Friday, September 9, 2005
Session 5: Taking Stock; Looking Back, Looking Ahead
CHAIRMAN KASS: Good morning. Welcome, Members of the Public,
Council Members. Thank you very much, once again, for last evening.
It's my great pleasure to start this session of Council by welcoming
as our guest for today and soon to be new colleague and Chairman
of this Council, Dr. Edmund Pellegrino, who sits to my left. Dr.
Pellegrino, if he's not already known to you all, should be.
He has been a physician for more than 50 years, still practicing
medicine, where he's Professor of Medicine Emeritus at Georgetown
University School of Medicine and makes rounds on the wards.
November, I think, is the next tour of duty. He has been one of
the country's leading thinkers and writers on the philosophy
of medicine, the doctor/patient relationship, the founder of —
co-founder of the Journal of Philosophy in Medicine and one
of the clear thinkers and wise guides in the area of ethics and
He's had administrative positions with organizations, I'm
sure, larger than the chairmanship of the President's Council
on Bioethics, the last — well, not the last, one of them being
President of Catholic University, was Vice President of Yale New
Haven Hospital, ran the hospital and I can't tell you how delighted
I am that Ed will be replacing me in the Chair. And to quell any
gossip from anybody who scribbles, I will be remaining as a member
of the Council and will be delighted to continue working with all
of you and under Ed's leadership and guidance.
So please join me in expressing our warm greetings to our new colleague.
CHAIRMAN KASS: I've asked Ed to sit in this morning
because the two topics for today are of a special interest for us
going forward. The first session is entitled "Taking Stock:
Looking Back and Looking Ahead," in which we will have a chance
to reflect on what we've done together these past four years
and to offer some suggestions and thoughts about what we might do,
suggestions we present amongst ourselves but also for Ed's consideration
as he contemplates the new directions.
And the second session will be on the "Medical Vocation Then
and Now," a subject not only dear to the new Chairman's
heart but absolutely central to many of the things that we've
been talking about and will talk about in the future. I'll
introduce that session when we go forward. I think we should divide
this session really into two parts. It's very rare for any
group of people, except in therapy sessions, of group therapy sessions,
to actually sit together and reflect openly and in this case, in
public, on the work that we've done and to try to think hard
about what it means to try to do public bioethics today with the
kinds of issues that we face, not primarily to settle scores or
to deal in anything petty, but to see if we've somehow learned
something that could be put to use in making the work better as
this Council goes forward.
And then second, I think we should do as we've done on previous
occasions, talk about possible topics of importance that this Council
might continue in its third term. Some of those things surfaced
yesterday and I thought you might like to bring them back. This
is sort of strange, but I would like to ask — so as to save
time, you've been given as a background paper, the talk that
I gave a year ago and is now going to be out in the Kennedy Institute
of Ethics Journal within a couple of weeks. So as not to waste
your time but because I would like to get certain things in that
article in the public record, could I ask unanimous consent to put
into the minutes of this meeting as if read a few of those general
reflections at the end so that people who are not here but who
know us only through the transcript of the meeting and will not
see that paper, can at least have one man's perceptions of these
matters. Is that all right? Good.
Then let me introduce the discussion today, the more reflective
part of the discussion with these comments. This Council has been
guided really by two inter-related purposes. The first purpose
has been to pursue what we've been calling a richer bioethics.
That is to say, to consider not just the technologies or the way
in which they give rise to questions familiar to either clinical
medical ethics or to general sort of common concerns of a liberal
democratic society, but also to see how these things which impinge
upon our humanity, in fact, touch our personal aspirations, our
human longings, our duties, our — the way we actually live
life every day and in deep and serious ways.
We've tried to think about what it means to suffer, what it
means to welcome a child into the world, what it means to perform
with excellence, what it means to respect life, what it means to
age well and care always, and almost everything we've done has
been informed by attention to these anthropological and not merely
ethical matters. And I don't think that this Council would
have satisfied itself with the view that all that bioethics can
say is that everyone should make informed choices for themselves.
As a public bioethics body respecting, to be sure, the pluralisms
of the society, we've been asked to offer as the charge this
Council had, the results of serious inquiry into the human and moral
significance of these advances and that we've tried to do. And
speaking for myself, I think that's something that we should
be very proud of.
The second purpose informed by the first, but not always easily
or comfortably related to it is to try to be useful to those who
are charged with making public policy in the age of biomedical science,
on issues ranging from stem cells and cloning to the regulation
of biotechnologies, to the care of the elderly, the demented and
We've tried to take seriously our mandate not just to think
but also to guide, and not just to think about ethics but to think
also about self-government on issues that are both ethically profound
and scientifically complex. It's, I think, not for us to judge
our achievements or failures in this area but it remains for me
a challenge and a puzzling question — what's the relation
between this search for a richer bioethics on the one hand and the
desire to be genuinely useful in the concrete decisions that public
policy makers face, and in particular the topic of regulation.
We've tried our hand at this. We are quite concerned that
we live in a society which is largely unregulated when it comes
to all of these revolutionary areas of biotechnology. And we know
that there are obstacles to going forward here, but it seems one
of the things that is very much worth pondering as we go forward,
can we hold these two tasks together and could we do either or both
of them better?
That's to prime the pump. I really — never mind that
there are scribes possibly in attendance. I think we should have
— this is not a time to pat ourselves on the back. It's
a time to try to figure out what have we learned from trying to
do this work together and what could we do in order to do these
MALE PARTICIPANT: This is the first time in history
you've completely silenced the Council.
CHAIRMAN KASS: No, no. I knew it was a good question.
You ask a good question in class, nobody speaks. Diana, was that
PROF. SCHAUB: I don't know if it addresses what you've
asked us to address but I think we ought to think about whether
we have done enough to reach the public. I mean, I think the Council
has done an incredible job on the score of a richer bioethics, but
has the public been sufficiently enriched by what we have done?
I mean, have we gotten it out to them? So I mean, I just wonder
if there are small things that — I mean, that we could do
more in the way of meeting that charge of educating the public and
informing the public.
I mean, the books are out there but people are not always readers.
So, you know, ask ourselves, you know, are these books getting into
the hands of the people that we want them to get to and for those
who are disinclined to read, are there other things that the Council
could be doing? I mean, I know that individuals do a lot of public
speaking to, you know, university crowds and you know, other kinds
of fora, but people do that as individuals. And the things that
I've done like — done in that line to alumni groups and,
you know, college audiences, there's a great deal of interest
and there is a great deal of ignorance.
So I mean, I wonder whether the Council could do something like,
you know, take this show on the road, you know, have a — these
are public meetings. Stage the public meeting not at a hotel in
Washington, D.C. but at a major university or I don't know,
I mean, it would just — you know, trying to figure out are
there other things that we could be doing or at the risk of being
too political, part of the charge is to inform policy makers and
legislatures. Are there acceptable ways to run information programs
on the books that we have — books that we have written for
you know, staffers, congressional staffers?
CHAIRMAN KASS: Thank you. This thought has — I'm
not going to editorialize after every comment but on this particular
point, it's been a concern of mine from the beginning and we've
been so preoccupied in a way with doing the reports that there hasn't
been a lot of time and energy for these things, but to send even
staff out with the reports to college campuses and do things like
that was one thing that we considered. I'd also considered
putting together a small group of journalists and have seminars
with them on the reports. I mean, just make them read the things
instead of the last page, and have regular seminars, but just there
wasn't time and energy enough to do that given these other things.
But a lot of what we — a lot of what we do insofar as it's
not — well, two things, three things. First of all, if one
is speaking about the policy makers directly, Charles Krauthammer
told me when I took this job, "In Washington if you want to
educate anybody, you have to tell them what to do, so a report with
no recommendations is politely ignored."
I mean, people look and say, "Is there anything here I really
have to pay attention to? I'll read it when I have time",
and these people have lots on their plate. So — but then
the people who really do the educating are a couple of dozen journalists
for, you know, medical journals, Science, Nature, the general
press, our fine observer, Mr. Saletan here, who is a very astute
reader of these things, and if one could sit down with this group
of people and get them to go past the things which very often make
up the stories about these matters to get them to deepen the accounts
that they give, there would be a way in which one could multiply
the educational effect through the people who actually do a lot
of the public education for worse and sometimes for better. And
that's, I think, something worth thinking about.
There was a third thing, but the gray cells are gone, so let it
be. Please, Robby?
PROF. GEORGE: Leon, I think the largely unwritten, even
unremarked, story of the Council was there right at the beginning
and it's the remarkable diversity of points of view on the Council.
The President's willingness to appoint to the Council not only
people who agree with his fundamental moral outlook on the questions
before us, but also some who don't and some who deviate very,
very sharply indeed from the President's own perspective.
When it became clear to me that that's the kind of Council
we would be, I wondered what the result would be in respect to the
reports that we would be able to put out and what the value of the
reports would be. Since most, perhaps all previous bioethics councils
have had more uniformity of viewpoint on them, they were able to
write reports that took a point of view and made an argument and
advanced that argument quite vigorously. Our reports have not been
shaped in that way precisely because of the diversity of points
of view on a number of occasions. So I wondered whether they would
be valuable. Well, my conclusion, now that we have a good deal
of experience with them is that, in fact, it is very valuable to
lay before the American public and particularly before people who
are genuinely interested in these issues, the best arguments to
be made on the competing sides of the question and the best available
information as to what the plain facts of the matter are.
In our initial report on cloning, although we were very badly divided
as a Council, we were, I think, able both to lay before the public
the strongest arguments that were available on the competing sides
of the question and also to clarify the underlying facts about which
there was floating around out there a lot of misinformation. We
were also, and I think a very, very important contribution neglected,
unremarked, able to clarify the language and to be clear on what
we were talking about at a time when the need for such clarification
of language was very, very important. I hope that we will continue
and I am confident that under Dr. Pellegrino's distinguished
leadership, we will be able to continue to produce work of this
quality and accomplish what we have been able to accomplish with
the reports that we have done this far. And when the day comes when
this Council wraps up its work and perhaps, a new President of whatever
party is elected and thinks about how to constitute such a Council
if he or she wishes to have a bioethics council and I suspect that
bioethic councils will continue in our future, I hope that a lesson
can be drawn from the diversity that we've had on this Council
and the valuable work that's come out of the diversity on the
CHAIRMAN KASS: Thank you. Frank Fukuyama.
PROF. FUKUYAMA: Well, in the spirit of Dan Foster not wanting
to grow extra muscles by patting ourselves on the back, I guess
I do want to register my own, you know, one area of disappointment
in what the Council has done. I accepted Leon's invitation
to become a member of the Council, with really one purpose in mind,
because I wanted it to address very forthrightly the regulation
issue. And my hope at the beginning of the Council had been that
this might develop a little bit like the Warnock Commission in Britain
in the 1980s which, you know, studied the upcoming, you know, revolution
in biotechnology and then recommended creation of the agency that
became the HFEA, the Human Fertilization and Embryology Authority
in the UK.
And I had hoped that our work might be able to lead in that direction.
Now, I think it became clear as we started very seriously delving
into the regulation issue, that we would, you know, touch on the
margins of that but I think that politically, I mean, it's not
the fault of this Council. I think it's just American political
culture. There's a kind of very deeply rooted anti-regulatory
bias on the part of both the left and the right in this country
for different reasons, you know... to produce the kind of situation
that we have. And I think on the Council, the reason we couldn't
go forward was a number of people, Gil and Alfonso, you know, raised
this question, well, if you don't know actually what you're
going to regulate or what the regulators are going to do and give
them, you know, those instructions substantively, how can you say
you can build the authority.
Now, I actually think we could have gotten past that because the
HFEA in Britain regulates and permits stem cell research and research
cloning. The Assisted Reproductive Agency of Canada, this recently
established body, prohibits research cloning and very strictly regulates
stem cell research and they have almost the identical institutional
structure. And I think it would have been possible, actually, to
recommend the creation of an agency with the appropriate powers
and domain and specifications and actually then kick the ball down
the road to the political authorities to decide, you know, whether
it looks more like the Canadian agency or more like the British
agency in terms of whether it either permits or restricts research
cloning. But, you know, it was a very difficult hurdle to get over.
We did, I think a very respectable job in the "Reproduction
and Responsibility" report where we actually, as a way of trying
to get past the cloning deadlock in Congress — I mean, in
fact, we made multiple efforts to suggest to the political authorities
concrete ways of, you know, breaking through the current political
logjam so there would at least be some effort on the legislative
front to address issues that we all agreed, you know, needed to
I believe, however, that this is still an area that we did not,
you know, push the ball all the way up the hill. That was one of
the reasons that I got independent funding for the study that I
presented to the Council last December, where I just went ahead
and on my own I kind of laid out what I thought this kind of an
agency ought to look like and I think that's still on the national
Now, being politically realistic, I think that what's going
to happen is that, you know, various people will make suggestions
along these lines and then at some point, some, you know, doctor
is going to try to clone a human being and it's going to lead
to some deformed, you know, horrible outcome and then people are
going to look and say, "Well, you mean to say that this was
legal in this country, that this isn't regulated?", and
you know, people saying, "Yes". Well, in fact, that is
the case, that we don't have any rules whatsoever that prohibit
this sort of thing.
And just as in — you know, as it took the Enron meltdown
to discover that we actually did have very good, you know, accounting
standards in this country, I think then people will be willing to
politically take up this issue in a more serious way. But I do
believe that this still remains on — you know, on the agenda
for not just this Council but future ones to think, you know, as
Leon was saying, more concretely about not just legislative acts,
but institutions that will, you know, help guide us and kind of
structure political decision making in this area as we go on into
CHAIRMAN KASS: Thank you. I would — I guess while
people are collecting their thoughts, I would underscore what Frank
has said but give, maybe one additional comment. It — it's
been one of my frustrations here, Frank, as well, though I saw very
early on, I think it might have been Gil, Gil said he'd be all
in favor of a regulatory body if we could — if he could identify
the goods in the name of which the regulatory body would regulate
and also appoint its members, otherwise he wasn't sure that
one wasn't going to be as it were, giving carte blanche to something
about whose moral rightness he had grave doubts, and it's too
bad, in a way. It was inevitable but too bad that we tackled the
regulation question in the absence of any kind of — maybe
we should just call it to begin with "oversight monitoring,"
which we don't even have other than on safety and efficacy criteria.
It's too bad that we tried to do that around the series of
innovations and technologies where the embryo stood in the center
of the road. And the embryo is really like Solomon's baby,
we're not going to split the difference on that one. Could
you do something to think about regulation with the off-label uses
of drugs? Much harder because those uses are decentralized. You
don't have any — it's much less visible and much harder
to get ahold of. If one were really interested not in the particular
area that had some kind of oversight and regulation, but the principle
that governance here means not periodically trying to ban something,
but to try to separate the better and worse uses of these innovations
and that it ought to be done by public means and not by accident,
then it seems to me the real task, recognizing the political difficulty
until there might be such a biotechnical Chernobyl, would be to
try to find some area where one could think about this without having
such a hugely divided view as to what the — what the morally
right thing is.
And I have to confess I haven't really thought this through
at the bottom, but it's not obvious to me. It was partly an
accident of what we started on and of the cloning report that we
turn to this intersection of genetic knowledge, reproductive technologies
and embryo research as the area to try to do this, but it became
very clear after a couple of meetings that at least in this body
and this body being somewhat representative of the larger community,
that intractable question was going to at least for the time being
stand in the way of getting some kind of an agreement.
So it is a disappointment of mine. It's a disappointment that
comes also with recognizing the reasons why we have this in addition
to the American hostility to regulation, the fact that the scientists
and the biotech people don't want government mucking about at
all, but I do think that it's worth all of our attention to
see if we could find some other area appropriate to things that
we're doing where it might be more — where we might be
more successful in suggesting some kind of oversight and monitoring
body and, perhaps, even some regulation. Gil?
PROF. MEILAENDER: One thing I want to note, this is not
the main point I wanted to make but in relation to Diana's comment
is, I had several times suggested that we should meet in other cities.
It's logistically sort of difficult and I think that was one
of the discouraging factors, but I thought it would be interesting
to do that.
But the main thing I want to say may seem perverse to Frank, for
instance, maybe even to our distinguished Chairman, but for me,
the — and I'm even willing to grant, I guess, before I
say it, that this may be to some degree a matter of temperament,
I guess, though it is in some ways also for me, anyway, a matter,
you know, having taught for 30 years, the day before I left for
here, I got an e-mail from a student I taught has to be 20 maybe
25 years ago, I had to pull out my file of old grade sheets to figure
out who she was, but who had read some stuff of mine and was helped
by it recently and wrote me.
If you do — if you teach this kind of stuff, your clientele
comes and goes and if you'll pardon the theological formulation,
you have to live by faith and not by sight. It doesn't pay
too often to ask whether you're accomplishing anything. You
just sort of have to do it and hope that somebody out there is benefiting
from it. And maybe over the decades this has had an effect on me,
but I very seldom ask what I'm accomplishing. I don't like
to ask that question. I prefer just to kind of let it go and see
what happens. And for me the most satisfying moments have been
when we haven't worried about whether we're going actually
to accomplish something in a policy sort of sense but have simply
tried to sort through a question and say something about it.
Now, it may be true, Leon quotes Charles. It may be true that
that falls into a black hole. I don't know about that but on
the other hand, in the moments when we have attempted to shape policy,
no one could claim we've been extraordinarily successful in
doing so. So I think that actually the best work we've done
has been in our attempts just to sort through hard issues and not
worry too much about the implications. The moments when we've
tried to come down to a point have several times been excruciating
but also, I don't know that they've gotten us very far.
So I don't think it's a bad thing that this should be, as
Robby said, a very diverse body, that we should not necessarily
be able to come to a point that it should be somebody else's
responsibility to try to accomplish something, and that we should
just think and talk and argue about questions. That doesn't
seem to me to be bad and I understand that it may seem perverse.
The one additional thing that I'd add is that — and this
is the place where I do have a little different tact from our Chairman's.
See, I don't think of the — what I grant are the unresolvable
life questions or whatever you want to call them, as sort of getting
in the way of making progress on other things. I just think they're
basic. You know, if you're going to talk about bioethics, sooner
or later you're going to talk about whose good counts among
us and if the price of recognizing that those questions are basic
is to be a little — to accomplish a little less, that's
okay with me, you know. I — that's sort of the story
of life as far as I'm concerned.
So I wouldn't want to — I wouldn't want to, as it
were, bracket those basic questions just in order to try to get
somewhere because I think usually you don't know where you're
getting actually and you only find out 30 years later anyway and
it's therefore, a bad idea to make that your chief priority
and I think we — a lot of times we haven't and that's
good and those are the best times as far as I'm concerned.
CHAIRMAN KASS: Alfonso.
DR. GÓMEZ-LOBO: In many ways, I feel in a similar
manner as Gil does. Accomplishments are something to be taken into
account but not too seriously. But, however, I would like to, perhaps
rehearse some of my differences with Frank on these matters. Even
if one is not out there to be successful, still I think the question
of regulation is important and I think that, of course, the political
community has to find regulations for the protection of some of
its most important values. I wouldn't doubt that for a second.
And my real problem with the British Human Fertility and Embryology
Authority is just how it works. That's where my main problems
are. First, I have a very, very poor opinion of the Warnock Report
itself. I was astonished when I first read it how shallow it is
philosophically. It puts forward a very simple utilitarian argument
then a moral sentiments argument and leaves it at that and then
comes down on the 14 days without further ado. I mean, it's
really astonishing how little reflection there is. For instance,
by comparison, and I'm afraid I'm patting ourselves on the
back again, our reports are much more careful in the — in
laying the foundations for whichever way the regulation may go.
It's just incredible that the British Parliament should have
taken that report as is, as basic, and passed the bill on those
But again, since we are dealing with such a fundamental value for
our society for the political community, value of life, I just don't
see how a committee of, I don't know how many members the British
committee had, but 20, 30 people, are making such important and
drastic decisions on their own authority. Now, there is guidance
and there's the possibility of guidance as Frank has reminded
us of the Canadian case, but if I could have my way, my preference
would be that there be regulation at a much more fundamental level
so that it would not be a small group of people that were making
— would be making these decisions.
And if we could move in that direction, that would be just wonderful
in the second stage, but again, it's not going to be possible
without a much deeper study and discussion of the grounding issues
here. Thank you.
CHAIRMAN KASS: Rebecca.
PROF. DRESSER: First I want to say, unsurprisingly, how
beautifully written this article is and I personally enjoyed very
much hearing that speech as well as reading your response finally,
sort of how you see our work, and it's a relief for you to speak
out and I appreciated that.
In terms of topics, I'll throw out a couple that we have talked
about previously. I'm not necessarily advocating on their behalf
but just to get some topics out. I think yesterday and previously
we have discussed trying to do something on the health care system.
What exactly that would be, how we could provide any wisdom given
our composition without health policy people and so forth, is —
those are questions but that's one possible topic.
The other we discussed in the past was commodification of the human
body and the role of the private sector. I think yesterday we heard
a lot about how the private sector is influencing the treatment
and the options for long-term care of older people. You have many
lobbyists promoting the cutting edge therapies and the drugs and
so forth. And those are the things that tend to get reimbursed
and supported. You don't have the lobbyists supporting plain
old personal human contact and social works kinds of things and
so those are not as available in the system.
So the role of the private sector is underlying most of the topics
we've considered and so maybe it would be interesting to do
a topic like commodification of the human body that would bring
it in a little bit more directly.
CHAIRMAN KASS: Thank you. And let me use Rebecca's
turn to possible topics to say that both questions are on the table
and we shouldn't let this session go by without really offering
eager thoughts and collectively trying to formulate some suggestions
of things that might go forward. Paul and then Mary Ann.
DR. McHUGH: Well, I wanted to follow up with what Rebecca
said but I also want to follow up on what Mary Ann also said and
was very persuasive about yesterday. I think there are two things
that I would like to see the Council move towards in relationship
to discussing matters of American life and ultimately following
the Krauthammer rule in telling people maybe what they ought to
do. We've spent time talking about the aged. Now I think is
the time to talk about children and the family.
It is at last becoming clear that the forms of families that have
been developed, especially divorce and the like, are very harmful
to children's psychological development and the casual way that
we approach that on regulatory and various other ways has been a
scandal to our country as is now clear to all psychiatrists who
care for the products of those families. But there are many other
things about the child's position and its vulnerability towards
— not simply towards its life, although that's at stake
too, but very much in relationship to its flowering and flourishing
as a human being and what constitutes the kind of structure that
if it can't be provided by the family, we should be talking
about how it could be provided and what kinds of things come natural
to a family and what kinds of things, therefore, have to be structured
In this sense, I'm reminded again, as a psychiatrist, is what
happened when we did the deinstitutionalization of the mentally
ill. For awhile, we simply turned them from the back wards into
the back alley of our cities until coherent community psychiatry
people like the leader at Hopkins, William Breakey, began to talk
about how we needed to reconstruct in the community the kinds of
resources that were easily available in the institutions —
the occupational therapy, the vocational therapy, the various kinds
of services that were previously available and did great good for
those people in the message of a less confined life for them. So
that's one issue that I think is right before us and might well,
as I say, for the child development policies that even the discussion
of them and even the considerations of the data that are now available
would be extremely helpful to developing policies.
The next thing related to the new director is a point that we've
made several times before, that this is a Council on bioethics and
maybe the time has come at some point to talk about whether the
bioethics move has met its promise. Some — the claim was
that with the new technologies and the new availabilities, that
we really needed people who had fought seriously about these matters
in order to help us doctors to deal with the issues in the front.
Well, that continues to be a — what we're seeing a lot,
yesterday, and empirical question at least and very much a question
that I struggle with and I hope our Council would.
Our coming Chairman has done wonderful work in my opinion in discussing
these matters and challenging what sometimes becomes the lingo of
bioethics, these autonomy words, beneficence words and talk to us
more coherently about the sort of virtues that spring up from a
flowering opportunity to care for people and the appeal that people
have to you when they come asking you for your expertise. So at
some point, I would like to hear the various champions of bioethics
come and tell me and us and therefore, the American people, that
they've advanced us from what were the ethical principles that
were taught to me in the '50s before bioethics was even heard of.
CHAIRMAN KASS: Mary Ann.
PROF. GLENDON: Well, Dan, I don't know exactly where
the deltoid is, but I'm sure wherever mine is, it needs some
exercise. I do want to amplify a little bit the theme that Robby
sounded about the diversity of this Council. Robby mentioned the
diversity of viewpoint but there are other kinds of diversity that
have posed a real challenge for us and I think one of the great
achievements of this Council has been to overcome them.
How difficult it has been for people to communicate across disciplinary
boundaries. That's something, I think, one tends to take for
granted that you can put a group of scientists and humanists around
a table and since we're all English speakers, we will be able
to get on with the business. I would say it took us even a year
or two to move across the boundaries, some of us with great enthusiasm.
I felt about the four years on this Council it's like going
to graduate school again. It's been wonderful. It's been
a great education. And there's another kind of diversity that
is equally challenging and that's the one that comes out in
the exchange between Gil and Frank. Some of us are more practice-oriented.
We're looking for concrete recommendations for conclusions,
solutions and some of us say, "Oh, oh, be careful. You don't
want to rush to the recommendations and conclusions unless you're
sure you have really understood these very complex problems".
And I think the way we have dealt with that — and our current
report on aging is a beautiful example of how we have kept that
tension alive, that theory and practice are, indeed, the two blades
of the scissors and you cannot make a pleasing construction without
using both of them. And it's always going to be a tension,
but it's one that I would hope the Council will keep alive,
that we can't really go off in one direction or another.
And finally, Paul has said it already, better than I could but
I would urge the Council in the future to try to adopt a capacious
understanding of bioethics along the lines that Rebecca has often
recommended and in the case of attention to the problems of demographic
change in our society, keeping in mind that children as well as
the elderly, are at risk of being marginalized and that questions
about priorities and research and allocation of resources in our
country are questions that have a strong ethical dimension.
CHAIRMAN KASS: Peter.
PROF. LAWLER: Let me just comment on some of the ideas put
forward. First, I want to agree with Alfonso and Gil that we professors
of abstract subjects really can't think in terms of accomplishments
very well. By coincidence, one of our new faculty members asked
me, you know, a relatively old professor, "How do you know
you have accomplished anything"? And then my dean asked me,
"How can you assess what you've accomplished"? And
these things make me feel guilty for the rest of the day but then
occasionally, there will be a moment like Gil had where you know,
well, maybe I have accomplished something. In terms of taking on
the profession of bioethics, in my opinion, all our reports take
on the profession of bioethics.
The question would be, should we continue our indirect assault
or go to a direct assault? A direct assault might result in many
casualties and I've been very relieved in attending these sessions
of this Council that we've never had a card-carrying professor
of bioethics testify. And —
CHAIRMAN KASS: That's really not true. It's repeated
but it's just not true and allow me to correct that.
PROF. LAWLER: Okay, well, it depends what you mean by card-carrying.
I don't think Mr. Caplan has testified. But I'm saying
the autonomy model of bioethics is taken on so forcefully and beautifully
in the report that just came out that I don't need — I
don't think we need to name names and go after people in particular.
We'll just continue what we're doing, thematically without
showing that the dominant academic approach to this is rather bankrupt.
We can show that by example without saying that straight out. I
could be wrong on this.
PAUL MCHUGH: Psychiatrists mainly.
PROF. LAWLER: And many other members disagree with me on
that, but the — and I think we're on the cutting edge
of this and they are the ones who are washed up actually is my true
opinion. An issue that —
CHAIRMAN KASS: You're now going to come to the provocative
PROF. LAWLER: No, I could say more, but I mean, we need
to be constructive now. The two issues that were brought up yesterday
that caused me to despair part of the evening. One was reform of
the health care system. Our report says that should be directed
to the new Commission and I think with good reason. We don't
have the technological expertise and yesterday we heard that these
days, which seem like critical days, will be the good old days in
the future. Everyone is dissatisfied with the present system.
No one knows what to do. Maybe this is not our task. Maybe this
requires more technical expertise than we have.
In terms of the demographic changes, the importance of those is
presupposed in the existing report, the report that's going
to come out at the end of the month, but certainly more study there
and what's the world going to be like with many fewer children,
I would be in favor of that. But the issue yesterday that was brought
up as a platitude many times is we have to value caregiving more
as kind of a content imperative. We have to value caregiving more
but no one explained how we would actually do that because caregiving,
like everything else, has been commodified.
It's a sustenance kind of thing. How do we value caregiving
more? So I would actually like to see us study that as a separate
issue. You can't just say you have to give these people more
value, you have to have some plan for giving people more value in
an individualistic autonomous world where people who just care are
devalued more and more. And so in general, the general issue of
commodification seems to me to be huge. And so maybe we ought to
focus on one particular area where commodification is a problem.
And I might think that area might be the valuing of caregiving.
CHAIRMAN KASS: Thank you. Diana.
PROF. SCHAUB: Yeah, I just wanted to make a quick response
to that anti-accomplishment crowd. That was a beautiful phrase,
Gil, about living by faith and not by sight, and I'm —
PROF. MEILAENDER: It wasn't original.
PROF. SCHAUB: No, no. You brought it forward in a lovely
way. And I'm certainly in agreement we don't want to, you
know, send out surveys to see how we're doing and we don't
want to come up with assessment mechanisms or anything like that.
We want to do what we do and give ourselves up to our inquiries
in some sense for their own sake. We're all, you know, scholars,
and we trust that there will be those who will read and be effected
by our scholarship.
So I have great sympathy with that, but I would just point out,
Gil, that you're — and Peter also, that you are teachers
as well as scholars and the reason that your student read you writings
was because you were her teacher first. And so my opening suggestion
was really that the Council think of itself as having a teaching
mission as well as a scholarly mission and to give some thought
to what that would mean to have a teaching mission.
And let me just add that my notion of teaching is not lecturing
the public or being dogmatic in some way, but engaging the public
in the same conversations that we've been having or certain
portions of the public that we think need to — you know, would
benefit from these conversations and to think about ways to find
the ways to do that. And this would be regardless of, you know,
what topic we take up in the future.
PROF. LAWLER: Alfonso.
DR. GÓMEZ-LOBO: On the topic of future themes that
we may study, I happen to — after thinking about it a little
bit, I think I side with Peter in the sense that I'm not sure
it would be wise to have bioethics, per se, as a topic of discussion
of the Council. The reason is this; I'm very skeptical about
the field of bioethics, per se. I think that the real battles are
fought not at the bioethics level but at the ethics level and the
deep disagreements on philosophical outlook that undergird particular
bioethics positions, those are very hard to reconcile, and it would
get us into an endless seminar of philosophy here. And I'm
not sure it would be wise to do that.
I think that we should do our little portion of ethics/bioethics
and put forward our arguments and, of course, if there are antagonistic
positions in the public, they are going to be discussed. On the
other hand, I happen to think that the topic of children is exceedingly
important. I agree with Mary Ann and those who have spoken about
that, because there is tendency to instrumentalization in present
day culture. I mean, technology drives us to see most things as
instruments and sometimes I get a sense that even children are viewed
as instruments, instruments for one's happiness, instruments for
one's prosperity or on the other hand, as obstacles, as instruments
that do not yield their fruits.
And that's why I think it is a very important and deep bioethical
or ethical question and I sort of suspect that if we start studying
it, we're going in for certain surprises. If we — you
know, if we bring in people who have thought about the field, who
have had the experience, and deliberating about that seems to me
a very important task.
CHAIRMAN KASS: Gil.
PROF. MEILAENDER: I didn't mean to launch us on a discussion
of teaching philosophy. That was not my intention, though I'd
be happy, Diana, sometime to take those questions up with you.
I hate to see you siding with those who want assessment plans or
PROF. MEILAENDER: But I wouldn't want to see us take
up bioethics as a topic, not because I don't think there's
a lot of important stuff there. I don't carry any animus against
the field and I don't think we do as a body because I think
it would focus us really solely on certain kinds of questions of
method and that, to me, doesn't seem to be what we're most
suited to do or even could do best. There are two places, one of
them — I'm just going to second what's already been
One hasn't been mentioned that I think that we could —
that are important and that we could profitably do work. One of
them I've mentioned before and we've always shied away from
it and we probably shied away from it for very sound reasons, and
it would — if we think we've found ourselves in impenetrable
thickets on previous occasions it might be even worse, but the whole
range of issues surrounding organ donation and transplantation are
really very much on the table these days and are very hard to sort
through, that kind of working definition, the criterion of when
you know someone's dead is under pressure from several different
directions. If you're interested in the commodification issue,
the sale of organs or various sort of forms of transaction that
perhaps fall a little short of sale, are also there.
So — and even questions just about whether it's always
worth it, whether a certain kind of desperation enters in. Those
would all be important questions to ask, though we might find ourselves
with more people angry at us than we've already created around
the country. So — but I do think it's an important issue.
The other one, I think that the children business is important.
I just wanted to add a couple things to the way it's been mentioned.
I mean, in a way it would be nice, if we looked at end-of-life aging,
if we looked at children that would be nice. I think there would
be a whole range of questions that haven't been mentioned.
I mean, just to think about how one ought to think about children.
We sometimes may think of them simply as kind of miniature adults
and that's not necessarily the right way to think about them.
In the bioethics literature, they're often just another vulnerable
population, along with various — you know, whether that captures
everything that one ought to say about them. The use of children
in research is still and will continue to be an important question
but not just in scientific research, use of children in advertising.
I mean, there are all sorts of questions one might raise. Whether
we have special responsibilities to children with disabilities.
So there'd be a range of questions one could take up.
Now, you know, whether they'd all fit together into some single
project, I'm not sure I could say right now, but it's a
very rich topic with a lot of different angles that could certainly
profitably be pursued.
CHAIRMAN KASS: Dan Foster.
DR. FOSTER: I just want to say a brief word in agreement
with Frank's initial comments. You may remember that in the
cloning report that the minority group on which I sat, was in favor
— voted, was in favor or research cloning and — but
it was coupled with the provision that proper regulation be attached.
That was part of the official position that we took under those
circumstances, recognizing that there would be certain biological
and other dangers associated with these techniques that were worrisome
and they should not be carried out freelance. And so, as a consequence,
it's almost necessary for the views of these new techniques
that there be some sort of regulation. We made an attempt to —
you know, we'd say, "Well, Congress or whoever shouldn't
allow you to make, you know, a human embryo with a goat", or
something like that. You know, there were broad regulations and
one thing that we might at least say right now, the probability
is that the regulation of these events is going to be vested in
the FDA and that may be a wise decision or it may be an unwise decision
and it wouldn't be inappropriate, I think, for this group to
at least give an accent to what type of regulation might be used,
what sort of body might be used even if not giving all the details
about how this would go.
I think that this — the reason that I think this is increasingly
important is that things are speeding rapidly in terms of stem cell
research. We came up with a White Paper about ways to avoid the
embryo question. I think that's going to happen real fast.
The embryo question is going to disappear and not by the techniques
that we talked about, maybe with a variant of Type 4.
As it turns out, Dick was at the London conference and I have not
yet seen the patent, but if it is possible to, in fact, make what
has been called the stem-bred, which is a remarkable technique,
the details because if there's a patent there or not, but what
Yuri Verlinsky in Chicago did was to take a stem cell line, I think
I mentioned this before, it's probably one he made himself rather
than an NIH stem cell line, and merged it, it was basically a cloning
experience, with a somatic cell. And what he was — and it
was a — it was a female cell line and the cell line that he
developed was an XY because it was taken from a man.
And so he established — he's established 10 cell lines,
at least he's reported, from diseased humans, which is what
we want, that's why you want research — the problem with
the lines we have, they're all from healthy, in vitro fertilization
things. They're not useful in terms of trying to deal with
disease. If that's the case, if that turns out to be the case,
that you can completely avoid the embryo question just by using
stem cell lines that are already there as the recipient and establish
an immortalized line from Parkinsonism and so forth, then we've
immediately got to consider the possibility of injecting these things
into humans and things of that sort.
Now, the other — the hybrid model that was just put out,
you know, which, you know, you made a heterokaryon, in other words,
it was a merging of a somatic cell and a stem cell, and you got
a dual nucleus cell to start off with and it differentiated the
somatic cell, so it was like a stem cell — the problem with
that is you've got to get rid of half of the chromosomes and
so forth, and that's going to take a lot longer, but my point
I'm trying to make is, that I think the embryo question —
I might be wrong, but I think the embryo question is going to disappear
because we're going to be able to make these stem cells without
having — every having an embryo. I mean, that was what Bill
Hurlbut wanted to do in his model, but once that happens, we've
got to have some sort of regulation.
You know, in the initial DNA things, you know, we've talked
about this before, the scientists thought that the RAC committee
— we had to decide who was going to get to do and what was
going to be approved, you know, the common thing. So my sort of
long comment here is that I believe it would be very important to
do what Frank has said, maybe in a broad sense to say, well, there
are several models by which one could do this: a scientific model,
a regulatory model of the Canadian or UK type, I'm not —
I don't care about that, or some modification of the FDA, but
somebody is going to have to say what we're going to do.
We're not going to do anything with these lines that we have
— that NIH has. They're worthless because they're
drone. I mean, use them for science, but not for therapy because
they're all grown on mice cells, you know. You got all these
viruses and things. Now, the Koreans, Hwang has now made cell
lines. He's got 11 that were not grown on animal tissues and
so that's also going to push things. So I think the need for
regulation is pretty — is much closer than what we say and
the question is well, should we comment on it or just leave it to
the other people? You could argue either way.
I would prefer for us at least at some point in the next term,
to have a suggestion about how this near imminent possibility of
using stem cells and so forth in therapy is going to be controlled.
So I want to speak in terms of at least having us think about that.
I just want to make one other — two other real quick passing
responses about whether anybody is going to read what has come out
of these volumes. Very few people will do that, that's true.
I mean, in medicine or science, I mean, there's a huge amount
of information and you always long for the people who are practicing
to have read the most important new things and oftentimes they don't
have time and they don't do that. And I think that we could
— I think that we could say that these reports — and
I'm not — let me back off.
At the Lasker Award, Joseph Goldstein, who was the Chairman this
last Lasker Award, he had a very interesting analogy and there was
a — I don't think I've ever mentioned this, there
was an — there was a monument on top of one of the museums
which was made out of stones — did I ever — well, the
bottom stone weighed two and a half tons and the top one —
so it was a pyramid. And up at the top was a two-pound stone.
Now, Goldstein's point was that there were 550,000 papers published
in the medical literature last year, 550,000 in the 4,000 journals
at the National Library of Medicine archives, okay?
And his point was that the mass of information that came out of
there was worthless. That there were only — there was a 2.5
pound set of papers that was importantly new and not trivially new
and I think that you just can't worry about that. I think that
in one sense that we probably were in — I mean, what has happened
here was really importantly new material that was covered and not
everybody is going to read it but that's okay. I mean, it will
still have some influence I think.
And I'm not so worried about — I don't think you
can go on television — look 47 percent of Americans believe
that all the species that exist today, existed exactly like they
are today from the beginning of time. Okay, 47 percent of Americans
believe that, so robins haven't changed at all. They've
always been exactly — you're not going to be able to deal
with that in terms of what we're doing.
The last thing I want to say is that the incentives about a lot
of things like health care are so — it's going to be hard
to overcome for the commodifications of — I would myself love
to talk about transplantation again. I said that before, but I
heard the head of Humana speaking to the Chairs of Medicine one
time and he said, and he had an impassioned speech by Tom Andreoli,
who was then the Chairman of the University of Medicine Arkansas
and he berated him as the head of a big company — You could
say the same thing for a big pharma, about their lack of interest
in terms of human things and medicine and so forth.
And the CEO said, "You know, it may well be that I would like
to give a million dollars from Humana to support the Chairs of Medicine",
or whatever he said, "but money is fungible and my first responsibility
is to the stockholders. I can be a cancer like Enron but my job
and for all the stockholders is to make money for them and I might
personally think that it was good for me to cut the prices of all
the drugs such that you could do that, but then money will flee
from Humana or from big pharma to another company and we're
out of business. So the incentives to do what we would like to
do are very heavy in the very heart of what the capitalistic system
is about. So we shouldn't be — we shouldn't be sanguine
about the fact that we can change that to make the health care system
more — that has to come from the Government or something of
So those are just casual comments, but the main thing is I hope
that whoever is on this Council before would look into the issue
of at least a broad overview of regulization. I truly think we're
going to need that.
CHAIRMAN KASS: Thank you. By the way, let me suggest that
we not have — despite the — I didn't mean it as
an invitation. No one should take this as an invitation to have
an argument about stem cell research, if that's all right.
DR. FOSTER: No, I don't think you understood me. I
said I think the arguments about stem cell research are going to
be over because I don't think we're going to have embryo
arguments and I know I've talked too long —
CHAIRMAN KASS: But lest someone rise to correct you on that
— I see the hands of some people who might want to do that,
and I wanted to tell them, don't.
PROF. GEORGE: I promise I won't.
CHAIRMAN KASS: Robby, take the floor. Turn your mike on.
PROF. GEORGE: This is not an argument about stem cell research.
I do want to comment on the first half of Dan's remarks but
only again by saying that I agree with a very, very large measure
of what Dan has said, including the call for us, and I think we
are the body to do it, to think about regulatory — at least
the procedural issues, the regulatory structures that really should
be in place in view of what we know is coming. Now, without arguing
with Dan about the embryonic stem cell issue, I do want to register
this; that of course I share Dan's enthusiasm for what Yuri
Verlinsky has evidently accomplished, what Kevin Eggan has done
at Harvard, Trounsen is doing similar things evidently in Australia
and as you know, I've been an enthusiast and a cheerleader for
Bill Hurlbut all the way along because I think his proposal is so
important and my hope, like yours, Dan, is that we will be able
to lay aside the embryo question because we've found a way around
it, a way to obtain pluripotent stem cells without embryo destruction.
But I want to say why I fear the issue won't go away and just
very briefly, it's this. I think that the next issue on the
embryo front is not going to be blastocyst stage stem cells, but
rather the gestation in either an artificial environment or the
female volunteer of the embryos for some degree of development after
which they would be destroyed and harvested. I think this issue
is coming at us. I've got an article coming out about this
in the Weekly Standard in the next issue but more important
and better than my article and I would commend to everybody on the
Council to read it, or read them, these are very much worth reading.
Will Saletan has a series, a multi-part series in Slate Magazine
online about this question. So as much as we would all like to
put the embryo question behind us and as hopeful as we are that
Verlinsky and Eggan and the others, Bill Hurlbut will help us to
get over the debate about blastocyst-stage stem cells, I just fear,
Dan, that it's going to be with us.
That doesn't detract in any way from the conclusion that you
rightly draw about the need for regulation one way or another, but
I just want to register ahat I know is a very uncomfortable point
because I, as much as all the rest of the members of the Council,
including our distinguished Chairman, would like not to have to
argue about this all the time.
CHAIRMAN KASS: Ben has been waiting.
PROF. CARSON: Actually, a completely different topic.
CHAIRMAN KASS: Good.
PROF. CARSON: You know, I alluded yesterday to the concept
of wellness and I want to just elaborate a little bit on that because,
you know, when we're looking at many of these bioethical issues,
we're looking at technological advances and how they can be
applied, you know, perhaps to eliminating cancer or how we can get
to a medication that might get rid of some of the amyloid bodies
and perhaps deal with Alzheimer's, but I would hope that at some
point we could concentrate on root causes of things because I think,
for instance, the environment is a huge bioethical issue. When
we look at the way our environment is being constantly polluted
by petroleum products and things.
And you look at the amount of money, for instance, that has been
spent over the last couple of decades by the NCI to get control
of cancer and yet, the rates of cancer are actually increasing.
Why is that? And I personally believe that there are some major
environmental issues and I know there are many others who believe
that as well. I wonder if we could have some of the experts in
those areas come and talk to us and begin to maybe formulate some
policies about that, because if we can put some science behind it,
we might be able to get some real public policy done there.
If you look at things like the dramatic increase in the number
of children diagnosed with attention deficit disorder, you know,
why is that? You know, there have been, you know, a number of proposals,
one of which is that it seems to be much more prevalent in this
country than in countries where they don't vaccinate children.
Shouldn't we be looking into some of these issues in terms of
some of the things that are placed in these vaccinations? I think
that that's a very good charge for a bioethics council.
CHAIRMAN KASS: Thank you very much. Bill and then Frank.
DR. HURLBUT: I don't want to reintroduce the embryo
CHAIRMAN KASS: I won't let you.
DR. HURLBUT: But I do want to say this, that in the deliberations
that were just referred to, we tried to shift the question off the
difficult dilemma of when in the progress of development, the developing
human embryo has more value to the question of what, and I think
there's no way for us to escape this crucial question of what
is the minimal construction that is worthy of human dignity and
I — for one thing, I agree with Dan about the issue of the
embryo but in a strangely different way. It's not clear —
it's becoming increasingly clear that it's not clear what
an embryonic stem cell is, what stage of development they would
optimally be taken from. Now it's turned out that via mice
there is successful harvesting of embryonic stem cells from the
eight-cell stage. Each stage may have a different property. I
don't think this is just going to be solved by creating stem-breds.
I think we've sequenced the human genome, are understanding
the proteins it produces and now we are entering the age of developmental
biology. From here on out, it's about living organisms and
the human living organism. This means that we can't run away
from the issue because as the body charged to deal with the ethical
issues of our age, this is the ethical issue of our age.
Now, we don't have to have endless arguments about when an
embryo develops moral standing because we have trouble resolving
that, but we are going to have to face the issue of at least what
is the minimal construction that constitutes a moral entity. Even
reprogramming poses that problem to us. When I put forward altered
nuclear transfer, some professors from Harvard made the comment
that you can't define human life on the basis of the absence
of one molecule. Well, I don't agree with them for one thing
because that may be the optimal way to do reprogramming, to bring
the cell back down to within one molecular type of its human constitution,
but the point — the larger point is, we are going to with
stem cells, create human parts, apart from the whole of the body.
We're going to have to start defining what is the minimal construction.
Is a brain with one sensory modality worthy of protection? I mean,
that's a science fiction scenario, but we need to start understanding.
If we're going to grow human parts apart from their place in
the living whole, we need to come to terms with the commodification
questions that are involved in growing whole organs, maybe even
organ systems in factories or such settings. We need to face the
question that Robby posed, that embryogenesis requires complex micro-environments
for its — for the successful differentiation of cells, tissues
and organs and the question of whether there are possibilities for
growing systems that are actually evolving in terms of development
that are still ethical because they don't constitute organismal
I just don't see how we can avoid this. We have to face the
questions of human-animal chimerizations, the complex questions
that may be summed up with the term the boundaries of humanity.
So I would urge us not to flee from that which is running toward
us. There's a saying in Russia, "When the dog runs at
you, whistle." I think this — just to carry this one
step further, I think it means that we need to develop effective
tools for collaboration with the scientific community in order to
help foster and encourage and even help the public come to accept
some of the less easily intuitive positive possibilities of scientific
advance and so I'd like to see a way to work in really positive
ways with the scientific community and also agree that that will
mean that we have to find ways to cooperate in the establishment
of some regulations.
And just to add a couple more points of further projects that hinge
off of this, I've been doing quite a bit of international travel
in the last couple of years and specifically, I was in Asia this
summer. And I think we have to face into the very profound significance
of the global community on these ethical issues. Part of our mandate
originally was to — I can't remember the exact quote but,
"Develop cooperative collaborations on an international level",
and I don't think we've effectively done that, although
we've had some testimony from other countries. I'm frankly,
worried about the significance of a world where arguments are made,
"We have to do it here because they're doing it there."
That seems to me not a good argument, but more importantly, there's
the omnipresent danger of the — what you might call the outsourcing
of unethical practices, if we can't do it here, we'll get
it done over there.
Now, obviously, we can't even figure out a way to regulate
our own country, we're not going to regulate the world, but
I think we need to start working in some measure of initial thoughtfulness
as to how we can establish cooperative international collaborations.
And I think, just to hinge on what Ben said, we are increasingly
coming to understand, those of us with scientific training, how
subtle and fragile biological systems actually are and how little
tiny things like any one of the 80,000 industrial chemicals in our
environment, artificial chemicals, might be altering something of
crucial human significance.
I'm not saying it's associated with vaccinations or with
the — you know, the artificial chemical in your couch or something
but some — for some reason there's an increase in autism.
We have to face these questions. There's this weird issue of
phthalates. What are they doing to the next generation's fertility?
And that would be a good public education thing.
CHAIRMAN KASS: Do you want to conclude?
DR. HURLBUT: What?
CHAIRMAN KASS: Do you want to conclude?
CHAIRMAN KASS: Pardon me?
CHAIRMAN KASS: Would you —
DR. HURLBUT: Wrap it up.
CHAIRMAN KASS: — move to the end.
DR. HURLBUT: Yeah. The other thing is I really think we
need to face into the — on an international level, the fundamental
danger of biotechnology tapping into our most primary desires because
I think what's happening to us as a society is we're using
biotechnology to short-circuit that which we've always wanted
to have in terms of media pleasures, sense of personal ideals of
appearance and performance and so forth.
That creates a very significant situation with the danger of desire
magnifying our powers to get what we want, putting a preoccupation
in our minds of what naturally is a positive desire but unrestrained
with biotechnology becomes a preoccupation or vanity and even a
selfishness and with 30,000 kids dying on average every day in the
world, it seems to me that we could use biotechnology to become
— enhance our own vanity rather than increasing our goodness
in the world.
And in that sense, I think we could end up being a society of addicts
to short-term goals instead of the comprehensive good. And finally,
I'd like to say that I would hope in the next session we might
consider the possibility of maybe having a Volume 2 of our anthology
of literature because we really need to extend the positive resources
and the affirmation that these bioethical issues are profound issues
around which there's been a great deal of thought in human experience
and wisdom traditions.
CHAIRMAN KASS: We are roughly at the end of this session.
Let me — I want to introduce a comment that I received from
our colleague, Mike Gazzaniga, who couldn't make this meeting
on the issue of new topics. "I continue to believe that a
full examination of health practices in America would be a great
topic, the short version," and Mike likes the short version
although he's introduced this to us before. "Have Americans
been oversold on the need to see a doctor? Health benefits are
bankrupting the country and institutions. I see this as a problem
both from a practical and ethical perspective". And this ties
into the presentation that we had from John Wennberg at a previous
meeting on what are all these costly interventions actually getting
Since I haven't said anything, indulge me three suggestions
of things that I think might be put on the table, and if you don't
mind, maybe I will try — once I've read the transcript,
try to distill some of the positive suggestions of topics into a
kind of memorandum to be circulated to all of you for amendment
and addition and make this my gift to the new Chairman for his consideration
for our collective consideration. So I'll try to distill some
of this and you'll all have a chance to add and develop it.
But I think I would like to underscore the children's topic.
It was — we touched on it most especially in "Beyond
Therapy" on the uses of psychotropic drugs as well as questions
of choosing sex of children, questions both of a practical and theoretical
sort. How to get a handle on this, whether one should really talk
about the medication of children or the kinds of things that will
give rise to the increased incidences of these disorders in children,
God knows why. I think that would be a terribly important subject
dealing with children not only because they're vulnerable and
don't have advocates, but because they really are our future
and we owe it to ourselves to bring our best thinking and ethical
reflection to bear on this.
Second, this is only sort of tacitly mentioned really in Rebecca's
comment but it was very prominent in yesterday's first discussion,
I believe, where we were talking really about sort of the ethical
dimensions of the access question, not the political arguments,
not the economic arguments and not to put it — Peter observed
yesterday that this Council doesn't generally speak a lot in
terms of rights. We tend to speak in terms of good. And then the
question is what does a decent and a good community in fact owe
to those of its members who are unable, in fact, to provide for
themselves in a way in which they would like if only they could?
And I think the aging topic is only one piece of it. And one has
to find some kind of manageable way to do this, but to do this in
a serious way, not simply to become an advocacy group for a particular
point of view, but try to really sort out how to think about this
in a constructive way. That would be, I think, an important contribution.
This is the case that all third things today I'm not going
to remember. One was the children, one was this — oh, yes,
the third thing has to do with what we'll talk about after the
break. Government regulation is one thing that we have considered,
but regulatio, as the report we issued makes perfectly clear, if
you understand regulation broadly to include things like tort laws,
professional standards, et cetera, so many of the things we talk
about enter into the lives of ourselves and our fellow citizens
really through the good offices of the medical profession. And
some reflection on the character of the profession, the medical
calling and its own professional self-regulation, a topic, I know,
very dear to Ed Pellegrino's heart, but one which we've
touched on tangentially but have never really taken up, especially
in its new context, an age no longer of lore, not to speak of Hippocrates,
but where you've got all of these commercial interests and the
changing practice, do we have something useful to say about how
to shore up, to articulate the medical vocation today in its current
circumstances and to offer something useful on that subject I think
might be another large thing that cuts across the small topics but
one on which under the new leadership, I think we would be very
well poised to say something.
Unless somebody has an epiphany or — it needn't be an
epiphany. Frank, you had your hand up before. Please, take the
last comment and then we'll break.
PROF. FUKUYAMA: Well, this is a suggestion for a new topic.
I think there ought to be some investigation of non-Western ethical
systems and what they imply for the future of biomedicine. There
was a KBS team in here that interviewed, I think, Rebecca and me
from Korea and they had this question, "Well, what do you think
of Dr. Hwang and don't you think that your high ethical standards
are holding you back, you Americans, while we Koreans race forward"?
It is — and I think that we ought to — it ought to
be looked at not as, you know, let's see Asia as a zone of unethical
practice but really from internal to those ethical systems, what
implications does it have for the way biomedicine is going to develop
in those countries? One thing — I mean, I can give a seminar
on ethics in Asia, but one thing for example is extremely clear,
the bright line that the Judeo-Christian tradition draws between
human and non-human that invests human beings with dignity simply
is not supported by any of the ethical systems in Asia.
Buddism, you know, Taoism and Shinto are polytheistic religions,
you know, so that everything is invested with spirituality in a
certain sense. Hinduism and Buddhism, you know, both have doctrines
of reincarnation where you can come back as an animal and it has
interesting effects because it gives — in those ethical systems
non-human creation has a higher moral status and so it's quite
interesting. The Japanese primatologists were the first to notice
that actually certain classes of macaques actually had culture that
could be transmitted. They're more open to this idea that non-human
creatures have, you know, a higher degree of dignity but this idea
that, you know, there's this moral status that switches on simply
because you're born a human being is really not supported by
any of those systems.
And I think you need to — and democracy in Asia is not going
to solve this question, you know. This is a problem in democratic
Japan, democratic South Korea. There's simply different, you
know, ways of looking at the world, and since so much of the science
is going to come out of that part of the world, I think that we
owe it to ourselves to educate ourselves a little bit about what
some of these alternative, you know, ways of looking at these issues
CHAIRMAN KASS: Thank you very much. Seventeen Council members
and 18 opinions. We'll try to sort out some of these comments
and give you a memo before you take the Chair.
We're adjourned. I don't want to steal too much time from
the discussion of the story, so please return promptly in 15 minutes.
I know some colleagues have to leave early.
(A brief recess was taken at 10:12 a.m.)