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Family Policy After Roe

Fri, 01 Oct 2021 00:00:00 -0400

After half a century, the struggle against the cruel and radical abortion regime imposed on our society by the Supreme Court may be nearing its end.

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The Perils of Religious Liberty

Mon, 01 Feb 2016 00:00:00 -0500

On January 24, 1774, the young James Madison, twenty-two years old and two years out of Princeton, wrote an exasperated letter to his college friend William Bradford, who lived in Pennsylvania. In Virginia, Madison wrote, a season of intolerance had dawned. “That diabolical, hell-conceived principle of persecution rages,” and perfectly well-meaning men of religion were finding themselves imprisoned for expressing any deviation from the views of the dominant Anglican Church. He told his friend that he had “squabbled and scolded, abused, and ridiculed so long” about this that he had no more patience for the fight. “So I leave you,” he concluded, “to pity me and pray for Liberty of Conscience to revive among us.”

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Blinded by Nostalgia

Thu, 23 Oct 2014 00:00:00 -0400

The twenty-first century has been a time of transition in American life. In our economy, our culture, our politics, and throughout our society, longstanding norms seem to be breaking down. Times of uneasy transition are often characterized by a politics of nostalgia for the peak of the passing order, and ours most definitely is.

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Taking the Long Way

Wed, 01 Oct 2014 00:00:00 -0400

And it came to pass, when Pharaoh had let the people go, that God did not lead them through the land of the Philistines, even though it was nearer.
—Exodus 13:17

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A Pessimistic Case for Hope

Thu, 25 Sep 2014 00:00:00 -0400

Ten years ago this fall, it seemed for a moment like social conservatives might be ascendant in our politics. Immediately after the 2004 election, some analysts on the right and left alike said George W. Bush’s reelection signaled a rising tide of “values voters” who would yield an enduring nationwide advantage for Republicans on social issues.

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After Progressivism

Tue, 01 May 2012 00:00:00 -0400

“After Progressivism” is one of three addresses given to a symposium on “After Liberalism,” put on in late February with the support of the Simon/Hertog Fund for Policy Analysis and of Fieldstead and Company. The following is a response to Wilfred M. McClay’s “Liberalism After Liberalism.” The other response, by James Rogers, can be found here . The other two addresses and the responses will appear in the June/July and August/September issues.

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Nothing to See Here

Tue, 01 Jun 2010 00:00:00 -0400

Whatever happened to bioethics? The decade between the cloning of Dolly the sheep and the election of Barack Obama was rife with heated public arguments about embryo research, cloning, assisted reproduction, and other matters bioethical. President George W. Bush’s first prime-time speech was about a new approach to public funding of embryonic stem-cell research. The first veto he issued, five years later, was of a bill to overturn that policy. State after state took up measures on one side or the other of the embryo question. And John Kerry’s 2004 campaign to unseat Bush featured prominent appeals on the stem-cell issue from high-profile celebrities.

Since Obama’s election, however, the bioethics battles have not been heard from much. The new president did overturn Bush’s funding policy. Since last July, the National Institutes of Health has been funding work on newly created lines of embryonic stem cells, thus providing, for the first time, a taxpayer-funded incentive for the destruction of embryos. But the new policy was not accompanied by an argument or an elucidation of its moral premises, and it has sparked almost no debate.

In fact, in announcing the policy last March, Obama denied the existence of serious moral debate about embryo destruction, insisting it was a matter for science alone. Pledging that his administration, unlike his predecessor’s, would “make scientific decisions based on facts, not ideology,” Obama signed an executive order that offered no more of a case for itself than the stark statement that “advances over the past decade in this promising scientific field have been encouraging, leading to broad agreement in the scientific community that the research should be supported by federal funds.” Since then, the administration has made no effort to draw attention to the funding, the research, or the moral debate.

Perhaps the best illustration of this avoidance of the bioethics debates has been the slow and peculiar development of Obama’s advisory commission on bioethics. Bush’s version of the commission was a high-profile and much discussed group of physicians, researchers, social scientists, humanists, and lawyers—the President’s Council on Bioethics (which both of us served as staff members). It was led first by the University of Chicago’s Leon R. Kass and then by Georgetown’s Edmund Pellegrino, prominent voices in American bioethics for decades who took leave from their other projects to manage the council’s work full-time.

Kass imbued the group’s work with his characteristically humanistic and philosophical approach to bioethical questions, seeking the deep human significance behind the heated debates of the day. And, under both chairmen, the council worked to keep key bioethical questions before the public. Members of the council were frequently at odds, and the reports they produced echoed their serious and informed disputes. The design, membership, and charge of the council made clear that Bush wanted to see the debates about bioethics amplified and elevated, not tucked away. The council, as Bush described it when he announced its creation, was to “give our nation a forum” in which to carry out those debates in a civil but unabashed way.

President Obama’s approach has clearly been different. For one thing, his advisory group—called the Presidential Commission for the Study of Bioethical Issues—has been long in coming. Although he announced his new stem-cell funding policy in March 2009, Obama announced the creation of an advisory commission only in November, and he waited until this April to name all of its members.

The new commission, moreover, will be led by two university presidents—its chair, Amy Gutmann, of the University of Pennsylvania, and vice chair, James Wagner, of Emory—who will not be taking leave from their regular jobs and so will have very little time to devote to the commission’s work. And although both were named when the commission was first announced five months ago, they have yet to choose their staff. In fact, the commission’s only staff at the moment are an interim director, an administrator, and a researcher, all of them holdovers from Bush’s council.

The other members, named this spring, confirm that the Obama council is designed not to highlight bioethical debates but to keep them out of sight. Conservatives worried that the commission would consist of familiar bioethical ideologues can rest mostly easy: There are only two “professional bioethicists” among the twelve members. One, Christine Grady, is a government official who now serves as acting chief of the department of bioethics at NIH’s Clinical Center. The other, Daniel Sulmasy, is a Franciscan friar, the commission’s only pro-lifer, and something of a conservative in the bioethics world.

This fact has not escaped the notice of the liberal bioethics establishment. A blogger at the American Journal of Bioethics spoke for many in those circles when she wondered, “Where are the bioethicists?”

There are, to be sure, some committed liberals on the commission—including Gutmann herself. But ideology is not the problem. The president, after all, has the right to choose advisers who share his ideological assumptions.

The problem, rather, is that the commission seems designed to keep bioethics out of the news. Its members are a far lower-profile group than those in Bush’s commission (or, for that matter, Bill Clinton’s). Its charter, which the president signed in November, repeatedly insists that the commission should focus on specific and programmatic policy questions. The president stressed the same point in the statement the White House released at the time: “This new commission will develop its recommendations through practical and policy-related analyses.”

The idea, no doubt, was to distinguish the focus of this commission’s approach from the broader and deeper approach of the Bush council, whose own charter said its foremost task was “to undertake fundamental inquiry into the human and moral significance of developments in biomedical and behavioral science and technology” and whose work (including an anthology of readings from great works of literature called Being Human and a report that reflected on the meaning of human-enhancement technologies but did not offer policy proposals) was sometimes described as too ethereal.

As its designers surely recognized, the likely effect of directing the new commission to take up narrower policy questions will be to keep it from taking up the most basic questions underlying our approach to science and technology.

If the primary question guiding the commission is not what but how , the range of topics it may examine is constrained—as so much of bioethics in recent decades has been—to utilitarian concerns and matters of procedure. As with the president’s implicit assertion that there is no debate to be had about embryo research, the idea is to treat the basic ethical questions as closed and to relegate the questions that remain to the judgment of experts. These remaining questions involve, for instance, not whether we should pursue the destruction of nascent life for research but how; not what advances in biotechnology mean for our humanity but how they can be made available to all.

Of course, the commission’s members may not let themselves be used in this way—as silencers of fundamental ethical and philosophical debates—and there is surely room to hope that they will contribute to public understanding of some of the most vexing and important questions of the coming years. But those who want to advance such understanding, and to persuade the public of the need to defend human dignity and human life in the age of biotechnology, need to do more than hope. They need to think, and they need to act.

For all the substantial work of the Bush council, many large questions require rethinking. What has the decades-long stem-cell debate taught us about the moral integrity of our leading scientific institutions and the moral seriousness of our leading scientists? What is the relation between the looming fiscal crisis created by the coming mass geriatric society (sure to be exacerbated by Obamacare) and the complex moral questions surrounding caring with dignity for the old? And what strains will such caregiving put on the already fragile modern family? What will it mean if genetic screening becomes a typical part of in vitro fertilization? What will life be like in an era when genetic tests at every stage of life give us imperfect information about the terrible diseases we will likely suffer in the future?

This intellectual agenda needs to be accompanied by a renewed and reinvigorated political agenda: to ban all human cloning, to ban the creation of man-animal hybrids, to prohibit federal funding for embryo-destructive research, and to create a new regulatory body that monitors the safety of new reproductive techniques.

A first step, which will be launched in the coming months under the auspices of the Witherspoon Institute, is to create a shadow commission that convenes and rallies the best scientists and ethicists to think and to act. But a reinvigorated bioethics will require as well a political leader who sees the bioethics agenda as central to the defense of American civilization in the years ahead. Otherwise, we will continue down a troubling path—seeking the power to make life better but losing the moral authority to distinguish better from worse.

Eric Cohen is editor at large of the New Atlantis and the author of In the Shadow of Progress . Yuval Levin is editor of National Affairs and a fellow at the Ethics and Public Policy Center. Both served as staff members of the President’s Council on Bioethics under George W. Bush.

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Another Stem Cell Advance

Mon, 02 Mar 2009 14:16:36 -0500

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Biotech: What to Expect

Sun, 01 Mar 2009 00:00:00 -0500

Over the past fifteen years, the pro-life movement has succeeded in enacting some modest limitations on embryo-destructive research. Passage of these depended heavily on Republican control of the Congress, and their defense in the past eight years depended heavily on a Republican president willing to use his veto pen. The new political environment puts all of these achievements at grave risk and makes further steps essentially impossible for the time being.

The crucial story of the past several years in stem-cell science has been the story of newly emerging sources of pluripotent stem cells. What began as a series of speculative proposals early this decade and then coalesced into a few avenues of research between 2004 and 2006 has become the story of somatic-cell reprogramming.

In November 2007, two teams of researchers (one in Wisconsin and one in Japan) announced they had successfully transformed regular human adult skin cells into what appeared to be the equivalent of embryonic stem cells without using human embryos. Since then, several crucial advances have made the technique more efficient, more effective, and safer, and the cells produced by this technique (called “induced pluripotent stem cells,” or “iPS cells”) have so far continued to display all the characteristics attributed to human embryonic stem cells. These techniques not only avoid any ethical concerns (concerns, of course, that researchers in the field generally do not share), but they offer a far cheaper and easier method of producing genetically matched or selected pluripotent stem cells, which makes them appealing to researchers.

As a result, this technique has begun to overtake the use of embryos in many stem-cell labs. At last count (in the fall of 2008), there were approximately eight hundred laboratories using iPS cells in their work, which has cut sharply into the number of those using human embryos or cells derived from embryos. If the cells involved continue to prove equal to human embryonic stem cells in abilities and characteristics, this technique offers a genuine alternative to the destruction of embryos for nearly every purpose to which human embryonic stem cells and human cloning for research have been proposed or employed. The chief exception is the study of human development itself, which certainly has some devoted champions in the scientific community but which makes for a significantly less appealing political message than does the pursuit of regenerative medicine.

To date, no therapeutic applications of embryo-derived cells have been demonstrated, and only one preliminary human trial has been approved by the FDA (though it has yet to begin). The work, however, is proceeding, and the political debate about the research has certainly raised its profile and thereby brought private and some state funding pouring in. There have been no game-changing breakthroughs in the use of embryonic stem cells in recent years, but researchers remain confident of their potential utility, and their use will certainly continue even as work with iPS cells will likely overtake embryonic stem-cell research in volume and scope.

Research in human cloning is also proceeding. Given the number and quality of labs around the world currently pursuing human cloning techniques and the increasing efficiency and success of cloning techniques in nonhuman primates, it is reasonable to expect the successful creation of a human embryo by cloning in the next year or two.

The most significant obstacle to such success at this point is probably the limited supply of human eggs for research, which severely restricts the ability of researchers in the United States and in most of Western Europe to engage in large-scale cloning experiments of the sort that led to the first cloning of primates a few years ago. For this reason, significant research efforts have begun to explore means to produce eggs”for instance, by transforming iPS cells or embryonic stem cells into human egg cells, by using or improving damaged or low-grade eggs discarded by fertility clinics, and by obtaining human eggs through ovarian biopsy. We should also expect to see growing pressure to ease various state and institutional limitations on the sale of eggs for research.

Some more eccentric embryo research”such as the creation of human-animal hybrid embryos or the development of embryonic stem cells from earlier-stage embryos”is likely to see a serious decline in interest over the next few years. The purpose of these techniques was to overcome the shortage of human eggs for straightforward (non-cloning) embryo research and to sidestep the political pressure and ethical concerns raised by the destruction of embryos for research. Both sets of problems are significantly alleviated by the development of iPS cells (and, it must be added, the political pressure is alleviated by the election of a Democratic president). It is likely, therefore, that the attempts to produce human-animal hybrid embryos (which we know have been tried in China and Great Britain) will be scaled back. Attempts to find new ways to derive cells from human embryos will be limited as well. We can, however, expect continuing efforts to extend the period of gestation of human embryos outside the body”as more developed embryos and fetuses yield more useful cells and tissues.

Another set of emerging techniques, which would employ pluripotent stem cells to produce human eggs and sperm, are likely to develop swiftly in the next few years. These techniques would allow for manipulations of human reproduction to permit, for instance, homosexual couples to reproduce biologically (using, say, an egg from one female, then transforming the skin cells of another female into sperm cells with her genetic characteristics, and then producing an embryo by in-vitro fertilization). These techniques are almost certainly already possible with existing iPS techniques, though the efficiency involved would be quite low and the expense quite high. They will improve dramatically in the coming years.

As a result of all this, the likely scientific developments over the next few years move in two opposed directions: On the one hand, techniques to produce pluripotent stem cells without the need for embryos will certainly take center stage, reducing the volume of embryo destruction. On the other hand, successful human cloning for research is very likely, and we will see growing pressure to make more eggs available for research.

With regard to actual medical advancement, it is important to take note of the changed tone of expectations. Researchers now speak far less frequently of actual direct-cell therapies for particular diseases and conditions, because the lessons of animal research (and some implications of human adult stem-cell research) in recent years suggest that direct delivery of cells into the body of a patient will always carry grave risks of mutation and cancer. Moreover, they will also always remain extremely difficult to scale up to levels that would be required for treatment of widespread diseases or conditions.

Cell biology is instead increasingly directed to the study of small molecules that may be used to manipulate the development of cells through gene activation. It seems more and more likely that the most significant findings of the stem-cell revolution will involve ways of altering existing adult cells in the body rather than replacing lost or damaged cells. This suggests a far less prominent role for human embryos in this field of biology in the long run, but it also suggests a continuing interest in the detailed study of human development in the short run, which does involve the use and destruction of embryos. The public argument that stem cells from embryos will themselves be used to treat sick patients, however, is becoming increasingly untenable and untethered from the work of actual researchers in the field.

As far as public policy in the United States goes, the effort to enact limits on the destruction of human embryos for research (and on other unethical practices at the margins of cell biology) have yielded some modest but important achievements. All of these are now at risk, and some are quite certain to be overturned.

In 2001, President Bush permitted, for the first time, some limited federal funding of human embryonic stem-cell research, but under rules that denied funding to the use of any newly created lines of cells”thus avoiding a federally funded incentive for the ongoing destruction of human embryos. Congress twice passed bills to overturn these limits and allow for funding of newly created lines, and Bush twice vetoed the measures.

During the 2008 campaign, President Obama committed to overturning the Bush policy, and he will certainly do so. The particular character of the new policy will make some difference: It could, for instance, involve parental-consent requirements that might constrain its scope somewhat. But federal support for the use of cells from destroyed embryos will certainly grow significantly.

At this point, such support could fund only the use of cells from embryos but not the actual process of destroying the embryos. The Dickey Amendment, attached to the federal budget since 1995, prohibits funding for work in which embryos are actually destroyed. The new Congress may choose to remove the Dickey Amendment in next year’s budget, allowing for essentially no restriction on federal funding for the destruction of human embryos.

Opponents of the amendment certainly have the votes to remove it, but they will need to judge whether there is sufficient demand in the scientific community to merit the political cost, which means that the pro-life movement needs to prepare its case on the Dickey amendment, to make plain that there would be a cost.

In 2004, Congress enacted a ban on the patenting of human embryos. This prohibition, known as the Weldon Amendment, prohibits the patent office from granting patents that encompass a human organism as a patented product. This both establishes the principle that human beings should not be treated as property and limits the appeal of some manipulations of human embryos for research. The Weldon Amendment was forcefully opposed by the lobbying arm of the biotechnology industry and by some advocates of embryo research, and it may well be at risk in the next budget process.

In 2006, Congress passed and Bush signed a prohibition on the use of tissues or organs from a human fetus who had been gestated for the purpose of producing such tissues or organs (a practice known as fetal farming). This prohibition, which is not just a budget amendment but a statutory ban, affecting both the private and the public sector, is not likely to be undone by the new Congress, as there is not sufficient pressure from researchers to reverse it, and a reversal would be extremely unpopular.

These are, more or less, the only existing protections in federal law. There is no limitation on human cloning at the federal level, no prohibition on human-animal hybrid work or similar techniques, and no restriction on the use, procurement, or purchase of human eggs for research.

In the past, when Republicans have proposed to prohibit human cloning, the Democrats advanced a measure they described as a cloning ban, though, in fact, it would have prohibited only the transfer of a cloned human embryo to a womb for development to birth. The Democrats might pursue such a measure as a preventative step in this new Congress, but, since current law places no restrictions whatsoever on cloning, they may more likely see it as a needless effort and leave things as they are.

The only real opportunity for some positive achievement (rather than successful defense) in the next few years”and even this is a long shot”involves the question of egg procurement for embryo research. We are very likely to see growing pressure from researchers to ease institutional and some state rules that limit their ability to pay for eggs and that constrain them from working closely with fertility clinics to obtain eggs. The egg issue raises some concerns for a small but potentially significant element on the left, and at this point the usual biotechnology and disease-group lobbyists have not made it a key focus of their efforts. It may be possible to form a bare majority for setting some modest boundaries on the sale or procurement of eggs for research.

The prospects on the embryo-research front in the coming years are grim. We will certainly see the Bush funding policy overturned, and we will likely see rolled back most of the other modest protections enacted through great and arduous effort over a decade and a half. The egg-procurement question presents the only plausible opportunity for progress, but the pro-life movement should not despair of defensive successes. The Dickey and Weldon Amendments both have determined opponents in the scientific community (and especially in the private biotechnology sector) but both have a decent chance of surviving if the political costs of eliminating them can be increased. The first budget cycle of the new Congress will be the most crucial and difficult test on both fronts.

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