Dimensions: 9.36'' x 6.36'' 313 pages Encounter Books Publication Date: January 2002 Hardcover ISBN: 1893554554

January 2002
Life, Liberty, and the Defense of Dignity: The Challenge for Bioethics
By Leon R. Kass

In a series of meditations on cloning, embryo research, the Human Genome Project, the sale of organs and the assault on mortality itself, Kass evaluates the ongoing effort to break down the natural boundaries given us and to refashion the human body into an instrument of our will. Kass believes that technology has done and will continue to do wonders for our health and longevity, and that we have much to thank it for. But there is more at stake in the biological revolution than saving life and avoiding death. We must also strive to protect the ideas and practices that give us dignity and keep us human. This summary is adapted primarily from his introduction.

Leon R. Kass, M.D., the Hertog Fellow at AEI, is the chairman of the President's Council on Bioethics. Kass is also the coeditor of Wing to Wing, Oar to Oar: Wing to Wing, Oar to Oar: Readings on Courting and Marrying (2000), coauthor of The Ethics of Human Cloning (1998), and author of The Hungry Soul: Eating and the Perfecting of Our Nature (1994).

Stem cells. Cloning. The Human Genome Project. If the year 2001 was any indication, issues of bioethics will be a dominant concern of our new century, indeed, of the new millennium. For much of the year, before the events of September 11 relegated everything else to the back page, the United States was absorbed in a difficult moral debate about whether the federal government should fund research on human embryonic stem cells. Proponents touted the life-saving and disease-curing promise of these cells that may someday enable doctors to replace tissues damaged by spinal cord injury, juvenile diabetes, Parkinson's disease, or other means. Opponents objected to the necessary exploitation and destruction of the human embryos from which the stem cells are extracted. In August 2001, in his first major televised address to the nation, President Bush announced his solution. Reaffirming the moral principle that nascent life not be destroyed for the sake of research, yet eager to explore the possible therapeutic benefits of these cells, he chose to permit federal funds to be used for research only on already existing embryonic stem cell lines. At the same time he announced the creation of a President's Council on Bioethics to monitor stem cell research and to consider all of the medical and ethical ramifications of biomedical innovation. In charging the council, the president has called for "fundamental inquiry into the human and moral significance of developments in biomedical and behavioral science and technology." He wants everyone to understand that the stem cell question, important in its own right, is but the forerunner of a horde of similar questions that we will need to confront sooner rather than later.

The subject of embryo research is not new, and neither is human cloning, the other hotly debated bioethical topic of the past year. Both matters surfaced in the late 1960s and 1970s, following the successful cloning of tadpoles (1962) and the birth of the first human "test-tube baby" (1978). The questions we face today are not identical to those of twenty-five years ago. For one thing, no one then was talking about stem cells or the prospects for regenerative medicine. But, despite changes in the science and technology, the basic moral and political questions remain the same. What does it mean to treat nascent human life as raw material to be exploited as a mere natural resource? What does it mean to blur the line between procreation and manufacture? What are the likely future technical possibilities and moral problems that our present decisions will create? What moral boundaries should researchers observe, whether they work with federal or with private funds? What are the goals of, and what are the proper limits to, the project for the mastery of human nature? Can we control where this project is taking us, so as to reap the benefits without losing our humanity? If so, how?

Our recent policy debates, like so many other arguments about biomedical technology, tend to neglect these larger questions. We find ourselves reacting piecemeal and ad hoc to the latest biotechnological possibility without seeing its meaning whole. Yet contemplating present and projected advances in genetic and reproductive technologies, in neuroscience and psychopharmacology, in the development of artificial organs and computer-chip implants for human brains, and in research to retard aging, we now clearly recognize new uses for biotechnical power that soar beyond the traditional medical goals of healing disease and relieving suffering. Human nature itself lies on the operating table, ready for alteration, for eugenic and neuropsychic "enhancement," for wholesale redesign. In leading laboratories--academic and industrial--new creators are confidently amassing their powers and quietly honing their skills, while on the street their evangelists are zealously prophesying a post-human future. For anyone who cares about preserving our humanity, the time has come to pay attention.

Preserving Human Dignity

If anything, September 11 has made us more prepared to meet the challenges of bioethics, by ushering in an era of increased moral seriousness and by awakening us to the limits of easygoing relativism. We can no longer live beyond good and evil, or believe that all technology is wonderful or benign. Yet the moral challenges we face from biotechnological progress are very different from the ones confronting the nation and world as a result of September 11. The greatest dangers we confront in connection with the biological revolution arise not from principles alien to our way of life but rather from those that are central to our self-definition and well-being: devotion to life and its preservation; freedom to inquire, invent, or invest in whatever we want; a commitment to compassionate humanitarianism; and the confident pursuit of progress through the mastery of nature, fueled by unbridled technological advance. Yet the burgeoning technological powers to intervene in the human body and mind, justly celebrated for their contributions to human welfare, are also available for uses that could slide us down the dehumanizing path toward "the abolition of man." Thus, just as we must do battle with antimodern fanaticism and barbaric disregard for human life, so we must avoid runaway scientism and the utopian project to remake humankind in our own image. Safeguarding the human future rests on our ability to steer a prudent middle course, avoiding the inhuman Osama bin Ladens on the one side and the post-human Brave New Worlders on the other.

Life, Liberty, and the Defense of Dignity aims to defend and define this middle way, to probe the meaning and possibility of the good life and good society in an age of biological progress, and to engage in what I call a "richer bioethics." The book moves from the very beginning of life to the very end, and it moves from general reflections about technology and ethics to specific discussions of the major bioethics issues of the day. From stem cells to cloning, from genetic manipulation to organ markets, from assisted suicide to "immortality research," I try to give an account of what the new biotechnology might mean for everyday life in all its richness and concreteness.

The surface thesis can be simply stated: The new biotechnologies threaten not so much liberty and equality but something we might summarily call "human dignity." Technology has done, and will likely continue to do, wonders for our health and longevity, for the defense of our freedom, and for our prosperity ("Life, Liberty, and the Pursuit of Happiness"). Yet it threatens human flourishing precisely because, in the absence of countervailing efforts, we may use the fear of death, our various freedoms and rights, and our unrestrained pursuit of profit and pleasure in ways that will turn us into human midgets. Our embrace of technology will thus turn out to be tragic, unless we redeem ourselves by nontechnological ideas and practices, which are today both increasingly beleaguered.

The first section of the book, The Nature and Purposes of Technology and Ethics, examines in general terms the two poles of the discussion: technology and ethics. Chapter 1 lays out "The Problem of Technology and Liberal Democracy" in a comprehensive statement, showing what I mean by suggesting that technology is not so much problem but tragedy. Chapter 2, "Practicing Ethics: Where's the Action?", dissects the current fashions in ethics and bioethics, and shows why they are woefully inadequate to the task of a truly human response to our new predicament, both in action and in thought.

Science: A Qualified Good

The second and longest section of the book, Ethical Challenges from Biotechnology, moves through selected areas of biomedical science and technology, from in vitro fertilization and genetic technology to organ transplantation and "immortality research." Its purpose is to expose the challenges that these new developments pose to life and lineage, identity and individuality, bodily unity and integrity, the dignity of the body, the care of the dying, and the virtues that are ours only thanks to our mortal condition.

Chapter 3, "The Meaning of Life--in the Laboratory," starts with the germinal beginnings of life and our abilities to manipulate them, both for producing children and for biomedical research. It focuses on the meaning of holding embryonic life in human hands and the temptation to reduce it to raw material for human use, exploitation, and commerce.

Chapter 4, "The Age of Genetic Technology Arrives," looks at some of the implications of the Human Genome Project and the coming prospects for genetic screening and genetic engineering, serving purposes both therapeutic and beyond. It defends the reasonableness of public disquiet regarding the dangers of "playing God," of coercion, and especially of dehumanization--in both deed and thought--that are raised by prospects of genetic "enhancement" and by an approach to human life that defines us in terms of our genes.

Chapter 5, "Cloning and the Posthuman Future," examines the much discussed matter of human cloning. It treats cloning as the opening gambit of a eugenic campaign of thought and action, one that would turn procreation into manufacture and that would have us treat children (even more than we already do) as planned products to be perfected rather than as mysterious gifts to be treasured. Recommendation of a legislative ban on all human cloning self-consciously argues in the name of human dignity for the need to set limits on human freedom, both regarding what scientists may do and regarding how babies are to be "made."

Chapter 6, "Organs for Sale? Propriety, Property, and the Price of Progress," looks at proposals to establish markets in organs for transplantation. It exposes the implications for our sense of identity and integrity of our death-defying commercial republic's growing willingness to turn all human body parts into commodities, replacing an ethos of love and philanthropic gifting of organs with an ethos of rent-seeking behavior--in human flesh. The right of property and the freedom of contract, central liberal notions, are shown to be insufficient protectors of human dignity.

Chapter 7, "Is There a Right to Die?", continues the critique of liberal rights, this time not the right to property in organs in the name of saving life, but the alleged new right to be made dead (with the assistance of others), if one wants out of life. Here the perversions of a rights-based approach to all moral questions are made clear for all to see, threatening even the dignity and well-being of the dying patients that the alleged "right to die" is intended to benefit.

Chapter 8, "Death with Dignity and the Sanctity of Life," the only chapter that thematically treats the idea of "dignity," provides a better alternative than "right to die" approaches for thinking about how to care for people at the end of life. The major focus here is to show how the dignity of life and the sanctity of life are conjoined, preparing the ground for the fusion of the perspectives of virtue and the perspectives of reverence.

Chapter 9, "L'Chaim and Its Limits: Why Not Immortality?", grabs the biotechnology bull by the horns, countering proposals that we pursue the conquest of death itself with arguments against our insatiable lust for unending life. Central to the case is an attempt to articulate what a dignified human life is all about: engagement, seriousness, the love of beauty, the practice of moral virtue, the aspiration to something transcendent, the love of understanding, the gift of children, and the possibility of perpetuating a life devoted to a high and holy calling.

The Wonder of Life

The final section of the book, The Nature and Purposes of Biology, draws back from the biotechnologies to have a brief look at the underlying scientific quest. Chapter 10, "The Permanent Limitations of Biology," develops the thought that the deepest threat to human dignity lies not in the techniques of biotechnology but in the underlying science itself, in an "objectified" treatment of life that fails to do justice to its subject. The chapter's purpose is to induce humility where there is now only epistemological hubris, and to recreate a sense of wonder and mystery about the world, a reverential contemplative attitude that is itself an expression of human dignity. For man is the only being on earth that can experience wonder and awe at the rich and incredible facts of life, soul, and human awareness. A restoration of appreciative wonder and respectful awe before the mystery of life is indispensable if we are to be able to defend life's dignity against the deadly distortions of scientistic abstraction.

Finally, a word of warning about the spirit of this book. I fear that little I can say will prevent many readers of this book from regarding it as a Luddite tract, and me as hostile to science and technology, or a natural pessimist, or someone simply fearful of the future. But I deny these charges. I regard modern science as one of the great monuments to the human intellect, and the field of modern biology as unrivalled in the wonderful discoveries it can and will increasingly offer us. I esteem greatly modern medicine for its contributions to human well-being--even where, for example, as with organ transplantation or in vitro fertilization, it is willing to call attention to some moral hazards.

Scientists and physicians, unused to thinking that their work is anything but self-justifying, may balk at the suggestion that their work may not be, in result, unqualifiedly good. Confirmed materialists will see the threat of theocracy hiding behind any challenge to the sufficiency of their explanations of the world. Doctrinaire libertarians will not consider that freedom can lead us anywhere but upward. Prosperous sophisticates cannot imagine that they are missing anything important in the beliefs to which they are so comfortably attached: "We are living well, what reason is there to worry?" But that is precisely the problem. The heart of the possibility of tragedy is that human glory and human misery are linked, that the triumph of human achievement contains intrinsically the source of human degradation. And the likelihood of suffering tragedy increases with a hubristic belief that we have everything under control. Anyone who cares for the future of human dignity no less than he cares for the future of human health should not want to be self-deceived in this matter. It is to encourage greater thoughtfulness in such readers that I have written this book.