Friday, July 25, 2003
Session 6: Beyond Therapy: A Progress Report
CHAIRMAN KASS: All right. The sixth session visits the
other large project that the Council has been carrying forward,
the working title for which is still "Beyond Therapy: A Progress
This project, just to remind you, is an inquiry into the available
uses of biotechnology that go beyond the healing of known disease
to achieve a variety of possible other human goals and satisfy widespread
human desires both worthy and unworthy.
And despite the difficulty of working on this topic, there are
many disparate technologies. The concerns are inchoate and very
We have agreed to pursue this topic for public discussion for
a number of reasons. First, it gives us an opportunity to talk
about the ends or the goals for which these technologies are to
be used and not simply the safety, efficacy, or the morality of
Second, it bears upon the question of the nature and meaning of
human freedom and of human flourishing. It addresses the alleged
promise touted by some of some super humanization and the alleged
threat deplored by others of dehumanization.
It also compels some attention to how these technologies force
us to ask the question of what it means to be a human being and
to be active as a human being. And although some of these things
are in the future, the current trends make it perfectly clear that
the push beyond therapy is already upon us in performance enhancing
drugs, in mood altering agents, and the like.
Also, some of these issues are of special interest in a free society
where the presumption in favor of the private uses of many of these
things to improve our lives might have consequences in the aggregate
that feed back upon all of us in which we might actually regret
the consequences of allowing everybody to have the benefits of their
own free choice. Choosing sex of children would be just one possible
instance of that.
In educating ourselves, we had presentations from experts on drugs
that affect behavior, mood, and memory. We had presentations on
drugs and genetic modifications that would affect athletic performance,
on choosing sex of children, research on aging and the life span,
genetic alterations of muscle, and the possible enhancement uses
of PGD and directed genetic change. And we had staff working papers
on all of these things which were discussed.
In working toward presenting our reflections in this area, we
decided to organize the presentation not around the technologies
themselves, but rather around the desires and the goals that either
drive our interests in these techniques, a desire for longer life,
or that will enlist the available powers that they make possible,
desires for longer life, finer looks, stronger bodies, sharper minds,
better performance, happier souls.
And this enables us also to think about how these new biotechnological
powers fit with previous and present human pursuits and aspirations,
not necessarily mediated by technology. I think that's one
of the interesting benefits of regrouping them in this way.
You've been reading some of the materials that have been organized
along these lines in connection with the desire for better children
where, surprisingly, we've tried to put together in one analysis
things that might improve the native capacities of our children
through genetic alteration and improving their behavior through
behavior modifying drugs and materials that discussed enhancement
of performance, whether enhanced, say, by steroids or by genetic
alteration of muscle and the like, and there will be materials to
I think everybody should remember that the spirit and purpose
of this enterprise is educational and not primarily political or
practical. There are urgent things that we've been called upon
to address, and we're going to try to show our ability to address
those, but here we want to take a step back and look at the larger
field to try to sort out fact from fiction, real technological possibilities
from merely imaginary ones, to clarify in an educational way the
ethical issues both for individuals and the larger society.
We want your careful comments on the materials that you are now
reading and will be soon receiving, but I think for today we would
like to have some general comments on the organization along these
lines and also on some of these substantive issues that we have
flagged for your attention along these lines.
And I don't want to give, you know, a fully account, but enough
to at least elicit the kind of general reflections and responses
I think that would be helpful. Specific comments on drafts as they
emerge we will certainly welcome.
Of course, in all cases one is interested in the benefits and
the possible benefits of any of these new technologies. Of course,
one is interested with questions of safety.
But when one thinks about the application of genetic technologies
to begin to possibly select offspring for traits, something that
was discussed for us by Francis Collins, there are questions that
have to do with parental responsibilities, questions about genetic
discrimination and quality, questions about parental responsibility
and the possibilities of changing attitudes towards children.
In the choosing of sex of children, there are questions about
the limitations of liberty, of reproductive choice. There are questions
about sex discrimination, and again the questions of parental control
over the quality of offspring.
And when you think about the seeking of better children with the
behavior-modifying drugs, there are questions of social control
and conformity, and the questions of the medicalization of moral
education, and finally, a kind of larger question about the meaning
of childhood altogether when it is all simply bent on enhancement
of performance to meet certain kinds of external standards.
In the discussion of the pursuit of superior performance with
the use of athletics as a model, not because we think that's
the only activity, but that's somehow visible to us, it's
important for us to try to distinguish between how biotechnology
would differ from, let's say just better weight training or
better diet and the like.
One has to think about questions of fairness and equality in those
activities where superior performance is competitive, and one has
to think about questions of the overt coercion of the sort one saw
with the East German swimmers and the more subtle coercion of the
sort that I believe it was — was it somebody who was counseling
one of the San Diego Charter linemen? Was it you Paul? —
about unilateral disarmament in a world in which all of the linebackers
are on steroids and the poor running back is at their mercy.
But also there are questions, perhaps the most philosophical question,
in that kind of discussion about the dignity of human activity,
for lack of a better word, about the relation of the doer and the
deed and the difference between acts of humans and human acts, that
is, acts that somehow reflect and flow from our humanity, things
in which superior performance is somehow related to the things that
we do as opposed to the things which we are merely passive and don't
result from our own exercise.
And in all cases, the question, in a way the most interesting
question and the hardest to get a hold of is never mind what this
might mean for individuals. What would it mean to live in a society
in which this kind of practice were generalized, in which the performances
were all enhanced of that sort or you couldn't somehow tell
who was or who was not in this way enhanced or in the case of children,
what would it really mean if one begins now to have — in a
society in which somebody was saying earlier in the meeting in which
there are high pressures to buy one's way into the nursery school
at the 92nd Street Y, where some of those advantages could be had
also with pharmacological agents that would improve the behavior,
attentiveness, and ability to learn.
So those larger questions about the social character are there
for discussion. I think the real question is about the organization
and whether these issues that have been identified are germane and
an opportunity actually even to discuss some of those issues here.
I should say, by the way, on a subject of concern to several of
us, well, we have, I think, in the spirit to, on the one hand, try
to dispel certain kinds of worries that seem to be unnecessary.
At the same time, without exactly prophesying the future, if there
are identified areas of concern, I think it's incumbent upon
us to at least put them out there for consideration so that they
can be studied and investigate, at least aware of the kinds of things
that are at stake.
So that sometimes the tone will strike some of you as unduly worried
and in other cases insufficiently so. It's difficult in this
area to strike the right balance, and we take your guidance on that
I hope that's enough to produce some responses on the basis
of the things that you have been reading and are now able to anticipate
PROF. MEILAENDER: Well, there's a whole range of things
I'd be interested to talk about, but let me just make two comments
right now. One is really no more than a comment on organization.
The direction the staff is moving now and inviting our response
to is one that is a little different, in fact, from what we had
been talking about, at least in the sense that we had kind of latched
onto the most obvious organization principle, namely, certain case
studies as kind of just examples to be taken up in their own right.
And the attempt now is to try to think of these in ways that cut
across the normal lines, organized under various human desires.
And my comment is simply to say I think that's quite good.
There are moments when it does seem counterintuitive. I mean
the combinations are at first sight strange, but what it suggests
is that it's not so much in many of these cases that we're
trying to take a case and sort of, as it were, vote up or down on
it, good or bad, but that rather we're simply trying to say
here's what a very different future may look like, and to see
these different things organized in these ways seems to me to be
a kind of promising way to do it. So I rather like that. That's
my comment on organization.
Then a second is — I guess it's still a comment, but
it's not quite as positive — is related to that insofar
as this is an attempt to organize things around goods or goals or
aspirations and not means questions.
That's fine. As I say, I like the organization, but I'd
want us to be careful how we formulate that connection. So that,
for instance, if we talk about parents selecting out certain children
or selecting in certain children, I'd want us to try to avoid
a certain tendency that I think easily crops up, given that we're
focusing not on means so much, but on goals and aspirations, and
that is to suggest that the one is weightier than the other because
it's concerned with goals.
I mean, I would say that though it's good, we should have
a lot of concern about selecting in children for various reasons,
what's really central to our concern in this project, a certain
kind of continuity with parental responsibility, you know, that
you're trying to help your child and improve the child in various
ways. It does stand in a certain continuity with it even if problematic
and dangerous in certain respects.
Selecting out I have a much harder time understanding as standing
in any kind of continuity with ordinary parental responsibility.
So I'm happy to have a focus on selecting in, but what I don't
want us to do is suggest that we have, therefore, somehow it upon
the weightier question. It's not weightier. It's just
different and deserves attention in its own way, but I'd want
us to be careful how we formulate that.
CHAIRMAN KASS: Thank you. A point well-taken.
DR. McHUGH: Well, maybe I can slip in here. I'm not
sure it will be helpful, but it kind of backs up what Gil is saying.
I believe that this is a very important enterprise we're beginning
here, and that the general principles that will come out of this
will teach us a lot about what we are preserving in the ethical
principles related to biotechnology today.
And again, because I'm a clinician, I'm always seeing
the down sides of all kinds of things, and I want to emphasize that,
therefore, I'm very conservative about any of these enterprises
that want to enhance things simply because I've seen how that
concern with enhancement, and particularly the concern with the
biological nature of people begins to get folks to look at their
vulnerabilities or the little bit of red ink that's in their
life and neglect all of the black ink, all of the wonderful assets
that they have.
And I think I've talked to the group before about the fact
that, again, in my clinical life at least once a year I have very
talented parents bring to me a young man or woman that is not living
up to Daddy's achievements. They're usually people who
have IQs of 140 to 150 and their kid has an IQ of 125 because there
is this reversion towards the mean.
And they're upset that the kid is not, you know, valedictorian.
Now, this kid, let me just describe for you. This kid is six foot,
two. It's from mid-court nothing but net, you know.
DR. McHUGH: He's absolutely the most attractive soul
you can imagine and they're wondering, well, why isn't he
valedictorian, and my job is to persuade them that their other things
in life and other things about this person that they have to appreciate,
and that I'm appreciating just by meeting them.
And my job, and by the way, it's not to hard eventually to
persuade them that there are many, many assets that need to be emphasized.
I believe, in fact, that it goes beyond this little, small story
that I'm telling you. I believe that part of our problem for
young adolescent people, particularly young adolescent people who
are high achievers themselves, who are already with 1600 SAT scores
and the like, that somehow or other in the challenges that they
face ultimately in places like Cal. Tech. and MIT, they begin to
believe that somehow that they don't quite measure up, and many
of them want to check out because of that.
And I think that has come about in part because of our assumption
that we are simply machines, that maybe we don't have all the
right gears for, and the suicide rate amongst adolescents, as you
know, has gone up very remarkably, and it has gone up, by the way,
amongst very talented adolescents. And places like MIT are very
much suffering from and trying to figure out how to work on it.
So I'm very anxious for us to talk about the goods of human
life itself, emphasizing that the assets are important to preserve
even as we think in terms of what can we do somewhat to help people.
Ultimately what am I trying to do? Am I trying to teach people?
I am trying to teach them to — well, Bill put it so well
— to savor their lives and the like, and I'd leave you
with perhaps an old chestnut about enhancement. Just maybe many
of you know it. So it's a corny story.
It's an old Yogi Berra story. You remember Yogi Berra, the
Hall of Fame catcher, and one day in a long, hot game, a batter
came to the plate, and he was a religious person, and he was blessing
himself three times, and Yogi said to him, "Why don't we
just let God watch the game today?"
DR. McHUGH: And to some extent I want to tell people,
"Can't you watch the game and see what happens?" with
the emphasis, therefore, on the parent to say, "You have a
lifetime experience with this gift that you have. At first you're
going to be spending a lot more time monitoring and shaping and
advantaging the child, but ultimately you are going to be somebody
who watches the trajectory of this life in a very special way, a
way of concern but in which you do not any longer fool with the
instruments but let the life go on enriching all of us."
And so I think this is a very important part of our things to
talk about. It's as important as any technological thing primarily
because of what kind of a message that we want to give people.
CHAIRMAN KASS: Thank you.
PROF. SANDEL: Well, I, too, think this is a very important
topic, and I think the organization is a good one. One question
I had really, and I don't know if this is the time to delve
into some of the actual ethical analysis that this question raises,
and my question has to do with, well, one that we have discussed
here on other occasions when we've talked about sports, which
is: why does it seem okay for an athlete to improve herself through
training, but not through bioengineering?
We've wrestled with this question before, and in trying to
get at the heart of the ethical issue we've put to one side
obvious safety considerations, and we've also discussed the
question of fairness in the competition. Would it give an unfair
edge if some had access to the bioengineering but not others?
But we've agreed that there is a further moral question.
Assuming it were available to everyone and assuming it were safe,
what would be wrong with bioengineering of athletes? And why is
it disquieting in a way that training regimes which enhance are
Now, one answer to that question locates the moral crux in the
idea of human activity. This is what you've referred to here,
Leon, and also on previous occasions. And the answer goes something
What's wrong with bioengineering superior performance is that
it undermines the dignity of the performance of the athletic excellence
by detaching the doer from the deed, by introducing what you've
called on various occasions the kind of biological magic so that
the athlete who trains rigorously is in some ways less alienated
from her performance than the athlete who simply takes a pill or
has an injection of a gene of some kind to enhance the performance.
And that you've argued — and here I just really want
to raise a question about that argument — that's the moral
crux of the issue, the alienation of the doer from the deed, and
here I have two questions really as a way of inviting you or others
to say whether this really is the moral crux of the disquiet.
Between training and bioengineering to improve performance are
other means that normally we don't find disquieting, like taking
vitamins or improving nutrition. But taking vitamins and improving
nutrition is a way biologically of improving ones body in a way
that is as much biological magic as the gene vector, well, except
to those who may be medically informed and who might be able to
give us, as Dan could, a detailed account of how the improved nutrition
or this vitamin actually leads to improved performance.
But then Dan or others could also give the same explanation of
the gene vector. So as far as the idea of authenticity, being in
touch, the doer and the deed, keeping them in contact, is there
a difference or does this analysis suggest that maybe we should
feel disquiet when some athletes undergo nutrition and vitamin regimes?
That's one question.
The other question is: why do we worry, if we worry, about the
dignity of human activity, about avoiding the alienation that comes
when we indulge in biological magic to get a result rather than
training? Why don't we worry about that in the case of healing?
Why is that only a concern in the case of enhancing?
If someone needs surgery or a medical procedure to heal an illness
or a disease, why don't we worry about the dignity of human
being in the world, activity in the world then? Why don't we
worry about the biological magic of medical therapies? Why is
it only a concern in the case of enhancement?
PROF. MEILAENDER: May I just piggyback on that?
CHAIRMAN KASS: Please.
PROF. MEILAENDER: I'm not going to answer his questions.
I just want to exacerbate them in a way.
But to come from the other side, in a sense, from the point of
the person who has used the genetic enhancement, it's just worth
noting that I think it would be true to say that at least in many
cases this wouldn't eliminate the need for continued training
regimen, for working on your skills, for plotting strategy for all
sorts of things. It wouldn't mean that you were necessarily
interested only in winning. You could still enjoy the performance
itself, though perhaps at a level you couldn't otherwise have
So that, in fact, many of those things that we probably have no
objection to would still continue to be part of the athlete's
package even at an enhanced level, and that to me, as I say, it
only complicates the question still further.
CHAIRMAN KASS: Dan and then Mary Ann.
DR. FOSTER: Just one question. I don't like the analogy
— I would rarely disagree with Michael about anything —
but I don't like the analogy of healing or treatment as part
of the thing because what medicine is doing by its treatment is
to try to prevent destruction of the organism, whereas the use of
these other techniques that you call biological magic are to enhance
So I don't think that that aspect of it is equivalent along
The only other thing I would say is it's pretty interesting
that the sports community itself in some sense intuitively has said
we need to keep the competition competition without enhancement.
And so they penalize if you take adrenal steroids or that you take
Ephedra or, I mean, if you've got an allergy or something, you
know. I mean, you've got asthma, and you get eliminated from
the Olympics because you might get some more, you know, adrenalin
equivalent to do that.
So we have a very broad aspect of human experience. I mean, the
East Germans, the horror of what they did to those women swimmers
and so forth was just awful, but that community which so far as
I know is not primarily involved with ethical issues; they're
involved with winning, but they want to win fairly; have said that
this is something that intuitively seems wrong to them.
At the end of this document, you know, there's a statement
about the computer chess player versus the human chess player, and
in some sense it's a little stretched, but in some sense it
is not about the game anymore because the computer does not use
the same — it doesn't sweat. It doesn't intuit it,
doesn't watch to do that.
So it's interesting to me that the participants in the issue
of sports have already decided universally, and when they're
not doing it, there's huge criticism about the fact that they're
not eliminating enhancers.
Now, you could argue if it's available to everybody, then
it would restore the competition. You know, if everybody took the
same amount of adrenal steroids and so forth, then you'd get
the competitive thing there. But it is interesting that they sort
of sensed, and I have to say that I think I sort of sense that there's
something flawed in this thing beyond.
I think training is different. I mean, I just think it's
intuitively different because it's a matter of work rather than
a matter of making something biologically happen.
And I should say as a physician, all of you know that there are
very serious side effects. People who use steroids and so forth
die earlier, you know. I mean, the men's testes shrink. I
mean, there are all sorts of—they build up muscles, but there
are great prices that are there, too.
So I just wanted to make those two points, that I don't think
we ought to use the biologic magic in medicine as an equivalent
PROF. SANDEL: Just, if I may, a point a clarification.
I was unclear when I spoke. I did not mean to equate medicine with
sports enhancement. To the contrary, I'm for medicine and I'm
against sports enhancement.
What I was suggesting was that the reason that Leon has offered
for objecting to enhancement is problematic because if it were applied
to medicine, it might condemn medicine as well as enhancement.
So I was trying to identify a feature of the argument against
enhancement, not to suggest that medicine is the same as enhancement.
DR. FOSTER: That is one of the most gentle responsive
criticisms I've ever heard. What he said is I didn't understand
a word he said, and I wouldn't have said what I said if I'd
really understood him.
DR. FOSTER: And so that's gentle. That's putting
the blame on the receptor rather than the agonist, you see. I
mean, I've got perfectly good agonists here, but my receptor
was not in the right mood.
So I accept.
CHAIRMAN KASS: Well, that kind of generosity only moves
me to come to your aid, sir. You shouldn't be so—Mary Ann,
do you want to get in first? Because I'm accumulating a number
of things on the substance that I'd like to respond to.
PROF. GLENDON: Yes. Well, I want to go back to Michael's
presentation where he said that training regimes are not disquieting.
I don't think we can say that easily, and reflecting on that
caused me to think that perhaps although I see why we took athletics
as an easy example, I think maybe athletics and the role it plays
in our society, maybe it's not such an easy example.
I'm thinking of the story of Mickey Mantle as a young boy.
His father took him out. He had no childhood. His father took
him out in the back yard and relentlessly pitched to him day in
and day out and created a certain kind of being who was a very skilled
athlete, and a human being who was lacking in several qualities
that one might think associated with a full human life.
And I think from what one reads about the training of tennis players
and Olympic athletes, there are many, many young people whose childhood
has been taken away from them and to the point where I'm not
advocating this, but suppose there were a pill that had no side
effects. Which would be better for the realization of a full human
life for an athlete, training day in and day out or popping the
CHAIRMAN KASS: Very nice.
Before there are more, let me make some kind of response. First
of all, we're really wrestled very hard with these distinctions,
and part of the discussion is to try to figure out, well, why are
biological technical means different, and there is some discussion
about training and various other things. And you line these things
up on a continuum, and it's sort of hard to know the boundary,
especially when you recognize that anything that you do brings about
a transformation in the body, and the mechanisms might be very similar.
And putting this not with a biotechnological focus but in the
context of the human desire for superior performance, it enables
one to cast reflective light exactly on the kinds of excesses of
I recommend this to everybody. While working on this stuff, we
rented the video ofThe Chariots of Fire, which is for those
of you who don't know it at all really one of the great movies
in the last couple of decades, and it's about the 1924 Olympics
in which one of the British runners is chastised for having a trainer,
which was absolutely unheard of in British amateur athletics to
And what I had forgotten was the Americans showed up at this Olympics,
all of them with trainers and already engaged in a highly methodical
approach to the body.
When Ted Friedmann was here and he was sort of mournfully speaking
about the death of the athlete understood as the amateur acting
out of kind of love of the activity and the concern for victory
and then ultimately the separation of the achievement from the achiever.
So the only question is how far did the ball go, in which you begin
to turn your performers not so much into athletes as entertainers.
The activity gets to be deformed.
You can see that with training. I mean, you can see that with
a certain kind of excess of training, and I think the point is very
And the next point is to say that the analysis ought not to be
to try to definitively answer this question, but to try to provide
the kind of language for the ongoing consideration of this question,
and we've gotten in the discussion multiple possible reasons
for being troubled by this.
To defend the argument, and this would take a long discussion
and maybe we should just start, it does seem, to me to come to Dan
Foster's aid, one could say that in the case of providing insulin
to diabetics, one is coming to the aid of a body seeking to heal
itself, and that while the mechanism of action is not known to the
patient and from the patient's point of view it might just as
well be magic, it nevertheless is an attempt to serve a particular
kind of given goal and to come approximate the way in which the
body does this on its own.
Whereas in these other areas, it seems that ordinarily we get
to be excellent by activity in which we sense the connection between
practicing the piano and getting good at play, which there is a
kind of connection between the mode of improvement and the thing
In fact, you improve in the various activities that you train
in, and to that extent on the point of human experience, there's
a certain intelligible relation between training and the thing that
And to that extent there does seem to be some kind of disruption,
though I want to acknowledge Gil's point. When it's not
talking about giving somebody a pill that's going to make them
out to be able to hit the three point shot, training and practice
still will be necessary. So it's not simply a magical pill
that replaces that.
But I do think healing is—
PROF. SANDEL: Healing is different you're saying because
it's a worthier end than souping up performance, but that has
nothing to do with the—
CHAIRMAN KASS: No, I don't think I'm saying it's
a worthier end.
PROF. SANDEL: Then what's the distinction exactly
that you have in mind?
CHAIRMAN KASS: I'm saying that one enters into the
healing activities and supplies biologicals to the body to aid the
body's own self-healing process. Look. We function all the time
without awareness of the biological processes that lie beneath all
the things we do and experience. For example, we speak and make
ourselves understood without being aware of everything that makes
it possible for us to speak, and that takes place beneath the plane
of consciousness. Of course, a scientist can try to analyze the
biological mechanisms, but from the point of view of human experience,
if you stop to think about it, speech and understanding remain absolutely
wondrous and mysterious, inexplicable in the language of biology.
I mean, who knows how it is that little things of sound fly from
over here across there and carry units of intelligibility? These
are the same biological processes that are in the same sense that
we use the term "magical."
So I grant you that this invites a kind of reflection of the way
in which our bodies are somehow mysterious to us, but there are
many ways in which we go about improving our ability to use our
bodies that proceed by activities that in their human import are
If I practiced the piano, God willing, I would get better at it
as a result of practicing, and similarly in various kinds of training.
So that one sees through the ways in which we use our bodies deliberately
to improve the activities, there is a certain continuity between
agency, accomplishment, improvement.
PROF. SANDEL: And so what about the vitamins or good nutrition?
CHAIRMAN KASS: Yeah, look. I want to acknowledge continuity.
I don't think the disquiet depends upon one's somehow crossing
some kind of bright line and saying you're in a terrible—although
I could say vitamins and good nutrition are—
PROF. SANDEL: Would you say a little alienating? It's
a matter of degree. So they're a little alienating and, therefore,
a little disquieting, but not as much so?
CHAIRMAN KASS: You'd have trouble getting me on good
nutrition and vitamins. I mean, it seems to me one could make the
case for good nutrition and vitamins just in terms of being healthy
and fit. If the question is whether I should give up eating a healthy
diet in order to eat only those things that will make me a terrific
wrestler, if any such there be, then I think you're in a different
I want to acknowledge the difficulty, Michael. I don't think
one's got a kind of bright line on the other side of which you
have the principal basis for disquiet, but this is a struggle, I
think, to try to figure out.
And the other alternative is to say control as such is bad. Let
God enjoy the game today. And that merges in with the hubris objection
that you've raised previously.
DR. FOSTER: I only want to make one response about vitamins.
Most of that is mythology, as the Institute of Medicine said. What's
characteristic of vitamins, they act in very tiny quantities and
they're not needed above that, and if you eat an average American
diet, everything is so filled with vitamins that you can't be
You know, if you're a Zen Buddhist, you know, you have to
do that. So most of this stuff that the athletes gulp down goes
out in their urine within 24 hours. So I mean, what they're
doing is they're trying to enhance the health of the sewage
or something, you know. Like that's—
CHAIRMAN KASS: And the vitamin-producing industry.
DR. FOSTER: But it has a big psychological effect. Now,
there are exceptions, but then when the exceptions are the vitamins
are not acting as vitamins. Vitamin E may be an antioxidant and
keep you from getting atherosclerosis, but it's not acting as
So this is mostly mythology. So the enhancement is due to the
psychological view that I'm building myself up, and not from
any biological magic in that sense. So I would say forget about
the vitamins. Okay?
CHAIRMAN KASS: Gil, still on this point? Yes, quickly.
PROF. MEILAENDER: Yes, two comments. One, we've tried
to get, in the Beyond Therapy project, we've tried to get beyond
the therapy enhancement distinction, and I do think that that distinction
does not fully work and does break down at some points.
But there is a sense in which maybe we shouldn't try to get
too far beyond it because it has reemerged in a way. Why good nutrition?
Health, you know. It has got nothing to do with enhancement per
And so in our, I think, correct effort to see that that distinction
is far more complicated than it has often been thought to be and
that it will not just in itself solve the questions we're taking
up, we should be careful not to go too far because, in fact, it
just reemerges at certainly places.
CHAIRMAN KASS: Right. Point well-taken.
PROF. MEILAENDER: And we need to see that.
The other point I just wanted to make—
PROF. SANDEL: But then, Gil, just to enter, that's
then back to the end. The end of health is worthier than souping
up athletes. It has nothing to do with this particular thing about
the dignity of human activity and about making the individual's
agency less humanly or experientially intelligible. No, it's
that we consider health is a higher end than souping up athletes.
PROF. MEILAENDER: I don't know about higher. See,
it's the worthier/higher language. We probably agree at some
level, but it's pretty low to the ground good, in fact, in some
ways. It's not the kind of thing I use "worthy" in
May I make one other related point?
CHAIRMAN KASS: Yes, please.
PROF. MEILAENDER: I don't generally disagree with
Mary Ann. I agree with her about 12 year old gymnasts, say, or
something like that, but it is the case if what we're interested
in is thinking about superior performance that almost all superior
performance requires an imbalanced, an unbalanced life in some respects.
And I would be sorry not to have been able to watch Mickey Mantle
do what he did as well as he did, and I'm old enough that I
did watch him.
Now, he paid a price for it. I can't say that he should have
paid the price for it. On the other hand, the superior performance
might not have been possible without it. So I'm always unsure
what I think about arguments about a balanced life.
Most of the good things in the world come from people who aren't
CHAIRMAN KASS: Jim Wilson and then Bill.
PROF. WILSON: I want to try an argument about which I
am most unsettled. So I plead with you not to spend the next hour
pointing out the obvious faults in it.
At the end of the paper, the author mentions watching Gary Kasparov
play a computer, and Gary Kasparov is one of the great chess geniuses
of all times. There was no doubt in my mind that eventually somebody
would invent a computer who could beat him, and it did.
But that was an interesting thing to watch, but then the author
of the paper goes on to say, "Would we watch two computers
play chess against each other?" I don't think so.
So there's something about the humanity of Kasparov that is
important. No matter what he went through in childhood suppression
and growing up in an oppressive state and learning chess as if nothing
else mattered and leading so far as I know a monomaniacal life,
he was a human being.
So that there's something about humanness that counts, but
that then raises the question of therapies of various sorts that
are designed to enhance it, and I want to say that I'm not sure
we should hold constant the possibility that all enhancing therapies
are equally safe because as I think about this, I want to make distinctions.
People take adrenal steroids, and as Dan has pointed out quite
correctly, these have some very adverse effects and objecting to
this behavior on the grounds that you're sacrificing your humanity
in order to advance your ability in one particular area, that is
to say to confront a middle linebacker of the San Diego Chargers,
But on the other hand, suppose you have asthma and suppose you
can take a drug that eliminates the asthma or some other thing,
which is on the prescribed list, or suppose you suffer from cluster
or migraine headaches and you take drugs for that or suppose you
have other things for which you take drugs which have some side
effects, but not the kind of side effects that are disabling.
It seems to me that in time society might drift in the direction
of saying we're going to loosen up the list of drugs that you
cannot take, and we are going to be more precise about specifying
those drugs which in some sense are inhuman. That is to say if
you take them, you are courting almost certainly extremely adverse
side effects which diminish your humanity, and to allow more drugs
that solve particular problems and have an acceptably low rate of
Now, since I have thought this through only in the last 12 seconds,
I'm sure that by tomorrow morning I may be reconsidering my
remarks, but I don't want to assume that we have to analyze
this on the assumption that all drugs are safe because all drugs
are not safe, and all drugs never will be safe. And we have to
realize that one of the reasons we are concerned about this problem
is that the unsafety of some drugs makes it a little bit more like
watching two computers play chess.
CHAIRMAN KASS: Thank you.
Bill Hurlbut and then Elizabeth and then Paul. Bill May, I'm
DR. HURLBUT: Dan mentioned the East German swimmers. I think
it was about 1964 that the first real use of steroid drugs became
evident in the Olympics, and I remember reading an article. One
reporter said to the coach of the East German swim team, "Why
do your swimmers"—this is a female swim team—"why
do your swimmers have such low voices?"
And his response was, "We didn't come here to sing."
And it raises the issue, well, what is the overall purpose of
a thing anyway. And I think that's the context in which we
have to look at this kind of an overspecialization, which is what
enhancement is aimed at.
I keep saying in these discussions, and I think we need to keep
this in the forefront of our minds that what are the purposes behind
enhancements anyway. Competition can have both a noble and a very
negative overtone to it, and yet I think we have to bear in mind
what the purposes of human existence actually are, and what are
the qualities that we as biological beings have that are special
to both our functioning and our sense of meaning.
And I keep coming back in my mind to the meaning of allowing yourself
to be specialized, which is what Gil was referring to. A lot of
great things come from narrowed, focused specialization in human
existence, but something else really great comes from not specializing,
and that is a broader, what you might call a breadth of comprehensive
engagement with the world.
And here I come to think of what's called focal dystonia,
which is a phenomenon you see among what's common among concert
pianists or classical guitarists, where they work with such focused
attention on a single task that they actually become semi-paralyzed
in their performance of that task, and they have to give up—Loren
Hollander, for example, a famous pianist, developed focal dystonia,
and he couldn't play the piano even though he had been a very
successful child prodigy. And he realized that what he had done
was he narrowed his life in such a way that he actually destroyed
the breadth of his performances and his ability to perform even
in a specialized way.
So the lesson I would take from that is that what is strong—the reason the hand can do what it can do is because it has a broad
experience and then can apply that broad experience to a particular
Maybe Paul will have to help me out with what I'm trying to
say here, but likewise taken in its breadth, the human fullness,
if you're coming to do something more than sing and win, if
you're coming to have a full, rich, human meaning, which we
are now coming to call a spiritual meaning in our society because
that's lifted us into a pluralistic realm that is also yet related
to something larger, transcendent that goes behind the individual,
but isn't specifically religious; if we're going to seek
that breadth of comprehensive significance, then we have to specialize
in such a way that it is part of that and not an isolated focus
that destroys the meaning of the whole.
I don't know if I got that across really, but dignity to me
means fullness, and fullness means a truly meaningful, engaged purpose,
not just winning.
CHAIRMAN KASS: Thank you.
Elizabeth, Paul, and Bill.
PROF. BLACKBURN: A general comment on the organization.
I thought it was very useful to bring it into the large questions
like this and not break it down just into technologies.
And I had a thought which struck me upon deliberating on this
and also as our discussion proceeded this morning, and I'm somewhat
disquieted by this term "magical" and "mysterious,"
not that I want to deny the complexity in our lack of understanding
of a lot of the processes that go on, but there are a couple of
things that I didn't really like about this, and one was that
it sort of implied that there is sort of an abdication of the need
to really think and grapple intellectually with what's going
on. Somehow if you just throw it into "magical" and "mysterious,"
that sort of says, well, okay, we don't need to think about
it anymore. And I think that's a sort of anti-intellectual
thing that I felt uncomfortable with.
And then slightly implicit, I thought, in some of the discussion
and perhaps the writing was the idea that, well, it was mysterious.
Dan would understand it, but those simple athletes wouldn't,
and I thought that's sort of, you know, perhaps even a little
condescending to sort of imply that, oh, it's mysterious and
magical to those people because they can't really think about
these things properly.
And so I think perhaps avoiding those terms as much as have been
used would be helpful because I don't think we want to just,
you know, abdicate thinking about them.
CHAIRMAN KASS: A quick response. Anything that smacks
of being anti-intellectual will come out. There is notoriously
a disjunction between the way science understands things and the
way human beings on the plane of human experience understand things.
These are two different languages. It's a vexed question of
how these things fit together, whether you take it up under the
mind-body problem or consciousness or what have you.
And when Michael said that Dan would understand this, I think
he was saying he could understand the mechanism of this, but I'm
not sure that the mechanism of it is identical to the experiential
knowing from the inside.
One can find a way to say that without appearing to be insulting,
and on the subject of mystery, this is, I suppose, a long discussion
and not for here, and the question is when scientists use the name
"mystery," they usually mean it as that which we do not
yet understand, but that in principle everything is capable of having
And I would at least like not for the document, but for the continued
reflection of everyone around the table to wonder whether that's
PROF. BLACKBURN: I think perhaps "magic" is
the more objectionable terminology.
CHAIRMAN KASS: Indeed.
PROF. BLACKBURN: I see what you're saying about "mystery,"
but "magic" to me sort of implies something, you know,
that's the last resort, is to call something "magic."
CHAIRMAN KASS: Terrific. Thank you.
Paul McHugh and Bill May.
DR. McHUGH: I have only a couple of things that I want
to add to what I said at the beginning about nature itself and,
in part, in relationship to what Mary Ann and Gil were talking about,
and that combines the issue of science and, interestingly, simple
observations about human nature.
It turns out that child psychiatrists have observed the schools
that do best with the children are the schools that offer a smorgasbord
of things for the kids to do, not just reading and writing and athletics,
but dance, art, other things.
And it turns out that the children themselves seem to become thriving
adults if at some early time in their life they discover that they
were a success at something, and you never know what somebody is
going to be a success at. So, therefore, lay out before them music,
dance, art, reading and writing, math clubs, stamp clubs, train
And it works out that they do well, and then it comes around to
the other side, to this Mickey Mantle issue. It turns out that
as you see people emerge as kids and come into their adolescence
and early adulthood, they begin to narrow down the things that they
want to do, and there is a sense that everybody, at least the happy
ones, put themselves through boot camp at some point. Okay?
I've got to do this even though it means I'm going to
have to give up a lot of other things because, darn, I want to do
it at the best level I can. I want to play every day at the big
league level, and to do that means I've got to do something
else, give up something else.
And those two things are natural, and we as parents or as other
people want to encourage that to happen for all of our kids.
CHAIRMAN KASS: Thank you.
Mary Ann, to this? Okay.
PROF. GLENDON: I just want to emphasize and partly in
response to what Gil said that there's a big difference between
a child's reaching the level of maturity where the child decides
he or she wants to go through boot camp and having the parent put
that child in boot camp from three or four years old.
And so this general question, and we shouldn't forget that
this general question is coming under the heading of better children
and under the heading of big questions about are we doing things
that are transforming the meaning of parenthood, parental responsibility
CHAIRMAN KASS: Bill May.
DR. MAY: I wanted to return to the question of the spirit
of reflection in this area. I've spent 52 years teaching.
I'm finished with it now in the classroom, and I just think
that work on these two topics that I've had a little chance
to look at would be wonderful teaching material.
So much medical ethics has been quandary ethics. I mean, you
identify a problem, and then you hunt around for moral principles
that will resolve your problem, and you go from one thing to the
next and some other problem.
And to think reflectively about better children and excellence
of performance offers a kind of meditation on the human condition
that I think would be very attractive.
And the word "mystery" was used, but I think it offers
the possibility for the stirring of wonder in young folks, the kind
that I've taught across 52 years. I mean, we're not doing
this for the sake of developing a preamble to regulations. We're
doing this to provide an educational resource, it seems to me, and
it seems to me that what I've seen so far would really allow
Now, just a couple of comments on the parenting and then excellence
of performance. On parenting I think I may have mentioned this
earlier and maybe it's time to close shop if one begins to repeat
things that one said earlier, but I overlapped one year with W.H.
Auden at Smith College, my first year of teaching, and we happened
to be in a faculty show together, and so I got to know him, and
he was talking about the pressures that American children were under
as opposed to English children, and he said in America the very
act of being an immigrant nation, except those who were forced to
come here, had a huge pressure in the direction of outstripping
And we place a lot of this in that setting, to produce better
children, and behind that lies the whole aspiration that people
came here maybe not because they thought they were going to produce
better children but a better environment that would allow their
children really to outstrip, and they put up with very considerable
sacrifices in many cases of a strange language and all of the rest
that tended to shrink the parents and justified this sacrifice in
terms of what it would do for the kids.
And we've not only been an immigrant nation, but in a sense,
a perpetually migrant nation. The mother ship then became the education
that would be offered that would allow kids to move out of the ghetto
neighborhoods to which my grandparents came, and then you move out
So it seems to me it's a very worthy enterprise to deal with
this whole business of producing better children and then talking
about what happens in the setting of biotechnology that feeds into
this very fundamental aspiration in the kind of society that we
On the other issue of excellence of performance, what I've
seen of it especially in theater, by accident in my own life, so
often you see the need for a double gift of both the talent and
a psyche to support the talent. And one talks about training the
talent, but there's the need for the discipline of the psyche.
And it's very interesting. One is talking not simply about
things that will enhance a talent, but those things that will sustain
a psyche to support this talent under special pressures, and they
are huge pressures, especially public performance.
What was it in the setting of
Greece? Truth, alethia, moving out into the unconcealed, and
that's a terrific transition from life that's concealed
to life that is displayed. In the sense of being tested by that,
you show what you are, and it's a very difficult and demanding
And so the huge temptation to find supports that will allow one
to do this, and then not psychic supports, but then instrumental
supports and the huge embarrassment for that bat to crack and splatter
and cork to be revealed, and so what seemed to be displayed is very
unfortunate. In so many ways an utterly admirable performer, and
I tend to accept his story about that.
DR. MAY: But it's very interesting him blurting out
as opposed to stepping out into unconcealment and showing your stuff
as a performer. It's a terrific collapse, and behind this,
behind what I've looked at here, I couldn't help but think
And I had to give a lecture once at Meilaender's institution,
Valparaiso. It's before he got there, and it was on the honor
code because that was a big thing at that school, and so I tend
to read Montesquieu on that, and I realize the difference between
the competitive meritarian (phonetic) society where in cheating
you perpetrate an injustice on somebody else.
In the setting of aristocratic past, in failing to live up to
the honor code, it's not simply an act of injustice against
others, but an act of self-diminution.
And I think this document interestingly deals with that. It may
end up rather too much harkening to an aristocratic past. The hand
and spirit of our Chair shows through in this.
DR. MAY: But so be it. I found what I've seen so
far very, very interesting and would provide just endless opportunities
in the classroom that I would delight in.
CHAIRMAN KASS: Thank you very much.
A child of immigrants appreciates the suspicion cast upon him
of aristocratic sympathies, but that's all right.
PROF. SANDEL: Well, what I have to say has very much to
do with what Bill has just pointed out, to do with the aristocratic
flavor of the main argument of particularly the section on performance,
And what I have to suggest is not that that's misplaced or
wrong-headed or misguided, the emphasis on excellence, but it does
raise a question about how relevant the sports metaphor is to the
Now, there is a powerful intuition that there is something to
the metaphor, something powerful to the metaphor of sports and a
meritocratic (phonetic) society such as the one we live in, and
I think part of what underlies that intuition is the sense that
there is a ratcheting up of the pressures, and Bill spoke of pressures
here, within the American meritocratic society, and that may be
why parents are trying to enhance their children or athletes to
There are the pressures there, and we also sense a ratcheting
up of the competitive pressures in sports. So there is a prima
But if the reason for our disquiet about sports enhancement, biotech
sports enhancement, depends on this aristocratic or Greek picture
of excellence, then the analogy has less force, might have less
force for the kinds of enhancements that people are tempted to pursue
to deal with the pressures of a meritocratic society for the following
There are really two dimensions of sports that are at stake in
performance enhancement. One of them is the honorific dimension
having to do with the way in which sports honors superior virtue
and excellence, and the other is the competitive dimension which
has to do with winning and losing, effectiveness.
Now, the argument here that tries to locate the moral crux of
our disquiet in sports focuses almost entirely on the first, on
the honorific, on the excellence. That's the aristocratic;
that's the concern with excellent display, the honorific dimension
But if it turns out that in a meritocratic society what leads
people to strive for enhancements is not that they want honor and
recognition, this Aristotelian virtue, but they want to get ahead.
They want their kids to get ahead. They want their kids to get
into the 92nd Street Y preschool. They want their kids to get into
Ivy League colleges. They want their kids to be well-equipped.
They want for themselves to be able to compete effectively for jobs
and under conditions where the pressures and the rewards and the
stakes are more intense.
Then if that's what's animating the drive to enhancement
in the larger society, then to show that this honorific thing is
at stake isn't going to be persuasive. It's not going to
be an apt metaphor because it takes that part of sports, the honorific
rather than the competitive that's least relevant to the striving
and the ratcheted up pressures that we see in contemporary meritocratic
society. That's about, you know, effectively getting admitted,
getting hired, getting ahead, making a living, competing in a kind
of ratcheted up thing that doesn't have to do with honorific
dimensions at all.
So if you're right, and you may well be right, if you're
right that this account of the dignity of human activity and so
on and the analogies that come to mind are painting, dancing, building,
designing, writing, singing, these all have to do with excellence,
But that's not what's animating the drive to enhancement
in a larger society, and so that may suggest that the analogy, the
prima facie analogy between sports and meritocratic society breaks
down if the reason for the disquiet is wholly cast in these aristocratic,
Aristotelian, virtue-based terms.
CHAIRMAN KASS: That's superb, Michael, and I think
further rounds could reflect the power of that. We have to add
And the sports, one is not uninterested in excellence. I think
everybody is, and Dan Foster's comments—I think it was Dan's
comments—about how the people in the sports somehow don't
want this, they could if they wanted to or if they were only interested
in having people hit the ball farther. Then they would legitimate
So there is some kind of concern for the, for lack of a better
term, the genuineness of the excellence there even though it is
a competitive activity and you might think that there would be reasons
why the drive for competition and bringing more fans to the park,
which is all to much on their minds anyhow and has led to certain
other corruptions of the games, why they would overturn that.
But I think the kind of striving that you mentioned has to be
dealt with in addition to the question of the concern for excellence