The Politics of Bioethics
From the May 10, 2004 issue: Playing defense isn't enough.
"NOTHING ILLUSTRATES this administration's anti-science attitude better than George Bush's cynical decision to limit research on embryonic stem cells," declared John Kerry in a December 2003 campaign speech. He was referring to the president's August 9, 2001, decision to permit federal funding for existing embryonic stem cell lines, where the embryos in question had already been destroyed, but to deny funding for research involving further embryo destruction.
Ever since President Bush announced his stem cell policy, research advocates have attacked it as "not enough." They want more funding for more lines, without restrictions. They want the freedom to produce embryonic stem cell lines indefinitely, using as many embryos as necessary to advance research on a long list of terrible diseases. The idea of limits--in this case, no taxpayer funding for new embryo destruction--strikes them as incomprehensible and indefensible. In this spirit, Kerry attacks the Bush administration's "recessive gene of pessimism about progress and people," and declares that when "faced with a basic decision on America's health, George Bush chose to go to the right wing instead of the right way." Kerry aims to portray the Democrats as the party of health and progress, the Republicans as the party of suffering, death, and religious zeal.
The question is: How will President Bush respond? No doubt he will defend his policy on federal funding. And no doubt he will argue that the eligible stem cell lines are "enough" to get the medical benefits we seek, and that the issue is fundamentally about "respecting human life," not using it as a means to even the noblest ends. But it is not clear that simply playing defense on this and other bioethics issues will succeed. Indeed, over 200 congressmen sent a letter to the president last week demanding that the current restrictions on federal funding of embryonic stem cell research be lifted. Furthermore, it is increasingly clear that limits on federal funding alone do not guarantee our successfully navigating the "vast ethical mine fields" that President Bush warned of in his stem cell speech. This means reexamining what we have learned in the bioethics fight since it began in earnest in 2001, and sketching what a realistic offense might look like in the months and years ahead.
Since the president announced his stem cell policy in August 2001, the science of the brave new world has continued apace--not just the destruction of human embryos on a growing scale, but the manipulation of human reproduction in radical new ways. In its latest report, Reproduction and Responsibility, the President's Council on Bioethics finds that the practice of assisted reproduction technology (ART) is largely unregulated. New baby-making technologies are introduced willy-nilly into clinical practice, with little research regarding their effects on the children produced with their aid. Because so many embryos are implanted all at once, nearly half the children born using ART are twins or triplets with disproportionately and often dangerously low birth weights. Some ART clinics already advertise cosmetic baby-making services--such as preimplantation genetic screening to choose the sex of one's child--and these services only promise to increase as our genetic knowledge expands. And it is the ART clinics and their patients that produce thousands of "excess" embryos each year--embryos that are frozen indefinitely or destroyed for research.
Meanwhile, in February 2004, South Korean scientists announced the creation of the first cloned human embryos to the blastocyst stage--the stage when they could be implanted in a woman's uterus to initiate a pregnancy or destroyed in the laboratory to harvest stem cells. The report in Science magazine sounds hauntingly like the "decanting room" in Aldous Huxley's Brave New World--systematic, precise, unrepentant about its use of women as egg factories and human embryos as raw materials. The South Koreans harvested 242 eggs from 16 women, tested 14 different cloning "protocols," developed 30 human embryos to the 100-cell stage, and destroyed them all to get a single stem cell line.
Just a few months earlier, researchers working with animals showed that it is possible to produce both eggs and sperm from embryonic stem cells, including eggs from male embryos and sperm from female embryos. This means that it might be possible, someday soon, to produce a human child with two male parents or two female parents--and even a human child whose mother, father, or both is a dead embryo. Still other researchers fused together male and female embryos to produce a genderless human hybrid. Chinese researchers have already produced chimeric clones using rabbit eggs and human DNA. And what now seems prosaic--the destruction of IVF embryos for their stem cells--is a growing practice, with a number of states (New Jersey, California) contemplating new public funding initiatives, and a number of universities (Harvard, Stanford) actively creating new embryo research institutes.
While this research has proceeded, the political debate on bioethics has stalled. President Bush's August 2001 decision established an important moral principle, but also left an ambiguous legacy. The moral principle is that society as a whole, using taxpayer money, will not endorse the destruction of human embryos for any purpose; and it will not create public incentives for embryo destruction in the future. Zealous critics have denounced the policy as the 21st-century equivalent of silencing Galileo--attacking the president directly for imposing his personal religious views on science, and often ignoring the fact that Congress, not the president, made the law that prohibits federal funding of embryo research. More sober critics have argued that because more stem cell lines have been produced since the president's decision, these new lines should also be eligible for funding. The "life and death decision," they argue, has once again already been made. But moving the date of eligibility would undermine the moral logic of the Bush policy. It would send the message that the date will keep moving, and that embryo destruction today will be publicly funded tomorrow.
But the Bush decision, while principled, is also a partial decision: It offers no practical proposal for limiting embryo research in the private sector, though it probably discourages some scientists from engaging in research that cannot get NIH funding. It does not confront the question of what to do about excess embryo creation in in vitro fertilization (IVF) clinics during fertility treatment, or what to do about the roughly 400,000 embryos now frozen "in storage." (Only 3 percent of these frozen embryos, by the way, have been made available by their parents for research purposes.) Finally, the Bush decision gives the nation a stake in the success of embryonic stem cell research as a whole, and probably benefits (indirectly) those who destroy embryos with private funds by advancing the field.
In the end, neither side in the embryo debate is happy with the current policy: Embryo research opponents lament the ongoing destruction of embryos in the private sector; embryo research advocates resent the limits on funding. But both sides also fear that things could get worse than they are now--that is, funding limits could loosen (the conservative worry) or legal restrictions could tighten (the liberal worry). The difference, however, is that research supporters are on the offensive--lobbying Congress and the president to make the funding policy more liberal, and aggressively seeking funding in individual states. Embryo research opponents, by contrast, are on the defensive: trying to preserve the Bush policy, with little hope or expectation of banning embryo research in the private sector.
In the one area where conservatives have tried to set broader limits on biotechnology--human cloning--the political fight remains stalled. Since 2001, the cloning debate has been a battle between two competing bills: the Brownback bill and the Hatch-Feinstein bill. The Brownback bill would ban all human cloning, including the creation and destruction of cloned embryos for research. The Hatch-Feinstein bill would endorse the creation and use of cloned embryos for research, then mandate the destruction of all cloned embryos to prevent the production of cloned children. The Brownback bill is the best way to stop the creation of cloned children, by stopping this act at the very first step. And it would set an important precedent that we should not "create human life solely for research and destruction." The Hatch-Feinstein bill, by contrast, makes the American public an accomplice in this troubling practice, and it creates for the first time a class of human life--cloned embryos--that must by law be destroyed.
The case for the Brownback bill is as clear today as it has been for the last three years. But while the Brownback bill has passed in the House of Representatives twice, passage in the Senate is blocked. In the meantime, there remain no ethical limits on biotechnology of any kind: no limits on radical new ways of making babies (cloning and beyond) and no limits on the creation and destruction of human embryos or later-stage fetuses for research, so long as it is done with private money. We are left fighting for limits that may never come, and playing defense for a policy that only deals with one small piece of the brave new world problem. Perhaps it is time to be both more realistic and more ambitious--more realistic about what is possible now, and more ambitious in seeking limits that go beyond the issue of cloning and beyond restrictions on federal funding for embryonic stem cell research.
FOR THOSE WHO WORRY about where reproductive biotechnology is taking us, there are three fundamental concerns: the destruction of innocent life, the degradation of the family, and the threat of eugenics. Each one requires some elaboration.
The first concern is that in the desire to save human life and promote scientific progress, we will become callous towards life, using the weakest among us as tools to keep the stronger alive. This concern overlaps--both politically and morally--with the abortion issue. Both involve questions about the violability or inviolability of nascent human life, and what we are willing to endure or forgo to respect it. But embryo research is at once more defensible and more corrupting than abortion. It is more defensible because the goal is a humanitarian one (to ease suffering and cure disease rather than end a pregnancy), and because the early-stage embryos in question are so existentially puzzling. They are microscopic, developing, genetically complete human beginnings--not just any beginnings, but the beginnings of a particular human life. But they are created outside their natural environment in the human womb, and often left frozen for years in the IVF clinics where they are made. These embryos may be "one of us," but they don't seem like one of us. The moral transgression of embryo destruction, though real, is not so obvious, while the sick child or Parkinson's patient is obviously suffering.
For the very same reason, embryo research is potentially more corrupting than abortion. It is a fruit we seek, not a transgression we tolerate. It is a premeditated project, not a decision made in crisis. Only the most extreme pro-choice advocates see abortion as a "good" and abortionists as heroes. But embryo-based medicine, if it were possible, would quickly become "standard practice" for the entire society, with leading researchers winning Nobel Prizes and parents who reject it for their children seen as legally negligent. Once cures exist, we might quickly forget that there is a moral problem here at all. Late-stage abortion requires a greater willingness of mother and doctor to look away from the facts of what they are doing, because of the obvious humanity of the developed fetus. But embryo research, so closely tied to the modern medical project that we all esteem, could become a celebrated American way of life in a way that abortion has not.
The second concern about biotechnology involves the degradation of the family, and the possibility that new ways of making babies will undermine the relationship between parents and children. So far, we see this problem most clearly in our fears about human cloning. To clone a child is to wreak havoc on the ties that bind the generations; it is to make our twin brothers into sons and twin sisters into daughters. It is to impose our perverse self-love on innocent children. But cloning is only one part of a larger project to transform human procreation and the human family. This larger project aims to use our biological cleverness to make us into post-biological beings--to create a world where male and female no longer matter, and where welcoming the newborn child as a mystery gives way to genetic screening, selection, and quality control.
Ironically, what made this project possible in the first place was acting technologically on the desire of infertile couples to have a child of their own, flesh of their flesh. To fulfill this biological desire, we invented a way to initiate human life in the laboratory--a way to bring human origins into full human view, and thus make them available for manipulation and control. The first IVF child was born in 1978. Since then, many infertile couples have had children of their own, with IVF to thank for this blessing. But as a result, we also opened the door to new ways of making babies that undermine the very biological ties that IVF aimed to serve. Only by bringing the embryo outside the human body is it now possible to give birth to another couple's child; to have a child where the identity of the father is "anonymous"; or to contemplate women giving birth to genetic copies of themselves or two men having a child that is the fruit of their mixed genes. While of course not all families reflect the biological ties between the generations, there is a difference between adopting a child in need and creating an orphan by design.
Looking back, the significance of IVF cannot be overstated: It is the source of the embryos that are now available for research; it is the technological solution for couples seeking a biological child; and it is the crucial first step in transforming human procreation in radical new ways. Looking ahead, however, it is also clear that we stand at yet another major threshold. IVF, in most cases, still mimics nature--producing a child that is the fruit of a coupled male and female. The new ways of making babies, by contrast, radically depart from nature's sexual pairing, and they violate the family structure that has long imitated and civilized our given nature in the rearing of children.
The final concern about biotechnology is that our growing technical control over reproduction will open the door to a new eugenics--where parents pick and choose the genetic characteristics of their offspring, and society pressures families not to have genetically unfit children. The longtime fear of genetic engineering--superbabies made to order--is far-fetched. The real danger is something more subtle. It is using genetic information to choose babies with a greater probability of their being superior in ways we desire--that is, a greater probability of being tall, or athletic, or musical, or smart. It is not so much the tyrannical parent as the tentative-obsessive parent that is the problem--the parent who is unwilling to accept the child as given, but obsessed with trying to get the best child possible.
The problem with assisted reproduction today is that infertile couples sometimes put their future child in danger. The problem tomorrow will be that fertile parents, so hungry to have the child they want, will forgo natural reproduction for the clinic--where embryos can be created, screened, and tested in advance. Today, we abort children with genetic diseases. Tomorrow, we will select children with genetic advantages--with all the expectations and deformations that this new imposition of parental will introduces into child-rearing.
AT PRESENT, all of these practices remain unregulated and unrestricted in America: The use of genetic screening techniques to try to pick children with "superior" genotypes is ungoverned and unmonitored. Embryo destruction remains fully legal in the private sector, and a recent law passed in New Jersey protects the right of researchers to harvest later-stage fetuses as research tools. Revolutionary new ways of making babies are unhindered, including the now imminent possibility of using the South Korean "cookbook" (as one researcher called it) to try to clone a human child.
In thinking about how to govern this free for all, we have the benefit of the recent unanimous recommendations from the President's Council on Bioethics. The council calls for a ban on implanting human embryos into an animal uterus; a ban on producing embryos with human sperm and animal eggs or animal sperm and human eggs; a ban on initiating a pregnancy for research purposes; a ban on buying, selling, or patenting human embryos; a ban on destroying or harming embryos for research once they reach the 10-14 day stage of development; and a ban on radical new ways of producing a child, including "blastomere fusion" (which would create a child with four genetic parents, not two), conceiving a child whose father or mother is a dead embryo or aborted fetus, and human cloning.
It should be obvious that enacting such recommendations would be a great improvement over the laissez-faire status quo. But the recommendations involving embryo destruction and human cloning have been criticized by some pro-lifers on a number of grounds: for not going far enough, for accepting practices that are unacceptable, and for undermining the ethical clarity required for opposing the misdeeds of the biotechnology project. These criticisms are serious but not decisive. They force the question with which we began: What is a realistic conservative offense on bioethics issues? How does the president balance the steady support of the pro-life community--often the only reliable critics of the new practices--with the need to reach beyond the pro-life community to pass bioethics legislation? Is there wisdom in the partial limits proposed by the council? We believe there is, and that it becomes clear by taking up the two major pro-life criticisms directly.
The first criticism is that the council's recommendations separate reproductive cloning and research cloning, and propose a ban on reproductive cloning only. In doing so, the critics say, the council tacitly endorses the creation of cloned embryos for research; it offers another version of the Hatch-Feinstein bill that pro-lifers have been fighting against for three years. But this is incorrect.
The council's recommendations offer a way of banning reproductive cloning that differs from the two bills that have so far gone nowhere in Congress. When it comes to the dignity of the family, the council is more ambitious than the Brownback bill--banning not only cloning, but a number of radical ways of making babies. But it does this by recommending a ban on the creation of cloned embryos (or other wrongfully produced embryos) with the intent of implanting them to begin a pregnancy. Such a law would not (like Hatch-Feinstein) mandate the destruction of any embryos. It would not (like Hatch-Feinstein) endorse the use of embryos for research, but rather preserve the status quo of public silence. The illegal act (unlike Hatch-Feinstein) would be embryo creation, if not all embryo creation. And it would allow the fight for the Brownback bill to continue in parallel, while banning a range of reproductive practices that everyone abhors.
The pro-life rejoinder is that silence means an implicit endorsement of cloned embryo research. And yet, as Leon Kass has pointed out, the Brownback bill, which aims to ban research on cloned embryos, is silent on the creation and destruction of IVF embryos for research. Of course, pro-lifers also reject this practice. They don't endorse it simply by not trying to ban it, and they don't imply that cloned embryos have a more sacred status than IVF embryos. Rather, they take aim at the evils they can limit in the real world, while remaining legislatively silent about the evils they cannot now stop. This is exactly what the council's recommendations do as well--protecting the dignity of human procreation, while remaining silent on the destruction of early embryos.
The second pro-life rejoinder is that by offering an alternative to the Brownback bill, the council recommendations will undermine ongoing efforts to pass the Brownback bill (or legislation like it in the states). They point to the fight in Nebraska, where a pro-embryo-research legislator introduced the council's recommendations verbatim in an effort to stop passage of the Brownback-style bill. But the fact that a pro-embryo research senator is willing to propose recommendations endorsed by pro-life council members like Robert George and Mary Ann Glendon suggests not a weakening of the pro-life side, but a possible movement of the pro-research side in a more conservative direction. Indeed, the Brownback strategy, by itself, may make pro-lifers less ambitious than they could be in conservative states, where they might ban all creation of human embryos for research, not just the creation of cloned embryos.
Another pro-life criticism of the council's recommendations is that banning the destruction of embryos for research once they reach the 10- to 14-day stage of development would implicitly endorse research on the earliest human embryos; it would suggest that the moral standing of developing human life changes at the 10- to 14-day line. But this argument seems to us to miss the wisdom of seeking partial--and principled--limits. To ban all embryo destruction after 10 to 14 days is the embryo research equivalent of a partial-birth abortion ban. The only difference is that instead of the 8- to 9-month fetus being given protected status under the law, it is the 10- to 14-day-old embryo. Imagine if a pro-abortion activist like Kate Michelman endorsed the proposition that all abortions after 10 to 14 days should be outlawed. Pro-lifers would be ecstatic. To enact a 10- to 14-day limit on embryo research would put in place the strongest legal protections of developing human life in the post-Roe v. Wade era. It would force the other side to accept that at least some embryos are morally and legally inviolable. And if those embryos are to be protected, why not others? It would shift the terms of the debate in a pro-life direction, and limit coming evils (like fetus farming) without betraying pro-life principles.
Certainly a total ban on cloning--indeed a total ban on embryo research--would be ideal from a pro-life perspective. But such bans do not seem forthcoming at the federal level. The status quo prevails--which is ultimately a victory for biotechnology without limits. What conservatives need, instead, is a realistic offense, and the council's recommendations are a good example of this approach, though one could imagine other initiatives along these lines as well. The council offers limits that are much better than nothing--by preventing the destruction of some innocent human life, stopping new ways of degrading human procreation and family ties, and shutting down some gateways to a new eugenics.
We stand at a crucial moment in the debate about reproductive biotechnology--a moment like the late 1960s and early 1970s on abortion, or the early 1970s on in vitro fertilization. Despite the many ethical and legal precedents cutting in the opposite direction--towards a culture of autonomy without limits--there is a widespread consensus today against the most radical new ways of making babies and against harvesting fetuses for research. Reproductive freedom does not yet mean the right to have a child by any means possible. And even the most ardent supporters of embryo research still say they would never harm an embryo after 14 days of development. This broad consensus leaves open a door for enacting limits on the most dehumanizing uses of biotechnology, but it is a door that will not remain open forever.
The council's report lays the groundwork for setting such limits. It establishes the principle that not all science is good for the country, and that scientists, too, must answer to the deliberative judgment of the American people. If we act today to prevent some of the worst abuses of biotechnology, we will at least have begun to face the task before us, governing scientific progress in a democratic and moral way.
Eric Cohen is editor of the New Atlantis, a resident scholar at the Ethics and Public Policy Center, and a consultant to the President's Council on Bioethics. The views expressed here are his own. William Kristol is editor of The Weekly Standard.