Mission Possible: National Bioethics Commissions Beyond the Conservative/Liberal Divide

What's a National Bioethics Commission to Do? Beyond the Conservative/Liberal Divide

In June 2009, President Obama dissolved his predecessor's President's Council on Bioethics (PCBE), announced the formation of a new President's Commission for the Study of Bioethical Issues (PCSBI), and spurred another round in an ongoing debate about the mission or mandate of a national bioethics commission, its methods, and the criteria by which its work should be judged. Given the contemporary climate for political and moral discourse in this country, one should not be too surprised that this once civil debate has become less so, diminished rather than enriched by sound-bite caricatures of the opposing sides and needlessly pitched between polar positions, one staked out and defended by conservatives and the other by liberals. This is an essay, an attempt, to develop a position beyond the conservative/liberal divide.

In simplified form, the conservative position is that a commission's mandate is to deliberate about fundamental philosophical questions generated by advances in biotechnology and by evolving practices in health care and biomedical research—questions about the ends of human life, human dignity and human flourishing. Shunning consensus as a goal, a commission should seek instead to elucidate the differing, often conflicting views of these ends and thereby enlighten the public and policymakers. The liberal position is that a commission's mission is to deliberate on bioethical questions with the eminently practical aim of achieving a consensus, thereby modeling the processes by which citizens in a liberal pluralistic democracy can and should deliberate together on these same questions. And, through the attainment of consensus, a commission should provide an ethically secure, politically legitimate basis for public policy.

Within the constraints of this either/or of seemingly irreconcilable positions, one is either for or against consensus. One is either for or against deliberation on fundamentally philosophical questions. One is either for or against the claim that a commission should contribute to the practical process of ethically enlightened policy making. In this essay, I attempt to defend a third position, unfettered by these constraints. From the perspective that informs my attempt, the dichotomy of conservative and liberal standpoints on the question of a commission's proper mandate appears false and over-determined—over-determined, that is, by the polarized character of contemporary political discourse and by the often strident controversy that surrounded the PCBE, generating critics and defenders who give no quarter to their opposition.

As for the substance of my position, it is informed by scholarly engagement with the theory and history of public bioethics and by personal experience, for I served, from January 2006 to September 2009, as PCBE's executive director. I set out from the basic observation that in the U.S., bioethics commissions have been, and should continue to be responsive to different needs—needs of the public and policymakers and for ethical advice. A commission can provide that advice in different forms, depending upon the specific need. The specific need determines the form of the advice rendered as well as the method and goal of a commission's deliberations. Thus, a commission should not be restricted to a particular process or goal and should, instead, have the flexibility to adapt these to the specific need for the advice it is called upon to give. Despite the rhetoric of today's debate, this sort of flexibility is observable in the actual practices of recent bioethics commissions, including the PCBE.

My position, however, imposes three necessary conditions on the rendering of that advice by a bioethics commission. First, in deliberating with the aim of providing the needed advice, even if the need is for "practical policy options," a commission must reckon with philosophical fundamentals, with ends as well as means, with often conflicting visions of what is good, right, and just.¹ Second, the advice rendered should be responsive to a need explicitly identified and articulated by the President (or by his surrogates in the executive branch). The executive order that established PCBE and the more recent order creating PCSBI contain nearly identical second sections stating that the...