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Life, Liberty and the Defense of Dignity: The Challenge for Bioethics
LEON R. KASS, M.D.
"Life, Liberty and the Defense of Dignity is the wisest of the burgeoning crop of bioethics books the single best resource for anyone who wants to understand how biotechnology is changing our way of life. Leon Kass exposes, as only a scientist deeply grounded in the humanities can, the far-reaching implications for our polity of man's increasing mastery over nature." - Mary Ann Glendon, Harvard University
Stem cells. Cloning. The Human Genome Project. If the year 2001 was any indication, issues of bioethics will be a dominant concern of the 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 lifesaving and disease-curing promise of these pluripotent cells, which may someday enable doctors to replace tissues damaged by spinal cord injury, juvenile diabetes or Parkinson's disease, among others. 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. Intent on 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. I was appointed to chair this council. The President has directed it to lead a "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). And I am not new to these subjects. In the 1970s I published several essays on laboratory-assisted reproduction, cloning, and manipulation of human embryos,' the last based on testimony I had given in 1978 before a National Institutes of Health Ethics Advisory Board on the very question of federal funding of human embryo research. The questions we face today are not identical to those of twenty-five years ago. For one thing, no one then was talking about stein cells or the prospects for regenerative medicine. Yet 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 are willy-nilly creating? 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. We largely ignore its contribution to the growing power for altering and controlling human bodies and minds. More important, we lack a rich enough understanding of the human goods we wish to preserve and defend. We need to realize that there is more at stake in the biological revolution than just saving life or avoiding death and suffering. We must also strive to protect and preserve human dignity and the ideas and practices that keep us human. This book is an invitation to remember these human and moral concerns, concerns that are themselves manifestations of what is humanly most worth preserving.
To place our moral inquiry in context, let us remind ourselves at the outset that 2001 was also the year in which our world was drastically changed, and with it our nation's mood and attention.
In numerous if subtle ways, since September 11 there is a palpable increase in America's moral seriousness, well beyond the expected defense of our values and institutions so viciously under attack. We have rallied in support of the respect for life, liberty, the rule of law and the pursuit of progress. But we seem to have acquired in addition a deepened appreciation of human finitude and vulnerability, and therefore of the preciousness of the ties that bind and the importance of making good use of our allotted span of years. A fresh breeze of sensible moral judgment, clearing away the fog of unthinking and easygoing relativism, has enabled us to see evil for what it is and, more important, to celebrate the nobility of heroic courage, the dignity of civic service, and the outpouring of fellow feeling and beneficence in the wake of tragedy. It has been a long time since the mood of the country was this hospitable to serious moral reflection.
Yet the moral challenges we face in the realm of bioethics are very different from the ones confronting the nation and the world as a result of September 11. In the case of terrorism, as with slavery or despotism, it is easy to identify evil as evil; the challenge is to figure out how best to combat it. But in the realm of bioethics, the evils we face are intertwined with the goods we so keenly seek: cures for disease, relief of suffering, preservation of life. Distinguishing good and bad thus intermixed is often extremely difficult.
As champions of modern liberal democracy* we face an additional difficulty. 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 what C. S. Lewis called, in a powerful little book by that name, 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 the image of our choosing. To safeguard 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 posthuman Brave New Worlders on the other. Unfortunately, we are not yet aware of the gravity of our situation.
Facing a Posthuman Future
The urgency of the great political struggles of the twentieth century, successfully waged against totalitarianisms of the right and of the left, seems to have blinded many people to a deeper and ultimately darker truth about the present age: nearly all contemporary societies, East as well as West, are traveling briskly in the same utopian direction. Nearly all are wedded to the modern technological project; all march eagerly to the drums of progress and fly proudly the banner of modern science; all sing loudly the Baconian anthem, "Conquer nature, relieve man's estate." Leading the triumphal procession is modern medicine, which is daily becoming ever more powerful in its battle against disease, decay and death, thanks especially to astonishing achievements in biomedical science and technologyachievements for which we must surely be grateful.
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 posthuman future. For anyone who cares about preserving our humanity, the time has come to pay attention.
Some transforming powers are already here. The Pill. In vitro fertilization. Bottled embryos. Surrogate wombs. Cloning. Genetic screening. Genetic manipulation. Organ harvesting. Mechanical spare parts. Chimeras. Brain implants. Ritalin for the young, Viagra for the old, Prozac for everyone. And, to leave this vale of tears, a little extra morphine accompanied by Muzak.
Aldous Huxley saw it coming two generations ago. In his charming but disturbing novel Brave New World (it appeared in 1932 and, for me, is more powerful on each re-reading), he made its meaning strikingly visible for all to see. Unlike other frightening futuristic novels of the past century, such as Orwell's already dated Nineteen Eighty-Four, Huxley's portrays a dystopia that goes with, rather than against, the human grain. Indeed, it is animated by our most humane and progressive aspirations. Following those aspirations to their ultimate realization, Huxley enables us to recognize those less obvious but often more pernicious evils that are inextricably linked to the successful attainment of partial goods.
Huxley depicts human life seven centuries hence, living under the gentle hand of humanitarianism rendered fully competent by genetic manipulation, psychoactive drugs, hypnopaedia and hightech amusements. At long last, mankind has succeeded in eliminating disease, aggression, war, anxiety, suffering, guilt, envy and grief. But this victory comes at the heavy price of homogenization, mediocrity, trivial pursuits, shallow attachments, debased tastes, spurious contentment and souls without loves or longings. The Brave New World has achieved prosperity, community, stability and near universal contentment, only to be inhabited by creatures of human shape but stunted humanity. They consume, fornicate, take "soma," enjoy "centrifugal bumble-puppy," and operate the machinery that makes it all possible. They do not read, write, think, love, or govern themselves. Art and science, virtue and religion, family and friendship are all passe. What matters most is bodily health and immediate gratification: "Never put off till tomorrow the fun you can have today." No one aspires to anything higher. Brave New Man is so dehumanized that he does not even realize what has been lost.
Of course, Brave New World is science fiction. Our Prozac is not yet Huxley's "soma"; cloning by nuclear transfer or splitting embryos is not exactly "Bokanovskification"; MTV and virtual reality parlors are not quite the "feelies"; and our current safe and consequenceless sexual practices are not universally as empty or loveless as those in the novel. But the likenesses between Huxley's fictional world and ours are disquieting, especially since our technologies of bio-psycho-engineering are still in their infancy, yet vividly reveal what they may look like in their full maturity. Moreover, the cultural changes that technology has already wrought among us should make us worry even more than Huxley would have had us do.
In Huxley's novel, everything proceeds under the direction of an omnipotent, albeit benevolent, world state. Yet the dehumanization that he depicts does not really require despotism or external control. To the contrary, precisely because the society of the future will deliver exactly what we most want health, safety, comfort, plenty, pleasure, peace of mind and length of days we can reach the same humanly debased condition solely by free human choice. No need for World Controllers. Just give us the technological imperative, liberal democratic society, compassionate humanitarianism, moral pluralism and free markets, and we can take ourselves to a Brave New World all by ourselves without even deliberately deciding to go. In case you haven't noticed, the train has already left the station and is gathering speed, although there appear to be no human hands on the throttle.
There are some who are delighted by this state of affairs: some scientists and biotechnologists, their entrepreneurial backers and a cheering claque of sci-fi enthusiasts, futurologists and libertarians.
There are dreams to be realized, powers to be exercised, honors to be won and money big money to be made. But many of us are worried, and not, as proponents of the revolution self-servingly claim, because we are either ignorant of science or afraid of the unknown. To the contrary, we can see all too clearly where the train is headed, and we do not like the destination. We can distinguish cleverness about means from wisdom about ends, and we are loath to entrust the future of the race to those who cannot tell the difference. No friend of humanity cheers for a posthuman future.
Yet for all our disquiet, we have until now done nothing to prevent it. We hide our heads in the sand because we enjoy the blessings that medicine keeps supplying, or we rationalize our inaction by declaring that human engineering is inevitable and we cannot stop it. In either case, we are complicit in preparing for our own degradation, and in some respects are more to blame than the biozealots who, however misguided, are putting their money where their mouth is. Denial and despair, unattractive outlooks in any situation, become morally reprehensible when circumstances summon us to keep the world safe for human flourishing. Our immediate ancestors, taking up the challenge of their time, rose to the occasion and rescued the human future from the cruel dehumanization of Nazi and Soviet tyranny. It is our more difficult task to find ways to preserve it from the soft dehumanization of well-meaning but hubristic biotechnical "re-creationism" and to do it without undermining biomedical science or rejecting its genuine contributions to human welfare.
We know it will not be easy, for many features of modern life will conspire to frustrate efforts aimed toward human control of the biomedical project. First, we Americans believe in technological automatism; where we do not foolishly believe that all innovation is progress, we fatalistically believe that it is inevitable. ("If it can be done, it will be done, like it or not.") Second, we believe in freedom: the freedom of scientists to inquire, the freedom of technologists to develop, the freedom of entrepreneurs to invest and to profit, the freedom of private citizens to make use of existing technologies to satisfy any and all personal desires. Third, the biomedical enterprise occupies the moral high ground of compassionate humanitarianism, upholding the supreme values of modern life-cure disease, prolong life, relieve suffering in competition with which other moral goods rarely stand a chance. ("What the public wants is not to be sick," says Nobel laureate James Watson, "and if we help them not to be sick, they'll be on our side.")
There are still other obstacles. Our cultural pluralism and easygoing relativism make it difficult to reach consensus on what we should embrace and what we should oppose; and serious moral objections to this or that biomedical practice are often facilely dismissed as religious or sectarian. Many people are unwilling to pronounce judgments about what is good or bad, right or wrong, ever in matters of great importance, even for themselves never mine for others or for society as a whole. It also does not help that the biomedical project is now deeply entangled with commerce: there are increasingly powerful economic interests in favor of going full steam ahead, and no economic interests in favor of going slow. Since we live in a democracy, moreover, we face political difficulties in gaining a consensus to direct our future, and we have almost no political experience in trying to curtail or even slow down the development of any new biomedical technology. Finally, and perhaps most troubling, our views of the meaning of our humanity have been so transformed by the scientific-technological approach to the world and to life that we are in danger of forgetting what we have to lose, humanly speaking.
It is this last matter to which this book is addressed. For we shall have little chance of protecting ourselves against the dangers of runaway biotechnology if we do not adequately understand what is at stake, if we do not recognize which human goods are in danger and worth defending. The first thing needful is a correction and deepening of our thinking.
The Need for a Richer Bioethics
To be fair, judging from my students' reactions to Huxley's Brave New World, we are not yet so degraded or so cynical as to fail to be revolted by the society he depicts. But it is instructive to notice the nature of their objections. Sensitive egalitarians, they are bothered first by the rigid hierarchy of the cognitively stratified society, which is divided impermeably into alphas, betas, gammas, deltas and epsilons, each class with its distinctive employments and pastimes. Yet they fail to notice that, thanks to effective childhood conditioning, members of each group are utterly and equally content with their lot, so that class envy and rivalry are nonexistent. What's more, it turns out that in the end there is precious little difference between the kinds of existence enjoyed if that is the right word by alphas and by deltas. Everyone's needs and wants are perfectly met. Everyone is equally healthy. Regardless of class, work is utterly routine, amusements are trivial, human relations are sterile and life's most intense satisfactions come from the chemist. Indeed, one could make the case that, despite the strict distinctions of class instituted to perform the differing levels of needed technical and economic activity, the Brave New World is a more egalitarian society than our own or let me be provocative any other society the world has known or is likely to know. The overt inequality goes little deeper than the variously colored uniforms assigned to the different classes.
Because we are liberals as well as egalitarians, our second complaint is about a lack of freedom. Everyone's endowments are predetermined through genetic engineering, all beliefs are conditioned, and conformity is obligatory. Using high-powered psychological and chemical techniques of behavior management, the World Controllers see to it that nothing disturbs the peace or social stability, and all deviants and misfits who think for themselves are whisked away to an island to live among their kind. Huxley himself apparently regarded the absence of freedom as the central problem of his dystopia: the epigraph he selected for the novel is a passage from Nicholas Berdiaeff predicting that the world's elite will soon turn its back on the march to utopia, calling instead for a society "less 'perfect,' and more free."
Yet the lack of freedom, while serious, is not the central defect. People with freedom are capable, entirely of their own volition, of embracing the same shallow relationships and trivial pursuits as the denizens of Brave New World. If you require proof, just look around. To be sure, while freedom is a great desideratum, it is no firewall against willful self-debasement. Everything will depend, finally, not just on the possibility of choice, but on what is chosen. What is most repulsive about the Brave New World is not inequality or lack of freedom, but dehumanization and degradation and, worst of all, that their posthuman estate is neither regretted nor recognized by anyone, and that they aspire to nothing humanly richer or higher. To the extent that we readers also cannot discern the dehumanization in Huxley's portrait, we are already more than halfway to it.
Our blindness to the signs and symptoms of dehumanization is, unfortunately, not confined to our work as literary critics of Huxley's novel. It also keeps us from noticing the deepest dangers connected with the brave new biology. Most troubling, this blindness is endemic even among American bioethicists, those whose profession it is to teach us about the meaning of the biotechnologies now being perfected, week by week, day by day. So little disquieted are mainstream bioethicists by what is coming that they have entered in large numbers into the employ of the biotechnology companies, bestowing their moral blessings on the latest innovation assuredly not for love but for money. If these "experts" can't see or don't care about what lies ahead, what hope is there for the rest of us?
The major principles of professional bioethics, according to the profession's own self-declaration, are these: (1) beneficence (or at least "nonmaleficence" in plain English, "do no harm"), (2) respect for persons, and (3) justice. As applied to particular cases, these principles translate mainly into concerns to avoid bodily harm and do bodily good, to respect patient autonomy and secure informed consent, and to promote equal access to health care and provide equal protection against biohazards. So long as nobody is hurt, no one's will is violated, and no one is excluded or discriminated against, there is little to worry about. The possibility of willing dehumanization is out of sight and out of mind.
Consider some of our recent bioethical debates: First, embryonic stem cell research, where the question was argued almost entirely in terms of the goods of life and health. Those in favor insisted that regenerative medicine using stem cells will eventually save countless lives and eliminate crushing incapacity; those opposed insisted that, in the meantime, lives would be sacrificed in the process, the lives of human embryos now stored in the freezers of in vitro fertilization clinics. Few people paid attention to the meaning of using the seeds of the next generation as a tool for saving the lives of the present one. (Consider as a parable in this regard the hypothetical case of the last couple on earth, he with Alzheimer's disease, she with exactly two embryos that could be used either to produce stem cells for the husband or to start the renewal of the human race.) Fewer people yet worried about the effects not on the embryos but on our embryo-using society of coming to look upon nascent human life as a natural resource to be mined, exploited, commodified. The little embryos are merely destroyed, but we their users are at risk of corruption. We are desensitized and denatured by a coarsening of sensibility that comes to regard these practices as natural, ordinary and fully unproblematic. People who can hold nascent human life in their hands coolly and without awe have deadened something in their souls.
Or take human cloning. President Clinton's National Bioethics Advisory Commission, in its 1997 report Cloning Human Beings, could agree only that human cloning is for now unethical, because it is, for now, unsafe an important objection, to be sure, but, note well, not an objection to cloning itself. Against these advisors stand the libertarians, who insist that all judgments about cloning or other novel forms of baby-making should be viewed solely as matters of private reproductive choice: in a free country, people have a right to reproduce by whatever means they wish, and regardless of who thinks otherwise. By and large, both these groups have pooh-poohed as irrational the widespread public repugnance to this prospect, choosing to prefer their reasonings and rationalizations to what might be a deeper, if inarticulate, wisdom. The bioethicists, whether libertarian, egalitarian or humanitarian, are by and large unconcerned with the positive good of keeping human procreation human, of upholding the difference between procreation and manufacture, between begetting and making. Few of them ponder what it will mean for the relation between the generations when children do not arise from the coupling of two but from the replication of one. Few seem to care about what it means for a society increasingly to regard a child not as a mysterious stranger given to be cherished as someone to take our place, but rather as a product of our will, to be perfected by design and to satisfy our wants.
Or take allowing commerce in organs for transplantation, a prospect now making a comeback in the United States after almost two decades of legal proscription. Once again, the battle is between the patrons of life and the patrons of justice: on the one hand, financial incentives will increase the supply of organs, hence fewer will die; on the other hand, financial incentives will lead to the exploitation of the desperately poor, compounding the injustice of their already unjust condition. Few people seem to be concerned about the implications of regarding the human body as alienable property or what all this bodes for ideas of human wholeness, identity and personal dignity.
Or take the coming knowledge of the human genome and the prospect of universal genetic screening and genetic engineering, including so-called germ-line modifications that will directly and deliberately affect future generations. In the United States the dominant ethical discussions are about genetic discrimination in insurance or employment and the matter of "genetic privacy." No one talks much about the hazards to living humanly from knowing too much about your genetic future. No one talks much about the meaning of acquiring godlike powers of deciding which genetic sins are capital offenses against the holy ghost of Health. No one talks much about the dangers of eugenics. No one talks at all about the hubris of believing that we are now, or ever can be, wise enough to use these powers to engineer "improvements" in the next generation.
Finally, take the use of drugs to enhance performance in sports, at school, or in the current crude replacement for what used to be called courtship. There are concerns about taking unfair advantage of an athletic rival (steroids and "blood doping") or an attractive female ("Ecstasy"), and there are concerns about coercive pacification of children by authorities (the misuse of Ritalin in schools). But there is little attention to what it means to begin to change the deep structure of human activity, severing performance from effort or, in other cases, pleasure from the activity that ordinarily is its foundation. We worry about addiction to powerful drugs and the bodily harm it causes or the crimes that are related to the fact that they are illegal. But we have yet to recognize the transformation in our humanity that would come from disturbing, through drugs or brain implants, our fundamental ways of encountering, enjoying, and acting in and on the world.
In a word, we are quick to notice dangers to life, threats to freedom, risks of discrimination or exploitation of the poor, and interference with anyone's pursuit of pleasure. But we are slow to recognize threats to human dignity, to the ways of doing and feeling and being in the world that make human life rich, deep and fulfilling.
The Strengths and Limits o f Liberal Principles
That this is so ought to be no surprise, given who we are. We come by this outlook honestly, for we are liberals and we are democrats (both lowercase). We are the privileged descendants of wise Founders who, in declaring independence from the mother country, defined themselves (and us) as a people by holding as self-evidently true that all men are created equal, equally endowed with the inalienable rights of life, liberty and the pursuit of happiness; and, further, that governments exist among men (solely) to secure these rights against the depredations of princes, prelates and their minions, or anyone else who might seek to deny them.
It is impossible to exaggerate the debt we Americans and the world at large owe to the political triumph of these liberal democratic principles. Thanks to liberal democracy and its fruitful contract with modern science and technology, many ordinary human beings today live healthier, longer, freer, safer and more prosperous lives than did most dukes and princes in premodern times. And yet though it may appear ungrateful to do so, especially when modern liberal societies have so recently come under lethal attack from religious zealots we must acknowledge that these liberal principles by themselves are inadequate for dealing with the threats of the brave new biology. For one thing, as we shall soon see, they neglect other worthy goods without which human life will not remain human. For another, they easily become a debased coinage and contribute to the forces that make a brave new world seem attractive and render its arrival more likely.
The liberal principles were, to begin with, narrowly political. The rights of the Declaration of Independence were asserted to protect against despotism, not to serve as sole moral tender in all social matters and private life. Here, morals and mores were rather to be informed by biblical religion, the source of a richer and fuller teaching about the whole of human life. Though the national government eschewed religious establishment or religious tests for office, the Founders were not neutral as between religion and irreligion, and several of the individual states had established churches. Yet as the nation has become more pluralistic and more secularized, and as the once merely political language of rights has invaded and come to dominate all moral discourse, the liberal principles have been transformed and, in my view, corrupted by expansion and exaggeration. Here's how:
Beyond an obligation to protect life against foreign enemies and local murderers, we now believe government has an obligation to preserve life from disease and to provide requisite health care. The fear of violent death, a root passion of liberalism that inspired men to abolish feudal and religious politics with their penchant for endless civil war, has become the fear of death altogether, summoning science and medicine to do battle with mortality itself as if death were but one more disease through hormones, regenerative medicine using stem cells, and attempts to reset the genetic clock that sets the midnight hour on the maximum human lifespan. From liberty understood first as freedom of conscience and the negative right not to suffer under the rule of despots has come liberty understood as a positive right to self-expression, self-assertion and full self-re-creation. In a moral realm impoverished by an overgrowth of rights, liberty is indistinguishable from license and becomes perfectly compatible with licentiousness. The liberty of self-assertion is even said to include the right of assisted suicide, the self-contradictory freedom to choose no longer to be a choosing creature. The inalienable right to own property has now become a right to alienate parts of one's own body as property. Living human embryos, if produced with the aid of genetic manipulation, are now patentable matter, and we are but a small step from instituting the buying and selling of body parts. Property, a right grounded in the inalienable "my-own-ness" of my body and its labor, has given rise to ideas of commodifying the body itself. Older pre-or nonliberal notions of human dignity, formerly the social counterweight to the political doctrine of rights, have been greatly attenuated partly thanks to the success of liberalism and its alliance with the modern technological project for the mastery of nature. The right to the pursuit of happiness that is, to the practice of happiness, to living one's life as one sees fit is, as a result, perfectly compatible with utter self-indulgence, mindless pastimes and the factitious gratifications of high-tech amusements and drug-induced euphoria. Anyone for Brave New World? Why not.
What is missing from the liberal pantheon of goods, especially in their postmodern version? What goods besides life, liberty and the pursuit of happiness do we seek to defend? What has been lost when we find degradation, debasement and dehumanization? As I have already indicated several times, the obvious candidate is "human dignity" a term we sometimes pair with "human freedom," implying (we are dimly aware) that human freedom is not the only good worth defending. Human dignity is in fact a useful notion, perhaps even the right one, and I confess to making much use of it myself. Yet if it is to be more than an empty slogan, we need to articulate its meaning, and in ways accessible and persuasive to our fellow citizens. This is no easy matter.
The Search for Human Dignity
The first trouble with "dignity" is that it is an abstraction, and a soft one at that. "Harm" is another abstraction, but we do not lack for concrete examples: a broken bone, a burned-down house, a stolen purse. "Dignity" is much more elusive, so much so that many in the field of bioethics mock it or treat it as a merely "symbolic" value meaning that it has no concrete reality. With some effort, these difficulties can be negotiated; but then the real trouble starts, because not everyone agrees about the nature and ground of human dignity.
Dignity is, to begin with, an undemocratic idea. The central notion etymologically, both in English and in its Latin root (dignitas), is that of worthiness, elevation, honor, nobility, height in short, of excellence or virtue. In all its meanings it is a term of distinction; dignity is not something that, like a nose or a navel, is to be expected or found in every living human being. Dignity would seem to be, in principle, aristocratic.
Though they did not have the term, dignity as honor linked to excellence or virtue would certainly be the view of the ancient Greeks, In the heroic world of the poets, the true or full human being, the he-man who drew honor and prizes as his dignity, displayed his worthiness in noble and glorious deeds. Supreme was the virtue o' courage: the willingness to face death in battle, armed only wit[ your own prowess, going forth against an equally worthy opponent who, like you, sought a victory not only over the adversary but, a it were, over death itself. This heroic dignity think Achilles and Hector is poles apart from the bourgeois fear of death and love of medicine, though, paradoxically, it honored the human body a a thing of beauty to a degree unsurpassed in human history. Later following the Socratic turn, heroic excellence was supplanted is Greek philosophy by the virtue of wisdom; the new hero was not the glorious warrior but the man singularly devoted to wisdom, lip Mg close to death not on the field of battle but by a single-minded quest for knowledge eternal.
The heroic warrior and the courageous wisdom-seeker may indeed be pinnacles of human dignity; we today still read about Achilles and Socrates with admiration. But the Greek exemplars are of little practical use in democratic times. Moreover, the problem with Brave New World is not primarily that it lacks glorious warriors or outstanding philosophers (or artists or scientists or statesmen) although the fact that they are not appreciated in such a world is telling. The basic problem is the absence of a kind of human dignity more abundantly found and universally shared.
In the Western philosophical tradition, the most high-minded attempt to supply a teaching of universal human dignity belongs to Kant, with his doctrine of respect for persons. Persons all persons or rational beings are deserving of respect not because of some realized excellence of achievement, but because of a universally shared participation in morality and the ability to live under the moral law. However we may finally judge it, there is something highly dignified in Kant's project. For he strained every nerve to find and preserve a place for human freedom and dignity in the face of the Newtonian worldview, a mechanized account of nature that captured even the human being, omitting only his rational will. And, in its content, there is something austerely dignified in the Kantian refusal to confuse reason with rationalization, duty with inclination, and the right and the good with happiness (pleasure). Whatever persists of a nonutilitarian ethic in contemporary bioethics descends from this principled, moralistic view. The respect for persons so widely celebrated in the canons of ethics governing human experimentation is in fact a descendant of Kant's principle of human autonomy. Never mind that for most people, human autonomy no longer means living under the universalizable law that self-legislating reason prescribes for itself, but has come to mean "choosing for yourself, whatever you choose," or even "asserting yourself authentically, reason be damned." Lurking even in this debased view of the "autonomous person" is an idea of man as something more than a bundle of impulses seeking release and a bag of itches seeking scratching. "Personhood," understood as genuine moral agency, is indeed threatened by powers to engineer our genetic makeup and to fiddle around with human appetites through psychoactive drugs or implanting computer chips in brains. We are not wrong to seek to protect it.
Yet this view of human dignity is finally very inadequate, not because it is undemocratic but because it is, in an important respect, inhuman. Precisely because it dualistically sets up the concept of "personhood" in opposition to nature and the body, it fails to do justice to the concrete reality of our embodied lives lives of begetting and belonging no less than of willing and thinking. Precisely because it is universalistically rational, it denies the importance of life's concrete particularity, lived always locally, corporeally, and in a unique trajectory from zygote in the womb to body in the coffin. Precisely because "personhood" is distinct from our lives as embodied, rooted, connected and aspiring beings, the dignity of rational choice pays no respect at all to the dignity we have through our loves and longings central aspects of human life understood as a grown togetherness of body and soul. Not all of human dignity consists in reason or freedom.
It is easy to see why the notion of "personal dignity" is of limited value in the realm of bioethics. As one would predict, the bioethics of personhood is very good at defending those aspects of human dignity tied to respect for autonomy against violations of human will, including failures to gain informed consent and excessively paternalistic behavior by experts and physicians. The justly celebrated canons of ethics governing human experimentation are, in fact, descendants of Kant's principle of human autonomy and the need to protect the weak against the powerful. But this moral teaching has very little to offer us in the battle against the dehumanizing hazards of a Brave New World. For it is, in fact, perfectly comfortable with embryo farming, surrogate motherhood, cloning, the sale of organs, or even extracorporeal gestation, because these peculiar treatments of the body or uses of our embodiments are no harm to that homunculus of personhood that resides somewhere happily in a morally disembodied place. Pace Kant, the answer for the threat to human dignity arising from sacrificing the high to the urgent, the soul to the body, is not a teaching of human dignity that severs mind from body, that ignores the urgent, or that denies dignity to human bodily life as lived. The defense of what is humanly high requires an equal defense of what is seemingly low.
The account of human dignity we seek goes beyond the said dignity of "persons," to reflect and embrace the worthiness of embodied human life, and therewith of our natural desires and passions, our natural origins and attachments, our sentiments and aversions, our loves and longings. What we need is a defense of the dignity of what Tolstoy called "real life," life as ordinarily lived, everyday life in its concreteness. It is a life lived always with and against necessity, struggling to meet it, not to eliminate it. Like the downward pull of gravity without which the dancer cannot dance, the downward pull of bodily necessity and fate makes possible the dignified journey of a truly human life. It is a life that will use our awareness of need, limitation and mortality to craft a way of being that has engagement, depth, beauty, virtue and meaning not despite our embodiment but because of it. Human aspiration depends absolutely on our being creatures of need and finitude, and hence of longings and attachments.
Sophisticated modern liberals will have a hard time with such a suggestion. What, they may well ask, is so dignified about our embodiment? What is inherently dignified about human procreation? What is so dignified in the fact that we rise from the union of egg and sperm, grow as an embryo and fetus in the darkness of a womb, or enter the world through the birth canal all rather messy matters, truth to tell rather than, say, as a result of being designed perfectly in the light of a tidy laboratory? What is so dignified about being the product of chance rather than rational design? Of natural sex rather than human artfulness? What would be wrong with cloning or any other sexless form of making babies?
Or, turning from procreation to the rest of life, what is so dignified about having a body that is subject to disease and decay? Given its inherent limitations, what's wrong with regarding it instrumentally as a tool, rather than pretending that it is a temple? What could be wrong with replacing its worn-out parts, as one does with an aging machine? And why should we not do everything in our power to combat the body's corruption, including especially its ultimate mortal fate? What is so dignified about the fact that, thanks to this mortal coil of flesh, we must the leaving no earthly trace?
Finding good answers to these tough questions is the deepest challenge for a truly human bioethics, one that seeks to keep human life human. Answers depend not on science or even on ethics but on a proper anthropology, one that richly understands what it means to be a human animal, in our bodily, psychic, social, cultural, political, and spiritual dimensions. For we cannot even begin to discuss the possible dignity of human embodiment, human procreation or human finitude if we do not seek to grasp their being and meaning. While I do not even pretend to tackle the job head on, I will broach these anthropological issues in the chapters to come, and will offer some insights and suggestions that may point the way to the right sort of account. For the time being, however, let the following remarks serve as an invitation.
It was not an accident that Aldous Huxley introduced us to the Brave New World by inviting us into the fertilizing room of the Central London Hatchery, where new human life is produced to order outside the body and cloning is routine. It was not an accident that "birth" and "mother" are regarded in that society as smutty notions. For there is a deep connection between these perversions of our bodily beginnings and attachments and the degraded flatness of soul that characterizes the entire society Huxley depicts. Why? Because to say "yes" to baby manufacture is to say "no" to all natural human relations, is to say "no" also to the deepest meaning of human sexual coupling, namely, human erotic longing. For human eros is the fruit of the peculiar conjunction of and competition between two divergent aspirations within a single living body, the impulse to self-preservation and the urge to reproduce. The first is a self-regarding concern for our own personal permanence and satisfaction; the second is a self-denying aspiration for something that transcends our own finite existence, and for the sake of which we spend and even give our lives. Other animals, of course, live with these twin and opposing drives. But only the human animal is conscious of their existence and is driven to devise a life based in part on the tension between them, in part on the fact that he does not fully understand what it is that his embodied life "wants of him." In consequence, only the human animal has explicit and conscious longings for something higher, something whole, something eternal, longings that we would not have were we not the conjunction of this bodily "doubleness," elevated and directed upwards through conscious self-awareness. Nothing humanly fine, let alone great, will come out of a society that has crushed the source oĢ human aspiration, the germ of which is to be found in the meaning of the sexually complementary "two" that seek unity and wholeness, and willingly devote themselves to the well-being of their offspring. Nothing humanly fine, let alone great, will come out of a society that is willing to sacrifice all other goods to keep the present generation alive and intact. Nothing humanly fine, let alone great, will come from the desire to pursue bodily immortality for ourselves.
Finding our way to such insights is, I admit, an increasingly difficult task in modern America. A culture that offers endless remedies to prolong the lives of the living is less likely to be a culture devoted to or interested in procreation. A society, when it does procreate, that sees its children as projects rather than as gifts is unlikely even to be open to the question of the meaning and dignity of procreation. And a culture instructed about life by a biology that sees whole organisms mainly in terms of parts or, what's worse, as mere instruments for the perpetuation of genes "a chicken is just a gene's way of making more genes" will reject the question of meaning altogether, because it believes that it already has the answer.
Here at last we have come to the bottom of our troubles. It turns out that the most fundamental challenge posed by the brave new biology comes not from the biotechnologies it spawns, but from the underlying scientific thought. In order effectively to serve the needs of human life, modern biology reconceived the nature of the organic body, representing it not as something animated, purposive and striving, but as dead matter-in-motion. This reductive science has given us enormous power, but it offers us no standards to guide its use. Worse, it challenges our self-understanding as creatures of dignity, rendering us incapable of recognizing dangers to our humanity that arise from the very triumphs biology has made. What is urgently needed is a richer, more natural biology and anthropology, one that does full justice to the meaning of our peculiarly human union of soul and body in which low neediness and divine-seeking aspiration are concretely joined.
In our search for such an account, we can get help from premodern sources, both philosophical and biblical. We can learn, for example, from Aristotle an account of soul that is not a ghost in the machine, but the empowered form of a naturally organic body. We can learn from thinking about Genesis what it means that the earth's most godlike creature is a concretion combining ruddy earth and rosying breath; why it is not good for the man to be alone; why the remedy for man's aloneness is a sexual counterpart, not a dialectic partner (Eve, not Socrates); why in the shame-filled discovery of sexual nakedness is humanity's first awe-filled awareness of the divine; and why respect for a being created in God's image means respecting everything about him, not just his freedom or his reason but also his blood. Exploring these possibilities is for another volume. For now it will be sufficient if we can come to see the need for both a new bioethics and a new biology: a richer ethic of bios tied to a richer logos of bios, an ethical account of human flourishing based on a biological account of human life as lived, not just physically, but psychically, socially and spiritually. In the absence of such an account we shall not be able to meet the dehumanizing challenges of the brave new biology.
Despite the dark picture I have sketched, things are not so dark on the ground. It may be that human dignity has a future, needing only some encouragement and voice for what many people still know in their bones. The events of September 11 have reminded us that courage, fortitude, generosity, righteousness and the other human virtues are not confined solely to the few. Many of us strive for them, with partial success, and still more of us do ourselves honor when we recognize and admire those people nobler and finer than ourselves. With proper models, proper rearing and proper encouragement, many of us can be and act more in accord with our higher natures.
In truth, if we know how to look, we find evidence of human dignity all around us, in the valiant efforts ordinary people make to meet necessity, to combat adversity and disappointment, to provide for their children, to care for their parents, to help their neighbors, to serve their country. Life provides numerous hard occasions that call for endurance and equanimity, generosity and kindness, courage and self-command. Adversity sometimes brings out the best in a man, and often shows best what he is made of. Confronting our own death or the deaths of our beloved ones provides an opportunity for the exercise of our humanity, for the great and small alike. Profoundly should we hope and pray that the recent shocking reminder of the vulnerability of all things human, and the recent stirring display of the dignity of ordinary human heroes, will encourage us to come to dignity's defense also against the seductive temptations of a posthuman future.
An Overview o f the Argument
It remains here only for me to introduce the structure of the book to offer a synopsis of its argument and to say a word about its spirit. The surface thesis has already been stated: the new biotechnologies threaten not so much liberty and equality as 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 make us into human midgets. Our embrace of technology would thus turn out to be tragic, unless we redeem ourselves by nontechnological ideas and practices, today both increasingly beleaguered.
The first section of the book, Nature and Purposes of Technology, and Ethics, examines in general terms the two poles of our discussion: technology and ethics. Chapter One 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" as "tragedy." Chapter Two, "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.
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 we possess only thanks to our mortal condition. Within this section are three subsections: Life and Lineage: Genetics and the Beginning of Life (Chapters Three to Five); Body and Soul: Parts and Whole in the Midst of Life (Chapter Six); and Death and Immortality: Staying Human at the End o f Life (Chapters Seven to Nine).
Chapter Three, "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 Four, "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 Five, "Cloning and the Posthuman Future," examines the much-discussed matter of human cloning. It treats this as the opening gambit of a eugenic campaign of thought and action, one that would turn procreation into manufacture and 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 selfconsciously 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 Six, "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 Seven, "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 deadly 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 wellbeing of the dying patients that the alleged "right to die" is intended to benefit.
Chapter Eight, "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 to 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 Nine, "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 third section of the book, Nature and Purposes o f Biology, draws back from the biotechnologies to have a brief look at the underlying scientific quest. Chapter Ten, "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 nothing 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. Only to the last do I plead guilty and then only in part though not as a matter of temperament or psychic flaw, but because the evidence seems to me to require deep moral concern about the direction we are pursuing. As to the other charges, I simply flat-out deny them.
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, with organ transplantation or in vitro fertilization I am willing to call attention to some moral hazards. And I am profoundly grateful, both personally and philanthropically, to modern American democracy for its safeguarding of life and liberty, equal opportunity and prosperity, and, above all, for the unprecedented opportunities of modern life to educate ourselves and to make something humanly fine and good out of our precious lives. If people wish to accuse me of being antiscience, I respectfully submit that the problem is theirs.
Scientists and physicians, unused to thinking that their work is anything but self-justifying, may balk at suggestions that their work may not be unqualifiedly good in its results. 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. If I have written too polemically, it is only because of a passionate concern that we consider before it is too late whether we truly know what we are doing. Anyone who cares for the future of human dignity no less than 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.
Leon R. Kass M.D. "Introduction." In Life, Liberty and the Defense of Dignity: The Challenge for Bioethics (San Francisco: Encounter Books, 2002), 1-26.
Leon R. Kass is a professor in the Committee on Social Thought at the University of Chicago and Hertog Fellow in Social Thought at the American Enterprise Institute. Among his books are Toward a More Natural Science: Biology and Human Affairs; The Hungry Soul; The Ethics of Human Cloning (with James Q. Wilson); and Wing to Wing, Oar to Oar: Readings on Courting and Marrying (with Amy A. Kass). In 2001, President Bush appointed Dr. Kass to chair the new President's Council on Bioethics.
Copyright Đ 2002 Encounter Books