The End of the Great Bioethics Compromise

The ideological struggle that riled bioethics in the most recent election cycle, embodied especially in the sometimes harsh debate about the President's Council on Bioethics, has been latent in the field from the very beginning. Joseph Fletcher's pioneering work in the 1950s and 1960s identified humanity's opportunity, made possible by the new era of genetic knowledge, for self-creation. Fletcher looked this brave new world in the face and liked what he saw, but as the first generation of self-conscious American bioethicists joined him in the later 1960s, they started ringing alarm bells. Gene therapy, recombinant DNA research, designer babies, organ transplants, xenotransplants, artificial organs, life-extending medical treatments, and bold human experimentation seemed to threaten traditional concepts of human boundaries.

Out of these esoteric worries and the public scandals and controversies that sometimes accompanied them, bioethics developed the consensus philosophy and social role it has largely assumed since the 1970s: Keep a close eye on scientific innovation for its societal implications, apply the brakes now and then as needed through regulations or guidelines or just the glare of public discussion, and let the bioethicists be the ones to analyze how all this is going. Call it the Great Bioethics Compromise.

A few scattered critics have argued that this arrangement ultimately guarantees science a green light, disguised as a flashing yellow, and empowers an in-group of self- and mutually-appointed bioethicists to manage traffic. Meanwhile, the argument goes, the public is bought off through superficial assurances that the shop is being watched. Even the unique and well-funded Ethical, Legal, and Social Issues program of the National Human Genome Research Institute can be viewed as a happy coincidence of the interests of science, which wants to appear to be restrained, and the interests of ethicists, who want to actually be paid.

One of the few who has for the past thirty years expressed varying degrees of discomfort with this implicit arrangement is Leon Kass. His gradual and somewhat grudging acceptance of in vitro fertilization technology has not diminished his consistent reservations about where science is taking the species. Also relevant is the fact that, until his current appointment, Kass seems to have studiously avoided becoming a part of the regulatory ethics apparatus of advisory committees, commissions, and the rest, even though as an early Hastings Center Fellow he certainly had the connections and status to be involved. He avoided such activities, that is, until he could be assured of leading a body whose bioethics agenda he could set, including avoiding moral consensus as a goal. What distinguishes Kass's approach to bioethics from that of many of his contemporaries is not so much his skeptical attitude about the prospects the life sciences offer humanity, as the fact that he is one of a very few whose discourse continues to resemble that of the prophetic founders of the field.

Kass never quite bought into the Great Bioethics Compromise. In the mid-1970s, Kass was one of a small group, perhaps a few dozen scholars and scientists, who met together as often as they could to share a common fascination for bioethical issues. The Compromise was established toward the end of that decade, in the wake of the Quinlan decision (1976) and during the National Commission for the Protection of Human Subjects (1974-78). In retrospect, it is remarkable that it all happened so fast, largely without the protagonists' awareness.

The Compromise was made possible partly thanks to an implicit agreement that in effect allowed deep divisions about certain issues related to the origins of human life to be courteously ignored. Until around 1980 the group was so small that all of its members fit into a single room, and they needed to get along well enough to keep talking. But consider that if Roe v. Wade had been decided in 1982 rather than 1972, bioethics might have been deeply split and the Great Bioethics Compromise severely threatened. As it was, there were so few people in the field in 1972 that the full effects of the decision were not immediately felt in incipient bioethics. The...