National service informs teaching
|
|
|
|
|
|
In 1996 President Clinton appointed President Shapiro to chair the newly created National Bioethics Advisory Commission; this fall he is teaching a freshman seminar, Historical and Contemporary Issues in Bioethics.
"The experience of leading the commission, which focuses on the intersection of ethics, biology and public policy, has had a big impact on my teaching in this particular class," Shapiro said. "I hope I can bring to it a sense of immediacy, relevance and focus. The students are enormously animated. It's not unusual for them to stay around talking after the class has ended, and I usually get a great deal of e-mail traffic between classes."
The freshman seminar begins with an overview of the historic and current scope of bioethics and the philosophical approaches that have been brought to bear on bioethical concerns. It then gives a brief overview of the development of attitudes toward the ethical obligations of physicians to patients.
The seminar also reviews controversies that have dominated bioethical discussion in recent decades and considers both US regulations and international codes designed to regulate relationships between clinical investigators, physicians and researchers, on the one hand, and human subjects and patients, on the other.
Shapiro's students have followed with interest the public controversy surrounding the appointment of Peter Singer to the Ira W. Decamp Professorship in the University Center for Human Values. Shapiro and his class attended the October 12 debate on "Ethics, Health Care and Disability" between Singer and Professor Adrienne Asch of Wellesley, which was sponsored by the student-run Bioethics Forum of Princeton, and Singer's writings are among the assigned readings.
|
|
|
|
|
|
"An important principle to which they can easily relate, especially when it involves a dilemma where we are unsure what our moral obligations are," said Shapiro.
"For example, who has the moral legitimacy to make decisions about how to treat a severely disabled newborn? The parents? The doctor? The state? Virtually everyone has either had a personal experience or knows somebody who has had one, where this type of question came up. Students like to grapple with an issue that has no obvious answers, where there are resources from moral philosophy that may help and where the topic has some grounding in their experience."
Commission fosters debate
Shapiro believes that one important role of the national commission is to foster public debate on bioethical issues, and its reports are its most important product.
"We hope to encourage more serious public discussion of the moral dilemmas on which bioethics is focused," he said. "Our reports never assume that the readers will know all the relevant science or necessarily be familiar with the basis of the important moral views that we are considering."
Rather, the reports thoroughly elaborate the relevant background in science and the divergent views of the ethical questions at hand, before systematically analyzing them and setting out conclusions. Shapiro notes with pride that the cloning report has generated a dozen books, as well as conferences and journal articles, and that its language has been widely adapted for legislative and regulatory purposes abroad.
In a recent paper for the journal Science and Engineering Ethics, Shapiro enumerated several key indices of the commission's success as he rated its performance in addressing the cloning of human beings via the "Dolly" technique, particularly whether the government should fund research on human cloning:
"[O]ur recommendations were accepted and legislation proposed by the president, but to date no new federal legislation has been implemented. The report was successful in helping to mobilize the interest of key constituencies and strengthening the network of understanding between experts and citizens of quite different perspectives.
"The educational role has been both more modest and more effective than I would have expected. On the one hand, while the report is widely read, it is often not read too carefully. On the other hand, the report has been the foundation or reference point of rather widespread, thoughtful speculation on the issues addressed. Perhaps ... we might give ourselves an initial grade of B."
Forging recommendations
How does Shapiro help forge recommendations on complex, controversial issues with a commission of diverse members, not all of whom are policy experts, scientists or ethicists?
First, the commission gets a grounding in the relevant science. Then it holds hearings to consider differing perspectives on the issues in question. "We invite scientists, other scholars, diverse advocacy groups and religious groups to present their views," Shapiro said. "We try to meet our obligation to build as empathic a view of the various perspectives on the issues before us as we can. On many controversial issues, however, the different perspectives usually cannot be bridged by any single policy. "
He cites abortion as an example where the detailed understanding of opposing views sometimes generates a little common ground.
"Most opponents of abortion," he said, "believe that certain exceptions exist where abortion may be morally justified, such as when an act of incest or rape has occurred or when a real and perhaps life-threatening danger exists to the mother during the pregnancy.
"The existence of such exceptions helps us understand that for many people the value accorded the life of the fetus does not exceed every other value. It is certainly important, but for many people, both for and against abortion, it is not the only value to be considered. By engaging in a kind of empathetic exploration, you can not only respect the moral worth of others but at times discover common ground."
"In the end, you try to articulate a coherent policy that does take sides but respects alternative points of view," he concluded.
Stem cell research
Turning to the commission's recommendations on embryonic stem cell research, Shapiro pointed out that some people object to research involving stem cells taken from aborted fetuses.
"Although in the case of aborted fetuses, death has already taken place, some people feel that by using aborted fetuses for important scientific and clinical research, you provide indirect support for the decision to abort by lending that act some moral worth. So one question becomes, if it is ethically inappropriate to use materials from aborted fetuses, where else can one derive embryonic stem cells?
"One answer is, from early stage embryos created through in vitro fertilization for the purpose of implantation to help a woman become pregnant. Rather than discarding any unneeded embryos, why not use them for valid scientific purposes and help meet our ethical obligation to cure disease and relieve suffering? On the other hand, there are those who argue that these early-stage embryos have the moral status of persons, and their destruction for whatever purpose is an act of homicide."
Benefits outweigh objections
In the end, the commission concluded that the potential benefits of stem cell research and society's obligation to the health and welfare of future generations outweighed the objections to using either cadaveric fetal tissue or material from donated early embryos initially created for procreative purposes which would otherwise be discarded. It noted that the use of cadaveric fetal tissue in therapy for people with serious disorders, such as Parkinson's disease, is widely accepted.
The commission recommended, however, the development of safeguards to ensure that the potential uses of tissue from aborted fetuses would not influence the abortion decision. It also noted that at the current time the scientific agenda does not require the creation of embryos specifically for research purposes, and since this was a more controversial source of embryonic stem cells, there is no need to provide government funding in this area.
President Clinton accepted the commission's report in September and carried its recommendations to Congress. However, the Senate Appropriations Committee subsequently stripped language from a funding measure for the National Institutes of Health that would have lifted a ban on federal financing for certain kinds of embryonic stem cell research, a ban that has been in effect since 1995.
Shapiro expressed disappointment but not dismay. "We must take a longer view than a single year's appropriation process," he said.