're trying to promote or those things that we're trying to defend against threat.

We have not yet I think identified what the precise concrete issues affecting children are that would justify our efforts, but if you are going to go into the field of bioethics and worry about the effects and here I mean not just of new technologies but also of the new way of thinking about childhood, whether borne of the advances of neuroscience so that as we talked previously, when we had all of these people in on the development of the nervous system and what would be required, in fact, to take advantage of this new knowledge, so that particularly the first few years of life were opportunities for real neurological growth and development of the brain in healthy ways, I think it behooves us to spend a little time.  I don't know what's on Ed's mind on this, and he should correct me if I am wrong.

But you want to begin by thinking about what actually is it about children that matters to us?  How do we conceive of them?  How do we somehow think about the ideal and what the obligations are?  How do we recognize those places where we're very far from the ideal and see how technology can or cannot help?

Now, if I may, it remains to be seen, but we have got a whole series of technological innovations now working their way into children.  New scientific discoveries are affecting what we think of the proper intellectual and emotional rearing of children.  It might be that subsequent sessions touch more closely on that.

I take it that the purpose of this discussion is somehow to think more generally about what the devil are these little creatures and who is responsible for them for what in some kind of inchoate way.

Now let me just add one thing.  I'm struck by the degree to which biomedical science and not just biomedical science but also social science begins to intervene into giving an account of how things go wrong or how things can be made right, that we in some ways lose sight of the perspective of, let's say, the household and real life so that you have an account, for example, in the paper we are going to be discussing of a road map for certain kinds of stages in which there is not a peep about such things as impulse control or toilet training or the development of habits of things of that sort, which if you start from the household of the parents, who don't somehow begin with the medical parameters, of which sorts of things are being met, become sort of uppermost.  And one begins to wonder, I think, at the outset, can a rich bioethics address some of those other pressing questions?

It's very important if you want to diagnose autism to sort of be able to look for its markers.  It's quite a different thing if you want to describe what healthy child-rearing would be and what people owe their own children and what the community owes those children that have had an unfair disadvantage.

So at least I am always more willing, Mike, to stumble around in conversations more if the end result is not known from the start than you are.  But I would like to think that this is somehow a preliminary conversation to have in our minds.  What do we really think about when we see a child?  What are its needs?  Who is responsible?

Is it right that if Gil says to us, you know, for all of your great efforts to try to manage all of this, you should remember that you are at the mercy of unknown things and you can't control it?  Do we then want to say to Gil once he said that, "Yeah, that's true, Gil, but I'm going to act as if the ten percent that is in my responsibility I'm not going to fall down on."

It's these sorts of attitudinal things that it seems to me affect very much the larger question once you get into the particulars.  So that's one man's view.  I don't know if it's the view of the Chairman or of the people who put together the readings, but —

DR. GAZZANIGA:  There is a famous story of a famous developmental psychologist at Stanford who had his first child and he came to class.  And he says, "There's a theory of child development."  And he would tell the theory about his first child.

Then he had his second child.  He came to class.  He says, "There are two theories of child development."


DR. GAZZANIGA:  As someone with six children, I guess I have got a ways to go.  With six children, I would have at least six theories of child development.  And these discussions go on, as almost my last case in medicine story, right?

And while all of that is going on, there are people who study these things.  And there are people who examine what are the big factors influencing child development.  And it all comes out to it looks like it's the unshared environment that has the biggest effect on child and unshared environments, that it's not the family environment, it's not the peer environment, it's the unexpected and unshared.  And there's a whole analysis that goes into this sort of thing.

That is an area that I don't — I mean, I understand your point that we want to see what the endpoint is.  And then once we're kind of clear on that, we'll see whether any of these biotechnological advancements that are around the edges are impacting that in any way.

I understand that's the strategy, but I don't have a sense that we're getting there because it's such a — I'll shut up — I find it sort of personally violating to offer my opinions on child development because whatever I did, it worked.  And I got more with Paul's that it's probably the afternoon that you've forgotten about that had the biggest effect.

Anyway, I think we should be clear about when we're starting something, why this relates to the initial charge of the Committee so that we have a sense of structure.


DR. CARSON: I will go out on a limb here and try to create a relationship between advancing technology and child development.  I have noticed that one diagnosis has proliferated greatly over the last two years, and that's attention deficit disorder.  Now, either people didn't recognize it when I was growing up or it has greatly increased.

One could entertain the question of whether or not there is a technological reason for this.  Now, think about the fact that nowadays, as soon as a kid is old enough to sit up by himself, a lot of people stick them in front of the television.  Zip, zip, zip, zoom, zoom, zoom, that's all they're seeing all the time.  I think that probably has an effect on that developing brain.

Now they're a little older, three, four, five years old.  They develop a little bit of eye-hand coordination.  We hand them the controls, the computers and the video games.  Zip, zip, zip, zoom, zoom, zoom.

Now they're five or six, and they go to kindergarten.  There's a teacher in front of the classroom not turning into something every few seconds.  It's very difficult for them to pay attention in that situation because that's not the mindset that they have as they were growing up.

I wonder if maybe that has an impact.  I have many parents who have come in to me and they're asking me, you know, should their kids be on this drug or that drug because of this diagnosis.  And I say, "Well, do they have any difficulty whatsoever playing video games?"

"Oh, no, no, no.  They can play that for hours and hours."

I say, "Okay."  I say, "Well, then they don't really have attention deficit disorder" or at least not in the classic sense.  They do have attention deficit disorder, but the diagnosis is misapplied because attention deficit is on behalf of the parents who are not paying attention to the children.  And, in fact, I wonder if maybe technology has had a deleterious effect in that sense.


Dr. Foster?

DR. FOSTER: Well, I just want to make a general point because I agree with Mike.  I just hope that we can deal with things that have an impact and that this may actually help.  I don't think that we can do anything about the fact that families are only 50 percent or something of that sort.

There's no point in us emphasizing again that it's nice to have a family.  There's a thing from Stanford about why Americans ought to always be thankful.  And one of the things is six percent of the people, six percent of all the wealth in the world is controlled by the United States and so forth.

But one of the things that's listed there says if you have parents who are alive and together, you are a very elite person.  I mean, it's not going to do any good for us as a council to say something about that.

I really have a lot of concern, as I told Ed, about this whole philosophical discussion this morning.  I don't think anybody besides us is going to be interested in the dignity thing.  The Bioethics Commission, the philosophical people, may want to read that, but the people who are interested in serious bioethical problems to my mind are not going to — I had to miss last time because of Dallas ice, but when I read that transcript, I said I just can't see what this says, not you don't have respect for persons or things like that.  So I just don't want us to get into something that's not going to help along these lines to say that.

Now, the one thing that I think we do know that might enhance the future of a child, which is coming up, apart from the enhancements that we talked about a whole lot, they've got to get piano and so forth, these transformational, as opposed to accepting love.  I mean, I think that's fine.  It's to do something about the education of kids.

In fact, we started off about this thing when Mary Ann Glendon and others, who were (concerned about) spending so much money on the end of life by the government and what it's going to cost to take care of , that we're robbing the children.  That was one of the things that started this.  Janet was very much into that and Rebecca, too.

The one thing that we know pretty well is that if you can get a good education, you at least have the tools to have the opportunity to look into these other things.  And the American schools are awful.

The National Academy of Sciences, as you know, — and I happen to know the person whom I think was most influential with the President about putting in the math and science teachers.  In math, we're in the bottom ten percent of the world.  And, yet, we do know that there are countries who have none of the resources that we do that are going to pass us up.  That's what the National Academy report says.

They started this just for the economy of the nation.  And the president of the National Academy of Sciences says that in ten years, maybe a little longer, that India and China will be way ahead of us in terms of economics and everything else.

Now, if they're able to do in — you know, some parts of the country that have the ability, they get kids they do educate and all of this.  It says something very fundamental about what we ought to be doing for children because, regardless of their parents, whether they're loving or not, if they've got the tools where they can read and learn things, they have the opportunity to at least project an economic ability to have a better life for their children and so forth.  And we know these things work.

I'm going to tell you two real quick stories.  One I told Leon at lunch today.  I heard a lecture.  And I am only going to tell one part of this because I wish I could tell you about what this person is doing for the developing world.  What he's going to do is he is going to get clean water and electricity, 14 villages in Bangladesh now that he has invented.

He's a very famous inventer.  He has a program which is called First.  If you want to read about this guy, his name is Dean Kamen, K.a.m.e.n.  He's called the Pied Piper of technology.  He has invented a home dialysis machine, the first insulin infusion pump.  These Segways, these scooters that the police ride on with gyroscopes, he invented that.  He invented a whole home dialysis center and wanted to know how to purify water so he didn't have to bring it in.  That's what he's using in Bangladesh.

But he was concerned about schools.  He went to six of the biggest companies in the Northeast unannounced because his name was known once it was there.  Originally he asked them for six engineers from their company:  IBM and so forth.  And he wanted them for six months, put them in public schools under-developed schools.  Six schools is what they started.

There were several things that happened at the end of this.  The engineers were thrilled because now they were working with children and doing what they always wanted to do, not work in a company just for bureaucratic things, but they wanted to use their engineering things.

Because the company, because DICA builds robotics, one of the other things they built, he built a wheelchair that can climb stairs with a gyroscope on it.  So the paralyzed patient — I saw the movies of this.  You don't have to have an elevator on the stairs.  He was concerned about this because he saw some woman trying to get up a curb.

So what the deal was was that they were to build robotics out of ordinary materials in the schools.  Okay?  Now, that thing has expanded all over the country.  The finals now will be held in the Georgia Dome.  I saw it from last year.  Disney bopped in for a while and built a big million-dollar tent for this to go on.

He says in these poor schools, what you were talking about, these kids have only two role models.  One is to be a rock star, and the other is to be a professional athlete and make millions of dollars.  And that is all they have.

They now have people who are building these robotics.  And they have a varsity system and so forth and so on.  It's gotten so big now that they are having to have regional playoffs.  We're having them to get into the finals of the Georgia Dome.

Now, what is remarkable about this is that taking people who couldn't do anything — and he brought to the Academy of Medicine, Engineering, and Science of Texas, where he was a keynote speaker, some of these robots that these kids have made.  And for real young kids, they built things with — what do you call those little plastic things? — Legos, yes, Legos.  In fact, they had a picture of Einstein that some of them had done.  It was just amazing.

Now, what that shows you is that, I mean, these kids are going to have a chance.  They're excited about doing it.  That's one thing that we can do.  We can do something about the schools to build them.

On a smaller level, there is a man in Dallas who is a great philanthropist named Peter O'Donnell.  He has for quite some years now in Dallas taken a similar thing, much less advanced than First is.  As I say, you can look up Google on Dean Kamen.  And about the fifth thing you can read about him is his astonishing life.

But what he does is that he pays.  He's got a lot of money.  But he pays in the Dallas school district, which is a terrible school district — we have seven percent Caucasians in the whole district, seventh largest school district in the country, and overwhelmed with people just in the country from Mexico and so forth, don't have clothes or anything else.

But he pays teachers on Saturday morning to tutor students.  All he wants to do is for Advanced College Placement in six things, no liberal arts, in math and so forth.  And he pays the kids to go there, and he pays the teacher to do that.  And if they pass the Advanced Placement there, they both get a prize:  money.  The teacher gets money beyond her salary.  And the kid gets money.

He's placing these kids, they're placing these kids, in Ivy League schools and so forth.  I mean, it's so inexpensive for what he did.  Now the Dallas school district is cooperating to make these teachers available and so forth.  So that makes a huge difference.

I'll tell you one thing.  We have a high school there called South Oak Cliff.  When the Dallas schools were segregated, it was in a really poor — they make athletic champions.  They have won the state football championship.  They're known for their athletics.

The most pricey high school in the area that you live in — only 11,000 people live here — is the Highland Park High School.  And they have always had more merit scholars than anybody else in Dallas.

Two years ago, South Oak Cliff High School had a higher percentage of people with Advanced College Placement than the Highland Park High School, in South Oak Cliff.  Okay?

My point is that I want to get beyond talking about these things that are not serious, and if we're going to talk about children's things, then what we ought to do is go with the National Academy and say we have an obligation, both from the private sector and so forth, that that is the one thing we can do to give them the chance to have a future where they can earn a job.

So I guess what I am saying, I don't want us to come out and say, "Look at this," and say, "Well, it's an awful thing that we don't have families" and to come in and say, "Well, we ought to love our children more" or things that are not realistic.  I think we ought to concentrate on things that are realistic.

I told Ed I think we decide what we are going to do the next two years.  I am not interested in just sitting around here talking about philosophical things.  There are a lot of subjects that we might look into, and this may be one of them.  But it ought to be real world.

I didn't mean to preach, but I'm just saying that this guy Dean Kamen and Peter O'Donnell changed what I think about what we ought to do about children.  And, as the Aational Academy says, this is not just altruistic.  The whole future of the country depends on it.

With all the crashes, what has happened to us, democracy works when you have a middle class.  And the middle class is shrinking.  I mean, all the data show that that is the case.  I mean, the stocks are owned more and more.

You know, so if we don't have a middle class, you can't be a middle class if you don't have enough to work, you see.  I know that you all know that, but I just don't want to hear again what we have said.

Raising kids.  You know, there is an old biblical statement.  And what it says is — Kierkegaard wrote a whole chapter on this one time — "Love covers a multitude of sins."  Okay?

You have told the kid story.  One time my kids, I said, "Why do you love us when all of your other friends when they are in high school don't seem to care about their parents?"  They said, "Well, you and Mom had lots of temporary fits of insanity, but we always knew you loved us," you see.  So love covers a multitude of sins, you know, if you really love somebody.  Okay?

It's the last thing I'm saying today.  Okay?

CHAIRMAN PELLEGRINO:  Thank you very much.  Thank you.


PROF. MEILAENDER:  You should want to sit here and talk about philosophical things, Dan.  And the reason is — well, there are several reasons.  One is anyone interested in that chapter by Kierkegaard, which is one of the chapters in The Works of Love, knows that that is an extraordinary philosophical discussion of what love means and that Kierkegaard does not for a moment think it is possible to talk about sort of everyday life without being forced into those larger conceptual questions.

And I think that is part of what has been good about what this Council has done so far, that we haven't ignored particular questions, questions that you might call questions of public policy, but that we have always been willing to think about them in larger ways that don't just assume that the way people frame them at the start is the right way to frame them.

Today, I mean, we're doing two different things.  The dignity stuff this morning you say nobody is interested in it.  All sorts of people are interested in the question of who has human dignity.

Remember the Terri Schiavo argument?  I mean, what do you think?  The dignity language was just coming out our ears at that point.  To clarify, to try to think about whether it is helpful and useful, whether it actually gets us anywhere would seem to be an important thing to do.

The children thing, I mean, I don't know where this is going to go either, but, see, I don't assume that I know what we want to do when we educate a child.  What are we trying to accomplish?

To what degree is what we are technologically able to do with medicines, for instance, driving our sense of how we diagnose and treat children's problems?  What degree of control is good for parents or others to exercise over children in the educative process?

I mean, we're never going to be able to ask practical questions unless we do think about those things, too.  So it just seems to me that while I don't wish to disagree at all that we would hope at some point we'll say something that, you know, might make some difference to someone's life somewhere along the way, we don't suppose that saying that can be done without raising larger, deeper questions.

The only question is whether you're going to be self-conscious about what you think about those larger, deeper questions or whether you're just going to sort of assume some things along the way.

There are going to be those deeper beliefs.  And I think part of our task has been to try to talk them through, even if it takes us a while and we sort of stumble along and we're not quite sure where we're getting for a while.  But that's the genius of the operation.

DR. FOSTER: Well, I don't object to you or me or anybody else thinking about these problems and so forth.  I just am not sure that a Bioethics Council is where one ought to do it or that — I don't know how many people bought our anthology about these readings and so forth.  I mean, maybe Leon does and so forth.

We got a lot of publicity on the stem cell things.  And I think the aging and the enhancement things, where a number of people other than philosophers and so forth, read, I mean, I'm not against that.

But what I wonder is, are there other things?  We talked a little bit about this today.  I'm very worried about the ethics of science.  We have had these huge frauds that are going on.  They're cheating everywhere.  There's another one coming out.

I'm worried very much about the prostitution of scientists with pharmaceutical houses and so forth.  I mean, these are real bioethical problems that one ought to consider looking at to make a comment.

Now, Leon asked me at lunch today, said, "Well, maybe the Institute of Medicine should be the one to look at this."  But somebody needs to look at that and make some comments about it.  That to me is maybe nowhere else.  And we can find out because I can ask the president.

We always know these studies that the IOM is doing.  I'll be happy to ask Harvey Feinberg whether this is in their purview.  If it is, I would much rather them do it.

We have got the issues of commercializations that are going on.  We can't get transplants done in this country.  You go to jail if you try to pay somebody for — you know, it's a felony if you try to pay somebody in the country.  People go out today.

I think we ought to look at that and say, "Let's take that away."  We ought to pay (families of) brain-dead patients, particularly the poor, for the donation of their organs for use.  I mean, already you have to pay UNF $21,000 for a liver.  We ought to free that up so that the you could — the insurance companies and so forth.  It takes five years to get a kidney in Dallas, five years to do it.  Your dialyzing people all the time costs a fortune and saves the things.

What I would do is that I would say, "Look, if you," particularly undertakers in poor areas, "don't want bodies cut up" because it makes it harder for them to embalm them and so forth, they tell them, "Don't let anybody donate."

So that's why we have so few donations in minority groups and so forth.  I would come in and say, "Let's look at this.  Is it illegal and immoral and unethical to pay people for their organs if they're brain-dead?"  I'm not talking about living donors and so forth.

We might be able to make an impact on the block of one of the most important things in the country that would save us money and save a lot of lives to do it.

That wouldn't take a great deal of time to even figure it out.  You know, we started talking about that at one point, and we didn't do anything.  That I would say would be a great practical thing.

It's not unethical to pay for somebody who has been declared dead to free up five or six organs that you might use for other people.  That makes sense to me.  That makes sense to me to do it.

It doesn't mean that I don't worry about families and all of these other things and maybe we ought to do both, but that is the sort of thing that I would like to get us in and be a real Bioethical Council that would have impact not so much on the philosophical issues.

I understand that you have to probably — I couldn't disagree more with some of the discussions here.  I just don't think that is what we are going to be paying for.  That is the point.

So I don't really mind about you thinking about it, but I'll tell you what —

PROF. MEILAENDER:  Just keep quiet, right?

DR. FOSTER: I'll bet you that this Council after the stem cell thing would get real — we have had a lot of praise — recognition if we took a couple of tough problems like this and struggled with them and said, you know, "We're really concerned."

Everybody talks about the greatness of science, but we've got a lot of problems there, as we said this morning that we have to do.

CHAIRMAN PELLEGRINO:  Thank you very much.

One more comment, two more comments?  Please?

DR. SCHAUB: Yes.  I just wanted to get a quick comment in about the assigned readings.  I was interested in two of the reflections that arose out of the Tolstoy reading.

Gil, you mentioned that it's the parent who is rendered vulnerable through the birth.  And, Bill, you spoke about the dignity of children being wrapped up in the dignity of the adults.

It strikes me that there might have been a good reason why the original formulation, the original biblical formulation, was not what do parents and society owe children but, rather, what do children owe their parents?  And the divine commandment says, "Honor thy father and thy mother."  And that obligation is not one that expires on the age of majority.

I suspect that we won't do better on our obligation to preserve, nourish, and educate our children until motherhood is again honored by society and fatherhood is again honored by society.  And I think it is a perplexing question to think about how you do that in the kind of liberal order that Peter referred to.


PROF. GEORGE: Dan, in your most recent set of comments, particularly toward the —

DR. FOSTER: I know there were too many.

PROF. GEORGE: All interesting, but toward the end of what you just said, I think you raised some issues which may very well be issues that we should be examining and maybe should be moved up near the top, where we could actually make a contribution.  I'm not quite sure in advance what the outcome would be, for example, on the question about purchasing organs.

I mean, I would want to hear.  I mean, obviously you have thought about this a lot.  I would want to hear more argument about it.  But it does strike me as the kind of thing that really ought to be examined.  And we are in a position to examine.

You said something else that really startled me or perhaps if I heard you correctly.  I thought you said in the course of your remarks that the cheating in science is fairly widespread.

Now, in light of these most recent scandals, I have had some discussions with my own scientific colleagues, who assure me that it's just a few bad apples and that science in general is in healthy shape from an ethical point of view.

Now, if it's widespread, that seems to me to be a very, very important thing because it would mean that the internal mechanisms of the scientific community for preventing and dealing with corruption are not working well.

Now, I don't know where one would go from there, but if it is not just a few bad apples, boy, that opens an interesting question for us, I think.

DR. FOSTER: I certainly didn't mean to imply that it was widespread.  There have been some major things that have come.  It's the pressure to achieve.  You're going to get a Noble Prize for this thing the first time I certainly didn't mean.

I think that most are, scientists are, responsible, but the editor of the Journal of Cell Biology in regard to the Hwang paper, you know, everything in the 2005 Hwang paper was made up.  There was not a single human line that was done.

But in commenting, the science editor said, "Well, we leaned on the reviewers."  And the editor of the Journal of Cell Biology said that he had turned down nine papers accepted by the reviewers for his journal because, as he looked at the papers, he thought that the figures, like those cell lines that were in the Hwang, were fakes.  And he said editors can't escape from the responsibility for doing this further.

There is a huge pressure on the best journals, but this is known that every journal wants to have the hottest topic.  Okay?  Now, I did at lunch, but I'm not going to mention the journal here.

Just take one of the very best journals in the whole world scientifically.  And an expert in a field reviewed who they had asked to write a review of a relatively new scientific discovery.  And she had been asked to review a paper that was from another country.

It was a foreign paper.  This was in the end of the year.  It was in December.  And she turned the paper down.  They published it anyway.  And the editor called her and apologized.  She said, "This is such a hot topic that we cannot have our index for a whole year's work not have that subject listed in the index; in other words, we can't let journal A and journal B have papers on this new discovery and journal C, us, not have it."  In other words, the editors did an unethical thing.  They turned down a paper for monetary and prestige reasons that our journal covers.

Now, I don't know how often that takes place, but this is written about.  So that's another thing that I think you could want to talk about with just helping to say — really, all I'm talking about is just helping to say again, you know, what are the standards or things that we need to do?  I certainly don't mean to think that this is widespread.

As an editor, I would say in one five-year editorship that I did of a major journal, I only had three, at least three, things that were cheating that we found out about.  And I found out about two of them by chance to do it.  So that's how small it was in just one journal.  So I don't know.

CHAIRMAN PELLEGRINO:  I see some hands flicking.  And we'll get to both of you, but the time is catching up on us.  I would like to make a comment also toward the end.

Paul?  Did you have your hand up, Robby?  No.  Okay.

DR. MCHUGH:  I just have a small comment about the cheating business.  None of us in America, especially those of us working on this Council, believe that it was just the pressure of science that led Science magazine to publish those things.

There was a political agenda there.  And they got burned on it.  And they should admit it.  They wanted to show that America was falling behind because of the President's decision.  And in that way, they got burned for it.

There are many, many reasons, some of which Dan has mentioned, that lead to fraudulent behavior, not the least amongst them the political actions in relationship to this very vexed subject in our country today.


Well, sitting here listening, I, first of all, want to thank you.  I think this part of the discussion has been very rich and very important to those of us who are trying to work with you to know where we go next.

I think we have heard two sets of worthwhile problems you all agree with:  one of the more general in nature, a very important issue; and one a very specific one.

I would like to tell you that, at least in my mind, I have been thinking seriously of not necessarily looking at those exclusively, that we could do one and the other as well, simultaneously, I hope a good job of both.

So I would think in the next coming meeting, we have already talked, some of us in the staff, not the staff but with the staff, about the organ donation question because that has been touched in the past.  And picking it up now I know is of interest.  And I think it's of great interest.

I personally in talking with Dr. Foster and my own experiences of 25 years of investigation, the context of science has changed.  It has changed in a way that makes it very difficult for scientists these days to put stimuli and pressures on them that are very, very unfortunate.  I think they are worth looking at.  When I say "worth looking at," to come next time with some presentations that would open up these issues and also to continue to look at what are the issues.

I guess my approach to the children was naive.  I personally would have asked it from the beginning in a different way perhaps.  And that is: What are our moral obligations?

We have, all of us, experiencd with children in very different ways.  And it would be a useful exercise to put down and just say these are some of the obligations we see for the future generation of our stewardship for those children.  And put it in ethical terms against the background of some of these larger issues.  I tend to start from what is the ethical problem?  What is the problem we have?  What are the data we have and so on?

I'm just giving you some insight as to my own thoughts.  I have been very quiet in most of these meetings, and I will continue to be mostly quiet, but I think we are at a point now where we need to decide on our agenda.

We don't have that much time in our existence left, really, basically.  We know what happens at the end of the administration to groups like this.  And I agree thoroughly with you we should do something that is very, very useful.  You have done it.

But I think our next step will be to look at maybe these three issues, continue to look at the children's issue, make it more specific in terms of the moral obligations that we might see and envision, maybe put them before you and see how you think about them, look at the question of the context of the atmosphere of the science.

I was worried about this 25 years ago.  I think we always heard there are only a few bad apples.  But if you look back at the history of the past 25 years, there have been more than a few bad apples.  I'm not blaming anybody, but this does happen.

So when I have been asked to write about this, the ethics of scientific research, I have talked about rules, regulation, principles.  I've talked about the character of the investigator.  Now, what do we do about that?  And how do we handle that?  You might want to go out in a different direction, but I recognize that as a problem.

Does anyone feel that this is a grossly inadequate way to take a next step?  Take these three issues:  the organ transplantation, which you've have talked about in the past.  It is an urgent one.  And I like the scientific change in the context: hat are the ethical problems of today compared to someone said the other day I was talking to a whole attitude of scientific research has changed?  It used to have the good of somebody else as its aim.  Now, it is for most scientists still, but some still are looking at it as an investment opportunity.  We know that.  So let's take a look at that.

Can I get a quick response to that?  If you want to shoot it down or we need to have some advice on what the next steps might be?

PROF. DRESSER:  I was going to mention that at one point we were talking about perhaps doing a report on commodification of the body.  It seems to me there are some strong connections between dignity and commodification.  So it might be that a dignity report could pave the way for the application to the —

CHAIRMAN PELLEGRINO:  I think the way we seem to be going for the moment, Dr. Dresser, is to work on that anthology and to try to round out the problem.  So I think we probably will not be discussing the dignity question here for a while before we have something specific to put before the Council with the papers and so on that will be contributed.  So that will be a work.  It is already on its way, I think.  And other issues could come up.  I just wanted to pick two or three.

We have to become specific.  I quite agree.  And, as a physician, I tend to look at some practical things, too, from time to time.

Yes, Gil?

PROF. MEILAENDER:  Just an off-the-top-of-my-head reaction is that it sounds like one problem too many.  That is, see, I'm not really sure we could do — if you're thinking of doing those three things simultaneously, I just have doubts about whether we could manage it.   But that's just my reaction.

CHAIRMAN PELLEGRINO:  No, no.  Well, I think I have doubts, too.  And I think the way to do it perhaps is what the architects call fast tracking, run two or three of them simultaneously and see which one is doing well and which one has to be dropped out.

And that will give us a little practical feedback, which we ought to do and whether we can do the three.  I agree.  I feel whatever we do, we ought to do well because you have established yourselves as having done a very good job on everything you have done.  And we don't want to lose that by any means.

Yes?  I'm sorry.  Yes?

DR. KASS:  Ed, just one comment on the substantive proposals.  And I had mentioned this to Dan at lunch.  I think the question of scientific integrity, the behavior of the journals and things of that sort, is a problem for scientific housecleaning and review.

I can't imagine that it would look very good for the President's Council on Bioethics to be pontificating about the misconduct of some scientists.  And if the National Academy of Science and the Institutes of Medicine were inclined to think this problem through, that would have a great deal of standing in the community and a great deal of weight.  I mean, it would be worth maybe having a conversation about it.

It is my sense that it would be a misuse and would not be well-received I think coming from this presidential body.  A lot of empirical research would have to be done to see how widespread this is.

Now, the question of commerce in these —

DR. FOSTER: Let me just say I actually would prefer that much myself, too, if we could do it.  And if the Chairman would like for me to, I would be happy to explore this with —

CHAIRMAN PELLEGRINO:  Would you do so?

DR. FOSTER: — the presidents and see if they have any interest along those lines.

CHAIRMAN PELLEGRINO:  Can you do that?  I appreciate that.  Let us know.  I think that's a good point.  But if they're not doing it, again, we ought to keep that in our sights.

I've just been alerted to the fact that we need to get Dr. Greenspan on by 3:45.  And if I let you loose now, I hope you will get back by 3:45.  Can you do that?  Forgive me for taking some of your time.

(Whereupon, the foregoing matter went off the record at 3:39 p.m. and went back on the record at 3:49 p.m.)


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