Today, medical science continues to achieve feats that would have been considered miracles not long ago. Humans can now overcome disease and suffering with the use of medical technology. We even have the potential to manipulate genes to create desired products. Humanity has become characterized by a belief in the limitless potential of medical advancement. This profound lecture questions the roots of the human condition. Dr. Gilbert Meilaender probes the deep questions raised by medical advancement. He raises the possibility that our potential for medical progress can cause us to lose sight of the true nature of our humanity. Respondent William Saletan moves the philosophical analysis to specifics and applies Dr. Meilaender’s ideas to current events and politics, such as moral concerns surrounding political support for stem-cell research. In his critique, he cites recent news reports that indicate questionable morality in medical research. Along with man’s power to manipulate and perhaps even conquer nature comes an important question: not whether we can, but whether we should.
MICHAEL CROMARTIE: Gilbert Meilaender is a renowned author, theologian and Christian ethicist. He is a member of the President’s Council on Bioethics. He studied at Princeton under Paul Ramsey, one of the early ethicists writing on bioethics, many years ago. I’m delighted that this subject that we chose to talk about three months ago was very much a part of the campaign and of our national conversation. We could not have anyone better than Gil Meilaender to speak to this question.
Gil, thank you for coming.
DR. MEILAENDER: Thanks, Michael. I think, in a way, what I’m going to do today is a little different from what your speakers yesterday did in that I’m actually probably not informing you of anything, in a way; I’m thinking through some matters with you and we’ll see where that goes.
I sent Michael my paper in order for him to send it on to Will a week ago, and the only thing he said to me was last night. He said, “Can you make it shorter?” And I said, “No, but I’ll read fast.”
So let’s see where we go.
When the Hastings Center was founded in 1969, it was the first bioethics think tank in the United States, and it planned research in four areas of concern: death and dying and, in general, overcoming the limits of our finite condition; behavior control, and the relation between human activities and the kind of happiness that follows upon them; genetic screening, counseling and engineering, which included questions about kinship, procreation and attitudes toward future generations; and population policy and family planning, which, at least implicitly, asked about the relation of our own time to future generations. Now, if you add to that list explicit attention to moral problems raised by human experimentation, the list could still today serve as pretty much an accurate catalogue of the main concerns of bioethics. The reason these issues have been and continue to be central, and no doubt at least one of the reasons bioethics has been a matter of such lively public concern, is, I think, obvious: These topics are not driven by concern for public policy regulation, though they give rise to questions like that. Rather, they involve some of the most important aspects of our humanity and they raise very deep questions about what it means to be human.
I want to think with you about some of those background questions — the questions behind the standard questions. And in order to do that I’m going to explore — without, for the moment, attempting to resolve — four questions about our humanity that I think almost inevitably arise when you begin to think about the kinds of concerns that bioethics raises. I want to emphasize that you shouldn’t make the mistake of thinking I’m like my students; the fact that I’m not trying to resolve them doesn’t mean I think they’re not resolvable and that there are no better or worse answers to these questions since they’re only matters of how you feel.
But in any case, acknowledging that more might be said about any of these questions, I’m going to take up four angles — they’re distinct but they’re related — from which bioethics invites us to think about what it means to be human. And these are the four I’ll take up: first, the unity and integrity of the human being; second, human finitude and freedom; third, the relation between the generations; and fourth, suffering and vulnerability. So that’s where I’m heading.
First, the unity and integrity of the human being. The beginning of wisdom in bioethics may lie in the effort to think about what human beings are and why it matters morally. From several different angles, medical advance and research advance have tempted us to lose sight of any sense in which the embodied human being is an integral, organic whole. And I’m going to try to illustrate this in two different ways, actually: first by noticing how advancing genetic knowledge encourages us to think of human beings as simply collections of parts. And I begin with some sentences from Ernest Hemingway’s The Old Man and the Sea. I mean, we’re at Key West and it seems as if we should do something like this. Let me read to you:
“He looked down into the water and watched the lines that went straight down into the dark of the water. He kept them straighter than anyone did, so that at each level in the darkness of the stream there would be a bait waiting exactly where he wished it to be for any fish that swam there….I have no understanding of it and I am not sure that I believe in it. Perhaps it was a sin to kill the fish….He urinated outside the shack and then went up the road to wake the boy. He was shivering with the morning cold….Then he was sorry for the great fish that had nothing to eat and his determination to kill him never relaxed in his sorrow for him. How many people will he feed? he thought. But are they worthy to eat him? … That was the saddest thing I ever saw with them, the old man thought. The boy was too and we begged her pardon and butchered her promptly…. The boy did not go down. He had been there before and one of the fishermen was looking after the skiff for him.”
Now, Hemingway’s prose is, of course, generally regarded as clear and straightforward, and I suspect that any single sentence in that passage was probably simple and transparent to you. I also suspect that the whole of it probably made almost no sense at all. There’s a reason for that. The sentences in the passage are drawn, at least in my edition, at random from pages 29, 104-5, 22, 74, 48 and 123 — in that order.
One of the great blessings of the computer age, we are sometimes told, is that one can move sentences or whole paragraphs around with ease. You needn’t work out a thesis or an argument. You just write and then you move the pieces around later. And believe me, I’ve read literally hundreds of papers where students appeared to do just that.
It’s as if the argument were somehow built up from below — from words, phrases and sentences moved around, combined and recombined; as if a thesis would just emerge without an organizing intelligence or an authorial perspective at work from the outset.
In our age of rapid advances in genetic knowledge, an analogous image has been used to characterize our humanity. Here’s a passage from the biologist, Thomas Eisner. It’s actually a rather often-quoted passage in bioethics literature. Eisner said:
“As a consequence of recent advances in genetic engineering, [a biological species] must be viewed as…a depository of genes that are potentially transferable. A species is not merely a hard-bound volume of the library of nature; it is also a loose-leaf book, whose individual pages, the genes, might be available for selective transfer and modification of other species.”
I have tried to provide a humble illustration of that by splicing together sentences from the pages of just one book — thereby producing something probably unintelligible. And, letting our imaginations roam just a bit, I might also have spliced in sentences from Anna Karenina and A Christmas Carol, producing thereby something we may not even know how to name. But to think of a book that way is to ignore the presence of an authorial hand. It would treat a book as if it were just the sum of a number of words, sentences, or paragraphs. We might try to think of human beings, or the other animals, in the same way, and, indeed, we are often invited to think of them that way, as collections of genes or as collections of organs possibly available for transplant. An,d of course, that’s very powerful in certain respects; it accomplishes certain things. But we might also wonder whether doing so begins to lose a sense of ourselves as integrated, organic wholes — as what my teacher Paul Ramsey called “useful pre-cadavers.” That’s what you all are.
“The reason these issues have been and continue to be central, and no doubt at least one of the reasons bioethics has been a matter of such lively public concern, is obvious: these topics are not driven by concern for public policy regulation, though they give rise to questions like that. Rather, they involve some of the most important aspects of our humanity and they raise very deep questions about what it means to be human.”
That’s the first way in which the integrity of the human being is being questioned.
Even if we think of the human being as an integrated organism, the nature of its unity remains puzzling in a second way. The seeming duality of person and body has played a significant role in bioethics. Indeed, there’s a dissertation waiting to be written on the rise of the term “personhood,” which nobody really used 30 years ago. As that language of personhood gradually has come to prominence in bioethical reflection, attention has often been directed to circumstances in which the duality of body seems especially pronounced. Suppose a child is born, for instance, who, throughout his life, will be profoundly retarded, or suppose an elderly woman has now become severely demented. Suppose because of trauma a person lapses into a permanent vegetative state. How shall we describe such human beings? Is it best to say that they are no longer persons — even if living human beings — or is it more revealing to describe them as severely disabled persons? Similar questions arise with embryos and fetuses. Are they human organisms that have not yet attained personhood, or are they the weakest and most vulnerable of human beings?
Related questions arise when we think of conditions that are often, even if controversially, regarded as disabilities. Perhaps, for instance, those who are deaf and have learned to sign create and constitute a culture of their own, what we call a manualist as opposed to an auralist culture. If so, one might argue that they are disabled only in an auralist culture, just as those who hear would be disabled if placed in the midst of a manualist culture. So long as the deaf are able to function at a high level within that manualist culture, you might ask, what does it matter in what way they function? Notice that the harder we press questions like that, the less significant becomes any normative human form. A head or a brain might be sufficient if it could find ways to carry out at a high level the functions that we think are important. If you’ve ever read C.S. Lewis’s, That Hideous Strength, which was written 50 years ago, that’s exactly what he pictures in a way there.
Such puzzles are inherent in the human condition, and they are sufficiently puzzling that we may struggle to find the right language in which to discuss that aspect of the human being which cannot be reduced to body. Within the unity of the human being a duality remains, and I will here use the language of “spirit” to gesture toward it. I’m not sure, actually, what the best language is. But as embodied spirits, or inspirited bodies, we stand at the juncture of nature and spirit, and are therefore tempted by reductionisms of various sorts. We have no access to the spirit — the person — apart from the body, which is the locus of personal presence; yet we are deeply ill at ease in the presence of a living human body from which all that is personal seems absent. We would be very reluctant, indeed, to bury that body while its heart still beat. We’d like that heart to stop before we did that.
In any case, the problems of bioethics force us to ask what a human being really is and, in doing so, to reflect upon the unity and integrity of the person. We must think about the moral meaning of the living human body, whether it exists simply as an interchangeable collection of parts, whether it exists merely as a carrier for something else that counts — whatever we call that; the realm of the personal or the spirit or whatever — whether a living human being who lacks cognitive, personal qualities is no longer one of us or is simply the weakest and most needy one of us.
So that’s my first take. Now, my second angle, which I said was about finitude and freedom.
In one of his essays, collected in The Medusa and the Snail, the late Lewis Thomas explores the deeply buried origins of our word “hybrid.” Thomas actually wrote a number of essays; he liked these etymological excursions. The word comes from the Latin hybrida (I haven’t actually checked; I just took Lewis Thomas’s word for it), the name for the offspring of a wild boar and a domestic sow. But in its more distant origins, the word, as Thomas puts it, “carries its own disapproval inside,” because the more distant etymological ancestor is the Greek word hubris, insolence against the gods. Which is to say, Thomas suggested, that buried somewhere in the development of our language is a connection between two beings unnaturally joined together and human usurping of the prerogatives of the gods. And he summarizes his excursion into etymology as follows. He says, “This is what the word ‘hybrid’ has grown into, a warning, a code word, a shorthand signal from the language itself: if man starts doing things reserved for the gods, deifying himself, the outcome will be something worse for him, symbolically, than the litters of wild boars and domestic sows were for the Romans.”
That is just one side of the matter. He goes on then to write:
“Is there something fundamentally unnatural, or intrinsically wrong…in the ambition that drives us all to reach a comprehensive understanding of nature, including ourselves? I cannot believe it. It would seem to be a more unnatural thing…for us to come on the same scene endowed as we are with curiosity…and then for us to do nothing about it or, worse, to try to suppress the questions. This is the greater danger for our species, to try to pretend…that we do not need to satisfy our curiosity…”
Using some very old religious language, we might say that Thomas sees how, given the duality of our nature, we can go wrong in either of two ways: what the tradition called pride or sloth. Pride didn’t mean sort of a little harmless vanity and sloth didn’t mean a little laziness. Pride meant the attempt to be all freedom, acknowledging no limits to our creativity, supposing that our wisdom is sufficient to master the world. And sloth meant a kind of timid fear of freedom, ignoring the lure of new possibilities. Either of these is a denial of something essential to our humanity. It’s a reduction of the full meaning of our humanity. But clearly, if you think of that last paragraph from Thomas that I read, he is most inclined to fear the dangers of sloth, which is simply to say that he is a good modern. That’s all that means.
In any case, the duality of body and person that I started with is related to what we may call a duality of finitude and freedom, because the human being is the place where these meet. There’s a kind of two-sidedness to our nature, and you can always look at a human being from each of these angles, and in a certain sense, you must look at a human being from both of them.
Drop me from the top of a 50-story building — there have been students who have contemplated that — and the law of gravity takes over, just as it does if we drop a stone from there. And that’s because we are finite beings. We’re located in space and time; we’re subject to natural necessity. But we are also free, able within some limits, perhaps, sometimes to transcend nature and history. So as I fall from that 50-story building, there are truths about my experience that cannot be captured by an explanation in terms of mass and velocity. Something different happens in my fall than in the rock’s fall, for this falling object is also a subject characterized by self-awareness. I can know myself as a falling object, which means that I can to some degree distance myself from that object. I cannot simply be equated with it. I am that falling object, yet I am also free from it.
As with nature, so also with history. I am the person constituted by the story of my life. I cannot simply be someone else with a different history. Yet I can also, at least to some degree, step into another’s story, see the world as it looks to that person — and thus be free from the limits of my history. Indeed, if we couldn’t do that, a virtue like justice would be impossible. The crucial question, of course, is whether there is any limit to such free self-transcendence — whether we are, in fact, wise enough and good enough to be free self-creators, or whether we should acknowledge destructive possibilities in a freedom that knows no limit.
Understanding our nature in this way, we can appreciate how hard it may be to evaluate advances in medicine, claims about the importance, or even obligatoriness, of research, attempts to enhance our nature in various ways, or efforts to master aging and death. On the one hand, if we simply oppose the forward thrust of scientific medicine, we will not honor human freedom. And my standard example is that you go to the dentist and you appreciate that somebody didn’t rest content in a world without Novocain, or even with just that little speed drill. It was all there was when I was young. So the zealous desire to know and to probe the secrets of nature, to combat disease — all that is an expression of the human freedom from the given. And it’s to be honored. Yet, of course, if we can never find reason to stop in this restless attempt at mastery — if the only vice would be sloth and not also pride — then we may fail to honor the finite limits of our wisdom and our virtue, and it may even trivialize freedom to think of it as limitless.
There is probably no cookbook that gives the recipe for knowing how best to honor, simultaneously, both our freedom and our finitude. That there ought to be limits to our freedom does not mean that we can very easily state them in advance. But a truly human bioethics will recognize not only the creative but also the destructive possibilities in the exercise of our freedom. That’s my second angle.
I might pause to say you’ve figured out by now that I’m not going to talk about particular issues. I’m happy to talk about them later, but I’m more interested in trying to think about some of these underlying questions.
My third topic is the relation between the generations. Because we are not only free but are also embodied spirits, the biological bond that connects the generations has moral meaning for us. We occupy a fixed place in the generations of humankind. Both Jews and Christians inculcate a command that calls upon us to honor our father and our mother. It is a puzzling duty, as all of us realize at a certain moment in our life: a duty to show gratitude for a bond in which we find ourselves without ever having freely chosen it. And we’re not actually very fond of bonds like that in our world. And it’s also true that insofar as it makes sense to talk, as I will in a moment, of the child as a gift, we might say that father and mother have also not chosen this precise bond. They too simply find themselves in it. A truly limitless freedom to make and remake ourselves, to pursue our projects in the world, would divorce us — potentially divorce us — from the lines of kinship and descent that locate and identify us. So we’d have to ask ourselves whether that would be the fulfillment of our nature or an alienation from it.
“We must think about the moral meaning of the living human body, whether it exists simply as an interchangeable collection of parts, whether it exists merely as a carrier for something else that counts —the realm of the personal or the spirit.”
It is, I think, fair to say that several different aspects of medical advance — in reproductive technologies, in psychopharmacology, in genetic screening, one day perhaps in techniques for genetic enhancement or cloning — these various kinds of advance have made it more difficult for both parents and children simply to honor and affirm the bond between the generations and to accept as a gift the lines of kinship that locate and identify them.
I want to give you an image of what it might mean to call the child a gift by reading you a poem. It’s not easy to listen to some poetry, but this is a good poem. I think you have to get to the very end of it to get my point. It’s Galway Kinnell’s poem, “After Making Love We Hear Footsteps.” Let me just read it to you.
For I can snore like a bullhorn
Or play loud music
or sit up talking with any reasonably sober Irishman
and Fergus will only sink deeper
into his dreamless sleep, which goes by all in one flash,
but let there be that heavy breathing
or a stifled come-cry anywhere in the house
and he will wrench himself awake
and make for it on the run — as now, we lie together,
after making love, quiet, touching along the length of our bodies,
familiar touch of the long-married,
and he appears — in his baseball pajamas, it happens,
the neck opening so small
he has to screw them on, which one day may make him wonder
about the mental capacity of baseball players –
and flops down between us and hugs us and snuggles himself to sleep,
his face gleaming with satisfaction at being this very child. In the half darkness we look at each otherand smile
and touch arms across his little, startlingly muscled body –
this one whom habit of memory propels to the ground of his making,
sleeper only the mortal sounds can sing awake,
this blessing love gives again into our arms.
“>That’s a great poem, I think, but that image of the child as a gift — a gift that is the fruition not of an act of rational will but an act of love — that image can be contrasted with an image of the child as the parents’ project or product. For that latter way of thinking, a way that we increasingly take up, having a child becomes a project we undertake to satisfy our purposes and make our life complete — all those colleagues of mine with the pictures of the two children on their office doors, one boy and one girl. And, of course, our desire may be not simply for a child but for a child of a certain kind: a certain sex, with certain characteristics or capacities — “I’d really like him to be able to turn the double-play, actually.” Human cloning, were it possible, would from one angle bring to completion this image of the next generation as a product of rational will, undertaken to fulfill our desires. From another angle, of course, cloning might be thought to break entirely the bond between the generations, since in the instance of cloning we really do not even know how to name the relation between progenitor and offspring.
Pondering how best to think about the relation between the generations, we are driven once again to questions about when we should use our freedom to seek mastery or control and when, by contrast, we should accept certain limits inherent in human bodily life. The twentieth century began with considerable confidence in the possibility for eugenic control of the relation between the generations. That confidence suffered eclipse just after mid-century in the face of revelations of Nazi eugenic experiments, but it has reemerged in a lot of different ways. Today — probably, at least, in a country like ours — any state-sponsored eugenic ideology would surely face considerable opposition. But what we’ve done instead — to use the barbarous locution now common — is we’ve “privatized” what are essentially eugenic decisions.
Now, here again, there is no simple recipe for making decisions. Parents must exercise reason and will to shape their children’s lives. It would be irresponsible not to do that. Parents do not and should not simply accept as given whatever disabilities, sufferings, or even simply disappointments come their children’s way. Still, as every child realizes at some point, the conscientious parent’s effort to nurture and enhance can be crushing. It can make it very difficult simply to accept the child who has been given; impossible to say, “It’s good that you exist.”
The implication for the bond between the generations becomes still more far-reaching when we consider that research may make possible — I mean, people actually have different views on it — but may make possible alteration of the human germline. More than 50 years ago, without any precise knowledge of such possibilities at all, C. S. Lewis, in an oft-quoted passage, contemplated such eugenic efforts, and he noted the point that relates to my theme. He wrote, “What we call Man’s power over Nature turns out to be a power exercised by some men over other men with Nature as its instrument.” Alterations in the human germline, were they to become possible, would in one way be an awesome exercise of human freedom — really stunning in a way — and if used in the struggle against disease might promise, over time, a cure not only for some individuals’ suffering but, in a certain sense, for the species, with respect to one disease or another. Yet at the same time, the exercise of freedom is also a tremendous exercise of power. And just as synchronically parents need to allow the mystery of humanity to unfold in the lives of their children, so also diachronically one generation needs to allow others their freedom. How we sort out these competing goods will reveal much about what we understand the character of human life to be.
And my fourth category: Suffering and Vulnerability.
Part of the sadness of human life is that we sometimes cannot and other times ought not do for others what they fervently desire. With respect to the relief of suffering, the great quest of modern research medicine, this is certainly true, I think. Some relief we are simply unable to provide. That’s a fact that only gives greater impetus to our efforts to discover causes and cures. It is precisely the fact of our inability in the face of suffering that fuels what Daniel Callahan has called the “research imperative,” of which we are of course all the beneficiaries. But it’s important to ask how overriding this “imperative” is — whether it’s really an imperative; whether there are means to the possible relief of suffering which we ought not take up, and whether it would be good if we were not vulnerable to suffering. We need to ask those questions.
So great is our modern concern to overcome suffering, we may almost forget that there are perspectives from which that goal has been deliberately made secondary. For anyone drawn to Stoic philosophy, for example — it’s hard to think of that in Key West, probably, but every other morning when I’ve gotten out of bed I’m drawn to it —
— for anyone drawn to Stoic philosophy, bodily suffering could never be of overriding importance. It can harm us only if we are deceived into supposing that anything other than inner mastery is what really counts. So, I give you a story from Seneca, one of the great Stoics. He tells the story of a man named Stilbo, who was a sage, whose country had been sacked by Demetrius, and whose children and wife were lost, and who, Seneca writes, “as he emerged from the general desolation alone and yet happy, spoke as follows to Demetrius, called Sacker of Cities because of the destruction he brought upon them, in answer to the question whether he had lost anything” — Demetrius sort of mockingly asks Stilbo whether he has lost anything, and Stilbo says, “‘I have all my goods with me!’ ”
And Seneca says, “There is a brave and stout-hearted man for you! The enemy conquered, but Stilbo conquered his conqueror. ‘I have lost nothing!’ Aye, he forced Demetrius to wonder whether he himself had conquered after all. ‘My goods are all with me!’ In other words, he deemed nothing that might be taken from him to be a good.” Now, while it may sometimes be hard for us not to be repelled in certain ways by a kind of harshness in that Stoic vision, it is equally hard, I think, not to recognize the nobility of a view that makes how we live more important than how long we live. And if it seems to us as if it’s sometimes likely to denigrate too much the goods of everyday life, you can see a similar nobility in another ancient worldview that does not think these ordinary goods of no account at all. Let me give you this illustration.
Discussing some sermons of St. Augustine that were first preached in the year 397 and then newly discovered only in 1990 — the existence of these sermons was not known until 1990 by modern scholars — Peter Brown, the great Augustine biographer, notes that Augustine was often required to preach at festivals of martyrs. And some of these newly discovered sermons come from occasions like that. In Augustine’s time the cult of the martyrs was still very important to Christians. I mean, they were past the age of persecution but it was still within living memory, and the martyrs were the great heroes, the “muscular athletes” and “triumphant stars” of the faith. But, Brown suggests, if you read these sermons you can see Augustine quite deliberately downplaying the importance of the martyrs, making them, Brown says, “less dramatic, so as to stress the daily drama of God’s workings in the heart of the average Christian.” Because that average Christian did not doubt that God’s grace had been spectacularly displayed in the courage of the martyrs. What the average Christian doubted was that that sort of heroism could be displayed in their own humdrum and mundane daily existence. So, Brown says, Augustine points “away from the current popular ideology of the triumph of the martyrs to the smaller pains and triumphs of daily life.”
Then he gives an example, and it’s this example that’s important for my theme. He quotes from one of the sermons. “God has many martyrs in secret,” Augustine tells his hearers. “Sometimes you shiver with fever: you are fighting. You are in bed: it is you who are the athlete.” And then Brown writes this:
“Exquisite pain accompanied much late-Roman medical treatment. Furthermore, everyone, Augustine included, believed that amulets provided by skilled magicians…did indeed protect the sufferer — but at the cost of relying on supernatural powers other than Christ alone. They worked. To neglect them was like neglecting any other form of medicine. But the Christian must not use them. Thus, for Augustine to liken a Christian sickbed to a scene of martyrdom was not a strained comparison.”
See, for you or me to forgo those would be no sacrifice. We don’t believe they’ll work anyway. But what they were being asked to do was to make a great sacrifice, so that there again, though in a way of life that will be, in some respects, different from Stoicism, you see an outlook for which relief of suffering, however desired and desirable, is not the overriding imperative of life.
The Stoics remind us that an authentically human life may prize goodness more than happiness and, indeed, that true virtue may be achieved precisely when we seem most vulnerable to suffering. And those ancient Christians remind us that one might value competing goods — faithfulness to God, in that case — more highly than relief of suffering.
Now, in our world we may admire such views. We may admire such views, but we tend to keep our distance from them. The quest for health (or it sometimes seems to be Health with a capital H) — the attempt to master nature in service of human need and to refuse to accept the body’s vulnerability to suffering — has characterized the modern period. And a great deal of good, of course, has come from that. I mean, I always have to say that when I make this kind of point: we all have profited immensely in ways we would be very reluctant to do without.
Now, if such a world offers less occasion for the display of nobility, it does not despise the sufferings of countless ordinary people — and that is no small gain. The research that makes such gains possible is greatly to be desired. The question is, is it also imperative? Many questions of bioethics, especially questions about research, invite us to try to determine the difference between the desirable and the imperative.
One of the now-classic essays in bioethics, first published in 1969, was Hans Jonas’s “Philosophical Reflections on Experimenting With Human Subjects.” It’s a very powerful essay. And Jonas articulated right at the very outset of the development of bioethics a difference between the desirable and the imperative. He noted that it is sometimes imperative that a society avoid disaster; so we conscript soldiers to fight. The fact that we do not ordinarily conscript experimental subjects indicates that, however much we value the improvements to life made possible by medical research, we do not think of ourselves as having an obligation to make such improvements. Research brings betterment of our life; it does not save our society.
Because this is true, we seek volunteers, not conscripts, in the cause of medical progress. And because this is true, far from using those who might be most readily available as handy research subjects, we should be most reluctant to use them. Indeed, Jonas defended what he called — I’ll quote him — “the inflexible principle that utter helplessness demands utter protection.” That is, the vulnerability that ought to concern us most is not our own vulnerability to illness and suffering but, rather, the vulnerability of those whose very helplessness might make them seem all too readily available to us — all too near at hand — in our never-ending struggle to make progress. If “utter helplessness demands utter protection,” we will have to ask ourselves whether it is right to build our medical progress upon the sacrificed lives of those such as, for instance — though it’s not language that I generally use — so-called spare embryos, who seem expendable because doomed to die anyway.
Finally, we must also ask ourselves whether there might be research that is neither imperative nor desirable. If goodness is to be prized more than happiness, the endless quest to remake and enhance human life, to overcome vulnerability, may destroy other, equally important goods in an authentically human life. We recognize this truth, for example, in our role as parents. Conscientious parents want with all their heart to give their children what those children want — to try to make them happy. They also know, however, that some goods simply cannot be given but must be developed and achieved in the child’s own life. We cannot simply give our children the happiness that comes from finding a vocation, a spouse, or inner strength. We can’t provide that. Trying to give such goods would, in effect, subvert and undermine them. So too we have to ask whether there might be research aims which, however well-intentioned, would seek to bestow traits of character and skill that have no value apart from the process through which they are developed and achieved. We are, that is, forced to ask hard questions about projects aimed at doing what we have come to call “enhancing” human nature.
Where do these reflections lead? Bioethics directs our attention to “bios” — to human bodily life in all its vulnerability and with all the goods that characterize it. For that life we seek health. In that life we seek to avoid suffering. These are great goods, but they may sometimes compete with other goods. A few times and places, avoiding such suffering may seem imperative; at many times and places it’s surely going to seem desirable; in some times and places, because we judge other, competing goods to be even more fundamental to human life, it may be neither imperative nor desirable.
Finally, when Jean-Jacques Rousseau published what we now call his “First Discourse,” discussing whether the arts and sciences had contributed to the betterment of human life, he chose as its frontispiece an image of Prometheus bringing fire to the Earth. And on the frontispiece, to a satyr standing nearby who reaches out to embrace and kiss the fire, Prometheus says, “Satyr, you will mourn the loss of the beard on your chin, for it burns when touched.” That’s our standard way of reading the Prometheus myth. It captures nicely the sort of ambivalence that the story is supposed to carry. Fire brings light and warmth, making possible all the useful arts and sciences that enhance human life, but it burns if you get too close and embrace it.
The exercise of human freedom through scientific advance is a great benefit, but we need to find a safe way to gain those benefits without simultaneously getting burned. I think that’s the standard way of reading it, and there’s something to that way of reading it. It’s an attempt to do justice to several aspects of our nature that I’ve been trying to unpack, and to the ambivalences that those aspects give rise to in the realm of bioethics.
But there is, I think, a certain danger in allowing ourselves to read the myth only in this way, because read in this way, the story of Prometheus tends to hold up before us a yellow light — not green, since after all we all know the myth, we know the dangers involved in the exercise of human freedom, and we would not want to be characterized by hubris, so we wouldn’t just hold up a green light. But also not red, since, after all, the scientific and technological advance gained through the exercise of human freedom brings great good and we want to garner its benefits. Not green and not red, but yellow.
And what does a yellow light mean? A yellow light means proceed with caution. That is to say, keep on going; keep on proceeding; don’t stop, and moreover, do so with a very good conscience because we know that we’re being cautious, thoughtful and morally concerned. We read the story of Prometheus. We know the dangers of Promethean hubris. People like that never find a good enough reason to stop.
Now, quite often, of course, proceeding with caution is perfectly sound advice. I mean, I wouldn’t dispute that at all. But, as I suggested, it may give us all too good a conscience about our mastery of nature. It never suggests that we should do anything other than continue to advance. But if we really want to be morally serious, the ability to stop, to decline to go forward, may also sometimes be needed, and I don’t think that real moral seriousness is possible unless we at least acknowledge such possibilities, not just in theory but also in practice. That other possibility has been nicely put by Kierkegaard, to whom I give the last word, when he wrote in a different sort of context, but nicely, “What does it profit a man if he goes further and further and it must be said of him: he never stops going further; when it also must be said of him: there was nothing that made him pause?”
MR. CROMARTIE: Well, thank you, Gil, very much. Next we’ll hear from our respondent, Will Saletan. I asked my colleague Eric Cohen, who is an expert on bioethics himself, to give me the name of a journalist who writes on this all the time and does it well, and he immediately said Will Saletan. So we have Eric to thank for that.
Will is also an author of a book called Bearing Right: How Conservatives Won the Abortion War, which got a lot of attention and still does in the current debates. We’re delighted you could be here, Will.
WILLIAM SALETAN: Thanks, Michael. In terms of the philosophical background, if I can use the term in Key West, I think you all sort of covered the waterfront, so I thought maybe what I could do is take some of the ideas that Gil talked about and apply them to the foreground, to current events and to politics, and basically I’m going to try to do a little philosophy and then gross everybody out. And if I have five minutes left at the end I’ll turn around and argue the other side.
I want to pick up on two points that Gil made in his talk. The first one is the perils of exploiting the helpless to serve our own medical needs, and second is the notion that we can just plow ahead with any scientific project because we know that we’re being cautious, thoughtful and morally concerned. These are phrases that we hear a lot in politics. This was the first presidential campaign in which biotechnology, and specifically embryonic stem-cell research, became a top-tier mainstream campaign issue. John Kerry talked about it routinely at campaign stops. His campaign devoted two major speeches and two of his weekly radio addresses to it. The Kerry campaign did an ad about it. They featured it at the Democratic Convention. You probably remember Ron Reagan’s speech on prime time.
Why did they do this? Basically because stem-cell research, unlike abortion, is a huge political winner for them. Some of you may have received the poll from the Kerry campaign — they were very proud to send around their polling showing that 69 percent of Americans supported embryonic stem-cell research. They broke it down by Republicans and independents as well. And obviously these numbers are different from, say, the abortion debate.
So why is stem-cell research, unlike abortion, such a big political winner for them? The answer is basically that it scores higher in a utilitarian calculus. And why not take a shot at the guy who gave me my job, Michael Kinsley? He is an advocate of stem-cell research and he wrote very eloquently the case for stem-cell research compared to abortion. Here’s what he wrote in The New Republic last month:
“Abortion doesn’t fully test the premise that human life and moral equality with every other human life begin at conception. On one side you have a fetus, several weeks or months along from conception, with perhaps the beginnings of real human characteristics: tiny arms and legs, rudimentary brains. On the other side you have something serious at stake for an indisputable human being [the woman], but it’s usually something less than life….The stem-cell controversy is different. On one side is not a fetus some distance along the way to birth, but an embryo just days after conception. You need a microscope to see it….This time human life is at stake on the other side, and not just a single human life, but potentially many if stem-cell research realizes its potential.”
Now, there’s a crucial fallacy in this argument, and it’s a fallacy that many liberals and conservatives are falling prey to, and that is that not all morality can be reduced to quantifying and weighing things against each other. The argument for the right to abortion is not just that the woman outweighs the fetus but that the fetus is inside the woman. It’s an argument for autonomy. It doesn’t say the rights of some other woman outweigh the life of the fetus; it says the rights of this woman outweigh the fetus because she is the one in whom the fetus resides.
But the argument for embryonic stem-cell research is fundamentally different. The embryo that would theoretically be killed to save somebody’s life is not inside that person’s body. That person has no autonomy claim over the embryo. It’s purely a utilitarian argument, and it says that you can end one life because another life is mathematically more important.
And here’s the crucial thing about these two principles: autonomy is an inherently limited principle. You’re only entitled to kill the fetus in your own body. So on this principle it would take millions of women to kill millions of fetuses, and if you’re a fetus, only one person has the right to kill you. Utility is an inherently unlimited principle. If one life is more important than another life, anyone has the right to take the first life to save the second. Everything is fair game and nothing is sacred.
Now, the most disturbing thing about the stem-cell debate is that people on both sides of the abortion debate, who came into the abortion debate as defenders of individual rights, either the rights of the woman or the rights of the fetus, are joining forces in the stem-cell debate, not as defenders of individual rights but as advocates of utility. Let me give you two examples.
“If we simply oppose the forward thrust of scientific medicine, we will not honor human freedom. The zealous desire to know and to probe the secrets of nature, to combat disease — all that is an expression of the human freedom from the given. And it’s to be honored. Yet, if we can never find reason to stop in this restless attempt at mastery, then we may fail to honor the finite limits of our wisdom and our virtue, and it may even trivialize freedom to think of it as limitless.”
This is a memo from NARAL Pro-Choice America from November 16: “We were also pleased that California passed its ballot initiative funding stem-cell research, a clear repudiation both of Bush’s policy in that area and the anti-choice premise that embryos deserve legal protection over and above all other interests.” NARAL is very happy that the initiative passed because they want to drive down the value of the embryo so that in the context of abortion the embryo won’t trump the woman. They’re looking at it in utilitarian terms, not caring or paying attention to the fact that this calculus would also apply in other contexts.
This is from Senator Orrin Hatch, a pro-life senator, from April 30, 2002, when he endorsed cloning. “Regenerative medicine is pro-life and pro-family. It fully enhances, not diminishes, human life….A critical part of being pro-life is to support measures that help the living.” What Senator Hatch is doing there is essentially redefining pro-life to mean pro-somebody’s-life – somebody important. It may not be the life of the embryo; it could be somebody else’s.
Now, what happened in 2004, both in the presidential race and in the campaign for Proposition 71 in California, for embryonic stem-cell research, was the debut of this utilitarian argument as a very powerful campaign message. John Kerry made this utilitarian argument very clearly. Here’s what he said in an ad on October 4: “There’s no time to wait. At stake are millions of lives.” Kerry made the argument very clear in economic terms as well. Here’s what he said in a speech in Denver on June 21: “By supporting stem-cell therapy…not only can we reduce the economic cost of health care, we can reduce the emotional and social cost to families.”
The campaign for Proposition 71 in California made the same utilitarian arguments. Here’s one of their campaign ads: “Stem-cell research can end the pain and suffering of so many people.” That was the message throughout the campaign. There was no talk of anything on the other side; it was just, “can save lives, can help people.”
Here’s the argument that Arnold Schwarzenegger made when he endorsed Proposition 71. This is an endorsement letter from Schwarzenegger: “California has always been a pioneer. We daringly led the way for the high-tech industry and now voters can help ensure we lead the way for the biotech industry….We are the world’s biotech leader, and Prop. 71 will help ensure that we maintain that position while saving lives in the process.” Here saving lives is almost an afterthought to the economic argument for it. So that’s the argument: save lives, save money, and make money.
What’s going to limit these utilitarian pursuits? What principle is going to stop them from running amok? President Bush has one answer. This is what he said August 2001, shortly after he decided not to fund research on future embryonic stem-cell lines: “The ethics of medicine are not infinitely adaptable. There is at least one bright line. We do not end some lives for the medical benefit of others.” Now, that is a direct repudiation of the utilitarian principle when it comes to destruction of life.
What did John Kerry say about that line? Here’s what he said in a speech in October in Ohio. He said, “By blocking stem-cell research, President Bush has sacrificed science to ideology.” Now, “ideology” was basically Kerry’s word for morality with teeth — morality that might get in the way of science.
So what was Kerry’s solution to the danger of utilitarianism run amok? Well, his answer was what Gil Meilaender warned against: Kerry promised to be cautious, thoughtful and morally concerned. Here’s what Kerry said in a radio address on June 12: “We must look to the future not with fear but with hope and the faith that advances in medicine will advance our best values….I know there are ethical issues, but people with good will and good sense can resolve them….If we pursue the limitless potential of our science and trust that we can use it wisely, we can save millions of lives.”
And then here’s what he said in Denver a week later: “We need to tear down every wall today that keeps us from finding the cures of tomorrow. I have full faith that our scientists will go forward with a moral compass, with humane values and sound ethics guiding the way. If we pursue the limitless potential of science and trust that we can use it wisely, we will save millions of lives.” So basically Kerry said, “Science will provide its own ethics; science, medicine and technology will limit themselves. We’re all good, reasonable people; you can trust us.”
So let’s see whether that’s true. What I’m going to do now is just go through a series of news reports from the past four years about new utilitarian frontiers in biotechnology. So listen to each one and ask yourself a question that Gil was asking at the end of his talk: where will science, technology and the principle of utility stop, and where will you stop? Let’s start with engineering animals for use in transplant. Animals seem like an easy call, right? — we eat them.
The Washington Post, January 4, 2002: “Scientists for the first time have created genetically engineered pigs whose organs lack a gene that triggers rejection by the human immune system, a key advance toward the goal of developing high-tech hogs bearing organs for transplantation into humans.” Okay, is everybody still on board? Engineering part-human animals for use in research, admittedly starting with a very small human part.
This is from the New York Times, November 27, 2002: “A group of American and Canadian biologists is debating whether to recommend stem-cell experiments that would involve creating a human-mouse hybrid. The goal would be to test different lines of human embryonic stem cells for their quality and potential usefulness in treating specific diseases. The best way to do that, some biologists argue, is to see how the cells work in a living animal.”
From the Washington Post, August 14, 2003: “Some mice, for example, have been endowed with human brain cells, or portions of the human immune system for research.”
Okay, let’s go on to substituting humans for animals in research for the sake of utility. This is from the New York Times, August 4 of this year: “Researchers at the University of Munich repeated the experiment 70 times. A healthy volunteer would receive a chemical injection and then be left alone to ride out an artificially induced panic attack. From the next room, doctors watched the volunteers’ restlessness via video camera, measured the quickening pulse and rise in blood pressure, and used an intercom to question the person about his or her feelings of impending doom. The attacks typically lasted five to 10 minutes….In the past, many of the tests might have been done only on animals….Scientists and industry executives, while acknowledging the potential for ethical issues, say that experiments on people are more reliable because animal tests often fail to accurately predict whether a drug will work on people.” Makes sense, right? That was August 4, 2004.
Okay, so now let’s go on and talk about embryos. There’s a whole lot of embryo stuff going on. Let’s start with weeding out embryos for minor defects. This is from the New York Times, June 20, 2004. This is an article on the use of, quote, “the wider range and earlier timing of prenatal tests.” “Dr. Jonathan Lanzkowsky, an obstetrician affiliated with Mt. Sinai Hospital in Manhattan, described one woman who had been born with an extra finger….Detecting the extra digit through early ultrasound, she has terminated two pregnancies so far….Other doctors said they had seen couples terminate pregnancies for poor vision whose effect they had witnessed on a family member, or a cleft palate.”
Okay, let’s go on to weeding out embryos that are not defective but carry a gene that might cause a nonfatal defect in a future generation. This is from theWashington Post, July 14, 2003: “Australian fertility doctors say they have used a genetic test to screen out embryos that carried a gene for deafness — the first-known instance of pre-selecting embryos to eliminate a non-life threatening trait….Some of the embryos initially screened out would not turn out to be deaf but would only have carried a gene that increased the odds of having deaf offspring.”
Weeding out embryos because they’re female — everyone knows this is going on. The Washington Post, December 2, 2002. “[In] a fertile farming state just west of New Delhi…the 2001 census found just 820 girls for every thousand boys among children under age six. The lopsided sex ratio reflects the spread of modern medical technology, particularly ultrasound exams, which allow Indian couples to indulge a cultural preference for sons by using abortion to avoid having girls….As noted in a recent UNICEF study, in South Asia…74 million women are ‘simply missing.’ ”
The Washington Post, May 29, 2001: “Figures released this year as part of China’s census show there are 117 boys born for every 100 girls. In heavily rural areas such as Guangxi, where boys are prized because of their value for farm work, the numbers approach 140 boys for every 100 girls.”
Let’s go on to creating. Now, this is not just weeding out; this is creating and then weeding out embryos for medical utility. The Washington Post, June 30, 2001: “Molly Nash, six, who was dying of Fanconi Anemia, had an inherited blood disease. Her parents had set out to create a sibling bone marrow donor for Molly, undergoing four cycles of in vitro fertilization to make a total of 30 embryos with Lisa’s eggs and Jack’s sperm. Using technology largely developed by” — a certain geneticist — “scientists in Illinois tested one cell from each of the 30 embryos and found that five of the embryos were free of the diseased gene and also perfect tissue type matches for Molly….Lisa gave birth to a boy, Adam. Soon after he was born, doctors transfused some of his blood cells into Molly’s veins.” Okay, so five of them were both matches — both free of the diseased gene and matched her. Presumably, some larger number were free of the diseased gene but didn’t match her, and they chucked those.
New York Times, October 4, 2000. “Dr. Wagner said 10 other families were preparing to use the procedure to have babies who would be free of genetic disorders carried by the parents and who would be able to provide cord blood transplants for siblings.” And that’s four years ago. I don’t know what the numbers are today — how many people have done that.
Let’s now take the same scenario but this time there’s no screening for an inherited disease. The embryos are going to be weeded out purely for utility. This is from The Associated Press, May 5, 2004. “A Chicago laboratory helped create five healthy babies through in vitro fertilization so they could serve as stem-cell donors for their ailing brothers and sisters. The infants, from different families, were screened and selected when they were still embryos to make sure they would be compatible donors…. This is the first time embryo tissue-typing has been done for common disorders such as leukemia that are not inherited….The Chicago doctors said the healthy embryos that were not matches were frozen for potential future use, but some ethicists said such perfectly healthy embryos could end up being discarded.” And they surely will.
Now, let’s go on to a couple of things about markets. Everyone talks about markets in these things as useful, and that’s the argument you’re going to hear in some of the passages to follow.
Markets in eggs. This is from the Washington Post, 2002. “Women who donate their eggs for in vitro fertilization are paid as much as $75,000 in some areas of the country.” That’s the high end. A lot of women are going to get paid less, but the point is that money is changing hands for eggs.
Markets in fetuses. This is from the Los Angeles Times, March 9, 2002. “The price list is macabre. Fetal eyes cost $75 apiece. Pituitary glands go for $300. Brains fetch $999. Almost as disconcerting are researchers’ orders for livers, thymuses, tracheas and spleen. Nobody quarrels with the goals of the tissue research — to find cures for the likes of Alzheimer’s Disease, juvenile diabetes and Parkinson’s Disease. But the medical promise is running into trouble, as some businesses are beginning to look at supplying fetal tissue as a moneymaker….Asked how much he charged for a fetal liver or kidney, one entrepreneur replied, ‘It’s market forces. It’s what you can sell it for.’ …In subsequent comments on the television report, this entrepreneur also made it clear that he advocated coercing women into consenting to donate the tissue.”
Okay, that’s markets in fetal parts. Let’s go to markets and babies. You knew this was coming. The Toronto Globe and Mail, February 2, 2002: “The unregulated world of surrogacy has given way to an even more disturbing practice: Canadian women are producing babies for sale to couples who have no relation to the infants.”
Markets in organs. This is from the Washington Post, April 30, 2002. “Speakers at the meeting cited evidence that an international trade in organs from living donors is flourishing, even though most countries ban the sale of organs. The black market price for a healthy kidney ranges from $1,000 in Bombay to $3,000 in the Republic of Moldova, to more than $10,000 in some Latin American cities.”
This is from the New York Times, May 23, 2004: “‘‘It is a common practice of many larger clinics to advertise on the Internet for transplant tourists, so we’re up to our necks in it,’ Dr. Scheper-Hughes said. ‘Transplant doctors,’ she says, ‘have developed a don’t-ask, don’t-tell policy.’ …Recife and its slums have become so lucrative a source for organs, in fact, that Brazilian investigators believe that by late 2003, Israeli brokers, in an effort to swell their earnings further, were considering moving their operations to hospitals here and in the other nearby cities. With poverty offering an unquenchable pool of volunteers, the local authorities say the ring” — the organ selling ring — “had also begun inquiring about buying other vital organs from poor residents, including lungs, livers and corneas.”
From the Associated Press, June 1, 2003: “[A] coalition of surgeons, academics, religious leaders and activists…wants a 1984 law prohibiting financial incentives for organ donations” — that’s in the United States — “to be rewritten to allow a project that would award $5,000 to families who authorize a deceased relatives organs to be used for transplantation….’It would just greatly increase the number of organs that are donated,’ Harold Kyriazi, a University of Pittsburgh neuroscientist who organized the group, said” — there’s the utilitarian argument — “Both the United Network for Organ Sharing — the nonprofit organization that administers the nation’s organ procurement network — and the American Medical Association have called for studies of financial incentives for organ donations.” We’re almost at the end here. You can feel us getting to the bottom of this slippery slope.
Killing prisoners for organs. This is the New York Times, November 11, 2001. “Kidneys, livers, corneas and other body parts from executed Chinese prisoners are being transplanted into American citizens or permanent residents who otherwise would have had to wait years for organs….Few of the condemned, if any, consent to having their organs removed” — beforehand — “people involved with the process say. Some of the unwitting donors may even be innocent, having been executed as part of a surge of executions propelled by accelerated trials and confessions that sometimes were extracted through torture….This year, 5,000 prisoners or more are likely to be put to death during a nationwide anti-crime drive….Taiwan also harvests organs from executed prisoners, albeit with strict consent requirements, as do some South American countries.”
And this is from the Washington Post, June 27, 2001: “A Chinese man seeking political asylum in the United States says that as a physician in China, he took part in removing corneas and harvesting skin from more than 100 executed prisoners, including one who had not yet died.”
Okay, and now we are at the bottom of the slippery slope, which, as you all know, is killing babies. This is from National Public Radio’s “Morning Edition” five days ago, December 1: “A hospital in the Netherlands has begun carrying out mercy killings of terminally ill newborns. Doctors there have reported euthanizing four babies last year. The main doctors’ organization has asked the Dutch government to create an independent board to review euthanasia cases for people with ‘no free will,’ specifically children, people who are severely mentally retarded, and people left in an irreversible coma after an accident. Dr. Eduard Verhagen is clinical director of the pediatric clinic of University Hospital Groningen in the Netherlands.” He tells NPR, ” ‘In extreme cases, the best way to protect life is to sometimes assist a little bit in death.’ ”
And I’ll leave it at that.