Beyond Therapy: Biotechnology and the Pursuit of Happiness by Leon Kass, Presidents Council on Bioethics, William Safire (Foreword by)

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groundbreaking new exploration of the promises and perils of biotechnology — and the future of American society.

Biotechnology offers exciting prospects for healing the sick and relieving suffering. But because our growing powers also enable alterations in the workings of the body and mind, they are becoming attractive to healthy people who would just like to look younger, perform better, feel happier, or become more "perfect."

This landmark book — the product of more than sixteen months of research and reflection by the members of the President's Council on Bioethics — explores the profound ethical and social consequences of today's biotechnical revolution. Almost every week brings news of novel methods for screening genes and testing embryos, choosing the sex and modifying the behavior of children, enhancing athletic performance, slowing aging, blunting painful memories, brightening mood, and altering basic temperaments. But we must not neglect the fundamental question: Should we be turning to biotechnology to fulfill our deepest human desires?

We want better children — but not by turning procreation into manufacture or by altering their brains to gain them an edge over their peers. We want to perform better in the activities of life — but not by becoming mere creatures of chemistry. We want longer lives — but not at the cost of becoming so obsessed with our own longevity that we care little about future generations. We want to be happy — but not by taking a drug that gives us happy feelings without the genuine loves, attachments, and achievements that are essential to true human flourishing. As we enjoy the benefits ofbiotechnology, members of the council contend, we need to hold fast to an account of the human being seen not in material or mechanistic or medical terms but in psychic, moral, and spiritual ones. By grasping the limits of our new powers, we can savor the fruits of the age of biotechnology without succumbing to its most dangerous temptations.

Beyond Therapy takes these issues out of the narrow circle of bioethics professionals and into the larger public arena, where matters of this importance rightly belong.

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What is biotechnology for? Why is it developed, used, and esteemed? toward what ends is it taking us? To raise such questions will very likely strike the reader as strange, for the answers seem so obvious: to feed the hungry, to cure the sick, to relieve the suffering -- in a word, to improve the lot of humankind, or, in the memorable words of Francis Bacon, "to relieve man's estate." Stated in such general terms, the obvious answers are of course correct. But they do not tell the whole story, and, when carefully considered, they give rise to some challenging questions, questions that compel us to ask in earnest not only, "What is biotechnology for?" but also, "What should it be for?"

Before reaching these questions, we had better specify what we mean by "biotechnology," for it is a new word for our new age. Though others have given it both narrow and broad definitions,* our purpose-for reasons that will become clear -- recommends that we work with a very broad meaning: the processes and products (usually of industrial scale) offering the potential to alter and, to a degree, to control the phenomena of life-in plants, in (non-human) animals, and, increasingly, in human beings (the last, our exclusive focus here). Overarching the processes and products it brings forth, biotechnology is also a conceptual and ethical outlook, informed by progressive aspirations. In this sense, it appears as a most recent and vibrant expression of the technological spirit, a desire and disposition rationally to understand, order, predict, and (ultimately) control the events and workings of nature, all pursued for the sake of human benefit.

Thus understood, biotechnology is bigger than its processes and products; it is a form of human empowerment. By means of its techniques (for example, recombining genes), instruments (for example, DNA sequencers), and products (for example, new drugs or vaccines), biotechnology empowers us human beings to assume greater control over our lives, diminishing our subjection to disease and misfortune, chance and necessity. The techniques, instruments, and products of biotechnology -- like similar technological fruit produced in other technological areasaugment our capacities to act or perform effectively, for many different purposes. just as the automobile is an instrument that confers enhanced powers of "auto-mobility' (of moving oneself), which powers can then be used for innumerable purposes not defined by the machine itself, so DNA sequencing is a technique that confers powers for genetic screening that can be used for various purposes not determined by the technique; and synthetic growth hormone is a product that confers powers to try to increase height in the short or to augment muscle strength in the old. If we are to understand what biotechnology is for, we shall need to keep our eye more on the new abilities it provides than on the technical instruments and products that make the abilities available to us!

This terminological discussion exposes the first complication regarding the purposes of biotechnology: the fact that means and ends are readily detached from one another. As with all techniques and the powers they place in human hands, the techniques and powers of biotechnology enjoy considerable independence from ties to narrow or specific goals. Biotechnology, like any other technology, is not for anything in particular. Like any other technology, the goals it serves are supplied neither by the techniques themselves nor by the powers they make available, but by their human users. Like any other means, a given biotechnology once developed to serve one purpose is frequently available to serve multiple purposes, including some that were not imagined or even imaginable by those who brought the means into being.

Second, there are several questions regarding the overall goal of biotechnology: improving the lot of humankind. What exactly is it about the lot of humankind that needs or invites improvement? Should we think only of specific, as-yet-untreatable diseases that compromise our well-being, such ailments as juvenile diabetes, cancer, or Alzheimer disease? Should we not also include mental illnesses and infirmities, from retardation to major depression, from memory loss to melancholy, from sexual incontinence to self-contempt? And should we consider in addition those more deep-rooted limitations built into our nature, whether of body or mind, including the harsh facts of decline, decay, and death? What exactly is it about "man's estate" that most calls for relief? just sickness and suffering, or also such things as nastiness, folly, and despair? Must "improvement" be limited to eliminating these and other evils, or should it also encompass augmenting our share of positive goods-beauty, strength, memory, intelligence, longevity, or happiness itself?

Third, even assuming that we could agree on which aspects of the human condition call for improvement, we would still face difficulties deciding how to judge whether our attempts at improving them really made things better-both for the individuals and for the society. Some of the goals we seek might conflict with each other: longer life might come at the price of less energy; superior performance for some might diminish self-esteem for others. Efforts to moderate human aggression might wind up sapping ambition; interventions aimed at quieting discontent might flatten aspiration. And, unintended consequences aside, it is not easy to say just how much less aggression or discontent would be good for us. Once we go beyond the treatment of disease and the pursuit of health, there seem to be no ready-made or reliable standards of better and worse available to guide our choices.

As this report will demonstrate, these are not idle or merely academic concerns. Indeed, some are already upon us. We now have techniques to test early human embryos for the presence or absence of many genes: shall we use these techniques only to prevent disease or also to try to get us "better" children? We are acquiring techniques for boosting muscle strength and performance: shall we use them only to treat muscular dystrophy and the weak muscles of the elderly ...