Bioethics in the Age of Trump

Ever since his unexpected victory, the media have been obsessing over what a Donald Trump presidency will mean for a range of important issues, such as the Paris Agreement on climate change, border enforcement, the judiciary, and Obamacare repeal. But one set of crucial concerns — those that go under the general category of bioethics/biotechnology — has received woefully short shrift, both in the campaign and the national discourse. Indeed, with the exception of abortion, these issues went wholly unaddressed during the election — and have certainly received no focus in the runup to the inauguration.

That needs to change. We are entering Brave New World territory, with potentially momentous impact on culture and the concept of family. Human cloning has, with way too little fanfare, been accomplished. Researchers are on the verge of creating sperm and eggs from skin cells. Efforts are underway to open the door to the creation of “three-parent” embryos. Transhumanists argue in favor of “seizing control of human evolution” and creating a “post-human species.”

Then there are controversies that affect the sanctity and dignity of human life. Assisted suicide has become a major national issue. Prominent voices in bioethics are urging that cognitively disabled people have their organs harvested as if they were dead. Scientists are now arguing to extend the age up to which embryos can be experimented upon from 14 to 28 days. Someday we may even return to the bad old days of live fetal experimentation.

What does our new president think about these and other such morally portentous matters? Your guess is as good as mine. Based on Trump’s public pronouncements — of which there are none — it would appear that he has given little thought to bioethical matters, much less pondered the ethical principles that would illuminate administration policy-making surrounding them.

That’s politically dangerous. Bioethics issues have the potential to explode suddenly into the public consciousness and grab an administration by the throat. Remember the embryonic stem cell research imbroglio under George W. Bush? Remember Terri Schiavo? A major technological breakthrough in, say, artificial intelligence or a court decision requiring Catholic hospitals to perform abortions could force President Trump and his administration to begin policy deliberations about complex and morally contentious issues with which they are ill-prepared to contend.

That’s why I am hopeful that one of President Trump’s early public acts will be the appointment of a bioethics advisory commission to help him grapple with these questions before they become urgent controversies. Other presidents, including the current one, have had such commissions, of course. Most made barely a ripple. The one exception was the President’s Council on Bioethics, formed by George W. Bush concurrently with the announcement of his embryonic stem cell research funding policy in August 2001.

For most of the Bush years, the council was headed by the venerable medical ethicist and philosopher Leon Kass, a profound and eloquent defender of human dignity. Kass gathered into the group mostly conservative deep thinkers — including Robert George of Princeton, my pal William Hurlbut of Stanford, Gilbert Meilaender, Francis Fukuyama, Charles Krauthammer, and other outstanding intellectuals. In the nearly eight years of its existence, the council pondered some of the deepest bioethical issues of the day — ranging from human cloning, to reproductive technologies, to the brain death controversy.

The President’s Council didn’t have the public and professional impact its work merited. There were several reasons for this underperformance. First, the media were dedicated to destroying the Bush presidency — as they will be Trump’s — and used the stem cell issue as a cudgel, alleging Bush put his religious views above science and relieving human suffering. Reporting fully and fairly on the council’s deliberations with a nuanced approach to biotechnological controversies of the day would have undermined that negative narrative.

The council also faced fierce antipathy from mainstream bioethicists, who disagreed adamantly with its generally conservative approach of defending intrinsic human dignity. (One prominent bioethicist even likened Kass to an “assassin” for his desire to ban human cloning.) That granted permission to those outside conservative circles to ignore the council’s findings rather than engage with its recommendations in a substantive and respectful give-and-take discourse.

Finally, the issues with which the President’s Council grappled were highly political. With people being fed the constant — and mostly unopposed — canard that Bush was “anti-science,” most elected officials ran as fast as they could from issues about which the council provided wise counsel.

For a Trump bioethics commission to be more successful than past advisory boards, it would have to break new ground in its approach and be much more visible. Let’s call it a “populist” expert bioethics commission.

That need not be oxymoronic. A populist bioethics board would be geared more toward public engagement than past commissions, in which intellectuals mostly interacted with other intellectuals and provided guidance “from on high.” What sometimes got lost in that approach was the presentation of digestible information that citizens and elected officials outside bioethical disciplines could comprehend. Thus, a populist commission would include academics and medical/legal professionals but would also welcome serious issues advocates with experience in public discourse and debate, giving the work of the board more energy and flash.

Past bioethics boards have generally reflected the politics of the administrations they served, which allowed political opponents to discount their work. A populist bioethics commission would be as messy as democracy, its ideologically diverse members disagreeing with each other and sometimes the administration itself. Everyone loves a good fight. A commission consisting of social conservatives and liberals, moderates and libertarians, liberal academics and conservative think tank members would both generate media interest and offer the public and government a full range of opinions, helping, through sometimes heated discourse, find areas of common ground.

Third, a populist bioethics commission would broaden its focus beyond offering arcane policy guidance. It should also sponsor public presentations and debates, have members appear on radio and television, and make extensive use of social media to engage the public in bioethical controversies and principles. If the people are paying greater attention to the potentially culture-changing issues within the commission’s purview, politicians would have little choice but to follow.

Such a commission could present political risks to the administration, to be sure. But President Trump is, if anything, a risk taker. And he was elected, at least in part, as a way of rejecting technocracy and unaccountable rule by experts. Enabling a populist bioethics commission to act independently of administration policy planning—and, well, rabble rouse—would be unconventional. But it would be fully in keeping with the new era of politics that has been birthed by the next president of the United States.