352 pages HarperCollins Publishers Publication Date: December 2003 Paperback ISBN: 0060734906

December 2003
Beyond Therapy: Biotechnology and the Pursuit of Happiness
A Report by the President's Council on Bioethics
Dr. Leon R. Kass, Chairman

This landmark report--the product of more than sixteen months of research and reflection by the President's Council on Bioethics--explores the profound ethical and social consequences of today's biotechnical revolution. Almost every week brings news of novel methods for screening genes and testing embryos, choosing the sex and modifying the behavior of children, enhancing athletic performance, slowing aging, blunting painful memories, brightening mood, and altering basic temperaments. This report looks ahead to where biotechnology might be taking us and challenges us to ask the most fundamental human questions: What is the significance of turning to biotechnology to fulfill our deepest desires? How would the use of biotechnology "beyond therapy" change the character of human life? Will biotechnology serve or threaten America's most cherished ideals? 

The golden age of biotechnology has begun, filled with hope and expectation. With the sequencing of the human genome and the emergence of stem cell research, we look forward to major insights into human development and novel treatments for human diseases. Advances in neuroscience hold out the promise of powerful new understandings of human behavior, as well as remedies for devastating mental illnesses. Research on the biology of aging and senescence suggests the possibility of slowing down age-related declines in bodies and minds and perhaps even expanding the maximum human lifespan. In myriad ways, the discoveries of biologists and the inventions of biotechnologists are steadily increasing our power to intervene more precisely into the workings of our bodies and minds and to alter them by rational design. 

We will surely welcome, as we have in the past, new technological measures that can bring us healthier bodies, decreased pain and suffering, peace of mind, and longer life. At the same time, however, the advent of new biotechnical powers is for many people a cause for concern. The scientific findings themselves raise challenges to human self-understanding: people wonder, for example, what new knowledge of brain function and behavior will do to our notions of free will and personal moral responsibility, formed before the advent of such knowledge. The prospect of genetic screening and genetic engineering, though welcomed for treatment of inherited genetic diseases, raises for some people fears of eugenics or worries about "designer babies." Psychotropic drugs, though welcomed for treatment of depression or schizophrenia, raise fears of behavior control and worries about diminished autonomy or confused personal identity. Precisely because the new knowledge and the new powers impinge directly upon the human person, and in ways that may affect our very humanity, a certain vague disquiet hovers over the entire enterprise. Notwithstanding the fact that almost everyone, on balance, is on the side of further progress, the new age of biotechnology will bring with it novel, and very likely momentous, challenges. 

While its leading benefits and blessings are readily identified, the ethical and social concerns raised by the march of biotechnology are not easily articulated. They go beyond the familiar issues of bioethics, such as informed consent for human subjects of research, equitable access to the fruits of medical research, or, as with embryo research, the morality of the means used to pursue worthy ends. Indeed, they seem to be more directly connected to the ends themselves, to the uses to which biotechnological powers will be put. These broader concerns attach especially to those uses of biotechnology that go "beyond therapy," beyond the usual domain of medicine and the goals of healing, uses that range from the advantageous (e.g., steroids or stimulants to improve performance) to the seductive (e.g., drugs that numb the emotional sting of painful memories) to the pernicious (e.g., genetically-engineered bio-weapons). Generally speaking, there are concerns about what others might do to us. And there are concerns about what we might voluntarily do to ourselves or to our society--as we turn to biotechnology to fulfill our deepest human desires. People worry both that our society might be harmed and that we ourselves might be diminished in ways that could undermine the highest and richest possibilities for human life. 

Truth to tell, not everyone who has considered these prospects is worried. On the contrary, some celebrate the perfection-seeking direction in which biotechnology may be taking us. Indeed, some scientists and biotechnologists have not been shy about prophesying a better-than-currently-human world to come, available with the aid of genetic engineering, nanotechnologies, and psychotropic drugs.  Yet not everyone cheers a summons to a "post-human" future. Not everyone likes the idea of "remaking Eden" or of "man playing God." Not everyone agrees that this prophesied new world will be better than our own. Some suspect it could rather resemble the humanly diminished world portrayed in Aldous Huxley's novel Brave New World, whose technologically enhanced inhabitants live cheerfully, without disappointment or regret, "enjoying" flat, empty lives devoid of love and longing, filled with only trivial pursuits and shallow attachments.

In order to think clearly about the coming age of biotechnology, we need to understand the scientific prospects: What is fantasy and what is reality? What biotechnical powers are here and what might be coming? But more deeply, these new technological possibilities give practical urgency to fundamental moral and philosophical questions: What is a good life? What is a good community? What is the significance of human mortality? What is the nature of human happiness? It is these types of questions that guide and structure the Council's inquiry--in an effort to understand what biotechnology is for and what biotechnology "beyond therapy" means. The report begins not with the technologies themselves but with the human desires and aspirations that move human beings to produce and use these new powers: desires for longer life, finer looks, stronger bodies, sharper minds, better performance, and happier souls. By structuring the inquiry around the desires and goals of human beings, the report adopts the perspective of human experience and human aspiration, rather than the perspective of technique and power. By beginning with long-standing and worthy human desires, it avoids premature adverse judgment on using biotechnologies to help satisfy them. It explores how the new technological possibilities for going "beyond therapy" fit with previous and present human pursuits and aspirations.

The heart of the report is four "case studies" or inquiries into the human ends we seek and the ways biotechnology might or might not help us achieve them. In Chapter 2, on "better children," the Council begins by reflecting on the meaning of childhood and what it means to seek a "better" child. It then considers the possibility of enhancing or controlling the native endowments of children using new genetic technologies and the possibility of making children more accomplished, attentive, or docile using new psychotropic drugs. How would expanded genetic control of children by parents affect the character of human procreation, the relationship between the generations, and the nature of parenthood and childhood? How would it affect the character of society as a whole--as in the case of sex selection? How might drugs that alter or control the behavior of children affect moral education, individuality, and aspiration? What might be lost--if anything--if stimulants or other drugs become an accepted and widespread way to enhance the performance of the young? 

In Chapter 3, on "superior performance," the Council begins with an exploration into the meaning of human activity--seeking to understand what makes a performance human and what makes it excellent. It then uses athletics as a case study to consider the scientific prospects and human significance of new performance-enhancing agents, especially new ways to improve muscle size and strength. As we discover better technical ways to enhance our given bodies, minds, and performance, are we changing or compromising the dignity of human activity? Do such potential enhancements alter the identity of the doer? Whose performance is it, and is it really better? Is the enhanced person still fully me, and are my achievements still fully mine? How would the widespread use of  performance-enhancing biotechnologies change the character of society as a whole? Would we savor our new high levels of achievement or would human beings come to resemble bionic machines or animals bred for the race?

In Chapter 4, on "ageless bodies," the Council begins with a reflection on human mortality--what it means to grow old, to be mortal, and to be embodied living creatures. It then considers the pursuit of "ageless bodies," both modest and bold, using either soon-to-be-available genetic interventions to increase the strength and vigor of muscles, or various efforts, somewhat more futuristic, to retard the general processes of biological senescence. How does being mortal affect the way we live our lives? What is the meaning of the human life-cycle--the rhythm of being born, growing up, growing old, and passing on? Would we live life urgently and purposefully if we believed we could live indefinitely? How would drastic increases in the human life-span affect the character of society and the relationship between the generations? 

In Chapter 5, on "happy souls," the Council begins by reflecting on the complicated nature of human happiness--and the connection between human happiness, lived experience, and personal identity. It then considers new psychotropic drugs--some already here, some on the horizon--that numb painful memories or brighten depressed moods. To what extent is human happiness shaped by our chemical make-up, by whether or not an individual's brain chemistry is in balance? In what ways would memory-dulling or mood-brightening drugs sever the connection between real life and psychological life? If a drug could make me happy, would it really be me who was happy? Could we live truly if a drug could take away the pain of losing a loved one, the shame of our most shameful deeds, or the horror we experience in the face of human evil? Why live truly at all--if true life is often so miserable? Is there a difference between happy feelings and true human flourishing or between a psychically-satisfied society and a good society?

Toward Perfection and Happiness

In the final chapter, the Council tries to bring together what we have learned from the various "case studies." While each of the separate instances aims to make our concerns concrete, the full value of the inquiry requires considering all these instances together and seeing them as part of a larger human project--toward perfection and happiness. 

On the optimistic view, the emerging picture of life in the age of biotechnology is one of unmitigated progress and improvement. It envisions a society in which more and more people are able to realize the American dream of liberty, prosperity, and justice for all. It is a nation whose citizens are longer-lived, more competent, better accomplished, more productive, and happier than human beings have ever been before. It is a world in which many more human beings--biologically better-equipped, aided by performance-enhancers, liberated from the constraints of nature and fortune--can live lives of achievement, contentment, and high-self-esteem.

But there are deep reasons to wonder whether life will really be better if we turn to biotechnology to fulfill our deepest human desires. We want better children--but not by turning procreation into manufacture or by altering their brains to gain them an edge over their peers. We want to perform better in the activities of life--but not by becoming mere creatures of chemistry or by turning ourselves into bionic tools designed to win and achieve in inhuman ways. We want longer lives--but not at the cost of living carelessly or shallowly with diminished aspiration for living well and not by becoming people so obsessed with our own longevity that we care little about future generations. We want to be happy--but not by taking a drug that gives us happy feelings without the real loves, attachments, and achievements that are essential to true human flourishing. 

Lacking prophetic powers, no one can say for certain what life in the age of biotechnology holds in store for us. Most likely, there will be the usual mix of unforeseen burdens and unexpected blessings, in addition to the realization of some of our explicit hopes and fears. But with our very humanity in the balance, it would be foolish to avert our gaze and trust to fortune. We must begin thinking about these issues now, lest we build a future for ourselves that cheapens, rather than enriches, America's most cherished ideals.  

 Available in Adobe Acrobat PDF Format