INSTITUTE Q&A

Q&A: Bioethics at the Institute June 2010

Bioethics at the Institute: Politics and the Stem Cell Debate

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

James W. Fossett and Michelle N. Meyer

Q: We’ve talked about the ethical issues in the stem-cell debate. Now let’s get into the politics. How was the debate framed during the Bush administration?



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The Institute occasionally posts Q&As that are lightly edited transcripts of conversations with our researchers. This is the third part in a series with the Institute’s experts on bioethics, who have written about stem cell policy during the Bush and Obama administrations in the Kennedy Institute of Ethics Journal. Previous Institute Q&As offered background on bioethics topics being examined at the Institute and the ethical issues in the debate over stem-cell research. A future bioethics Q&A will look at 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.

Jim Fossett: Stem cell policy was initially linked very tightly to the abortion debate, which has been one of the more toxic and intractable debates in American politics. The Catholic Church, for example, has weighed in very heavily with this notion that the blastocyst (the part of the embryo where stem cells are derived) is a human thing — a human entity, if not a person.

Michelle Meyer: They would say it’s a person.

Jim Fossett: There are a number of more conservative types that agree that this is a person, and you shouldn’t do anything to damage it. The scientific community hasn’t weighed in on the theological issues, but they place very heavy stress on the idea that we can potentially do all this great stuff that will make people we can’t treat now, better off.

But even the Clinton administration didn’t quite know what to do with this stuff. They were perfectly OK with an agreement that says you can’t use federal money to create stem cells.

So there’s been this group of conservative types that are grounded in the abortion issue. Then there’s another group of people that’s generally, but not always, pro-choice who said we have this potential to do good for a large number of people, and that outweighs whatever theoretical ethical violations you commit.

But increasingly it’s become less and less of a culture-war issue. So you’ve had a certain number of Republicans, even pro-life Republicans, who have been willing to say this is stuff that has great potential, we ought to pay for it. You have people like (Republican Senator) Orrin Hatch, Bill Frist – who was once the majority leader of the Senate — even someone like (former first lady) Nancy Reagan – who I think bought a lot of Republicans cover for voting for this stuff.

So Congress essentially passed twice what Obama later implemented by executive order — expanding the use of federal funds for lines derived from excess embryos.

Q: This had already passed during the Bush administration.

Jim Fossett: Twice. Not once, but twice.

Q: It passed twice, but was then vetoed.

Jim Fossett: Vetoed. Bush said we’re going to limit federal support to lines already in existence when I sign this executive order (on August 9, 2001).

Michelle Meyer: It literally had a time stamp.

Jim Fossett: There was some debate about how many lines there actually were. The Bush administration was pushing a position that we’re not anti-science, we’re not opposed to the research, we just have concerns about where the cells come from. They were claiming there were close to 100 eligible lines, but some of them proved to be contaminated in various ways, so they finally got down to something like 21. And there were then concerns expressed about the informed-consent origins of another five, weren’t there?

Michelle Meyer: Right.

Jim Fossett: So by the time the Bush administration went out of office there were fewer than 20 (stem cell lines eligible for research with federal support). But a lot of scientists decided to focus on using those two or three lines that there really wasn’t any conflict about.

Q: During the Bush administration, this whole field then grew in a state-by-state …

Jim Fossett: There was this set of lines that the feds were willing to support research on, and they were the ones that existed before this particular time and date (on President Bush’s executive order). And the National Institutes of Health spent a modest amount of money to support research on those lines. And a number of states — mainly the states where stem-cell research was already being done, so it was New York; California; New Jersey tried two or three times, had a variety of problems doing it; Maryland; Connecticut; Wisconsin — were starting state-supported research programs of their own. Now a lot of these things were sold as economic development programs. That’s certainly the way they were sold here — there was this big coalition of medical schools and research institutes that issued a big report about stem-cell research in New York, and here’s what’s going on, and here’s all the great economic benefits that would flow from this.

Q: With the idea being that you would bring in researchers that weren’t able to do this work in every other state in the country, and draw economic benefits from that.

Jim Fossett: Yeah, that you’d wind up with companies that were able to produce these things, then produce the therapies that flowed from these things. That was the way (former New York Governor Eliot) Spitzer sold it here, it’s the way (current New York Governor David) Paterson’s talking about it. It’s been very much that way, that’s been the pitch.

Q: Was there an expectation when Obama was elected that something different, dramatically, was going to happen at the federal level that was going to change the state-by-state system of doing stem cell research?

Jim Fossett: There were a lot of folks who said the feds are going to get back in business, that’s going to eliminate the need for these separate state programs. It’s great that the states have been doing all of this, but the federal government is where all the big money is.

But the feds have not come forward with big money so far. And the changes that they’ve made have been fairly carefully considered, they’ve been decidedly incremental.

So the states that now have a group of grantees that don’t have to be dependent on the feds anymore, and some of whom want to do research on a broader set of lines — they’re not big.

Q: You mentioned the executive order that President Obama signed earlier this year. What does that open up, and what doesn’t it change?

Jim Fossett: What the executive order that Obama signed did was nothing more than repeal the Bush executive order. It got rid of the Bush limitations, the time stamp.

Michelle Meyer: In the statement accompanying the executive order, all he really said was, “NIH, it’s your job, go figure it out, come up with a plan for spending federal dollars on this stuff.” And the only clues he gave NIH — at least explicitly, I’m sure there were behind-the-scenes discussions — were pretty low-hanging fruit:

One, NIH’s policy should be consistent with existing law.

Two, he said it must be done ethically. But the rub is what constitutes ethical research in this area.

Three — and here’s the one piece of substance that he did give — reproductive cloning is morally wrong, and we will not do anything that opens the door to that. That sort of hinted that maybe therapeutic cloning was going to be a no-go, precisely because it arguably opens the door to reproductive cloning. But all he explicitly said was that reproductive cloning is out, which is hardly controversial. Then he handed over stem cell policy to NIH to see what they would do with it. [For a brief discussion of reproductive and therapeutic cloning, see a previous interview.]

Q: What other clues do you see in any of the administration’s efforts or moves in this area?

Jim Fossett: You can look at this as consistent with the way the administration is trying to approach a range of issues that have a religious or a strong moral overlay to them. They tried to set up the White House Office of Faith-Based and Neighborhood Partnerships, for example, in a way that really was not all that different from the Bush approach. They were trying to mount an abortion reduction initiative, until it got swallowed up in the health care reform debate.

So they’ve been trying fairly carefully to not be terribly ideological, to put forward the things that are going to have reasonably wide appeal.


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