Way back at the start of this decade, three high-tech, almost exotic issues dominated the bioethical landscape: cloning, embryonic stem cell research and bioterrorism.
In the early 2000s, the question on everyone’s lips was: “How can we keep clones from taking over the world?”
As we enter 2010, however, three mundane and low-tech issues are overshadowing the bioethical discourse: health reform, coping with the flu and what to do about obesity.
What happened? How did what we started out worrying about come to bear such little resemblance to the ethical dilemmas we’re facing now?
Admittedly, there were a number of other hot-button issues that popped up during the decade just passed. Long before her death in 2005, Terri Schiavo became the poster-child for many in the right-to-life movement who considered the removal of her feeding tube a moral travesty perpetrated on a helpless, disabled woman. Despite the findings of an autopsy that the Florida woman had permanently lost all capacity to see, speak, communicate, think or feel, many continue to vilify her husband, who believed she would have wanted to be allowed to die.
Ethical dilemmas abounded
During later years, there was no shortage of ethical dilemmas. Conflict-of-interest scandals rocked the pharmaceutical and academic worlds; Hurricane Katrina raised questions about the duties of health workers in a crisis; and genetic testing flourished on the Internet.
In more recent years, the International Olympic Committee wrestled with the question of whether a man with prosthetic limbs could compete; organ trafficking reached into American hospitals; Washington state joined Oregon in allowing assisted suicide; and the first-ever vaccine to prevent cancer, Merck’s Gardasil, appeared.
Sure, all of that is pretty remarkable, but what the heck happened to the clones?
Well, the science for making cloned people was never really easy to do. The one scientist who claimed to have made cloned human embryos, South Korean Hwang Woo-Suk, resigned in disgrace when his work was exposed as a hoax. Moreover, there was very little interest on the part of legitimate researchers in cloning people. Instead, they were and remain interested in cloning only as a research technique because that is where the money is.
Banning federal funding for embryonic stem cell research was center stage in the culture wars in the early part of the decade. Despite a good deal of yelling and finger-pointing, a compromise emerged: embryonic stem cells could be made from unwanted embryos created at fertility clinics.
As for bioterrorism, it remains a threat but worries about terrorists releasing smallpox and anthrax have faded to concerns mostly for the Department of Homeland Security and other national and international agencies.
Public health threats take center stage
What replaced those ethical debates is new-found doubt about the ability of the United States and the world to deal with boring, ordinary public health threats.
The sci-fi technologies did not have legs, at least as far as compelling bioethical arguments.
What does merit scrutiny is the inability of the world to make enough vaccine to deal current crisis of familiar and emerging strains of the flu, including the H1N1 swine flu.
What also commands attention is that, despite all our new genetic knowledge and increased understanding of the human brain, we don’t seem to be able to get any traction on the obesity epidemic.
And in the U.S. it seems touch-and-go whether politicians can figure out how to do what every other comparable nation has done and provide basic health insurance to every citizen.
None of these ethical issues lends itself to a quick or easy fix. Each will require revamping our fundamental attitudes and public policies toward vaccines, diet and the cost of health care.
The lesson of the decade, it seems, is that we can’t focus on cutting-edge technologies when we haven’t solved the most basic problems.
In a country that’s been short on flu vaccines, where seven-stack cheeseburgers are advertised to an obese nation, and where there’s not enough basic infrastructure to delivery basic medical care to children and pregnant women, we have work to do.
Welcome, 2010. Maybe this will be the decade when we get our moral priorities in order.
Arthur Caplan, Ph.D., is director of the Center for Bioethics at the University of Pennsylvania.