Panel Politics

The President's Council on Bioethics has broken new ground by investigating the ethics of age retardation. But will its conclusions reflect the concerns of its conservative chair or the optimism of other members?

When it comes to the prospect of dramatically extending the human life span, Leon Kass, chair of the President's Council on Bioethics, has been on the record for some time: He's against it. In a 2001 article published in the conservative journal First Things, Kass argued that "the finitude of human life is a blessing for every human individual, whether he knows it or not." The same philosophy permeates a recent staff-prepared working paper, written to prompt discussion at the council's meeting last month. According to the paper, the "anti-aging medicine of the not-so-distant future" represents "a questionable notion both of full humanity, and of the proper ends of medicine" because it would treat the natural arc of a human life as a disease. When the council debated the paper, however, Kass seemed to have few allies in his worries about the prospect of "age retardation," as the group calls it. The scene represented a reversal from previous council discussions of topics such as human embryo cloning.

Michael Sandel, a Harvard political philosopher who doesn't buy Kass's concerns, dominated the March session with his criticisms of the council's working paper. The paper, Sandel noted, suggests that prolonging the human life span might have negative consequences, such as decreased societal investment in the young or a decline in human industriousness as people put off until tomorrow what they could do today. But if we're so sure that bad things will happen if we live longer, Sandel mused, wouldn't similar logic lead to the absurd conclusion that good things would happen if we all died younger? Sandel's deliberate parody prompted other council members to state that they too found the working paper unnecessarily pessimistic.

During the coming months, the council will refine its thinking on age retardation. It will then fold the conclusions into a larger report called Beyond Therapy, an investigation of several different biotechnological forms of human enhancement, which is likely to be published sometime this autumn. If the criticisms levied by Sandel and other members take hold, the document's treatment of aging could take a far less Kassian tone than the current working paper. Either way, the council's consideration of age retardation constitutes a cutting-edge ethical inquiry into an area that has not been explored by previous bioethics bodies in the United States. This first official treatment of the subject, notes bioethicist Arthur Caplan of the University of Pennsylvania in Philadelphia, could "help set the parameters" for future discussions of human life span extension.

Of Councils and Commissions

The divide between Kass and Sandel underscores a rift that emerged during the council's opening session in January 2002, when Kass asked members to read Nathaniel Hawthorne's tale "The Birthmark." The story is about a scientist who accidentally kills his wife by trying to remove her one blemish; its selection suggests that Kass shares Hawthorne's view that we'll be better off if we don't tamper with human life as it has been "naturally" bestowed upon us. Yet in the view of Sandel and his intellectual allies, such an approach accords "undue moral weight to the given," assuming incorrectly that human life today represents the way we ought to live and that change would be wrong or even unnatural.

Officially, the council's mandate is to "advise the President on bioethical issues that may emerge as a consequence of advances in biomedical science and technology"; in setting its priorities, the panel is supposed to consider, among other things, the "urgency" and "gravity" of different issues. The prospect of slowing aging in humans clearly lies some ways in the future, so the inquiry isn't "urgent." However, from the perspective of someone concerned about the ways in which indulging the scientific temperament could lead to fundamental alterations in the nature of human life, it is undoubtedly "grave."

Any attempt to predict how the President's Council on Bioethics might come down on age retardation has to take into account the political nature of this body. Unlike countries such as Australia or Denmark, the United States does not have a standing bioethics advisory commission. Instead, over the past several decades, six different temporary panels have been appointed under different presidents. Not surprisingly, these bodies have tended to reflect the political exigencies of the moment. According to bioethicist R. Alta Charo of the University of Wisconsin, Madison, who served on President Clinton's National Bioethics Advisory Commission (NBAC), bioethics panels are an irresistible temptation for presidents who want to "punt" on difficult issues--or to rely on an outside group of carefully picked experts who can provide moral justification for an already reached conclusion.

Because Congress doesn't vet the members or chairpersons of presidential bioethics committees, the executive branch can easily influence the councils' political leanings. When Kass was appointed, for example, significant public controversy erupted over his previous writings, particularly his questioning of cadaver dissection in medical education, organ transplantation, and other long-accepted health and reproductive practices. But senators had no opportunity to challenge Kass or to vote on his confirmation.

Politics and current events overwhelmed the current panel's predecessor, NBAC. After the cloning of Dolly the sheep in 1997, Clinton ordered the group to prepare a report on the ethical reverberations of human cloning, an inquiry that more or less defined its tenure. Similarly, the deliberations of the current President's Council on Bioethics have thus far been dominated by the single most polarizing issue in bioethics today, the moral status of the human embryo. Bush announced the formation of the council on national television in an address devoted to laying out his position on embryonic stem cell research, the most hotly debated issue in the months leading up to 11 September 2001. Kass had already advised the president on this topic, and echoes of his approach could be detected in the president's speech, particularly in Bush's allusion to Aldous Huxley's 1932 novel Brave New World, a favorite Kass reference. This context, observes Caplan, has made the council look like "a committee in some ways charged to defend the embryo."

Bioethics, Minus the Bioethicists

The identity of the council's 17 members gives a clear sign to how they think about issues relating to the moral status of the embryo. As befits a Republican administration, the pro-life presence on the committee is a strong one and includes individuals such as theologian and Christian ethicist Gilbert Meilaender of Valparaiso University in Indiana and Catholic law professor Mary Ann Glendon of Harvard. "We did have members with right-to-life convictions on NBAC, but we didn't have as many, and they weren't as vocal as the comparable people on the new President's Council," says NBAC member Thomas Murray, president of the Hastings Center, a bioethics think tank in Garrison, New York.

But the President's Council on Bioethics harbors at least two other broadly defined ideological camps as well. One, says Murray, is a group of thinkers who are perhaps best characterized as "dyed-in-the-wool science skeptics." They include Kass himself, political philosopher Francis Fukuyama of Johns Hopkins University in Baltimore, and Washington Post columnist Charles Krauthammer. These individuals often tend to reach what are essentially pro-life conclusions on issues such as human embryonic stem cell research and embryo cloning, but they do so for reasons that have little to do with religion, such as a feared loss of human dignity or the notion that technology will send us careening down a slippery slope toward more troubling developments.

Although the council generally reflects the moral and political complexion of the Bush Administration, it also has a strong dissenting minority of scientists, doctors, and other secular thinkers who lack the pessimism of the science skeptics. These include cell biologist Elizabeth Blackburn of the University of California, San Francisco, neuroscientist Michael Gazzaniga of Dartmouth College in Hanover, New Hampshire, and Harvard's Sandel. But what might be most striking about its overall composition, according to Dartmouth University bioethicist Ronald Green, is that despite the council's title, "biomedical ethics is not as well represented as it was on the NBAC." Instead, the current council sports a panoply of public intellectuals, such as Fukuyama and University of California, Los Angeles, political scientist James Q. Wilson; law professors, such as Glendon; and philosophers. This makeup reflects Kass's oft-expressed distaste for the overly technical nature of modern bioethical deliberation. In a 1990 Hastings Center speech, Kass called upon bioethicists to "return to what animated the enterprise: The fears, the hopes, the repugnances, the moral concern, and above all, the recognition that beneath the distinctive issues of bioethics lie the deepest matters of our humanity."

Pessimists 10, Optimists 7

With its three ideological cohorts, the President's Council on Bioethics does not lack intellectual diversity; the group is "deftly constructed to include a spectrum of views," says medical ethicist Samuel Gorovitz, former dean of arts and sciences at Syracuse University in New York. Nevertheless, as a whole, the body clearly leans in a particular philosophical direction. If the pro-life camp and the troubled-about-science camp see eye-to-eye on a given issue, they are more or less guaranteed a majority over the pro-science camp. When it comes to the council's first and only major report thus far, which tackled the hot-button issue of human cloning, Gorovitz points out that the panel composition is "such that it would have been astonishing for them to come to conclusions not congenial to the present administration."

In that report, entitled Human Cloning and Human Dignity: An Ethical Inquiry, 10 council members recommended a 4-year moratorium on the cloning of human embryos for the purpose of medical research, whereas seven recommended allowing the work to proceed with proper safeguards in place. The majority position here tracks fairly closely with views that Bush had expressed before the release of the council's report, when he called upon the Senate to pass a bill to criminalize all forms of cloning.

On the less-polarizing question of age retardation, the council seems unlikely to repeat its 10-to-7 split, as quickly became clear at the March debate. To kick off discussion, Kass asked the group to consider whether biological aging should be thought of as a disease--a simple question, perhaps, but one with hidden implications. If the council decides, as Kass seems to think, that aging is not a disease, its members might be further prompted to conclude that aging should not be subject to medical interventions. Instead, following the lead of the working paper, the council could opt to view even the most meager medical attempts to extend the human life span as selfish and indicative of a "desire for immortality."

At the March meeting, Sandel refused to accept this formulation, arguing that making humans immortal and lengthening life by retarding aging amount to "two separate issues." Columnist Krauthammer, who supported Kass on the moratorium on embryo cloning, seemed influenced by Sandel, suggesting that the council should be very cautious about straying beyond an "advisory or ... analytic approach" to the topic of age retardation. In other words, the group should suggest possible individual and social implications of life span extension, but "it would be odd," said Krauthammer, "if we were to as a body begin to argue against or question the value of this enterprise." Like Krauthammer, law professor Rebecca Dresser of Washington University in St. Louis, Missouri, and Johns Hopkins psychiatrist Paul McHugh, also moratorium supporters, seemed less worried about life extension than they were about the cloning of human embryos, judging by their remarks at the March meeting. Their attitude suggests that the council members might be realigning themselves as they tackle a new issue.

Biologist Steven Austad of the University of Idaho in Moscow, who testified in front of the council on research into the genetic underpinnings of aging in December 2002, says he agrees with Krauthammer: The harm that could theoretically result from life span extension is far too speculative at this point for the President's Council on Bioethics to take a strong stance against it. If council members produce a consensus document on age retardation, says Austad, it will likely look very different from the current working paper, whose conclusions he says he disagrees with "pretty vehemently." "In a lot of ways it's just worries about unknowns," says Austad.

Nevertheless, raising societal questions about research into aging is important, notes demographer S. Jay Olshansky of the University of Illinois, Chicago, who also testified before the council: "What they're suggesting is that now is the time to be discussing these issues before any sort of breakthrough occurs, and I completely agree with that." But if the council is the first such body to take up the ethics of age retardation, it is also the first to be strongly influenced by a sensibility--that of chair Kass and his allies--that can be described as dubious of all scientific advances that could dramatically change the way human lives are lived today. The question now is whether that sensibility will dominate the council's ultimate report.

Chris Mooney is an old man in a young man's body living in Washington, D.C.