Leon R. Kass, M.D.
First Meeting, January 17-18, 2002
It is over five months since President Bush, in his address to the nation about federal funding of stem cell research, 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 easy-going relativism, has enabled us to see evil for what it is and, more important, to celebrate the nobility of heroic courage, civic 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 for serious moral reflection.
Yet the moral challenges the Council faces are very different from the ones confronting the President and 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, 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 anti-modern fanaticism and barbaric disregard for human life, so we must avoid runaway scientism 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 Brave New World on the other. President Bush has given us the opportunity and obligation of helping him plot and navigate this 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 28, 2001, states the
Council's mission as follows (I read from the briefing book, Tab 4B):
- 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:
- to undertake fundamental inquiry into the human and moral significance of developments in biomedical and behavioral science and technology;
- to explore specific ethical and policy questions related to these developments;
- to provide a forum for a national discussion of bioethical issues;
- to facilitate a greater understanding of bioethical issues; and
- 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 Center and The Kennedy Institute at Georgetown, none of the pioneers had training in bioethics. Indeed, none of us referred to ourselves as "bioethicists." Actually, the word "bioethics," coined a few years earlier by 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 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 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, has a different valence that is in fact close to what I take to be our mission: bioethics as "the ethics of bios," "the ethics of life." But the ancient Greek root, bios, means not "life" as such nor animate or animal life -- for these, the Greeks used zoe -- but rather, "a course of life" or "a manner of living," "a human life as lived," something describable in a bio-graphy. Animals have life, zoe; human beings alone have a life, a "bios," a 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 developments in biomedical and behavioral science and technology. We must strive to understand the meanings of the intersection of biology and biography, where life as 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 bioi and how they interact with the findings of biology and the technical powers they make possible.
It is for this reason that the Council is charged [Sec. 2, (b)] not only with looking at ethical issues raised by this or that specific technological activity (such as embryo and stem cell research, assisted-reproduction, cloning, or the uses of knowledge and techniques derived from human genetics or the neurosciences), but also broader ethical and social issues not tied to a specific technology: for example, the protection of human subjects in research, the appropriate uses of biomedical technology, the consequences of limiting scientific research, and so forth.
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. 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" [Sec. 2(c)] 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 [Sec. 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 enter our public discourse in ways that do not appeal to special privilege or 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 bio-genetic 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 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 and advance, rather than by reactively considering merely the potential consequences of this or that particular technological innovation. A rich and proper bioethics will always keep in view the defining and worthy features of human life, features that biotechnology may serve or threaten. 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. Bioethical thought must therefore be ready and able to bring the aforementioned general considerations to the specific ethical issues at hand. Maintaining this difficult but all-important balance shall be part of the goal of the Council's thinking.
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 re-established) 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 (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 requirements firmly in mind. The agenda has been developed to initiate work on two different projects, one long-term, 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. This wisdom-seeking and prudential approach begins by developing the terms of discourse and modes of inquiry that are best suited to the task. This we shall strive to do in all of our work, both by self-conscious reflection on a "truly human bioethics" and by example, in the way we tackle more specific topics. The first part of the 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 topic 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 comes into existence and about which we are 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.
In conclusion, I wish to 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 9, 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, the pre-clinical phase) of these investigations, the number of ES lines are more than adequate 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 non-embryonic 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.
One little noticed substantive matter about last summer's stem cell
debate deserves special mention, 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 of the debate
were arguing solely on what one may call "the life principle," the principle
calls for protecting, preserving, and saving human life. The proponents
of embryonic stem cell research argued 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 sort 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 the lives of juvenile diabetics or people with Parkinson's disease"
versus "Embryonic stem cell research will kill hundreds if not
thousands of embryos." 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 the virtues we have
seen displayed on and since September 11. 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 they will be central to the work of
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