politics bioethics science policy

7/25/2019 Politics Bioethics Science Policy

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HEC Forum (2008) 20 (1): 2947.DOI: 10.1007/s10730-008-9062-9 Springer 2008

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Leigh Turner Ph D Associate Professor William Dawson Scholar Biomedical Ethics Unit Department

Politics, Bioethics, and Science Policy

Leigh Turner

Many commentators argue that science policy should be above or

beyond politics; they insist that science policy ought to be based

exclusively on science. However, science policy formation includesethical and political considerations. Science and scientific facts do not

determine science policy, though bodies of evidence developed by

communities of scientists play an important role during policy-making

processes. I argue that science policyparticularly policy-making related to

medicine, biotechnology, the life sciences and other areas raising basic

questions about identity, morality, and social orderis inevitably

politicized in pluralistic societies.

Introduction

A term regularly invoked in bioethics scholarship, moral consensus is

frequently elusive in contemporary societies (Engelhardt, 2002; Moreno,

2005; Powers, 2005). The achievement of consensus or wide reflective

equilibrium often seems less likely than the persistence of normative

conflict (Hampshire, 2000; MacIntyre, 1988; Stout, 1988). Several leading

approaches in bioethicscasuistry and principlist bioethics as well as other

models predicated upon the notion of reflective equilibriumemphasize

shared, common resources for ethical deliberation. Many bioethicistspromote consensus-based models in which interlocutors articulate

disagreements, provide reasons in support of particular moral claims,

respond to criticisms, and reach consensus. This model of moral deliberation

is optimistic that review of evidence or scientific findings coupled with

reasoned argumentation will end in a common understanding of what

constitutes sensible practices and policies. However, anyone who has played

a role in developing policy within institutions, professional societies, or

legislative assemblies will recognize the many challenges facing efforts to


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craft broadly acceptable policies. The difficulties facing members of policy-

making bodies at hospitals and professional associations are multiplied at the

level of provincial, state, federal, and transnational policy formation. At this

level of policy development, many constituencies must be addressed. These

groups can have different interests, objectives, and moral predispositions(Sowell, 2002). They often disagree with one another about what counts as

credible evidence and who can be characterized as reliable authorities.

Policy-making within Institutions

Within hospitals, to select just one type of social institution where policy-

making occurs, policy-makers are sometimes criticized for failing to seek

appropriate representation from members of various groups. In other

instances, policy-makers are criticized for not fully grasping thecomplexities of particular domains of medical research or clinical practice.

Criticism can come from many sources. Critiques can be particularly intense

when policy-makers are expected to address contentious, divisive moral

issues that generate considerable passion. Interlocutors can disagree

concerning what constitutes ethical practices and policies. Researchers,

nurses, doctors, hospital administrators, patients and other social actors can

all claim that their interests are inadequately represented in policy-making

arenas or incorporated within institutional policies (DeVries and Forsberg,

2002). Critiques can focus on the inclusiveness or exclusiveness of policy-making processes, fairness or legitimacy of processes of policy formation, or

the substantive content of particular policies. Issues of substance and

processinsofar as matters of process are not also substantivecan both

serve as lightning rods for conflict. Disputants can complain that they were

not properly consulted during the policy-making process. Critics can argue

that a policy emphasizes particular moral norms while paying insufficient

heed to other values. Alternatively, dissatisfied parties can claim that a

policy reflects the interests of one group while failing adequately to address

and incorporate the concerns of other social actors.To focus on policy-making within hospitals, nurses can assert that

physicians are given too much influence over policy-making processes and

organizational practices. Doctors, in turn, can argue that they are not

adequately included in various phases of policy development. They can state

that the voices of hospital administrators, rather than clinicians, are

consistently given too much weight. Social workers, physical therapists, or

occupational therapists can condemn overrepresentation of doctors and

nurses and express dismay that the voices of members of allied health

professions are neglected.


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Even if a particular category of professionals is well-represented during

the policy-making process, members of that group will sometimes claim that

their official spokespersons fail to represent diverse moral viewpoints within

the institution. For example, nurses might express satisfaction that nurses

serve on the clinical ethics committee crafting a particular policy, yet arguethat the particular nurses on this body are unrepresentative of all nurses at

the institution. Charges of authoritarianism, marginalization of stakeholders,

and unrepresentative decision-makers must be acknowledged and

addressed. In settings informed by democratic, egalitarian values, criticisms

about exclusion and lack of representation must be seriously considered.

There are many ways that various organizational actors can challenge

policies and the policy-making process.

Extra-institutional Social Actors

Even if caregivers from various health-related professions develop a

consensus and agree that different constituencies are well-represented, the

policy-making process is fair, and the completed institutional policy is

reasonable, patient representatives, family representatives, or local

community leaders can argue that the interests of patients, the moral

concerns of family members of patients, or the interests of the larger local

community were insufficiently recognized during the process of crafting a

particular institutional policy. Non-clinicians with a stake in hospital policycan accuse health care professionals of being elitist, undemocratic, and

inattentive to the interests and concerns of community stakeholders.

Concerted institutional efforts to engage community members and involve

them in organizational policy formation can generate a different set of

problems. If the exclusion of various social actors from the policy-making

arena sometimes leads to charges of elitism, efforts to promote more

democratic policy-making exercises can increase the likelihood of

encountering intractable conflicts concerning what values ought to guide the

policy-making process. When interests and normative frameworks of groupsdiverge, policy-makers can find it impossible to achieve consensus.

Representatives of religious groups, ethnic groups, community

associations, political bodies, and other social organizations can have diverse

views concerning the basic, core, or foundational moral norms that

ought to guide policy formation. Even if all interlocutors share general moral

principles, they can disagree over how general moral norms ought to be

weighed, specified, and interpreted in particular circumstances (Engelhardt,

2002). Agreement about statements of principle need not lead to agreement

about specific policies or practices.


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Policy-making exercises within just a single institution can generate fierce

debates. Ethical issues related to the beginning and ending of human life are

particularly contentious. Priority setting and resource allocation exercises

must often confront competing notions of justice and fairness (Hampshire,

2000). Furthermore, professional rivalries, longstanding struggles forinstitutional power, personal conflicts, conflicting religious values, cultural

differences, basic disagreements about fundamental moral values, perceived

slights or perceptions of exclusion or marginalization, and, of course, the

satisfaction some parties feel when provoking opponents or blocking their

interests whenever opportunities arise can all serve to slow or derail policy-

making initiatives.

Making Social Policy

Challenges facing efforts to achieve consensus or wide reflective

equilibrium multiply when we move beyond the level of a single institution

to the state, province, or nation. State, provincial, and federal policies can

affect the lives of millions or hundreds of millions of individuals. Within

political entities that have relatively homogenous cultural and religious

traditions, a common normative framework can limit obstacles associated

with crafting social policy. However, in multicultural, multifaith, pluralistic

societiesmost contemporary Western liberal democracies contain multiple

religious groups, religious communities, and political partiesthere can bemany different normative frameworks in play. In most contemporary liberal

democracies, it does not make sense to refer to Christian, Jewish,

Muslim, Hindu, or Buddhist values. (The list of religious traditions

could be greatly expanded.) To the contrary, diversity will characterize

various religious traditions.

Just as moral frames can differ within and among various religious

groups, it is often a gross simplification to refer to Hmong, Korean-

American, or Chinese Canadian belief systems or worldviews.

Ethnic groups, much like religious groups, are often diverse rather thanmonolithic. Disagreements over basic moral values and the morality of

specific social practices and policies can occur within and not only between

ethnic groups. Value orientations can differ across generations, intraethnic

groupings, gender lines, socioeconomic status, and many other social

categories.

Fragmentation of Civil Religion

In countries where there is a broad, pervasive, overarching civil religion


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(Bellah, 1975), cultural and religious differences might not have much

influence on broad matters of social policy. Rather, members of various

social groupings will share a common civil religious tradition or public

philosophy (Almond and Verba, 1963; Kingdon, 1999; Sandel, 1996). This

shared normative fabric will provide common symbols, metaphors, andnarratives; there will be many resources for mutual deliberation and shared

moral convictions. However, if such a civil religion does not exist, or if this

pervasive social ethic loses its public authority over time, the presence of

multiple normative frameworks can make it very difficult to reach public

agreement on ethical issues related to childrearing, parenting and family life,

health, illness, dying, and death (Hunter, 1991). Interestingly, the bioethics

movement in the United States emerged at a time when many social

commentators suggested that the civil religion of the United States was

fragmenting (Bellah, 1975). The rise of bioethics is sometimes seen as aresponse to developments in medicine, biotechnology, and the life sciences.

Acknowledging the role of specific technologies in prompting questions

about moral values, the emergence of bioethics as social movement,

academic field, and occupation might also be connected to the fragmentation

of civil religion in America (Bellah, 1975; Engelhardt, 2002). As

background presuppositions about public morality were thrown into question

and a crisis of moral legitimation occurred, philosophers, theologians, and

clinicians were increasingly asked to justify particular social policies.

Longstanding norms could no longer be assumed. Particular values, policies,and social practices required justification in the face of public disagreement.

Competing Political Philosophies

Social scientists pay considerable attention to the moral discourses,

worldviews, and mores of various cultural and religious communities.

Political traditionsconservative, liberal, libertarian, and social democratic,

for examplealso transmit social norms and connect broad visions of

society to particular policy issues (Holm, 2004; Sowell, 2002). Just asreligious and cultural traditions can promote different normative

frameworks, competing political philosophies also characterize many

Western liberal democratic societies. Some countries have a well-defined

political center. Various political parties know that however much they

might wish to differentiate themselves from competing political parties, they

must try to claim the common ground of mainstream political discourse.

To surrender this common ground is to accept a place on the periphery of

power. In settings where there is a well-defined civil religion or public

philosophy, political leaders fight to define, occupy, and control the political


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center. In other countries, political discourse is far more polarized (Hunter,

1991). Common ground and possibilities for bipartisan accords shrink and

the likelihood of conflict over basic moral premises and the normative basis

of social order increases. James Davison Hunter (1991) argues that the

United States provides an example of a democratic society locked in aculture war. In fractured political landscapes, bioethicists will not have an

easy time claiming that their normative claims and arguments rise above

or beyond political conflicts. Rather, discussion of ethical issues related to

such topics as embryonic stem cell research and therapeutic cloning will

occur within turbulent social arenas (Caplan, 2005; Moreno, 2005; Powers,

2005).

Culture Wars

Moral issuesonce they shift from being perceived as personal, private

matters of conscience to matters of public policybecome swept into the

public sphere of political conflict. In polarized political arenas, bioethics

becomes enrolled in the the culture wars (Callahan, 2005; Caplan, 2005;

Charo, 2004; Charo, 2005; Check, 2005; Hunter, 1991; Mooney, 2005;

Moreno, 2005). Within such settings, some social actors assert that

scientific matters must remain uninfluenced by political values and moral

agendas. Clinging to the assumption that science must not be politicized,

they assume that scientific facts must drive public policy. However, inmulticultural, multifaith, politically diverse societies, scientific facts will

not end policy disputes and ethical conflicts (May 2006; Moreira, 2007).

Rather, studies by scientists are swept into larger social conflicts; the

meaning and credibility of various scientific claims becomes part of ethical

debate and public policy formation. Science does not solve these political

disputes and moral conflicts. Instead, scientific facts are used to lend

legitimacy to particular normative claims and policy recommendations

(May, 2006). Studies produced by scientists are used to establish credibility

and authority in the same manner that religious injunctions, exegesis ofparticular sacred texts, or other authoritative conversation-stoppers (Rorty,

1999) are used in settings where particular religious convictions hold broad

sway.

Politicizing Science Policy

At the level of national policy deliberations, policy-making often occurs

against a backdrop of partisan conflicts between political parties,

longstanding moral conflicts dividing citizens, considerable scientific


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uncertainty, and questions concerning the legitimacy of particular advisory

bodies (Barke, 2003; Green, 2006; Gutmann and Thompson, 1996; Kennedy,

2003; Moreno, 2002; Pellegrino, 2006; Pielke, 2002; Pollard, 2001; Powers,

2005; Revkin, 2004; United States House of Representatives Committee on

Government Report, 2003). At this level of policy formation, one of the mostcommon accusations directed at policy-making bodies is that they are

politicizing science and technology policy (Blackburn, 2004a; Blackburn,

2004b; Grimes, 2004; Kass, 2004; Shulmar, 2007). Critics rarely explain

what shape an apolitical policy somehow above or beyond politics

would take. The usual assumption is that political opponents are partisan

ideologues whereas the critics themselves are guided by common sense and

reasonable convictions. Accusations that science is being politicized can

emerge from all points along the political spectrum.

Sometimes, these criticisms have a straightforward meaning. Accusationsof the politicization of policy-making can mean that evidence is being

neglected, research is being ignored, and qualified individuals are removed

or blocked from advisory bodies. Accusations of politicization of science

policy can refer to the failure to include diverse voices or an incapacity to

defend particular policy claims against criticisms from reputable authorities.

Acknowledging that accusations of the politicization of science can have a

straightforward, legitimate meaning, I want to nonetheless argue that policy-

making is inevitably politicized or political in nature.

Opponents of particular public policies or advisory bodies regularly arguethat science and not politics ought to dictate science and technology

policy (Grimes, 2004; Leshner, 2003; Malakoff, 2003). In the United States,

the current Bush Administration is repeatedly excoriated by its critics for

politicizing science and technology policy formation (Blackburn, 2004a;

Boonstra, 2003; Ferber, 2002; Greenberg, 2001; Greenberg, 2004; Grimes,

2004; Malakoff, 2003; Mooney, 2005; Novak, 2003; Shulman, 2007; Union

of Concerned Scientists, 2004). At present, the Bush Administration is

accused by Democrats of politicizing science. At some point, Republicans

will lose political power and Democrats will drive national science policyformation. When this occurs, we can anticipate that Republicans will accuse

Democrats of politicizing science. I want to challenge the assumption that

science policy can somehow take an apolitical form.

Policy-making as Political Process

In democratic social orders, the formation of science policy is an ethical and

political process; science alone cannot serve as the sole basis for crafting

science policy (Barke, 2003; Powers, 2005). Though we might want to


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criticize particular policies, we should not criticize policy-makers for

politicizing questions related to science and technology. We can criticize

policy-makers for the values they hold or the way they interpret particular

values in specific contexts. Criticisms can also be directed toward the uses of

evidence, selection of scientific authorities, and exclusion of particularscientific voices from the policy-making process. The suppression or

exclusion of dissent can serve as one example of an unwiseand potentially

dangerousresponse to science and technology policy formation (Ferber,

2002; Greenberg, 2004; Novak, 2003; Union of Concerned Scientists, 2004).

However, even if dissenting voices are included in deliberative bodies,

policy formation will still be political. It will still include contestable

judgments, the search for credibility and legitimation, the marshalling and

critique of evidence, and often rhetorical appeals to the public good. Policy-

making is a key element of what politicians and their designated advisorybodies do in democratic societies. Reaching resolutionhowever

temporaryon contestable, often divisive topics is a highly political process.

Conflicts, disagreements, accusations and counter-accusations of bias, and

questions about the suitability of particular policymakers are standard

features of making public policy in pluralistic democratic societies

(Gutmann and Thompson, 1996).

Policy-making as a Value-laden Enterprise

The positivist attitude toward science policy formation rests on the

assumption that science, nature, or the laws of physics can automatically

dictate social policies. This view assumes that scientific knowledge free of

substantive ethical, social, economic, and political judgments can be used to

generate social policy. To the contrary, public policies are not based solely

on scientific research findings. For example, scientific research can provide

information concerning the risks and benefits of particular pharmaceutical

products or medical devices. However, determining what counts as minimal

risks, acceptable risks, or a reasonable risk/benefit ratio cannot bedecided exclusively on the basis of particular outcomes. The determination

of what counts as an appropriate risk/benefit threshold involves a moral

judgement; numbers alone do not set the bar for evaluating risks posed by

particular interventions or technologies.

Policy-making must address many factors, including ethical, legal, social,

economic, and environmental issues. The politicization of science is

widely characterized in negative terms, reflecting the common assumption

that value judgments should be squeezed from science policies. Such

accusations commonly make reference to the suppression of important


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scientific research, exaggerated emphasis on the significance of particular

scientific findings, Machiavellian manipulations behind closed doors, the

stacking of advisory and regulatory bodies with partisan members and the

exclusion of credible voices of dissent from deliberative processes

(Boonstra, 2003; Kennedy, 2003; Novak, 2003; Lancet Editors, 2002;Mooney, 2005). The politicization of science, in this sense, justifiably has

negative connotations. In effect, the phrase refers to breakdowns or

shortcomings in democratic processes required to craft robust, credible,

science policies. However, in another sense, policy-making will inevitably

occur as a contentious, argumentative, value-laden political process.

Particular social actors must make decisions. Evidence needs to be weighed,

judgments defended, claims and counterclaims debated, risks and benefits

assessed. Such exercises in reasoning involve substantive deliberations; they

do not turn exclusively on scientific findings. We should expect that socialpolicies related to issues in bioethics will include substantive judgments and

commitments, and that different actors will often disagree over the particular

weight that ought to be accorded various moral principles, how guidelines

should be interpreted, and how arguments ought to be assessed. Science

policy-making draws upon substantive convictions that are not reducible to

scientific forms of knowledge even though research by scientists informs

policy-making.

Substantive Judgments

Social policies and advisory documents that recommend or characterize

policy alternatives do not simply convey data extracted from scientific

reports. They incorporate substantive judgments such as what benchmarks

should be used when establishing reasonable risk/benefit ratios, whether

short-term considerations should outweigh long-term consequences, and

whether cost effectiveness analysis or cost-benefit assessment can serve as

an adequate ethical framework for deliberation (Emery and Schneiderman,

1989; Goklany, 2002; Marchant, 2003; van den Belt, 2003). While better orworse arguments can be made when forming substantive judgments and

crafting policies, such judgments will be political and contestable. Rather

than focusing upon the politicization of science policy-makingas though

there is an alternative to political deliberationsattention might better be

focused on the dangers of suppressing voices of dissent and forms of

evidence that ought to be included in policy-making arenas. However, these

points can be distinguished. Even more inclusive approaches to policy-

making are political. To recognize the value of including dissenters or

social critics in policy debates is not to argue that science policy-making


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should be above or beyond politics and guided only by science.

Interpreting Scientific Studies

Policy documents often draw upon findings from scientific studies. Forexample, advisory reports, policy briefings, and policy guidelines related to

embryonic stem cell research, gene transfer technology, or therapeutic

cloning will utilize findings from researchers working in various fields

within the life sciences. Science policy necessarily engages scientists and

scientific research. Engagement with scientific research commonly plays a

crucial role when crafting science and technology policies related to such

topics as gene transfer technology, embryonic stem cell research,

xenotransplantation, and somatic cell nuclear transfer. However, research

findings established on the basis of research methods broadly accepted byparticular communities of scientists constrain but do not determine how to

craft regulations and guidelines. Decisions about which areas of scientific

research to fund, regulate, or prohibit, how much biodiversity ought to be

preserved, or which endangered species to protect involve considerations of

ethical, legal, social, and economic arguments. Such decisions require

debates about the risks and potential harms to which we are willing to

expose humans and other organisms. Statistical estimates of risk inform risk

analysis, but they do not automatically identify which risks to tolerate and

which ones to minimize or prevent (Goklany, 2002).Decisions about tolerable levels of risk require exercises in moral

judgment. Such judgments will draw upon cultural models of what risks are

acceptable and which ones need to be reduced. Similarly, considerations of

moral and legal norms beyond cost-benefit calculationssuch as the dignity

of the person or obligations to future generationsinvolve deliberations that

are not reducible to scientific findings. Discussions concerning the relative

significance of individual liberty, the common good, the environment, the

comparative effectiveness of market mechanisms and governments in

distributing resources, and the demarcation of particular goods as public orprivate require political and ethical debates. Scientific findings and

scientific research are important components of these debates but they are

not the only elements of social policy formation. Findings from

epidemiology, immunology, biochemistry, and physiology do not

automatically dictate how to craft social policies and regulate particular

practices. Rather than deploring the politicization of advisory bodies and

policy development, we should expect political controversies and

disagreements over science and technology policy formation for at least four

reasons.


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Moral Politics of Technologies

First, different political parties commonly have different core values, social

agendas, and policy platforms (Sowell, 2002). In some countries, differences

between mainstream political parties are quite minimal. A shared civilreligion or common public philosophy provides a bounded space within

which mainstream political actors must function (Bellah, 1975). In other

social contexts, various political parties offer markedly different visions of

social order and the public good (Sowell, 2002). Even in countries where the

political center is relatively easy to identify, political parties still offer

somewhat different policy platforms to the voting public. These values and

policy orientations are connected to scientific research, but include

substantive ethical, legal, social, and economic judgments about how society

ought to be organized. For example, more liberal or progressive politicalparties typically emphasize the role of government in promoting social

justice and addressing social inequities. Progressive political parties have a

history of crafting policy initiatives intended to redistribute wealth from

wealthier to poorer members of society. In contrast, contemporary

conservative parties tend to be less supportive of government exercises in

redistributing wealth. They often seek to promote the role of markets in

distributing goods and services. Democrats and Republicans, Liberals

and Conservatives, and members of other political parties are concerned

about justice, but what justice means and how justice is pursuedcommonly takes different forms when representatives of these parties debate

matters of public significance.

Scientific issues are debated within social, political, and economic

environments in which different political actors are informed by distinctive

normative convictions (Sowell, 2002). However, these social actors do not

all have equal access to political power. In many political arenas, particularly

in settings where one political party does not overwhelmingly dominate the

political apparatus, bipartisan support is consequently an important

component of gathering public legitimacy for a particular policy. In settingswhere major political parties offer quite different substantive agendas,

dominant parties will often be susceptible to criticisms that they are paying

insufficient attention to the concerns of voices outside the center of power.

Here, politicization of policy-making refers to the exclusion or

marginalization of competing claims.

Policy frameworks and normative commitments do not always neatly map

onto traditional political divisions. Debates and conflicts exist both within

and across political parties. Many Republican politicians oppose embryonic

stem cell research but some Republic politicians support increased federalfunding for this area of research. However, taken as a whole, different


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political parties are typically informed by particular constellations of norms.

The presence of different substantive moral traditions in pluralistic liberal

democracies means that policy issues are charged with ethical and political

significance. Scientific findings do not directly address questions about

whether stem cells should be obtained from embryos and used to developnovel stem cell therapies. Public policies concerning embryonic stem cell

research, gene transfer technology, and xenotransplantation need to address

ethical, legal, social, economic, and, in some social settings, religious

considerations. Studies in elite scientific journals by experts in regenerative

medicine, gene therapy, stem cell research, and other scientific domains will

not tell policy-makers everything they need to know about how these

technologies ought to be subject to legislation and regulation. Scientific

research is not self-interpreting or self-regulating. In multicultural,

multifaith, politically pluralistic societies, particular values used to shapepublic policy will often not be shared by all social actors (Powers, 2005;

Sowell, 2002).

Decisions about how to regulate particular technologies involve

considerations about safety, risks, harms, benefits, respecting core moral

norms, and protecting the public good. Such questions are political matters.

The policy-making process involves many individuals engaging in public

debate, relying upon different experts, drawing upon sometimes diverse

bodies of evidence and argumentation, and making claims for alternative

regulatory models. There are few instances where all social actorsimmediately agree upon the specifics of complex social policies.

Disagreements can occur over general frameworks, particular guidelines, the

interpretation of regulations and laws, the credibility of specific scientific

claims, or the long-term implications of implementing particular policies.

Scientific studies might reveal that specific technologies are unfeasible or

have low rates of success. However, where evidence exists that technologies

are practically feasible, questions will remain about whether the technology

ought to be permitted and how it should be regulated. We might refer to

substantive conflicts over core social norms and the use of particulartechnologies as the moral politics of technologies. Often, different social

actors will disagree over whether a particular technology is ethically or

legally justifiable. They will disagree over what they regard as reasonable

regulatory frameworks. Legislation and social policy are crafted in the

political realm. Scientific expertise addresses just one domain of questions

about the regulation and appropriation of technologies.


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Politics of Authority

Second, science advisory boards and other committees intended to provide

recommendations and policy alternatives to government agencies are staffed

by particular individuals. Typically, only a small subset of the available poolof possible participants will be invited to participate in the policy-making

arena. For example, in the United States, The Presidents Council on

Bioethics currently includes just seventeen members. Many other qualified

citizens and professionals could serve on this body. Scientists, lawyers,

physicians, economists, and other citizens who are equally qualifiedand

doubtless viewed by their supporters as better qualified than existing

memberswill inevitably be excluded from participation in the policy-

making arena. Critics of the membership of particular bodies can quite

credibly claim that politics was a factor in deciding who gets to sit at thedeliberative table (Anderson, 2004; Blackburn, 2004a; Kass, 2004; Weiss,

2004). The process of selecting participants in the policy-making and

advisory process is inherently political. Even where government

administrations strive to seek balance and fair representation, some

qualified individuals are bound to be excludedintentionally or

unintentionallyfrom the deliberative arena. Even if representatives of

various groups are given opportunities to present their concerns to advisory

boards and policy-making bodies, they can legitimately charge that they are

excluded from the powerful role of setting the agenda, defining the terms ofdebate, and playing a decisive role in decision-making processes. We might

think of this realm as the practical politics of who gets to have authority

within the arena of deliberation and policy-making. Complex social and

technological issues are not assessed by neutral social actors. Rather, they

are explored by particular human beings with personal histories, community

roles, interests, preferences, and goals. Policy-making involves the view

from somewhere. Policy-making does not occur behind a veil of

ignorance. Particular humans make specific choices at concrete historical

moments. Democrats and Republicans, social democrats and libertarians,progressivists and conservatives, all have interests, predispositions, and tacit

values. In societies where significant social cleavages exist over matters of

public policy, we should expect to see controversies over which individuals

are excluded from the policy-making arena. In large, complex societies with

different forms of representative democracy, most citizens have very limited

access to policy-making arenas. The qualifications of those individuals who

make it into the inner circle of policy formation can usually be challenged.

Other individuals could take the place of those individuals granted access to

the corridors of power. Social actors on the margins of debate will often takeissue with not just the substance of particular policies. They will also ask


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why those individuals in positions of power have authority and a place at the

debating table.

Politics of Knowledge

Third, in some areas, disagreements exist among both scientists and

nonscientists about what constitutes reliable, accurate, credible knowledge.

Conflicting knowledge claims are quite common even though many

individuals like to think of science as providing definitive, unambiguous

answers. Some social actors will lay claim to a particular body of research

and rely upon its data and expert scientists. Other social actors will turn to

competing data and alternative claims to expertise. In domains where

conflicting values and policy alternatives are present, different bodies of

scientific research can often be used to legitimate divergent practicalconclusions. Various groups all claim that scientific research validates

their preferred social policies or recommended guidelines. Different political

actors will call upon scientists to support or oppose particular policy

frameworks. Disputants will seek to use science and scientists to their

advantage. In social settings where scientists have considerable cultural

capital, supporters of particular policies know that they need to find

respectable scientists to support their cause. To have the weight of

scientific authority on the side of the opposition is to suffer a major loss of

public credibility. We might think of this realm as the politics of knowledgeand claims to scientific expertise.

In complex policy disputes, we can anticipate that participants in the

debate will claim that their preferred policy has scientific backing and

support from credible scientific experts. They will not just challenge the

ethical framework or policy recommendations of their opponents. Often, a

powerful strategy to undermine alternative policy options is to challenge the

scientific claims used to support particular conclusions. In disputes about

global warming and the emission of pollutants, we can see one example

where social actors engage in fierce battles over which bodies of scientificresearch are credible and who can serve as reliable, trustworthy experts. In

contemporary democratic societies, to fail to make a case for the credibility

of claims to scientific expertise is to suffer a major crisis of legitimation in

public debate.

Politics of Uncertainty

Fourth, when crafting guidelines for novel technologies or responding to

other developments, existing scientific research can provide only limited


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insight into the long-term consequences of particular policies. Often, little

will be known about the long-term implications of promoting a particular

initiative. Policies commonly have unforeseen consequences. Technologies

can be used in unanticipated ways; unexpected problems or benefits often

emerge. For example, important questions about therapeutic cloning andxenotransplantation will need to be addressed before these biomedical

technologies can ever become normal, relatively routine components of

the clinical management of patients. Even if such technologies proceed

through clinical trials and become routinized aspects of medical care,

unresolved questions will likely remain about the long-term biological and

social consequences of such technologies. Years will need to pass before the

long-term benefits and harms of particular technologies become apparent.

Some individuals will likely argue that the immediate needs of desperately

ill patients ought to be given greater weight than concerns about the eventualspread of an unanticipated virus as a result of xenotransplantation. Other

individuals might argue that we should set a high threshold for safety

standards and not let the care of contemporaries potentially jeopardize the

health of future generations. Such policy disputes involve conflicts over how

to weigh individual goods and community goods, and possible short-term

consequences versus potential long-term consequences. Calculations about

costs and benefits are difficult to make; considerable uncertainty about

future outcomes often permeates debates. Just what current generations

owe future generations is a matter for discussion; science does not tellus how to weigh the interests of future citizens.

Uncertainty about the ethical, social, economic, and environmental

consequences of particular technologies will often generate different policy

conclusions. Risk averse individuals will perhaps rely upon a version of the

precautionary principle and insist that a technology should be deemed unsafe

until it is proven safe (van den Belt, 2003). Here, the regulatory bar is placed

quite high. All new technologies are subject to intense critical scrutiny and

evidentiary standards. Other individuals will argue that, on the basis of

existing research, a technology should be deemed safe, ethical, andpermissible until such time as evidence leading to a different conclusion

emerges. Here, new technologies are seen in a more optimistic light and the

regulatory bar is lowered. We might think of such debates as involving the

politics of uncertainty and time-horizons. To focus on the immediate or

long-term consequences is to shift the terms of debate. Even where scientific

evidence offers reliable insight into the short-term implications of particular

technologies, there will sometimes be considerable uncertainty about the

long-term consequences of permitting a particular technology to proceed. In

the early years of the 20th century, for example, it would have been difficult


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HEC Forum (2008) 20 (1): 2947.44

indeed to envision how aircraft would be used in the 21st

century.

Technologies are often used in ways unanticipated by their early proponents.

Existing knowledge does not provide a crystal ball allowing clear visions

of the future. Often, scientific studies provide little insight into important

questions about the practical consequences of a particular technology as it isused over time. Decisions must still be made, notwithstanding the

impossibility of knowing the consequences of developing a particular

technology over years and decades. The view from the present invariably

differs from retrospective analysis. In retrospect, problems often appear

obviously recognizable and easy to anticipate. At the time decisions are

made, even the most insightful specialists often have difficulty envisioning

in fine-grain detail future benefits and problems. Policy-making occurs in the

present; policy-makers lack the benefit of hindsight though they can look to

past events as a source of guidance concerning how to think about currenttechnologies. Anticipated benefits and harms can be factored into analysis.

However, policy-makers are not all-knowing. Interlocutors will often

disagree about the long-term implications of particular policies.

Conclusion

Many commentators insistently claim that science and not politics must

drive science policy. Science, nature, or scientific experts can supposedly tell

us how to proceed. However, it is misguided to think that science orscientific facts alone can drive science and technology policy. Rather than

criticizing the politicization of science policy, it makes more sense to

question the substantive content of particular policies. Calling particular

committees or policies politicized is a red herring; there are more effective

allegations to make when opposing a particular public policy or advisory

board recommendation. Similarly, if suppression of voices of dissent is at

issue, or credible bodies of research are being neglected in policy

deliberations, then arguments need to be made about the value of permitting

dissent in democratic societies, responding to the concerns of dissenters, andrecognizing the extent to which legitimacy flows from inclusion of diverse

social actors in policy-making processes. In instances where the concerns of

significant portions of the public are not incorporated into policy-making

arenas, a key problem is that policy-making is being shaped in ways that are

at odds with the core norms of large segments of the populace. In such

instances, policy-makers should be criticized not for politicizing social

issues and particular technologies, but for ignoring the moral concerns of a

significant portion of the citizenry. Of course, in settings where consensus

cannot be reached and basic moral norms are in conflict, ignoring the moral


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HEC Forum (2008) 20 (1): 2947. 45

concerns of significant numbers of citizens is precisely what happens when

social policy is established. The price of resolution is social exclusion. Wide

reflective equilibrium amongst interlocutors is not reached. There are

political winners and losers in the policy-making struggles. Politicization

is the word marginalized participants in public debate use to refer to theprocesses whereby their intellectual leaders, bodies of evidence, and modes

of reasoning fail to set the terms of debate, define policy, and shape social

order. The term politicization carries considerable rhetorical power even

though the crafting of science policy is a thoroughly political matter in

democratic societies where various political actors often have very different

views about what constitute ethical practice.

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