Decision Points

Just as the stem of a vine grows into many distinct branches, embryonic stem cells have the capacity to grow into nerve cells for the brain, muscle tissues for the heart, or other organs. These cells offered a possible way to treat ailments from juvenile diabetes to Alzheimer’s to Parkinson’s. The technology was new, and the science was unproven. But the potential was significant. However, the only way to extract embryonic stem cells is to destroy the embryo. This raised a moral dilemma: Could the destruction of one human life be justified by the hopes of saving others?
    Congress’s answer seemed clear. Every year since 1995, the House and Senate had passed legislation banning the use of federal funds for research in which human embryos were destroyed. The law was known as the Dickey Amendment after its sponsor, Congressman Jay Dickey of Arkansas.
    In 1998, a researcher at the University of Wisconsin isolated an individual embryonic stem cell for the first time. As the cell divided, it created a multitude of other cells—called a line—that could be used for research. Soon after, the Clinton administration adopted a novel interpretation of the Dickey Amendment. Lawyers argued that taxpayer dollars could be used to support stem cell research on lines derived from destroyed embryos so long as the destruction itself was funded by private sources. The National Institutes of Health prepared to award grants under those terms, but President Clinton’s term ended before any funds were distributed. The immediate decision facing me was whether to allow those grants to proceed.

    It was clear this would be more than a funding dispute. The moral questions were profound: Is a frozen embryo a human life? If so, what responsibilities do we have to protect it?
    I told Margaret and Deputy Chief of Staff Josh Bolten that I considered this a far-reaching decision. I laid out a process for making it. I would clarify my guiding principles, listen to experts on all sides of the debate, reach a tentative conclusion, and run it past knowledgeable people. Afterfinalizing a decision, I would explain it to the American people. Finally, I would set up a process to ensure that my policy was implemented.
    To run the process, Josh tapped Jay Lefkowitz , the general counsel of the Office of Management and Budget, the agency that would oversee my funding policy. Jay was a thoughtful and lively lawyer from New York with a serious commitment to his Jewish faith and a dry sense of humor. I liked him immediately. That was good, because we were going to spend a lot of time together.

    With Margaret Spellings and Jay Lefkowitz.
White House/Eric Draper
    Jay loaded me up with background reading. He included articles from medical journals, writings on moral philosophy, and legal analyses. The reading he sent spanned the spectrum of viewpoints. In
Science
magazine, bioethicist Dr. Louis Guenin argued, “If we spurn [embryonic stem cell research], not one more baby is likely to be born. If we conduct research, we may relieve suffering.”
    Those on the other side of the debate argued that government support for the destruction of human life would cross a moral line. “Embryonic stem cell research takes us onto a path that would transform our perception of human life into a malleable, marketable natural resource—akin to a cattle herd or copper mine—to be exploited for the benefit of the born and breathing,” bioethics expert Wesley J. Smith wrote in
National Review
.
    At its core, the stem cell question harked back to the philosophical clash between science and morality. I felt pulled in both directions. I had no interest in joining the Flat Earth Society. I empathized with the hopes for new medical cures. I had lost a sister to childhood leukemia. I had served on the board of the Kent Waldrep National Paralysis Foundation, an advocacy group led by a former Texas Christian University football player who had suffered a spinal cord injury. I believed in the promise of science and technology to alleviate suffering and disease. During my presidential campaign, I had pledged to follow through on the commitment Congress made in the late 1990s to double funding for the National Institutes of Health.
    At the same time, I felt that technology should respect moral boundaries. I worried that sanctioning the destruction of human embryos for research would be a step down the slippery slope from science fiction tomedical reality. I envisioned researchers