It’s time again for the annual review of my predictions in bioethics. I have good news and bad news. First the good news: My predictions for 2012 were almost 100% accurate. Now the bad news: My bioethics predictions for 2012 were almost 100% accurate. For this prognosticator, it was disheartening to be so right.
The Affordable Care Act
As I predicted, the continuing political and legal controversies swirling around the Affordable Care Act, aka Obamacare, proved to be the most important story in bioethics in 2012. Here’s what I said would happen:
“Prediction 1: Obamacare will not be repealed legislatively in 2012.” Big deal: With the Senate controlled by Democrat ACA supporters, even the most untalented crystal ball gazer could have gotten that one right.
“Prediction 2: Obamacare’s Individual Mandate Will Be Declared Constitutional:” I really nailed this one: The Supreme Court, in an utterly incoherent 5-4 decision, declared the ACA to constitutional. Why do I say “incoherent?”
First, Chief Justice John Roberts ruled that the individual mandate, requiring all to buy health insurance or face a penalty, was not a tax. That ruling allowed the case to proceed to ultimate resolution.
Then, he ruled the ACA violated the Commerce Clause by regulating economic inactivity. That should have been the ball game.
But in an act of audacious judicial activism, as if by magic, the “not a tax” was transformed back into a tax for purposes of finding the law valid.
Et viola: An unconstitutional law was able to be declared constitutional by being both not a tax and a tax at the same time. Like I said: incoherent.
I explained last year why the Court would protect the validity of the ACA regardless of the legal merits:
I believe the majority of the Supreme Court will rule that Obamacare’s purposes are laudable, that universal coverage is equitable and necessary for the country’s future, and that since the mandate is a necessary element of making the new law work, it is constitutional. That may sound like bootstrapping, but there it is.
And so it came to pass. I scare myself sometimes.
“Prediction 3: Even though majorities of people oppose the law, this will not redound to President Obama’s substantial [electoral] detriment:” Precise! I also wrote, “The Supreme Court’s ruling will . . . make people resigned to an Obamacare future.” Look around. It’s true.
“Prediction 4: Obamacare Opponents Will Not Have Sufficient Electoral Success to repeal the Law Legislatively in 2013:” Talk about an understatement!
Last year, I considered it my most important task to explain the bases of my Obamacare predictions at some length, so was very concise in the rest of my prognosticating. With one exception, I will maintain that brevity here:
I predicted 2012 would be a “big year in the assisted suicide battle internationally.” It was, and from my perspective turned out very well. Here’s how I did:
“No state legislature will legalize assisted suicide.” Bingo.
“The United Kingdom’s Parliament will not legalize assisted suicide.” Bingo.
Swiss “suicide tourism” will continue to make the news by growing increasingly radical in scope, perhaps including the suicide of someone who is mentally ill. That happened too, although not the mental illness part.
The Supreme Court of British Columbia will rule that there is a constitutional right to assisted suicide, forcing Canada’s Supreme Court to take up the case. Bingo, although the case has not yet been accepted for review by the Canadian Supreme Court.
Massachusetts Voters Will Vote Yes to Legalize Assisted Suicide. Hooray! I was wrong! Although, in my defense, I also stated, “I argue that the MA initiative can be beaten, but it will require opponents to pull out every stop.”
And that’s what happened. Going into the last month before the election, the yes vote was trouncing the opposition in the polls. But a convergence of four factors turned the tide so that legalizing assisted suicide lost 51-49%. Here’s why:
1. The diversity of opponents got through to the voters: Legalizers of assisted suicide usually push the false idea that opponents are trying to force their religion on others. But the anti-assisted suicide coalition is actually very diverse, including secular types such as disability rights activists, medical professional organizations, egalitarian liberals, and advocates for the poor, in addition to Catholics and pro-lifers. Unlike in Washington a few years ago, the opposition in Massachusetts was able to get that message out.
2. People are not marching in the streets demanding legalized assisted suicide: Backing for legalizing assisted suicide is a mile wide but only an inch deep—allowing concentrated opposition to evaporate just enough support to obtain the victory.
3. Massachusetts is a Catholic State: MA is a very liberal state, but it also retains a Catholic identity. The vigorous opposition to Question 2 by Cardinal Seán Patrick O’Malley made enough of a difference to hold the line. And the usual blatant anti-Catholic tactics of supporters found less traction, even among Catholics who disagree with their church.
4. The Kennedy Name: Victoria Kennedy, Ted’s widow, wrote a powerful op/ed against Question 2, lending the late senator’s aura to the no effort and providing “liberal” cover to opposing assisted suicide.
Bottom line: Assisted suicide finds tough slogging because the usual liberal coalition is fractured on the issue, plus there remains sufficient traditional morality in the country, to continue to hold the agenda at bay.
Successes in “direct reprogramming,” that is, changing one kind of cell into another without requiring a stem cell stage, will continue. Bingo.
Geron’s defunct embryonic stem cell program will be purchased by another company and the human trials it started continued. Not yet, but talks are ongoing.
Another breakthrough toward learning how to engage in full human SCNT cloning will be announced. Yes, with monkeys.
Adult stem cell successes will continue in human trials, and still be generally underreported in the media. But you knew that yourselves.
IVF will continue to cause controversy as the boundaries and propriety of using the technique are applied in ever more radical ways. Yup, with the prospect now very real of creating a three-parent embryo.
At least one state will permit organ donors to receive some form of compensation, disguised as expense reimbursement. Nope, but being discussed.
Scientists will grow primordial gametes from human stem cells. Yup.
All in all, not perfect, but 2012 proved that I am a major league prophesier of our bioethics future.
Do you want to find out what will be happening next year? I’ll be back in January with all the predictions fit to print.