[Paleopsych] Public Interest: Jonathan Rauch: Being well
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Thu Oct 14 15:04:10 UTC 2004
Jonathan Rauch: Being well
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
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
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.
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