Academic journal article Ethics & Medicine

Bioethics in Liberal Regimes: A Review of the President's Council

Academic journal article Ethics & Medicine

Bioethics in Liberal Regimes: A Review of the President's Council

Article excerpt

Abstract

On August 9, 2001, President George W. Bush announced his much anticipated decision on the use of federal funds for research involving embryonic stem cells.1 At the same time the President also announced the creation of the President's Council on Bioethics, which would study issues related to bioethics and report findings and recommendations to him and the public. In forming such a commission, the President was following a well established tradition. Since the early 1970s there have been three other major U.S. national commissions established to study a variety of issues in bioethics and make recommendations about policy to the federal government and the states.2 This essay is meant to consider the work of the President's Council to date, with five reports and one "white paper" issued and one work containing classic pieces of literature that encourage reflection on important themes in biomedical ethics.3 I will describe the work of the Council in the context of the three other commissions, explicate the key work of the Council, and argue that the work of the Council shows us much about the possibilities and limitations of bioethics as a public enterprise in liberal regimes.4

I

National Commission: 1974-78

The first commission relevant to our discussion is the National Commission for the Protection of Human Subjects in Biomédical and Behavioral Research, which began work in 1974 and produced its final report five years later. This commission had its genesis in revelations of the later part of the 1960s concerning what appeared to be serious violations of simple moral standards that should govern biomedical research: coerced participation, failure to inform patients or research subjects of the nature and risks associated with the specific study, research on the aged and infirm that might be lethal, etc. To these lapses were added a series of emerging issues raised by serious thinkers such as the late Paul Ramsey. One question raised by Ramsey was the morality of non-therapeutic research involving children. By definition such research cannot benefit the child/patient. On what grounds then could a responsible parent consent to such research? In his seminal work, The Patient as Person, Ramsey disputed the moral standing of research in children from which they cannot benefit. He thus began a discussion that the National Commission resolved in favor of such research.

The Commission and its resulting Belmont Report are excellent examples of what we might call a process-oriented bioethics. The Commission did not question any specific sorts of studies unless they could only be conducted in violation of the Commission's guidelines. What the Commission was interested in were policies or rules that would enhance the prospects of "informed consent" to participation in research by individuals. Regarding the "informed" side: Was the patient adequately informed about the nature of the research (i.e., the goal, the method, the actual procedures such as blood tests, the time frame, etc.)? Regarding the "consent" side, issues of the voluntary nature of the consent dominated the discussion: Can prisoners or members of the military ever give completely voluntary consent?, Can parents consent for children?, or more pointedly, Can parents give consent to research that may not benefit their child (so called non-therapeutic research)? The National Commission thus had a limited mission. It was not set up to examine any or all issues that might arise in the broad field of bioethics. Though even at that time many areas of concern were under serious discussion-treatment of handicapped newborns, living wills, brain death, etc.-the National Commission had no mandate to engage these questions, and it did not do so. In these very limits of the National Commission, however, we can see the nature of official or semi-official bioethics in liberal regimes. Liberal regimes are preeminently regimes of process not "product". …

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