After Kass: the future of the President's Council on Bioethics.

On October 1, Leon Kass stepped down as chairman of the President's Council on Bioethics. Kass was succeeded by one of the "founding fathers" of modern bioethics, Edmund Pellegrino, professor emeritus of medicine and medical ethics and adjunct professor of philosophy at Georgetown University.

Kass garnered his share of fans and critics as head of the council, and his departure hasn't gone unnoticed by them. In contrast to the "topic of the week" mentality that characterizes most discussions in bioethics, Kass laudably pursued a broader educational function for the council. Many bioethicists, in their desire to achieve political consensus on divisive issues, focus primarily on procedural matters. Deeper questions--about human nature, the meanings of parenting as a social practice, etc.--are often bracketed as being beyond resolution, according to the canons of postmodernism and the predilections of many secularists. By contrast, Kass explicitly set a more ambitious goal, the pursuit of what he called a "richer vision" for bioethics.

That vision was addressed in the council's seven reports over the past four years. In those documents, Kass's council asked the "big questions" posed by cloning, stem-cell research, the uses of biotechnology in human reproduction, and, most recently, the challenges of an aging population. While not indifferent to practical questions, the reports' authors were not shy about their more metaphysical interests.

Two examples are worth noting here. As I mentioned in a previous column ("Immortality," February 13, 2004), in Beyond Therapy, the council assessed a wide range of supposed developments in biotechnology--from attempts to make "better babies" through embryo screening to efforts to recast aging as a conquerable disease. "Advances" in biotechnology, the report insisted, are less about technology itself than about how "human desires ... may be transformed and inflated by the new technological powers we are acquiring."

In its most recent report, Taking Care: Ethical Caregiving in an Aging Society, the council acknowledges the pressing economic issues raised by shifting demographics, but challenges the usual bioethics emphasis on preserving personal autonomy. Instead, the report focuses on the obligations of responsible care. "The moral emphasis on choosing in advance needs to be replaced with a moral emphasis on caring in the present. The moral emphasis on independence needs to be supplemented with a moral commitment to serve the lives of those we love regardless of their disabilities." In effect, the report makes a compelling argument for an ethic of genuine equality. As both givers and receivers of care, we are of equal worth in our humanity, whatever our cognitive function or physical condition. As caregivers, our responsibilities toward the elderly must proceed from our acknowledgement of that fundamental value, not from economically driven judgments about relative "quality of life."

Several of Kass's critics, some also members of the council, have called for a return to the more focused efforts of earlier advisory groups. Arthur Caplan, for example, characterizes the current council's discussion of long-term rather than pressing concerns as "a distraction." Harvard bioethicist Dan Brock views the council's reports as a reflection of "[Kass's] special interests, or obsessions if you prefer." It's hard to know what to make of such remarks. On the one hand, commissions and panels active during previous administrations provided useful guidelines on various issues, especially on research involving human subjects and on end-of-life care. On the other hand, when it came to more contentious issues--for example, society's "responsibility" to provide basic health care or to fund embryo research--the "pragmatic" recommendations of earlier panels did little to resolve such matters. Moreover, several of the current council's reports have offered broad recommendations about social and policy choices, though not with great specificity. (Kass deemed that kind of work more appropriate for legislative action than for executive blueprint.) Overall, it seems curious that critics judge the council's efforts so negatively, unless they intend to deny a rightful place in the public square to Kass's thicker sort of conversation.

Indeed, that may be what critics actually do desire. If so, a rather obvious irony emerges in their calls for immediacy and relevance. The work of the National Bioethics Advisory Commission (NBAC), which ran from 1996 to 2001, is often praised by Kass's critics as the more pragmatic model that should be emulated. In its Cloning Human Beings (1997), NBAC called for a ban on attempts to clone human beings. It concluded that, given the current state of science, any such attempt posed an "unacceptable danger to the fetus," and was, therefore, "morally unacceptable." At the same time, NBAC recommended a broader public conversation about other "social and moral values" at stake and urged that as "we move ahead to the next stage of our national discussion," those values "be thoughtfully addressed." One might argue that Kass did in fact take to heart NBAC's recommendations in setting his council's agenda.

I'm left, then, with the sense that Kass's critics are impatient with both the slower pace of his pedagogy and the broader substance of his inquiry, whereas I remain untroubled by either aspect of his approach. In resisting the utilitarian spirit of the age, Kass pursued what, in an earlier era, was called a more "perennial" wisdom--also known as the Truth.