Q&A: Bioethics at the Institute May 2010

Bioethics at the Institute: Democracy, Federalism & Moral Issues

An Interview with James W. Fossett and Michelle N. Meyer

James W. Fossett and Michelle N. Meyer

Q: Tell us what the field of bioethics includes, and what questions you are interested in here at the Institute.

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The Institute occasionally posts Q&As that are lightly edited transcripts of conversations with our researchers. This is the first part in a Q&A series with the Institute’s experts on bioethics. Future bioethics Q&As will focus more specifically on stem cell research and assisted reproductive technologies.

James W. Fossett directs the Institute’s research program in bioethics and federalism, and is associate professor of public administration and public health at the Rockefeller College of Public Affairs and Policy, University at Albany. Institute Fellow Michelle N. Meyer is a Greenwall Fellow in bioethics and health policy at the Johns Hopkins Bloomberg School of Public Health and the Georgetown University Law Center, and associate faculty in the Union Graduate College–Mt. Sinai School of Medicine bioethics program.

Michelle Meyer: It’s a very broad term, and it encompasses all kinds of ethical questions pertaining to not only medicine, but also biotechnology. Some bioethicists want to expand that to include not only humans, but also other sentient creatures, nonhuman animals, even the environment — there’s some environmental ethical work that sometimes goes under the rubric of bioethics.

So it’s a fairly broad label. But some of the most important and recurring themes in bioethics are issues at the beginning and end of life. At the end of life, for example, are moral issues involving euthanasia, physician-assisted suicide, cadaveric organ donation and criteria for determining death. At the beginning of life are things like abortion, stem cell research, genetic testing and screening for various conditions during pregnancy, and assisted reproductive technologies. And in between the beginning and ending of life is a whole list of other things, including:

  • living organ donation;
  • biomedical research;
  • issues involving the patient-clinician relationship, including informed consent, privacy and confidentiality, and conflicts of interest;
  • issues of health care access, quality, and cost; and
  • rationing of scarce health-care resources (kidney dialysis has been a historic example).

Q: What are you focused on here in your work at the Institute?

Jim Fossett: For reasons that are more accidental than anything else, we have been spending a lot of time worrying about human embryonic stem cell research.

Q: What do you mean when you say “accidental reasons”?

Jim Fossett: It’s received more press coverage than other scientific issues except global warming.

It’s also something that fits very well with the Institute’s traditional interest in federalism. The federal government has been the traditional payer for biomedical research, but the Bush Administration was adamant about limiting what the federal government was willing to pay for in the case of stem cells. In response, a lot of states have devised their own programs for making this research easy to do, and, in some cases funding it at fairly significant levels. Other states have restricted what people inside their borders can do.

So it’s something that fits very well with our traditional interest in federalism. And it’s been fairly visible in the political process. So that’s where we’ve been concentrating the bulk of our efforts.

Q: How does the U.S. system of federalism play into all the issues that you look at? Are there advantages and disadvantages to a federalist system in terms of how these various technologies and areas of research develop?

Jim Fossett: When you’ve got a society that’s as diverse as ours is, in terms of religious traditions and cultural traditions, you don’t want to make policy without some underlying basic moral consensus, if you will.

The British can make a national policy about stem cell research, because they’ve had this working majority going back a long time for the proposition that health is a collective good that’s an appropriate subject for regulation by the political process. Setting up national bodies to make policy in these areas has not been something that’s terribly controversial — though some of their individual decisions have been. But in terms of, “Is this an appropriate thing for the political process to be doing?” There’s not been a lot of debate about that. The Brits until relatively recently have been fairly homogeneous — they all come from the same basic cultural background, they’re all basically Protestants. But you can’t really say that about us. We are all over the place in cultural and religious terms.

One of the advantages of a federal system, that’s been argued since the Federalist Papers, is that it provides a means of accommodating and managing these kinds of conflicts. If you can’t have a national majority — and I don’t think we’ve got one for any of this stuff — you can have state majorities. And what that very kind of decentralized system does, it at least maximizes the number of people who live under a moral regime they approve of. That’s not a bad thing in a democracy.

If you tried to push a national consensus on some of these terribly controversial issues, where one doesn’t exist, it’d be a complete waste of time. We’ve got this culture that’s very much about individual choice, it’s very decentralized, we’ve got a whole host of political — and to a certain extent, ethical and moral — reasons that have kept the government out of these issues. And with our level of cultural and religious diversity, a system that gives maximum play to this diversity is not such a bad thing. We’ve drawn the line at some other places — abortion is one of the few procedures that states can’t interfere with. But by and large, we’ve left this stuff pretty much alone.

Q: Or up to the states.

Jim Fossett: Or up to the states. And the states haven’t really been all that aggressive about it either. Again, because it’s so controversial.

Michelle Meyer: The other value I think to the federalist system is, as Jim says, it’s good not to create a policy unless you can get decent consensus for it. Also good not to create a policy — at any level of government — unless you have decent empirical evidence to back up your policy.

It’s a complicated historical story about how the field of bioethics came to be, but it started out in theology and then quickly got taken over by philosophers, so it’s very much driven by humanists, who have little to no empirical training. And I include myself in that mix, so I don’t mean to say anything disparaging. But sometimes bioethicists make moral arguments that are premised on empirical assumptions: if we do a, it will surely lead to b. Well, maybe it will and maybe it won’t. And a federalist system allows us to test that hypothesis by comparing outcomes where states deal differently with some of the same problems, and hopefully giving us better empirical bases for our bioethical pronouncements.


The Nelson A. Rockefeller Institute of Government, the public policy research arm of the State University of New York, conducts fiscal and programmatic research on American state and local governments. It works closely with federal, state, and local government agencies nationally and in New York, and draws on the State University’s rich intellectual resources and on networks of public policy academic experts throughout the country.