Biotech Ethics
By
Leon R. Kass , M.D., Gregg Easterbrook, Diana Schaub, Peter Augustine Lawler
Biotech Ethics:
Modern Man and the Pursuit of Happiness
Following are excerpts from a recent panel discussion at AEI on the new report of the President’s Council on Bioethics, Beyond Therapy: Biotechnology and the Pursuit of Happiness. The panelists were Council chairman and AEI fellow Leon Kass, M.D.; Gregg Easterbrook of the New Republic; Diana Schaub of Loyola College; and Peter Augustine Lawler of Berry College.
An expanded version of Schaub’s and Lawler’s remarks will be published in the Winter 2004 issue of The New Atlantis: A Journal of Technology and Society (www.thenewatlantis.com).
Leon Kass:
The age of biotechnology has begun filled with hope and expectation. Advances in genetics, drug discovery, and regenerative medicine promise cures for dreaded diseases and relief from terrible suffering. Advances in neuroscience and psychopharmacology promise better treatments for the mentally ill. Techniques of assisted reproduction have already allowed more than a million infertile couples to have their own children. With-out such advances—past, present, and future—many of us would lead diminished lives or not be here at all.
But our desires for a better life do not end with health, and the possibilities of biotechnology are not limited to therapy. Although most biomedical technologies have been developed for therapeutic purposes, once here, they are quickly available to serve many other ends, good ones and bad. In mischievous hands, they provide new possibilities for bioterrorism or for social control, possibilities we do not take up in this report. But for people with innocent hands, the powers that biotechnologies provide to alter the workings of body and mind are attractive not only for healing the sick and comforting the suffering, but for satisfying widespread human desires to look younger, per-form better, feel happier, or become more perfect.
Some of our most popular dreams and nightmares, such as a world of genetically engineered designer babies with parents ordering up their children’s characteristics, are, as the report takes some pains to indicate, scientifically unlikely. But other scenarios are more than plausible, and many desire-satisfying uses of biotechnology are already here: embryo screening or sperm sorting to choose the sex of offspring; growth hormones to make children taller; Ritalin and similar drugs to control behavior or boost performance in the young; and Prozac or sim-ilar drugs to brighten moods or alter temperaments—not to speak of Botox, Viagra, or anabolic steroids.
Many of these technologies are used mostly for good medical reasons, but not always. And I should point out that the cosmetic uses of biotechnology are spiraling out of bounds even before some of these new powers are available. In 2002, Americans spent over $1 billion to treat baldness, about 10 times as much as what was spent worldwide seeking a cure for malaria. And in 2002, $7.7 billion was spent on 6.9 million cosmetic procedures in the United States, more than triple the number just five years earlier.
Looking ahead, other biotech projects are already visible on the horizon: drugs to erase or at least flatten the emotional tone of painful or shameful memories; gene inserts to increase the size and strength of muscles; nanomechanical implants to enhance sensation or motor skills; and perhaps techniques to slow the entire process of biological aging and to increase the maximum human life span.
All this leaves us wondering: Where’s the problem? What could be wrong with seeking better children, superior performance, ageless bodies, or happy souls? These are, after all, old and often worthy human desires which biotechnology promises to help us satisfy. Moreover, in free societies like ours, choices about using technical enhancers are not made by central planners pursuing some vision of a perfect future society. They are made largely by private individuals pursuing their personal dreams of happiness. Why worry, then, about letting people decide for themselves which uses of drugs or devices serving which goals are right for them?
There are, to be sure, questions about the safety of the new technologies and about the equality of access to them. But these familiar concerns do not reach either the true promise or the deeper perils of the biotechnology revolution. Our hopes for self-improvement and our disquiet about a possibly post-human future are much more profound. At stake are the kind of human being and the sort of society we will be creating in an age of biotechnology.
Relative to its potential importance, the subject of this report, “Beyond Therapy,” is one of the most neglected topics in public bioethics. No previous council has taken it up, not even in part.
It speaks, in fact, to the major sources of public concern about the biological revolution. It raises some of its most weighty questions. It touches on the ends and goals to be served by the acquisition of biotechnical power, not just on the safety, efficacy, and the morality of the means we use to pursue them. It bears on the nature and the meaning of human freedom and human flourishing and it faces squarely the alleged threat of dehumanization as well as the alleged promise of super-humanization. It compels attention to what it means to be a human being.
The members of the President’s Council on Bioethics spent 16 months learning about the science and technologies, present and projected, from the experts in the field, and discussing among our-selves the likely human and social significance of the use of these technologies beyond therapy.
Two important decisions governed our approach. First, we decided to consider all uses together. Rather than look piecemeal at, say, genetic engineering or anti-aging technologies or psychotropic drugs, we saw them as aspects of one big picture—human life in the age of biotechnology. Second, in organizing our reflections, we decided that the big picture of the age of biotechnology is not, in fact, about biotechnology itself, but rather about human beings empowered by biotechnology. Accordingly, we have organized our report not around the specific technologies or even around the powers they place in human hands, but rather around the human desires that they may serve.
Proceeding this way lets us see how these new technological possibilities for going beyond therapy fit with previous and pre-sent human pursuits and aspirations, including those well-represented in the goals of modern medicine. They enable us also to assess critically the desirability of these goals and the significance of any successes in attaining them.
Let me close by posing this dilemma: We are not criticizing the uses of biotechnology, nor are we troubled particularly by human desires. These desires are in fact the source of much that is good about us. The question is: What happens when these natural human desires become empowered by these technological means? One could put the dilemma in the following way: We want better children—but do we want better children if it means turning procreation into manufacture, or if it means altering their brains to give them an edge over their peers?
We want to perform better in the activities of life—but do we want to accomplish this by becoming mere creatures of our chemists, or by turning ourselves into bionic tools designed to win and achieve in inhuman ways?
We want longer lives—but do we want them at the cost of living carelessly or shallowly with diminished aspiration for living well, or by becoming people so obsessed with our own longevity that we care less and less about the next generation?
We want, of course, to be happier—but do we want to be so by means of drugs that give us happy feelings without the real loves, attachments, and the achievements that are essential for human flourishing?
We also deal with questions of identity and individuality and the risks of turning ourselves into something other than ourselves as we pursue these forms of perfection, and the question of whether, in pursuing them, we don’t jeopardize true human flourishing.
The document finishes with a brief look at biotechnology and American ideals. There we deal with three things that are really quite challenging: The question of commerce and the manufacture of new desires; the question of the growing medicalization of human life and what it means to understand human life in biomedical terms; and finally, the question of how the American ideas of life, liberty, and the pursuit of happiness are both friendly to the growth of these new biotechnologies beyond therapy. How they might, in a way, serve to moderate some of the extreme possibilities, but also how we must remind ourselves of what purpose these ideals have—if we are to reap the benefits of these technologies without walking willingly down the road to our own degradation.
From Beyond Therapy, Chapter 2,
“Better Children”:
In most of our efforts to assist our children’s development, we proceed through speech and symbolic deed, using praise and blame, reward and punishment, encouragement and admonition, as well as habituation, training, and ritualized activities. Yet nature sets limits on what can be accomplished by education and training alone. No matter how much we try to help, the tone-deaf will need more training to learn to carry a tune, the short will be less likely to excel at basketball, the irascible will have trouble restraining their tempers, and the insufficiently smart will remain handicapped for competitive college admissions. If the inborn “equipment” is faulty, or even only normally limited…it is inviting to think about improving the native powers or the efficacy of their expression and use. For whether we like it or not, certain desired improvements in our children will be possible, if at all, only by improving their native equipment....
According to some predictions, our ability to improve our children’s native endowments may soon take a quantum leap, thanks to prospects for genetically engineered improvements of native human powers.... It is these prospects—for so-called “designer babies” and for drug-enhanced children—that we shall consider…. Once seen in the context of the common goal, “better children,” the different technologies raise overlapping and similarly pro-found ethical and social issues—especially about the significance of procreation, the nature of parental responsibility,
and the meaning of childhood.
Gregg Easterbrook:
The kind of futuristic, brave new world genetics—dial-up properties for your children—does not seem probable based on current technology. What does seem probable is what the Council’s report calls “negative eugenics.” Ever-improving tests similar to amniocentesis, while not allowing you to insert the properties that you want into a child, do allow you to find defects or worrisome properties. Right now, amnio looks for properties having to do with severe mental problems and a few physical ones. It is possible to imagine procedures in the near future somewhat similar to amnio, perhaps even simpler and less invasive, that could test for clumsiness, baldness, or shortness.
Parents have a responsibility to present their children with the best possible world. You can already get cello lessons for your children, and send them to the best schools. If it becomes possible to present your children with the best possible genetics, even if it’s only by eliminating the presence of flaws, many parents are going to find incredible pressure on them—self-imposed or social—to do so. Although at the early stages it will probably be expensive and only available to the rich, in a relatively short time it will be widely available to everybody.
Just think for a minute: If you had a choice between a short, clumsy child who was going to become prematurely bald, and a tall, athletic, handsome kid with a full head of hair, every parent would choose kid number 2. You’d almost have some sort of weird responsibility to choose kid number 2. And yet, think of the great contributions that have been made to the world by short, clumsy, bald people. Think of the short, clumsy, bald people whom you personally have loved, the people who have obvious things about them that would show up as a genetic defect in some advanced test, and yet have turned out to be wonderful people. This is why negative eugenics was what scared me when I read the report. It feels like something that’s going to be practical and for sale sometime in the next ten or 20 years.
We tend to assume all technological developments are inevitable. One of the things this report is about is asking whether, just because these things are inevitable, we really want them. But we also have to ask ourselves about the evolutionary inevitability as well. This is a thought that doesn’t give me much comfort, although it may not matter all that much to future generations. Things that seem strange or even grotesque about bioengineering to our generation may be mere adaptations to future generations. Future generations may consider it part of the natural scheme that first there was undirected evolution followed by directed evolution. They may consider it totally obvious that this was what was going to happen all along and wonder why we, in the early twenty-first century, were fighting it.
I think there are some good reasons that we should fight it, or at least regulate this technology very closely. The report lays out most of those reasons. But as we do so, I think we must bear in mind that future generations are likely to take biotechnology for granted—which makes it all the more important that we elucidate very clearly the moral reasons for our fight.
When it comes to performance-enhancing physical drugs— the report uses athletics as an example—clearly, some of them are with us already. The steroids that are used especially in major league baseball are all around us today. If you look at pictures of baseball games from the 1960s, the players look like stick figures compared to the players of the present. Today even the short-stops of major league baseball teams look like hulking muscular guys who should be working as male strippers for a living.... It’s not just because they’ve been hitting the Nautilus machines, although that’s part of it.
The report points out that, from the standpoint of public appreciation of sports, the cross check here against baseball is that maybe the public will just never be interested in the performance of genetically enhanced athletes because it won’t seem human or interesting and engaging in the way the Olympics seem to us today.
I would think that most sports fans and Olympics fans are going to strongly resist performance-altering drugs, even if they’re widely available inexpensively to everybody, because it will change the nature of the competition. It won’t be a human competition anymore.
From Chapter 3,“Superior Performance”:
The striving for superior performance is…central to our humanity. But it also raises a series of questions and dilemmas, and sometimes unease and concern, not only about the means we employ, but also about the goal itself. We worry that the desire to become better could deform elements of human life that are not properly measured according to the standard of “superiority,” or that our improvements will be achieved only at the price of our integrity and dignity. We worry that pressures to excel will overwhelm us, or that the desire to be the best will tempt us to “cheat” our way to the top. We worry that putting such a high premium on excellence will crowd out the disadvantaged, or lead us to mistreat those who are “failures.” In short, we worry about balance, fairness, and charity—but also, and perhaps more profoundly, we worry about pursuing the wrong goals in the wrong way, or posing as some-thing we are not….
To fully understand the meaning of using these new biotechnical powers...we would need to explore the reasons we seek to become better.... We would need to pay attention both to the ends we seek and the means and manner by which we seek them...as we discover new and better ways to “improve” our given bodies, minds, and performance, are we changing or compromising the dignity of human activity?... Is the enhanced person still fully me, and are my achievements still fully mine?
Diana Schaub:
To talk about the “Ageless Bodies” chapter might be the most difficult, particularly if one wants to follow the report in arguing that such a quest is questionable. To make the case against the prolongation of one’s life, one has to make an argument for human mortality. Love, excellence, and happiness all sound a whole lot better, and more likely to be part of a persuasive speech, than does death. One could try to make the Grim Reaper sound less grim by speaking of the natural human lifespan or employing poetic language like “three-score and ten,” but one still comes up pretty hard against our desire for self-preservation, our love of life, our dread of decline, and our fear of death.
Now would be the time, before a dramatically extended human life span is on the horizon, to conduct some thought experiments aimed at ascertaining whether longer life holds promise or peril. The report does this by speculating about possible transformations in our outlook on life and death, our level of commitment and aspiration, and our familial and societal relations. It struck me while reading the report that science fiction has always been a good source of such thought experiments. Perhaps science fiction could help in forming the sort of public opinion that will be necessary to stave off some of these developments. To anyone interested in these issues, I strongly recommend “Star Trek”—the original series of course, not any of the second-rate sequels. Given the scientific mission of the USS Enterprise (“to explore strange new worlds, to seek out new life and new civilizations, to boldly go where no man has gone before”), you might expect that the show would be gung-ho for the conquest of nature, including pushing the envelope of our human nature. But “Star Trek” episodes repeatedly confirm the needfulness of human limitations nd, indeed, revel in the self-imposed acceptance of those imitations. Interestingly, this attitude is embodied most in the ship’s chief medical officer, Doctor McCoy, whose nickname is “Bones,” a nickname that forcibly reminds us of the limitations of the medical art: The bodies doctors attend upon will die.
Many episodes of the show dealt with mortality and immortality. Let me mention just two—one, titled “Miri” (a name intentionally reminiscent of Shakespeare’s Miranda who delivers the famous line “O brave new world that has such people in’t!”), and one called “Requiem for Methuselah” (Methuselah being the longest-lived of the Biblical figures; the Bible says he lived 969 years.) In “Miri,” the USS Enterprise answers a centuries-old distress call from a parallel planet Earth. There, the crew happens upon the results of a Life Prolongation Project that went disastrously awry in the 1960s. All the adults on the planet are dead, victims of a manmade virus that afflicts individuals at the onset of puberty. The planet is populated entirely by children, who are hundreds of years old, living a Lord of the Flies-type existence. As a result of the Life Prolongation Project, they age one month for every 100 years of real time until reaching puberty, at which point the virus causes them to age rapidly and horribly. We see before us the dystopia of an almost eternal childhood.
The episode raises some important considerations: In any project to lengthen life, what stage of life do we want to lengthen? All stages equally, or some more than others? Perhaps most fascinatingly, the story is premised on the connection between mortality and fertility—a connection highlighted by the Council’s report. In the research conducted thus far, the most common side effect of age retardation seems to be sterility or reduced fertility. It seems as if, in pursuing an ageless body, the balance between the individual and the species is altered. When we choose vastly longer life for the individual, the propagation of the species is sacrificed. The society in “Star Trek” is a drastic rendition of the trade-off. In pursuing immortality, the residents of the planet made clear their hostility to the succession of the generations. They sought to make themselves irreplaceable. In a sense, the virus is the internal truth of their project, for the virus makes the succession of the generations impossible. Fertility brings with it an immediate sentence of death, and fertility cannot achieve its purpose. Without any power of regeneration, this society of perennial youngsters is slowly dying. Miri, for whom the episode is named, is a girl on the cusp of adolescence, fearful of growing up, but also drawn to the adult world, and especially Captain Kirk, with whom she falls in love. Fittingly, it is her love for him that eventually allows the crew to intervene and reverse the effects of the Life Prolongation Project.
“Requiem for Methuselah” examines another sort of immortality, lest we think that perpetual maturity would be better than perpetual youth. The Enterprise encounters Flint, a 6,000-year-old man who has retreated from the human world to his own private planet. He was born in 3834 B.C., inexplicably endowed with the capacity for instant tissue regeneration. He has lived a thousand different lives, many of them notable. He was, for instance, Leonardo da Vinci and Johannes Brahms. Over the centuries he has amassed wealth and knowledge. And yet he is now as cold and unyielding as his name, Flint. He is quite prepared to kill the entire crew of the Enterprise in order to protect his privacy. Doctor McCoy is astonished at his cruelty: “You have been such men, you have known such beauty….” But as Flint explains: “I have seen a hundred billion fall.” His longevity has rendered him misanthropic.
He is not, however, a misogynist. He is at work manufacturing the perfect female android, an immortal mate for himself and a remedy for his solitude and boredom. “Star Trek” almost always portrayed those who go beyond the normal limits of an embodied existence as cruel, controlling, and intolerably lonely. Often they feel their longevity to be a curse. Of course, Captain Kirk and company manage to escape Flint’s clutches, and again it is love that provides the corrective, in this case the android’s rebellious love for the starship captain. When Flint’s creation self -destructs, he relents. In the end, Flint learns that in leaving Earth’s atmosphere, his immortality has been compromised. From now on he will live out a natural life span. This knowledge of his mortality immediately improves his character, as he resolves to devote the remainder of his now precious days to helping his fellow man.
My years watching “Star Trek” have left me receptive to the view that mortality is, if not precisely a good thing, then at least the necessary foundation of other very good things, and that there is something misguided about the attempt to overcome mortality.
From Chapter 4,“Ageless Bodies”:
The scientific quest to slow the aging process is not explicitly aimed at conquering death. But in taking the aging of the body as itself a kind of disorder to be corrected, it treats man’s mortal condition as a target for medicine, as if death were indeed rather like one of the specific (fatal) diseases. There is no obvious end-point to the quest for ageless bodies: After all, why should any life span, however long, be long enough? In principle, the quest for any age-retardation...seeks to overcome the ephemeral nature of the human body, and to replace it with permanent facility and endless youth.
The finitude of our power, and of our time, is part and parcel of our being embodied living creatures. An ageless body is almost a contradiction in terms, since all physical things necessarily decay over time, and so experience the passing of time in a most immediate way. To escape from time and age would be to escape from our bodily self.... In these fundamental terms, the wish for ageless bodies and its potential fulfillment by biotechnology may be the most radical of the subjects we address in this report.... It is, at its core, a desire to overcome the most fundamental bounds of our humanity, and to redefine our bodily relationship with time and with the physical world.
And yet, although supremely radical, it is at the same time a perfectly routine desire, one which absolutely every one of us has often felt: watching helplessly as a loved one weakens and declines; contemplating the limits of our time here on earth; or just hearing an unfamiliar “snap” in our back as we reach up for a rebound on the basketball court or bend over to lift up a grandchild. The possibility that biotechnology might be able to significantly slow the process of aging invites us to consider carefully the meaning of this routine but radical desire…. The moral case for living longer is very strong, and the desire to live longer speaks powerfully to each and every one of us. But the full consequences of doing so may not be quite so obvious.
Peter Augustine Lawler:
The case for conscious, biotechnological mood control only makes sense to those who really believe that we do or will be able to completely understand human consciousness or the human soul. So it doesn’t make much sense to me. And I think this penetrating report would be even more powerful if it were more consistently confident that the mood control project is mission impossible, in fact, nuts.
Every modern or technological attempt to make us more at home in this world has had the main effect of making us more homeless. This one will be no different. We may soon enough believe that there is nothing we can do except pop the right mix of pills, to make ourselves happy. This new and quite fundamental dependence on technological manipulation will make our existences more contingent than ever, and just beneath the surface of our new good feelings will be a new form of anxiety. Our pursuit of happiness will be more fanatical and more futile than ever. But the good news is that there will be in some ways more evidence than ever that we have souls.
So this report, in my view, is in some ways incoherent because it provides plenty of evidence that what its authors sometimes seem to fear—that we will manipulate our chemical make-ups to withdraw into private fantasies—could not really happen. We will still be stuck with all the tough demands of living in a very high-tech, very meritocratic, very competitive society. Because it will be possible for us, the report astutely speculates, we will come to be expected to brighten our moods to maximize our productivity and to be a source of constant pleasure to others. We will not only have to dress, but feel, for success. Being alienated, depressed, sad, shy, or just introspective will be regarded as problems that we have the duty to solve by a quick trip to the drugstore.
Contrary to what our silly libertarians think, designer mood control will be an unprecedented constraint on individual freedom. We will no longer have a right to our anxiety—and that will make us more anxious and, I think, in some ways angrier than ever. Our anger will be directed, whether we know it or not, against an attempt to deprive us of part of the truth about our human being.
So this report is strongest when it is clearest that our pharmacological attempts at mood control will be yet another failed escapist solution to the problem of our obsessive individualism. Our biotechnological efforts will do nothing to solve any of the problems that come with the contemporary denials of the goodness of the limits and directions imposed on us by nature.
Our futile biotechnological pursuit of happy souls will erode still further our experiences of continuity, permanence, love, and friendship—our genuine connections with the world and the human beings around us—that really do moderate our genuinely human experiences of homelessness in this world.
So all honor to Leon Kass for getting the government to venture a bit into thinking about the soul. The biggest news this report gives us is that there is no substitute for the practice of virtue, for really being good, if we want to be as happy as we can be. We need to think about what sort of virtue will be required to live well in the strange new biotech world. The secret to enjoying real human happiness lies in fulfilling the demanding moral responsibilities given to usself-conscious mortals in a grateful and dignified way.
From Chapter 5,“Happy Souls”:
Until recently, biotechnological aids to psychic flourishing have been relatively feeble and non-specific. Drugs for soothing bad memories have been utterly lacking. And drugs to brighten mood or raise self-esteem have been imperfect: unsafe, inadequately effective, transient, liable to side effects, and frequently illegal or stigmatized. Thanks to recent breakthroughs, however...the burgeoning field of neuroscience is providing new, more specific, and safer agents to help us combat all sorts of psychic distress….
To be sure, these agents—and their better versions, yet to come—are, for now at least, being developed not as means for drug-induced happiness but rather as agents for combating major depression or preventing post-traumatic stress disorder. Yet once available for those purposes, they could also be used to ease the soul and enhance the mood of nearly anyone. Should this occur, further research and development of drugs helpful to the direct pursuit of happier souls—surely a profitable business venture—would very likely take place. As a result, our pursuit of happiness and our sense of self-satisfaction will become increasingly open to direct biotechnical intervention….
By directly inducing changes in our subjective experience, the new psychotropic drugs create the possibility of severing the link between feelings of happiness and our actions and experiences in the world. Who would need better children, superior performance, or more youthful bodies if medication could provide the pleasure and sense of well-being that is the goal of so many of our aspirations? Indeed, why would one need to discipline one’s passions, refine one’s sentiments, and cultivate one’s virtues, in short, to organize one’s soul for action in the world, when one’s aspiration to happiness could be satisfied by drugs in a quick, consistent, and cost-effective manner?
Ye t it is far from clear that feelings of contentment severed from action in the world or from relationships with other people could make us truly happy.... More generally, would the pharmacological management of our mental lives draw us toward or estrange us from the true happiness that we seek?
