Toward a More Natural Science

Leon R. Kass

• Publisher: Free Press
• Year: 2008
• ISBN:
  9781439105689
• Topic: Philosophy
• Subtopic: Philosophy History & Theory

Kass shows how the promise and the peril of our time are inextricably linked with the promise and the peril of modern science. The relation between the pursuit of knowledge and the conduct of life—between science and ethics, each broadly conceived—has in recent years been greatly complicated by developments in the science of life. This book examines the ethical questions involved in prenatal screening, in vitro fertilization, artificial life forms, and medical care, and discusses the role of human beings in nature.

PART I

Eroding the Limits
Troubles with the Mastery of Nature

CHAPTER ONE

The New Biology
What Price Relieving Man’s Estate?

Science bestowed immense new powers on man and at the same time created conditions which were largely beyond his control. While he nursed the illusion of growing mastery and exulted in his new trappings he became the sport and presently the victim of tides and currents, whirlpools and tornadoes, amid which he was far more helpless than he had been for a long time.

—Winston Churchill

May you live in interesting times.

—Ancient Chinese curse

Recent advances in biology and medicine suggest that we may be rapidly acquiring the power to modify and control the capacities and activities of men by direct intervention and manipulation of their bodies and minds. Certain means are already in use or at hand, others await the solution of relatively minor technical problems, while yet others, those offering perhaps the most precise kind of control, depend upon further basic research. Biologists who have considered these matters disagree on the question of how much how soon, but all agree that the power for “human engineering,” to borrow from the jargon, is coming and that it will probably have profound social consequences.

These developments have been viewed both with enthusiasm and with alarm, but only recently have they started to receive serious attention. Several biologists have undertaken to inform the public about the technical possibilities, present and future. Practitioners of social science “futurology” have begun to predict and describe the likely social consequences of and public responses to the new technologies. New institutions, public and private, have been established to assess the new technologies. All of these activities are based upon the hope that we can harness the new technology of man for the betterment of mankind.

Yet this commendable aspiration points to another set of questions that are in my view sorely neglected—questions that inquire into the meaning of such phrases as the “betterment of mankind.” A full understanding of the new technology of man requires an exploration of ends, principles, and standards. What ends will or should the new techniques serve? What principles should guide society’s adjustments? By what standards of better and worse should the assessment agencies assess? Behind these questions are others: what is a good man; what is a good life for man; what is a good community?

While these questions about ends and ultimate ends are never unimportant or irrelevant, they have rarely been more important or more relevant than they are now. That this is so can be seen once we recognize that we are here dealing with a group of technologies that are in a decisive respect unique in that the object upon which they operate is man himself. The technologies of energy or food production, of communication, of manufacture, and of motion greatly alter the implements available to man and the conditions under which he uses them. In contrast, the biomedical technology works to change the user himself. To be sure, the printing press, the automobile, the television, and the jet airplane have greatly altered the conditions under and the way in which men live, but men as biological beings have remained largely unchanged. They have been and remain able to accept or reject, to use and abuse these technologies; they choose, whether wisely or foolishly, the ends to which these technologies are means. Biomedical technology may make it possible to change the inherent capacity for choice itself. Indeed, both those who welcome and those who fear the advent of human engineering ground their hopes and fears in the same prospect, that man can, for the first time, re-create himself.

Engineering the engineer seems to differ in kind from engineering his engine. Some have argued, however, that biomedical engineering does not differ qualitatively from toilet training, education, government, law, and moral teachings—all of which are forms of so-called social engineering with man as their object, used by one generation to mold the next. In reply, it must at least be said that the techniques that have hitherto been employed are feeble and inefficient when compared to those on the horizon. This quantitative difference rests in part on a qualitative difference in the means of intervention. The traditional influences operate by speech or by symbolic deeds. They pay tribute to man as the animal who lives by speech and who understands the meanings of actions. Also, their effects are, in general, reversible, or at least subject to attempts at reversal. Each person has greater or lesser power to accept or reject or abandon them. Biomedical engineering, on the other hand, circumvents the human context of speech and meaning, bypasses choice, and goes directly to work to modify the human material itself, and the changes wrought may be irreversible.

There is also an important practical reason for considering biomedical technology apart from the other technologies. The advances we shall examine are fruits of a large, humane project dedicated to the conquest of disease and the relief of human suffering. The biologist and physician, regardless of their private motives, are seen with justification to be the well-wishers and benefactors of mankind. Thus, in a time in which technological advance is more carefully scrutinized and increasingly criticized, biomedical developments are still viewed largely as benefits without qualification. The price we pay for these developments is thus more likely to go unrecognized. For this reason, I shall consider only the dangers and costs of biomedical advance. As the benefits are well known, there is no need to dwell upon them here. My discussion is, in this regard, deliberately partial.

Yet it is, in another sense, also comprehensive. Though we are compelled in practice to consider the implications of each technological innovation as it arises—and I myself do so in the next four chapters—we can understand its full human significance only if we attend also to the whole biomedical project of which it is a part. In this opening chapter I seek such a synoptic view. I begin with a survey of the pertinent technologies. Next, I consider some of the basic ethical and social problems in the use of these technologies. Then, I briefly raise some fundamental questions to which these problems point. Finally, I offer some very general reflections on what is to be done.

The Biomedical Technologies

Biomedical technologies can be usefully organized into three groups according to their major purpose: (1) control of death and life; (2) control of human potentialities; and (3) control of human achievement. The corresponding technologies are: medicine, or those parts of medicine engaged in prolonging life and controlling reproduction; genetic engineering; and neurological and psychological manipulation. I shall briefly summarize each group of techniques.

Control of Death and Life

Previous medical and public health triumphs have greatly increased man’s average life expectancy. Yet other developments, such as organ transplantation or replacement and research into aging, hold forth the promise of increasing not just the average but also the maximum life expectancy. Indeed, medicine seems to be sharpening its tools to do battle with death itself, treating death as if it were just one more disease.

More immediately and concretely, available techniques of life prolongation—respirators, cardiac pacemakers, artificial kidneys—are already in use in the fight against death—though, ironically, the success of these devices has introduced confusion in determining when death has indeed occurred. The traditional signs of life—heartbeat and respiration—can now be maintained entirely by machines. As a result, most physicians have adopted so-called new definitions of death, although others more radically maintain that the technical advances have shown that death is not a concrete event at all, but rather a gradual process—like twilight—incapable of precise temporal localization.¹

The real challenge to death will come from research into aging and senescence, a field just entering its own puberty. Recent studies suggest that aging is a manipulable process, distinct from disease, under biological control but alterable by diet or drugs. Extrapolating from animal studies, some scientists have suggested that a decrease in the rate of aging might also be achieved simply by effecting a very small decrease in human body temperature. According to some optimistic estimates, it may soon be technically possible to add from twenty to forty extra years to the human life span.¹

Medicine’s success in extending life is already a major cause of excessive population growth: death control points to birth control. Although we are already technically competent, new techniques for lowering fertility and chemical agents for inducing abortion will greatly enhance our powers over conception and gestation. But problems of definition have been raised here as well. The need to determine when individuals acquire enforceable legal rights gives society an interest in the definition of human life and the time when it begins. These matters are too familiar to need elaboration.

Technologies to conquer infertility proceed alongside those to promote it. The first successful laboratory fertilization of a human egg by human sperm was reported in 1969,² and by a year later human embryos could be grown in vitro up to at least the blastocyst stage (that is, to the age of one week).³ In 1978, after many failures, such a laboratory-grown embryo was successfully reimplanted into a woman previously infertile because of oviduct disease, and the first “test-tube baby” was born, an achievement now repeated many times in many places.

Work continues on techniques to support and sustain embryonic and fetal growth in artificial environments. The development of an artificial placenta, now under investigation, will make possible full laboratory control of fertilization and gestation. In addition, sophisticated biochemical and cytological techniques for monitoring the “quality” of the fetus have been developed and are being used.² These developments not only give us more power over the generation of human life, they also make it possible to manipulate and modify the quality of the human material.

Control of Human Potentialities

Genetic engineering, when fully developed, will wield two powers not shared by ordinary medical practice. Medicine treats existing individuals and seeks to correct deviations from a norm of health. Genetic engineering, in contrast, will be able to make changes that are transmittable into succeeding generations and may be able to create new capacities and, hence, new norms of health and fitness.

For now, however, the primary interest in human genetic manipulation remains strictly medical: to develop treatments for individuals with inherited diseases. Genetic disease is prevalent and increasing, thanks partly to medical advances that have enabled those affected to survive and perpetuate their mutant genes. The hope is that normal copies of the appropriate gene, obtained biologically or synthesized chemically, can be introduced into defective individuals to correct their deficiencies. While this therapeutic use of genetic technology is still probably some years away, astounding progress has been made in the past decade in sequencing, synthesizing, and transferring genetic material—thanks to new techniques for DNA recombination (or genesplicing). Yet, there is some doubt that gene therapy will ever be practical because of difficulties in delivering the therapeutic gene precisely and specifically to the desired bodily target and because the same end might be more easily achieved by simply transplanting cells or organs that could compensate for the missing or defective gene product.

Far less remote are technologies that could serve eugenic ends. Their development has been endorsed by those concerned about a general deterioration of the human gene pool and by others who believe that even an undeteriorated human gene pool needs upgrading. Artificial insemination with selected donors, the eugenic proposal of Herman Muller,⁴ has been possible for several years due to the perfection of methods for long-term storage of human spermatozoa. At least one commercial sperm bank (in California) now overtly boasts a eugenic intention, offering interested women the semen of several Nobel Laureates and other high achievers. The successful maturation of human oocytes in the laboratory and their subsequent fertilization now make it possible to select donors of ova as well. But a far more suitable technique for eugenic purposes may soon be upon us: nuclear transplantation, or cloning.

Bypassing the lottery of sexual recombination, nuclear transplantation permits the asexual reproduction or copying of an already developed individual. The nucleus of a mature but unfertilized egg is replaced by a nucleus obtained from a specialized cell of an adult organism or embryo (e.g., an intestinal cell, a skin cell). The egg, with its transplanted nucleus, develops as if it had been fertilized and, barring complications, may give rise to a normal adult organism. Since almost all the hereditary material (DNA) of a cell is contained within its nucleus, the renucleated egg and the individual into which it develops are genetically identical to the adult organism that was the source of the donor nucleus. Cloning could be used to produce sets of unlimited numbers of genetically identical individuals, each set derived from a single parent. Cloning has been successful in amphibians and is now being tried in mice; its extension to man merely requires the solution of certain technical problems.³

Production of man-animal chimeras by the introduction of selected nonhuman material into developing human embryos is also expected. Fusion of human and nonhuman cells in tissue culture has already been achieved. The scientific grapevine also reports attempts (thus far unsuccessful), using artificial fertilization, to cross human egg or sperm with sperm or egg of other primates.

Other, less direct means for influencing the gene pool are already available, thanks to our increasing ability to identify and diagnose genetic diseases. Genetic counselors can now detect biochemically and cytologically a variety of severe genetic defects (e.g., Down’s syndrome, Tay-Sachs disease) while the individual is still a fetus in utero. Since treatments are at present largely unavailable, diagnosis is often followed by abortion of the affected fetus. With some diseases, more sensitive tests will also permit the detection of heterozygotes (i.e., unaffected individuals who carry a single dose of a given deleterious gene). The eradication of a given genetic disease might then be attempted by aborting all such carriers. In fact, it has been suggested that cystic fibrosis, a fairly common genetic disease, could be completely eliminated over the next forty years by screening all pregnancies and aborting the 17 million unaffected fetuses that will carry a single gene for this disease. Such zealots need to be reminded of the consequences should each geneticist be allowed an equal assault on his favorite genetic disorder, given that each human being is a carrier for some four to eight such recessive lethal genetic diseases.

Control of Human Achievement

Although human achievement depends at least in part upon genetic endowment, heredity determines only the material upon which experience and education impose the form. The limits of many capacities and powers of an individual are indeed genetically determined, but the nurturing and perfection of these capacities depends upon other influences. Neurological and psychological manipulation hold forth the promise of controlling the development of human capacities—in particular, those long considered most distinctively human: speech, thought, choice, desire, emotion, memory, and imagination.

These techniques are in a rather primitive state at present because we understand little about the brain and mind. Nevertheless, we have already seen the use of electrical stimulation of the human brain to produce sensations of intense pleasure and to control rage, the use of brain surgery (e.g., frontal lobotomy) for the relief of severe anxiety, and the use of aversive conditioning with electric shock to treat sexual perversion. Operant-conditioning techniques are widely used, apparently with success, in schools and mental hospitals. The use of so-called consciousness-expanding, euphoriant, and hallucinogenic drugs is widespread, to say nothing of tranquilizers and stimulants. We are promised drugs to modify memory, intelligence, libido, and aggressiveness.

From its inception, modern science has been especially interested in finding reliable biological means—means more effective than exhortation or praise and blame—to attain the ends of sensible, decent human conduct and peace of mind. Insisting on the mind’s acute “dependence on the temperament and disposition of the bodily organs,” René Descartes projected a new medicine, based upon what one might call “psychophysics,” that would render mankind more prudent and capable than ever before. This dream—or nightmare—may soon come true, as the following passages from a book by neurophysiologist José Delgado—a book instructively entitled Physical Control of the Mind: Toward a Psychocivilized Society—make evident. In the early 1950s, it was discovered that with electrodes placed in certain discrete regions of their brains, animals would repeatedly and indefatigably press levers to stimulate their own brains with obvious resultant enjoyment. Even starving animals preferred stimulating these so-called pleasure centers to eating. Delgado comments on the electrical stimulation of a similar center in a human subject:

[T]he patient reported a pleasant tingling sensation in the left side of her body “from my face down to the bottom of my legs.” She started giggling and making funny comments, stating that she enjoyed the sensation “very much.” Repetition of these stimulations made the patient more communicative and flirtatious, and she ended by openly expressing her desire to marry the therapist.⁵

Delgado sees no reason to be alarmed or troubled by these electrifying prospects:

Leaving wires inside of a thinking brain may appear unpleasant or dangerous, but actually the many patients who have undergone this experience have not been concerned about the fact of being wired, nor have ...

Table of contents

• Cover
• Dedication
• Preface
• Introduction
• Part I: Eroding the Limits Troubles with the Mastery of Nature
• Part II: Holding the Center The Morality of Medicine
• Part III: Deepening the Ground Nature Reconsidered
• Epilogue: From Nature to Ethics
• Endnotes
• Index
• Copyright
• Endnotes