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Thursday, January 16, 2003

Session 3: Beyond Therapy: Biotechnology and the Pursuit of Human Improvement

Discussion of a
Paper Prepared by Leon R. Kass, M.D.

CHAIRMAN KASS: I think we're all here except for Frank who's coming back from a Dean's meeting as soon as he can. This afternoon we come to our topic on "Beyond Therapy," sometimes known as our topic on enhancement.

We have two sessions. The first, sort of general reflections and the second, the taking up of a particular case study, the ethical aspects of sex control.

Council members will have seen this paper/lecture, more a lecture than a finished paper, that is intended as a discussion paper to continue the conversations that we've had a couple of times, most recently the very excellent conversations stimulated by Michael Sandel's wonderful discussion paper.

I don't want to say very much. The lacunae in the paper and the notes that are invitations to the author for further development are there, and the limitations, I think, are clear.

I do think I would call attention, I guess, to three things of some importance, namely the three parts at the end. One, the discussion of our attitude with respect to these Beyond Therapeutic interventions, what I call the attitude of mastery, and it's in that place where we explore several things and try to discuss some things that were in Michael's paper.

Then sections on possibly questionable means and then some discussion of the desirability of the ends, either the end of indefinite agelessness of body or the pursuit of a certain understanding of happy souls, part of which I argue, in fact, is not happiness indeed.

I would prefer it, I think, if the conversation focused on those last things, on the constructive, or the attempt to say what issues I think are somehow most important, rather than the ones that I've raised if only to set aside, though I would say only one thing in addition.

By taking up this question mostly in terms of the choices of individuals, I think I've blundered. I mean, in some way, as Charles Krauthammer and Frank and others have argued in the past, it might very well be that the major worries we have about these technologies are not what you'd say to the individual case, but only when you see these things in the aggregate.

I have, for my own reasons, tried to argue the moral case in the individual case, but the questions of liberty and its constraint through technologies that what go to work on others, and the Ritalin case that we took up last time is a perfectly good example, means that to do this paper properly, the things that have been set aside for the purposes of this analysis would have to be brought in and emphasized.

But with that apologian introduction I would like to ask, and Michael has kindly agreed, to ask Michael to serve as Chair of this discussion and try to guide it, just so that I won't have to try to keep order and also attend to the – what I trust will be the interesting criticisms and comments.

So thank you Michael.

PROF. SANDEL: The floor is open. Gil?

PROF. MEILAENDER: Leon, let me start with – I may have some other sorts of questions later, but let me start with some questions that do not necessarily reflect my considerable sympathy with where the paper's going, but would just ask some questions to maybe get you to expand a little more on the way you discuss the loss of agency in the use of some of these techniques and the importance of that.

Let me just ask three questions about that general issue. It comes up in pages 14 and 15 in the paper where you – I guess it's in the "Means" section and you move beyond some kind of simple, natural-artificial thing to try to get at what more deeply is going on and the issue of passivity and playing no role and so forth.

The three questions would be these. What if it makes us happier? If the use of one or another of these techniques makes us happier, and I don't just want you to tell me that better to be Socrates dissatisfied.

What I mean is, what if in some sense, you know, if you think back to the stuff we read about Prozac, for instance, and so forth. What if in some sense I think I've really gotten a little more to myself here, this is something more to the real me. What do you say about that?

Then the second matter, what if – what if we really do choose this? In what sense are we not exercising agency? You want to say that we're not while, at the same time acknowledging that the law might well hold us responsible in certain cases and seem to back into the law being a fiction at that point.

I wonder if you might want to say a little more about that. Then a third question, maybe not – doesn't go quite so directly out of anything you say in the paper, but with respect to germ line alterations done before I had any agency, how does the agency analysis that you give deal with that?

I mean, any agency that I have is built on whatever those alterations might be, so I don't quite see how that analysis works. Those would be sort of just for starters, three questions about what I think is a fairly important move in your argument there.

CHAIRMAN KASS: No, those are very welcome – and good questions. Let me change the first one slightly. I don't think it affects the point. What if the use of these means doesn't necessarily make us happier, but makes us, in fact, more able to function in the ways in which in the last section of the paper, or even here I'm claiming are somehow essential to our flourishing.

I do give some examples of things which are non-therapeutic, which one would, I think, countenance. The use of agents to keep pianists' hands from sweating, or a neurosurgeon's hands from trembling, or let me make it even stronger.

What if it really is the case that part of the reason that one is frustrated or unhappy or incapable, in fact, of pursuing one's own activity is that there really is some kind of wiring or chemical problem in the brain.

Why not treat this as in some way the restoration of some kind of wholeness of equipment so that – now that's not exactly your question, but with respect to the way I've reformulated it, I'd have to say I'd have a hard time making the case against it.

In other words, the fact that something is non-therapeutic doesn't seem to me necessarily a violation of this in the genuineness of our activities; that there are certain kinds of things that we would take that would be aids to our functioning well, humanly speaking.

Even if they were means to which we were passive and in some ways functioned in us magically without our really understanding how they proceeded. You're smiling so I should let you interrupt.

PROF. MEILAENDER: Well, I just want to – I wonder, and I may be missing something here, but if we could stick a little more with my un-reformulated question.

You distinguish between a sort of mood that might be humanly intelligible. I have joy at the arrival of a loved one, say. You distinguish between that, which you call humanly intelligible and the mood that isn't so intelligible.

I just have joy because I've been programmed to have it, and I guess I still want to ask – See, what's so bad about having joy? Is there somewhere back in the kind of underpinnings of your view the sense that really I ought to feel a little alienated in some way in the universe, or just if you can just expand.

CHAIRMAN KASS: Unlike our visitors on the Prozac discussion, I'm not a friend of deliberate alienation. There's plenty of it in the world, thank you very much, without having to go cultivating it.

No, I guess the argument is that leaving aside the very real possibility that the basis of our moods are not only determined by fit responses to the things we encounter, but in fact might be determined by the intactness or fitness of our equipment unbeknownst to us.

I mean, some people are in fact given a good gift by nature, and then there's Eeyore and I think if one could do something for Eeyore I wouldn't be averse to doing it.

But having said that, it does seem to me that on the whole, we think – we'd like to think that our feeling states are somehow related to either our own activities or our own relations to the world; that we feel joy –

I mean, if somebody is medicated to, you know, feel joy at the World Trade Center disaster, you'd say something is grotesque, and therefore there's a certain sense of the fitness between the way we feel and the things of our experience without being doctrinaire about it and without saying, `I know in all cases what the fitting response is.'

There's room for a lot of variation, but it does seem to me that to begin to deal with the feeling state and the general mood state in a way that is somehow unrelated to the events of one's life is to sacrifice something of what it means to be in relation, properly responsive to, appreciating and feeling in the world and in relation to other people.

I think there's a lot of ambiguity there, I mean, I –

PROF. MEILAENDER: Just one more. I don't want to occupy too much time, but isn't – if you think of sort of completely pre-pharmacological era possibilities, isn't in a certain sense a description of certain philosophical attitudes toward life precisely that?

Doesn't the stoic, for instance, want to develop a certain kind of, in this case it's really a kind of an almost non-emotional response, regardless of what the events of life are?

CHAIRMAN KASS: That's a nice point, though. I guess I would say that that's not so much an attempt to produce a kind of apathy regardless of the events of life, but it's an attempt to somehow bring one's feelings into an alliance with what they take to be the deeper truth about life, which is to say that the only things which –

There are things which are in our power, and there are things which are not in our power, and there's absolutely no point, I think, in somehow wasting one's psychic energy on the things which are not in our power.

It's not a philosophical view to which I'm attracted, but I think they would claim that's precisely an attempt to move one's self in a fitting direction, they just don't see the world in the same way that other people do.

Very quickly on the other two points, what I meant by saying that, you know, someone who loads themselves up with medication and ceases to be in their right mind – and we don't have to go to drugs, we could start with alcohol – is somehow responsible for all of the things that happen as a result for having put themselves in that condition, but when people wake up the morning after, they say, "Gee, that wasn't me."

That people behave not in their right minds, or that there's somehow a transformation of who they are, and what happens to them is unbeknownst to them. Now, if you've done it enough times, I suppose – and you're one of these people who sits on your own shoulder and watches yourself undergoing these experiences, you can say, "Oh yes, I'm beginning to feel high now, and my speech is getting a little slurred, and now I can't really tell the difference between my friends and my enemies."

But for the most part, people lose themselves as a result of some of these agents, and that's partly what I meant by saying one puts one's self in the condition where one allows things to happen which are unintelligible, and that there is – I mean, granting there are occasions for joyous drink and all of that, but as a chronic diet, it would seem to me that one would have surrendered who one was to these things that work on you.

Now, the last question about germ alteration, I would also want to enlarge, because it makes trouble for the point of view that I'm taking here. In a certain way, the equipment with which we start in life is magically given to us. Right?

I mean, we didn't choose it, we don't really understand when we're born the fact that we have sensation or what it means that we see, that we smell. All these things are somehow part of the given-ness of things.

As was pointed out, actually, by some staff response to this, the given-ness would be a matter of indifference, whether it was given to us by nature, by God or by genetic engineers.

We would acquire a kind of equipment to start with which we would then exercise, and in a way without really understanding what we're doing. That is, my paper abstracts altogether from the kind of – much of the mysteriousness of human experience, and seems to talk more about its intelligibility and that we somehow can figure out what we're doing.

I think that's a deficiency. The only reason I think I'd stay with that is because I do think that, whether you believe it's evolution or whether you believe it's divine plan or nature, something like that, there is a way in which most of the ways in which we encounter ourselves and encounter the world around us and fellow human beings, the means and the ends that we pursue are to a greater or lesser extent accessible to us, granting that the original equipment might be mysterious.

To surrender even more of that to forces that just work on us and that we don't understand is, I think, to lose at least a partial grip on the kind of life that nature or God has given us.

That's, I think – So, I mean, the more I work on this the harder it is to simply say there's a line here, but I do think that the disruption of activity, the disruption of normal activity is, I think, an important aspect of what it is to worry about here.

PROF. SANDEL: Thank you. Paul, welcome.

DR. MCHUGH: Thank you very much. I had a number of things I wanted to say, and perhaps will go on too long, so you must cut me off, Michael. I found this article, along with Michael's article before, very fascinating, important.

I have great sympathy for it, and then I get very discouraged. I get discouraged, not because I disagree with any of these things, but I'm concerned that we're talking about a growing break between the higher culture and the common culture in our world.

That's affecting medicine as well as everything else. I went over this article very carefully and saw at least seven points that you were talking about.

I only want to talk about a few of them. In relationship to our hopes that the things which are common in our culture, the good can be lifted and made even higher by their expression.

To some extent in reading your article, Leon, I looked for examples of what are the problems seen here, and the problems that come from this issue of enhancement.

It led me back to those things that are – in which the higher culture and the common culture interlock happily. I'd like to draw a few examples of people, I think, that we recognize take from the common culture but make it higher.

The two that I want to remind you of are Cal Ripken and Frank Sinatra. Cal Ripken is different from Pete Rose, and Frank Sinatra is different from Elvis Presley.

Why is that? We'll start with Sinatra first. For Sinatra, Sinatra showed us – Sinatra's part of the common world, part of the common culture. He sings common songs, but he shows us what those wonderful music can be, and that's why we love him.

It's not just that Bobby Soxers screamed about him. I mean, I'm not a Bobby Soxer and I still listen to Sinatra. Why do I do that? I do it because he makes us aware just what the music can do.

Elvis on the other hand, the music was to make Elvis. That's why people say Elvis isn't dead, because he's an icon, okay? Elvis lives because – Sinatra is dead because he's a human and made music what it could be.

Elvis is alive because he's an icon and tried to make music make him. You don't sing many Elvis songs. You know, it's the same thing. You could go on in the music area. Louis Armstrong versus the Rolling Stones, Ella Fitzgerald versus the Supremes.

I mean, it's all the same. Why do we love them? They make the higher culture from the common culture. The same thing in baseball. What a wonderful game, and Michael and I spend perhaps much too much time thinking about it.

But it's the same thing with Cal Ripken versus Pete Rose. It was interesting, wasn't it, and problematic at the World Series that although the American people, the majority said that the greatest achievement was Ripken's achievement, the people cheered loudest when Pete Rose was out there.

I suppose I can understand that. But the thing about Ripken that I want – the little story about Ripken I want to tell you about. I shared it with Michael, but it's so telling, and it came when Ripken's stretch of games had come to exactly the point where it matched Lou Gehrig's.

People came to Ripken, lots of them, and said, "Cal. Stop now. The record is yours with Gehrig and that's enough." Ripken, you know, and to some extent you can see the sympathy of that.

I mean, the fact that Lou Gehrig had to stop because he had amyotrophic lateral sclerosis. He stopped because disease stopped him in his tracks. Ripken was going strong and could have celebrated, in a sense, that.

But he said, no, that would be very wrong. That would imply that I did this to reach this record. This record was the outcome of my desire to play major league baseball – play baseball at the major league level every day.

That's what it was about. I don't care about this record. I want to play every day. Showing us that the game is not there to glorify me. I'm here to show what can be done with the game, okay?

Now, the same thing now applies – Rose is another, for him, he could gamble, he could do anything, he could debase the game for his purposes, for all that he was – The game was for him and to make him what he is.

I can go on a little further. Medicine is intended to help us overcome an illness and to be what we are intended to be. To use it in another way is to take what we've discovered and misuse it.

But I'm not sure I could persuade anybody of this, because this is talking about, you know, the higher culture, and we live most of the time in the common culture.

We need to be sure that we're telling people what they're losing, because the higher culture ultimately is to bring us on – we might have to give something up to be in the higher culture, but it makes up for it in all kinds of ways.

The higher culture really tells us what can be done, and I'm quite worried that people aren't going to hear that, even as they hear what you have pointed out, things like family despotism at the expense of childhood, conformity and courage, the break with nature, the non-environmentalist aspect of this intrusion, the hostility towards replacement and ultimately, therefore, the hostility towards little children themselves, that we see everywhere.

We still see it. You know, you can't fly on an airplane with a crying child without the person sitting next to you squawk and holler, and I remind them that's Social Security, buddy. I mean, they're the people that's going to be working when I'm not.

(Laughter.)

DR. MCHUGH: They always say, "Well, I hadn't thought of that." I say, right, you know, they're going to be working so for God's sakes, put up with their crying.

I think I'm rambling a bit here, but just recently, for example, in relationship even to our other enterprises, look, we're at war now, and it's a terrible war, but now a couple of our pilots were given amphetamines to let them be more strong in some way, and they probably killed those – it may well have led to their killing the Canadian soldiers, which was extremely sad.

So, I end by saying I read both of the things you say, but this theme that maybe we're talking and could accept what was individual, then we begin to get disturbed when it becomes practice.

I think that's another expression of the fact that we lose in the higher culture when the common culture is not inspired.

CHAIRMAN KASS: Paul, thank you very much. You provide a much larger context. Whether people agree with you in the details of the choices is beside the point, is to recognize that to talk about this subject without paying attention to the larger cultural context is a mistake.

However, I think one should take some heart, for example, in let's say the concern about the steroid use in athletics. If one thought, and by the way it's somewhat surprising, because on the one hand one could say that there is a common over-emphasis on the mere achievement, regardless of how it's achieved.

There are certain tendencies in the culture, not only in sports but all kinds of places, where the accomplishment separate from the activity is all that matters. Granted.

Yet, lots of people are, in effect, bothered by the use. Maybe it's because, as Charles says, these people are cheating or that it's somehow unfair. But there's also the sense that, you know, this isn't quite the same activity, or may not be the same activity.

Sport, in fact, if I thought it wouldn't somehow embarrass us here to be giving more time to that topic, its seeming to be too trivial for our work, it would seem to me it would be a very good example, because that's one of the places in the culture where there really is a respect for genuine excellence and where you can often tell which it is, and not just by who wins, not only, and where there is a link between what's common and what's excellent.

On the one hand, the athletic heroes that one admires most seem to do things that are just superhuman. At the same time, they're doing the things that the rest of us can do slightly, if badly, and therefore we understand that there's a continuity between what is ordinary and what is extremely fine in the performance of ordinary things.

So, and I think that there's a certain way in which even the people who play sports in an ordinary way somehow understand that the pleasure of it is in the activity, and is in somehow the pursuit of some kind of excellence, and I wouldn't say that we're simply corrupt on this altogether.

The question is whether or not one can take advantage of those kinds of sentiments and, in a certain sense, some kind of worry that the ultimate uses of these technologies will be degrading in the sense that activity will be distorted and excellence will be lost.

That's just part of this.

DR. MCHUGH: Well, I agree with that, and agree strongly. I happen to think that sport is a very important part of human life, because it's a place where you can see human challenge without bloodshed.

It's the issue of you can see the hero and the emerging of human possibility in an arena that costs, ultimately, if you like certain games, costs people no injury, and therefore can show human capacity in this way.

I agree with you on the steroids very much, and it's discouraging. Although, you know, there's something to be said for the fact that there is a bit of turn-off about the home runs, for example, in baseball, you know, the old line, if you think it's a hopped-up ball, you haven't looked at the hopped-up ball players.

I mean, here we have a record of 60 home runs that lasted for multiple decades, and then suddenly we smash it again and again and again, and there's something, you know, very suspicious here.

It takes away from that, and so I think that – I very much want to use the model and imagery and symbolism of sport to talk to other people about the way we live other aspects of our life and see our excellence there and how we are cheating.

I agree completely with Charles that it's cheating to have these guys bulk themselves up.

PROF. SANDEL: Okay. There are a few people waiting, but I want to see if just on this thread, Janet, was yours on this thread?

DR. ROWLEY: Mine was on that thread.

PROF. SANDEL: Go ahead.

DR. ROWLEY: I guess the concern I have with the emphasis on the steroids is that my own assessment of academic, really, superior playing is that it's more than just strength.

So it's really coordination. You know, an outstanding tennis player, a Michael Jordan, for example – and I don't know whether he's an appropriate example or not, but coming from Chicago it's important that I at least mention him – that sports, ice skating, hockey, these do require strength, and if you don't have it you're at a substantial disadvantage, but that doesn't make you an outstanding player.

It's coordination and other aspects. A lot of it is skill and practice. So you just don't get it from the bottle, and so I'm concerned that we, in the focus on the steroids, we don't lose sight of the fact that there's a great deal of human values and skills still present in this.

PROF. SANDEL: I wonder if before calling on the others, just following on Janet's point, Leon, that I could just ask you about two specific examples that you mentioned in your paper.

I wasn't clear what you thought about them. Drugs to steady the hand of a neurosurgeon, or to prevent sweaty palms in a concert pianist cannot be regarded as cheating, but they are not the source of the excellent activity or achievement.

They may not be cheating, but are those objectionable, or they're okay?

CHAIRMAN KASS: Well, if I'm forced to say objectionable or okay I'm going to say okay. I'm not sure that the things should be –

PROF. SANDEL: Well, the reason I ask is do they violate the norm that you emphasize about human activity – intelligible and transparent and working with one's initial equipment and not being mysterious and magical and passive.

CHAIRMAN KASS: No, I partly said that – I don't have the place exactly, page what?

PROF. SANDEL: Thirteen.

CHAIRMAN KASS: These are side matters that somehow get in the way of the fundamental character of the activity. It's not somehow intrinsic to being a neurosurgeon that you've got shaky hands or that a pianist would necessarily sweat.

These are things which are adventitious. They occur in some individuals, and here's an opportunity, in fact, to blunt the noise and let the activity flourish.

I don't think one has fundamentally altered the activity that one has engaged in, or the satisfaction that comes from it just because one has blocked out these distractions or these things which get in the way.

PROF. SANDEL: So the shaky hand of the surgeon is a distraction. What about a drug not to steady the shaky hand, but to make the hand somewhat more dexterous?

CHAIRMAN KASS: Well, this, I mean, here Janet's admonition is somehow valuable, that almost all of these activities that we value are not unidimensional.

They're not just the function of body parts. There's the question of desire and attention and if we're going to do a kind of analysis of all of these things and find out, well, there's this piece which you could enhance slightly and you can take me to the next one, and before you know it I've given away the entire activity and we've got some kind of – the equivalent of some kind of little demon who's inside of me who's doing this.

At some point maybe I'll say, you know, I've gone too far with this agreement, but let me concede that there will be a whole series of such intermediate cases that I'm going to be able to justify and say you haven't yet, somehow, corrupted or perverted the activity or taken it away from the agent whose activity it is.

But I think you'll cross the twilight and at a certain point you're going to be in darkness, and it will be a very different kind of thing. This is not an area, I think all of us would agree this is not an area that comes with bright lines and "thou shalt's" and "thou shalt not's" and "this is degrading" and "that's improving."

A casuistry is needed, and yet if this paper has any value in it, at least it would be to call attention to the kind of thing about which we should be thinking when we think about the continuity of the continuum.

PROF. SANDEL: Right. Just on this issue of the continuum or the range of examples, Charles, is it on that?

DR. KRAUTHAMMER: Yes, it is, if I could just pick up. In the example that Michael brought up, it seemed that to me the distinction between the steadying of the shaking hands and the increase in dexterity would be a distinction between what you might want to call therapy on the one hand and enhancement on the other; suppressing a defect as opposed to creating a capacity.

Now, what was most interesting to me in your paper was your rejection of that notion, that bright line between distinguishing between therapy and enhancement, and you pointed out all of the difficulties in doing it.

But I wonder, since intuitively we might say, keeping the surgeon's hand from shaking, that sounds okay. Making a surgeon of Rank A into a surgeon of Rank A+ with a drug, that sounds a little bit like what we're deploring.

It would seem to me that the reason that we intuitively say yes to A and no to B is that one is what we would think of as therapy, correcting a defect, and the other is enhancement, creating something new.

It seems to me that if you take away that notion of the distinction between therapy and enhancement, between disease on the one hand and sort of superhumanity on the other, you have kind of disarmed yourself intellectually in this discussion.

I'm not sure you could carry it through without that distinction, given all of its problems.

PROF. SANDEL: Do you want to take that on now or after you hear some other?

CHAIRMAN KASS: Let's go with some more.

PROF. SANDEL: Okay. Robby?

PROF. GEORGE: While I'm having trouble resisting just getting involved in the casuistry with you guys, but let me see if I can force myself, too, to raise the point that I had actually raised my hand about.

Although it will take us away, Michael, I was going to raise a completely different and a lot mushier issue, so if you want –

PROF. SANDEL: All right, well is there anyone else who wants to pitch in on the casuistry? Go ahead, then.

PROF. GEORGE: Okay. Leon, as I was reading sections three and four of the paper, an issue occupied my mind that's completely different from anything we've raised heretofore on the Council, but I wonder if you've given it any thought and if you have anything to say about it.

As I say, it's somewhat mushy. It's this. There seem to be some values and virtues, and perhaps what even might be called attitudes, that individual people, or at least families or units of society, as distinct from the larger society as a whole, are capable of understanding, seeing the point of, practicing, even if sometimes with difficulty.

Virtues and values aren't always easy to live up to or to exercise, in the case of virtues. But there seem to be other values and virtues, and I should think attitudes, and perhaps the attitudes that you're commending, sometimes, as the opposites of those that should be rejected, like the attitude we take when we regard our lives and aspects of our lives as gifts, which it's extremely difficult for an individual or even families to get hold of, to understand, to see the point of and to practice in the absence of a larger culture which formally through its institutions and informally through its public opinion and habits and so forth, is supporting.

The example that I'll borrow – I hope it's useful – I borrow from Joseph Raz, the Oxford legal philosopher who talked about this issue in his 1986 book, which was called The Morality of Freedom.

His example was monogamous marriage. He said monogamous marriage, assuming for the sake of argument that it's the uniquely valuable form of marriage; that it's the morally best and right form of marriage, Raz says that monogamous marriage can't be practiced by an individual or by individual couples.

No, he says, rather, it requires a larger cultural structure that supports it through its public laws and policies and even more importantly, perhaps, by its informal attitudes.

Now, I take Raz to mean there not that a society that does not value and practice a widely practice monogamy, it would be impossible for a man to confine himself to a single wife, or a wife to a single husband.

It doesn't mean that. Obviously, that would be possible. He's not supposing that it would be made against the law to take only one spouse. I think what he means is that individuals would just have an extremely difficult time working from scratch seeing the point and value of monogamous marriage in the absence of a culture that gives them a sense of that value and of the virtues associated with it and needed for it to flourish.

If you're trying to just reinvent the wheel – it's not as if you can't actually construct a pretty rigorous argument in Aristotelian fashion, perhaps, for monogamous marriage, but it will simply seem a kind of sterile argument, a kind of casuistry that people will, whether they can find some logical flaw in it or not, not really be able to make use of in getting a grip on this good, valuable thing.

In reading parts three and four of the paper, I was thinking, you know, the attitude that you're here holding up, and the attitude that Michael held up in his paper at the last meeting, might be just that sort of thing, that this is not a matter really of individual choice exclusively, but the kind of thing that's inherently a gift.

The attitude itself, a gift, made possible, not made certain, but made possible by a culture that provides the resources for it by that kind of formal and informal support.

CHAIRMAN KASS: This is a continuation of Paul's comment in, not speaking about the higher and common culture, but speaking about the world understanding of the culture as a whole.

I think one of the – although I found that Michael's analysis, though welcome, thought it didn't go far enough. He did go in a way to the extent to which these more philosophical questions of goals and means can be dealt with at all, it might only be possible if one has a culture that shares a certain kind of attitude with respect, for example, to the issue of appreciating and savoring as opposed to trying to master and the like, which is why I think beginning with attitude is not just to be set aside, but there's something primary about that.

Michael, at the end of his little paper, hinted that the roots of this matter might, in fact, be with a certain turn in Western thought, both about the nature of nature and about what our attitude toward it should be, and that perhaps we need to rethink that.

I wish him lots of luck. I would like to do it too, and to do it without sacrificing all the great benefits that all of us have as a result of this turn. But, no, I think you're absolutely right, and there are lots of things in the culture that stand in the way of getting to these kinds of questions, even if one wanted, even if one could do it intellectually.

On the other hand, and I really do mean this, I do think that when people look at some of these biotechnological developments and the world that they might be producing for our descendants, yes, some people are worried about the ethics of the means and the questions of the sanctity of embryonic life, but some of them are really worried about the question of what would human activity be like and what would human institutions be like.

The power of the novel like Brave New World is that it at least – it evokes those kinds, still evokes those kinds of concerns. So, I'm, at least for myself, not willing to turn my back on this culture and declare it as being incapable of resonating to these sorts of things, because I sense the people's worries about those matters.

I mean, sure, there are prophets who say, look, the post-human future will be wonderful, we should go there. Evolution has in fact made it possible for us to take the reins of our own destiny and to produce something better than human beings.

But I think that the people as a whole are concerned about this, and public bioethics has yet, I think, to give voice to that concern. That's part of the justification for working at this difficult project, because I do think it touches some of the really deepest questions.

What kind of a world will these technologies produce if they were allowed to develop in their own way?

PROF. GEORGE: A brief follow-up Michael?

PROF. SANDEL: Yes, go ahead.

PROF. GEORGE: Leon, I certainly agree with that. I wonder if the strong libertarian streak that we Americans do pride ourselves on and which has served us very well in very many respects, and which foreigners often comment on, does provide, though, a particular challenge to seeing the problem, because we're always tempted to believe that we can solve these things, handle these issues as a matter of individual choice and sometimes, then, fail to see the respects in which they are inherently and profoundly social.

Still matters of choice, there's still choosing that needs to be done, but social and not entirely individual.

PROF. SANDEL: While we're still in – I have Bill and Frank waiting and then Gil on the issue of shaping attitudes and the moral culture. Were there people who wanted to speak to that before we moved on to others?

Was yours on that, Gil? No. Okay, in that case, Frank and then Bill. Oh, Bill, I'm sorry.

DR. MAY: Well, several comments now. First, you give us directly the quote from Montaigne, "The Hymn to Aging," and the benefits of that, "led by nature's hand down a gentle and virtually imperceptible slope towards the grave."

You quoted this at an earlier meeting, and I'll repeat a comment I think I made at that point. There's certainly a truth to that, but I guess I've had more powerful sense of readiness for the grave with a sense of work completed.

I'm acutely unready for it when that book is not yet written or almost finished or something like that, and I think more generally in life people sense when they've got those children grown and they're no longer taking in water out in the harbor, but they're rolling along in the seas, a sense that their work is done.

Yes, I suppose signs that the castle is crumbling also prepares us, but it's not the indispensable way that we are prepared for our mortality, it seems to me. That's the first point.

The second relates to what Frank has said. I mean, there are stretches of this paper that is perfectly beautiful. The closing coda is a very beautiful paragraph indeed.

Excuse me, Paul's comment about the distinction between the high culture and the common culture, the low culture, and one begins to wonder whether we're talking about stuff that is susceptible to policy-making and legislating or we're talking about things where the appropriate mode of relationship is education.

I'm a little bit hesitant about the distinction high and low, because its fineness and crudeness or sensitivity that doesn't necessarily relate to what we think of when we talk about high and low.

Last comment you offer is on a very previous – and appreciative conversation with Michael Sandel on the question of mastery and giftedness. I simply would be very interested in hearing from our temporary Chair what his response might be to those sections of your paper that refer to Michael Sandel's comments.

CHAIRMAN KASS: Could I do something quickly on the first and then? I'm very eager to hear, also, I'll only deal with the first comment. It's very interesting, it was interesting when we had our people on aging research present at the last meeting.

I had occasion with Dr. Austad over dinner to pursue the question with him further. The degree to which they regard life sort of like a time line having no shape, but you could add increments to it as if it had no form of its own; that it was either going to be more of it or less of it or a lot more of it, or something like that.

What I was in a way arguing for here, are a number of things, that to really think that – to take seriously finitude not as just a curse, but as – and none of us will ever know exactly in advance what the shape will be like, and I certainly don't want to romanticize the end of life the way many people now have to go through it. That should be said.

But to perceive one's life as time, the extension of which is to be regarded homogenously, as if it were just a variable in physics, rather than to see it as part of something that has a shape and a trajectory and a form, I think, is a kind of distortion of what the truth about things is.

Partly in the quotation from Montaigne, one does begin to see, you know, as my friend Joseph Epstein said, "I look in the mirror and I say to myself, where did I ever get such a turkey neck?"

You know, and he's beginning to see that there are certain kinds of intimations. That's not the whole story. The other thing has to do with the perception of time future, and whether or not you think that there is always going to be tomorrow, which one is going to be encouraged to do if there are no intimations that things are slowing down, then it seems to me one also misperceives the shape of a life and may not even have the same kind of attitude toward having a project, finding something to complete, having a family, doing these various kinds of things that are somehow tied to the trajectory of a life.

So I didn't want the Montaigne thing to stand alone. I think one wants to talk about both readiness for finitude, as well as the perception and uses of time in the early part of life, which is a lot – we'd look upon it very differently if you thought it was extendable indefinitely, than if you thought you were on the way up, or that you were at your peak, or that you were now part of the generation that was supposed to make way.

Michael, please?

PROF. SANDEL: My response to Leon's response. As I understand it, Leon's reply on the point about mastery, leaning against mastery and cultivating and appreciation of giftedness.

As I take it, Leon accepts the critique of a certain Promethean aspiration to mastery, but goes on to make the point that simply to assert as the rival norm giftedness or an appreciation for the given is indeterminate.

It's indeterminate in the sense that it doesn't tell us by itself which things can be fiddled with and which should be left inviolable. He gives the example of smallpox being among the things that are given, and simply because it's given doesn't mean we should acquiesce in it and not intervene to confront it or even to eradicate it.

I certainly agree with that. I agree that the notion of giftedness or restraining the drive to mastery is indeterminate in the sense that it doesn't by itself specify what things we should try to alter and what things we should stand back and simply appreciate or savor.

Though I'm not sure that any norms at this level of abstraction, no norm in this range would be determinate, I think. But then the question arises, well, then, how do we go about deciding.

Here I think I would agree with Leon, that we have to assess the worthiness of the ends, the goodness or badness of the givens that we step back to contemplate or to reflect on, possibly to appreciate, maybe to try to eradicate.

So then the question is, well, all right, if we agreed that we have to reflect on the goodness of the gifts, not all gifts are ones that we would want to simply affirm or leave in place, what's the source of those moral judgments?

I agree the source can't just be an invocation of the idea of the gift. I think there is a certain conception of a good life for a human being implicit in the general account.

It's one that Bill May brought out last time when he was giving what I took as a sympathetic elaboration that there's a tension between the molding and beholding, Bill's language, between the shaping, the intervening and the savoring, and it seems to me the account of the good life that this gestures toward is one that says we have to hold in tension these two stances toward the natural world and toward ourselves.

It's not easy to hold them in tension, especially when we live in a culture where the drive to mastery is so predominant that it crowds out the other sorts of attitudes and appreciations.

So there is a kind of norm there. It's a norm of a certain kind of life, a certain kind of goof life. It's not, though, one just specified in those general ways that will help us say, well, what should we alter and what should we accept.

But here I think we have to look case by case. Here's where I don't think we can expect a global answer. So, for example, we could look at smallpox, and we have to investigate whether smallpox, despite the great damage it does to human life, is there some, nonetheless some very important end that we should respect in preserving it, and if there isn't then we should eradicate it.

We have to have a local examination of each case. When we come to sex selection, we have to say, well, here's a case where the drive to mastery seems to be getting the better of us, but is there some important human end that's served by specifying the sex of our children.

If we can't give a good answer to that question, then that would be a case where that would be a good reason to restrain the drive to mastery. Is some important, crucially important end served here?

Whereas in pre-implantation genetic diagnosis to screen out dread diseases, there we might say, yes, some very important human end is served here. So we have to go case by case. There has to be, it seems to me, a local, particularized moral inquiry in order to make determinate this general account of where the culture seems to be going wrong in the drive toward mastery.

I don't – and here I have some questions maybe for later about what I take to be the other account, the other normative account, Leon, in your paper, which emphasizes this kind of undivided, transparent, unmediated relation to one's own activity.

Insofar as that's attractive, I don't know that it's more determinate than the other kind of standard, and I'm not sure I fully understand the moral weight of it, so I'd like to ask about that.

But this, maybe we should put that off. I think we do have to assess the good of the given. I agree with that, but I don't think we can fully specify the good of the given just in general.

I think we have to deliberate and engage in moral reasoning case by case with respect to each practice or given that we would alter.

DR. MAY: May I add a word on the question of gift which you talked about. In my limited experience with actors and singers and so forth, I so often realize that there's really a double gift.

One is the gift of the talent, and the second is the gift of the psyche to support it, and oftentimes you have an immensely talented person, but the psyche to support that, in performance particularly, and all the acute anxieties that can go with performance.

Now you face an interesting problem with regard to range of normal and so forth. That person's psyche could cope with normal functioning in life. It's in the setting of the stage that there are demands upon it that they're not able to support.

Now you've got an interesting problem. Do you offer medical treatment to sustain the psyche in this particular task, when in fact, in so many ways, the alternative would be to walk away from it?

But in walking away from that second gift, the gift of the talent, then, yes, they can function, and it's within a range of normality, but there is also an enormous loss associated with that walking away from something that you've been given.

It seems to me this is a range of complication in that discussion.

PROF. SANDEL: Just on this, Paul?

DR. MCHUGH: Just to finish off your comments, Bill. I just wanted to make the point that I didn't use the word "low culture." I used the word "common culture," and I'm in favor of common culture because we're a part of it.

I want the higher culture to lift it, and my problem now with what we're talking about in the examples I gave to you is that I think that music deteriorates in the common culture into Elvis. Okay?

I don't want to see medicine deteriorate into Dr. Feelgood with his shadowy cousin Dr. Kevorkian, because that's the way it will go.

PROF. SANDEL: Frank?

PROF. FUKUYAMA: Well, Leon, you mentioned that there's a whole social dimension to enhancement that you don't really deal with in the paper. I thought I might say a little bit about that, because actually, to me, that's in a way the most threatening aspect of enhancement.

I think that it's actually an argument that you can present in a straightforward way that is fairly clear to people, although I really like the paper and I think the discussion it stimulated indicates how useful the paper is.

But let me just lay out a framework for thinking about when you scale this up to the level of societies, what's wrong with enhancement. One obvious problem has to do with so-called positional goods, or goods that have to do with status, in which you're basically involved in a zero-sum game with other members of society where a gain for you is a loss for others and vice versa.

Now it seems to me many potential objects of enhancement involve these kinds of zero-sum games. Height is a perfect example. Being of shorter than average stature, I know perfectly well that there are lots of disadvantages to that, and all sorts of opportunities that I haven't had that I would have had if I were, you know, six foot three.

But that's not an absolute good. If I had been born in the year 1500, or you know if I had been born in Japan or some other place, that disadvantage wouldn't have accrued to me.

Robert Frank actually, the economist Robert Frank has this wonderful book called Choosing the Right Pond, where he points out that actually many economic goods that we think of as absolute goods are in fact positional goods, or some of them are actually mixed, so that you may want that Masarati because even on a desert island you just love the look of the carburetors, but you know, many people also like the fact that their neighbor has a Jaguar and they can one-up them.

So the motives are fairly complicated, but there is definitely going to be one class of enhancements that will be positional goods, and the typical solution to this kind of arms race situation is actually for a public authority to intervene and simply say, look, you just don't compete along this dimension because in the aggregate, although you can have individual winners and losers, in the aggregate nobody can win this kind of game.

So that, I think, is fairly straightforward. A second category of issues has to do with public bads, or negative externalities, or, you know, we've dealt with this already.

I would think that actually much of life extension falls in this category. It's of obvious benefit to an individual to have another ten years of life, even ten healthy years, but it seems to me, on the whole, it's not good for society as a whole.

I mean, there are a number of reasons why this might be true. I think actually things like innovation, change, adaptation to new circumstances actually goes on generational cycles, and if you lengthen the length of generations, I mean, you wait for Franco or Castro to die or you wait for the Depression generation to get out of the way so that you can actually spend money instead of putting it in bank accounts.

This sort of thing. I mean, all of these things slow down dramatically, which imposes a cost on society as a whole, even though every individual in the society would individually want that extra ten years of life.

So I think that that's one appropriate way of thinking of that. Now, the final problem, I think, has to do with the problem of social control and social engineering where one group of people will attempt to use enhancement technology to shape the behavior of other members of the society.

Now, and this has already come up in our discussion of Ritalin, which it seems to me, if Dr. Diller is right, that seven out of eight children being prescribed Ritalin actually don't have – aren't being prescribed it for therapeutic uses.

Then in fact, most of the use of that drug is really as an agent of social control. This actually then gets back to I think the issues that you raise in your paper.

What's wrong with social control? Well, the answer is nothing in itself. Parents try to socially control the behavior of their children. It's called education, socialization, so forth.

You don't want them to grow up as criminals. You want them to put off short-term gratifications for long-term ends, and all of that. So we do that all the time.

What is wrong with this class, this potential class of technologies that may permit new types of social control that we haven't seen? Here I think you end up bringing back a lot of the considerations that are in your paper that have to do with wholeness and integrity and in a certain way the complexity of a whole human being, because I would say that the biggest problem with most attempts at social control and social engineering are that they are based on an oversimplified model or understanding of human behavior that does not understand the complexities of human motivation, and therefore when they try to push on this one lever thinking they're going to solve one problem, it comes out somewhere else because they don't understand that actually all the levers are connected to one another.

This, in fact, is actually one of the – would be part of – I asked you the other night. I was asking you what your answer would be to the Darwinian, you know, talking about giftedness and if you don't believe that God gave you all these characteristics as a gift, then presumably the other big alternative is that evolution gave it to you.

You can say, well, if that's just a snapshot in evolutionary time what's so great about that gift and why do we have to defend it. I guess my answer to that question would be that actually evolution created a whole human being whose – and the interworking of the different parts make an adaptive sense that's extremely complex and that we don't perceive many times.

So that, for example, many targets of enhancement like hatred, competitiveness, violent aggression, all sorts of propensities that we don't like actually are there for good evolutionary reasons, and they're linked to things that are very positive.

We deplore our group-mindedness. We always divide human societies into insides and outsides, but if you think about it in evolutionary time, if we didn't do this, we wouldn't be the social species that we were, and it's very hard to separate the good aspects from the bad aspects.

Some of those are simply unsolvable, I think, dilemmas of social organization. There's actually a lot of game theory that's quite interesting in this regard.

There's this game in evolutionary game theory, hawk and dove, where you have a population of hawks that are predators and doves that are peaceful minded, so forth.

It turns out that given – I mean, it depends on the starting behaviors of the populations, but the doves who cooperate but are very passive don't win, but the hawks don't win either because in a way both the hawkishness and the dovishness, when scaled up to a social level, have kind of off-setting advantages.

So as the game is played, you actually get a mixed population of hawks and doves, and so both of those characteristics are actually adaptive in a certain sense.

It seems many human characteristics are like that. What I see as the single most threatening thing about enhancement technology is that somebody is going to say, `Hey, great, we can change this particular obnoxious characteristic of human beings that we don't like.'

If it's not totalitarian states doing it, it'll be some school district or some group of parents that gets it in their head that girls should be less feminine or boys should be some other way, or some other thing.

Maybe it's just the opposite. Maybe in some point they'll want more feminine girls and more aggressive boys. Whatever, but it seems to me that it's almost inevitably the case that if, in fact, all of these human characteristics are bound up in these extremely complex wholes, where the good things are inevitably linked to the bad things, that virtually any intervention like this, using these new, more powerful technologies is almost always going to lead to unforeseen consequences.

I really think that that's the issue of hubris, when people – it's not the hubris of the method bringing modern science to bear to try to achieve these ends, because we do that all the time through all of our other technology.

It is the hubris of thinking that we understand this, you know, especially the interrelationship of human emotions into a whole human being, and that we understand how those interrelate and how the good emotions relate to the bad emotions well enough that we can intervene and manipulate to make people ultimately happier.

So I guess that's my overall sense of the lay of the land on the social side of this, what's wrong with this stuff.

PROF. SANDEL: Could I just make a comment to Frank, and Leon, you can feel free to react or to leave it till your full reaction. What you're doing in explaining what's wrong with enhancement essentially is translating all this talk about the moral objection, trying to locate the moral objection, to translate it into problems of social organization or evolutionary complexity.

In a way, what you're – and maybe you're right, but you're making a radical suggestion that the whole moral inquiry is misplaced or misdirected. You are really, because all of the, as I listened, tell me if I'm wrong, as I listened to each of those four reasons to worry about enhancement, all of them – none of them has to do with identifying anything intrinsically morally objectionable in the enhancement.

It all has to do with adverse effects on social organization or misunderstanding evolutionary complexity and therefore giving rise to unforeseen consequences.

Do I have that right?

CHAIRMAN KASS: Don't agree. Look, this goes back to an exchange that we had at the last meeting where you listed a number of things and, you know, deformed human life, it would do this, that and the – but where's the moral problem?

As if the moral problem was simply is it objectionable in itself, is it good or is it evil. Frank is talking about things that would transform the character of human life for the worse.

I take that to be a moral comment, and not merely an operational one. It's not a moral objection in terms of thou shalt and thou shalt not. It's a moral objection in terms of the greater good and the lesser good, if I'm –

PROF. GEORGE: Well, but I think Michael's entirely right to notice that lurking there in the background, behind the considerations that Frank raised is some judgment that Frank must have in his mind that enables us to distinguish the good from the bad or the greater good from the lesser good.

It's the kind of thing that I think just has to be teased out. It's not that there's something wrong with Frank's analysis necessarily, it's just incomplete until we get to those considerations which are plainly there in the background, but are hovering in the background and naturally they interlock, you know, what are they.

DR. KRAUTHAMMER: Or to put it another way, perhaps to harmonize it with your analysis, Leon, which is very individually based. I think what Frank is saying is that if you – it's rather difficult to see what's essentially wrong with enhancement in an individual.

You try to tease it out, because intuitively it seems like a good idea. What Frank is saying is that when you aggregate it, then you can see it much more clearly.

I'm not sure that there is a contradiction between the social analysis and the individual moral analysis. I think the social analysis helps to illuminate the moral analysis by saying that if you do it on a societal basis then it jumps out at you how distorting and dehumanizing these activities are.

PROF. GEORGE: Distorting and dehumanizing will be concepts that are intelligible only against an understanding of the human. The understory of human flourish –

DR. KRAUTHAMMER: No one is denying that. Everybody is –

CHAIRMAN KASS: Everybody who's spoken I think agrees to that.

PROF. GEORGE: Well, I think Michael was saying to Frank – Michael, you can speak for yourself, but I think what he was saying to Frank is not that he was denying it, but it was just left untreated.

CHAIRMAN KASS: Unspecified.

PROF. GEORGE: Right.

CHAIRMAN KASS: Right, okay. Yes, well, in fact, in the paper, I mean, in terms of the ends, which I've lifted up to view as the ends that seem to me to be most likely candidates, attractive candidates for personal use, namely ageless bodies and a certain understanding of happy souls or at least not unhappy souls.

When I came to try to make the case against what might be wrong with the pursuit of ageless bodies, I thought the only way you could begin to show that, in fact, was to aggregate the consequences and have a look at what it would like if that were the practice of a population as a whole, in the mirror of which we might be able to see how it might be deforming for any given life to live in a world like that, and that only by somehow aggregating the multiple choices and picturing what that means, both with respect to the perception of time, the shape of a life, and various other things that do touch.

I did admittedly, not with much precision, listed a number of things that I thought to be fundamental human goods that were at risk here. I mean, I don't think, having read some things of Frank's, I think there are things – I think he could, if we stopped speaking, let him speak, he could sort of fill in that content for himself.

I mean, there is some sense of human nature, not something absolutely inflexible, but nevertheless the activity of which and the flourishing of which is what one is trying to defend here, and the attempt to somehow improve it by piecemeal intervention without regard for the complexity of the whole of it is to run the risk of degrading ourselves, not just getting things to go wrong.

Am I?

PROF. SANDEL: I've got – Now, we're going to end at 3:30 or after? We started late.

CHAIRMAN KASS: Take five extra.

PROF. SANDEL: All right, because I still have, I've got Bill and Gil and I was tempted to take one more crack at this issue, but maybe put that aside? No.

CHAIRMAN KASS: Go ahead.

PROF. SANDEL: It seems to me there are two different ways in which aggregating consequences can help us better understand the effect of some of these practices of enhancement.

The way that I understood, Leon, you to be aggregating consequences in order better to see the moral defect was if we imagine, when you invite us to imagine what would happen if people didn't age, but just suddenly died, and wouldn't this have the effect, if you imagine it aggregated across a society, of changing certain important practices and understandings that we have.

So that's aggregating consequences in a way that highlights the moral defect of the practice. It transforms our relation to one another, the relation between the generations deforms, relations of parents to children and one's own self-understanding.

There's a second way of aggregating consequences to show what's wrong with enhancement that doesn't aggregate in order to show here how morally we would transform ourselves, but instead shows here if you imagine the arms race, it wouldn't work, morality aside.

The example here is Frank's first example about enhancement to increase height, where parents could go and get growth hormone to have their less than average child lifted up.

But then if we aggregate that, Frank points out, and imagine everyone doing that, why then it wouldn't work. There'd be an endless arms race. People would have to go back again and again just to try to stay ahead as the average height increased.

Now, that's an argument against enhancement that appeals to aggregated consequences, but at no point did those aggregated consequences highlight the moral objection to the enhancement.

They have all to do – this is what I meant by emphasizing the social coordination problem of the endless arms race – it simply wouldn't work to achieve the individual aim.

PROF. FUKUYAMA: My first two examples are completely utilitarian. That's right.

PROF. SANDEL: Rebecca, quickly on this and then we'll go.

PROF. DRESSER: One methodological point. It seems to me as a public bioethics counsel, our strategy is best to bring in all these different considerations, because we have this problem of convincing others, including the common culture and physicians and so forth.

So I would rather use these in an additive way and that's one thing I liked about our cloning report.

CHAIRMAN KASS: We agree completely.

PROF. SANDEL: Okay. I have Bill and then Gil.

DR. HURLBUT: When I read this essay, I was – I wholeheartedly agree with the central insights of the essay, but as I was reading it, I was asking myself what is this happiness going to be like that you're hypothesizing?

Indeed, what would agelessness be like? Well, starting with agelessness, it certainly isn't going to be the overcoming of death, because there would always be the possibility of death from accidents or homicide.

So that's going to linger over us like a shadow for sure. Then, what would this happiness be like? Well, the happiness can't be a static state of comfort, because creatures as complicated as human beings are made happy by something that is dynamic in the ability to meet an ongoing series of possibilities.

It's an open phenomenon. So I was asking myself what enhancements could lead to such states? Even if you hypothesized they were possible, what would these enhancements be like?

It all came back down to me to a little bit what Frank was talking about. Well, where did we come from, what are we for, and the question of what does happiness mean at all.

Looked at from one perspective, happiness is an agency of evolution. It's related to drawing us into that which is good for us as organisms and for evolutionary process.

Looked at another way, happiness is that blessed possibility given to us by whatever it be, God or evolution. In that sense, what it seems to me is at stake here in the very center of the core of this is the question of the meaning of the natural.

How does happiness relate to the given world? Its human dynamics, its dependencies, its modes of creative extension and so forth. You defend very well in your essay and you illuminate the notion that being at work in the world as we find it could be very crucial to our happiness; that it's not just as we find it, but as we could be perfected without ceasing to be ourselves in the process of it.

So, when I started looking at all that together, I don't know if this connects easily, because it's a hard thought to get at, but why are we as we are and what makes for happiness?

It struck me that we are as a creature a general purpose organism, a best balance of body, mind and the real world such that we have certain qualities of freedom and open-endedness, and that all of these enhancements are in some ways self-limiting.

They are taking us off – not up higher, but taking us beyond the top of that which is our most central quality of human nature. This is a hard thought.

I don't know how to say it easily, but when I think of what would you do these enhancement projects for, I ask myself, well, why would you do these interventions against given nature, and even when you consider there's a risk involved.

The first one that comes to my mind is the trivial uses of them. The sort of indulgent pleasures or whatever it might be, what's been called "free play", a kind of indulgence in aesthetics of the body or some superficial contentment, which is sort of like what Nietzsche called pitiable comfort, that trivializes human life.

One can see right away why that's wrong. The other one would be competition. That seems to me to be – that has a little more bite. It is a giving over to another natural impulse, so we're losing ourselves in a way that way too.

But the third one that struck me is noble purposes. When you look at what happiness is, you clearly aren't going to get happiness by taking a drug.

The whole of the unfolding of life is a process of removing us from the level of the basic molecules of determinism into an arena of agency where there's a rising scale of indeterminacy, of freedom that's emerging.

So there's no magic carpet to happiness or contentment. Contentment actually relates in some strange way to the process of life. It's like, maybe you could change the dye a little bit, but that wouldn't change the – it's like, if life is a Persian carpet, you might be able to change the dye temporarily, but life's happinesses are actually the pattern put in one knot at a time through living.

In that sense our happiness is related to ideas, concepts, cosmology, not to the color but the pattern of life. So what pattern of life would give us the meaning that would, in fact, be happiness?

I don't think the self-limiting that would be involved in the trivial or the competitive would do that, because I just don't think they would. I don't think there's any way to engineer those kinds of things.

But what struck me in this is that there is a way where – there's an amazingly interesting thing about all this where the meaning of agency is also connected to the deepest happiness.

Where – and this is where the triviality of the individual or the competitive quality actually are solved. Where the individual and the community meet. This brought me back to Hans Jonas' essay that we read at the beginning of this project on enhancement.

It struck me that there was something profoundly beautiful and true that, as he spoke about the meaning of human experimentation, and he spoke about that devotion, that dedication, that sense of true sacrifice from the highest devotion, and how it's absolutely free.

The sublime solitude of dedication and ultimate commitment away from all reckoning and rule into a whole different sphere. That struck me as the thing that's the highest extension of this quality that Leon speaks of as being at work in the world and being perfected through an agency that keeps us – that moves us toward perfection, but also keeps us, preserves that inner essence of what we are.

That struck me as the one place where enhancement meets. This is a very hard thought. I'm not sure I'm getting it across, but it struck me, that's where enhancement meets and coordinates with this true human meaning.

It's – You can see how you could use enhancement as a surgeon, or maybe for some explorer, exploration or artist. All these involve that dedicated devotion, but they engage the full human faculties, and they increase dignity.

They all have an element of giving, of being used up, and this is where the meaning of the natural seems consistent and the other uses of enhancement seem inconsistent.

That was a very hard thought. I'm sorry if that was so wordy, but I think there's something in there.

PROF. SANDEL: Gil? We're running close. Why don't, Gil, you make your comment and then Leon can respond in general.

PROF. MEILAENDER: Okay. I had two points. The one is just a very minor quibble, the other Frank's having rubbed your nose in social realities, I want to get you to think about something very ethereal.

The very minor quibble, I want to make it, even though you understand that I think this is a great paper. But very near the start, on page two, you contrast what you're going to take up – or you say it will get us beyond our narrow preoccupation with the life issues.

I'd just like to encourage you to find a different formulation. It's a different preoccupation, but there's nothing narrow about seeking to honor the time and the place that every human being has.

DR. KRAUTHAMMER: He meant endless, not narrow.

PROF. MEILAENDER: Oh, well.

(Laughter.)

PROF. MEILAENDER: He may have meant narrow, but this is an old conversation, but I wanted to encourage you. Now the other point. I want to see if I can get you to think about heaven, because in your wonderful last section on dubious ends, you make various kinds of claims that we need our finitude to make possible the best things; that the very prospect for human happiness requires the possibility of deep unhappiness.

You say things like that, and that might not make too much difference if you didn't say in your last paragraph that the life that you've described is a life that stretches towards some fulfillment to which our soul has been oriented.

The question would therefore be whether – what one would mean by such fulfillment, whether we can conceive of fulfillment that is only destructive of the best life, as you've described it, or whether we can conceive of fulfillment that would somehow complete it and be fulfillment in that sense.

PROF. SANDEL: Gil doesn't like the Greek flavor of this, Leon.

CHAIRMAN KASS: Or Hebraic.

DR. MCHUGH: Can I just finish up one other thing before? I just for 30 seconds want to remind you that what we're doing in a sense is some people would say reinventing the wheel as we look at the problem of beholding and the tension with it that you make with transforming, because there was a person in education that saw those two things and brought them together, and that person is Maria Montessori who you remember had as her theme the biological concept of liberty in pedagogy.

She said that the child must be free to act spontaneously, but should fit an environment that's ready for his spontaneous action, what she called auto-education that we need to work with, with the idea that growth should be enjoyed, beheld, but at the same time helped in ways that speak to liberty.

Her work is something that we should remind ourselves of whenever we are thinking that maybe no one ever thought of these two things and bringing them together successfully.

PROF. SANDEL: Thank you. We'll give Leon the last word.

CHAIRMAN KASS: I should be brief. First of all, thank you all for taking the paper so seriously and offering helpful comments, and there's lots more to think about here.

Bill Hurlbut, we should talk further, but I got something from that. It seems that to talk somehow about the natural or the natural and fulfilled or the natural and improved without ceasing to be what we are, and then to try to give it some specificity, whether it's in terms of open-endedness and freedom as you and Paul were saying, or whether other kinds of qualities don't have to enter into this, that's the hard task.

I mean, the natural of the squirrel is a lot simpler than the natural of the human, especially because of the indeterminacy and how much is filled in by culture and the like and we're not going to –

It seems to me one might be able to make a case for not squashing certain kinds of human capacities without having to settle the differences amongst the various cultures as to how they try to fill in that view of the perfection.

I mean, there is a way in which we can read one another's culture and recognize them as human, even as we continue to fight about who might have the clearer understanding.

So it's a matter of not letting the human floor fall below the possibility of reaching for whatever account of the fulfillment that we have. I thought it was probably as far as we were going to get in this Council when Robby George last time tried to get Michael Sandel to see whether he was willing to take on the proof of the existence of God, but now you give me heaven that I have to deal with.

PROF. GEORGE: By the way, I think we should hold any discussion of heaven until Michael Gazzaniga is here.

CHAIRMAN KASS: I am at best an agnostic on heaven. At best, and it doesn't enter into my –

PROF. GEORGE: How about hell?

CHAIRMAN KASS: More likely. No, it seems to me that to give a kind of anthropological answer is to say that part of the reason why so many different cultures have somehow postulated a life hereafter, and I don't mean to say that they've postulated it because they haven't divinized that there must be such a thing, but why it shows up in so many different places is partly to give a hopeful answer to the fact that there seems to be a gap between the aspirations to which we are pointed here in earthly life and the fact that we don't get there.

Therefore, there is a hope that there might be a different and a better life in which those aspirations could be realized. For myself, I'm content to be aspiring. I don't insist on the guarantee.

That may be shallowness on my part, but I take this direction as a gift. Whether or not there's a giver, and whether or not there is a better place in which you and people of your ilk might someday go, I'm probably going somewhere else if there is such a place.

DR. FOSTER: Well, Leon, there was a famous rabbi who once said, "What I aspired to be and was not comforts me."

PROF. SANDEL: Well, those are two graceful notes on which we can end by thanking Leon for a very stimulating paper. Thank you.

CHAIRMAN KASS: Let's take ten minutes this time. We're, as usual, behind.

(Whereupon, the foregoing matter went off the record at 3:46 p.m. and went back on the record at 4:06 p.m.)



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