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Bioethics Panel’s Role May Be Small on Policy, Big on Issues July 2009

Bioethics Panel’s Role May Be Small on Policy, Big on Issues

By James W. Fossett and Michelle N. Meyer

Fossett and Meyer

President Obama’s recent announcement that he will replace the members of the President’s Commission on Bioethics met with strong reaction across the political spectrum. For many on the right, the announcement was a harbinger of the administration’s impending “anti-life” policies. For those on the left, it gave hope of an administration committed to “progressive” science unfettered by religion.

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James W. Fossett directs the Institute’s health and Medicaid studies 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. An earlier version of this commentary appeared in the Bioethics Forum, a blog hosted by the Hastings Center.

The assumption underlying both sets of reactions is that, for better or worse, a presidential bioethics commission will have a substantial impact on the nation’s bioethics policy. The reality, however, is that an Obama commission is likely to have a much more modest policy role, and policymakers responsible for bioethics and health policy need not wait with bated breath for the new commission’s pronouncements.

Presidential bioethics commissions, like all presidential advisory commissions, can serve (and arguably have served) a variety of purposes, depending on the mandate given to them by the president. For instance, presidential commissions may be primarily investigative; they may be convened to address a specific crisis; they may act as a public forum for initiating national conversation about emerging issues; they may be broadly advisory, helping the president prioritize and set an agenda in a particular policy area; or they may be mostly political. Commissions established for political purposes may provide symbolic evidence of the president’s priorities or, more cynically, act as a rubber stamp for the policies the president has already chosen or even as cover to allow the president to avoid making a decision on a controversial issue.

What mandate is Obama likely to give his bioethics commission? White House officials have been quoted in the national media as favoring a commission that, unlike its predecessor commission, exhibits two features: an inclination toward concrete policy advice rather than abstract philosophizing; and a commitment to recognizing and building on consensus, rather than to identifying singularly correct bioethical positions. In theory, this twin emphasis on policy and consensus is appealing. For instance, one of the outgoing commission’s central projects was a 527-page tome on the meaning of “human dignity.” Even most philosophers — who are prone to abstraction — find this concept hopelessly vague and of dubious value in informing policy. And with its seeming origins deeply rooted in the Judeo-Christian tradition, the concept seems more poised to stir, rather than calm, the waters of the culture wars.

So Obama’s possible mandate to his new bioethics commission to focus on concrete policy options that reflect national consensus is understandable. But is it practical?

Consider, first, the emphasis on policy. Unlike other senior presidential advisors, the chair of a bioethics commission is ill-placed to be an active participant in the policymaking and implementation process. Such officials as the president’s national security and domestic policy advisors, directors of the Office of Management and Budget, National Economic Council and Council on Environmental Quality, and even the president’s science advisor, all clearly reside inside the president’s circle, with responsibilities for developing, implementing and marketing the president’s program in their respective areas. They frequently bear the title of Assistant to the President, frequently (though not always) have offices inside the White House and are organizationally identified as part of the Office of the President. They sit atop elaborate institutional machinery that includes representatives from multiple departments charged with developing policies for the president to consider and overseeing the implementation of the president’s agenda.

But chairs of bioethics commissions typically lack this clout. Historically, they have had no title linking them to the president, no offices inside the White House and no responsibilities for managing or coordinating the activities of the National Institutes of Health, the Centers for Disease Control, the Department of Health and Human Services, the Environmental Protection Agency or any of the other federal agencies whose jurisdictions include issues that might be considered part of a “bioethics portfolio.” Individual presidents can and have asked bioethics commissions for formal or informal advice on particular issues, and politically sophisticated chairs may be able to leverage considerable influence, but bioethics commissions have typically lacked the institutional ties to the White House or the standing to speak for the president to make them major players in ongoing policymaking.

Perhaps more important than the peripheral role of presidential bioethics commissions in the executive branch is the fact that most American bioethical policy is not made in the executive branch, or indeed in Washington at all. “Policy” around such issues as abortion, stem cell research and assisted reproduction is instead made in a decentralized, market-driven fashion in which state legislatures and courts, professional societies, insurance companies, and individual patients and providers are the major players. There are, for instance, enormous disparities across states in the accessibility of abortion, the scope of legal stem cell research and the laws governing assisted reproduction. Federal influence over these sorts of policies is so limited that it really may not matter what a presidential bioethics commission concludes. To the extent that the commission is tasked with suggesting concrete policies, it will arguably play less of an advisory role to the president than to these state and local policymakers, making the title “President’s Commission” a misnomer.

Moreover, where the federal government has taken on the role of setting the country’s bioethical policy agenda, the president has already assigned important portions of that agenda to existing agencies, raising the question of what, if anything, might be left for a bioethical commission to tackle. Important questions regarding the ethics of human subjects research has long been delegated to the National Institutes of Health (NIH)’s Office for Human Research Protections, and the NIH’s Recombinant Advisory Committee has played a similar role in evaluating gene therapy research since 1983. President Obama has extended this tradition by delegating responsibility for stem cell policy to the NIH and oversight of the abortion reduction initiative to the Office of Faith-Based and Neighborhood Partnerships.

President Obama’s emphasis on concrete policy options is even more puzzling when read in juxtaposition to his second focus — on consensus-building. Many argue that the proper role of bioethics “experts” is less to identify “the” correct view on a given issue than to articulate the relevant individual or community values and help guide decision-making in a way that is faithful to those values. But whose values should commissioners seek to articulate? Although President Obama’s desire to transcend the culture wars by finding, and building on, consensus is admirable, unlike countries such as England, where it is possible to speak of national bioethical policy made and promulgated by national entities with the clear authority to do so, it is difficult to identify values that are at the same time shared widely across America and yet specific enough to inform the concrete bioethical policy the administration is said to seek.

Does this mean that an Obama bioethics commission is doomed to irrelevance? Far from it. Just as there is a limited role for the federal government, so too should the new national bioethics commission be aware of its correspondingly limited role. But a role that is limited in scope need not be limited in importance. A national bioethics commission might in fact be quite helpful in a variety of ways.

For instance, as science and medicine become increasingly global in scale, so too do the ethical issues they raise. Adequately addressing many bioethical issues means attending to international law and policy, and there is a clear role for a federal commission to play in this regard.

Second, in addition to its global turn, bioethics has taken an empirical turn. Our federalist structure produces a natural experiment in the outcomes of different policy choices. Individual states lack the resources, and perhaps the incentive, to take advantage of this natural experiment. A federal commission — staffed more heavily than in the past with empiricists — could usefully collect and analyze data on the results of different state (and perhaps international) bioethical policies, providing policymakers with outcome-based, empirically supported bioethical guidance.

Finally, a national commission might focus on emerging technologies. State governments and federal agencies have limited resources requiring them to focus on the bioethical policy questions that are certain and immediate. A national commission has the leisure of taking on the important task of initiating a national conversation about the bioethical issues that may confront us on the horizon.


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.