Leading a Worthy Life

Finding Meaning in Modern Times

Leon R. Kass

• Publisher: Encounter Books
• Year: 2017
• ISBN:
  9781594039423
• Topic: Philosophy
• Subtopic: Ethics & Moral Philosophy

Most American young people, like their ancestors, harbor desires for a worthy life: a life of meaning, a life that makes sense. But they are increasingly confused about what such a life might look like, and how they might, in the present age, be able to live one. With a once confident culture no longer offering authoritative guidance, the young are now at sea—regarding work, family, religion, and civic identity. The true, the good, and the beautiful have few defenders, and the higher cynicism mocks any innocent love of wisdom or love of country. We are super-competent regarding efficiency and convenience; we are at a loss regarding what it's all for. Yet because the old orthodoxies have crumbled, our "interesting time" paradoxically offers genuine opportunities for renewal and growth. The old Socratic question, "How to live?", suddenly commands serious attention. Young Americans, if liberated from the prevailing cynicism, will readily embrace weighty questions and undertake serious quests for a flourishing life. All they (and we) need is encouragement.This book provides that necessary encouragement by illuminating crucial (and still available) aspects of a worthy life, and by defending them against their enemies. With chapters on love, family, and friendship; human excellence and human dignity; teaching, learning, and truth; and the great human aspirations of Western civilization, it offers people who are looking on their own for meaning, and as well as to people who are looking to deepen what they have been taught or to square it with the spirit of our time.

II · Human Excellence and Human Dignity

Real and Distorted

CHAPTER SIX

Ageless Bodies, Happy Souls

Biotechnology and the Pursuit of Happiness

WE LIVE NEAR the beginning of a golden age of biomedical science and technology. For the most part, we should be mightily glad that we do, as we and our friends and loved ones are many times over the beneficiaries of its cures for diseases, prolongation of life, and amelioration of suffering, psychic and somatic. Since the latter third of the last century, most people in technologically advanced countries have been living healthier and longer lives than even the most fortunate individuals in prior human history. Diphtheria, typhoid, and tuberculosis threaten us no longer. While there is no definitive cure for deadly cancers, half the people who are today treated for those cancers survive more than five years. The average American’s life expectancy at birth has increased from forty-seven years in 1900 to seventy-eight in 2000, and millions are now living healthily into their eighties and nineties. Thanks to basic research in neuroscience and new psychotropic drugs, the scourge of major depression and other devastating mental illnesses is finally under effective attack. We have every reason to look forward to new discoveries and new medical blessings. Every one of us should be deeply grateful for the gifts of human ingenuity and for the devoted efforts of scientists, physicians, and entrepreneurs who have used these gifts to make those benefits possible.

Yet, notwithstanding these blessings, present and projected, we have also seen more than enough to make us concerned. For we recognize that the powers made possible by biomedical science can be used for nontherapeutic purposes, serving ends that range from the frivolous and disquieting to the offensive and pernicious. These powers are available as instruments of bioterrorism (for example, genetically engineered drug-resistant bacteria, or drugs that obliterate memory); as agents of social control (for example, drugs to tame rowdies and dissenters, or fertility blockers for welfare recipients); and as means of trying to improve or perfect our bodies and minds and those of our children (for example, genetically engineered supermuscles, or drugs to improve memory). Anticipating possible threats to our security, freedom, and even our very humanity, many people are increasingly worried about where biotechnology may be taking us.

In this chapter I want to discuss only the last and most seductive of these disquieting prospects: the use of biotechnical powers to pursue “perfection,” both of body and of mind. I do so partly because it is the most neglected topic in public bioethics, yet it is, I believe, the deepest source of public anxiety, represented in the concern about “man playing God,” or about a Brave New World or a “posthuman” future. It raises weighty questions about the ends and goals of the biomedical enterprise, about the nature and meaning of human flourishing, and about the intrinsic threat of dehumanization (or the vaunted promise of superhumanization). It compels attention to what it means to be a human being and to be active as a human being. And it gets us beyond our narrow preoccupation with the “life issues” of abortion or embryo destruction, important though they are, to deal with what is genuinely novel in the biotechnical revolution, exciting to some but worrisome to many: not the old, crude power to kill the creature made in God’s image, but the science-based, sophisticated powers to remake him after our own imaginings.

What exactly are the powers that I am talking about? What sorts of ends are they likely to serve? They are powers that affect the capacities and activities of the human body, powers that affect the capacities and activities of the mind or soul, and powers that affect the shape of the human life cycle, at both ends and in between. We already have powers to prevent fertility and to promote it; to initiate life in the laboratory; to screen human genes, in adults and in embryos, and to select (or reject) nascent life on genetic criteria; to insert new genes into various parts of the adult body, and someday soon also into gametes and embryos; to enhance muscle performance and endurance; to replace body parts with natural or mechanical organs, and perhaps soon, to wire ourselves using computer chips implanted into the body and brain; to alter memory, mood, temperament, appetite, and attention through psychoactive drugs; and to prolong not just the average but also the maximum human life expectancy. The technologies for altering our native capacities are mainly those of genetic screening and genetic engineering; drugs, especially psychoactive ones; and the ability to replace body parts or to insert novel ones. Some of these techniques have been demonstrated only with animals, but others are already being used in humans.

It bears emphasis that these powers, at least for now, are not being developed for the purpose of producing perfect or posthuman beings. They have been produced largely for the purpose of preventing and curing disease, and of reversing disabilities. Even the bizarre prospect of machine-brain interaction and implanted nanotechnological devices starts with therapeutic efforts to enable the blind to see and the deaf to hear. Yet the “dual use” aspect of most of these powers, encouraged by the ineradicable human urge toward “improvement” and the commercial interests that see market opportunities for nontherapeutic uses, means that we must not be lulled to sleep by the fact that the originators of these powers were no friends to Brave New World. Once here, techniques and powers can produce desires where none existed before, and things often go where no one ever intended.

How to organize our reflections? One should resist the temptation to begin with the new techniques or even with the capacities for intervention that they make possible. To do so runs the risk of losing the human import and significance of the undertakings. Better to begin with the human desires and goals that these powers and techniques are destined to serve: better children, superior performance, ageless bodies, happy souls, a more peaceful and cooperative society, etc.* Here I will leave aside the pursuit of optimum children or superior performance (the subject of Chapter Eight) or better citizens, to concentrate on the strictly personal goals of self-improvement, on efforts to preserve and augment the vitality of the body and to enhance the happiness of the soul. These goals are, arguably, the least controversial, the most continuous with the aims of modern medicine and psychiatry (better health, peace of mind), and the most attractive to most potential consumers – indeed, probably to most of us. It is perhaps worth remembering that these were the goals that animated the great founders of modern science, Bacon and Descartes: flawlessly healthy bodies, unconflicted and contented souls, and freedom from the infirmities of age, perhaps indefinitely.

Here are some of the technological innovations that can serve these purposes in varying degrees. With respect to the pursuit of “ageless bodies”: We can replace worn-out parts by means of mechanical devices and organ transplantation, or, in the future, through regenerative medicine where decayed tissues are replaced with new ones produced from stem cells. We can improve upon normal and healthy parts, for example via precise genetic modification of muscles, through injections of growth factor genes that keep the transformed muscles whole, vigorous, and free of age-related decline – powers already used to produce “mighty mouse” and “super rat,” and soon to be available for treatment of muscular dystrophy and muscle weakness in the elderly but also of interest to football and wrestling coaches and to the hordes of people who spend two hours daily pumping iron and sculpting their bodies. Most radically, we can try to retard or stop the entire process of biological senescence. Recent discoveries in the genetics of aging have shown how the maximum life span of worms and flies can be increased two- or threefold by alterations in a single gene, a gene now known to be present also in mammals.

With respect to the pursuit of “happy souls”: We can eliminate psychic distress; we can produce states of transient euphoria; and we can engineer more permanent conditions of good cheer, optimism, self-esteem, and contentment. Drugs now available, administered promptly at the time of memory formation, blunt markedly the painful emotional content of the newly formed memories of traumatic events (so-called “memory blunting or erasure,” a remedy being sought to prevent post-traumatic stress disorder). Simple euphoriants like Ecstasy, a precursor of Aldous Huxley’s “soma,” are widely used on college campuses. Powerful antidepressants and mood brighteners like Prozac are wonderful for the treatment of major depression, but also capable in some people of utterly transforming their personalities, changing their outlook on life from that of Eeyore to that of Mary Poppins.

Problems of Description: Therapy or Enhancement?

People who have tried to address our topic have usually approached it through a distinction between “therapy” and “enhancement,” the first being the treatment of individuals with known diseases or disabilities, and the second being the directed use of biotechnical power to improve upon the “normal” workings of the human body and psyche. Those who introduced this distinction hoped by this means to distinguish between the acceptable and the dubious or unacceptable uses of biomedical technology: therapy is always ethically fine, while enhancement is, at least prima facie, ethically suspect. Gene therapy for cystic fibrosis or Prozac for psychotic depression is fine; insertion of genes to enhance intelligence or steroids for Olympic athletes is not.

This distinction is useful as a point of departure – restoring to normal does appear to differ from going beyond the normal. But it proves finally inadequate to the moral analysis. Enhancement is, even as a term, highly problematic. Does it mean “more” or “better,” and if “better,” by what standards? Can improved memory and selective erasure of memory both be enhancements? If “enhancement” is defined in opposition to “therapy,” one faces further difficulties with the definitions of “healthy” and “impaired,” “normal” and “abnormal” (including “supernormal”), especially in the area of “behavioral” or “psychic” functions and activities. Some psychiatric diagnoses are notoriously vague and their boundaries indistinct: how does “social anxiety disorder” differ from shyness, “hyperactivity disorder” from spiritedness, “oppositional disorder” from the love of independence? Furthermore, in the many human qualities that distribute themselves “normally,” such as height or IQ, does the average also function as a norm, or is the norm itself appropriately subject to alteration? Is it therapy to give growth hormone to a genetic dwarf but not to an equally short fellow who is just unhappy to be short? And if the short are brought up to the average, the average, now having become short, will have precedent for a claim to growth hormone injections.

Needless arguments about whether something is or is not an “enhancement” get in the way of the proper question: What are the good and bad uses of biotechnical power? What makes a use “good,” or even just “acceptable”? The fact that a drug is being taken solely to satisfy one’s desires does not by itself make its use objectionable; consider alcohol consumption as the test case. Conversely, certain interventions to restore natural functioning wholeness – for example, to enable postmenopausal women to bear children or sixty-year-old men to keep playing professional ice hockey – might well be dubious uses of biotechnical power. The moral meaning and assessment of the intervention are unlikely to be settled by the term “enhancement” any more than by the nature of the technique used.

This last observation points to the deepest reason why the distinction between healing and enhancing is insufficient, both in theory and in practice. For the human whole whose healing is sought or accomplished by biomedical therapy is finite and frail, medicine or no medicine. The healthy body declines and its parts wear out. The sound mind slows down and has trouble remembering things. The soul has aspirations beyond what even a healthy body can realize, and it becomes weary from frustration. Even at its fittest, the fatigable and limited human body rarely carries out flawlessly even the ordinary desires of the soul. Moreover, there is wide variation in the natural gifts with which each of us is endowed: some are born with perfect pitch, others are born tone-deaf; some have flypaper memories, others forget immediately what they have just learned. And as with talents, so too with desires and temperaments: some crave immortal fame, others merely comfortable preservation; some are sanguine, others phlegmatic, still others bilious or melancholic. When nature deals her cards, some receive only from the bottom of the deck. But it is often the most gifted and ambitious who most resent their limitations: Achilles was willing to destroy everything around him, so little could he stomach that he was but a heel short of immortality.

Because of these infirmities and shortcomings, human beings have long dreamed of overcoming limitations of body and soul, in particular those imposed by bodily decay, psychic distress, and the frustration of human aspiration. Until now these dreams have been pure fantasies, and those who pursued them came crashing down in disaster.† But the stupendous successes over the past century in all areas of technology, and especially in medicine, have revived the ancient dreams of human perfection. Like Achilles, we beneficiaries of modern medicine regard our remaining limitations with less equanimity, to the point that dreams of getting rid of them can be turned into a moral imperative. Thanks to biomedical technology, people will increasingly be tempted to realize these dreams, at least to some extent: ageless and ever-vigorous bodies, happy (or at least not unhappy) souls, and excellent human achievement (with diminished effort or toil).

Why should anyone be worried about these prospects? What could be wrong with efforts to improve upon human nature, to gain ageless bodies and happy souls with the help of biomedical technology? I begin with some familiar sources of concern.

Common Concerns about Biotechnological “Improvement”

Not surprisingly, the objections usually raised to “beyond therapy” uses of biomedical technologies reflect the dominant values of modern America: health, equality, and liberty.

1. Health – issues of safety and bodily harm. In our health-obsessed culture, the first reason given to worry about any new biological intervention is safety. Athletes who take steroids will later suffer premature heart disease. College students who take Ecstasy will damage dopamine receptors in their basal ganglia and suffer early Parkinson’s disease. To generalize, no biological agent used for purposes of self-perfection will be entirely safe. This is good conservative medical sense: anything powerful enough to enhance system A is likely to be powerful enough to harm system B. Yet many good things in life are filled with risks, and free people if properly informed may choose to run those risks if they care enough about what is to be gained thereby. If the interventions are shown to be highly dangerous, many people will (later if not sooner) avoid them, and the FDA and/or tort liability will constrain many a legitimate purveyor.

As an ethical matter, it surely makes sense that one should not risk basic health by pursuing a condition of “better than well.”‡ On the other hand, if the interventions work well and are indeed highly desired, people may freely accept even considerable risk of later bodily harm as a trade-off. But in any case, the big issues have nothing to do with safety; the real questions concern what to think about the perfected powers, assuming that they may be safely used.

2. Equality – issues of unfairness and distributive justice. An obvious objection to the use of personal enhancers by participants in competitive activities – such as blood doping or steroids for athletes, or stimulants for students taking the SAT – is that they give those who use them an unfair advantage. But even if everyone had equal access to brain implants or genetic improvement of muscle strength or mind-enhancing drugs, a deeper concern would remain. Were steroid use by athletes to be legalized, most athletes would still be ashamed to be seen injecting themselves before coming up to bat. Besides, not all activities of life are competitive: it would matter to me if she says she loves me only because she is high on “erotogenin,” a future brain stimulant that mimics perfectly the feeling of falling in love. It matters to me when I go to a seminar that the people with whom I am conversing are not drugged out of their right minds.

The distributive justice question is less easily set aside than the unfairness question, especially if there are systematic disparities between who will and who will not have access to the powers of biotechnical “i...

Table of contents

• Cover
• Title Page
• Contents
• Dedication
• Introduction
• I · Love, Family, and Friendship: Some Reflections on Modern Culture
• II · Human Excellence and Human Dignity: Real and Distorted
• III · In Search of Wisdom: Learning, Teaching, and Truth
• IV · The Aspirations of Humankind: Athens, Jerusalem, Gettysburg
• Acknowledgments
• Notes
• Index
• Copyright