A review of Biomedical Advances Confront Society: Congressional Hearings and the Development of Bioethics, 1960-1975, by Frazier Benya.
In her dissertation, Frazier Benya offers a detailed and nuanced history of the development of the first US federal bioethics commission, the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. She further demonstrates the important role that US Congressional discussions of the social implications of biomedical research played in shaping both the institutional and intellectual trajectories of American bioethics. She argues that 1960s conversations around (what would later be labeled) bioethical issues, and the institutional and professional structures that came out of them, were neither purely a reaction to technological developments, nor an outgrowth of an autonomous body of philosophical expertise. Similarly, while the legislation that created the National Commission was catalyzed by political responses to research scandals like Tuskegee in the early 1970s, Benya demonstrates that the scope and mandate of the Commission took form in the context of prior, broader attention to issues of social impacts and scientific responsibility. She reveals the broadly interdisciplinary tenor of early bioethics debates, showing how efforts to construct the National Commission became a focal point for the forms of political, scientific and philosophical attention that shaped the development of American bioethics.
The first chapter examines emergent debates among biomedical researchers in the 1960s, before the development of bioethics. During this period, a set of encounters between science and law took shape around issues of consent in human experimentation, and particular domains of medical practice like organ transplantation. Common accounts of the origins of bioethics point to these domains as its historical source. Benya examines a third domain: discussions, particularly amongst scientists, about the social responsibilities of science for emerging forms of knowledge and technology. These conversations initially took shape around the bomb, but, as Benya demonstrates, in the 1960s they extended first into concerns about military applications of biology, and then social dimensions of advances in the biosciences more broadly. During this period, which Albert Jonson has called the “decade of conferences,” the biosciences became an important locus of discussions about scientific social responsibility as physicians and researchers began to discuss the implications of their work, and to reflect on the forms of responsibility appropriate to their professional roles. Benya demonstrates that this line of discussion was not contained within or subsidiary to issues of human experimentation or medical ethics, but emerged largely independently and with a distinct set of preoccupations, priorities and participants in deliberations. These discussions raised the visibility of social issues in biomedical research, ultimately catalyzing more widespread, public attention. Drawing on a wealth of archival material, she follows deliberations through a series of conferences and initiatives, mapping the early engagements that at once set nascent deliberative agendas and served as the fora in which influential figures like Joshua Lederberg and Leon Kass began to engage with bioethical issues.
The second chapter offers an examination of early US congressional attention to social issues in the biosciences. It traces the efforts of Senators Fred Harris to examine federal investment in biomedical research, and to examine the social implications of that research. Benya demonstrates that these discussions informed the scope and agenda of politically focused attention and legislative responses to the social impacts of science and technology. These efforts built upon existing congressional attention to consumer protection and environmental regulation, and a sense of the need for science advice to inform agendas for strategic investment in research to benefit the American public. Harris and Mondale’s hearings expanded this focus beyond fiscal and administrative considerations to attend to social impacts. Members of a contingent in Congress who had taken up the mantle of Johnson’s Great Society, they were young senators who broadly advocated using social-science informed government initiatives to affect positive social change. They argued that research agendas were matters of social policy, and should be informed by robust social-scientific knowledge about society’s needs on the one hand, and impacts of science and technology on the other. Benya demonstrates that these discussions were grounded in the conviction that it was Congress’ responsibility to attend to the social outcomes of novel research. In parallel to the emerging attention to the “unintended consequences” of technological change in the environmental arena, these discussions laid the groundwork for Mondale’s proposal for a federal advisory body to examine the social and ethical implications of biomedical research.
In the third chapter, Benya examines Walter Mondale’s efforts to put on the legislative agenda the creation of an institutional mechanism to attend to these challenges—a federal bioethics committee. Benya observes that Mondale’s proposal took form in an environment of deteriorating trust in biomedicine. Thus he imaged a body that would address a wide range of scientific, technological, social and policy issues, from emerging techniques of genetic engineering, to organ transplantation, to professional and public education, to the priorities that should inform research agendas and applications of health resources. Given its broad scope, the proposal raised questions about who had the authority and competency to be made responsible for assessing social impacts, and thus about the representational configuration and role of such a body as an institution of democratic governance. Predictably, the proposal drew criticism from prominent figures in the biomedical research establishment, who argued that it was redundant with respect to existing norms of social responsibility in biomedicine, and furthermore might impede socially beneficial scientific research. Benya traces how a general concern with social issues, laid down in prior years, transmuted into questions of the institutional identity, place, and purpose of the proposed National Commission. Debate came to focus on questions of membership, of relationships with and position within the wider institutional ecology of science governance, and on the appropriate relationship of a commission with the public, be it representative, educational, or advisory. Mondale insisted that a National Commission should have a broad topical focus, and include a similarly broad range of expertise. Benya argues that the lack of a well-specified and circumscribed remit led to hesitation and qualified support even from the advocates of a commission. Yet she also notes that Mondale’s broad topical focus was replicated in the public discussions that were catalyzed by his legislative proposal. It thereby played an important role in shaping the scope and interdisciplinary character of the field of bioethics that would emerge, in part, in response to these discussions.
The fourth chapter follows Mondale’s legislative proposal from 1969 through 1974 when a modified version of his proposed National Commission was authorized as part of the National Research Act. During this period, medical advances like the successful creation of human embryos in vitro and numerous successful heart transplantations continued to prompt public discussions about social implications. Benya demonstrates that notions of scientific social responsibility were evolving in this period, and that the foundations of bioethics as a professionalized and institutionalized field were also laid down with the establishment of the Hastings Center and the Kennedy Institute for Ethics, as well as the National Academy of Science Committee on the Life Sciences and Social Policy. It was also during this period that a series of scandals around biomedical research on human subjects unfolded. Most prominent among these was the now infamous Tuskegee Syphilis study. Public outrage over this and related experimental abuses of human subjects catalyzed a political response that subsumed discussions of social and ethical issues in biomedicine. Senator Kennedy, who had been active in the early 1970s in calling for a public institutional role in the emerging field of bioethics, held hearings on human experimentation. He wrapped Mondale’s proposal for a National Commission into legislation that was ultimately passed as the National Research Act. Its primary mandate was narrowed to human experimentation, but with a secondary focus on broader issues of social implications of biomedical research.
Taken as a whole, the dissertation offers a rich picture of a critical period in the history of American bioethics, and an important revision to the dominant historical account. Benya demonstrates that the National Commission, though often seen as merely a response to Tuskegee, had a deeper, more complex and more consequential origin. She shows that the idea of a public advisory body was not proposed merely in reaction to a specific lapse in governance. Rather, it was conceived as an institution for democratic deliberation of a host of challenging domains in biomedicine, from genetic engineering, to organ transplantation, and from human experimentation to psychological research. She demonstrates that the creation of the National Commission not only established the public bioethics body as an important institution in US democratic governance of the biosciences, but the decade of wide ranging deliberations that led up to it played a critical role in giving shape to American bioethics more broadly. With these deliberations, the foundations for a rapid legislative response to Tuskegee had already been laid.
Thus, Benya demonstrates that attention to “social implications” and issues of democratic oversight and governance played a critical role in giving shape to the field of bioethics, and that Congress was instrumental in this process. She demonstrates that bioethics emerged neither as a sui generis professional field, nor as an institutional response to specific crises. Rather, the concerns that opened the way to public bioethics were primarily focused on the broad social implications of emerging directions in the biosciences and new biotechnologies, and on the need for corollary innovation in governance. As the dissertation compellingly demonstrates, the imperative of a broad agenda, of robustly interdisciplinary research, and of social-science informed attention to responsibilities of democratic governance of the biosciences and technologies predate the field (and, indeed, the concept) of bioethics. It is a valuable history of this formative period, and one that invites us to ask whether the now well-established field of bioethics has lived up to early visions of its promise and its purpose.
J. Benjamin Hurlbut
Assistant Professor, School of Life Sciences
Arizona State University
Archival materials from various sources including:
Carl Albert Center Congressional Archives, University of Oklahoma, Norman, OK; Walter F. Mondale Papers, Minnesota Historical Society, Saint Paul, MN; Albert and Shirley Small Special Collections Library, University of Virginia, Charlottesville, VA
US Congressional Record
Published materials (popular periodicals, academic journals, etc.)
University of Minnesota, 2012. 248 pp. Primary Advisor: Sally Gregory Kohlstedt.
Image: Senator Walter Mondale. WikiMedia Commons.