Howard Fine couldn't have been more startled by the sudden turn in the conversation.
One of a dozen physicians summoned to the White House last week to talk about the patients' bill of rights, Dr. Fine was "surprised" when President Bush veered into a different - and highly sensitive - subject: stem-cell research.
Mr. Bush's eagerness to consult the doctors is just one indication of the painstaking, deliberative way the president is going about making the most morally charged decision of his young presidency: whether the US should fund research of stem cells taken from human embryos. So heavily does the decision weigh on him, say Bush aides and others, that he's taking an uncharacteristically long time to make up his mind - reading up on the subject and talking personally with ethicists, doctors, and scientists.
Lately, Bush has been unexpectedly bringing up the subject at meetings - even if it means running into overtime, as happened with Fine's group. "He ventured into stem-cell research,
which we never would have done, because that was not the focus of our activity there and because we knew that he saw it as a little sensitive," says Fine, president of the American Society of Cataract and Refractive Surgery.
The central issue Bush is struggling with, says another participant at the patients' bill of rights meeting, is balancing the "promise of science" with "the ethical considerations" of destroying embryos to derive stem cells. Many researchers believe the cells will eventually cure some of today's most debilitating diseases. Those who oppose the research argue that, because it destroys embryos, it destroys human life.
A question of US funding
Specifically, Bush is considering whether he wants to change funding guidelines established by the Clinton administration. The guidelines apply to "spare" embryos frozen at in vitro fertilization clinics - embryos too numerous to be implanted in the mothers and which would be discarded. The Clinton policy, which does not fund the actual destruction of the days-old embryos, covers research on the stem cells after they have been removed. Stem cells, however, cannot be removed without destroying the embryo.
"This is not a simple matter, and the president is very aware that the ramifications of whatever decision he makes will be with mankind for a considerable period of time," says Ari Fleischer, White House spokesman.
While White House aides describe the choice as an agonizing one for this pro-life president, others wonder if there isn't an element of show, providing the political cover of careful consideration for whatever decision is made. If Bush overturns the Clinton policy, they note, such research would continue at private labs and companies in the United States. It also will proceed in other countries such as Britain, which publicly funds such research.
One Republican consultant says Bush is deliberately dragging out the decision until after he visits Pope John Paul II next week while in Italy. "The whole body language of agonizing is a good delay tactic to get to this trip to Europe," says the consultant. "They do not want to have to say 'no' to the Pope."
Many expect Bush to strike a compromise. Possibilities include allowing funding for research on the existing supply of embryonic stem-cell "lines" - cells that have already been separated and have multiplied - or funding only research on stem cells taken from adults. A new study from the National Institutes of Health, released yesterday and commissioned by the Bush administration, recommends research on both embryonic and adult stem cells.
"I think that this president is a strong pro-life president, but that he clearly understands the role of science in solving some of these deadly diseases," says the GOP consultant. "He's a new kind of Republican, like his father. As a Bush, he's going to look to open this up."
In his last year in office, the first President Bush vetoed a bill that would have allowed US funds to be used for medical research on tissue from aborted fetuses. On the other hand, he also issued an executive order creating a fetal-tissue bank that could use tissue from miscarriages, for instance, but not from abortions. Since then, fetal-tissue research, which was also held up as promising for fighting diseases, "has had a very mixed outcome," says Jeffrey Kahn, director of the Center for Bioethics at the University of Minnesota.
Even before George W. took office, he was being lobbied on the issue. On Jan. 17, the American Medical Association urged him to allow federal funding of embryonic stem-cell research. In February, 80 Nobel laureates did the same. Anti-abortion groups such as the National Right to Life Committee have urged the opposite.
He is besieged, too, by lawmakers on both sides of the issue. At hearings on Capitol Hill this week, one family testified about "adopting" in-vitro twins, while a girl implored lawmakers to support the funding in hopes that it could help her fight diabetes.
Meanwhile, the administration is divided. Tommy Thompson, secretary of Health and Human Services, favors the funding, while others, such as political adviser Karl Rove, are concerned that allowing it will alienate an important constituency for Bush: Roman Catholic voters.
The decision has been "much more [watched] than I've ever seen on a medical research issue," says Larry Soler of the Coalition for the Advancement of Medical Research, which favors the funding.
Bush's religious views
For Bush, sorting out his views on this issue may be, in part, intensely personal. His sister died from a disease that scientists say could potentially be treated as a result of stem-cell research. Yet his strong anti-abortion views are tied to his religious beliefs.
Mr. Fleischer, the White House spokesman, says the president's religious beliefs will not influence his decision "as a matter of religion."
But Fleischer also made clear that Bush would be influenced by his experiences. "The president approaches these decisions ... on a basis of who he is and what he believes is best for the country. Who he is is shaped by a variety of factors, and that's his background as a governor, it's his faith, it's his experience in working with Democrats and Republicans to bring about bipartisanship," Fleischer says. "You cannot separate a man's background from his approach."
During the campaign, Bush came out against embryonic stem-cell research. In a May 18 letter to the Culture of Life Foundation, which opposes the research, he wrote: "I oppose Federal funding for stem-cell research that involves destroying living human embryos. I support ... medical research on life-threatening and debilitating diseases, including promising research on stem cells from adult tissue."
Chris Straub of Culture of Life sees an iron-clad promise in there.
But Mr. Soler, of the medical research coalition, sees wiggle room. "Many scientific texts define an 'embryo' as two weeks old. The cells here are less than two weeks of age." Further, he asks, is a frozen, fertilized egg, to borrow Bush's word, "living"?
Richard Land, an anti-abortion ethicist who is in regular touch with senior administration officials, says he's been impressed with the depth and specificity of questions the White House is asking him. "It's obvious his staff is really probing," says Mr. Land, president of the Southern Baptist Convention's Ethics and Religious Liberty Commission, which opposes the funding.
Besides the ethical and scientific considerations - which have dominated the debate - politics are also coming into play. If Bush breaks his campaign promise and allows the federal funding, says Land, "it will be the cultural conservative equivalent of his father's 'no new taxes' pledge being broken."
On the other hand, if the president makes another decision seen as favoring the anti-abortion camp, he will further alienate moderates and independent swing voters, says Rep. Amo Houghton (R) of New York, who wrote an appeal to Bush to fund the research.
"The danger is, if there are too many issues that come out against people who are pro-choice, it's going to jeopardize our base," he says. "You have people like myself, who are pro-choice Easterners, who have vulnerable districts."
(c) Copyright 2001. The Christian Science Monitor