Beyond Therapy: A Report of the President's Council on Bioethics

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We have by now become accustomed to having national bodies appointed to examine public policy questions raised by our increasing biotechnological powers, and we have become equally accustomed to reading reports issued by such bodies. But what would we say about a report that is more than 300 pages long, that is in large part an extended philosophical discussion, and that offers no policy recommendations whatsoever? Clearly, this would be something different; yet, that is a rough description of Beyond Therapy, a report issued in October 2003 by the President's Council on Bioethics.

Because this report does not conform to our standard expectations, it is hard to predict what sort of reception it will receive. Perhaps it will prove too long and too theoretical for readers. Perhaps it will be sucked into the black hole where--some say--anything without immediate policy implications ends in Washington, D.C. Perhaps, however, it may prove to have uses that are more far-reaching and less likely to be outdated quickly than the sorts of reports we have come to expect. Insofar as a national body such as the President's Council should, among other things, help to initiate a public educative process about important bioethical questions, this report clearly has an important role to play.

Enhancement and Eugenics

Beyond Therapy connects with long-standing bioethical discussion in several ways. For example, especially since rapid advances in genetics began to appear, a distinction between using bioethical powers (whether genetic or pharmacological) for "therapy" and for "enhancement" has been standard. At one time the distinction was made in order to assert that, while use of our new powers for therapy was unobjectionable (and, really, just an extension of traditional medicine), use of these powers to enhance individuals (or human nature more generally) was deeply disturbing and ought not be done. Yet, anyone attentive to the literature will have noted that this distinction has begun to break down in recent years. As enhancement has come to seem more possible, its detractors have begun to fade away. This is significant especially because so many of the new genetic or pharmacological interventions that may be on the horizon are likely to have dual uses. Thus, genes to increase the size and strength of muscles may help to counteract the loss of skeletal muscle that comes with aging, but they may also be of great interest to wrestlers and their coaches.

The report also connects with our concerns about eugenics. Scientific attempts to improve the inborn characteristics of the human species were not uncommon in this country in the early decades of the twentieth century. The abuses of the Nazi doctors at mid-century gave eugenics a bad name, and support for it went underground. But in the last few decades a new kind of eugenics has resurfaced and has come--in the eyes of many--to seem respectable. This is not government-sponsored eugenics but, instead, "private" eugenic choices made by parents who want children of a certain sort (free of certain inherited diseases, perhaps of a specific sex, perhaps with certain other traits). Indeed, some aspects of such private eugenics have become almost a standard feature of prenatal care.

Issues of enhancement and eugenics lie in the background of Beyond Therapy--and they are concerns that must be reflected upon not in order to deny the undoubted medical progress that is on the horizon, but in order to appreciate its full complexity. In a number of meetings, held over approximately sixteen months with testimony provided by many experts, the President's Council gradually formulated its report. The heart of the report lies in chapters two through five, which treat successively the topics of "better children," "superior performance," "ageless bodies," and "happy souls." (No one, however, should ignore the general reflections that conclude the report in chapter six. Indeed, it so successfully synthesizes the report that it might in some respects be the place to start.)

Technology and Human Desire

An important feature of the report, however, is that it is not just organized around technologies, as if technology were somehow our problem. On the contrary, it is organized around common, perfectly understandable, and (in some respects) quite appropriate human desires--for healthy and successful children, for excellent performance in the tasks we undertake, for more years of life and more life in the years we have, and for the sort of flourishing that comes from inner peace. Each of these desires, it turns out, can grasp and make use of a wide array of different technologies.

Thus, in our quest for better children we may find ourselves drawn to means of selecting their traits, or even their sex, but we may also (in a wonderful example of the dual use problem) use psychotropic drugs to enhance their attention and regulate their behavior. In our quest for superior performance, we may go beyond the relatively accepted ways of improved equipment or training and attempt to look upon and treat our own bodies as if they were just another piece of equipment to be improved or enhanced in ways that are not really self-involving. In our quest for ageless bodies, we may overlook the cumulative effects for future generations of our individual desires--and, perhaps an even deeper problem for religious believers, we may confuse (quantitatively) more of this life with the (qualitatively) different life that is the true object of the human heart's desire. And in our quest for happy souls (whether through drugs that blunt memories or drugs that enhance mood), we may turn the problems and attachments of life into, simply, medical problems.

A Call to Reflection

Beyond Therapy does not suggest that all these things must or will come to pass. Indeed, the report is at some pains to distinguish what may actually soon be possible from what is unlikely to be within our grasp. So the point is not just to scare ourselves about the future or about uses of biomedical technology. The point, rather, is an educative one: that we need to think now, not later, about the sort of human beings and the sort of society we want to emerge from the progress of biotechnology. Precisely because a free society such as ours so often leaves these matters to private individuals moved largely by the desires that come naturally to them, it is all the more imperative that we think together about the world toward which we move (or are moved).

Because it begins with our very ordinary human desires, the report invites us to note that these desires--for better children, superior performance, ageless bodies, and happy souls--are largely limitless. From that perspective the report might be titled not Beyond Therapy but Toward Perfection. Our seemingly limitless desires to surpass old limits are not simply bad; they are, after all, part of the freedom that marks our created nature. Indeed, we are fortunate to live in an age so blessed by medical advance. Nevertheless, it is still important that we think--not just privately, but as a people--about whether there is sadness that is necessary to experience in life, whether the decline of our bodies is always to be avoided as much as we can, whether control and mastery of the next generation is sometimes evil.

Helping us to think about such questions is the true contribution of Beyond Therapy. Indeed, policy recommendations--which the report eschews--might, by focusing attention on themselves, have undermined this invitation to reflection. But there is also, I think, a deeper reason why the report offers no such recommendations. That is because the problem Beyond Therapy explores--our limitless desire to be, finally, more than human--is not the sort of problem one solves with policies. It is also not the sort of problem one solves simply by thinking better, which means there are limits to what the report itself can accomplish. The problem--and any "solution"--go much deeper than that. Hence, we should turn to Beyond Therapy not as a solution to the problem of limitless desire but, rather, as an invitation to think about what it really means to be human. In so doing we may perhaps recognize our own limits.