Reprogenetics: Law, Policy, and Ethical Issues

9 A Brief History of Public Debate about Reproductive Technologies: Politics and Commissions

A Brief History of Public Debate about Reproductive Technologies Politics and Commissions C H A P T E R N I N E Over the past thirty years, society has faced a steady progression of advances in medically assisted reproduction and genetics that have been simultaneously considered everything from miraculous to immoral, depending on one’s point of view. In vitro fertilization (IVF) and other assisted reproductive technologies, prenatal diagnosis, preimplantation genetic diagnosis, fetal tissue transplantation, prospects for germline gene transfer, human embryo research, and now human cloning have increased the need for public discussions about difficult public policy choices. Many of these choices, although lumped under “bioethics,” are in fact social issues of considerable importance for policy. They have significant implications for choices regarding research funding, legislative prohibitions, regulations, moratoria, health care financing, and reimbursement. They can even enter campaign politics in critical election years. Underlying many of the debates over these issues is a concern for the sanctity of human life and the relative importance of an individual life when weighed against the importance of many lives. Thus, often two “good things” are in conflict, such as a societal incentive to ameliorate disease through embryonic stem cell-based therapy and an individual’s belief that the destruction of an embryo is the equivalent of murder. How to set boundaries and a course for proceeding as a society in this web of ethical complexity has become extremely contentious. K AT H I E . H A N N A Controversy over science and technology, especially over those matters pertaining to reproduction and genetics, entails unique clashes between expertise and ignorance, encompassing ideals about rationality and progress and challenging our traditional notions of legitimacy and authority. Who gets to decide these important issues when so many are affected and there is no central authority? In the absence of a single authoritarian church or other mechanism with which to handle these issues in a pluralistic democracy, U.S. society increasingly finds itself turning to its government for the resolution of knotty ethical issues. The need has not been so much to find moral solutions to complex policy issues but to identify the moral problems and define the trade-offs among alternative moral principles (Hanna 1991). Beginning in the early 1990s, the need to discuss these issues at the national level has been increasingly recognized. In calling for a forum for such discussions in the early 1990s, former senator Mark Hatfield said, “in public policy, if there is a vacuum, government eventually will fill it, right or wrong, good or bad. We just can’t let difficult bioethical matters evolve at will; we ought to help direct them” (U.S. Congress, Office of Technology Assessment (OTA) 1993). Pluralism and democracy do not provide a very efficient set of processes through which to resolve such complexity. Government involvement in the area of reproductive science policy has demonstrated that, in general, we adjust the system in incremental ways through a variety of convoluted processes. This approach to governance, called “the science of muddling through” by economist Charles Lindblom (1959, 1979), is by no means unique to reproductive technology. It has long been the hallmark of U.S. public policymaking . However, it is particularly germane to our national response to reproductive technology, for several reasons: (1) rather than engaging in rational research and assessment of all possible solutions to a complex set of problems , it allows policymakers to concentrate only on measures that differ incrementally from existing policies; (2) the issues to be addressed are continually redefined until a response that is most amenable to solution is identified; and (3) as a result, a “suitable solution” does not exist, only a series of endless assaults on the problem(s) (within the realm of feasibility). With this strategy toward public policy and decision making, it is a wonder that the government ever gets anything done. And sometimes that is the point. Inaction is action. Incrementalism results in decision making that is sometimes merely therapeutic, aimed at soothing some existing shortcomings and not at promoting future social goals (Lindblom 1959, 1979). It serves a useful purpose when society is critically divided on issues that cross scientific, technical , legal, social, political, and spiritual boundaries. 1 9 8 K AT H I E . H A N N A Since 1974, numerous federal commissions, committees, and panels have been created...