How Bush Got There

For a while this year it seemed that George W. Bush buttonholed everybody he met to get his or her view on stem-cell research. Emissaries from Capitol Hill, delegations of scientists, pro-lifers, bioethicists, patients’ advocates, the Pope–if they had a take, they had his ear. “Almost everyone in the White House, well, he asked your opinion at one point,” says presidential counselor Karen Hughes. “He also questioned what led you to that decision. He wanted to know the rationale.”

Of all the advice Bush got, however, none was more important than the consultation he held on Aug. 2 with doctors and scientists from the National Institutes of Health. Weeks earlier, Bush had sent the NIH on a treasure hunt through clinics and laboratories around the world, searching for available lines of stem cells. These are cells extracted from embryos created for fertility treatments but not used to produce children. The extracted stem cells potentially can be made to grow into any cell in the human body, making them an extraordinary resource in the fight against Alzheimer’s, Parkinson’s, diabetes and other diseases.

Religious conservatives argue that using those stem cells means deriving benefit from the destruction of human embryos–fertilized eggs in the early stages of development–in their eyes no less a crime than abortion. And Bush, son of the great tax-promise breaker, did not want to go back on his vow that he would not fund such research. He believed that if he banned federal funding of research using stem cells derived from embryos destroyed in the future, many pro-lifers might swallow their misgivings about the use of stem cells already extracted from discarded embryos. There was still a problem. Bush and his advisers were being told there were probably a dozen, maybe 20, such lines–not enough, many scientists said, to sustain the necessary research. But the Aug. 2 meeting with the NIH scientists lifted that cloud. They told Bush there were more than 65 lines available worldwide–not as many as scientists would like but enough for a plausible compromise.

“It made this decision possible,” said a senior White House official. “It allowed you to balance the hopes of research against the moral imperative that the government should not be funding the destruction of human life.”

Last spring, when Bush was running for the White House, stem-cell research was for most people an obscure specialty on the frontiers of medicine. In a campaign dominated by education and tax cuts, his promise, made in a letter to the U.S. Conference of Catholic Bishops, that “taxpayer funds should not underwrite research that involves the destruction of live human embryos” must have seemed like a detail on the margins of his platform, like his pledge to reform the crop-insurance program.

Instead, it has provided the central predicament of his young presidency. It is an issue that has placed Senate pro-lifers like Orrin Hatch and Strom Thurmond on the side of those who want federal funding, and brought out stars like Mary Tyler Moore and Michael J. Fox to speak on behalf of juvenile diabetics and people with Parkinson’s disease, who might benefit from the research. For Bush, the past few weeks provided a supreme opportunity. For a man who has sometimes seemed to lack the gravitas that the presidency demands, the stem-cell debate offered the chance to show that he was thoughtful, earnest, tireless–in short, worthy of holding the title of President of the United States. Bush’s prolonged rumination about the right thing to do was not just a time for soul searching. It was a way of signaling that he could engage issues that mattered at a level commensurate with their importance. In the days just before and after his speech, his aides were everywhere to spread the word that Bush had given this question every last ounce of the consideration it deserved. “I think he just really took it seriously,” says an Administration official involved in the decision. “He was bombarded from so many sides. I think he just had to sift and sift.”

What Bush announced in his televised address last Thursday night was a compromise that was, at least in the short term, wonderfully adroit. By allowing funds for research on the small number of already existing stem-cell lines but denying money for any work with stem cells derived from embryos destroyed in the future, he positioned himself in the narrow political space that allowed him to claim he had not stood in the way of promising medical investigations. At the same time, he could insist that he had kept his promises to the Republican right, which abandoned his father after the elder Bush broke his no-new-taxes pledge. To placate scientists who argue that Bush did not go far enough, he promised “aggressive federal funding of research on umbilical-cord, placenta, adult and animal stem cells, which do not involve the same moral dilemma.” The government is already spending $250 million on such research this year.

The White House is hoping that the Bush compromise will deflate moves in Congress to push through legislation that would override his decision. Majorities in both houses support federal funding for research on embryonic stem cells. The Bush compromise might be enough “to head them off at the pass,” says Pennsylvania Senator Rick Santorum, an opponent of embryonic stem-cell research. It helped that Bush timed his announcement for the summer recess, when members of Congress are scattered, making it harder for Democrats to offer a speedy, unified alternative.

For the most part, Bush also defused the fury from the right. The U.S. Conference of Catholic Bishops–to whom he initially made his no-funding promise–blasted his decision as “morally unacceptable.” Ken Connor, president of the Family Research Council, said that by trying to distance himself from the destruction of the embryos, Bush was like Pontius Pilate, who “washed his hands of the blood” of Christ. But evangelical leaders like Jerry Falwell and conservative radio host James Dobson called the compromise one they could live with.

If nothing else, it was not the outcome that pro-lifers feared most–the compromise developed last month by Republican Senator Bill Frist of Tennessee, the only physician in the Senate, who has been an important Bush adviser on medical and health-care issues. Frist’s plan would allow stem cells to be extracted from surplus embryos currently in stock and due for destruction in clinics and labs around the country, a supply that numbers between 100,000 and 1 million. Senate majority leader Tom Daschle, who was mildly critical of Bush’s compromise, says he will introduce a broad stem-cell funding bill that could embrace the Frist approach; in the fall Daschle will find out whether Bush has cut him off at the pass.

For months a White House working group led by Karl Rove, the President’s top political adviser, had been taking views from all sides on the stem-cell question. Bush turned to the issue seriously three months ago. On May 8 he had lunch with Tommy Thompson, the pro-research Secretary of Health and Human Services. At the time Thompson was fairly certain that Bush would not budge from the position he took during the campaign, when the question had been turned over to aides who handled abortion issues, with predictable results. To Thompson’s surprise, Bush insisted that he was looking for a solution somewhere between a total ban and the kind of green light that might encourage the spread of virtual embryo factories. “He made it clear that he was up in the air,” says a White House aide.

Thompson was a major advocate of the idea that already existing lines of stem cells might serve as the basis for compromise. He spoke from time to time with James Thomson, the stem-cell pioneer at the University of Wisconsin (see America’s Best), who had led him to believe there could be useful research with even a limited number of stem-cell lines.

Bush continued to seek views from everywhere. On an Air Force One flight to Philadelphia a few months ago, G.O.P. moderate Senator Arlen Specter of Pennsylvania presented the case for a bill he had sponsored that would fund and control stem-cell research through the NIH. Bush listened attentively but gave no hint of what he thought. On July 11, Bush met with medical leaders to talk about the patients’ bill of rights. Toward the end of the meeting, he broke away from health care to tell his audience that “the issue I am wrestling with is stem cells.” Dr. Stan Pelofsky, president of the American Association of Neurological Surgeons, says he told Bush that “the genie was out of the bottle” and that federally funded research with oversight would accomplish the best of both worlds. “You would perhaps get spectacular benefits down the road,” he said, “and you would also have governmental oversight.” But again Bush gave no indication of which way he was leaning.

As the President peppered people with questions, his staff suggested a series of Oval Office meetings with representatives from all sides of the issue. One of them, in early July, turned out to be pivotal. Bush met with conservative bioethicists Daniel Callahan, co-founder of the Hastings Center, a bioethics institute, and Dr. Leon Kass from the University of Chicago. (Bush named Kass last week to head an advisory panel that will monitor stem-cell research and recommend guidelines.) At the July meeting, the two ethicists reinforced Bush’s growing conviction that he should not fund research on newly extracted stem-cell colonies. Now it only remained for him to find a way to make the narrower compromise work. When the NIH discovered the larger number of existing stem cells, the shape of the policy was locked in.

Meanwhile, pressure was building in Congress. On July 25, Rove huddled with 43 moderate Congressmen of the Republican Mainstreet Partnership at the Capitol Hill Club. Minnesota Representative Jim Ramstad, whose mother suffers from Alzheimer’s disease and whose first cousin died from juvenile diabetes, stood up and made an impassioned plea for stem-cell research. In reply, Rove recounted how on a trip he took to Georgia a young couple came up to him and pleaded for stem-cell research to continue for another six months so it might save their ailing child. The President, Rove told the Congressmen, considered the consequences of a stem-cell decision “no less important than a decision to commit troops to war.”

The next weekend, when both men were attending the G.O.P.’s Midwest Leadership Conference, Ramstad informed Rove that a letter would soon be delivered to the White House with the signatures of 202 Congressmen backing the research. Forty were Republicans. “And I have 15 other Republicans,” Ramstad warned, “who have committed to us but who didn’t want to go public with their support.”

Pressure also came from stem-cell opponents on the Hill. In early July House majority leader Dick Armey, majority whip Tom DeLay and Republican Conference chairman J.C. Watts had issued a joint statement demanding that Bush prohibit funding. “It is not pro-life to rely on an industry of death,” they argued, “even if the intention is to find cures for diseases.” House Speaker Dennis Hastert, though he opposes stem-cell research, refused to join his three top lieutenants in the statement.

For all his consultation on the subject, Bush did not talk much with members of Congress. Even Senator Frist did not have an in-depth talk with Bush after Frist floated his own compromise. “He was searching more for moral authority than political counsel,” says Senator Sam Brownback, the Kansas Republican who opposes funding.

The speech Bush ultimately gave last week was written by Hughes, who has a gift for conveying complex issues in kitchen-table language. She rehearsed it with him Wednesday. Until the final hours before he delivered it, just a handful of people knew what he would say–Vice President Dick Cheney, Rove, Hughes, chief of staff Andrew Card, White House communications aide Dan Bartlett and legal adviser Jay Lefkowitz. Half an hour before airtime, Rove held a conference call with five Republican members of Congress who were outspoken opponents of embryonic stem-cell research–Senators Brownback and Santorum plus Representatives Christopher Smith, David Weldon and Joseph Pitts.

“The reaction was first one of relief,” says Santorum. “We had heard rumors that the President was going to fund stem-cell research, and many of us thought this was going to be the Frist proposal.” Santorum says Bush’s decision might “actually stop further destruction of human life because the scientists who now are looking for robust funding programs are going to be working with these existing stem-cell lines. So the desire to create more stem-cell lines through destruction of human embryos will be alleviated.”

In weeks to come, protest against the compromise is likely to intensify among both scientists and people waiting for medical breakthroughs. There were immediate questions about whether Bush was correct in saying there are “more than 60” existing stem lines available for research. A White House that has often called for “sound science” on global warming will now have to prove that it has not offered a rosy number of available stem-cell lines.

One way that Bush may have come up with a higher number of available stem-cell lines is through a relaxation of the ethical rules governing how they are collected. The Washington Post reported last Saturday that one of the ethical guidelines put in place by Bush–that the embryo donors must have given “proper informed consent”–was less strict than rules established under Bill Clinton, which specified in detail what informed consent would be. That change could have helped make a larger number of stem-cell lines available for research.

Bush may end up tripping on his own logic. Now that he has sanctioned the principle of government funding for research in existing stem-cell lines, he may have difficulty holding the line at 65. Privately funded researchers will be producing new stem-cell colonies from discarded embryos. When scientists come to Bush saying the federally approved cell lines show promise but they need more cell lines, by what argument will he be able to say no? “I have made this decision with great care,” Bush said in his address. “I pray it is the right one.” It may be, at least for a little while.

–Reported by James Carney, Matthew Cooper, John F. Dickerson, Michael Duffy and Douglas Waller/Washington and Cathy Booth Thomas/Crawford