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Transcripts

Chairman's Opening Remarks
Leon R. Kass, M.D.
Second Meeting, February 13-14, 2002

Let me begin by reminding us of the charge given to this Council: "to advise the President on bioethical issues that may emerge as a consequence of advances in biomedical science and technology." To offer sensible advice for action, we must first seek clarity in thought. We must examine carefully and critically the specific ethical and policy questions related to biomedical advances. Yet this modest way of describing the work of public bioethics belies the weightiness of our subject. Many of the ethical and policy challenges we shall increasingly face arise because of new and foreseeable powers to intervene in the human body and mind in unprecedented ways and, in some cases, for indeterminate ends. Though these powers are being acquired as part of the project to cure disease and relieve suffering, their acquisition often raises serious moral questions and their possible uses go beyond the goals of therapy for which they are first sought. Everyone understands, even if only dimly, that how we use these powers could make a very big difference for what it means to be a human being, for us and especially for future generations. To be sure, the powers arrive piecemeal and gradually, and we rarely see our choices as influencing what the future of humanity will be like. Even so, this is exactly what may be at stake as human biology and human biotechnology increasingly exert their novel influences on human biography, the experienced lives of individuals and communities, both for better and for worse.

Precisely for this reason, the ethical issues we face necessarily go beyond the utilitarian concerns of ordinary technology assessment, which confines itself largely to questions of "Will it work?", "Is it safe?" or "How much does it cost?" They even go beyond the traditional questions of medical ethics or even the ethics governing research on human subjects, with its reliance on informed consent or its application of the abstract principles of "beneficence," "respect for autonomy," and "justice." To develop a bioethics that does justice to the subject, we need to develop a view that is broader and deeper. We must to begin with take pains to locate the new biomedical developments-with their promise and their peril-within the larger context of human life. We must not merely reactively respond to the potential consequences of this or that particular technological innovation. We must rather prospectively articulate the human goods, activities, relationships, and institutions that we wish to defend and advance (in addition to the gaining of knowledge and the relieving of suffering). We must pursue the full human meaning of possessing and using the various bio-technical powers. And we must try to articulate the ways in which these powers might serve or undermine human well-being, both for the people involved and the larger society. Developing the ideas, questions, and approaches for a "truly human" bioethics is one of the prime goals of this Council, one that we shall pursue both thematically and by example, as we tackle our particular topics.

At our first meeting, we spent roughly half our time explicitly reflecting on how we should conceive and approach our subject. Using Hawthorne's story, "The Birthmark," we considered the meaning of a one-sided pursuit of the otherwise noble struggle against what Bill May called "the unelected marks that go with our birth," which include-whether we know it or not-disease, decay, and death itself. And we struggled with the question of the extent to which this aspiration is or is not part of the aspiration of modern science and the culture that celebrates it. With the help of Gil Meilaender's paper, we took up some of the essential themes of a bioethics true to the character of human life: questions about whole and part and about soma and psyche, crucial to understanding the unity and integrity of the human being; questions about human freedom and its limits; questions about the relation between the generations, a nexus of connection that we owe to the fact that, as finite beings, we beget and we belong in families; and questions about the project to relieve human suffering and its moral standing among other human goods, as well as questions about what means we may morally use to attain this worthy goal. In the discussions that followed, people spoke about human equality and human dignity (though with little specification given), as well as about the dangers of trying to subdue the mysteries of life or of seeking to exchange our position in the world as "imperfect recipients of a gift" for one as "flawed manufacturers," controllers, and designers. We have much more to do on these matters, and we shall in future meetings build in time to do so explicitly.

For this meeting, however, we shall spend all our time on human cloning, our first short-term project. It is my hope-nay, my expectation-that the way that we shall proceed with our exploration of human cloning will show signs of our striving for the richest possible treatment. This means, concretely, thinking about cloning in the context primarily of human procreation: what it means to have a child; the meaning of "origins" for one's identity and sense of self; what it means to regard the child as a project or a product rather than as a gift or "a given"; the difference between "begetting" and "making"; the balance between what Bill May called "accepting love" and "transforming love" of children; the relation between the freedom to have a child and the great limitation of freedom implicit in the duty to protect, nurture, and educate it; and other comparable matters. It also means thinking about cloning in the context of the progress of biomedical science, as well as the growing technological powers to control human reproduction and to influence human genetic endowments.

These considerations remind us that we are taking up the cloning question not only because it is timely and a matter of intense public discussion to which we have been asked to contribute. Indeed, we can contribute most fruitfully to that discussion especially as what we will say keeps these larger contexts in mind. We are mindful that cloning intends not only to produce a child but a child of a particular and approved genetic endowment; in this sense cloning is discontinuous with IVF and stands as a possible forerunner of future efforts at genetic design and even eugenics. We note also the social-political context of the current ethical debate. We recognize that the argument about whether cloning should be banned is in fact also about who should bear the burden of persuasion or proof regarding the introduction of such radical new technological alterations of human life. It also makes explicit the complicated relation between science and society, as freedom of inquiry, innovation, and medical research may be threatened or limited, rightly or wrongly, by public strictures. A broad view makes clear that there is more at stake in the cloning discussion than cloning itself.

The first task of any serious and thoughtful inquiry is a self-conscious consideration of how the topic should be described. Terminology matters. The answers one gets are no better than the questions one poses, and the questions are shaped by what one chooses to call the matter in question. Human speech is necessarily precarious and contestable; the word is not the thing. Always, there are always dangers of mischief and misunderstanding. There is risk of imprecision, euphemism, and the ever-present temptation to win a moral argument by choosing focus-group-tested soothing usages. In our area of bioethics, there is an additional and crucial danger of terminological distortion: what are fundamentally human activities are frequently described in merely technical terms, and the choices presented are described medically and technologically rather than humanly and ethically. This happens especially where bioethics proceeds reactively in response to a new technology, rather than prospectively from the vantage point of the human activity involved. For example, in considering ethical issues of assisted reproduction, framing the questions in the human terms of having and rearing children will yield one result, framing them in the scientized/medicalized language of reproductive technique and medical risk will yield another.

As it happens, there is a great deal of confusion about the terms used in discussing human cloning. There is honest disagreement about what names should be used, and there are also attempts to select and use terms in order to gain advantage for a particular moral or policy position. It is terribly important to try to be accurate and fair in the matter of language. Efforts to win the moral argument by Orwellian use of speech must be resisted. The issue is not a matter of semantics; it is a matter of trying to call things by their right names, of trying to fit speech to fact as best one can. We should not only stipulate the meanings we intend by our use of terms; we should also choose terms that most accurately convey the descriptive reality of the matter at hand. If this is well done, the moral argument can then proceed on the merits, without distortion by linguistic sloppiness or chicanery.

We begin, then, with a discussion of terminology, prepared by Working Paper # 5.

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