Lessons and Opportunities for Presidential Bioethics Commissions

The November 2009 creation of the Presidential Commission for the Study of Bioethical Issues by the Obama administration signals a new chapter in the history of federal bioethics advice.¹ Coming several months after the previous group, the President's Council on Bioethics, was disbanded, the establishment of the new commission adds to the thirty-five year history of federal government interest in expert advice on bioethics.

While presidential bioethics commissions appear to have become a standard presence in Washington, their purpose, membership, agenda, audience, and impact have attracted considerable attention and debate among scholars, the media, and the public.² Some ask whether a need for such groups even exists, at least in the form employed by recent administrations. As the Obama bioethics commission begins its work, it would be well served to reflect upon the experiences of prior groups, examining the merits of their respective approaches both to studying topics in bioethics and to offering advice to the government. This work should be part of a sustained inquiry regarding the future of government bioethics advice, in the hope of establishing a model that is both capable of providing meaningful assistance to policy-makers and responsive to the novel issues raised by future advances in science and medicine.

A Short History of National Bioethics Commissions

There exists a growing literature on the histories and legacies of the many bioethics commissions that have existed in the past four decades. While there is some debate as to which groups should be included on such a list, most point to the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (1974-78), best known for the Belmont Report, as the progenitor of bioethics advisory groups at the federal level.³

Following the National Commission, subsequent bioethics panels included the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (1978-83) and the Ethics Advisory Board (1978-79).⁴ Referring to this first generation of committees as "bioethics commissions" is somewhat of an anachronism, as the field of bioethics was still in its infancy at the time. While these groups addressed issues that are now central to contemporary scholarship in bioethics, only some of their members saw themselves or their work as part of the developing bioethics community at the time.

In the early years of the Clinton administration, the Human Embryo Research Panel (1994) and the Advisory Committee on Human Radiation Experiments (1994-95) were both created.⁵ Sharing a short lifespan, a specific mandate regarding topics to explore, and an interdisciplinary membership including those affiliated with university-based bioethics departments and programs, these bodies may be viewed as the second generation of bioethics commissions.

The 1995 establishment by President Bill Clinton of the National Bioethics Advisory Commission (NBAC) began the third generation of bioethics commissions, also including the President's Council on Bioethics (PCB), created in 2001 by President George W. Bush. These groups existed during a time of rapid growth for bioethics departments, graduate programs, and academic journals. Events including the cloning of Dolly the sheep, advances in stem cell science, and the case of Terri Schiavo attracted major interest and debate among policy-makers and the public, providing an opportunity for bioethics and bioethicists to raise their profiles in Washington and in the media. Unlike earlier groups, the Clinton and Bush commissions have "bioethics" in their names. This may reflect a heightened awareness of the value of bioethical inquiry or the political value of demonstrating concern for bioethical considerations by creating presidential advisory committees devoted specifically to them.

Despite profound differences in membership, ideology, and products, the structures of both NBAC and PCB were quite similar. Both commissions were established by executive order, with charters renewed through the conclusions of their respective administrations.⁶ The origins of both groups can be traced to specific scientific issues of interest to the president at the time: human subjects research for Clinton and NBAC and embryonic stem cell research for Bush and PCB. While the commissions were instructed to study these topics, the executive orders creating both...