Reshaping the bioethical landscape

In mature Western democracies we have competing societal values, with abortion at the eye of the storm.

The electoral tidal wave which swept Democrat Barack Obama into the White House and Democrat majorities into the Senate and the House of Representatives could reshape the bioethical landscape in the United States.

The most obvious issue is abortion. Mr Obama is a strong supporter of a woman’s right to abortion. The leading abortion action group, Planned Parenthood, gave him “100%” on its electoral scorecard. After reviewing Obama's legislative record, Professor Robert P. George, of Princeton University, wrote a scathing analysis of his views on pro-life issues. His conclusion: “Barack Obama is the most extreme pro-abortion candidate ever to seek the office of President of the United States. He is the most extreme pro-abortion member of the United States Senate. Indeed, he is the most extreme pro-abortion legislator ever to serve in either house of the United States Congress.”

Under George W. Bush, a relatively pro-life president, abortion activists felt threatened. On his first day in office he had blocked federal aid to foreign groups that promoted abortion. He appointed two justices to the Supreme Court who apparently took a dim view of Roe v. Wade, John Roberts and Samuel Alito. He signed a ban on partial-birth abortion. His appointees in the Federal bureaucracy tried to thwart sales of emergency contraception to minors and promoted abstinence-only sex education. In Planned Parenthood’s eyes, Bush had declared war on women.

Nor, before the election, was the situation in all of the 50 states altogether favourable for abortion supporters. The 1973 Roe v. Wade decision by the Supreme Court effectively guaranteed abortion on demand. However, opponents have managed to restrict this in a number of small ways on a state-by-state basis – banning late-term abortions, requiring parental notification, mandatory counselling, restricting health insurance payouts and so on. These form a patchwork of regulation throughout the 50 states.

But with the election of Obama and a Congressional majority which is broadly favourable to abortion rights, all restrictions could vanish. In 2007, as both sides of the abortion divide remember well, Obama promised Planned Parenthood that "the first thing I'd do as President is sign the Freedom of Choice Act" (FOCA). This act has been kicking around Congress since 2004, but Obama became a co-sponsor of the Senate version in 2007. The purpose of FOCA is to codify Roe v. Wade, invalidating every restriction on abortion at least up to the stage of viability.

The website of the new administration’s transition team does not mention FOCA. But it does reassure abortion activists that Obama “has been a consistent champion of reproductive choice and will make preserving women's rights under Roe v. Wade a priority as President. He opposes any constitutional amendment to overturn the Supreme Court's decision in that case.” It also declares that he will support the Prevention First Act, which will increase funding for family planning and comprehensive sex education and promote emergency contraception.

Obama still has not taken office, so many details remain to be worked out. Will hospitals which currently refuse to do abortions be threatened with loss of funding? Will health care workers effectively lose the right to conscientious objection in abortion and emergency contraception?

Stem cell research is another area which will be affected by the Democrats' victory. Obama supports “research of human embryonic stem cells derived from embryos donated (with consent) from in vitro fertilization clinics”. Restrictions on Federal funding for existing stem cell lines are likely to be lifted.

The result is unlikely to be a rapid proliferation of embryonic stem cell research. Few scientists are placing their hopes for cures in ESCs. First of all, after ten years, no one has yet derived a flourishing stem cell line from cloned human embryos. And second, reprogrammed cells, which are uncontroversial ethically, are currently the best hope for useful therapies. Federal funding in the Obama Administration is likely to be directed towards them.

But what will happen when Obama is asked to fund innovative fertility technologies – as he surely will be? The Parliament in the United Kingdom recently approved a thorough-going revision of its fertility act. Apart from authorising saviour siblings, making abortion easier, and doing away with the need for a father in IVF treatment, it also gave a green light to hybrid embryos and cloning embryos with tissue harvested without consent from incapacitated adults or children. The rapid advance of stem cell technologies guarantees that scientists will be creating new dilemmas for law-makers. Artificial sperm and eggs are on the horizon, for example. These would make it possible for gays to create their own children without resorting to donors. Genetic engineering could be used to manufacture children who are free of genetic diseases or who have high IQs. Given his permissive views on abortion, would Obama resist pressure to allow these techniques to proliferate? 

Another important issue which may emerge while Obama occupies the White House is physician-assisted suicide. Voters in the state of Washington followed the lead of neighbouring Oregon on Tuesday and approved Initiative 1000, which allows doctors to prescribe legal drugs for terminally ill patients. The measure sailed through by a margin of 58% to 42%. This will embolden euthanasia activists in other states, especially California.

His attitudes on bioethical issues like these will show whether Obama is a vote-hungry pragmatist, a progressive ideologue, or basically a Christian social democrat. Any of these interpretations can be supported – although the last of these is increasingly unlikely. A few months ago, fundamentalist pastor Rick Warren organised a forum in which he tried to draw out both McCain and Obama on when life begins. McCain immediately blurted out, “At the moment of conception.”. Obama wriggled: “whether you're looking at it from a theological perspective or a scientific perspective, answering that question with specificity, you know, is above my pay grade.”

Bush also faced the thorny bioethical issue of stem cell research early in his first term. To give him advice he created a President’s Council on Bioethics. This body was split down the middle on the issue between “progressives” and “conservatives”, but under the leadership of Dr Leon Kass it produced some of the most thoughtful, well-reasoned, and eloquent discussion papers ever to emerge from a government department. Since bioethical questions are above his pay grade, Obama will no doubt appoint his own panel of bioethics experts. Which advisors he chooses will provide the best clues about the future of bioethics in the United States -- and possibly the world. 

Michael Cook is editor of MercatorNet. He also edits the bioethics newsletter BioEdge.