Hastings Center Report

The policy soup. At the recent Hastings Center fortieth anniversary celebration dinner, I was seated next to a gentleman who asked me a provocative question. Aren't you an advocacy group? Well, no, I responded. We're nonpartisan, and we don't advocate for any legislation. He pushed me on this a bit, noting that we might not be political, but that any time a Hastings scholar says that euthanasia is wrong, for example, or that stem cell research on spare IVF embryos is not, we are advocating for something. I acknowledged that individual scholars have positions, but not the Center itself. What the Center supports is that diverse, well-considered ideas get aired. This made me think. It is advocacy, of a nontraditional sort. It's the advocacy of ethical dialogue, rooted in a belief that such exchange leads to good policy.

Does such "abstract" advocacy matter? I think so. At the Fellows meeting that followed the dinner, Beecher award-winner Alex Capron recounted how patient autonomy—now a bedrock American value—was codified into research and medical practice. It took the careful, intellectual Hastings Center process of listening to thinkers from different backgrounds, expertise, and perspectives at the table, over time, to polish the concept. This intellectually rigorous process has a heft—and an impact—that advocacy groups chanting outside hospital barriers would have been unlikely to achieve alone, he said.

Today, as the Center is more proactive in the policy world, we rely on that same approach. I write these Field Notes literally from the field (or the sky above it), while flying back from one of the increasingly frequent trips to Washington that the Center scholars and I make. The current focus of our efforts is health reform. Are we advocating for any particular policy? No. Rather, we are endorsing a dialogue around fundamental values—such as liberty, justice, efficiency, stewardship, responsibility—and how they need to be engaged in any reform effort. Indeed, without that discussion being made explicit, we doubt that the effort can get enough of the public behind it. The nuts and bolts of employer tax exclusions, mandates, guaranteed access, and public plans are essential (see Dan Callahan's must-read Health Care Cost Monitor blog at www.healthcarecostmonitor.org for insight on these issues)—but they need to be built on a strong foundation.

Toward this end, the Center has produced Connecting American Values with Health Reform, a set of essays that was recently sent to Report subscribers. The response to it thus far—from policy-makers on both sides of the aisle and from the media—has been enthusiastic. At the same fortieth anniversary dinner, a television producer said to me that health reform is the biggest domestic issue facing the nation, but there's no talk of the values behind it. Why aren't bioethicists at the table? Funny you should ask, I said—conveniently knowing that he would receive a copy of the essay set at the end of the evening. We are there—advocating for making values part of the discussion, and convinced that will lead to better policy.