As we come to the end of the first tenth of the 21st century, pundits are making lists about the decade just past: the biggest stories, the worst movies. In that spirit, here’s a list of the top ten stories in bioethics.
This isn’t an idle exercise. Bioethics matters. The field exerts tremendous influence over the most important questions of public policy and moral values: How should we treat the most vulnerable and dependent among us? What makes us human? Indeed, is it even morally relevant that one is human? Trends in bioethics, thus, illuminate where we are as a society and the nature of the culture we are creating for our progeny.
- The ascendance of an anti-human environmentalism. Deep ecology, the most radical expression of environmentalism, maintains that human beings are the world’s enemy — the AIDS of the Earth, as one advocate put it — and that saving the planet will require depopulating the Earth to under 1 billion. It is easy to dismiss such misanthropy as the radical fringe. Alas, during the last decade, vocal and unapologetic support for draconian depopulation has become a part of the environmental mainstream, and is now almost universal within the global-warming movement. China’s one-child policy is not considered anathema by many global-warming alarmists, and is even extolled by influential leaders. The head of the U.K. Green party, Jonathon Porritt, who chairs the U.K. government’s Sustainable Development Commission, said that curbing population growth through contraception and abortion must be at the heart of policies to fight global warming. Radical environmentalism appears to have morphed into anti-humanism, the result of which could be a new impetus for eugenics and radical population control.
- The growth of biological colonialism. Desperate and destitute people are increasingly being exploited for their body parts and functions. For example, a black market has developed in human organs, in which well-off Westerners avoid transplant waiting lists by traveling to countries such as India, Bangladesh, or Turkey to purchase kidneys. The exploitation got so out of hand in the Philippines that the government was forced to outlaw organ-transplant surgery for non-citizens. Matters were even worse in China, where it was credibly charged that prisoners — perhaps practitioners of Falun Gong — were executed and their organs sold.Organ buying wasn’t the only growth sector in biological colonialism. The Daily Mail reported that women in Ukraine were being paid to get pregnant and have abortions to create stem cells for use in beauty treatments; the BBC reported the practice might even include infanticide. Poor women in India are renting their wombs to rich women for gestation, and some Westerners are buying Indian IVF embryos because it is cheaper than having them made at home.
- The increase in American pro-life attitudes. In the last decade, polling showed a dramatic increase in the number of people who identify themselves as pro-life. For example, in 2000, a Gallup poll found that 48 percent of respondents were “pro-choice” and 43 percent “pro-life.” In 2009, those numbers had more than reversed, with a majority identifying as pro-life (51 percent) and only 42 percent pro-choice. These changed attitudes were reflected in public policy, for example the passage of the federal ban on partial-birth abortion and the Born Alive Infant Protection Act. If this trend continues, it could eventually shake the Roe regimen off its foundation.
- The struggle over Obamacare. The political brouhaha over Obamacare was the bioethics story of 2009, not only in the U.S. but throughout much of the developed world. The strong victory of Obamacare opponents in the political debate — which may not prevent the bill’s becoming law — demonstrated that the majority of Americans do not want European-style health care, nor, for that matter, health-care rationing (thus the resonance of Sarah Palin’s “death panel” remark). The debate will not end with the passage or failure of a bill, and health-care reform will likely be one of the most important stories of the coming decade.
- Legalization of assisted suicide in Washington. Though some thought it inevitable, legalized assisted suicide faced very rough sledding after Oregon passed its breakthrough law in 1994. After many years of failure, in 2008, an abundantly financed initiative campaign, fronted and partially paid for by a popular ex-governor, finally succeeded in Washington. Interestingly, as soon as the law went into effect, so did the pushback: Many Washington doctors and health-care systems publicly opted out of participation. A month later, a Montana trial judge declared a constitutional right to assisted suicide; the Montana supreme court eventually vacated the decision, but also ruled it legal under the living-will law for doctors to write lethal prescriptions for their terminally ill patients. Then, in 2009, the old stalemate reemerged, with legislatures in states as widespread as Hawaii, Arizona, Wisconsin, Vermont, and New Hampshire refusing to follow Washington’s lead. Still, the Washington victory boosted the morale of assisted-suicide activists, who promise to wage an energetic legalization campaign in the coming decade.
- The success of adult-stem-cell research. When the embryonic-stem-cell debate first emerged at the end of the Clinton presidency, bio-scientists and their media acolytes insisted that embryonic stem cells offered the “best hope” for developing regenerative medical treatments and cures. At the same time, the potential for adult stem cells was downplayed, for example because they can’t become every type of cell in the body, a capacity known as “pluripotency.” But things didn’t turn out as expected. Embryonic stem cells proved difficult to harness and are still not approved for use in any human trials due to safety concerns, although two studies may begin next year. In contrast, adult stem cells have shown remarkable capacities. For example, in early human trials, adult stem cells have helped diabetics get off insulin, restored sensation to paralyzed people with spinal-cord injuries, helped heal unhealthy hearts, and provided hope to patients with autoimmune diseases such as multiple sclerosis. These and other amazing advances in adult-stem-cell research provided one of the few pieces of truly good news in a sour decade.
- “Suicide tourism” in Switzerland. Over the last decade, Switzerland became Jack Kevorkian as a country, its suicide clinics catering to an increasingly international clientele — mostly from the United Kingdom — with the victims ranging from the terminally ill, to people with disabilities, to even a double suicide of a terminally ill elderly woman and her frail husband, who wanted to die rather than be cared for by others. Alas, as was the case with Kevorkian in the 1990s, audacity was rewarded. In the face of a wave of high-profile suicide-tourism stories, England’s head prosecutor published guidelines that, in essence, decriminalized family and friends’ assisting the suicides of the dying, disabled, and infirm. Others mimicked the Swiss. In the U.S., the Final Exit Network appears to have created mobile suicide clinics, leading to the indictment of several of its organizers. Meanwhile, the Australian “Dr. Death,” Philip Nitschke, traveled the world holding how-to-commit-suicide clinics. Still, as the decade came to a close, there was a sense that the tide could be turning: The Swiss government appears poised to shut down the suicide-tourism industry, perhaps even — although this is less likely — outlawing assisted suicide altogether.
- IVF anarchy. The story of Nadya Suleman — better known as “Octomom” — epitomized all that has gone wrong in the assisted-reproduction industry. With the field virtually unregulated in the U.S. (and many other countries), oftentimes, anything goes. Because there were no regulations on the number of embryos that could be made during an IVF procedure, we now have 400,000 “spare” embryos on ice, looked upon by some as being akin to a crop ripe for the harvest. The lack of regulations has also led to a market in human eggs, in which eugenically correct college-age women are paid huge fees to donate their eggs — a procedure that can leave donors dead, infertile, or seriously ill. IVF has led to childbirth as manufacture, with our progeny chosen for their genetic makeup. It is likely that babies will soon be created with three parents. What comes next is anybody’s guess.
- The Bush embryonic-stem-cell funding policy. When Pres. George W. Bush signed an executive order restricting federal funding of embryonic-stem-cell research to lines already in existence on Aug. 9, 2001, he set off a nearly decade-long firestorm. It wasn’t that the NIH didn’t fund ESCR during the Bush years: It did to the tune of nearly $200 million. California passed Proposition 71, authorizing $3 billion in bond money to be spent on ESCR and human-cloning research over ten years. Other states and private philanthropies also funded the research. Indeed, a study published by the Rockefeller Institute reported that $2 billion–plus was put into ESCR from private and public sources during the Bush years.So what was the fuss all about? Yes, the policy inconvenienced researchers, requiring, for example, that experiments on “Bush qualified” ESC lines be segregated from non-qualified research. And yes, the limited number of authorized lines may have dissuaded some researchers from entering the field. But the real poke in the eye for the Science Establishment and liberal media was that Bush’s policy sent a clarion message that embryos — which are, after all, nascent human life — matter, thrusting his policy into a buzz saw involving our most touchy cultural issues, particularly abortion.
Ironically, Bush repeatedly expressed his confidence that scientists could find ways to obtain the benefits of ESCR without destroying embryos. That prediction appeared to come true in 2007 with the creation of induced-pluripotent stem cells, which are made from normal skin or other tissues. With the potential of IPSCs to do most of what scientists said they wanted from ESCR, the stem-cell issue lost its political potency. Thus, when President Obama revoked the Bush policy, it was something of an anticlimax. But look for the issue to be revived in all its emotional force in the next decade if scientists learn to reliably clone human embryos.
- The dehydration of Terri Schiavo. The emotionally wrenching tug of war over the life of Terri Schiavo, covered sensationally by the international media and culminating in her slow death, was — hands down — the decade’s most important story in bioethics (as well of one of the most important stories of the early 2000s). Who hasn’t heard her name? Who doesn’t have an opinion about what happened? For a seeming eternity, the world groaned and argued bitterly about the weighty moral question of whether it is right to deprive a human being of food and water because he or she is profoundly cognitively impaired. Nearly five years after her death, we are not over it yet. Whenever a “miraculous awakening” story is reported, our minds and the media’s pens immediately come back to the question of whether that case is somehow “different” from Terri Schiavo’s.It hasn’t stopped there. With Terri dead and buried, and with majority poll support, some of the most notable voices within bioethics and transplant medicine openly argue that persistently unconscious patients should, with consent of family, have their organs harvested — which results in death — or be used in research as if they were actually dead. And with Obamacare coming full throttle, the question of whether the expenses required to care for these most helpless patients will continue to be borne has become a subject of acute bioethical attention.
Hubert Humphrey (among others) once said that a society is judged by the way it treats its most vulnerable citizens. That truism explains why the Terri Schiavo case was far more than a personal and family tragedy: It was a modern-day passion play from which we are still reeling.
What do these stories tell us about ourselves and our society? The signals are mixed. First, we are in danger of supplanting human exceptionalism — belief in the intrinsic dignity and equality of human life — with a “quality-of-life ethic” in which some of us are deemed to matter more than others. But the path to such a brave new world is proving to be neither straight nor unimpeded. Indeed, there are encouraging signs the sanctity of life could make a comeback. This much is sure: Bioethics will continue to matter profoundly in the years and decades to come.
Wesley J. Smith is a senior fellow at the Discovery Institute, and consults for the International Task Force on Euthanasia and Assisted Suicide and the Center for Bioethics and Culture. His book A Rat Is a Pig Is a Dog Is a Boy will be released later this month by Encounter Books.