Eschewing the academic mainstream, Bush panel focuses on technology’s dangers
Biography: Leon R. Kass
List: Members of the President’s Council on Bioethics
Colloquy: Join an online discussion about whether President Bush’s advisory panel on bioethics is being led by its chairman, Leon R. Kass, to issue reports that treat scientific innovation with suspicion and offer little in the way of useful policy recommendations.By JEFFREY BRAINARD
Before the first test-tube baby was born, in 1978, Leon R. Kass, then a professor in the Committee on Social Thought at the University of Chicago, was worried. The procedure, he wrote, could harm children created in the laboratory and implanted into mothers’ wombs. He suggested that researchers refrain from attempting in-vitro fertilization until its safety could be ensured.
Today his concerns appear to have been overstated. More than one million children worldwide have been born through the procedure, and physicians generally regard it as safe.
Dr. Kass now describes his controversial views about in-vitro fertilization as misunderstood, and at times taken out of context. He has said the same about the reports of President Bush’s advisory council on bioethics, which Dr. Kass has led since it was created, in 2002.
Some academic observers don’t buy that. The council, they assert, is driven by conservative ideology and has rushed to alarmist conclusions about the social and human ramifications of medical research in areas like memory, aging, and embryo cloning. Others argue that the council has ignored prosaic topics, such as access to medical care, that are more relevant to the nation today than some of the exotic technologies it has explored, like human-animal hybrid embryos.
“Leon has been a technological pessimist from the get-go,” says LeRoy B. Walters, a professor of Christian ethics at Georgetown University. “He accents the risks and dangers.” One of the council’s recent reports, which raised warnings about drugs that enhance human performance, makes it seem “as if most of basic research is dangerous and not directed toward important goals,” continues Mr. Walters. “I just think that’s false.”
Dr. Kass says the council is right to tackle issues that most academic bioethicists have neglected, because their studies are too narrowly focused. Even scholars who disagree with some of Dr. Kass’s conclusions agree that the council has raised important questions.
“Read the transcripts” of the council’s meetings, Dr. Kass says. “Read our reports. Show us where ideology, homogeneity, those kinds of things, have taken precedence over serious, thoughtful, and balanced reflection.”
Contemplation is one thing, influence another. Even though the council’s ideas and membership have spurred enough controversy in the last two years to place it at one of the most-contentious, high-profile intersections of academe and federal policy, its impact remains unclear. Just two of the council’s four reports, for instance, contain specific recommendations for public policy.
“It’s like they’re running a national seminar,” says George J. Annas, a professor of health law, bioethics, and human rights at Boston University. “They say, ‘This stuff is worrisome, but we’re not ready to do anything about it.’”
Limits of Traditional Bioethics?
The President’s Council on Bioethics was born out of the national debate over stem-cell research. When President Bush announced, in August 2001, that he would allow federal research funds to be used to study colonies of human embryonic stem cells that existed at that time, he also called for a panel of experts, headed by Dr. Kass, to monitor the research.
In January 2002, the president named the council’s 17 other members, all but one of them affiliated with a college. Mr. Bush asked the panel “to help be the conscience of the country” on developments in medicine and biomedical and behavioral research, and to help evaluate their “human and moral significance.” The council’s mandate also called for it to consider specific issues, including cloning, embryo research, and assisted reproduction.
It was not the first such panel: Five other national bioethics panels have been established by presidents or Congress since the 1970s. Although they too were intended to serve only an advisory role, some have fostered major improvements in medicine and research. One commission’s report, in 1979, led to the first federal regulations for the protection of human research subjects. And work by another panel, in the early 1980s, helped push states to develop laws allowing patients to write “living wills,” which spell out whether they should be given life-saving medical treatment if they become comatose.
The current council is different in several respects. The earlier panels approached issues largely from the standpoint of how to protect the rights, autonomy, and safety of patients and research volunteers. That’s the same approach used by most experts in the academic field of bioethics, which has evolved over the same period.
Dr. Kass says that the field has encouraged laudable changes in medicine, but that academic bioethics and previous advisory councils have neglected broader and important questions about the uses of biomedical research. For example, will medical advances that cure disease lead to an ever-expanding population of older people selfishly pursuing longer life, regardless of the burden they place on younger people to pay for their care? Will genetic engineering allow people to tinker with their bodies and minds in ways that society is not prepared for?
“If you think you could go into this field [bioethics] and do justice to its profundity by talking only about a new regulation here, or a new informed-consent procedure there, you’ve missed the deep meaning of what the biological revolution is,” he says, speaking in a recent interview in his office here. “I’m not even talking about the eugenic zealots who talk about perfecting human beings and improving human nature. I’m simply talking about the consequences of success in our ordinary efforts to alleviate human suffering and cure disease.”
“The benefits of these technologies are obvious,” he continues. “They’re widely known -- better health, longer life, relief of suffering, elimination of disabilities -- and none of our reports gainsays those benefits. What’s less obvious are the possible costs of success.”
Dr. Kass’s Unusual Views
Dr. Kass, 65, brings an eclectic background to such discussions. He is a medical doctor and earned a doctorate in biochemistry but long ago stopped practicing in those fields. At Chicago, where he is now on leave, he has taught and written widely in the humanities, with an emphasis on the Bible, Greek philosophy, and literature.
That work has informed his own writings about bioethics and a variety of topics. While his scholarship is generally regarded as distinguished, some observers find some of his conclusions odd. For example, his 1994 book The Hungry Soul explores connections among food, social relations, science, and humanity. The book is known for some provocative remarks about “more uncivilized forms of eating, like licking an ice-cream cone -- a catlike activity that has been made acceptable in informal America but that still offends those who know eating in public is offensive.”
Asked about that excerpt, Dr. Kass suggests, as he frequently does about the council’s work, that a reading of the entire book reveals a fuller meaning, in context.
“Sure, there are fine occasions -- picnics, food fests -- where the usual presumption against eating in other people’s faces is relaxed and overcome,” he says. “But commentators on manners throughout the centuries have generally adhered to the view that it is impolite to compel people involuntarily to participate in your digestion. I was not interested in criticizing and condemning, but in raising our awareness of how we try to civilize and refine the manners by which we meet our bodily necessities and of the connection between eating and sociality. Read the book.”
On the question of in-vitro fertilization, or IVF, Dr. Kass also holds something of a minority view. Although he notes that he endorsed the technology for infertile couples soon after the first test-tube baby was born, he wrote in 1971 that the procedure would be unethical because it represented an experimental and potentially risky treatment, to which the resulting children could not have objected in advance.
“The lucky result,” as he now puts it, that most of the babies appear to be healthy “does not make having raised the question wrong.”
“Also,” he says, “my concerns back then that IVF would set us on a path toward cloning, genetic selection of embryos, and all kinds of sticky questions about the exploitation of so-called spare embryos [that scientists have destroyed in research] have been entirely justified by events over the last 30 years. IVF was a watershed development, whose full human meaning is not yet apparent to us.”
Dr. Kass’s concern about in-vitro fertilization stems from limited evidence of increased risks of birth defects in children created through the procedure. A recent report by the bioethics council picks up on that worry, calling for the federal government to finance further research on the question for the first time.
Despite his protestations to the contrary, some bioethicists suggest that Dr. Kass’s conservative leanings and personal views, such as his skepticism about in-vitro fertilization, have come to dominate the council and its reports. “Unlike any other presidential commission, [this one] has become associated with the views of its chair,” says R. Alta Charo, a professor of law and bioethics at the University of Wisconsin at Madison and a member of President Bill Clinton’s bioethics advisory council.
Disputed Appointments
Controversy over the council members’ views flared in February, when President Bush declined to reappoint two members, Elizabeth H. Blackburn of the University of California at San Francisco and William F. May, a retired professor at Southern Methodist University.
The two had taken issue with the president’s policy limiting federal funds for stem-cell research. In renewing the council’s charter, Mr. Bush appointed three new members, two of whom were on record as opposing research cloning. The procedure involves the creation of cloned human embryos or blastocysts as a source of stem cells for experimental use to treat damaged or diseased tissue.
More than 170 academic bioethicists signed a letter of protest. Some saw the dismissals as an attempt to stack the council and, perhaps, to reverse its 2002 report on cloning. In that report, 10 council members endorsed a moratorium on such research, and 7 of them supported an outright ban, including Dr. Kass. Seven others, including Ms. Blackburn and Mr. May, supported the studies, with regulation.
The two newcomers opposed to research cloning -- Diana J. Schaub of Loyola College in Maryland and Peter A. Lawler of Berry College -- could shift that vote in favor of an outright ban. And their lack of name recognition among academic bioethicists has fueled suspicion about why they were appointed. (In one sense, though, the issue may be moot: Before President Bush appointed the original council, in 2002, he said he wanted to ban research cloning.)
Dr. Kass, who is plainly annoyed by the fuss, dismisses charges of ideological bias in the selection of council members. The new members, he says, have studied subjects that the council may take up, including care for the elderly and research in neuroscience. What’s more, Dr. Kass insists that the council is more politically and intellectually diverse than any of its predecessors, partly because, unlike them, it includes several members who oppose abortion.
“You cannot have pro-life members on a council, and scientists recognized as leading members of the scientific community, and expect them to agree on everything, especially about the moral status of the early human embryo,” he says. “It would have been a lot easier to be the chairman of a homogeneous council, let me tell you. But I wouldn’t have done it. ... I like this diversity of opinion. I welcome it.”
The suggestion that members of the council are clones of Dr. Kass is simply wrong, says another member, Rebecca S. Dresser, a professor of law and ethics in medicine at Washington University in St. Louis.
“He’ll throw something out for discussion, and the people really have individual views on just about everything,” says Ms. Dresser, who describes herself as a liberal Democrat. The council staff, she says, does “a wonderful job of incorporating suggestions and coming up with reports that I feel comfortable with.”
“Our country is so polarized right now, and I think the discussions on the council reflect that,” she says. In outside discussions about the council, “the focus has been much more on the politics of this group than the substance of what we’re saying.”
Technology, Pro and Con
Perhaps reflecting that polarity, scholars who have read the council’s reports have offered mixed reviews about what they contain -- or leave out. Some critics, for example, have suggested that the council’s report “Beyond Therapy,” which examines performance-enhancing drugs and other emerging medical technologies, is anti-science.
In a letter to President Bush, Dr. Kass said the report explored the “dual uses” of medical technologies that are useful not only to sick people but also to healthy ones “who would use them to look younger, perform better, feel happier, or become more ‘perfect.’”
Some examples included well-known cases ripped from recent headlines: choosing the sex of children while they are embryos, giving children psychotropic drugs to improve their behavior and academic performance, and the use of steroids by athletes. The report also pondered research that could have the effect of increasing the maximum human life span or dulling the pain of unpleasant memories.
Those cases involve natural human urges that could be carried to extremes, Dr. Kass says. “There are reasons to wonder whether life will really be better if we turn to biotechnology to fulfill our deepest human desires,” he wrote in the letter. Rather than proposing to ban research or medical practice in those areas, the report proposed to encourage public understanding and discussion of the issues involved.
But some scholars have reacted sharply against concerns expressed in the report about how medical innovations might transform human nature and violate human dignity. Those are fuzzy concepts that mean different things to different people and ultimately appeal more to emotion and possibly religious faith than to reason, suggests Glenn McGee, a professor of medical ethics and philosophy at the University of Pennsylvania.
Others argue that the council has raised important practical questions that policy makers and society have not adequately considered. For example, will screening out embryos with genetically unfavorable traits be followed by screening for traits perceived as desirable, such as blue eyes?
Some scholars also argue that it’s misleading to view the council simply in terms of a liberal-conservative political divide. Instead, they say, it’s more accurate to describe the council as taking up debates between supporters of technology and skeptics. The doubters include some on the left who worry about corporations’ controlling and marketing such powerful technologies.
As to whether the report is overly pessimistic about science, Dr. Kass suggests considering an issue as seemingly simple as research on aging. An increase of 50 years in the maximum life expectancy, he says, “would produce massive and unprecedented changes in human society.”
“I’m not in favor of cutting off research,” he says. “But I am in favor of some greater thoughtfulness against the shallowness of utopian thinking that sees something in the human condition that it doesn’t like and thinks you could intervene and fix it up without producing all kinds of systemic changes in the kind of being that we humans are.”
While the report is long on that kind of reflection, it offers no public-policy recommendations because, it says, many of the new technologies are still developing. As a result, some critics have questioned the report’s utility. A critical editorial in the journal Nature Biotechnology concluded that “there are times for getting to the damn point.”
Missed Opportunities?
Even when the council has made substantive policy recommendations, though, it has drawn criticism.
In a report about reproductive technologies, released last month, council members concluded that while they could not agree on whether the government should allow research cloning, they did suggest that the government outlaw some exotic types of reproductive research, including the creation of embryos by fusing human and animal cells, and the implanting of human embryos in animal wombs. The report suggested laying down “boundaries” before “rogue” scientists crossed them.
“Look, we shouldn’t discover that certain boundaries are crossed just because we were looking the other way and didn’t notice,” Dr. Kass says. “If these boundaries are to be crossed, let it be because someone has come forward and made the case for the necessity of doing so.”
But one of the council’s members, Michael S. Gazzaniga, dean of the faculty and director of the Center for Cognitive Neuroscience at Dartmouth College, suggests that some of the examples in the report are “arguments by freak show.” Although scientists in China have reported implanting a human cell nucleus into a rabbit ovum -- creating a hybrid that did not develop further -- few if any serious researchers want to duplicate such work, Mr. Gazzaniga says.
Such research “probably has a certain attention-grabbing quality,” and discussing it is a useful exercise for “intellectual gaming,” he says.
But Mr. Gazzaniga wonders if a taxpayer-supported bioethics council should focus on such topics “unless there’s a direct and immediate biological issue related to public policy, like there was with the stem-cell and cloning issues.”
Indeed, some criticism of the council relates not to what it is studying, but what it is not.
One such area is public access to health care. In 1983 a bioethics council described health care as something akin to a right of all citizens. Today, with 40 million Americans lacking health insurance, the issue is ripe to be revisited, says Mr. Walters of Georgetown.
In addition, fears of bioterrorism since September 11, 2001, have raised new questions that the bioethics council should tackle, says Mr. Annas of Boston University. For example, should the Food and Drug Administration relax its rules for the safety and efficacy of drugs to counteract biological-warfare agents? And how could such drugs be ethically tested?
Some previous bioethics panels were more focused on such “nuts and bolts” policy questions, Ms. Dresser notes. But if the current one ends up contributing mostly to a broader public understanding of bioethics issues, that will be a useful service, she says.
“I think that over time, different councils are going to make different contributions,” she says. “The next presidential council will probably go in a different direction, and that’s probably healthy.”
In the meantime, she says, “I’m enjoying very much stepping back and trying to think in terms of some bigger ideas. I think that’s consistent with what academic people ought to do.”
LEON R. KASS
Born: February 12, 1939, in Chicago. His parents were secular, socialist, immigrant Jews from Eastern Europe.
Education: B.S., biology, University of Chicago, 1958; M.D., University of Chicago, 1962; Ph.D., biochemistry, Harvard University, 1967.
Career highlights: Fellow, American Enterprise Institute, 2002-present; professor in the Committee on Social Thought, University of Chicago, 1976-present (on leave); research professor in bioethics, Kennedy Institute of Ethics, Georgetown University, 1974-76; tutor, St. John’s College, Annapolis, Md., 1972-76; executive secretary, Committee on the Life Sciences and Social Policy, National Research Council, National Academy of Sciences, 1970-72; researcher, Laboratory of Molecular Biology, National Institute of Arthritis and Metabolic Diseases, National Institutes of Health, 1967-70; founding fellow, Hastings Center, a bioethics think tank in Garrison, N.Y.
Selected books: The Beginning of Wisdom: Reading Genesis (Free Press, 2003); Life, Liberty, and the Defense of Dignity: The Challenge for Bioethics (Encounter Books, 2002); Toward a More Natural Science: Biology and Human Affairs (Free Press, 1985).
Personal: Married since 1961 to Amy Apfel Kass, a senior lecturer in the humanities at the University of Chicago. They did organizing work with the civil-rights movement in Mississippi in 1965. They have two daughters and four granddaughters.
Dr. Kass says he works seven days a week as chairman of the President’s Council on Bioethics. (The position is unpaid, although council members get a small honorarium for each day they attend council meetings.) His hobbies include bicycling, hiking, bird-watching, opera, conversation with friends, “losing with the Chicago White Sox,” and reading good novels aloud with his wife.
Dr. Kass has just finished reading The Forgetting, a book by David Shenk about Alzheimer’s disease, and is now reading Memoirs of a Jewish Extremist, a book by Yossi Klein Halevi about his involvement in right-wing Jewish political movements.
SOURCE: Chronicle reporting
MEMBERS OF THE PRESIDENT’S COUNCIL ON BIOETHICS
Leon R. Kass (chairman), fellow, American Enterprise Institute; on leave as professor in the Committee on Social Thought, University of Chicago
Benjamin S. Carson, director of pediatric neurosurgery, Johns Hopkins University
Rebecca S. Dresser, professor of law and ethics in medicine, Washington University in St. Louis
Daniel W. Foster, professor of internal medicine, University of Texas Southwestern Medical Center at Dallas
Francis Fukuyama, professor of international political economy, Johns Hopkins University
Michael S. Gazzaniga, professor of cognitive science, Dartmouth College
Robert P. George, professor of jurisprudence, Princeton University
Mary Ann Glendon, professor of law, Harvard University
Alfonso Gómez-Lobo, professor of philosophy, Georgetown University
William B. Hurlbut, consulting professor in human biology, Stanford University
Charles Krauthammer, syndicated columnist
Peter A. Lawler, professor of government, Berry College
Paul McHugh, professor of psychiatry and behavioral sciences, Johns Hopkins University
Gilbert C. Meilaender, professor of Christian ethics, Valparaiso University
Janet D. Rowley, professor of medicine, of molecular genetics and cell biology, and of human genetics, University of Chicago
Michael J. Sandel, professor of government, Harvard University
Diana J. Schaub, professor and chairwoman of political science, Loyola College in Maryland
James Q. Wilson, professor emeritus of management, University of California at Los Angeles
http://chronicle.com Section: Government & Politics Volume 50, Issue 37, Page A22