The Public Interest, Fall 2004
JOHN Sperling, a man who has been called the Howard Hughes of biotechnology, has $3 billion and a dream: to retard aging and extend human longevity. According to a recent article in Wired magazine, he intends to found an endowment generating at least $150 million a year for biotech research. “I am 100 percent for human enhancement!” he told the magazine. “The more you can get, the better! What do we want? To improve the quality of human life to maximize happiness, right?” His dream is the worry of President Bush’s Council on Bioethics, which is headed by Leon R. Kass.
Worrying is this council’s job description. “The benefits from biomedical progress are clear and powerful,” states the council in its recent report, Beyond Therapy: Biotechnology and the Pursuit of Human Happiness.† “The hazards are less well appreciated, precisely because they are attached to an enterprise we all cherish and support and to goals nearly all of us desire.” The council’s determination to peer relentlessly into the darker side of human biological enhancement might have made for 300 pages of the sort of grandiloquent droning for which federal blue-ribbon commissions are renowned. Instead, Beyond Therapy is a kind of miracle.
Anyone who has worked in Washington, D.C., knows that, upon receiving a government report, the first thing to do is flip to the end and read the angry minority dissent. But the council’s report, the work of its 17 members and Kass, is unanimous. The second thing to do with normal government reports is skim the obligatory recommendations for reform. But this report includes not even one recommendation. Well, then, surely the report must be pabulum. But, to the contrary, it is a work of uncommon distinction — not least for literary merit. In its ability to turn a phrase, to touch profundity without pomposity, it astonishes time and again. “Pleasure follows in the wake of the activity and, as it were, lights it up into consciousness.” When was the last time you read a sentence like that in a government report? Read this passage aloud: “A flourishing human life is not a life lived with an ageless body or an untroubled soul, but rather a life lived in rhythmed time, mindful of time’s limits, appreciative of each season and filled first of all with those intimate human relations that are ours only because we are born, age, replace ourselves, decline, and die — and know it.” If bureaucratic Washington can produce such eloquence, there is yet hope for us all.
More impressive still is the report’s intellectual audacity. The council brushes aside all three of Washington’s defining approaches to biotechnology. Libertarians think the only important issue is making sure that individuals, rather than the state, control the uses of biotech. As long as no one is coerced, what’s the problem? Liberals think the only real issue is ensuring equitable access to biological enhancement. As long as the benefits are spread fairly, what’s the problem? Lawyers and policy wonks believe it is process that counts most. As long as there are rules and lawsuits and 87 layers of appeal, what’s the problem? But, as the authors of Beyond Therapy point out, individuals can make thoughtless or short-sighted decisions, and a dangerous technology can be all the more perilous for being broadly available, and we cannot regulate well without knowing what it is we should seek to do. So the report insists on drilling down, deep down, into the bedrock ethical questions and dangers that inhere in the technology itself.
WHAT, exactly, are those? The report takes up an assortment, but its varied worries share a common structure, one rooted in a particular notion of what being human means. The report turns out to be about not technology but humanity.
To be human, for the council, is to cope with certain limits and tradeoffs. Human excellence or distinction is achieved in the encounter with life’s limits. Inherent in achievement, in living well, is the idea of doing things for and as yourself — occasionally, with luck, surpassing yourself. And this is possible only if you are yourself. “What matters is that we produce the given result—the objects that we make — in a human way as human beings, not simply as inputs who produce outputs.” What matters is “our best performance as human beings, not animals or machines.”
Our essential limits define us in many ways. For example, our physical abilities are limited. Athletes who modify their bodies, not through personal effort but as passive recipients of biological enhancement, become less like athletes and more like machines, receptacles of technology. Their accomplishments become less admirable even as they become more impressive. The council warns that already, in American sports, “the line between person and equipment may be eroding.”
Another kind of limit is that we do not choose our children; they, so to speak, choose us. If parents intervene directly to select or enhance a child, they become less like parents and more like breeders or manufacturers, with potentially profound consequences for intergenerational relations. Human aging and mortality represent another important limit. Surely, everyone wants to add years to his life and life to his years. But what if half of life becomes old age: How would society change, and what would become of the natural rhythm of life? Alternatively, what if we slow the aging process and spend twice as many years reaching maturity?
Then there is the question of our happiness and its limits. Suppose a drug could hand us happiness on a silver platter. That might seem wonderful, but it might blur or even obliterate the line between personality and medication. The pangs of conscience, the despondencies of failure, the reveries of grief, even personality itself might all become pathologies to be treated. “Nothing hurts,” warns the council, “only if nothing matters.”
This is all quite troubling, but it is also only the beginning. One cannot understand the full extent of the potential hazards, according to Beyond Therapy, without appreciating the problem’s dynamic dimension. For there is a last crucial limit that biotechnology endangers: the limit on breaking all other limits.
The trouble is that medical technology, individual aspirations, and social pressures may all interact to produce an accelerating flight from humanness. Competition for top schools and top jobs may make artificial enhancement seem indispensable for success, as it already is in some sports. At the same time, biotech companies, galvanized by new profits and markets (think of Prozac and Ritalin), will spend untold billions selling biological quick fixes. As enhancement becomes more widespread, even those who are reluctant will feel pressure to conform. Children may ask for growth hormone or memory enhancement the way they once asked for braces and bikes, and what doting parent would refuse? As the council puts it:
Our desires to alter our consciousness or preserve our youthful strength, perhaps but modest to begin with, could swell considerably if and when we become more technically able to satisfy them. And as they grow, what would have been last year’s satisfaction will only fuel this year’s greater hunger for more.
Some day humanity may awaken to find itself a changed species, without ever having stopped to understand what it was doing. We may enhance our performance by denuding our character; and then, finally, we may lose our grip on the very idea of character. We may, at last, become our own interventions. Instead of giving man control over his biological destiny, technology may steal it away.
AGAIN and again the council’s report cautions that it is not predicting, only worrying. “In offering our synopsis of concerns, we are not making predictions; we are merely pointing to possible hazards, hazards that become visible only when one looks at the ‘big picture.’” Fair enough, and the report does indeed raise all the right questions. Yet those who are familiar with Kass’s work and temperament know he is something of a pessimist, deeply influenced by Aldous Huxley’s dystopic fantasy in Brave New World. That makes him the right man for the job he is doing. Mercifully, however, there are reasons to think the council may have overlooked a much more heartening prospect.
At its core, the council’s fear is that biotech is a slippery slope with no bottom. Yet there are already all kinds of enhancement tools that most people forgo. Cosmetic surgery is readily available and fairly inexpensive. But it remains very much a minority taste, showing no sign of becoming the norm. For that matter, Americans could live longer, look better and even feel happier by exercising vigorously for a few hours a week. Most don’t. What is surprising is not how much people will do to make themselves “better than normal,” but how little.
Is expense the obstacle? Probably not. Most people who could afford a face lift or tummy tuck still do not have one. Laziness or apathy? Are people less concerned about their health, happiness, and success than Beyond Therapy supposes? Also possible. But most people care a great deal about these things. The appeal of self-enhancement may be self-limiting for deeper reasons.
One is that there is no free lunch. Exercise is tiring and time-consuming; plastic surgery is painful and risky. Likewise, all known biotechnological interventions cause side effects. Beyond Therapy mainly dismisses the problem of side effects. Over time, the council assumes, the technology will become more effective and less risky, until eventually side effects will be reduced to triviality. Geneticists and pharmaceutical companies will be able to offer what amount to magic bullets. In order to reach the ethical problems of biotechnology in their purest form, the council conjures up a perfect biotech: drugs that edit out bad memories without also smudging good or useful ones, or drugs that make their users feel better than normal without also making them feel less than themselves.
But technology, like humanity, probably has its limits. Drugs and genetic therapies will improve, no doubt, but they will always entail trade-offs. The magic bullet will remain magic. Thus the market for artificial enhancement, like the market for regular exercise or cosmetic surgery, may remain self-limiting. Most people will not want to take the trouble or assume the risks that inhere in manipulating one’s genes and body chemistry.
Moreover, and more important: Instead of running out of control, biotechnology may be subject to a natural restraining principle, a natural equilibrium. That possible equilibrium is what we call “wellness.”
THE report makes brisk work of the notion of wellness, or, as the council calls it, the “therapy vs. enhancement” distinction. For one thing, people disagree on where therapy ends and enhancement begins. For another, many technologies that make people well (therapy) can also make people better than well (enhancement); and many people will want to be better than well; and as more people become better than well, they will redefine the baseline upward; and so the notion of wellness itself may tumble down the slippery slope.
But most people do not in fact want to be better than well during most of their lives. (Professional football players are not most people, and the Olympics are not most of life.) People are happy to be well, and they know wellness when they see or feel it. In fact, as any public-health nag will confirm, persuading people to do anything that might make them “better than well” is like persuading a cat to swim. That is why so many people take up exercise only after their heart attack. Most people will do almost anything to become well, and practically nothing to become better than well.
Wellness is not as hard to define as some claim. For most people wellness means, simply, the state of not thinking about how one feels. Of course, one could construct enjoyable paradoxes concerning hypochondriacs who do not feel well and cancer patients who do. But what most of us want is to get on with our lives without worrying about our health; and when we are well, that is what we do.
A bodybuilder on anabolic steroids may be in some sense enhanced, but he is also likely to be obsessed with his health, spending a lot of time and money monitoring himself for side effects and modulating his drug regimen. In that respect, he resembles less a well person than a diabetic on insulin therapy. And, significantly, he will usually try to get “off the juice” as soon and as often as he can. Similarly, one hears often about people who did well on antidepressants but who nonetheless risked, and then experienced, serious relapse in order to try life without the drugs. Though they benefited from the medicine, they did not really like it; and though they felt better when medicated, they did not feel fully well.
If it is true that most humans naturally seek wellness rather than perfection and know wellness when they’ve got it, then we have much less to worry about than Beyond Therapy fears. Some people, like Michael Jackson, might stop at nothing to “improve” themselves; but those people would remain a minority, more pitied than envied, cautionary lessons rather than exemplars. The distinction between therapy and enhancement would hold for most people, most of the time. In fact, the weird effects of future biotechnological enhancements—which could make Michael Jackson look normal in comparison—might make wellness more appealing than ever. The idea of being better than normal may prove a bigger flop than the Edsel.
That is where I would put my money. But let us count our blessings for the council’s worrying, because it is wise and eloquent and humane. It is also a magic-bullet antidote for smugness. One sure way to enhance the human mind and character—guaranteed free of side-effects—is to read this report. It is a thing of wonder.
† Regan Books. 328 pp. $28.95.