How do we resolve bioethical issues that affect us individually and societally, and about which we may profoundly disagree? This was the task the Presidential Commission for the Study of Bioethical Issues (PCSBI) set out to address in its final report this May. In “Bioethics for Every Generation: Deliberation and Education in Health, Science, and Technology,” the PCSBI proposes joining democratic deliberation and education in “a virtuous circle, reinforcing one another to create a more democratic and just society.”[1]
The Commission’s guidelines for deliberation reflect its focus on practical and policy-related issues. (The contrast with its predecessor is remarkable. Led by two full-time chairs, Leon Kass and Edmund Pellegrino, the President’s Council on Bioethics pursued “fundamental inquiry into the human and moral significance of developments in biomedical and behavioral science and technology.” The chair and co-chair of the current commission are university presidents who did not take leave.)
The report defines democratic deliberation as “a method of decision making in which participants discuss and debate a question of common concern, justifying their arguments with reasons and treating one another with mutual respect, with the goal of reaching an actionable decision for policy or law, open to future challenge or revision.”[2]
Elsewhere, Commission Chair Amy Gutmann and Dennis Thompson explain the nature of “public reasons”: “When citizens make moral claims in a deliberative democracy, they appeal to reasons or principles that can be shared by fellow citizens who are similarly motivated,” that is, those who are also motivated to bring their own public reasons to a deliberative process in terms that are “accessible to their fellow citizens.”[3]
While making arguments in terms that are understandable and perhaps accepted by others may be an important posture as a matter of prudence, it is a far different thing to require that participation in deliberative democracy necessitates said motivation and rhetorical stance. Is the speaker to be bound by the subjective experiences and attitudes of the listener? A listener who might agree that the argument is well-supported might nonetheless reject its appropriateness because they dislike the moral conclusion, despite the mandate for “mutual respect.” The “accessibility” demand might very well exclude any number of sincere, thoughtful citizens who think about bioethical issues in essentially theological or religious terms, and who do not wish, or lack the skill, to express matters of deep faith while confined to the bland vocabulary of public deliberation.
There seems to have been a deliberate effort to sidestep the contributions of religion, spirituality, and theology, and their significance for most people’s lives. Even though religious belief is reportedly on the decline in the U.S. (52% of Americans say religion is “very important” in their life),[4] eighty-three percent of Americans still identify as Christian, with only 13% percent reporting no religion.[5] Yet, the report mentions ‘religion’ barely three times, twice to describe members of public bioethics organizations, and once to suggest that a community organization or church might offer a class in “world religions.” The only reference to ‘spiritual’ or ‘spirituality’ is a 2000 AARP survey revealing that a top learning motivation of people over the age of fifty is “spiritual growth.” References to “theological bioethics,” “theological ethics,” or even plain vanilla “theology”? Zero.
The distancing of deliberative democracy from religious discussion is even more puzzling, given that “people who are highly religious are . . . more likely to volunteer [and] more involved in their communities.”[6] If the people who are most likely to show up at a community forum are highly religious, why should something that is core to their identity be ignored or, at worst, excluded? Would a religious person offering a religious perspective, even a well-presented one, be accused of not “giving a reason”?
Last year, the Commission invited public comment on deliberation and bioethics education. In response, CBHD filed a letter highlighting the necessity of including not just deliberative competence, but normative competence in bioethical dialogue.[7] The pursuit of a kind of generalized public morality (the likely outcome of democratic deliberation) could sideline contributions of those with deeper metaphysical, axiological, and theological commitments. If the policy under discussion affects religious people, then religious perspectives should be specifically included. Issues such as fetal tissue research, dispensing of the “morning-after pill” to minors, and organ donation come to mind. Exclusion of theological or more broadly religious perspectives points toward deliberation that is political, rather than public.
Despite the overtures to include those who might be affected by a proposed policy (which could mean the majority of Americans), the ground rules for democratic deliberation privilege an elitist posture that favors a seemingly neutral perspective of public morality and values, while ignoring the theological roots and trunk upon which the moral fruits of virtue grow.
Furthermore, the outcome of deliberation appears to be skewed in favor of those conducting it. The report cites favorably and at length the “national-level deliberation” in the UK over three-parent embryos, described as “mitochondrial donation.”[8] The 13-month process that resulted in Parliament’s approval in 2015 demonstrated “general support.”[9] However, the process has been critiqued for its misrepresentation of science, including safety for the resulting children, and its inadequate ethical discussion of the ban on germline engineering and cost/benefit analysis.[10] The Human Fertilisation and Embryology Authority (HFEA) selected the focus groups and opinion polls that supported legalization. An independent poll showed only 20% of the public agreed with the HFEA plan.[11]
Let me be clear. CBHD is committed to charitable critique, collegial scholarship, accessible language, and mutual respect. We aim to persuade with cogent arguments and compelling ethical analysis. But there are times when the best arguments are overtly and richly theological. If democratic deliberation excludes those reasons from the conversation, it will be a barren public square indeed.
[1] Presidential Commission for the Study of Bioethical Issues, Bioethics for Every Generation: Deliberation and Education in Health, Science, and Technology, May 2016, 17. http://bioethics.gov/sites/default/files/PCSBI_Bioethics-Deliberation_0.pdf.
[2] Ibid, 3.
[3] Amy Gutmann and Dennis Thompson, Democracy and Disagreement (Cambridge, MA: Harvard University Press, 1996), 55. The Commission report, not surprisingly, relied extensively on the work of its chair Amy Gutmann in deliberative democracy and democratic education (citing her work 25 times in 152 endnotes).
[4] Gallup Poll, www.gallup.com/poll/1690/religion.aspx.
[5] Gary Langer, “Poll: Most Americans Say They’re Christian,” ABC News, July 18, 2016. http://abcnews.go.com/US/story?id=90356&page=1.
[6] “Religion in Everyday Life,” Pew Research Center: Religion & Public Life. April 12, 2016. http://www.pewforum.org/2016/04/12/religion-in-everyday-life/.
[7] The letter can be accessed at https://cbhd.org/content/comment-letter-deliberation-bioethics-education.
[8] PCSBI, 23.
[9] PCSBI, 24.
[10] David King, “Manipulating Embryos, Manipulating Truth.” Council for Responsible Genetics, Gene-Watch 27, no. 3 (Sep-Nov 2014). http://www.councilforresponsiblegenetics.org/genewatch/GeneWatchPage.aspx-?pageId=543&archive=yes.
[11] King, “Manipulating Embryos.” See also http://www.comresglobal.com/wp-content/uploads/2015/06/Care_Three-Parent-Embryo-Survey_2nd-February-2015.pdf.
Paige C. Cunningham, "From the Director's Desk,” Dignitas 23, no. 3 (2016): 2–3.
