Life, Liberty and the Defense of Dignity The Challenge for Bioethics by Leon R. Kass Encounter, 313 pp., $26.95 WE LIVE in a very rich country (in case you hadn’t noticed), and from the heaping surplus of our prosperity we have carved a number of professions that–to put it as kindly as possible–are not completely, vitally necessary. The herbologist and the golf pro, the pollster and the journalism professor, the Feng Shui counselor and the aroma therapist: In a country less indulgent, less able to tolerate excess baggage, less rolling in dough, the labors of these men and women would be regarded as frivolous at best, freeloading at worst. And now, having followed the recent national debates over cloning, euthanasia, and other issues of biotechnology, I would like to add bioethicists to this list of spongers. What, you can’t help but wonder, are they good for? To paraphrase the cultural critic Edwin Starr: absolutely nothing–in most cases. It was not always so. The job title “bioethicist” is only about thirty years old, and the first bioethicists had already led lives of distinction in other fields by the time the tag attached to them. Among the assortment of thinkers who coalesced to form the Hastings Center, the first research institution devoted to bioethics, there were lawyers (Paul Freund), theologians (Paul Ramsey), philosophers (Daniel Callahan), and biologists (Ernst Mayr), each of them capable, in his chosen line, of throwing the long ball. What brought them together in the late 1960s and early 1970s was a desire to explore the moral significance of advances in medicine and biotechnology, which had just then set off at a galloping pace. Many of the developments that alarmed them, or in some cases merely intrigued them, have already come to pass or soon will: the generation of human life by nonsexual means, the genetic manipulation of offspring, the widespread harvesting of bodily organs, the use of human embryos for research, and so on. Owing partly to the high standards these men brought to their work, bioethics grew in prestige among the thinking classes and in time became a profession. By the mid-1970s, you could get a degree in it. Hospitals and pharmaceutical companies were eager to hire you to “do” bioethics, under their auspices, at generous salaries. The paradoxical consequence was probably unavoidable. Just as schools of education now specialize in producing bad teachers and graduate programs in creative writing train novelists to be unreadable, the professionalization of bioethics produced very few moral philosophers and very many academic careerists and commercial hacks. The field is in bad shape. In his new collection of essays, “Life, Liberty and the Defense of Dignity: The Challenge for Bioethics,” Leon Kass frames the problem this way: “The rise of professional bioethics may have been good for bioethicists, but how good has it been for our ethics? Have these been substantial improvements in the practices or moral sensibilities of physicians, scientists, entrepreneurs, or the general public in bioethical matters? Are the choices that we are making . . . better than they were thirty years ago and better than they would have been in the absence of the work of bioethicists?” Kass’s answer, as you might have guessed, is no. He speaks from inside the profession himself. A physician by training, he was one of the founders of Hastings and one of the first medical doctors to make bioethics his main occupation. He’s still at it. Last year, President Bush appointed him chairman of the President’s Council on Bioethics, which made news this summer when it publicly recommended a national three-year ban on the cloning of human embryos. KASS’S COMMISSION is a demonstration of how he thinks that bioethics, at its best, should proceed. The first bioethicists, trained in law, philosophy, medicine, and the life sciences, were amateurs–there being no such thing as a professional bioethicist in those days–who were drawn to the intersection of morality and science by their own intellectual curiosity and moral concern. In the same way, Kass has attracted a variety of intellectual types to sit on the president’s council: a couple of legal scholars, a clinical psychiatrist, a sociologist, three philosophers, several research scientists, even a journalist. None of them has formal training in “bioethics.” They meet in public sessions at regular intervals, trade ideas constantly by e-mail, and occasionally, as with their recommendation of a cloning ban, touch earth long enough to issue a bull on a subject of political interest. The council, under Kass’s direction, treats bioethics as an open-ended inquiry. Two of its sessions have been given over to long and rambling discussions of short stories; the stories were instructive because, in Kass’s reading, they touched on “the deepest human questions.” This is not, needless to say, the way that bioethics is usually done nowadays. Like so many specialized fields, bioethics has succumbed to the tyranny of expertise. “The ethicist,” Kass writes in one of these essays, has become “another technical expert like the ophthalmologist or the cardiologist.” We call ethicists in to solve specific problems. Has grandma had a stroke? The hospital has an ethics board that specializes in just such “termination-of-treatment cases.” Is a biotech firm about to clone the CEO? It will have an ethicist on retainer, who has studied the procedure in all its particulars and can reassure the public (and the shareholders). These bioethicists do their work in a tidy and efficient manner. It is their job to abstract problems from the specific human situation before them and apply rationally developed theories toward their resolution. But this process, as Kass knows, has it exactly backwards. Experts work this way, but real people, in real life, don’t, and shouldn’t. When grandma takes sick, the discussions of the hospital ethics board will be very different from the ones that her family, together with friends and clergy and doctors, undertake at bedside. The board’s discussions “are generalized, remote, highly influenced by the current fashions of bioethics,” such as the newly minted “right to die.” We laymen, on the other hand, will bring to the discussion the sum of our attachments and affections, and our deepest beliefs about what life is and what it’s for. And this human element is what bioethics commonly leaves out. “Moral life,” says Kass, “flows from character–ingrained, concrete, steady, like a second nature”–and not from the bloodless application of theory. And moral life, meanwhile, has its origins in tradition, reinforced by a community, where decent conduct and sensibility are rewarded and encouraged by law and custom. “Speech and philosophy have a role to play here,” Kass writes, “but we should not exaggerate their power.” Moral understanding, in other words, is built into a man, not laid on top of him. And we certainly can’t be argued into it by fine reasoning. WHY THEN have we begun to defer to ethical experts, these hired guns in the rational arts, when it comes to the most intimate matters of life and death? Because it seems there’s nowhere else to turn. The tradition and community that once instilled moral understanding have been corroded. Following the depredations of modernism and postmodernism, and maybe even post-postmodernism, our contemporary culture is uniquely impoverished. As Kass puts it, we now lack “a master cultural and moral narrative that can guide us through the minefields of the biotechnological revolution”–a revolution that presents us with questions of selfhood, identity, and mortality. In an earlier age we might have turned to religion to guide our responses. But religion and religious premises are no longer deemed suitable for public disputation in a pluralistic society–and certainly not appropriate in the secular hothouse where bioethicists cultivate their theories. For bioethicists, as for an ever larger segment of the intelligent public, the “master narrative” is today provide
d by science. And who can blame them? Unlike the messy accumulations of tradition, science seems surefooted and hardheaded. Science works. Its method has brought us undreamed-of successes–marvels of technology, cures and treatments for disease, a lifespan nearly twice what it was a century ago. The problem is that on the big questions of who we are, why we are here, what we are for, science has nothing to say. Yet its silence is taken as affirmative evidence: What science can’t account for, doesn’t exist. If Darwinian theory shows evolution to be a series of chance events, then the universe itself must lack larger purpose. If neuroscience fails to locate a soul in the folds of the brain, then the self must be an illusion. If biochemistry shows thoughts and emotions to be endlessly manipulable, then free will is a lie. Thus does our new master narrative devolve into the crudest materialism. Kass quotes a manifesto released in 1997, signed by an army of well-known biologists and ethicists, in support of cloning human embryos for research. According to some “ancient theological scruples,” the manifesto said, “human nature is held to be unique and sacred.” But the signers were not fooled by such hoary superstitions: “As far as the scientific enterprise can determine, humanity’s rich repertoire of thoughts, feelings, aspirations, and hopes seem to arise from electrochemical brain processes, not from an immaterial soul that operates in ways no instrument can discover.” The nihilistic implications of this view, now so widely shared, are pretty thoroughgoing. It is a view that undercuts even itself. As Kass notes, no one who holds it could claim any standing to declare the results of his own “electrochemical brain processes” truer than anyone else’s. The very scheme of truth versus error–defined in any sense beyond “what works” versus “what doesn’t”–becomes unsustainable. So does much else that should be essential to the bioethical project. When science overtakes morality, sooner or later all notions of dignity, freedom, self and soul, purpose and attainment, the very foundations of ethical inquiry, are ploughed under. As a profession, then, bioethics finds itself in a pickle. Its original purpose was to place proper limits on the uses we make of science. Yet just at the moment when science reaches for new and unimagined powers, bioethics lacks the philosophical wherewithal to provide any guidance at all. It’s little wonder that the profession tumbles down into either corruption or irrelevance. Bioethics has become an instrument of the enterprise it was meant to police. Many bioethicists serve as corporate shills, trotted out by biotech companies to certify that whatever new technology their employers pursue for profit is officially “ethical.” Others expend their professional energies on subsidiary questions, or even trivialities. Here’s one example. The success of the Human Genome Project has raised the prospect of “genetic profiling”–assessing a person on the basis of his genetic predisposition to certain kinds of behavior or disease. Among bioethicists, the discussion has been about politics and employment law. How will we prevent employers from discriminating against applicants on the basis of their profile? How will medical insurance rates be fairly adjusted in light of this genetic knowledge? What are the implications for the “right to privacy”? THESE ARE INTERESTING QUESTIONS, perfect for op-ed page chitter chatter, and no doubt in time legislators and regulators will resolve them (probably without much useful participation from bioethicists). But they are not the important questions; they are not the questions that might point us toward restoring the moral narrative. Kass approaches the issue of genetic profiling entirely differently. He considers the purposes of the technology itself and its unforeseen consequences. He points to “the hazards and the deformations in living your life that will attach to knowing in advance your likely or possible medical future.” Is there sometimes a wisdom in not knowing certain things? The Greeks taught that “ignorance of one’s own future fate was indispensable to aspiration and achievement.” Further, how will genetic profiles alter the way in which we think about others, about what it means to be human? “One of the most worrisome aspects of the godlike power of the new genetics is its tendency to ‘redefine’ a person in terms of his genes,” Kass writes. “Once a person is decisively characterized by his genotype, it is but a short step to justifying death solely for genetic sins.” Anyone who doubts this should consider the widely popular practice of prenatal genetic screening, after which enormous pressure is brought upon parents to abort any child with a “defect” like Down Syndrome. What that first generation of bioethicists feared is already here. The questions Kass poses will strike most current bioethicists, and perhaps most of the rest of us too, as fussy and grandiose. They are certainly inconvenient; taken seriously, they might even stand in the way of “progress.” Research cloning, genetic therapies, and the rest of the biological revolution have led to a giddiness about the promise of technology and boundless human aspiration–a giddiness that today’s bioethicists actively encourage. Kass, in contrast, is a twenty-first century Jeremiah, trying to revive our appreciation for humility, mystery, and human finitude. He could not be more out of step with his times. His work, and this book especially, is a reminder of the original promise of bioethics. It is brave, wise, and doomed. Andrew Ferguson is a contributing editor to The Weekly Standard and a national-affairs columnist for Bloomberg News.
