Back in the late 1990s, when cloning was about Dolly and not about stem cells, I had the privilege of attending an ancillary meeting of the International Association for Bioethics annual conference. Representatives of national bioethics commissions from around the world had gathered at this meeting to discuss the possibility of a global consensus position on reproductive cloning.
The conversation moved along predictable lines, with all agreeing that reproductive cloning was unsafe for now, and that even if it ever was safe, it was generally a distasteful idea. The reasons for finding it distasteful ranged from concerns about excessive parental egoism to disregard for children's expectation of uniqueness to a (mathematically unpersuasive) diminution in human genetic variation. Countering these arguments were, again, the predictable bows in the direction of personal autonomy in reproductive decision-making.
Although consensus was easily reached on the merits (or lack thereof ) of reproductive cloning, proposals to harmonize national policies were more troublesome. While many countries had invested unfettered power in their national governments, the United States was faced with questions about federal versus state jurisdiction and about constitutional protections for reproductive choices. In addition, although many countries had the political freedom to craft compromise positions in the realm of human reproduction, U.S. politics was strongly influenced by the bitterly divisive abortion debate, a debate that had led pro-choice groups into extreme libertarian positions lest the principle of reproductive choice be undermined.
As I listened, I found myself thinking that any effort to harmonize national policies would depend less upon a consensus concerning the technology and more upon whether national legal and political cultures could be harmonized. And further, if we genuinely value diversity in national cultures, harmonization of diverse national policies would not only be difficult, it might not even be desirable.
I also wondered if the way to craft bioethics public policy or to predict the outcome of bioethics policy debates might be to start not with an ethical analysis of the technology itself but with a political analysis of the particular national or regional governmental setting. In other words, is it possible that sweeping political forces—historical, cultural, structural, legal—may overdetermine the outcome of bioethics public policy debates? This is not to suggest that analyzing the duties of parents or physicians, or the difference between withholding and withdrawing care, or the distributive justice questions underlying access to health care, is pointless; merely that such analyses are inadequate to justify what we ought to do or to explain why we will pick certain bioethics policies over others. Furthermore, ethical analysis, while relevant, does not represent a superior or more pure approach to public policy. Politics is not merely an irritating constraint that prevents us from doing what is right; it is rather an embodiment of other values best discussed in terms of political philosophy rather than moral philosophy, and these values, too, must guide our decisions.
Unique histories yield unique phenomena. The antibiotechnology and antieuthanasia forces, though present in all countries, are particularly robust and influential in Germany because of its Nazi heritage. While eugenics was most certainly a phenomenon in the United States, it has far less hold on American politics because it was not part of a national trauma (although it is frequently cited by anti-choice activists because of its association with early birth control movements). One of the few areas in which the issue of eugenics has really had traction in the American national debate is in its intersection with racial equality, a phenomenon that itself reflects the unique history of the United States, in which slavery is our original sin.
Other factors are more economic or cultural than historical. In countries with national health care, for example, doctors are part of a system of service prioritization. As a result, they are part of the management team, and, along with economists, philosophers, and administrators, will form an alliance that decides which services are owed to patients and which are not.1 In the United States, by contrast, physicians often work in fee-for-service settings, and they become allies with their patients in a consumerist demand for more patient autonomy in...