George J. Annas and Sherman Elias

Bioethics in the United Statesreflects US culture and tends to bepragmatic, market-oriented andinsular. Add embryo politics to thismix and, over the past few years, theresult has been a bioethics that has become so narrow and self-absorbed as to be virtually irrele-vant to the rest of the world. Not allthe blame for this can be placed onPresident George W. Bush’s politicalagenda for his President’s Councilon Bioethics, now in its third year of operation, but much can.The council has made publicbioethics the servant of politics bypursuing a narrow, embryo-centricagenda. More remarkably, althoughthe attacks of 11 September 2001changed almost everything in theUS government, the bioethics council — and bioethics in general— were strangely unaffected.

Both the president and the chairof the council, Leon Kass, have citedAldous Huxley’s Brave New World asjustification for the council’s work.The threats portrayed in this novel— artificial reproduction of humans in state ‘hatcheries’ and drug-induced contentment — are real,but preventing them is not theworld’s only, or most important,bioethics problem.Both domestic and globalaccess to healthcare, the commercializationof science and medicine, pharmaceuticalpricing, conflicts of interest, gene patentingand international research rules merit atleast as much attention.

It is understandable, but not acceptable,that a neoconservative bioethics councilwould have nothing to say about access tohealthcare by the tens of millions of uninsuredand underinsured Americans. But after 11 September, the president and Congressimmediately set about writing new laws thathad profound ethical implications for medical research, including the USA PatriotAct, the Bioterror Act and the Bioshield Act.It is almost beyond comprehension that the council had nothing to say about any terrorism-related medical research issues:not about classified biotechnology research;not about the attempted smallpox vaccina-tion of 500,000 US health workers and children; not even about the testing ofbioterrorism countermeasures on humans.

Of course, an administration that hasdeclared an open-ended war on terror mightnot want the bioethics council involved inthese discussions. The Bush administrationcertainly does not want to suggest to US citizens that George Orwell’s 1984, with itsperpetual war,doublespeak and governmentreliance on fear, is as relevant to contempo-rary bioethics as Brave New World. In the war on terror, the nonpartisan US NationalResearch Council has reasonably concludedthat controlling biotechnology for terrorismand warfare will require international cooperation1.So will meaningful bioethics.

We believe it is the narrow focus of USbioethics, both geographically and philo-sophically, that permitted terrorism and warto be placed ethically ‘off-limits’. The inter-national language of ethics is the language ofhuman rights, and international humanrights law in particular, but US bioethicsretains an isolationist worldview. From thebioethics council’s perspective, using theglobal language of human rights would have

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been counterproductive, becauseembryos do not have the same statusas human persons in any human-rights document. But whether it isthe failure of US physicians at AbuGhraib to stop the abuse of Iraqi prisoners there, or the possible ethical shortcuts taken by Koreancloners in obtaining human eggs, aglobal bioethics based on humanrights would demand respect for thehuman dignity and rights of people— not just embryos. Bioethics in theUnited States has been noticeablysilent on these issues2.

Had the United States adopted aninternational human-rights perspec-tive on bioethics, it too could havejoined the UN proposal of August2001 by France and Germany to draft atreaty to outlaw human reproductivecloning, thereby protecting children.US joint sponsorship of this proposalcould have led to the world’s firstbioethics treaty. Instead, embryo-centric bioethics led the United Statesto effectively kill the proposal byinsisting that any cloning treatysimultaneously outlaw the creationof embryos for research purposes.

A full understanding of the Presi-dent’s Council on Bioethics requiresrecalling its original political agenda.The council was announced by President Bush during a speech on 9 August 2001 in which he said he

would limit federal funding for embryonicstem-cell research to stem-cell lines that had already been created “where the life-and-death decision has already been made”,and would provide no “taxpayer fundingthat would sanction or encourage furtherdestruction of human embryos that have at least the potential for life”. The council’smandate was to “monitor stem-cell research,to recommend appropriate guidelines and regulations, and to consider all ofthe medical and ethical ramifications ofbiomedical innovation”.

The bioethics council has so far issuedfour reports and one collection of readings.Only two of the reports contain policy recommendations. The best known isHuman Cloning and Human Dignity (2002),which called on Congress and the presidentto ban human reproductive cloning and tohave a moratorium on research into cloningfor therapeutic purposes. The two mostrecent reports of the commission focusdirectly on stem cells. Monitoring Stem Cell

Politics, morals and embryosCan bioethics in the United States rise above politics?

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Research (2003) is a heroic attempt to provide an ethical justification for the stem-cell policy articulated in Bush’s speech of 9August 2001. The ‘ethics’ of the Bush posi-tion is based entirely on the argument thattaxpayer money should not be spent ondestroying any more human embryos in theUnited States — the private sector and othernations can do what they want. This meansthat public funding is crucial to the argument.

The council boldly attempts to justify thisposition, saying: “The decision to fund anactivity is…a declaration of official nationalsupport and endorsement,a positive assertionthat the activity in question is deemed by the nation as a whole,through its government,to be good and worthy. When something isdone with public funding, it is done, so to speak, in the name of the country, with its blessing and encouragement.” This is powerful rhetoric, but wrongly equates politics and morals. It is the criminal law thatreflects the nation’s minimum morality, notfunding decisions3. Congress funds, or refusesto fund, thousands of projects that are ofinterest to only tiny minorities — sometimescalled ‘special-interest’ groups. Federal fund-ing of these projects, whether tobacco-farm-ing subsidies or new nuclear weapon designs,does not imply that they are “deemed by thenation as a whole…to be good and worthy”.

State funding decisions are also political.This November, voters in California will decide whether to amend their state constitution to make embryonic stem-cellresearch for therapeutic purposes a constitu-tional right, and to provide US$3 billion inpublic funds for stem-cell research. This proposal is excessive, but it is an understand-able referendum on the Bush administration’sstem-cell policy. It also demonstrates the muddled ethics of the bioethics council,whose overall position would cause it toreject the California initiative, but whose“will of the people” rationale lends supportto the idea of voting to determine the moralityof this research.

Born with an embryo-centric, anti-abortion and anti-regulationpolitical agenda, Bush’s Presi-dent’s Council on Bioethics hasrepeatedly failed to transcend it.In its latest report, Reproductionand Responsibility (2004), thecouncil attempts to come togrips with the ethics of assisted-reproduction technology, butultimately reverts to embryoprotection. A thoughtful national report onpublic oversight for the assisted-reproductionindustry is long overdue in the United States.Unfortunately, this report — unlike much earlier UK and Canadian reports — avoidsalmost all the tough ethical-policy issues inassisted reproduction by concluding that thereis insufficient factual information available to make regulatory recommendations.

In Reproduction and Responsibility (2004),the council also makes the only legislativerecommendations it has made since itscloning report, the most important of whichare to “prohibit attempts to conceive a child by

any means other than the unionof egg and sperm; prohibit theuse of human embryos inresearch beyond a designatedstage in their development(between 10 and 14 days afterfertilization); and prohibit thebuying and selling of humanembryos”. These prohibitionsare reasonable, but a more

ethically and politically constructive approachwould be for Congress to provide both federalfunding and meaningful federal regulatoryoversight for embryonic stem-cell research.

During the Clinton administration, wesupported the US National Institute of Health’s position that federal fundingshould be available for embryonic stem-cellresearch conducted with ‘surplus’ in vitro

fertilization embryos donated by couples.However, we noted at the time that the ratio-nale for this limitation on the federal fundingof embryo research was political — not ethical4 (the moral status of a human embryono more depends on how or why it was created than does the moral status of a child).It is easier for a politician to support researchwith ‘surplus’ embryos than with embryoscreated for that purpose. But if one believesthat embryos should never be created ordestroyed for research, such activities shouldbe made a crime, not turned over to anunregulated private sector.

The ‘surplus embryo’ compromise maystill be politically possible, having gained thesupport of 58 US senators (including somewho oppose abortion) and former first ladyNancy Reagan, but not until after theNovember presidential elections. Given theinability of Bush’s bioethics council to provide a credible ethical rationale for hisAugust 2001 position, Bush may pay a political price in the November elections,especially from patient advocates and theirfamilies.

Bioethics is important in US politics, justas morality is important in law-making, butwhen bioethics is used primarily to serve anideological, domestic political agenda,rather than helping to develop a global ethic,it is of little use to anyone but narrow-interest groups. It is too late to reform Bush’s bioethics council. Even mainstreambioethicists who accept the reality that federal panels can never be totally divorcedfrom politics find the politics of this councilextreme and isolated5. In our view, futurebioethics panels in the United States must beindependent, not ‘presidential’. For the benefit of medicine, science and society, itwould be better to establish a permanentNational Institute of Bioethics as part of theNational Academy of Sciences. Its mandatemust be broad, and it should adopt interna-tional ethics, especially those embraced inthe Universal Declaration of Human Rights,so that it can proceed from a global ratherthan exclusively US perspective6. ■

George J. Annas is at the Department of HealthLaw, Bioethics & Human Rights, BostonUniversity School of Public Health, 715 AlbanyStreet, Boston, Massachusetts 02118, USA.Sherman Elias is at the Department of Obstetricsand Gynecology, Feinberg School of Medicine,Northwestern University, 333 East Superior Street,Chicago, Illinois 60611, USA.1. Biotechnology Research in an Age of Terrorism (National

Academies Press, Washington DC, 2004).

2. Annas, G. J. American Bioethics: Crossing Human Rights and

Health Law Boundaries (Oxford Univ. Press, New York,

in the press).

3. Fuller, L. The Morality of Law (Yale Univ. Press, New Haven, 1964).

4. Annas, G. J., Caplan, A. & Elias, S. New Engl. J. Med. 334,

1329–1332 (1996).

5. Charo, R. A. J. Law, Med. & Ethics 32, 307–314 (2004).

6. The Medical Profession and Human Rights for a Changing

Agenda Handbook British Medical Association (Zed

Books, London, 2001).

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Leon Kass (above) and George Bush have “madepublic bioethics the servant of politics”.

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