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Thursday, January 17, 2002


Session 1: Welcome and Opening Remarks

CHAIRMAN KASS: First of all, I would like to welcome members of council and members of the public to the first meeting of the President's Council on Bioethics.

Dean Clancy, if I might call on you officially to open this meeting as the designated federal officer.

MR. CLANCY: Thank you, Dr. Kass. I am Dean Clancy, the Executive Director of the Council and designated federal officer. As I understand it, my duties are a combination of justice of the peace, part-time baby sitter and potential sacrificial victim. And I just want to say as an editorial note I am very honored and humbled to be able to serve with Dr. Kass and such a distinguished panel of Americans.

The job of the designated federal officer is to be a proclaimer that the law has been conformed to in terms of the requirements for holding public business in this council and, therefore, it is with pleasure and a bit of enthusiasm, anticipation and humility that I proclaim this meeting in session.

CHAIRMAN KASS: Thank you very much. We will shortly go around the room and ask council members to identify themselves. This time just name and institutional affiliation. You will all have opportunities later in this session to speak substantively about your own thoughts and concerns for our group.

I will identify myself as Leon Kass of the University of Chicago on leave and at the American Enterprise Institute in Washington.

And if I might then just proceed to my right and ask Elizabeth Blackburn to go next.

By the way, the first housekeeping matter, if you want to speak press the button on and off and try to speak fairly closely to the microphone because the session is being recorded and will be transcribed.

Please?

DR. BLACKBURN: Good morning. Elizabeth Blackburn, University of California, San Francisco.

DR. GAZZANIGA: Mike Gazzaniga, Division of Cognitive Neuroscience at Dartmouth College.

PROF. MEILAENDER: Gilbert Meilaender, Valparaiso University.

DR. GEORGE: Robert George, Princeton University.

PROF. DRESSER:: Rebecca Dresser, Washington University in St. Louis.

DR. FOSTER: Dan Foster at the University of Texas, Southwestern Medical School in Dallas.

PROF. MAY: William May, Southern Methodist University, professor emeritus.

DR. HURLBUT: William Hurlbut, Stanford University.

PROF. FUKUYAMA: I am Francis Fukuyama at the Johns Hopkins School of Advanced International Studies.

DR. MCHUGH: I am Paul McHugh from the Johns Hopkins School of Medicine.

DR. KRAUTHAMMER: I am Charles Krauthammer. I represent that small sliver of the American population who are not professors. I am a syndicated columnist for the Washington Post.

PROF. GLENDON: Mary Ann Glendon, Harvard University.

PROF. CARTER: Stephen Carter, Yale University.

DR. ROWLEY: Janet Rowley, University of Chicago.

DR. WILSON: James Q. Wilson, professor emeritus at UCLA and currently some time lecturer at Pepperdine University.

PROF. SANDEL: Michael Sandel, Harvard University.

CHAIRMAN KASS: Thank you. I want to thank all of you for your willingness to serve on this council. We have a daunting task and I am very much looking forward to working with all of you.

I should mention that one of our number, Professor Alfonso Gómez-Lobo, who is professor of metaphysics and moral philosophy at Georgetown, is recuperating nicely but still recuperating after recent surgery and is not yet able to join us but I have been in touch with him and he will hear either the tape or read the transcript of this meeting and will join us on the next occasion.

I would also at this point like to introduce the staff of the council, people who have been working enormously hard under very stressful conditions to produce the materials for this book.

Dean Clancy, the Executive Director, you have already met.

To his — to Dean's right — and, people, would you please stand.

Next is Lee Zwanziger, who is the research director of the staff.

Then Rachel Wildavsky, who is the senior editor and staff writer.

Yuval Levin, senior research analyst.

Dick Roblin, who is the scientific director.

And Eric Cohen, who is also senior research analyst.

Before proceeding to my own opening remarks there are a few housekeeping items that I would like to go through.

First of all, there is a change in the agenda for today owing to the fact that President Bush has invited all members of council to a gathering at the White House this afternoon. We will accordingly have to stop at 3:00 p.m. sharp to board buses in front of the hotel at 3:15 and we are due at the White House at 3:30.

If there is logistical assistance required please see Debbie McMahon, who is the office manager. Debbie is over there where I thought you might be. Please speak to Debbie if you need help on that.

We will work from the back up agenda that has just been distributed to you. We had a choice of either dropping the afternoon session today or by squeezing a little bit here and starting a little earlier to try to get at least the beginning discussion on all of the topics and we have chosen to do the latter. We will stop at 3:00 o'clock rather than 2:45. Otherwise the agenda is as you have it before you.

Next I should mention that the council operates under a number of federal statutes and regulations. Most important of which are FACA, the Federal Advisory Committee Act; second the Ethics in Government Act; and third the Freedom of Information Act. Copies of the first two are either in your briefing book or have been handed to you this morning. Please read these over and if you have any questions about them please speak to Dean Clancy. Contact him either at this meeting or subsequently.

Next, something about the papers that are outside at the table. All of the materials that have been prepared for this meeting are available for the public but I would like to observe that the four working papers on human cloning have been prepared by the staff on short notice intended solely to stimulate the council discussion at these meetings. They are not part of any preliminary council report. They are marked not for quotation and attribution and we please ask everyone to honor our requests.

And with respect to media inquiries, they should be directed to Diane Gianelli, the communications director, who is standing to the left of the door. We regret that the need to abbreviate the meeting today means that there will probably not be very much time for council members to meet with the press today but perhaps we can do some of that tomorrow.

I would like to begin with a semi-coherent statement having — saying something about my view of the council's work. After which, that statement is open to discussion and, even more important, I would like to hear from whoever is interested in making a statement about their own concerns and interests for our common work.

It is over five months since President Bush announced his intention to create this President's Council on Bioethics. Our world has changed drastically since that time and with it the nation's mood and attention. The council and its business have not been immune to these changes. For one thing, the events of September 11 pushed stem cells off the daily front pages where they had been ensconced for months. More importantly, the needs of war and homeland security understandably slowed efforts to get this council organized.

But if the aftermath of September 11 has hampered our getting started, paradoxically it may assist us in performing the council's task. In numerous, if subtle, ways one feels a palpable increase in America's moral seriousness well beyond the expected defense of our values and institutions so viciously under attack.

We have rallied in support of the respect for life, liberty, the rule of law and the pursuit of progress but we seem to have acquired in addition a deepened appreciation of human finitude and vulnerability and, therefore, of the preciousness of the ties that bind and of the importance of making good use of our allotted span of years.

A fresh breeze of sensible moral judgment clearing away the fog of unthinking and easygoing relativism has enabled us to see evil for what it is and, more important, to celebrate the nobility of heroic courage, civil service and the outpouring of fellow feeling and beneficence in the wake of tragedy.

It has been a long time since the climate and mood of the country was this hospitable to serious moral reflection. Yet the moral challenges the council faces are very different from the ones confronting the President of the nation as a result of September 11.

In the case of terrorism, as with slavery or despotism, it is easy to identify evil as evil and the challenge is rather to figure out how best to combat it but in the realm of bioethics the evils we face, if indeed they are evils, are intertwined with the goods we so keenly seek, cures for disease, relief of suffering and preservation of life. Distinguishing good and bad thus intermixed is often extremely difficult.

As modern Americans we face an additional difficulty. The greatest dangers we confront in connection with the biological revolution arise not from principles alien to our way of life but rather from those that are central to our self-definition and well-being. Devotion to life and its preservation, freedom to inquire, invent or invest in whatever we want, a commitment to compassionate humanitarianism and the confident pursuit of progress through the mastery of nature fueled by unbridled technological advance.

Yet the burgeoning technological powers to intervene in the human body and mind justly celebrated for their contributions to human welfare are also available for uses that could slide us down the dehumanizing path toward a brave new world or what C. S. Lewis called in a powerful little book by that name "the abolition of man." Thus just as we must do battle with the antimodern fanaticism and barbaric disregard for human life, so we must avoid runaway scientist and the utopian project to remake humankind in our own image.

Safeguarding the human future rests on our ability to steer a prudent middle course avoiding the inhuman Osama Bin Ladens on the one side and the post-human Mustafa Mond, Aldous Huxley's spokesman for the brave new world, on the other.

President Bush has given us the opportunity and obligation of helping him plot and navigate his course. Duly mindful of the daunting task before us, we humbly accept this service.

The Executive Order creating this Council on Bioethics signed by the President on November 28th of last year states the council's mission as follows: I read from the briefing book, Tab 4B. Section 2A: "The council shall advise the President on bioethical issues that may emerge as a consequence of advances in biomedical science and technology. In connection with its advisory role the mission of the council includes the following functions:

  1. To undertake fundamental inquiry into the human and moral significance in developments in biomedical and behavioral science and technology.

  2. To explore specific ethical and policy questions related to these developments.

  3. To provide a forum for a national discussion of bioethical issues.

  4. To facilitate a greater understanding of bioethical issues.

  5. To explore possibilities for useful international collaboration on bioethical issues."

Central to the charge to the council is the idea of bioethical issues. Permit me a few words on what I think this means and how I suggest we construe it.

Bioethics is a relatively young area of concern and field of inquiry no more than 35 years old in its present incarnation though the questions it takes up are, in fact, ancient. When the field was started in the late 1960s and early 1970s around the Hastings Centers and the Kennedy Institute at Georgetown none of the pioneers had trained in bioethics. Indeed, none of us referred to ourselves as bioethicists.

Actually the word "bioethics" coined a few years earlier by a biologist, Van Potter, in fact, referred to something rather different. It was the name for Potter's vision of a new ethic based not on inherited philosophical or religious foundations but built instead on the supposedly more solid ground of biological knowledge. The bioethics Potter intended was a new naturalistic ethical teaching founded on the modern science of biology but Potter's term took on a life of its own. It came to be applied first to a domain of inquiry regarding the intersections between advances in biological science and technology and the moral dimensions of human life.

Today it also names a specialized academic discipline granting degrees in major universities and credentialing its practitioners as professional experts in the field.

It is my understanding that for this council "bioethics" refers to the broad domain or subject matter rather than to a specialized methodological or academic approach. This is a council on bioethics, not a council of bioethicists. In fact, very few of us are trained bioethicists. We come to the domain of bioethics not as experts but as thoughtful human beings who recognize the supreme importance of the issues that may arise at the many junctions between biology, biotechnology and life as humanly lived.

We are seekers for wisdom and prudence regarding these deep human matters and we are willing to take help from wherever we can find it. We should do all in our power to find and develop the best ideas and the richest approaches in order to do justice to the subject.

As it happens, the term "bioethics" etymologically considered as a different valence that is, in fact, close to what I take to be our mission. Bioethics is the ethics of bios, the ethics of life but the ancient Greek root "bios" means not life as such nor animate nor animal life.

For these the Greeks use "zoa" but rather a course of life or a manner of living or a human life as lived, something describable in a "bio-graphy," biography. Animals have life, zoa. Human beings alone have a life, a bios, life lived not merely physiologically but also mentally, socially, culturally, politically and spiritually.

To do bioethics properly, I suggest, means beginning not with judging whether deed X or Y is moral or immoral but with what the Executive Order says is our first task, undertaking fundamental inquiry into the full human and moral significance of the developments in biomedical and behavioral science and technology." We must strive to understand the meanings of the intersections of biology with biography where live lived experientially encounters the results of life studied scientifically.

Even as we tackle specific issues we must always attend to the deep character of humankind's individual and social "bio" and how they interact with findings of biology and the technical powers they make possible.

It is for this reason that the council is charged section 2(b) not only with looking at ethical issues raised by this or that specific technological activity, embryo or stem cell research, but also broader ethical and social issues not tied to a specific technology. For example, protection of human subjects in research, the appropriate uses of biomedical technology, the consequences of limiting scientific inquiry and the like.

Next to our manner. If our scope is to be broad our manner of inquiry must be searching and open. We are a diverse and heterogeneous group. By training, we are scientists and physicians, lawyers and social scientists, humanists and theologians. By political leaning, we are liberals and conservatives, republicans, democrats and independents. And by religion, protestants, catholics, jews and perhaps some who are none of the above. I, frankly, have no idea in many cases. But I trust that we share a deep concern for the importance of the issues and the desire to work with people from differing backgrounds in search for truth and wisdom about these vexing matters, eager "to develop a comprehensive and deep understanding of the issues."

Because reasonable and morally serious people can differ about fundamental matters it is fortunate that we have been liberated from an overriding concern to reach consensus. As the Executive Order indicates in section 2(c) in pursuit of our goal of comprehensive and deep understanding "the council shall be guided by the need to articulate fully the complex and often competing moral positions on any given issue and may, therefore, choose to proceed by offering a variety of views on a particular issue rather than attempt to reach a single consensus position."

All serious relevant opinions carefully considered are welcome. Any that may not now be represented on the council we will seek out through invited testimony. Moral positions rooted in religious faith or in philosophy or in ordinary personal experience of life are equally relevant provided that the arguments and insights offered and enter in our public discourse in ways that do not appeal to special privilege or special authority.

Respect for American pluralism does not mean neutering the deeply held religious or other views of our fellow citizens. On the contrary, with the deepest human questions on the table, we should be eager to avail ourselves of the wisdom contained in the great religious literary and philosophical traditions.

Up to this point my discussion of the council's mission has emphasized the philosophical aspect of our task. I have abstracted from the fact that we are a public body created by and responsible to the President, charged not just to find wisdom about these matters but to be genuinely helpful in the practical decisions the President and the nation face.

All our meetings are open to the public and we shall no doubt have numerous interactions with various governmental agencies and with the media. These features of our work and the high public visibility of our deliberations prompt the following additional reflections:

  • The President's Council on Bioethics comes into existence at a time of heightened public awareness of the importance of the difficult moral issues raised by biomedical advance. We have just experienced a year of unprecedented public debate and decision making about human cloning and stem cell research, in particular, and the ethical dilemmas of biological progress in general.

  • We have every reason to believe that these debates will continue and perhaps become something of a permanent fixture in American public life. Legislators, scientists and citizens will be called upon to consider the human and moral meanings of new areas of scientific research and how new or potential biogenetic technologies might transform various human activities both for better and for worse.

  • They will also be called upon to make prudential judgments about the proper role of government in the regulation of scientific technological innovation in these areas, including public funding decisions, the responsibilities of new or existing regulatory agencies, and the proper scope of state and federal law.

If the council is to offer proper help for meeting these challenges, two requirements stand out. One for "thought" and one for "action."

Among the most urgent of the council's intellectual tasks as I have already hinted is the need to provide an adequate moral and ethical lens through which to view particular developments in their proper scope and depth. Doing this must involve careful and wisdom seeking reflection about the various human goods at stake, both those that may be served and those that may be threatened by 21st Century biotechnology, and in either case going beyond the obvious concerns of safety and efficacy.

This sort of analysis must begin by prospectively considering what we wish humanly to defend in advance rather than by reactively considering merely the potential consequences of this or that particular new innovation. A rich and proper bioethics will always keep in view the defining and worthy features of human life. Yet at the same time responsible public bioethics must not lose sight of its practical duty to shape a responsible public policy as the demands for policy decisions arise piecemeal and episodically often without any preparation.

Our bioethical thought must, therefore, be ready and able to bring the aforementioned general considerations to the specific ethical issues at hand and maintaining this difficult but all important balance is part of the goal of our work.

On the practical side we remind ourselves that this council came into being in connection with President Bush's decision regarding federal funding of embryonic stem cell research. Its work is informed and guided by the President's desire for thoughtful consideration of bioethical matters that bear on his responsibilities and on public policy more generally.

It has been insufficiently observed that the President's decision established or rather reestablished the precedent that scientific research, being a human activity, is primarily a moral endeavor. One in which some human goods, the pursuit of cures for the sick, the inherent value of scientific freedom and curiosity must be considered in light of other human goods, the inherent dignity of human life, attention to the unintended consequences of research and the use of technology, and the need for wisdom and realism about the meaning of human life, human procreation and human mortality.

In addition, the President's stem cell decision and the surrounding public debate also demonstrated the capacity of democratic representatives to make moral distinctions in scientific matters. It is our belief that armed with the necessary facts and with responsible guidance and advice the institutions of American democracy can and must take it upon themselves to consider the meaning of advances in biotechnology and to ask whether and which of these advances demand and, if so, what sort of public oversight or public action. This council will endeavor to provide those facts and to offer responsible advice and guidance.

Our first meeting has been designed with these two fundamental requirements in mind. The agenda has been developed to initiate work on two different projects. One long term and one short term. The ongoing project is to develop the attitudes, ideas and approaches for a richer and deeper public bioethics, one that does justice to the full human meaning of biomedical advance and that can also provide guidance to the President and the nation regarding the concrete policy decisions that inevitably arise.

The wisdom seeking and prudential approach begins by developing the terms of discourse and modes of inquiry best suited to this task and the first part of this meeting is all about how we should approach and do bioethics.

The second part of the meeting seeks to demonstrate that approach with the specific of human cloning, our first short-term project. Here we must explore the meaning of cloning human beings and the ethical issues cloning raises but we must do so in a way that also explicitly addresses directly the policy and legislative debate in the midst of which this council, whether it likes it or not, comes into existence and about which we will be called upon to comment.

We shall accordingly consider both what to think and what to do about the prospect of cloning human beings. Here we must work not only to analyze and understand but also to judge and advise as best we can.

Winding up I want to say — make two comments about the subject of embryonic stem cell research and the controversial debate with which the council's birth was entangled. In his speech on August 9th the President stated that he wanted the council "to monitor stem cell research" and "to recommend appropriate guidelines and regulations." We take these tasks as a central part of our responsibility but we shall not be discussing them thematically in the immediate future.

Firmly articulating his own moral position President Bush has made a clear decision regarding federal funding of embryonic stem cell research.

Federal funds are now available for research using existing embryonic stem cell lines and there are many more good cell lines available for such research than anyone knew existed before the President's decision. Leading scientists have indicated that at least for the research phase, that is in the preclinical phase of these investigations, the number of embryonic lines are more than adequate to begin to explore their therapeutic potential.

Now is, therefore, the time for research to commence and proceed with vigor so that we may discover in the next few years whether these cells perform up to their advanced billing as holding the key to regenerative medicine.

This council will wait and watch and monitor. We shall ask NIH and any other relevant agencies to provide us regular reports that describe, assess and compare the successes achieved with both embryonic and nonembryonic stem cells. We will take up the subject thematically at some point down the road once we know more about where the research is going.

Finally, one little noticed substantive matter about last summer's stem cell debate deserves mention at least in my view for it bears on my view of the concerns important to this council.

Unlike some ethical debates where each side is defending a different principle or good, here both sides were arguing solely on what one may call the "life principle." The principle that calls for protecting, preserving and saving human life.

The proponents of embryonic stem cell research argue vigorously and single-mindedly that stem cell research would save countless lives. The opponents of the research argued with equal vigor and single-mindedness that it would in the process destroy countless lives.

It was, in short, an argument between two sorts of vitalists who differed only with respect to whose life mattered most, living sick children and adults facing risks of decay and premature death or living human embryos who must be directly destroyed in the process of harvesting their stem cells for research. Each side acted as if it had the trumping argument. Embryonic stem cell research will save lives of juvenile diabetics or people with Parkinson's disease QED versus embryonic stem cell research will kill thousands of human embryos QED.

These are surely important concerns but at the risk of giving offense I wish to suggest that concern for life, for its preciousness and its sanctity, whether adult or embryonic, is not the only important human good relevant to our deliberations. We are concerned also with human dignity, human freedom and the vast array of human activities and institutions that keep human life human, including, by the way, the virtues we have seen displayed on and since September 11th.

Important, though it is, the life principle cannot become the sole consideration in bioethical discourse. Some efforts to prolong life may come at the price of its degradation, the unintended consequences of success at life saving interventions. Other efforts to save lives might call for dubious or immoral means while the battle against death itself as if it were just one more disease could undermine the belief that it matters less how long one lives than how well and sometimes lives may need to be risked or even sacrificed that others may survive and flourish.

In my view, such questions of the good life, of humanization and dehumanization, are of paramount importance to the field of bioethics and I hope that they would become central to the work of this council.

Thank you for your patience. The floor is now open to discussion. I remind you if you wish to speak to press the microphone and I would like people to either make responses to these remarks or even better to weigh in with some statements if they wish about their own interests and concerns in this field, what they hope we might accomplish, topics that they would like to see tackled, and I will simply from now on try to keep order.

If this were my class I would call on you.

(Laughter.)

CHAIRMAN KASS: Mary Ann, may I?

REACTIONS AND OPENING STATEMENTS
MEMBERS OF COUNCIL

PROF. GLENDON: Yes. Well, my own preoccupations as a legal scholar have been to investigate what other countries of a type that we often like to compare ourselves with have done with respect to problems that our legal and political and social systems find puzzling and difficult, and so the observation and question I would like to raise is whether there will be some opportunity for our council to be in touch with or be informed by what other similar councils are doing, either at the state level as in California or in the international level.

CHAIRMAN KASS: Thank you. I do not think there is any determined decision on this. We have been encouraged in the Executive Order to explore opportunities for international cooperation on these matters. I think it would be highly desirable for us to do so. We have just had, I think, thanks to Elizabeth Blackburn, been notified of the existence of the California report that has been — the web site for that, I think, has been circulated to all members of council and hard copies would be made available.

I also can say slightly in advance that the National Academy of Sciences Report on the Medical and Scientific Aspects of Human Cloning will be issued shortly. I believe tomorrow.

And we are in touch with — people from international bodies have been writing to us and would like to establish contact.

So with the qualification that we should figure out how to do this in the most effective manner. I think it is terribly important that we learn what other countries are doing and participate in. If you would like to help take a lead in that it would be terrific.

Robby?

DR. GEORGE: Thank you, Dr. Kass. Let me begin by saying what an honor it is for me to serve with such a distinguished group under your leadership.

I hope it will not be considered trite, I certainly never consider it trite to begin our reflections with some reflections on the nature of the political order in which we function and address the important, as you say, daunting questions of bioethics that are before us as we seek to assist the President.

So I would simply recall the great proposition on which the nation was founded, the proposition articulated in the Declaration of Independence that "we hold these truths to be self-evident that all men are created equal and endowed by their creator with certain unalienable rights and among these are life, liberty and the pursuit of happiness."

I do not suppose that reflection or simply averting to those words to that proposition will solve the problems that we face. However, I hope that our deliberations will be structured with that principle in mind and right now just at the beginning I would recall or point out perhaps a couple of features of that principle that I think are relevant to what we will be doing.

First, of course, is the principle of equality that all human beings are created equal. None is a mere means or an instrument to the ends of others or to the larger collectivity. There is a principle there that we might articulate today as the principle of the dignity of the person, that the person is not a mere cog in the social wheel, that it is important as social life is to the flourishing of individual human beings. Nevertheless none is reducible to something that has meant some instrument, some mere means to serve larger collective interests.

In the last century, of course, we fought and prevailed against an ideology that quite explicitly treated the human being as a mere cog in the social wheel and we fought that struggle in the name of the principle of human equalities articulated in the Declaration of Independence. Of course, it is not a principle that our country has always been able to live up to faithfully.

It is often remarked that the nation was — even as it articulated that principle at its founding — conceived in the sin of slavery but it was in the name of that principle that slavery was fought and ultimately defeated at great cost and blood and treasure that the aftermath of slavery, segregation and Jim Crow fought, and I would say — I would argue very largely defeated in the name of that principle.

And the second thing that I would observe about it, the principle of the Declaration of Independence, is the idea of life and liberty as gifts. Not as something that it is within our human power to create. It is certainly within our human power to destroy them but they are not things that we make and can, therefore, simply cast aside on the basis of our own judgment. Perhaps what I am gesturing towards here is the idea that you raised, Dr. Kass, in your remarks when you observed that it might be something that we would want to reject that we can remake man in our own image.

That, of course, recalls the biblical proposition that man is made in the image and likeness of God and in the Declaration, of course, we are told that our basic rights and liberties, our most fundamental rights and liberties, come as gifts endowed by the creator. The state did not give them to us, the government did not give them to us, the king did not give them to us, nor can these mere human individuals or institutions rightfully take them away.

And I think the concept particularly of human life as a gift as we enter into deliberations and debate about bioethics is a very important one for us to bear in mind. It points to the limits of our own moral authority over human life.

So with those remarks, Chairman Kass, I will cease and desist.

CHAIRMAN KASS: Thank you very much.

We have a procedural matter of whether we are going to go formal or informal here in terms of the way we address one another. In my own institution the students are all Mr. or Ms. I am one of the hold outs on that but I think to make it — I think make the conversation flow more easily if I might take the liberty of suggesting that we do as informal Americans and call each other by our first names. Is that a problem for anybody in the room? I would respect it if — is that all right?

DR. GEORGE: It is not a problem for me, Dr. Kass — I mean, Leon.

(Laughter.)

CHAIRMAN KASS: Thanks very much, Robby.

People are free to engage one another or pick up on things that have just been said. Please, Gil Meilaender?

PROF. MEILAENDER: Yes. I want to more directly engage your own remarks if I may. Two comments. One specifically responding to it and then the other that grows out of it but it says something about my own vision of what we might accomplish.

One I just wanted to — I cannot resist noting that it would be possible to dispute your description of the stem cell research debate as between two sorts of vitalists and it would be possible to describe — to pick up on your own language of not using dubious means to describe the position of those who thought one should not destroy embryos in order to enhance or preserve life. So I just want to note that that is an arguable and a disputable description of the way the debate went and I did not want to just accept it without engaging it a bit.

But then the other matter that relates to sort of where we might go, there is a kind of tension — I do not say this at all critically but a tension in the several things you laid out that on the one hand we have to concern ourselves with policy, with public policy. On the other hand, we are specifically not required to seek consensus and the question is how you shape policy without seeking consensus.

I simply offer my statement about how important it is to me to take seriously that we do not have to seek consensus but that we rather really seek to engage one another, look at the arguments, make the arguments, and we may or may not find that we agree and we, therefore, are not policy makers. We — whatever we do, we might hope would inform those who make policy but other people are elected to various offices to make policy and it seems to me, therefore, that what we do freed from the necessity of doing that can, in fact, be something different and accomplish something. In that sense this council is a little different from some of its predecessor bodies and I would hope that we take that seriously so that is important to me in terms of how we proceed.

CHAIRMAN KASS: Thank you. Just a small comment. I think as I understand it the President would like from this body the same — the process that he followed in reaching his decision on the stem cell research was to consult very widely and to hear from the various people with different interests and different points of view. What he would like, I think, from this body is something comparable, only that these positions such as they are be developed at a very high level and show the effects of having engaged the other side of the conversation so that one is not simply talking with preconceived notions but that our deliberations would, in fact, issue in the best possible statements of whatever points of view are germane to the issue.

If we have agreement so be it but it seems to me we are not necessarily driven by that and I would be very surprised if on some of the vexed questions that we have to deal with that everybody is going to be like minded so we should not muzzle our best thinking just for the sake of producing an agreement.

Stephen, is that a hand or a half a hand?

PROF. CARTER: It is certainly a hand. It was not raised for any particular reason but to scratch my forehead.

(Laughter.)

PROF. CARTER: But I suppose I am happy to — as a law professor, I am happy to weigh in on any point on any topic, whether I am familiar with it or not.

A couple of comments on what has been said so far building, in part, on Gil Meilaender's point about not seeking consensus. I also think we have to be very careful in our deliberations in our exchanges not to fall into the trap of so many policy discussions today of thinking that every position that is expressed is expressed as a basis for a proposed regulation. That is to say one of the problems that we often have in discussing difficult issues, whether in bioethics or any other field, is that a public statement about the morality or immorality, desirability or undesirability of a course of action is taken as a public call for requirement or prohibition of that course of action. I think it is very important in our deliberations to be able to distinguish between our comments that are intended to go to morality, desirability, undesirability and our possibly identical but possibly very different comments that are meant to go to the issue of what our public policy actually ought to be.

One of the dangers, seductions but also great glories of living in a free society is the ability to establish an order in which we can often take up moral propositions without their having to lead to legal propositions.

With that said I also want to register one small point of disagreement, Leon, with what I thought was overall an excellent and really inspiring introduction. You mentioned — I think I got my note correctly — that we should not be closing our ears in advance to any particular form of knowledge. You mentioned religion for example, morality, ordinary experience but you mentioned religion it seemed to me with a qualifier that it not be — except where it rests on special authority, which I took to be perhaps authority inaccessible to others somehow.

If that was what was what you meant then I think I probably dissent because my view of public policy, and those of you who know my work this will be no surprise, and deliberation in a democracy generally is that we ought to invite to the public square anyone speaking from any perspective and that is what makes democracy so mighty and strong. And if we do not happen to be persuaded because of the special authority to which they appeal or anything else, we are certainly free to ignore what they have to say.

One last very small comment is that I do think it is possibly to think of the debate as involving vitalists or involving a fight over great principles in any case and certainly it may have those aspects.

But in my work I tend to be less interested in rights as such or freedoms as such than interconnectedness and so perhaps to suggest a bias from the beginning, and perhaps this comes from my own christianity, many of my comments, I think, over the course of our meetings and deliberations will be directed to the notion of thinking less about various ideas in terms of consequences as such or rights as such but rather how they bear on the questions of human connectedness and things that make us not so much a whole integral human being but a whole integral and organic society.

CHAIRMAN KASS: Charles?

DR. KRAUTHAMMER: Yes. Let me start by saying what an honor it is to serve on this committee. I think the work that this council is doing is of extraordinary importance. I think the 21st Century will be known as the century of biology.

CHAIRMAN KASS: Charles, can you get a little closer to the mic, please.

DR. KRAUTHAMMER: And that the great promises and the threats to our — thank you. Maybe I should raise this a bit. The promises and the threats to our way of life hinge more on biology than possibly any other human endeavor.

If I could I would like to start by just expanding on what you said, Dr. Kass, about the vitalist debate. And I think it is an extremely important point that you expressed rather elegantly and if I may I would like to express it rather crudely since that is what I do for a living.

(Laughter.)

DR. KRAUTHAMMER: Essentially I think the bioethics debate has been reduced in the public mind to a debate about life and as you indicated it is, of course, an extremely important issue but it is not the only issue and yet there is an impression that these debates hinge on the questions of when do you believe life begins and that essentially these debates are subsets of the debate on abortion. I think that is a misconception and it is a misunderstanding of what these issues are about.

Clearly the issues of the origin of life are important but, as I wrote in an article earlier last year, in the debate about stem cells in particular it seems to me that the more important issue is not where the cells come from but where they are going. It is not so much the origin of the cells but their destiny, which is another way of saying that the real issue and the issue I think that we ought to focus on is the problems, the promises and the threats posed by the prospect of human manufacture.

We are entering an age of human manufacture. That is why this council has been called into being. That has never happened in human history. We have now in our hands the technology where we can make and create kinds of human life, variants of human life never before imagined.

And I think in the briefing, the papers which were issued to us last week, I think there is a healthy focus on this as the larger coming issue and I think to the extent that we make the public understand, the policy makers understand, and ourselves understand that these are the central issues of bioethics rather than just tired restatements of the abortion debates. I think to that extent we will have performed a great public service.

CHAIRMAN KASS: Thank you.

Bill? Rebecca, please?

PROF. DRESSER: Thank you. I, too, am honored to have an opportunity to serve on the council. I was glad to hear Leon say that we want to consider bioethics from a wide scope. I think that matters such as cloning raise important social and symbolic issues but I also hope that we will spend some time considering what I call ever day bioethics issues. Issues that have major effects on many people. For example, many people lack the opportunity to benefit from proven therapies because they lack insurance or they are under insured. Many chronically and terminally ill people do not get the kind of humane care that we would all like to have ourselves.

And I agree with Mary Ann that we ought to consider international issues. For example, all of the issues raised by the HIV/AIDS epidemic in Africa and Asia as well.

So I hope we can think about things like the morally defensible allocation of limited resources for health care and research.

And then just as a last point I think having read the materials generated by other commissions and councils of this nature, I guess my reaction is that commissions really make more of a difference when they deliberate in a balanced way that speaks to people with a lot of different viewpoints so I hope that we can do that.

And, also, communicate clearly and make our positions accessible to ordinary people. I hope that we will not become too academic even though I certainly think we are in danger of doing so. So those are my hopes for the council.

CHAIRMAN KASS: Thank you very much.

Bill Hurlbut?

DR. HURLBUT: Coming after that remark this is going to seem a little vague but my hopes for this council certainly center around the every day and practical realities but I also hope that unlike so much bioethics which tends to be reactive and remediative that we can really step in and recognize where we are in the course of the evolution of life as a species that has radically changed the fundamental realities leaped out of our environment of evolutionary adaptation and do a technological culture.

I hope we can have very forward thinking and anticipate where we are heading in this manufacture or transformation of human life and in that process my hope is that we can provide a positive platform for human possibilities. A solid framework for issues of extraordinary urgency or opportunity for our species and for our place within the larger ecology of life. Here I think of both negative and positive things.

We have to recognize the changed biological realities of a situation where there is rapid spread of emerging infectious diseases where chemical and biological warfare are realities and where we are preparing to perhaps alter human physiology for manned exploration of space.

What I am trying to say is I hope that in thinking about what it is that is centrally human we can provide a platform for positive possibilities that seem at first perhaps unintuitive but also seem to be part of our extending nature as a species.

CHAIRMAN KASS: Paul McHugh?

DR. MCHUGH: I also want to thank the organizers for inviting me to join this remarkable council and remarkable both in its constitution and the aims that you laid out in that wonderful address that you began us with, Leon.

As well I want to say that my great interests, of course, out of my professional life are in the realm of neuropsychiatry. Those particular conditions such as Alzheimer's disease, Parkinson's disease, the dementia and depression of AIDS and the like are vitally involved in the enterprises that we are considering and I want to make the — emphasize your point that this is a council on bioethics, not of bioethicists. This is very important because I am afraid that bioethics as you have described it has a wonderful goal but often in expression in university and hospital places has turned out to be — to miss its aim, often becoming more accommodating to anyone's particular wishes about how to deal with a person in a life rather than a place that are a group that has raised high issues and put forward the aims of the claims of life and the claims of patient life in particular.

In making that point I want to celebrate really the President's address that formed this council not only because of what he said in it but what was implicit in what he said and that was to say not only announcing his plan but announcing that he would encourage the use of stem cells that are presently available for scientists, and in that way put the burden of proof back where it belongs.

The burden of proof that experts can help us with will be and should be carried by people who wish us to change and to produce new ways of work with people and with the future. I believe that our — the good ethics comes from good data but that good data also should be used to prove the points and the burden of proof should be kept on the individuals that are encouraging us to do change. Often it is seen that people have concern are simply trying to hold — being made to prove why we should hold back. I think we should ask our experts to tell us why we should go forward and I look forward to the opportunity to meet those experts in this forum.

Thank you.

CHAIRMAN KASS: Bill May?

PROF. MAY: I take it for granted from what you have said and Gil emphasized, and others, that we do not meet as a policy making body and further policies do not automatically convert into regulations but as one thinks in the past about the development of policies and research in human subjects it affected basically federal policies but since almost all research institutions depended upon federal money at that point there was not much consideration of the further matter, which is now in a different situation significant.

That is marketplace initiatives are much important today than they were at the point at which at an earlier time one developed policies and experimentation on human subjects. There is an increasing and heavy involvement of the corporations in the university research agenda today which was not the case decades ago.

I simply wonder even though we are not making policy we are reflecting upon the whole arena of policies and whether this includes not simply federal policies bearing on federal research monies but on the larger investment of funds in scientific research, whether that investment comes from federal sources or marketplace initiatives.

CHAIRMAN KASS: Janet Rowley?

DR. ROWLEY: I, too, join my colleagues in expressing my pleasure of being within this group and I look forward to the challenging discussions we are going to have in the next series of meetings. I do want to emphasize a point that you made tangentially, Leon, that in one sense we are discussing a moving target because much of what we need to know to make — to both have a thoughtful discussion but also to try to come to some reasonable decisions really involves issues about which we do not yet have data.

And following on with what Paul said, it is important that as we try to evaluate the options and what the consequences are of one course of action as compared with another, we do not really have the information that is required to make a thoughtful decision on many of these issues and this is a challenge to us to try to guess what will happen in the future but I think also a challenge to us to try to not preclude the possibility of getting good answers in the future.

CHAIRMAN KASS: Thank you.

Please, Elizabeth?

DR. BLACKBURN: I think I agree with the council members who have spoken so far. We have very, very weighty issues ahead of us here and I think I was struck by a couple of points which perhaps are worth adding to what has already been said in terms of how we make our decisions and what sort of input we are getting. I think it was Rebecca who said she hopes we do not become too academic a body but I think what the corollary of that is we want to educate not only ourselves and be a way of educating the public, I think we need to have people who can inform us, as Janet says, come in and talk to us so we really are clear about some of the issues that, as Charles Krauthammer mentioned, have become somewhat conflated perhaps in the discussion.

And I think we need to think quite carefully and perhaps even analytically about some of these issues as we make — this is to do with the issues of the biological sides of things I am thinking about — a we come to our decisions. We want our decisions, as Janet said, to be made based on very good information so I think, as you plan to do, we are going to bring people in who can perhaps clarify some of these biological questions.

CHAIRMAN KASS: Michael?

PROF. SANDEL: That was a great opening statement, Leon. It really cast our project in very broad terms and invited a generous expansive conception of public discourse.

One thing that strikes me reading the materials and listening to the comments around the table is that our — what we may be involved in here in thinking about bioethics may not just be a matter of bringing moral and ethical principles and reflections to bear on practical questions raised by biotechnology but in the process of doing that we may find ourselves reconceiving or rethinking what ethics and moral philosophy are about.

The natural sciences and the human sciences were once thought to be linked. They were the sorts of things that philosophers did back in the time of Plato and Aristotle but in the last three or four hundred years they have been driven apart.

There has been a division of labor between the natural scientists on the one hand and the human sciences on the other and what philosophers do and what social scientists concern themselves with.

It may be that biotechnology and the ethical dilemmas that arise are bringing those two domains of science and philosophy closer together but it may also change the way we think about ethics because so many of our recent debates about ethics depend on this much discussed and often hard fought distinction between persons on the one hand and things on the other. Persons are worthy of dignity and respect, whereas things are open to use.

So much of the weight of debates, including the debate about abortion, has been on deciding who counts as a person because unless something — some natural being gets the status of a full human person, anything goes. That thing then is open to use and this distinction between persons and things.

This very sharp dichotomy goes back to have such an influence on us but it may be that the biotech revolution and the ethical issues that it raises may suggest that that very sharp dichotomy, all or nothing, human person worthy of respect or a thing open to use needs to be called into question.

And we may find ourselves discussing or exploring or groping for ways of articulating modes of valuation, modes of reverence that are appropriate to different types of life, forms of life, different beings in nature such that it may not be all or nothing, on or off, respect or use.

And I think that if this discussion about biotechnology and ethics leads us to elaborate and articulate a range of different modes of reverence, respect, regard, valuation for different beings, different types of creatures in nature then we will have enlarged not only public debate about biotechnology but also maybe even the way we in the contemporary world reflect about ethics.

CHAIRMAN KASS: Thank you.

Michael Gazzaniga, please.

DR. GAZZANIGA: Again thank you for including me. I see my chore as trying to bring to the committee some current understanding in issues that arise from studying the brain in the area of neuroscience. One can in the current issue of cloning and stem cells see the issue is life with a brain versus life without a brain an equivalent status for us to consider. We will have to look at that.

More importantly, jumping ahead, I think the neuroscience literature where these new brain imaging technologies are raising a whole set of new questions that we will have to address as we go on having to do with such issues as cognitive privacy. We are getting to the point where we can ask the brain something and forget about the person and find out what they are really thinking. What sort of issues will that raise for the legal system? What sort of issues will that raise for us personally? So I see the nervous system playing a large role in the discussions to come.

CHAIRMAN KASS: Thank you.

Dan Foster?

DR. FOSTER: My microphone is trying to keep me from speaking. It popped back off.

I only want to make a brief observation. I think it was 1954 C.P. Snow wrote a book called The New Men in which he posed the angst of the nuclear physicist about the nuclear powers possibility of achieving good and achieving harm. The Michigan geneticist Neil said fairly recently that 50 years later it is the molecular geneticist that is now on the hot seat in place of the nuclear physicist and I thought he made an interesting remark.

He said, "The power available to us must be used wisely, otherwise it would be a desecration to humanity." And I believe he is right on with that statement.

CHAIRMAN KASS: Frank Fukuyama?

PROF. FUKUYAMA: Leon, thank you also for including me.

As I understand it, the commission has a two year mandate and then it may either get renewed or goes out of business. My observation as a political scientist is that you never have any long lasting impact on policy unless you actually create some institutions and I hope that what — one of the things that this commission will consider is the institutional design of a system for in the long run making decisions on bioethical issues.

As you, yourself, have said previously things like the legislative ban on cloning — I mean, we have different opinions about the wisdom of that but, in general, legislative bans are not a good model to follow for making this kind of decision in the future, that there are going to be too many decisions, they will be too nuanced, and really what you need is a regulatory model.

But I think it is pretty evident that our existing regulatory structure for biomedicine is really inadequate to deal with the kinds of decisions that will have to be made in the future. The FDA and NIH have a structure that really excludes, I think, consideration of a lot of the kinds of ethical issues that we are going to be dealing with on this commission and so I think that one of the things that we can positively contribute is some thought. Since there are a lot of lawyers and political scientists around the table, you know, one thing that we might consider is whether — you know, what — as a very practical matter what kinds of institutions might be necessary to create in the future to basically carry on the work of this commission beyond its two year terminus.

CHAIRMAN KASS: Thank you. Unless I am missing a queue, it is left to you, Jim, if you want to say something. I think everybody else has been in once. Am I right?

Further discussion on any of the things raised by one or another people here? Do people want to come back?

Let me say while you are thinking about things to add, I mean I have taken some notes and others have, a lot of the — everything that this council does is public and documents that we circulate amongst ourselves between meetings are covered by the Freedom of Information Act. We should not regard this as a handicap. We should not be saying anything to one another of importance that we would not take responsibility for but not everything that can be done on this council can be done only at the times that we are together.

And that means that everyone is invited — I will make this remark more than once but everyone is invited to go home and send in as — in as short or as lengthy a way your further reflections on the remarks just made or after thoughts, both about the issues that you think are most salient, both about the kinds of projects that you think we should be considering.

Frank Fukuyama makes, I think, a very important point. We have a two year life span and we have a start. The start was made before the council was put together. Someone had to make a decision and we made it. The President has asked us to take up the cloning question and it is a topic of current interest. I do think that we at least on the intellectual side have an opportunity to make a more lasting — a lasting contribution to the extent to which we can develop the terms and demonstrate the manner of a richer kind of bioethics. Hence I would like at least in each of the meetings that we are together to be spending some of our time trying to do that. The next two sessions this morning are devoted that and Gil Meilaender's paper in particular has been prepared with that task in mind.

But what else we tackle and certainly what else we tackle after the cloning question I think is up for discussion and just as we should be thinking about the modes of analysis and approach that this subject matter deserves so it does seem to me that the institutional and political questions, I do not mean partisan political questions but the institutional questions that Frank has raised, deserve some of our attention.

Anything further? Jim, please?

DR. WILSON: Is there a list of addresses or e-mail addresses by which we can reach other members of the commission?

CHAIRMAN KASS: Yes. Have these been distributed at this point? We had trouble distributing things because for a variety of reasons the announcement of the membership did not come until yesterday afternoon. Those of you who were discreet left town without telling your wives why you were going to Washington, and husbands — husbands, indeed, or sons or secretaries but we will get this to you even before you leave. We will get the roster of names, addresses, e-mails.

And if some people have multiple places where they can be reached it will be helpful to know where you prefer to be reached.

DR. WILSON: A follow-up question.

CHAIRMAN KASS: Yes.

DR. WILSON: Are direct communications between myself and one other member of the committee, is that part of the public record?

CHAIRMAN KASS: Did you hear the question?

MR. CLANCY: I did. I am still trying to find out the answer.

CHAIRMAN KASS: One of the defects of operating in the way in which we have been operating, (a) we do not yet have an attorney. We have been getting legal advice on these various matters. Members of council — we have several attorneys here but you have got more important things to do than advise us on how to solve that problem.

I think — I do not want to give an answer. My impression is that one on one conversations are not but as soon as there are two people — but I think — I do not want to — I think one should give the correct answer rather than speculate on this.

If there somebody in the room who really knows, now is the time. Good.

DR. GEORGE: Well, I cannot say that I really know but I served for six years on the United States Commission on Civil Rights and that is an independent government agency subject to the same regulations that we are subject to. And it was the understanding at the commission that private conversations even if they pertained to commission business were not matters of public record.

CHAIRMAN KASS: We will get an answer on that. We are speaking to possible candidates for a legal position with the council and we need somebody quickly.

This last point brings up something else that is also worth mentioning. There are materials in the Ethics of Government Act that pertain to questions of speaking, teaching and writing in relation to the work of this council. You should read it through and we will get clarification on any ambiguities that exist.

However, there are a number of people in this room who have written on bioethical topics and people have asked are we now muzzled or what may we speak and what may we say. It seems to me that public writing about the business of the council as a council is out. And the sort of activity — and no one should be writing or speaking in the name of the council unless designated to do so, for example, should we be asked to testify before congressional committee. But all of you — all of us are thoughtful and responsible people who, I think, ought not to be muzzled and ought to simply proceed with discretion in the way in which we conduct ourselves.

Many people in this room serve on other bodies where the same kinds of questions come up and I think the main thing is to try to do it prudently and avoid anything that would be — that you could imagine would be embarrassing to our collective work but we are who we are and we have contributions to make in our different voices and I think that if we conduct ourselves responsibly on this matter that will not be any difficulty.

If people are going to sign petitions, please do not sign as members of the President's Council on Bioethics, and things along that line.

Is that agreeable? Is there anyone who thinks that that is going to be a problem?

All right. We have a long day and we have squeezed the schedule. It is just shortly before 10:00. Why don't we break now and reconvene, let's say — let's make this a healthy break. We will convene at 10:15. It is the only really healthy break before lunch. We have got a short one in between. We will reconvene to discuss the Hawthorne short story The Birth-mark at 10:15.

(Whereupon, a break was taken.)


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