The Ramazzini Institute
for Occupational and Environmental Health Research   

Who Are We?

Moral Questions
Leon R. Kass: Playing Politics With the Sick?

     In the heat of the Bush-Kerry race for the White House, even the widow and the son of late President Ronald Reagan, and of course the hopeful afflicted among the famous in Hollywood and the families in Hoboken, have been engaged in the politics of new government-funded sources for new lines of embryonic stem cells for research. From the day of appointment nearly four years ago, President George W. Bush’s Council on Bioethics has been injected with political controversy and accused of being a ‘conservative’ cluster of ideological “clones.” The Chairman of the Council, a politically appointed agency within the Office of the President, charges Senator John Kerry with ignoring “the weighty moral issues involved’. [Leon R. Kass. “Playing Politics With the Sick”. Washington Post Op-Ed October 8, 2004.] But how many of the antagonists in the political debate have actually read the commission’s report? 
     While the political controversy clearly exists and persists, the charge of political cloning can hardly be credible, given the wide disparity of views within the Council itself and the public positions taken by members, especially members who are medical scientists. Moral questions about bioethics itself, and how it is practiced appear to be obscured. In contrast to the dialectic of the Council’s deliberations, Kass’ introduction relies on ‘principalism”, rather than the ‘slippery slope’ argument for inevitable human failure explored in Council deliberations by journalist/physician Charles Krauthammer and other members of the Council. The “mainstream” of the bioethics community may accept the ‘principles’. They may not accept Kass’ application of the principles. [See www.thehastingscenter.org  for testimony and public statements of Thomas H. Murrary, President of the Hastings Center, who has taken positions closer to those of Senator Kerry in the political controversy.] There are even questions about the validity of the “principles” themselves. [See B. Gert et al. “Bioethics: A Return to Fundamentals.” Oxford 1997 and the work of sociologist Elaine Draper on genetic testing in the workplace and the moral dilemma of the company doctor.]
     For the dialogue that will continue after the election, it might be useful to read what Chairman Kass wrote in his introduction to the Council’s report on the issue.

Excerpt [XIX – XX] from the Introduction
Being Human
Washington, DC: The President’s Council on Bioethics, December 2003
Leon R. Kass, MD, PhD. Chairman[1]

     The major principles of professionalized bioethics, according to the leading textbook in the field, are these: (1) beneficence (or at least "non-maleficence"-in plain English: "do no harm"), (2) respect for persons, and (3) justice. As applied to particular cases, these principles translate mainly into concerns to avoid bodily harm and to do bodily good, to respect patient autonomy and to secure informed consent, and to promote equal access to health care and to provide equal protection against biohazards. So long as no one is hurt, no one's will is violated, and no one is excluded or discriminated against, there may be little to worry about. Fitting well with our society's devotion to health, freedom, and equality, this outlook governs much of today's public bioethical discourse.
     Thus, we worry much that human cloning may be unsafe, but little about what it might mean for the relations between the generations should children arise not from the coupling of two but from the replication of one or should procreation come to be seen as manufacture. We worry much about genetic privacy and genetic discrimination, but little about acquiring godlike powers of deciding which genetic defects disqualify one for birth or about how we will regard our own identity should we come to be defined as largely a collection of genes. We worry much about issues of safety or unfairness when athletes use steroids or college students take stimulants, but little about the way these (and other mediating) technologies might distort the character of human activity, severing performance from effort or pleasure from the activity that ordinarily is its foundation. We worry much about the obstacles to living longer, but little about the relation between trying to live longer and living well.
     In a word, we are quick to notice dangers to life, threats to freedom, and risks of discrimination or exploitation. But we are slow to think about the need to uphold human dignity and the many ways of doing and feeling and being in the world that make human life rich, deep, and fulfilling. Indeed, it sometimes seems as though our views of the meaning of our humanity have been so transformed by the technological approach to the world that we may be in danger of forgetting what we have to lose, humanly speaking.    
     To enlarge our vision and deepen our understanding, we need to focus not only on the astonishing new technologies but also on those (in truth, equally astonishing) aspects of "being human" on which the technologies impinge and which they may serve or threaten. For bioethlcal dilemmas, though generated by novel developments in biomedical science and technology, are not themselves scientific or technological matters. They are human dilemmas-individual, familial, social, political, and spiritual--confronted by human beings at various stages in the human lifespan, embedded in networks of meaning and relation, and informed by varying opinions and beliefs about better and worse, right and wrong, and how we are to live. Often, competing human goods are at stake (for example, seeking cures for disease versus respecting nascent life); in other cases, the evils we seek to avoid are deeply intertwined with the goods we ardently pursue (for example, eliminating genetic defects without stigmatizing those who have them). Moreover, both in practice and in our self-understanding, bioethical issues generally touch matters close to the core of our humanity: birth and death, body and mind, sickness and health, sex and procreation, love and family, identity and individuality, freedom and dignity, aspiration and contentment, the purposes of knowledge, the aim of technology, the meaning of suffering, the quest for meaning. A richer bioethics would attend to these matters directly and keep them central to all bioethical inquiry and judgment. A richer bioethics would feature careful and wisdom-seeking reflection regarding the full range of human goods at stake in bioethical dilemmas.