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Thursday, January 17, 2002

Session 3: How to Do Bioethics

Discussion of Gilbert Meilaender Paper,
"In Search of Wisdom: Bioethics and the Character of Human Life"

CHAIRMAN KASS:

This session which will run until shortly before 1:00 o'clock is entitled "How to do Bioethics," and it will be a discussion of a paper written especially for this meeting by Gil Meilaender, a paper entitled: "In Search of Wisdom: Bioethics and the Character of Human Life."

I remind you that one of our goals has been to start trying to develop the terms and the approaches and the questions that belong in a richer and fuller form of bioethical discourse, and I am especially grateful to Gil, under very short notice and under some additional duress, for producing what I think is a wonderful paper to start us off down this road.

I might say, by the way, that it has been suggested in staff that in the course of our time together that there would be opportunities to invite all members of council to attempt some kind of a paper that would be a contribution to this question "how ought we to do bioethics to do it well" and those papers by themselves might make an interesting contribution to this discussion but not everyone has Gil's gifts and that is not yet an assignment.

But let me turn it over to Gil who is going to get the ball rolling on this wonderful paper.

PROF. MEILAENDER: Thank you, Leon.

My understanding of my assignment from Leon was that I try to write something that would invite discussion among us about some of the most important human goods that are at stake in bioethics. I am not quite certain how one decides, you know, on the list precisely what that is but what I tried to do was focus attention briefly on four that I think are significant and that are in some ways interrelated.

All I am going to do is just say a brief word about each and then raise two questions that grow out of it and that seems to me it might be useful for us to discuss, though you will not doubt go in whatever directions you are moved to go.

So, briefly, the four issues that I focused on are these:

First, the advances in science in medicine, though also different ways of thinking morally, have raised for us puzzling questions about the unity of the human being as an organism.

I note several ways in which this happens. Two of the most significant are thinking of human beings as what we might call collections of genes and what that makes possible. And then, second, distinguishing in ways that come close sometimes to separating the human person from the body. And we are forced, therefore, to ask whether any sense of the unity and integrity of the embodied person is one of those human goods that is worth preserving or not. So that is the first issue that arises.

And, second, part of the reason we can think in ways that seem to undermine the unity of the human being is that there really is a kind of duality in our nature. You can try out various languages to describe it. I use here the language of "finitude and freedom." We are on the one hand limited and located beings.

On the other hand we seem to have the capacity indefinitely to transcend those limits and so we are forced to ask whether it is only the exercise of our freedom that is among the goods of human life or whether acknowledgement of some limits may also be humanly important. And that is my way of putting something that in a way Bill May got at with his savoring and saving language before.

Third, one of the most fundamental of those given limits, which we might nevertheless seek to transcend and are to some degree able to transcend, involves the relation, which is a bodily relation, between the generations.

This is, in part, a matter of the relation between parents and children in large part but it is also perhaps increasingly a matter of the relation between present and future generations more generally as we expand our capacity to shape decisively the character of future generations. So we are forced to ask whether there is some human good to be found in the giveness of human relationships between the generations, whether that is one of the human goods we ought to be concerned with.

And then, fourth, when we think about the relation between the generations we realize that one of the things that parents try to do for their children is keep them from suffering. It is a natural thing for parents to do and yet we also know that two single-minded an attempt to do that may crush the developing child. So we may not be able to give our children everything they need and we may have to accept their vulnerability in order to let some other important goods come to fruition in their lives. That points us to the more general question whether relief of suffering, undoubtedly a very important human good, is always an imperative or even always desirable. An issue that arises time and again in bioethics.

So those — you know, that very brief form, those are the four issues that I tried to unfold briefly.

Again that summary of the paper's contents I would pose two questions for us. At least a place where we might start. The first arises very directly out of the substance of the big questions explored in the paper because they are questions which will often bring us back to the meaning of human freedom. So we might ask ourselves does the meaning of our humanity lie finally simply in the freedom to make and remake ourselves? Is that what it means to be human or are there other characteristics equally integral to humanity and equally in need of respect and protection and, if so, can we talk about them?

And then the second question is not as directly raised by the paper but a little thought about the questions the paper does raise, I think, might lead us to it and it concerns something about how one does bioethics.

If there should — if human beings are not just the freedom to make and remake themselves if there should be any limits to our freedom. They are not likely to just sort of collapse all at once or be attacked all at once. Those limits are gradually eroded. And any given erosion may seem like a good idea because it will surely appeal to some other undoubted human good. Seeming to offer considerable benefit perhaps without undue harm.

It may not look like the place where you would want to draw a line in the sand and say no but if that is the case then the question is how we can do justice to the larger questions of human good if we just take up bioethical problems piecemeal moment by moment, issue by issue, and whether we lose the deeper underlying issues that are at stake. That would be my way anyway into the discussion of the paper.

CHAIRMAN KASS: Clear enough? So that we do not talk about both questions at once let's start with the first one. If I misstate it you will correct me. The emphasis on human freedom with its opportunities to constantly make and remake ourselves, is that somehow the heart of who and what we are or are there some other goods that we treasure that properly ought to set limits to that free exercise of creativity and, if so, what are they?

Bill?

PROF. MAY: What I found helpful about this paper is that so much reflection on what we do in the future moves into the mode of this could happen, this may happen, we might face and so forth, and measured against the right to do this or that.

It always seems to be fear mongering about some kind of slide into this or that which — and since we have not had experience with it, therefore, is written off as speculative, as speculations.

And this paper it seemed to me instead of engaging in that kind of speculation, which is often times readily dismissed, asks us to think about the admittedly complex features of our nature and ask is this not an important feature of our nature which we ought not to dismiss? And it seems to me forcing us to think back into the whole question of human nature is what this paper accomplishes instead of simply a paper — papers which I read, the grammar of which is always "this could happen, this might happen, this may be what we face." And which always seems to lack force when measured against a declared right.

CHAIRMAN KASS: I think — I mean, while you are working yourself up with enough nerve to speak, it seems to me that Gil has done exactly what I hoped he would do, which was to abstract from this or that particular development but to try to lay out and to do so by the way not by asserting this is important or that is important but to lay out certain kinds of polarities which are intrinsic to our existence and to make us realize that you cannot really — whether you know it or not when you are thinking about bioethics, these are the questions that are implicit if not explicit in the conversation.

And what he has done, I think, is to try to make these considerations explicit and invite us, hard though it is, to speak somewhat at this more abstract level to ask, you know, are there any kinds of limits that should be placed on the human freedom to remake or to recreate and, if so, in the name of what goods would want to assert those limits.

Charles, is that half a hand?

DR. KRAUTHAMMER: Yes, it was half a hand so here is half a thought. It is interesting that on the one hand you have the sense in environmentalism that we ought to put great restrictions on human freedom to shape, to mold, to remake what Michael referred to earlier as sort of the inanimate world, which you would think ought to be a world of use, and yet we have a sense that, you know, when you strip mine you have to put it back together again after you have been there to restore nature to its wholeness and this here we are dealing with nonhuman things, sometimes nonliving things like a hill. And yet we have that strong sense that there ought to be a restriction on human freedom in that kind of manipulation of the natural inanimate world but it is not, I think, matched in passion by that same sense that we ought to have the same reverence and sense of restraint in reshaping the human world. For example, strip mining embryos to produce stem cells. You would think that a civilization that has put great restrictions on strip mining hills ought to put the same on living organisms but the passion for the second in many people, particularly those who tend to want to protect the environment, is rather limited and rather wont.

CHAIRMAN KASS: Rebecca?

PROF. DRESSER: I think a lot of this goes back to something we were talking about in the earlier session. Line drawing, what factors should be considered in terms of justifying an intervention? And just I think basically we or most people can agree that limits such as risk — physical harm to others, perhaps psychological harm to others would justify restrictions on freedom. What kinds of harm? What chance of harm? How certain must we be about potential harm and potential benefit? And how much agreement must there be on all of these things before we go forward? And I think the difficulties are in the details there.

CHAIRMAN KASS: Paul?

DR. MCHUGH: I want to first of all just agree very much with Charles on the idea that we should be thinking of what we are asking in our environmental challenges and compare what we are asking in these biological challenges but I also want to thank Gil for this wonderful article that he has written here and also his ability to condense it down to a couple of little important — these important questions at the end.

What does it mean "our freedom"? Is the meaning of our humanity the freedom to remake ourselves? Well, I think there is also an aspect of our humanity that he mentions in his article that is the freedom to contemplate ourselves and contemplation — after all, the great contemplative here he mentions is St. Augustine. And Augustine talking about the issues of what it means to suffer allows us to appreciate how often that suffering is going on for many and that appreciating that suffering and contemplating it can give us better aims for the future.

Remember in Augustine's time one of the big arguments he was having was with Donatists, the people who felt that the only worthy transmitters of the tradition were those people that did not give in to Diocletian and were martyrs but kind of tried to get around the necessity for martyrdom in order to live and bring life further along. Augustine was on the side of those people that, you know, said, "Well, you know, it was very important for the tradition as well that we live."

And a contemplative idea here is what is going to be important for us so that we can live in the face of the challenges that are being asked to do as for progress.

CHAIRMAN KASS: Robby?

DR. GEORGE: I think this is a point at which it is well to be reminded of a comment that Stephen Carter made in this opening remarks about having in mind the distinction, although also the relationship between the question of legal regulation or regulation as such, and the question of moral evaluation. I think as important as the question of regulation, including legal regulation is to this issue that Gil has put on the table, as important is the question of what sort of ethos we ought to try to nurture or if it is already in place to the extent that it is in place maintain both in the community as a whole and also in the scientific world.

Very often what keeps us on track, keeps us from going off the rails, is not just formal regulation, be they legal or otherwise, but the ethos that is in place in our community or in a particular subcommunity that is dealing with issues of moral substance and import.

So whatever the substantive answers are to the question Gil has put on the table they go beyond questions just of regulation and into the broader question of the maintenance of an ethos, a moral understanding of the goods that have to be protected and cannot be compromised even for the sake of other important goods.

CHAIRMAN KASS: Stephen, did you want to join in on this?

PROF. CARTER: Just a small point, I suppose, going back to Gil's paper and also something that Bill May said, I think, earlier that when we think about parenting, mother and father, and we think about children, one of the questions that it seems to me is very directly raised about human freedom that we encompass, those who are parents and even those who are not confront every day, is the freedom to make a variety of different kinds of decisions regarding children. This has very important moral implications that are directly related to a lot of the conversations we have had and will be having over the next few months.

In particular, the distinction — I suppose we could think of it are children production or consumption. When we think of children as having to perfect them, we are going to live our lives through them, we are going to push them to do — you have got to excel in this sport or you have got to play the flute or at least you have to bring home straight As, we have got to do one of those things because you have got to. It strikes me that one aspect which one might think about a moral limitation on human freedom that I suggest would not have any regulatory implications at all is precisely on this question of how we view our own children and interventions in their lives, whether we are speaking of interventions after they are born or before they are born. We can well imagine a great spectrum of things, of ways that we might think of parents raising and nurturing children for the good of the parents, for the satisfaction of the parents, for the dreams and desires and needs of the parents, or of other members of the family versus thinking of the children as ends in themselves.

DR. GEORGE: Precisely on the point that Stephen now raises, whatever one thinks about, and down the line we may get into issues about IVF and other assisted reproductive techniques, I certainly always find myself even though I have now seen these ads many times just arrested by ads in the student newspaper where I teach and I am sure at your universities you will find the same thing advertising for egg donors and stipulating a certain SAT score range of the student from whom the eggs are desired. The idea really is here to have a child who is going to be, as they say and I am as disgusted by this as I hope the rest of you will be, of "ivy league quality."

We have run into a problem here. What kind of an ethos produces a situation where ads like that can freely appear? We are not talking about legal regulation or stopping people from putting them in. The ethos is one in which people have no problem about advertising in these kinds of terms that strike me at least as quite dehumanizing.

DR. BLACKBURN: Not only dehumanizing but I just want to briefly interpolate that that is probably even not well founded that there will be an inheritable aspect of it. So, you know, I am repelled by the — you know, the lousy science aspect of it as much as the other aspect.

DR. HURLBUT: It says, "Egg donor needed, large financial incentive, intelligent, athletic egg donor need for loving family. You must have at least..." this is from the Stanford Daily. "...intelligent, athletic egg donor needed for loving family. You must be at least 5'10", have a 1400 plus SAT, possess no major medical issues," and they are offering $50,000.

One of my students followed up on this and she got to be second in line for possible egg donation. Filled out a 30 page questionnaire that included such questions as "Did your grandfather freckle when he tanned?" And was finally introduced to the parents.

And I was on a CNN program just after this came out and the broker, the lawyer for the brokerage firm that was brokering the deal was asked by one of the people in the audience, "Well, why do you want such a tall, intelligent, athletic donor?" And he said, "Well, it is a tall, athletic, intelligent family." But when my student finally got to meet the prospective mother she turned out to be about 5'1".

So I wondered if maybe —

CHAIRMAN KASS: It is just enhancement.

DR. HURLBUT: Huh?

CHAIRMAN KASS: It is just enhancement.

DR. HURLBUT: Just a what?

CHAIRMAN KASS: Enhancement.

DR. HURLBUT: Enhancement. I do mean to say like I know what is really going on but I wondered if maybe the prospective father, he would be the biological father too, was not satisfied with his wife like in our birth-mark story and wanted to be sure he would not have a child who was — maybe he wanted a boy and wanted to be sure he would not have a short boy.

CHAIRMAN KASS: Yes.

DR. HURLBUT: Bad genetics too but beyond that bad social attitude, bad expectations of children.

CHAIRMAN KASS: Gil, do you want to come back?

PROF. MEILAENDER: Yes. Just to play a sort of devil's advocate role. I mean, I am more or less sympathetic to these comments but if you assume at all that using these technological means to go about producing a child is worthwhile or at least a legitimate thing to do then you might say, "Well, why not the best?" I used to have students watch a program that Barbara Walters had done on TV and she interviewed some parents who had gone to Mensa Sperm Bank, you know, and the husband said, "Well, it is not that we are looking for the perfect child but why not the best?"

And presumably to the degree that it is within your control, and I am sure that Elizabeth is right that there are many aspects of it that are not, but presumably you would not set out to create something distinctly inferior. So if you once set off on this path then why exactly shouldn't you seek the best? I mean, I think that is a question that needs to be addressed.

CHAIRMAN KASS: In the name of what other words would one say to these people this is a misuse of your freedom?

Rebecca?

PROF. DRESSER: I was going to make that comment that is, all right, so we are on CNN or one hopes we are in a situation where we could actually deliberate with people who are convinced or at least very interested in these kinds of things and think they are positive, and we want to have a dialogue that is not just about regulations but about morality and a more rich discussion. How do we communicate? How do we speak without sounding, you know, parentalistic? You know, we know what is best for you and so forth. I think that is a major challenge for us.

CHAIRMAN KASS: Could I invite you, Rebeccas or anyone else, how would you put — if invited to make the argument about what is wrong with this loosely speaking? I mean, why this is a use of freedom that is — this is a use of freedom that threatens other things? What is being threatened here?

I mean, Gil says, 'Look, a couple wants to have a child of their own. They are prevented by oviduct obstruction or something and they are going to use egg donation.' Surely one would want to say one wants to give the child the best shot in life and you certainly would not take eggs from someone with severe genetic disease, right, presumably. So, I mean, how can one — in the name of what sorts of things must one raise some questions about this?

PROF. DRESSER: I do not have the answer. I think one major issue is this line between enhancement and good health. What kind of — and this goes on with donor sperm as well. What kinds of characteristics are perhaps cosmetic, frivolous, versus getting someone who is going to give a child a healthy start in life.

CHAIRMAN KASS: Paul?

DR. MCHUGH: Well, my answer to you, Leon, would be that again we are seeing the slippery slope here. I agree with Rebecca that you are moving away from health to some kind of higher quality but you are giving up on the giftedness of life as it arrives and you are moving steadily towards manufacturing and manufacturing is partly seen here.

By the way, it is important as well to give the data that Elizabeth mentioned, and that is that as the generations go on there is a reversion towards the mean. You could be asking for 1,400 SAT scores in this egg and the offspring will move back towards the mean in the next generation. And, by the way, in my practice with VIPs the biggest issue that I have with families is bringing in what seem to be very attractive offspring and being told by the father or mother that "he is not the valedictorian and I was, and isn't this a terrible tragedy?" And I try to say, "Isn't he a wonderful person?"

DR. BLACKBURN: There are many aspects of intelligence. The SAT is but one very narrow culturally defined aspect. I think that was the objection I was primarily raising that we are defining something poorly —

PROF. SANDEL:: Including grade point average and a wider range of attributes that would have been all right.

(Laughter.)

DR. KRAUTHAMMER: Leon, if I could —

CHAIRMAN KASS: Charles, and then Stephen.

DR. KRAUTHAMMER: I think the approach to the answer to your question is the word "eugenics." The word "eugenics." This is a form of eugenics. I think as Gil noted in his piece it is privatized eugenics so that sanitizes it to some extent. But what is interesting about the history of eugenics is that earlier in the 20th Century it was, as you all know, a progressive course and then it fell into the wrong hands and was discredited obviously in mid Century by the Nazi experience but its recovery now is under the guise of privatization.

It is not easy to answer your question why shouldn't you if you could choose a child who would have all of these enhanced attributes. I think what scares us and maybe beginning even an understanding of the problem here, the repulsion that we feel is if everybody did it or if the state ordered it, we enter a brave new world.

And I think it is again the question of the slope. Once you grant the principle that you can do this then perhaps you get to a point where you are going to have to do this and then where are we and who are we?

CHAIRMAN KASS: So your answer is that it is finally in the name of freedom that one accepts some limitations of freedom because if you start this way you are going to have coercers rather than that there is something wrong with the thing itself?

DR. KRAUTHAMMER: No, I am not sure that the only good that is threatened here is freedom. I think there are other goods which are threatened. Diversity, creativity, spontaneity, contingency. There are other things that will be threatened. Freedom is one of them but I think that it opens us to a completely new world. We have never been able to manufacture humans and we are now able — almost able to do it and certainly by the end of this Century we will be. We have to prepare ourselves for what that can mean and begin to make restrictions and limitations to keep it from becoming a horror.

CHAIRMAN KASS: Stephen?

PROF. CARTER: Well, I want to — in an effort to answer the question and you are right to raise it and to challenge us because it is one in which all of us have instincts and they are hard to articulate but first to go back to something that Paul said a moment ago about the sense of the giftedness of life. And the more that we try to adjust people from the beginning, I think the less we tend to view them as a gift.

This has implications that someone mentioned earlier, a couple people mentioned about equality as well. There is a lovely and very depressing essay by Stanley Howass (?) in which he talks about a commercial, a television commercial that he saw that was intended as part of a crusade against what was described, a particular kind of — as he was describing the commercial — birth defect and he is concerned about the term "defect."

And he said that the theme of the commercial seemed to be wouldn't we better off if no one was born with this and he said in the one sense from the point of view of the individual or the agonized parents it is easy to understand that theme but from the sense of human equality it is suggesting that there are people who really ought not be among us, that we as a society are a better and richer society if certain types of people are not around us.

And it is not so much that that is anybody's intention. It is not that is a theme that is chosen or even a hidden but intended subtext. It is rather a risk of our rhetoric and our way of talking about these problems and a risk of when we ask what human goods at stake, the very good that has been articulated around the table that we have an obligation of equality — the obligation — the word "love" was used by Bill a little earlier — to all human beings is at stake it seems to me when we suggest that somehow there are some that are less lovable than others and let's make sure we build a society of the more lovable ones.

CHAIRMAN KASS: Michael?

PROF. SANDEL: I am going to push Charles a little bit. Let's grant that it is eugenics, this ad. Doesn't that beg the question about what is it that is objectionable about eugenics? Apart from the coercion which many actual forms took. And if we — and one way of making that question harder is to take not the enhancement cases, which seem more readily objectionable, but the — but remedial eugenics, if we could somehow through genetic engineering assure that babies would not be born with Down Syndrome or would not develop diabetes.

And I do not mean this as a rhetorical question to say — to defend the genetic engineering even in the remediation case but to see whether that — whether articulating what is objectionable in eugenics apart from coercion does not push us to this somewhat inchoate but intuitively powerful idea that has been part of the discussion all day about according some respect or reverence or consideration or moral weight to the given or the natural which is not, strictly speaking, human nature only. It may extend to sequoias as well as to babies and embryos.

DR. KRAUTHAMMER: Let me respond by trying to push you and say that — let's speak about a completely uncoerced eugenics, privatized eugenics that would produce a class of people who are super human. I am asking what will life be like? What will society be like? What would it be like to live in a world where you have a class of super humans among us?

This is not as weird and science fiction as we are thinking. If this stuff could work we can manufacture extremely intelligent, extremely powerful, extremely resistant people. Presumably that would be done. Some people would do it.

Do you have — I mean, does that arouse in you any trepidation? I am saying I think that is the reason some of us are resistant and hesitant. Are you saying that it is not a problem?

PROF. SANDEL: No, I think it is a —

DR. KRAUTHAMMER: I am speaking of a super race, which is what we are talking about here.

PROF. SANDEL: Right. No, I think that is a problem but what I am trying to — but I would say the reason that is a problem is — requires us to give us some account of what modes of reverence, let's say, or respect are appropriate to what forms of life and I would not restrict it to human life given by nature. And to answer that question we have to ask what does it mean to act and to value goods in ways that are fitting with their nature? What are appropriate modes of valuation for not only human beings but goods generally? And beings, creatures and nature generally?

But that pushes — so — and if that is — what seems to me wrong with the nightmare scenario of the super human enhanced creatures is that it is a kind of hubris. The objection is not that it violates somebody's rights or that it causes harm to anyone even but that it is a mark of — a deep mark of bad character having to do with a kind of hubris, a human hubris that assumes that nature is merely open to use for our purposes.

So the offense is in the hubris, not in the harm or in the violation of rights that might be done to any particular person.

DR. KRAUTHAMMER: I grant you that and I think that is — I would agree with you entirely on that. I would simply add that in addition to the sin of hubris involved here there is also the consequentialist question of what kind of society would that look like. Apart from the morality of the act of creating it, I am asking what it would be like to have created it? What would it be like to live in it and what would happen to the values that we now share in such a world? So I am adding a layer of concern. I am not questioning your's.

CHAIRMAN KASS: Jim?

DR. WILSON: Did you want to respond?

PROF. SANDEL: No.

DR. WILSON: We are getting very close to the core issues here in this exchange between Charles and Michael and I am trying to draw some lessons from the three births with which I have been distantly, not so distantly in one case, connected. My wife and my daughter and my daughter-in-law, and why they valued the experience so much. Did they value it because they knew the kind of child that would emerge? No.

They valued it for a different reason, that it was a mysterious gift, that it was a union governed to be sure at the margins by genetic laws which produce imperfect or unpredictable results. And they spent a great deal of time talking about who the child most resembled. To me, of course, it most resembled a worm, a worm that I loved, but women have a better eye for this than I do.

They speculated about its developmental unknowns. When it would walk, what it would do, would it be tall, would it be short, would it fair, would it be dark? They talked about all of the unknowns of these things and in my experience this is an unrepresentative sample and everyone in this room may have very different and quite critical judgment but these unknowns, this mysterious gift was to them a great gift.

And I take if I am correct in my assessment some comfort in this that the outcome of a human birth is a delight to its parents in part because they are being given something new, something whose identity they cannot predict about which they have anticipations but no firm convictions.

Now since I live on the west side of Los Angeles I am all too aware there are many people who do not have this view. The magazines that circulate on the west side of Los Angeles are primarily supported by advertisements for cosmetic surgery. And I have noticed now of late in my trips to Boston the Boston magazines are supported by ads for cosmetic surgery. There are a lot of people there who get engaged on a weekly basis and a legion of men who practice something that could only be called serial monogamy so that I know that I am not generalizing about all people.

But it seems to me that the emotional context of birth, the idea that it is a mysterious gift is important to understanding where people on the average would draw the line. I think on the average they would draw the line if they could do so with confidence at removing defects but not producing enhancements because removing a defect is removing a specific thing. Cerebral palsy, down syndrome, spina bifida, et cetera, which although countless parents do a splendid job in raising such children, most would have been happier had they not had the obligation to do this. But adding enhancements, that eliminates the mystery. That eliminates this gift that they have been given.

CHAIRMAN KASS: Janet, then Frank.

DR. ROWLEY: Well, I would like to say from the standpoint of a scientist I feel quite lucky if I can figure out what are the reasonable questions to be asking in the next year or two and I am concerned that if we focus on things that might possibly happen 100 years from now we are not necessarily going to be providing the kind of guidance that is needed in the near term. And I think that it is important to separate what is potentially possible some very long time from now with what is — clearly are possibilities now and what are the unknowns that would be helpful if they were resolved so that we could make wiser decisions.

And just to come back to the specific issue in the ad, fortunately it is not a concern of mine because I was able — my husband and I were able to have our own children but I have to say if I were in the position of not being able to have a child, I would think very carefully about what kind of qualities I would like in an egg donor to then have the child that would be born have the best possibility of a successful and rewarding life.

So I guess I am not quite as offended as some people are. 5'10" is not one of those qualities I would choose to have but I think that a potential parent given the apparent impossibility of having a child completely of both parents, then trying to think of what qualities are important to that parent.

Now this is an individual family making this kind of individual decision based on their assessment and it does not really speak to manufacture, which is not necessarily directly a consequence of a single family making this kind of choice.

DR. KRAUTHAMMER: Could I just make one comment about the time horizon for our thinking here?

CHAIRMAN KASS: Please.

DR. KRAUTHAMMER: I would defend the 100 year time horizon for the following reason: We are at a unique time. We just — the cloning of the first mammal occurred only a few years ago. That never happened before and it opens a whole new possibility of what can be done.

I think we have — I have a sense that we are at a time where the decisions that we make because these questions are so new are going to have a remarkable effect on the future. I do not think that these technologies are that speculative or science fiction. I think the moral decisions, the legal decisions, the regulatory decisions taken now are going to have reverberating effects for decades because they are new and because they had not been dealt with before.

If we choose wrongly, I think we will open futures which will be very unhappy and that we will regret and that is why I think that we have to have a horizon that is rather long thinking about how our decisions are going to have reverberating effects.

DR. ROWLEY: Well, I just want to respond that Dolly, being the first cloned mammal, now apparently has arthritis at age five years, which is far earlier than expected. So I think at least in the scientific community it is recognized that at least some of these experiments are fraught with great dangers or untoward consequences and I think that people are less likely to — at least some people are less likely to rush into this than we may imagine.

CHAIRMAN KASS: It seems to me this — not to adjudicate away the tension in the discussion, it seems to me the question of how long a time horizon is appropriate for this body is a question that we all wrestle with continually. We are trying to not duck what is right in front of our face but we are also trying to see this in the context of things to come and I would advert to Gil's second question in which he pointed out that other values that might be threatened by the untraveled use of freedom are rarely assaulted head on.

In fact, if they are assaulted at all it is as a kind of indirect consequence of a certain use of this development, say the treatment of infertility that we all embrace, but ten years from now that becomes a kind of precedent not just in technique but also in the logic and justification. And, therefore, it seems to me we need this kind of double vision. The things for the long range future are admittedly speculative and what the facts will be we do not know.

On the other hand, one sees to some extent the continuity of the powers here gathering and the decisions we make about the present ones are not without consequence for how we will be thinking about the future ones.

So I would want to say I think you are right and I think he is right and how we deal alternatively with the need to look both close at hand and down the road, I think, is — we are just going to have to struggle with it.

There was a hand. I think, Frank, you have been wanting to get in for some time.

PROF. FUKUYAMA: As in a lot of cases if you wait long enough most of your points get made by other people. On this question of long term versus short term I do think that some of the questions that have already been raised about enhancement versus therapy are ones that we are going to confront in the short term and they do not depend on the development, for example, of germ line engineering or things that are, you know, I think fairly far down the road.

For example, you are going to have preimplantation, diagnosis and screening, you know, fairly shortly for a lot of conditions where you are going to be basically forced to make therapy versus enhancement types of choices. In drug — in neuropharmacology you can have enhancement versus therapeutic uses of a lot of, you know, neuropharmacological agents.

In fact, we already make implicit, you know, distinctions between those so I do not think it is at all inappropriate to — you know, to be aware of, you know, the fact that there could be extremely large technological developments way down the road but to begin the discussion about just a couple of short points.

Just in response to something that Michael said earlier, I really do not think the only problem with the — you know, the super enhanced people is the matter of hubris.

I mean, I think that the principle of liberal equality really, in fact, is based in our modern democratic world on the empirical equality of people when you strip away all nonessential characteristics like — you know, like social status and race and the like. So when you start monkeying around with essences I think a lot of people are much too casual about what the implications of that for human rights are. The only one that was not — did not have these kind of blinkers on was Nitze (?), he said, "Yes, let's do this and then we can go back to natural aristocracy and the domination of, you know, one set of human beings by another." I think that a lot of people are not going into this with their eyes open.

The other thing that struck me, even if you do not want to get into these kinds of issues, is just simple things like family law. This is something that Mary Ann Glendon knows much better than I do but one thing that has always struck — you know, you are asking in the name of what would you accept restrictions on human freedom.

I have always thought that there is something strange about family law in that it tends to take the interest of parents much more seriously than the interest of the children that they produce or tends to regard, you know, the choices that people make as preeminent. You can see this already in the cloning debate that it is almost exclusively debated as, well, can you think of a parent that would like to clone himself or herself and if you can find that interest then, you know, that is sufficient to justify the practice and then you can kind of presume the consent of the cloned child, you know, to go along with whatever the parents have decided.

It seems to me that that in itself is not an appropriate way to think about these kinds of decisions because, in fact, I do not know how you could ever presume the consent of someone to be born as a clone. I mean, you could say after the fact, of course, anyone that is born will be grateful. I mean, they are not going to contest the choices that their parents made but, you know, there is a deeper problem embedded. And I think a lot of current family law that it actually does not take, you know, account of the interests of children and simply sees the children as a result of the personal, you know, autonomous decisions and preferences of the parents.

CHAIRMAN KASS: Stephen?

PROF. CARTER: I want — oh, I am sorry.

CHAIRMAN KASS: I missed Rebecca.

PROF. DRESSER: I was just going to say that one way to bring together the far off developments and the ones at hand is to think about — with many of these technologies there tends to be an assumption that enhancement will work, germ line will work, cloning will work. And I guess for us a question now is, is it — how much risk are we justified in exposing people to in order to develop these technologies so the research phase issues. And then the other would be given that we have limited resources to spend on research, is this an area that ought to receive priority or are there other areas of research that would be more worth developing to get away from enhancement and health issues?

CHAIRMAN KASS: Let's see. I am in danger of really losing control of the whole order. I think it was Bill May, Bill Hurlbut, Stephen and Robby unless I have missed somebody.

PROF. MAY: To return to your earlier question what would allow one to say that this is an abuse of freedom. It seems to me that is very — a crucial question. I recall reading one paper on reproductive rights where the word "right" is used without quotation marks with respect to the freedom but then what is right, use of freedom, "right" there was used with quotation marks. So the suggestion is that the fundamental feature and characteristic of human beings even in parenting is freedom and what I think Gil's paper has asked us is to think whether that is the sole feature of human beings that trumps all other considerations.

Whether other considerations are merely frothy or dependent upon the particular views of particular groups and so forth and, therefore, cannot enter into public discourse.

So it seems to me what is very crucial is that this paper forces us to think back about human nature and what are the enduring features of human beings that would allow the word "right" to be used with regard to the question of right and wrong and not simply dismissed in quotation marks whenever it used in that way and simply to be honored as right when it refers to rights.

Now how that works out with regard to our political decisions as a nation that is another question but our moral discourse it seems to me is shrunk if we do not face that question.

CHAIRMAN KASS: Let's see. Bill Hurlbut and I will add Mary Ann to the list.

Bill?

DR. HURLBUT: To pick up on a couple of themes and if I may ask a question of Professor Gazzaniga. We were speaking about enhancement and what we should be practically considering and so forth. To pick up on what Francis was saying, there is a story about the labor leader when asked what his ultimate goal was he pounded the table and said, "We will not be satisfied until every worker in America is making above average wages." It seems to me that there is something in the human psyche that is not satisfied with being average and yet what danger are we under?

I think we need — one of the things we need to do in this council is to realistically assess the science. I mean, I hear an awful lot of things about where they we are heading futuristically that I think are at least, from what I know of genetics, unrealistic. So we need to assess what the dangers really are. It is not going to be easy to manufacture human beings. That is for sure.

But the larger question is if we can what will we do. And I — the question I would like to put to Professor Gazzaniga is if you say that there is not certainly — maybe biologically grounded impulse to self-assertion in human nature and we have the tools of our technology, like Nitze said, "To be naturalist, to dare to be as immoral as nature," and the evolutionary psychologists tell us that we are like Gil Bailey said not — or Gil Meilaender said, "We are not cobbled together collections of —" what was your term? A loose leaf folder of genes? We are, in fact, a coherent creature.

The question is what kind of a mind do we have? What actually? When we speak of freedom what do we really mean? Increasingly neuroscientists are saying that we have modular minds, that we have various neurologic programs for various purposes that do not necessarily form a capability to find a coherent cosmology, the ultimate kind of split brain.

And so what I would like to ask you is what is nature's mind? In that sense what — are we capable of coherent use of freedom in a moral way? Is freedom biologically capacity to do the good, in fact?

CHAIRMAN KASS: Do you want that?

(Laughter.)

CHAIRMAN KASS: Do you want to say something or do you want to pass?

DR. GAZZANIGA: I will answer that in great detail at the bar tonight.

(Laughter.)

DR. GAZZANIGA: I do not mean to be facetious. It is a tough question and it is the notion that there is a structured human nature that reflects a series of adaptations that have been built into the human brain over evolutionary time. It is a very active current belief which rides up against the more common social science model of the blank slate, which we start with a clean slate and interacting with culture we build who we are.

I think the formed view is that there is a lot of us that come with mini mental structures that are sort of built at the factory and that we — as we interact in our environment we structure ourselves differently as a function of how those built in systems interact with the environment that we grow up in.

So that then leads to the question of where do you structure freedom? Freedom of action and what does it mean. That is a really tough one. I think everybody in this room probably is a 20th Century informed scientist and we believe in the forces of the physical world and how they guide biologic processes and so forth. I think everybody in this room probably believes that the brain enables mind. I do not think anybody thinks that it is floating somewhere around our skull, that somehow the brain constructs our cognition.

And that leads one to the kind of obvious statement that by the time you and I know something consciously our brain has probably done hard work on it and that gives rise to this threat, this sense of, well, then who is in charge here and are we out of the loop and so forth. That is a deep question that we could all talk about at great length with great intensity but it is an example of how neuroscience, I think, and cognitive science and the philosophically interested natural sciences are going to have to come together and talk about these issues that once we get beyond the stem cell thing all those issues are very relevant to how we think about science and how it interacts with our culture.

CHAIRMAN KASS: Stephen, then Robby, then Mary Ann.

PROF. CARTER: I want to go back a little bit, although this will tie in to some recent comments, to a very interesting point that Janet made a few minutes ago. Not the point about the — which century we should be concerned about but rather that when you think about something like the ad in the Stanford Daily or in the Yale Daily News or the other ads that these are in effect private decisions of families who are often in a situation which they find painful and challenging and trying to make the best of it and so they are making choices. Let's assume for the moment that certain kinds of enhancements are reliably possible, that is to say that if you did get the right ad you could get some good traits. Assume that were true. It seems to me that this is — even though it is not exactly the problem — that is that this exercise of freedom may be a private exercise but it is a public act and these collective exercises of freedom drive the market, which we talked about then driving science. That is if a lot of families decide this is the way to go that pushes research in a particular direction but it also does something else. It drives our sense of what is valuably human.

So that is so if we find that a lot of families given the choice would say I would like somehow to enhance something measurable about some aspect of my child's intelligence that conveys a sense of what we as a culture find valuable in the human and, of course, by negative implication conveys a sense of what we find not so valuable. We get — it interferes in an interesting way with this vision of empirical equality and it interferes with the vision of equality in the abstract because then the announcement that is made through an ad like that, even if the ad does not work, even if what they are doing is impossible, the ads say we will pay you this much money if your SAT is over 1500, that conveys a message about the value we place on people whose SATs are below 1500 and the value that — not just places as a university admission committee but as something in this society in a larger sense.

Finally, the last part, to bring something that Rebecca has mentioned twice and we have not talked about very much but I assume we will as the time goes on, there are distributional concerns as well. You say, well, suppose that you do possess these various attributes and you could contribute an egg and one family says, "We will give you $100,000 for it," and the other family says, "We do not have any money to give you but, gee, we want it for our kid, too." Well, the market is going to operate and most of these eggs will be sold to the highest bidder if, indeed, we decide that private market decisions are the right way to conduct such transactions.

CHAIRMAN KASS: Could I just ask for clarification? Surely the question of whether the society values and values properly or over values the intelligence of our children, which are — there are as many individual variations probably as there are households on this as to where it fits into the scheme of the household's evaluation so if someone were to say, "Look, what difference does it make if we are doing this with biological means since those values are either properly formed or deformed culturally speaking already?"

What does the fact that we might be doing this genetically or pharmacologically do to our concern? Is there something there? Is it just that we have got other scientists in there whom we are nervous about or is there something different about doing this biologically rather than doing it culturally?

PROF. CARTER: Are you asking me or the group?

CHAIRMAN KASS: Yes, because you — I just wanted to draw you out to see if you had an intuition on that.

PROF. CARTER: I am sure I will bore people at length on my views on this as the months go by but let me just say something brief about it now.

The problem is what it says about human possibility and the values of different kinds of human possibility. The cultural trend that we have already is enormously dangerous and does enormous damage to the fabric of society, to children, to families who seem bent on insuring that for reasons they, themselves, can scarcely articulate their kid gets to the top of the heap because there is some deep failure, familial failure, genetic failure, the school failed, somebody failed if somehow the child fails to rise to the top of the heap.

Already, and all of us are familiar with this in various aspects in our own lives already, in the society the culture is deeply distorted by the emphasis on intellect as — and especially the measurable aspects of intelligence as a vitally important divider and a vitally important tool for assigning cultural worth.

At least if one is battling against that trend one is able to point out that we are given a great deal of diversity, all equally beloved we hope. If it turns out that, well, no, actually we have the capacity to manipulate this it strikes me that the message is actually reinforced, the cultural trend in some sense becomes worse in the sense that equality becomes weaker.

CHAIRMAN KASS: I have got others down here but some people, I think, want to follow this line if I might. So, Robby, if you would hold off and let Janet and then Gil, I think.

DR. ROWLEY: I just want to point out that it depends on what measure you use to say that society values intelligence and intellectual success over all others. If you look at the monetary rewards, one would raise serious concerns that that is not what society values. It is beauty and how well you can sing and how well you can play basketball, and intellectual pursuits are highly under valued in our society if you look at the monetary rewards. People with Ph.D.s having gone to college and up to six years of graduate school or more can then get a position of $30,000 a year as a post-doctoral fellow. So I do not look on this as society values it very much.

CHAIRMAN KASS: A question not to be settled at this moment.

Gil, and then Robby.

PROF. MEILAENDER: Yes. I thought that the question Stephen raised could be generalized. It would not have to deal with valuing intellect. It could value various things and, you know, is an important question but it seems to me it really drives to a deeper issue about how one thinks about the child in language that has come up at various places along the way and that I use the Galway Kinnell poem to get at, which I take this opportunity to mention again since it is such a wonderful poem.

But it seems to me that there is a deeper question, Stephen, that your position would have to face even though I agree with your position. If the child really is in some sense our product then it seems to me you ought to take responsibility for it. You see it is irresponsible not to exercise a kind of control over something that is our product.

So the really fundamental question is how we think about the child, how we go about developing attitudes that teach us to think about the child in different sorts of ways because I think, you know, things that are our products you are supposed to exercise quality control over.

CHAIRMAN KASS: Robby?

DR. GEORGE: Leon, I think that in the discussion in response to your question about what values, what considerations, what goods can be placed in jeopardy by the exercise of freedom, three hypotheses have emerged and it might be more than three and these are not incompatible with each other.

Freedom itself could be jeopardized by the unrestricted use of freedom. History is replete with examples of that happening in other areas so there is absolutely no reason to suppose that it will not happen or cannot happen here.

The second would be dignity.

And the third equality.

It seems to me that in our discussions going into the future will probably be exploring and testing these hypotheses with a view in every case to seeing if they stand up or in what senses they stand up but I would like to just kind of put on the table early on that while I suspect all will be borne out as representing values that can be seriously jeopardized in the area of biotechnology by the unrestricted use of freedom, I suspect that the concept, the value, the good of human dignity is going to be playing a special foundational and perhaps in a certain sense even architectonic role because it undergirds our conception of why freedom and equality are valuable.

And by dignity here, which I admit is something of an obscure concept, I mean what it is we have in mind. What we are gesturing toward when we attempt to distinguish — let's just take the case of the child since it has been on the table — the child as a gift and the child as a product. When we recoil, at least those of us who do recoil, from the idea of manufacturing human beings or the idea of ivy league quality human beings, it is what we have in mind when we intuitively, as if we are groping in darkness, move towards the distinction between therapy and enhancement. Not quite sure what to make of it but perceiving that there is something there, that people have a kind of special thing that just makes it wrong to use them or treat them or merely use them and treat them as instruments, treat them as means rather than as ends in themselves.

Just a quick final point because we are bound to continue to work with these concepts, and Bill May helpfully introduced this question of the difference between the — what Mary Ann Glendon has, a very important book called The Language of Rights as opposed to the concept of right and wrong.

I would put on the table as a hypothesis, and I am sure Michael Sandel can speak to this very intelligently, I would put on the table the hypothesis that the concept of rights, whatever else is to be said, that modern work in moral and political theory makes clear that the concept of rights, whatever else is to be said about it, is parasitic, which is not to denigrate it but is parasitic on the concepts of right and wrong and the possibility of distinguishing between right and wrong such that we can say, for example, that there is something wrong with violating the rights of other people. That it is not just an interesting fact about the world that people have rights that can be violated and sometimes they are violated sometimes by genocidal maniacs. That is just not an interesting fact about the world. There is something wrong with violating people's rights.

CHAIRMAN KASS: We, I think, are close to lunch. The question that has been talked about sometimes head on and sometimes around about way will, you will not be surprised, be back after lunch when we come to our first session on human cloning, which we are not going to take up in the first instance by asking for discussion today of the arguments for and against reproductive cloning. But in keeping with our sense that we want to think about the human context into which this technology fits, we begin rather with human procreation and biotechnology.

One of Gil's themes that we did not talk about explicitly, though it was in a way when we talked so much about children, was really the question of the relation between the generations. That comes back in that session again.

And as a person who is as guilty as anybody in the room of repairing to the notion of human dignity, and who would have a very hard time, if pressed, articulating it in terms that would be satisfactory even to me, I would be — I would want to underscore my agreement with Robby that that is at least one of the notions very important to our discussion and yet incumbent upon us to do more than use it as a slogan and a banner and to try to give it some kind of weight.

Just with a view to the next discussion — well, let it sit there. We will get into the procreative questions when they come up.

Council members have lunch next door. Who knows where? Is it — it is through one of these doors. We will tell you when we break.

The public members and visitors are, unfortunately, given not too long a time for lunch because of the truncation of our schedule. We would like to reconvene at 1:30, which is 40 minutes from now.

(Whereupon, at 12:52 p.m., a luncheon recess was taken.)





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