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Life Liberty & the Defense of Dignity: The Challenge for Bioethics (Encounter Broadsides) Paperback – January 1, 2004
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From Publishers Weekly
For many people, the brave new world of biotechnology promises a utopian society where we will be free from diseases because of our manipulation of the genetic code. According to Kass, chairman of President Bush's Council on Bioethics, this vision of the future involves dehumanization, because the fundamental principles of cloning and stem cell research involve altering our human nature so dramatically that we are no longer human but posthuman. Fundamental to our human nature, Kass contends, is our human dignity, "our awareness of need, limitation, and mortality to craft a way of being that has engagement, depth, beauty, virtue, and meaning." Modern biology, he argues, has persuaded us that our embodiment is a fact of life to be overcome through germline manipulation or other biotechnological techniques. Through stimulating examinations of genetic research, cloning and active euthanasia, Kass makes a case that, in spite of its many promises, biotechnology has left humanity out of its equation, often debasing human dignity rather than celebrating it. In the end, he calls for a new bioethics and a new biology that will provide "an ethical account of human flourishing based on a biological account of human life as lived, not just physically, but psychically, socially and spiritually." Although some will object to Kass's importing the spiritual into the biological, his cry will strike others as a clarion call to protect human freedom from the excesses of biotechnology. Still others will be wary of his influence on the present administration.
Copyright 2002 Reed Business Information, Inc. --This text refers to the Hardcover edition.
From The New England Journal of Medicine
Leon Kass is the Addie Clark Harding Professor on the Committee on Social Thought at the University of Chicago and a founding fellow of the Hastings Center, the nation's first bioethics research center. Given these credentials, when Kass speaks, we should listen, particularly since August 2001, when President George W. Bush appointed him to chair the President's Council on Bioethics. It is not that one expects the administration to turn to this council for moral advice, but rather that Kass was chosen to vet its membership to ensure its compatibility with the President's political stands on the matters submitted to it -- most notably, on the propriety of stem-cell research. Thus, Kass's Life, Liberty and the Defense of Dignity is not merely another theoretical disquisition on bioethics but, rather, in my opinion, expresses the administration's likely positions on issues central to medicine and medical research. For that reason alone, it warrants close reading. What one discovers is disquieting. This is what Kass asserts about moral life in the United States and the role of science in its decay: It is hard to claim respect for human life in the laboratory in a society that does not respect human life in the womb. It is hard to talk about the meaning of sexuality and embodiment in a culture that treats sex increasingly as a sport and has trivialized gender, marriage, and procreation. It is hard to oppose federal funding of baby-making in a society that increasingly expects the federal government to satisfy all demands, that -- contrary to so much evidence of waste, incompetence, and corruption -- continues to believe that only Uncle Sam can do it. During the past few decades, we have heard claims of a right to health or health care, a right to education or employment, a right to privacy (embracing also a right to abort or to enjoy pornography, or to commit suicide or sodomy), a right to dance naked, a right to clean air, a right to be born, even a right not to have been born. In this atmosphere, we hear much about the ultimate rights claim, a "right to die." How persuasive are these allegations? The waste, incompetence, and corruption that brought us Enron, WorldCom, and Tyco occurred in the private, not the public, sector and arose from lack of government regulation. Right-to-lifers (professing reverence for life in the womb), not laboratory scientists, have assassinated physicians and health workers. Church officers, not federal officials or biologists, have covered up for pedophiles. Our society is imperfect, but most Americans are remarkably decent folks. Why, according to Kass, has the quality of moral life deteriorated to such an extent? His book traces the "dehumanization" to the very ideology of biologic science, not merely its techniques: 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 sciences not only fail to provide their own standards for human conduct; their findings cause us to doubt the truth and the ground of those standards we have held and, more or less, still tacitly hold. The challenge goes even further than the notorious case of evolution versus Biblical religion. Is there any elevated view of human life and goodness that is proof against the belief that man is just a collection of molecules, an accident on the stage of evolution? . . . Does not the scientific world view make us skeptical about the existence of any natural rights and therefore doubtful of the wisdom of those who've risked their all to defend them? If survival and pleasure are the only possible principles that nature does not seem to reject, does not all courage and devotion to honor look like folly? . . . We are quite frankly adrift without a compass. Can contemporary bioethics save us? Not a chance. Its theories, based on analytic philosophy, are "hyper-rational." The bioethicist Kass most admires is the late Paul Ramsey, professor of Christian ethics at Princeton, whose principles were based on religious faith. But to build on faith in a pluralistic society is to build on sand. As John Locke noted four centuries ago, "Every church is orthodox to itself; to others, erroneous or heretical." Kass's book dismisses the rationalists who disguise themselves as bioethicists in these woeful times of ours: "Expert" professors of ethics or bioethics are . . . unequal to these tasks. They are tasks, rather, for families and for communities of worship, where cultural practices enable the deepest insights of the mind to become embodied in the finest habits of the heart. Not for nothing does the Good Book say that the beginning of wisdom is the fear [awe, reverence] of the Lord. The theoretical and rationalistic approach to ethics has grave weaknesses. . . . Though originally intended to improve our deeds, the reigning practice of ethics, if truth be told, has, at best, improved our speech. Would that it had improved speech! Language is not neutral; words have connotations. Labeling stem-cell research "human cloning" summons images of scientific Frankensteins creating monsters. Call the process "nuclear transfer" (introduction of the nucleus of an adult somatic cell into an enucleated egg allowed to multiply for no more than 14 days), and the project will hardly raise an eyebrow. Label it "stem-cell research," recall that the 100,000 or more fertilized eggs now in a frozen limbo are slated for destruction, and compassion urges their use for research to combat degenerative diseases. Kass insists that he is not a Luddite. Notwithstanding his disavowal, what other than a Luddite should we call a man who would ban not only stem-cell research, but also reproductive medicine itself? He writes: even the benevolent uses of humanitarian technologies often have serious unintended and undesired consequences. . . . The ability to intervene technologically in the human body and mind brings vexing dilemmas, anxious fears and sorrowful consequences -- about abortion, genetic manipulation, organ transplantation, euthanasia, and use and abuse of drugs and worst of all . . . the conquest of nature for the relief of man's estate could lead to severe dehumanization -- in C.S. Lewis's words, to "the abolition of man." We learn to prevent all genetic disease, but only by turning procreation into manufacture. We have safe and shame-free sex, but little romance or lasting intimacy. We live much longer, but can't remember why we wanted to. Kass professes to "sympathize with the plight of infertile couples," but it is difficult to discern anything resembling sympathy in his moral fulminations about extracorporeal fertilization: Any honest biologist . . . must be inclined, at least on first glance, to the view that a human life begins at fertilization. . . . The most sensible policy is to treat the early embryo as a pre-viable fetus, with constraints imposed on early embryo research at least as great as those on fetal research. . . . The need for a respectable boundary defining protectable human life cannot be overstated. The current boundaries, gerrymandered for the sake of abortion -- namely, birth or viability -- may now satisfy both women's liberation and the United States Supreme Court and may someday satisfy even a future pope, but they will not survive the coming of more sophisticated technologies for growing life in the laboratory. "Gerrymandering" by the Supreme Court has reduced the rate of death from abortion by 90 percent during the past two decades. Human lives outside the womb are less important to this philosopher than the Court's lack of precision about the boundaries of viability. He goes on to lament in vitro fertilization: "What is the significance of divorcing human generation from human sexuality, precisely for the meaning of our bodily natures as male and female, as both gendered and engendering?" As much as a third of infertility, Kass tells us, results from tubal obstruction secondary to gonococcal pelvic inflammatory disease. This belief leads to a savage comment: leaving aside any question about whether it makes sense for a federally-funded baby to be the wage of aphrodisiac indiscretion, one can only look with wonder at a society that would have Petri dish babies before it has found a vaccine against gonorrhea. . . . Much as I sympathize with the plight of infertile couples, I do not believe they are entitled to the provision of a child at public expense, especially now, especially at this cost, especially by a procedure that involves also so many moral difficulties. Kass then adds, with disgust: "A few years ago an egalitarian Boston-based group concerned with infertility managed to obtain private funding to pay for artificial insemination for women on welfare!" If Life, Liberty and the Defense of Dignity were simply another jeremiad about the decline of morality, there would be little reason for concern; as a blueprint for federal policy, it is alarming. It is not accidental that "the pursuit of happiness" is not to be found in the book's title: Kass elevates suffering to a moral virtue. Where moral analysis is called for, he provides moral exhortation. We are given cant, not Kant. Leon Eisenberg, M.D.
Copyright © 2003 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS. --This text refers to the Hardcover edition.
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About half of this book deals with abstract, and half, concrete, issues. His abstract sections I was almost in total agreement with. Ethical philosophy, he writes, long ago lost track of how to deal with issues rather than theories, and real peoople rather than 'rational man' constructs. Minutia is argued on a quest to develop a consistent theory of the human right and good. BUT NO SUCH THEORY NEED TO BE CREATED! We are dealing with people who make most decisions on a hearty combination of feeling (not amenable to intellectualization) and rational thought. This is where Kass comes from.
Add to this that biology has gone on so well with the reductionist program that even it has started to lose track of how to deal with the whole person. Like wantling to understand a person-in-full by studying the small minutia of their lives seperately, event-by-event; you won't get the feel of the whole person that way; she must be studied as a whole person. Biology, by breaking us down to the smallest constituent parts, don't explain us, so much as break us down to the type of bite-sized chunks they find helpful in THEIR studies.
So Kass starts from the philosophy of the whole person. It is here that I feel he uses this more as an excuse to be inarticulate than a tool to REALLY examine the issue. Whether it is cloning, euthenasia, the selling of organs; he keeps taling about how our human dignity is threatened but never even attempts to explain what in the world he means.
He argues that our instinctual revulsion to such processes may reflect a deeper wisdom that intellect can't articulate. But didn't we also feel revulsion to the idea of heart transplants too? Many of us feel revulsed by the very idea of surgery (going under the knife and all). Does that mean that we are expressing a 'deeper wisdom' and should not have surgury at all? I think our revulsion to biotech comes more from the thought of the unknown and our desire to hold on to the "natural order of things".
Life, he tells us, is precious. Thus, we must be very careful with how we treat it. I agree. But why does it follow that we have to, then, leave birth up to the chance process that causes miscarriages, deformities, premature deaths, and...let's be honest...unwanted babies that may well grow up to abuse? And why does it follow that an old woman who is nearing a painful end to her life (with only a glimpse of hope for recovery) be made to live out her last days when she wants to end it?
To be sure, there are quite a few philosophers who are just as sensitive to human dignity as Kass is who take the opposite conclusions. John Lachs ("Community of Individuals", "Relevance of Philosophy to Life") and Sidney Hook ("Convictions") are two notable examples.
To close, though I agree with Kass's theoretical goals, I disagree on virually everything else. This book, though, is professionally writte, gives some (some, that is) strong points and never comes off as zeolous, abrasive, or mean-spirited toward critics. Read this - even if you don't agree with Kass.
One person who has done so is biologist and philosopher Leon Kass of the University of Chicago. He has spend a lifetime thinking about, and writing on, the new reproductive technologies and the challenges they present. And he has done so always with a view to the implications for human dignity and freedom. This volume, which includes articles which have appeared elsewhere, contains of wealth of information and ethical reflection on the new technologies.
All the major issues are covered here: cloning and stem cell research, IVF and assisted reproductive technologies, the new genetics, euthanasia and end of life decisions, and other recent developments in biotechnology.
Also carefully discussed are the hard questions: What is the moral status of the human embryo? Should there be limits to where we are heading in biology and technology? Are there areas of mystery in life that science should simply leave alone? Should autonomy, and the modern concept of human rights, trump other social and community concerns? What is the nature of medicine and what are its goals? These and other important ethical concerns are all given wise and careful consideration.
Kass examines the relationship between liberal democracies and the new technologies, for example, offering incisive and cautious reflection. He notes how democracies help create a climate which makes possible the growth of science and technology. But he also warns that without a moral vision of how that technology should proceed, there is the danger of commercial interests and utopian schemes derailing the science into undemocratic ends.
Indeed, since the time of the Enlightenment, an overly rationalist and utopian dream of the perfectibility of man has been pursued, often with disastrous consequences. Only by continually affirming the mystery and sacredness of life, and the dignity and wonder of man, can we prevent such coercive utopianism.
However, as Kass so clearly points out, the real threat is not coercive utopianism, but well-intentioned utopianism. That is, the real dangers come from those who speak of compassion, the relief of suffering and the battle for immortality. Says Kass, "the benevolent uses of humanitarian technologies often have serious unintended and undesired consequences." The promises of the relief of all suffering and the extension of life may sound pleasing to the ears, but can in fact bring bitterness to the soul.
Lost in the discussions of overcoming all problems and eradicating all unhealthiness, is the concept of the human person, of human dignity. To what end should we strive for immortality? What benefit will it be if we can live longer but not better lives? It is living well, not just living longer, that should preoccupy our minds and dreams. Yet the modern quest for perfection rarely addresses those more important concerns. Indeed, the modern rationalistic and secular march of science and technology often deliberately eschews any moral or religious considerations.
The whole problem of designer babies is another outcome of the new technologies. We now have the power to determine in advance how a baby can and should live. We not only have the power to change an individual's life through the new genetics, but generations to come. And with the new genetic medicine comes the power to decide who will live and who will die.
As we redefine a human being in terms of his or her genes, we run the risk of "justifying death solely for genetic sins". Genetic reductionism makes it easier, not harder, to allow experts and scientists to make the difficult choices of who is allowed to live. Eugenics, even if done with the best of intentions, is still eugenics. And the new eugenics is not so easily discerned, when it comes hidden behind a white lab coat or in an attractive fertility clinic.
The pressure of science and Big Biotech to simply do whatever can be done, without asking whether it should be done, will only continue. Especially when sold in the guise of relieving suffering, or offering more lifestyle choices. We have, as Kass says, the "biomedical equivalent of a spiraling arms race" where research and technology seem to know no limits. The consequences are frightening.
Kass concludes by acknowledging that he is not a Luddite, that there has been much good to come from the new technologies. But there is much to fear as well, especially if our scientific advances are not coupled with moral and spiritual growth. A perfect body, with a hole in the soul, may not be progress, but an unspeakable regress.
Which way the future unfolds is an open question at this point. The future in many ways is up to us. Do we allow a future with dignity and freedom, or do we passively accept the dehumanisation and depersonalisation that comes with unbridled scientific advance? The important warnings offered here need to be read and heeded, if we are to advance on the right course.