[Paleopsych] Public Interest: Jonathan Rauch: Being well

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Jonathan Rauch: Being well
http://www.thepublicinterest.com/current/article3.html
2004 Fall

    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 Bushs Council on Bioethics, which is
    headed by Leon R. Kass.

    Worrying is this councils 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 councils 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 councils 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 times 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 reports intellectual audacity. The
    council brushes aside all three of Washingtons 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, whats the problem? Liberals
    think the only real issue is ensuring equitable access to biological
    enhancement. As long as the benefits are spread fairly, whats 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,
    whats 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 lifes 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 resultthe 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 problems 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 years
      satisfaction will only fuel this years 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 councils 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 Kasss work and temperament
    know he is something of a pessimist, deeply influenced by Aldous
    Huxleys 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 councils 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 dont. 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
    ones 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 theyve 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
    enhancementswhich could make Michael Jackson look normal in
    comparisonmight 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 councils 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 characterguaranteed free of side-effectsis to read
    this report. It is a thing of wonder.

    Reagan Books. 328 pp. $28.95.

    Jonathan Rauch is a writer in residence at the Brookings Institution
    and a senior writer for National Journal.