Tackling tough issues

As a bioethics expert, Rebecca S. Dresser, J.D., the Daniel Noyes Kirby Professor of Law and professor of ethics in medicine, asks a lot of questions.

Questions such as: Is it ethical to destroy a human embryo in order to make its stem cells available for research? Is killing a human embryo like killing a human child or adult? If embryos aren’t the same as persons, does this mean we should regard them as having the status of property?

Whose responsibility is it to oversee the safety and ethical concerns of new biotechnologies? Are we obligated to enable every human to live a long and healthy life? What is the ethical and moral approach to end-of-life directives?

Dresser not only ponders these questions, but she also helps both law and medical students ponder the complex and emotionally fraught issues that arise with each new medical advance. There may be no easy answers, but it is critical that the questions be asked nonetheless.

But while Dresser is happy pondering the answers to these kinds of complicated questions, the very modest Indiana native does not like to talk about herself.

“I’m not interesting enough to write about,” she protests.

But her colleagues line up to praise Dresser.

For example, Philip Ludbrook, M.D., professor of medicine and of radiology and associate dean and chair of the Washington University Human Studies Committee, says, “In her work on the committee, Rebecca brings all of her legal, ethical and medical insights to bear on issues at the interface between law, medicine and ethics.

“Despite her exceptional wisdom and experience, she is gentle in her approach, preferring to offer her insights, albeit usually persuasive and convincing, as suggestions and opinions rather than dogma. She is the ultimate committee member. She articulates her thoughts clearly and succinctly, then allows the discussion to continue and a vote to be taken.

“The Human Studies Committee is extremely fortunate to have Rebecca as a member, and is proud of her national reputation and visibility in the medical research ethics community. She is both a respected authority at the national level and a willing contributor locally.”

And Thomas Murray, president of the Hastings Center, an independent, nonpartisan, and nonprofit bioethics research center founded in 1969, says of Dresser, “Rebecca is not only a very good lawyer and legal scholar, but she is also very knowledgeable about clinical medicine and science and is very sophisticated on the philosophical level. These three skills inform her scholarship in a way much more creative and valuable than most.”

Dresser earned a bachelor’s degree in psychology and sociology and a master’s in education, both from Indiana University. Attending Harvard Law School, Dresser intended to pursue the intersection of law and psychology, though she never planned on being a law professor.

“I always was interested in school and I did well,” Dresser says. “My family was very supportive, though no one is an academic. The amazing thing is, I engaged in very little career planning, and I ended up doing something I love.”

Dresser became interested in bioethics before there really was much of a field. Having spent time as a postdoctoral fellow in the psychiatry department at the University of Wisconsin (on a National Institutes of Mental Health training grant), Dresser gained a familiarity with bench scientists and basic research.

One point she often makes is that the general public needs to better understand that the scientific progress, particularly as it relates to medicine, is slow and painstaking. The basic science behind possible cures is complex and the research is time-consuming.

Not understanding this, patient advocates and the media are often guilty of announcing a breakthrough therapy years before it is, in fact, applicable to human subjects and creating false hope and unreasonable expectations.

But on the other hand, Dresser has also been an advocate of getting the public more informed and even involved in setting research priorities. Sometimes, research scientists get caught up solely in intellectual pursuits, or seeking funding or publishing their next paper and lose sight of the individuals affected by, say, a certain disease.

Dresser has supported the insights that patient advocates bring to the table. In this way, she truly is a bridge between the two communities of scientists and advocates, both of which have so much to offer the other.

Dresser serves as a bridge in another way. In her extensive writings, she demystifies some of the science being done and explores the implications of the latest scientific advances as they relate to moral and ethical issues.

For example, she received a grant from the National Institutes of Health to examine the ethics of studying germline genetic interventions in humans. This approach has never been tried in humans until now, and it involves correcting “bad” genes in either the sperm or egg before fertilization or in the zygote at a very early stage.

Researchers are more optimistic of success at this stage because the “new” gene would then be incorporated into every cell as the embryo divided.

The current gene therapy approach, called somatic cell gene therapy, involves injecting large quantities of the “good” gene into a patient (via a benign virus) and hoping some get incorporated into the body. Preliminary results with this approach have been disappointing.

In an article, Dresser examined the long-term, multigenerational impact of such an approach. What if, for example, the gene degrades over generations, causing some worse affliction? In addition, many afflictions are caused by multiple genes, so “fixing” one doesn’t guarantee a cure.

Likewise, in many cases, having a certain gene for a disease doesn’t mean someone will get the actual disease, so in those cases doctors would be intervening when it might be unnecessary.

“There has been a lot of hype about so-called ‘designer babies,'” she says. “I wanted to explore what it would take to actually get there and the ethics of human testing.”

Before joining the University faculty in 1998, Dresser taught at Baylor College of Medicine and at Case Western Reserve University. At Case Western, she met her partner, Peter A. Joy, J.D., professor of law and director of the Criminal Justice Clinic at WUSTL.

In addition to her teaching and writing responsibilities, Dresser is serving on the President’s Council on Bioethics. Over the past two years, the council has released several reports on topics ranging from reproduction and stem-cell research, to cloning and the implications of biotechnology. The council is in the early phases of two new projects. One focuses on aging and dementia as it relates to care-giving; the other will examine neuroscience ethics.

“I’m happy about the project on aging and dementia because it is a group of issues that faces people right now,” Dresser says. “It’s an everyday ethics concern and certainly is only going to increase with the aging of the baby boom generation.

“One of the wonderful things about the council is we have experts who are willing to take their time to present the latest information. It’s like a very high-level seminar. I’ve found it to be the most interesting intellectual experience I’ve ever had.”

Dresser credits council chair Leon Kass for striving for what she calls a “richer public bioethics.”

“Rather than present material that is a little bit … boiled down, with a lot of the nuances removed, he prefers to have us talk about the whole range of considerations and really expose different views and conflicts and just get the material out there so that someone in the community who is interested and confused can read through the report and say, ‘I might not agree with this position but I understand why people hold it,'” she says.

This philosophy mirrors Dresser’s as well. One of her strengths is being able to clearly see two sides of an argument, to really revel in the complexities of a given issue, and still be able to clearly articulate her position.

And she has no qualms about admitting when she doesn’t understand something.

“You have to be willing to ask dumb questions,” she says. “I’ve been blessed and privileged to work with a lot of people in medicine and science who are willing to help me.”