Summary

A groundbreaking new exploration of the promises and perils of biotechnology -- and the future of American society. Biotechnology offers exciting prospects for healing the sick and relieving suffering. But because our growing powers also enable alterations in the workings of the body and mind, they are becoming attractive to healthy people who would just like to look younger, perform better, feel happier, or become more "perfect." This landmark book -- the product of more than sixteen months of research and reflection by the members of the President's Council on Bioethics -- explores the profound ethical and social consequences of today's biotechnical revolution. Almost every week brings news of novel methods for screening genes and testing embryos, choosing the sex and modifying the behavior of children, enhancing athletic performance, slowing aging, blunting painful memories, brightening mood, and altering basic temperaments. But we must not neglect the fundamental question: Should we be turning to biotechnology to fulfill our deepest human desires? We want better children -- but not by turning procreation into manufacture or by altering their brains to gain them an edge over their peers. We want to perform better in the activities of life -- but not by becoming mere creatures of chemistry. We want longer lives -- but not at the cost of becoming so obsessed with our own longevity that we care little about future generations. We want to be happy -- but not by taking a drug that gives us happy feelings without the genuine loves, attachments, and achievements that are essential to true human flourishing. As we enjoy the benefits of biotechnology, members of the councilcontend, we need to hold fast to an account of the human being seen not in material or mechanistic or medical terms but in psychic, moral, and spiritual ones. By grasping the limits of our new powers, we can savor the fruits of the a

Members of the President's Council on Bioethics	p. xi
Foreword	p. xv
Preface	p. xix
Biotechnology and the Pursuit of Happiness	p. 1
The Golden Age: Enthusiasm and Concern	p. 4
The Case for Public Attention	p. 7
Defining the Topic	p. 10
Ends and Means	p. 11
The Limitations of the "Therapy vs. Enhancement" Distinction	p. 13
Beyond Natural Limits: Dreams of Perfection and Happiness	p. 17
Structure of the Inquiry: The Primacy of Human Aspirations	p. 20
Method and Spirit	p. 22
Endnotes	p. 25
Better Children	p. 27
Improving Native Powers: Genetic Knowledge and Technology	p. 30
An Overview	p. 30
Technical Possibilities	p. 32
Prenatal Diagnosis and Screening Out	p. 34
Genetic Engineering of Desired Traits ("Fixing Up")	p. 37
Selecting Embryos for Desired Traits ("Choosing In")	p. 40
Ethical Analysis	p. 44
Benefits	p. 46
Questions of Safety	p. 47
Questions of Equality	p. 51
Consequences for Families and Society	p. 53
Choosing Sex of Children	p. 57
Ends and Means	p. 59
Preliminary Ethical Analysis	p. 61
The Limits of Liberty	p. 66
The Meaning of Sexuality and Procreation	p. 68
Improving Children's Behavior: Psychotropic Drugs	p. 71
Behavior Modification in Children Using Stimulants	p. 74
What Are Stimulant Drugs?	p. 77
Behaviors Inviting Improvement Through Stimulant Drugs	p. 79
The "Universal Enhancer"	p. 83
Ethical and Social Concerns	p. 85
Safety First	p. 86
Rearing Children: The Human Context	p. 87
Social Control and Conformity	p. 88
Moral Education and Medicalization	p. 91
The Meaning of Performance	p. 92
Conclusion: The Meaning of Childhood	p. 94
Diagnostic Criteria for Attention-Deficit/Hyperactivity Disorder	p. 95
Endnotes	p. 98
Superior Performance	p. 101
The Meaning of "Superior Performance"	p. 102
Sport and the Superior Athlete	p. 106
Why Sport?	p. 106
The Superior Athlete	p. 107
Different Ways of Enhancing Performance	p. 108
Better Equipment	p. 109
Better Training	p. 110
Better Native Powers	p. 110
Muscle Enhancement Through Biotechnology	p. 111
Muscles and Their Meanings	p. 111
Muscle Cell Growth and Development	p. 113
Opportunities and Techniques for Muscle Enhancement	p. 115
Ethical Analysis	p. 123
How Is Biotechnical Enhancement Different?	p. 124
Fairness and Equality	p. 131
Coercion and Social Pressure	p. 135
Adverse Side Effects: Health, Balance, and the Whole of Life	p. 137
The Dignity of Human Activity	p. 140
The Meaning of Competition	p. 141
The Relationship Between Doer and Deed	p. 143
Acts of Humans, Human Acts: Harmony of Mind and Body	p. 145
Superior Performance and the Good Society	p. 151
Endnotes	p. 157
Ageless Bodies	p. 159
The Meaning of "Ageless Bodies"	p. 160
Basic Terms and Concepts	p. 163
Scientific Background	p. 168
Targeting Specific Deficiencies of Old Age	p. 168
Muscle Enhancement	p. 168
Memory Enhancement	p. 169
General (Body-Wide) Age-Retardation	p. 172
Caloric Restriction	p. 173
Genetic Manipulations	p. 174
Prevention of Oxidative Damage	p. 177
Methods of Treating the Ailments of the Aged That Might Affect Age-Retardation	p. 178
Hormone treatments	p. 178
Telomere research	p. 179
Ethical Issues	p. 181
Effects on the Individual	p. 183
Greater Freedom from Constraints of Time	p. 187
Commitment and Engagement	p. 187
Aspiration and Urgency	p. 188
Renewal and Children	p. 188
Attitudes Toward Death and Mortality	p. 190
The Meaning of the Life Cycle	p. 191
Effects on Society	p. 192
Generations and Families	p. 194
Innovation, Change, and Renewal	p. 195
The Aging of Society	p. 196
Conclusion	p. 197
Endnotes	p. 203
Happy Souls	p. 205
What Are "Happy Souls"?	p. 210
Memory and Happiness	p. 214
Good Memories and Bad	p. 218
Biotechnology and Memory Alteration	p. 221
Memory-Blunting: Ethical Analysis	p. 225
Remembering Fitly and Truly	p. 228
The Obligation to Remember	p. 230
Memory and Moral Responsibility	p. 232
The Soul of Memory, The Remembering Soul	p. 233
Mood and Happiness	p. 234
Mood-Improvement Through Drugs	p. 239
Mood-Brightening Agents: An Overview	p. 240
Biological and Experiential Effects of SSRIs	p. 243
Ethical Analysis	p. 251
Living Truly	p. 252
Fitting Sensibilities and Human Attachments	p. 255
What Sorrow Teaches, What Discontent Provokes	p. 258
Medicalization of Self-Understanding	p. 261
The Roots of Human Flourishing	p. 264
The Happy Self and the Good Society	p. 266
Conclusion	p. 268
Endnotes	p. 271
"Beyond Therapy": General Reflections	p. 275
The Big Picture	p. 275
Familiar Sources of Concern	p. 279
Health: Issues of Safety and Bodily Harm	p. 279
Unfairness	p. 280
Equality of Access	p. 281
Liberty: Issues of Freedom and Coercion, Overt and Subtle	p. 283
Essential Sources of Concern	p. 286
Hubris or Humility: Respect for "the Given"	p. 287
"Unnatural" Means: The Dignity of Human Activity	p. 290
Identity and Individuality	p. 293
Partial Ends, Full Flourishing	p. 295
Biotechnology and American Society	p. 301
Commerce, Regulation, and the Manufacture of Desire	p. 303
Medicine, Medicalization, and a Stance "Beyond Therapy"	p. 305
Biotechnology and American Ideals	p. 308
Endnotes	p. 311
Bibliography	p. 313
Council Staff and Consultants	p. 329
Table of Contents provided by Ingram. All Rights Reserved.

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Excerpts

Beyond Therapy
Biotechnology and the Pursuit of Happiness

Chapter One

Biotechnology and the Pursuit of Happiness: An Introduction

What is biotechnology for? Why is it developed, used, and esteemed? toward what ends is it taking us? To raise such questions will very likely strike the reader as strange, for the answers seem so obvious: to feed the hungry, to cure the sick, to relieve the suffering -- in a word, to improve the lot of humankind, or, in the memorable words of Francis Bacon, "to relieve man's estate." Stated in such general terms, the obvious answers are of course correct. But they do not tell the whole story, and, when carefully considered, they give rise to some challenging questions, questions that compel us to ask in earnest not only, "What is biotechnology for?" but also, "What should it be for?"

Before reaching these questions, we had better specify what we mean by "biotechnology," for it is a new word for our new age. Though others have given it both narrow and broad definitions,* our purpose-for reasons that will become clear -- recommends that we work with a very broad meaning: the processes and products (usually of industrial scale) offering the potential to alter and, to a degree, to control the phenomena of life-in plants, in (non-human) animals, and, increasingly, in human beings (the last, our exclusive focus here). Overarching the processes and products it brings forth, biotechnology is also a conceptual and ethical outlook, informed by progressive aspirations. In this sense, it appears as a most recent and vibrant expression of the technological spirit, a desire and disposition rationally to understand, order, predict, and (ultimately) control the events and workings of nature, all pursued for the sake of human benefit.

Thus understood, biotechnology is bigger than its processes and products; it is a form of human empowerment. By means of its techniques (for example, recombining genes), instruments (for example, DNA sequencers), and products (for example, new drugs or vaccines), biotechnology empowers us human beings to assume greater control over our lives, diminishing our subjection to disease and misfortune, chance and necessity. The techniques, instruments, and products of biotechnology -- like similar technological fruit produced in other technological areasaugment our capacities to act or perform effectively, for many different purposes. just as the automobile is an instrument that confers enhanced powers of "auto-mobility' (of moving oneself), which powers can then be used for innumerable purposes not defined by the machine itself, so DNA sequencing is a technique that confers powers for genetic screening that can be used for various purposes not determined by the technique; and synthetic growth hormone is a product that confers powers to try to increase height in the short or to augment muscle strength in the old. If we are to understand what biotechnology is for, we shall need to keep our eye more on the new abilities it provides than on the technical instruments and products that make the abilities available to us!

This terminological discussion exposes the first complication regarding the purposes of biotechnology: the fact that means and ends are readily detached from one another. As with all techniques and the powers they place in human hands, the techniques and powers of biotechnology enjoy considerable independence from ties to narrow or specific goals. Biotechnology, like any other technology, is not for anything in particular. Like any other technology, the goals it serves are supplied neither by the techniques themselves nor by the powers they make available, but by their human users. Like any other means, a given biotechnology once developed to serve one purpose is frequently available to serve multiple purposes, including some that were not imagined or even imaginable by those who brought the means into being.

Second, there are several questions regarding the overall goal of biotechnology: improving the lot of humankind. What exactly is it about the lot of humankind that needs or invites improvement? Should we think only of specific, as-yet-untreatable diseases that compromise our well-being, such ailments as juvenile diabetes, cancer, or Alzheimer disease? Should we not also include mental illnesses and infirmities, from retardation to major depression, from memory loss to melancholy, from sexual incontinence to self-contempt? And should we consider in addition those more deep-rooted limitations built into our nature, whether of body or mind, including the harsh facts of decline, decay, and death? What exactly is it about "man's estate" that most calls for relief? just sickness and suffering, or also such things as nastiness, folly, and despair? Must "improvement" be limited to eliminating these and other evils, or should it also encompass augmenting our share of positive goods-beauty, strength, memory, intelligence, longevity, or happiness itself?

Third, even assuming that we could agree on which aspects of the human condition call for improvement, we would still face difficulties deciding how to judge whether our attempts at improving them really made things better-both for the individuals and for the society. Some of the goals we seek might conflict with each other: longer life might come at the price of less energy; superior performance for some might diminish self-esteem for others. Efforts to moderate human aggression might wind up sapping ambition; interventions aimed at quieting discontent might flatten aspiration. And, unintended consequences aside, it is not easy to say just how much less aggression or discontent would be good for us. Once we go beyond the treatment of disease and the pursuit of health, there seem to be no ready-made or reliable standards of better and worse available to guide our choices.

As this report will demonstrate, these are not idle or merely academic concerns. Indeed, some are already upon us. We now have techniques to test early human embryos for the presence or absence of many genes: shall we use these techniques only to prevent disease or also to try to get us "better" children? We are acquiring techniques for boosting muscle strength and performance: shall we use them only to treat muscular dystrophy and the weak muscles of the elderly ...

Beyond Therapy
Biotechnology and the Pursuit of Happiness. Copyright © by Leon Kass. Reprinted by permission of HarperCollins Publishers, Inc. All rights reserved. Available now wherever books are sold.

Excerpted from Beyond Therapy: Biotechnology and the Pursuit of Happiness by Leon Kass
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