Decision Points

by George W. Bush

  Andy Card was with me as I took my place at the Resolute for the first time. My first Oval Office decision was to replace the desk chair—a bizarre contraption that vibrated when plugged in—with something more practical. Then the door to the Rose Garden swung open. I looked up and saw Dad.

  “Mr. President,” he said. He was wearing a dark suit, his hair still wet from the hot bath he’d taken to thaw out.

  “Mr. President,” I replied.

  He stepped into the office, and I walked around the desk. We met in the middle of the room. Neither of us said much. We didn’t need to. The moment was more moving than either of us could have expressed.

  Dad and I together in the Oval Office that day. White House/Eric Draper

  On my ninth day as president, my domestic policy team gathered in the Oval Office. Everyone was on time. That was what I expected. Timeliness is important to make sure an organization does not get sloppy. The chief briefer that day was Margaret Spellings, a smart and feisty mother of two. Margaret had served with me in Austin and moved to Washington as my top domestic policy adviser. She covered a variety of topics that day, including a new initiative for people with disabilities and an election reform commission chaired by former Presidents Ford and Carter. Then she launched into a discussion of embryonic stem cell research. “The Clinton administration issued new legal guidelines that interpret the Dickey Amendment to permit federal funding for embryonic stem cell research. We have several options going forward—”

  With Margaret Spellings. White House/Eric Draper

  That’s as far as she got before I cut her off. “First of all,” I asked, “what exactly is a stem cell?” I learn best by asking questions. In some cases, I probe to understand a complex issue. Other times, I deploy questions as a way to test my briefers’ knowledge. If they cannot answer concisely and in plain English, it raises a red flag that they may not fully grasp the subject.

  As usual, Margaret was well prepared. She started by explaining the science. Embryonic stem cells are a special medical resource because they can transform into a wide variety of different cell types. 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. After finalizing 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 to medical reality. I envisioned researchers cloning fetuses to grow spare body parts in a laboratory. I could foresee the temptation of designer babies that enabled parents to engineer their very own blond-haired basketball player. Not far beyond that lies the nightmare of full-scale human cloning. I knew these possibilities would sound fanciful to some people. But once science started heading down that path, it would be very hard to turn back.

  The stem cell question overlapped with the abortion debate. It seems hard to believe now, but abortion was not a major political issue when I was young. I don’t remember it coming up much during Dad’s early campaigns or in conversations at Andover or Yale. That changed in 1973 when the Supreme Court, in a decision Justice Byron White called “an exercise in raw judicial power,” deemed abortion a right protected by the Constitution.

  The abortion issue is difficult, sensitive, and personal. My faith and conscience led me to conclude that human life is sacred. God created man in His image and therefore every person has value in His eyes. It seemed to me that an unborn child, while dependent on its mother, is a separate and independent being worthy of protection in its own right. When I saw Barbara and Jenna on the sonogram for the first time, there was no doubt in my mind they were distinct and alive. The fact that they could not speak for themselves only enhanced society’s duty to defend them.

  Many decent and thoughtful people disagreed, including members of my family. I understood their reasons and respected their views. As president, I had no desire to condemn millions as sinners or dump new fuel on raging cultural fires. I did feel a responsibility to voice my pro-life convictions and lead the country toward what Pope John Paul II called a culture of life. I was convinced that most Americans agreed we would be better off with fewer abortions. One of my first
acts in the White House was to reinstate the so-called Mexico City Policy, which prevented federal funding for groups that promote abortion overseas. I supported state laws requiring parental notification for minors seeking abortions. And I supported, signed, and defended a bill banning the grisly practice of partial-birth abortion.

  Laura and I were also strong supporters of adoption. After having difficulty conceiving children, it was hard for us to imagine anyone rejecting what we considered a precious gift. Yet as the father of daughters, I could envision the dilemma facing a scared teenager with an unplanned pregnancy. Adoption was such a positive alternative to abortion, a way to save one life and brighten two more: those of the adoptive parents. I was pleased to sign legislation increasing funding for crisis pregnancy counseling centers, as well as to expand tax credits to offset the costs of adoption.

  In the long run, I hoped a change in hearts would lead to a change in law, as new technologies like 3-D ultrasounds help more Americans recognize the humanity of unborn babies. I also hoped political leaders would continue to speak out for a culture that values all innocent human life. Bob Casey, the late Democratic governor of Pennsylvania, said it well: “When we look to the unborn child, the real issue is not when life begins, but when love begins.”

  Beginning in the spring of 2001, Margaret, Jay, and Karl Rove—who was in close touch with advocacy groups on both sides of the issue—invited a series of distinguished scientists, ethicists, religious thinkers, and advocates to discuss embryonic stem cell research. The conversations fascinated me. The more I learned, the more questions I had. When I delivered the commencement address at Notre Dame, I brought up embryonic stem cell research with Father Ed “Monk” Malloy, the president of the university. When I spoke at Yale the next day, I raised the topic with Dr. Harold Varmus of the Memorial Sloan-Kettering Cancer Center. At a birthday party for a doctor in the White House Medical Unit, I asked all the physicians there what they thought. As word got out that I was seeking opinions, I was bombarded with input from Cabinet secretaries, staffers, outside advisers, and friends.

  Of course, I asked Laura for her advice. Her father had died of Alz-heimer’s, her mother had suffered from breast cancer, and she held out great hope for the possibility of new cures. But she worried that advocacy groups would overpromise what embryonic stem cell research could achieve, leaving desperate families with dashed hopes.

  Members of the scientific community presented two main arguments in favor of funding embryonic stem cell research. First was the medical potential. Researchers told me there were millions of Americans suffering from diseases that might be alleviated through treatments derived from embryonic stem cells. Experts believed that only a few stem cell lines would be needed to explore the science and determine its value. “If we had ten to fifteen lines, no one would complain,” Irv Weissman, a prominent researcher from Stanford, told the New York Times.

  A research team from the National Institutes of Health told me that several dozen stem cell lines were already under development. They also reported some preliminary research into alternative ways of deriving stem cells without destroying embryos. Their unanimous opinion was that denying federal support for embryonic stem cell research would result in a missed opportunity. Taxpayer dollars were important not only as a source of financing, they explained, but also as a seal of approval for scientific innovation.

  The scientists’ second point was a practical one: Most of the embryos used to derive the stem cells would likely be discarded anyway. The primary source of these embryos was In Vitro Fertilization (IVF) clinics. When a couple signed up for IVF, doctors usually fertilized more eggs than they implanted in the prospective mother. As a result, some embryos would be left after the treatment was complete. They were usually frozen and stored by the fertility clinic. Since these so-called spare embryos were not going to be used to conceive children, scientists argued, didn’t it make sense to use them for research that could potentially save lives?

  One of the groups most actively supporting embryonic stem cell research was the Juvenile Diabetes Research Foundation. In July 2001, I invited representatives from the organization to the Oval Office. Among the delegation were two friends of mine, Woody Johnson and Mike Overlock. Both men were political backers, and both had children suffering from diabetes. They were passionate, compelling advocates with an unmistakable devotion to their children. But their certainty about a rapid embryonic stem cell breakthrough surprised me. When I pointed out that the science was unproven and that there could be alternatives to embryo destruction, it was obvious that the advocacy group had left no room for doubt in their minds. The meeting was a window into the passions the issue could generate.

  That same day, I also met representatives of National Right to Life. They opposed any research that destroyed embryos. They pointed out that each tiny stem cell cluster had the potential to grow into a person. In fact, all of us had started our lives in this early state. As evidence, they pointed to a new program run by Nightlight Christian Adoptions. The agency secured permission from IVF participants to place their unused frozen embryos up for adoption. Loving mothers had the embryos implanted in them and carried the babies—known as snowflakes—to term. The message was unmistakable: Within every frozen embryo were the beginnings of a child.

  Many of the bioethicists I met took the same position. They acknowledged that most embryos frozen in IVF clinics would not become children. Yet they argued that there was a moral difference between allowing embryos to die naturally and proactively ending their lives. Sanctioning the destruction of life to save life, they argued, crossed into dangerous moral territory. As one put it, “The fact that a being is going to die does not entitle us to use it as a natural resource for exploitation.”

  I heard some opinions that surprised me. Dr. Dan Callahan, a thoughtful ethicist, told me he was pro-choice on abortion but against embryonic stem cell research. He believed there was a moral distinction between aborting a baby for the direct benefit of its mother and destroying an embryo for the vague and indirect purpose of scientific research. Dr. Benjamin Carson, one of the world’s most respected surgeons, told me that stem cell research could be valuable, but that scientists should focus on alternatives to embryo destruction, such as collecting stem cells from the blood of umbilical cords. On the other hand, Orrin Hatch and Strom Thurmond, two of the most staunchly pro-life members of the Senate, supported federal funding for embryonic stem cell research because they thought the benefit of saving lives outweighed the cost of destroying embryos.

  In July 2001, I visited Pope John Paul II at his beautiful summer residence, Castel Gandolfo. Swiss Guards in full regalia escorted us through a series of rooms and into the reception area. Pope John Paul II was one of the great figures in modern history. A survivor of Nazi and communist rule in his native Poland, he had become the first non-Italian pope in 455 years. With his call “Be Not Afraid,” he rallied the conscience of Central and Eastern Europe to bring down the Iron Curtain. As the distinguished Cold War historian John Lewis Gaddis later wrote, “When John Paul II kissed the ground at the Warsaw airport on June 2, 1979, he began the process by which communism in Poland—and ultimately everywhere else in Europe—would come to an end.”

  Visiting Pope John Paul II at Castel Gandolfo in 2001. The Holy Father urged me to defend life in all its forms. White House/Eric Draper

  By 2001, the Holy Father’s vigor and energy had given way to frailty. His movements were deliberate, his speech soft and slow. Yet his eyes sparkled. He was filled with an unmistakable spirit. He gingerly walked Laura, our daughter Barbara, and me to a balcony, where we marveled at gorgeous Lake Albano below. He and I then retired to a simple meeting room, where we discussed a variety of issues, including stem cell research. He understood the promise of science—the Holy Father himself was stricken with Parkinson’s. Yet he was firm in his view that human life must be protected in all its forms. I thanked him for his example of principled leadership. I explained that the C
atholic Church’s steadfast support of life provided a firm moral foundation on which pro-life politicians like me could take a stand. I told him I hoped the Church would always be a rock in the defense of human dignity.

  When the Holy Father passed away in 2005, Laura, Dad, Bill Clinton, and I flew together to his funeral in Rome. It was the first time an American president had attended the funeral of a pope, let alone brought two of his predecessors. Shortly after we arrived, we went to pay our respects to the Holy Father while he was lying in state. As we knelt at the communion rail to pray over his body, Laura turned to me and said, “Now is the time to pray for miracles.” An unexpected impulse came over me. I prayed for Peter Jennings, the ABC News anchor who was dying of cancer.

  The funeral mass was incredibly moving. The crowd in St. Peter’s Square cheered, sang, and carried banners celebrating the Holy Father’s life. After a homily by Cardinal Joseph Ratzinger—who eleven days later emerged from the conclave as Pope Benedict XVI—a group of Church officials carried the Holy Father’s casket up the stairs toward St. Peter’s Basilica. Just before entering the doors, they turned to face the crowd and lifted the coffin for a last time. As they did, the clouds parted and the sun shined through onto the simple wooden box.

  After several months of listening and reflecting, I was close to a decision on stem cell research. A defining moment came in a conversation with Leon Kass on July 10. Leon was a highly respected physician and philosophy professor at the University of Chicago. He had written and taught in fields as diverse as evolutionary biology, literature, and the Bible. He struck me as a thoughtful and wise man.