All We Need is (Unconditional) Love

On March 24, 2017, Joe Gibes posted an entry on this blog, entitled “A ‘disabled’ person speaks out against a particular form of discrimination.”[1] That post featured links to several stories about Kathleen Humberstone, a young woman with Down Syndrome who spoke at a recent UN event commemorating World Down Syndrome Day, which was observed on March 21.

After reading through Joe’s post and the stories to which his post links, I’d like to add the following two very basic observations (which I will only state here – further elaboration shall have to await another time):

  • OBSERVATION #1: Thankfulness and disability are entirely compatible – indeed, one can be genuinely thankful for one’s disability. “Thank you Down’s syndrome!” Kathleen says enthusiastically, in her prepared remarks for the UN event.[2] It’s hard to imagine she doesn’t mean this sincerely.
  • OBSERVATION #2: As Hans S. Reinders has said repeatedly,[3] often the thing that people with profound intellectual disabilities need most is simply to be chosen as friends. This point is easily generalizable to persons with any kind of disability—very often, what we “need” most is simply friendship, not “healing” or “relief” or “freedom” from the (supposed) “burden” of disability itself.

With continued developments in prenatal genetic testing techniques, including the relatively recent advent of non-invasive prenatal testing (NIPT), it has become even easier to detect, at earlier and earlier points in pregnancy, the presence of disabilities such as Down syndrome. And this, of course, opens the door to so-called “selective termination” of unborn children who test “positive” for such conditions.

For Denise Humberstone, Kathleen’s mom, this makes no sense whatsoever. Why shouldn’t we accept all persons, Denise wonders, including those with Down syndrome and other disabling conditions, with the same kind of unconditional love that we would offer to any other, nondisabled person?

“Whatever happened to unconditional love?” she asks. “When did society decide we should want and love a child only if it is as perfect as medical research allows?”

In a Facebook post[4] written just prior to Kathleen’s speech at the UN event, Denise addresses the “unrealistic demands for perfection” that appear to drive so many of these decisions to abort unborn children diagnosed with Down syndrome and other disabilities:

I’m also wondering if in parallel to scientific research, these unrealistic demands for perfection stem from the fact that we are also now living in a world where we can not only get anything we want off the internet but that item always comes with a return form should it not be up to your expectations. Not perfect? Bam! Return it, free-post, no questions asked, item will be replaced in no time….

What are we teaching our children? People are worthy of life and love only if they are perfect? We can’t cope with children unless they’re perfect? Your marriage/partnership won’t last unless your children are perfect? Siblings will be ok as long as they are all perfect? I can assure you that my friends are not happier because they don’t have a child with special needs…. There is always something to be unhappy about, it’s human nature.

So why can’t we just go back to the basics and try and love unconditionally? Why can’t we just deal with the hand we’ve been dealt… and rise up to the challenges that life throws at us?

Around the same time as Joe posted his blog entry about Kathleen Humberstone, quadriplegic and disability advocate Joni Eareckson Tada posted a blog entry[5] about World Down Syndrome Day. Here’s what she wrote:

I love smiling children… the image imparts such hope and joy, reminding us we are all made in the image of God. I especially delight in the smile of a child with Down syndrome. Anyone who has rubbed shoulders with someone who has Down syndrome will rave about the love, openness, and zest for life they bring to every family. Their laughter and joy is infectious. Today, as we celebrate World Down Syndrome Day, I’m reminded of a touching video I saw two years ago – titled “Dear Future Mom,” it shows children and teens with Down syndrome. Each has something brief and sweet to say about their disability. Then, they look into the camera and address the worries of any pregnant woman who is fearful about carrying a child with Down syndrome.

This video blessed me so much, I just had to share it with you. Perhaps you know of an expectant mother who has learned her baby has a genetic disorder. Please share this with her – the smiles on the faces of these young people will ease fears and give hope, helping her welcome her precious baby into the world.[6]

In the end, Kathleen Humberstone and the children and teens featured in “Dear Future Mom” remind us of what we all need the most: unconditional love.


[1] See


[3] See, for example, his Receiving the Gift of Friendship: Profound Disability, Theological Anthropology, and Ethics (Grand Rapids, MI: Eerdmans, 2008).



[6] “Dear Future Mom” can be viewed here:

The Gift of Finitude

I’ve been thinking a lot lately about finitude. About limits. Incompleteness. Even failure.

Like the friend of a friend who is dying and has just been admitted to hospice, whose young teenaged daughter is facing the prospect of a life without her mother.

Like the colleague who is grieving the loss of both a spouse and a parent within a month of each other.

Like my power wheelchair that keeps breaking down, making everyday activities significantly more challenging.

Like the never-ending “to-do” list that seems to be anything but finite, and never quite seems to get any shorter.

Life is, in a word, full of limits. Boundaries. Unavoidable stopping points.

Or is it?

What if we could transcend our limits, as recent developments in genetic and related technologies (e.g., CRISPR) seem to promise? What if, through genetic manipulations of various sorts, we could significantly reduce our limitations—eliminate specific diseases and disabling conditions, improve cognitive function, “select” for desired physical traits, and so on?

If we could do these things, should we do them?

Of course, as anyone who has followed the field of bioethics for even a short period of time knows, these questions are neither new nor hypothetical. In many ways, the “future” is already here: we “enhance” ourselves, “transcend” limits and boundaries, and otherwise seek to “overcome” finitude in a myriad number of ways, on a daily basis. And much of this is salutary.

Still, it’s always worth pausing to consider: supposing finitude could be eliminated entirely from our lives (which seems extraordinarily doubtful), is it the sort of thing we ought to try to eliminate? Put differently: is there anything good about finitude, such that we ought to embrace it (even if in a qualified way)?

Gilbert Meilaender, a bioethicist and Distinguished Fellow of The Center for Bioethics and Human Dignity, suggests that there is something good about finitude. In a reflection on the “created duality” of our human nature—we are simultaneously both “free” and “finite”—Meilaender observes that this “two-sidedness” to our nature both opens up possibilities and imposes certain limits upon us. We are, he observes,

created from dust of the ground—finite beings who are limited by biological necessities and historical location. We are also free spirits, moved by the life-giving Spirit of God, created ultimately for communion with God—and therefore soaring beyond any limited understanding of our person in terms of presently “given” conditions of life…. Made for communion with God, we transcend nature and history—not in order that we may become self-creators, but in order that, acknowledging our Creator, we may recognize the true limit to human freedom. Understanding our nature in this way, we learn something about how we should evaluate medical “progress.” It cannot be acceptable simply to oppose the forward thrust of scientific medicine. That zealous desire to know, to probe the secrets of nature, to combat disease—all that is an expression of our created freedom from the limits of the “given,” the freedom by which we step forth as God’s representatives in the world. But a moral vision shaped by this Christian understanding of the person will also be prepared to say no to some exercises of human freedom. The never-ending project of human self-creation runs up against the limit that is God. It will always be hard to state in advance the precise boundaries that ought to limit our freedom, but we must be prepared to look for them.[1]

I am inclined to agree with Meilaender. Moreover, as I have shared in an autobiographical essay published recently,[2] my own experiences as a person with a physical disability have taught me valuable life lessons that, arguably, might not have been learned otherwise—lessons such as the value of patience and endurance, accepting my limits (an ongoing struggle, I must admit!), and even the importance of having a sense of humor at the (sometimes ridiculous) circumstances in which one finds oneself. Our limits shape our character, our career, and our life choices as much as do our “freedoms”—often in surprising and unexpected ways, and frequently for the better.

None of these reflections, of course, even begin to scratch the surface of the “what?”, “where?”, “when?”, “how?”, or “why?” questions related to the ethical permissibility (or lack thereof) of pursuing various genetic, reproductive, or other technologies. Nor do they, by themselves, tell us whether (and when) we ought or ought not to avail ourselves of abortion, physician-assisted suicide, euthanasia and the like.

They do, however, remind us of one very simple, yet all-too-often overlooked fact: finitude is, in many ways, a gift. Let us not neglect it.


[1] Gilbert Meilander, Bioethics: A Primer for Christians, 3rd ed. (Grand Rapids, MI: Eerdmans, 2013), 3-5.

[2] See “Why am I Disabled? Reflections on Life’s Questions and God’s Answers,” in the Beyond Suffering Bible (Tyndale, 2016), available at and

Dignity and Destiny, Part 2

The following is the second in a two-part review of John Kilner’s new book entitled Dignity and Destiny: Humanity in the Image of God (Eerdmans, 2015). This review was originally published in the Spring/Summer 2015 (Vol. 4.1) issue of the Journal of the Christian Institute on Disability (JCID), for which I serve as Book Review Editor. Information on the JCID, including subscriptions and downloadable articles, can be obtained at



My last post (“Dignity and Destiny, Part 1,” March 16, 2015) traced John Kilner’s argument that creation in the image of God has to do more with God’s intentions for us—to be conformed to the image of Christ—than it does with our present capacities or functional abilities. For Kilner, the “image of God” is not a substantial (physical) object to which one can point, or a degreed property of which one can have more or less. Instead, it is a fixed and invariable standard—namely, (the person of) Christ himself—to which people made “in,” or “according to,” that image, and who have “embraced” their intended destiny through faith in Christ, are being conformed over time. At present, sin interferes with our ability to reflect godly attributes; it does not, however, affect either the “image of God” itself, or humanity’s status as created in (according to) that image. Consequently, a lack of present capacities or functions on the part of any individual human being cannot be taken as evidence that that individual somehow fails to be “in,” or to “bear,” the image of God.

In the book’s concluding chapter, Kilner lays out a few of the implications of the foregoing theological investigation. Here, his remarks are preliminary and suggestive, leaving it for others to develop these possibilities in greater detail. Still, as he recognizes, the potential implications are far-reaching. One could imagine, for example, applications to a wide array of contemporary concerns, including bioethics, spiritual growth/formation, pastoral care and counseling, personal relationships, church life, social/political structures, and our interaction with the natural environment, among others. For people with disabilities, the potential ramifications are especially profound. Consider, for example, the person in a persistent vegetative state, or an individual with a severe cognitive or intellectual disability. On the account developed here, there is no reason to conclude that such an individual has somehow “lost,” or never was “in,” the image of God. Whatever else we might say about her current condition, we cannot say that she does not bear the image of God; instead, we must conclude that she bears the image just as much as anyone else and thereby has the same dignity that all others have. Importantly, this means that she is entitled to be treated with the same respect—and afforded the same protections—as other human beings generally, regardless of her present functional capacities (or lack thereof). She is, in a word, an image-bearer and must be treated accordingly. This does not, of course, automatically tell us what specific course of action should be taken when faced with difficult bioethical decisions. It does, however, mean that we cannot justifiably proceed in such cases on the assumption that we are dealing with anything—or anyone—less than a human being who is fully “in” the image of God.

As this illustrative example shows, readers of this book should expect to be challenged. They will likely recognize ways in which they themselves have spoken about the imago Dei—ways which turn out to be inadequate, inaccurate, and (in some cases) even harmful. If taken seriously, the argument of this book has potential to catalyze a major paradigm shift in how the church thinks about, speaks of, and acts in regard to the image of God—with powerful implications for its interactions with various marginalized groups, including persons with disabilities.

Dignity and Destiny – Part 1

The following is the first in a two-part review of John Kilner’s new book entitled Dignity and Destiny: Humanity in the Image of God (Eerdmans, 2015). This review was originally published in the Spring/Summer 2015 (Vol. 4.1) issue of the Journal of the Christian Institute on Disability (JCID), for which I serve as Book Review Editor. Information on the JCID, including subscriptions and downloadable articles, can be obtained at



The concept of the “image of God,” while central to much theological reflection over the ages, has often not been well understood. The image of God has frequently been defined by picking out one or more present human attributes—moral virtues, functions, or capacities such as “reason,” “righteousness,” “relationship,” or “rulership”—which are taken to render human beings either “like God” or “unlike animals,” and thereby possessing “dignity.” The problem with these accounts is that no matter which current human attribute one identifies as constitutive of being “in the image of God,” it will inevitably be a degreed property, rendering some human beings more “in the image” than others. Consequently, large segments of the human population will be excluded from participation in the imago Dei, either in part or in whole, with significant implications for their subsequent treatment. Indeed, as Kilner observes, history is riddled with examples of “image-inspired devastation,” in which entire classes of human beings—women, enslaved Africans, and Jews during the Nazi holocaust, to name a few—have been deemed to be lacking the “image of God,” and therefore lacking in human “dignity.” From there the slide toward abuse, oppression, and even wholesale murder of such groups has been an easy one.

Kilner traces the source of problems with discussions of human dignity to the acceptance of two faulty assumptions: (1) being in the image of God has to do primarily with current human attributes; (2) the image of God can be damaged. In rejoinder, Kilner argues—by way of careful biblical exegesis of all relevant biblical texts—that creation in the imago Dei has more to do with intended rather than current (human) attributes, and that the imago Dei itself remains undamaged despite the presence and impact of sin. It is human beings who have been damaged (by sin) and are in need of restoration, not the image of God. We are created by God in his image, which means we have a special connection (of similarity rather than identity) with him and are intended ultimately to reflect his attributes to the fullest extent possible for human beings—at which point we will then in that sense be his image (through union with Christ by faith in him, who is the image of God). For now, we bear his image, with the divine intention being that through the process of sanctification—culminating in post-resurrection glorification—we will increasingly reflect godly attributes as we are “renewed in” the image of (God-in-) Christ, thereby fulfilling our intended destiny of being, or becoming, the image of God. Thus, creation in the image of God has to do more with God’s intentions for us—to be conformed to the image of Christ—than it does with our present capacities or functional abilities. The “image of God” is not a substantial (physical) object to which one can point, or a degreed property of which one can have more or less. Instead, it is a fixed and invariable standard—namely, (the person of) Christ himself—to which people made “in,” or “according to,” that image, and who have “embraced” their intended destiny through faith in Christ, are being conformed over time. At present, sin interferes with our ability to reflect godly attributes; it does not, however, affect either the “image of God” itself, or humanity’s status as created in (according to) that image. Consequently, a lack of present capacities or functions on the part of any individual human being cannot be taken as evidence that that individual somehow fails to be “in,” or to “bear,” the image of God. Together, these realities of created connection with God and intended reflection of his attributes ground our dignity and our destiny as human beings, both individually and collectively.

On (Being) “Better than Human” – Part 3D

With apologies in advance to my readers for the length of the recent posts in this series, I finish up here my critique of Allen Buchanan’s argument in Chapter 2 of his Better than Human. This chapter contains a great deal of theoretical machinery, which machinery will prove central to Buchanan’s argument in the rest of the book. For that reason, I have spent considerable time on those details in the last few posts, with a view toward proceeding more economically through the respective arguments of subsequent chapters. I beg the reader’s indulgence.


First, as we have seen, Buchanan prefers to think of evolution as being more like a “morally blind, fickle, tightly shackled tinkerer” than a “master engineer.” He makes much in particular of the fact that evolution is “morally blind,” using the cruelty of nature—both in the way it selects against certain traits and in the way it selects for other (“beneficial”) traits—as a point of departure for pontificating on the Problem of Evil (pp. 37-39), which he defines as follows: “Given how much human suffering there is in the world—much of it utterly undeserved—how could such a world be the creation of a being that is both all-powerful and supremely good?” (p. 37).

In this context, Buchanan contends that Darwin’s theory of natural selection not only deals a “blow” against the very notion of there being an intelligent designer, but also strikes another, “equally devastating blow against religion: It shows that the Problem of Evil is even worse than we thought” (p. 37). As Buchanan points out, “the whole survival of the fittest thing is astonishingly cruel,” leading him to ask the question: “If God is supremely good, why would he choose such a bloody mode of creation?” To the suggestion that our suffering is “compatible with God’s goodness because suffering enriches our lives, builds character, etc.,” Buchanan rightly points out that “many humans—especially children who die from violence or diseases and the millions of young men who die in war—experience suffering without much opportunity for gaining from it” (p. 38). But, Buchanan objects, “God’s making them suffer so that you and I can have a deeper appreciation of existence seems obscenely unfair” (p. 38). Moreover, “it appears there’s surplus suffering: God seems to have given us more than enough of it to make his point” (p. 38).

Even granting that human suffering might, perhaps, enrich our lives, Buchanan asks, how could it possibly have value for other, non-human creatures? As Buchanan puts it, “[t]he elk that’s devoured by wolves while still alive can’t console itself with the thought that elk life is enriched by character-building suffering. Thinking that the good that humans get from our suffering is so wonderful that we can simply turn a blind eye to the misery of all the other creatures seems a tad anthropocentric to me” (p. 39).

The “central point” of these reflections on the Problem of Evil, for Buchanan, is simply this: “IGM has the potential to achieve the good results of UGM, without the butcher’s bill” (p. 39). If we can, for example, introduce beneficial genetic changes more quickly and with fewer deleterious effects than the (unassisted) process of UGM would otherwise produce, this gives us good reason to consider pursuing IGM. Or, as Buchanan sums it up: “Evolution doesn’t count the cost of its improvements and it doesn’t care how the costs are distributed—it’s morally blind. If IGM can achieve the good that UGM achieves and do it not only more quickly, but without the moral costs, then that counts heavily in favor of it” (p. 40).

All of this is both de rigeur and “par for the course” when it comes to discussions of the Problem of Evil in the contemporary philosophical literature, and a thorough discussion of that problem is beyond the scope of this post. With respect to Buchanan’s attempted foray into the philosophy of religion in this context, suffice it to say that his comments here are less than persuasive. For one thing, we might ask the following question: might a perfectly good, all-powerful Creator have a good reason (or set of reasons) for permitting such suffering/evil to occur—i.e., some reason (or set of reasons) other than, or in addition to, “enriching” our lives? If this is possible, then it will hardly do to simply point out that there is such suffering/evil, intimate that we don’t understand what the good reason for it might happen to be, and then conclude from that fact that, therefore, there is no Creator.

More fundamentally, what if we, too, are not only epistemically but also “morally blind” as well? Given our own epistemic and moral limitations—especially our propensity toward moral evil—is there any good reason to think that we would do any better a job (through IGM) than UGM has done thus far?

One might argue, further, that talking about “suffering” (etc.) makes sense only in a theistic universe, i.e. one in which there is an intelligent designer of some sort. It certainly makes little, if any, sense in a strictly naturalistic universe, at least not in the sense in which Buchanan intends here—namely, that in which such “suffering” is morally significant.

Finally, Buchanan speaks of the ubiquity of “design flaws”—“suboptimal design,” he says, is “everywhere” (pp. 30-31). But speaking of “design flaws” in the products of evolution presupposes some sort of objective standard against which such deviations or “imperfections” are measured. Such a standard, in turn, may also imply the existence of a “species standard.” At the very least, it opens the door conceptually to one: if an objective standard is possible, then why couldn’t there be a full-fledged species design as well? And if a there is such a thing as a “species design” after all, then there may very well be good reason to be wary of the prospect of IGM.

In the end, if all you have just is a strictly naturalistic universe, then all you have just is life, death, development, coming into and going out of existence, etc., of various species. On such a scenario, “design flaws” are such only with reference to purely subjective criteria (individual goals, objectives, etc., of an organism), certainly not with respect to any objective standard of design. So it becomes difficult even to speak coherently of a design flaw.


In the next post in this series, we will move on to an analysis of Chapter 3 of Better than Human. In that chapter, entitled “Changing Human Nature? Or, Unnatural Acts, and Not Just with Sheep Like Dolly,” Buchanan addresses the “changing human nature” and “changing biology” objections to the enhancement enterprise, respectively.


Works Cited in this Post:

Buchanan, A. (2011). Better than Human: The Promise and Perils of Enhancing Ourselves (Philosophy in Action Series). New York: Oxford University Press.

On (Being) “Better than Human” — Part 3C

In this post and the next, I want to conclude my discussion of Chapter 2 of Allen Buchanan’s Better than Human: The Promise and Perils of Enhancing Ourselves by focusing on several points of critique of Buchanan’s argument in this chapter. Specifically, my comments will focus on a cluster of moral, epistemological, and conceptual difficulties with his argument.


In the context of a discussion of the “the danger of losing valuable genes forever” (pp. 42-43), Buchanan considers the charge that IGM runs the risk of creating a “monoculture”—that is, the danger that in pursuing IGM, we will succumb to the folly of attempting to “create a standard type of new human, with a specific genotype, and allowing all other human genotypes to go extinct.” Buchanan’s response to this worry—which amounts, essentially, to the claim that IGM will have the effect of reducing rather than increasing genetic diversity—is two-fold. First, he says, “we need to appreciate the fact that UGM, because it relies on the gene filter of natural selection, reduces genetic diversity as a matter of course and that this has its risks.” Second, he goes on to say, “we need to understand that IGM may be the only effective way to counter the risks of decreased genetic diversity.” Given the vast amounts of human tissues—each of which constitutes a human genotype sample—that are now stored in tissue banks for purposes of drug and other research, we could, through IGM, avail ourselves of this “huge genetic bounty” in order to “reintroduce genes that are in danger of going extinct in the normal course of UGM or… to speed up the proliferation of valuable genes.” Consequently, on Buchanan’s view, “[t]he risk of monoculture is not to be dismissed, but it has to be put in perspective.”

By way of brief analysis, two comments are in order here. First, with respect to Buchanan’s points about “risks” and risk-taking, there is an important difference, morally speaking, between unavoidable risks, on the one hand, and those risks that are freely taken on or assumed, on the other. It is one thing to face risks that cannot be avoided—the everyday risks involved in driving to work, operating machinery, even stepping outside to check the mailbox. It is, arguably, another thing altogether to set out, intentionally, to take on risks that might otherwise be avoided—for example, rock climbing, surfing, or white water rafting. Similarly, it is one thing to acknowledge the reality that UGM might have its own risks, as Buchanan rightly points out; it is another thing altogether to knowingly and intentionally take on the risks (if any) that might be involved in IGM. The point at present is not to suggest that a case cannot be made for assuming such risks, but rather to underscore the fact that that case needs to be made. More importantly, simply pointing out that UGM has risks of its own is insufficient, by itself, to warrant the assumption of risks inherent in intentionally pursuing IGM.

It’s also worth noting that there’s a significant difference between involving ourselves in risk, on the one hand, and imposing risks on others, especially without their consent. This issue may be particularly acute if we’re talking about imposing risks on future generations of human beings, who by definition are unable to give their consent to undergoing such risks.


As noted previously, Buchanan characterizes the “master engineer” view of nature—on which evolution is like a master engineer who, in his “wisdom,” produces organisms that are “finely balanced” and “delicately integrated” (p. 27)—as evincing a commitment to a “rosy, pre-Darwinian” view of nature, much like “the previously dead and buried, but recently resurrected argument from intelligent design” (p. 28). On Buchanan’s view, Darwin demonstrated just the opposite: namely, that rather than being like a “master engineer,” evolution—operating by way of natural selection—is more like a “morally blind, fickle, tightly shackled tinkerer,” producing organisms that are genetically inferior and then “discarding” them. I have already discussed in detail the “analogy wars” (pp. 48-49) to which Buchanan draws our attention, so I will not rehearse those points here. The point I want to make, at present, is this. It seems to me that Buchanan engages in a conflation of what he terms “pre-Darwinian views of nature” (frequently referring to them as “religious” or “teleological” views), on the one hand, and Intelligent Design theory, on the other. To be sure, there is a relationship between these concepts, but they are by no means identical. In fact, many ID theorists accept some form of evolutionary theory, e.g. as an accurate account of the development of life as opposed to its origins. Conceivably, one might even accept evolutionary theory regarding the origins of life as well, while insisting that an Intelligent Designer is necessary to account for the origins of the universe itself. Moreover, as many thinkers have noted, Intelligent Design is, in fact, a rather minimalistic theory—taken by itself, it merely gets us to an intentional designer, certainly not to the Judeo-Christian God, nor to any other highly determinate “religious” conception of the Designer. By contrast, many “pre-Darwinian views of nature”—including Christianity—were (and are) embedded in the context of a theologically complex system of thought involving, among other things, a conceptually “thick” concept of the Divine Being to whose agency the existence of life and/or the universe was (is) credited. So to simply conflate the “pre-Darwinian religious view of nature” and Intelligent Design theory is misleading at best.

Setting that issue aside, however, there are at least two other, more fundamental problems with Buchanan’s argument in this chapter—to which I will turn in my next post.


Works Cited in this Post:

Buchanan, A. (2011). Better than Human: The Promise and Perils of Enhancing Ourselves (Philosophy in Action Series). New York: Oxford University Press.

In Memory of Edmund D. Pellegrino

I cannot claim to have had anything more than a casual and intermittent personal acquaintance with Professor Pellegrino, whose passing this last week is a great loss for bioethics, medicine, academia, and the church alike. I did, however, have the privilege of meeting him on several occasions (always at CBHD summer bioethics conferences!), as well as, more recently, the honor of serving as a co-editor of an edited book volume to which he contributed a chapter.[1] In all my interactions with him, he was always the epitome of graciousness and generosity of spirit.

As several other bloggers have noted on this site, one of Pellegrino’s chief contributions was to draw our attention, repeatedly and consistently, to persistent and fundamental questions and concerns that are all-too-often neglected in this age in which the “technological imperative” so frequently carries the day. Questions such as: what exactly are the “ends” of medicine? And how do our present medical practices square with those ends? Concerns such as: what does it mean to be a physician? To be a patient? To encounter one another, as physician and patient, respectively, in the clinical context?

Chief among these concerns was an increasingly countercultural commitment to the notion that medicine, as both an art and a profession, really does possess an “internal” morality—that is, a coherent set of moral principles and ethical guidelines arising out of the nature of the medical practice itself, and embodied in a shared set of assumptions (moral and otherwise) and values to which members of the medical profession are (or ought to be) committed. This contention of Pellegrino’s, central as it was to so much of his work, naturally attracted much criticism—and, to be sure, one cannot help but suspect that, for all practical purposes, medicine as an institution today increasingly looks more and more like a “vending machine” responsive primarily to the vagaries of consumer demand and sociopolitical agendas, rather than the robust, ethically-constrained profession to which Pellegrino continued to call its practitioners throughout his career. To his credit, however, he stayed true to his convictions on this matter, even in the face of opposition—a strength of conviction that is worth emulating in its own right.

Importantly, as a Catholic believer, Pellegrino was both courageous and consistent in his insistence that a proper understanding of medicine as a practice can be attained only in the context of a theologically-informed understanding of reality. For Pellegrino, this meant a continual return not only to the philosophical underpinnings of medical practice, but ultimately, the theological foundations upon which all of human experience—including the clinical encounter—is grounded.

For his rigorous, consistent, and persistent insistence that bioethics be approached from within a philosophical-theological framework that attends to the deep, fundamental “first things,” Pellegrino is to be admired and emulated. For his unfailing personal graciousness, he will be missed. And for his contributions to bioethics, medicine, academia, and the church, he will be cherished.

Rest in Peace, Edmund Pellegrino.

[1] See The Development of Bioethics in the United States (Springer, 2013). Pellegrino’s essay, entitled “Medical Ethics and Moral Philosophy in an Era of Bioethics,” addresses four issues in particular:

First, it examines the sociocultural context that gave birth to bioethics, which is characterized by the rejection of traditional moral authority and the rapid development of biomedical sciences and biotechnology. According to Pellegrino, this particular milieu recast traditional medical ethics outside its philosophical foundation and paved the way for the emergence of bioethics. The second issue relates to the decline of medical ethics as the source for the professional ethics of physicians. Bioethics reconfigured medical ethics within the particular socio-cultural and scientific context of the 1960s. Pellegrino deplores this shift because it redefines the patient-physician relationship in term of social mores instead of the traditional foundations of medical ethics. Third, Pellegrino looks at the meaning of the word “ethics” in the terms “medical ethics,” and “bioethics,” each presupposing different moral visions. Medical ethics, he contends, presupposes rigorous classical philosophical ethics whereas bioethics, in its latest iteration (i.e., “progressivist bioethics”), combines the values of liberalism and pragmatism to advance its socio-political agenda. Pellegrino sees the latter development of bioethics as problematic because it conflates social mores and political ideology with ethics. In his view “ethical discourse must go beyond activism or political ideology,” whether in its progressivist or conservative conceptualization. The fourth and final issue Pellegrino addresses is the plea for a “more rigorous adherence to classical philosophical ethics” to ground ethical reflections in concepts such as the good, the right, and the just, rather than in particular ideologies. To this end, he makes a call for a reconsideration of the potential role of moral philosophy in bioethical and medical ethics debates.

Jeremy R. Garrett, Fabrice Jotterand, and D. Christopher  Ralston, “The Development of Bioethics in the United States: An Introduction,” in J. R. Garrett, F. Jotterand, & D. C. Ralston, eds., The Development of Bioethics in the United States (Springer, 2013), p. 12.

On (Being) “Better than Human” — Part 3B

Picking up where we left off last week (see my post of 05/20/13), in Chapter 2 of his Better than Human, Allen Buchanan identifies and discusses several major “limitations” of what he terms “unintentional genetic modification” (UGM), or “evolution as usual.” As I noted last time, Buchanan’s aim here is to adduce reasons for us to accept the idea that, in at least some instances, it may be preferable to pursue “intentional genetic modification” (IGM) rather than leaving the development of the human species up to UGM alone.[1] To that end, he draws our attention to three major limitations of UGM.

First, UGM is “insensitive” to post-reproductive quality of life (pp. 32-34). That is to say, given that UGM acts only on (or with respect to) traits that are conducive to reproductive fitness, it also leaves intact a number of traits that greatly reduce quality of life after one’s reproductive years. More precisely, on the “Darwinian worldview” in terms of which Buchanan advances his argument, natural selection acts as a “gene filter”—that is, “it tends to prevent genes that have a greater negative impact on reproductive fitness than other genes from being passed on to the next generation” (p. 32, italics in original). As such, natural selection doesn’t operate beyond an organism’s reproductive years—which, for long-lived organisms such as human beings, can leave them with a whole host of problematic traits, ranging from decreased libido to increased risk of various cancers and cardiovascular disease, osteoarthritis, cognitive impairments such as dementia and Alzheimer’s disease, and the many other forms of degeneration that tend to accompany older age. This fact constitutes, according to Buchanan, “a sharp blow against the master engineer analogy.” After all, he asks, “[w]hat kind of master engineer creates beings that fall apart once they’ve reached post-reproductive age and makes no provision for repair?”[2] By contrast, Buchanan suggests, “[o]ne of the chief advantages of IGM (intentional genetic modification) is that it could help us avoid or ameliorate the harms we suffer as a result of UGM’s insensitivity to post-reproductive quality of life” (p. 33). In fact, he goes on to suggest, given the significantly increased lifespans that the various “historical nonbiomedical enhancements”[3] have made possible for us, “[w]e may need further enhancements—including biomedical ones—to cope with the consequences of these earlier enhancements” (p. 33). Indeed, “biomedical enhancements that enable us to live a very long life, with the worst ailments compressed into a very short period at the end, might be needed just to sustain the average level of well-being in our lives. In other words, paradoxically, we may need to enhance just to keep things from getting worse” (p. 34, italics in original)

There are additional problems with UGM. For one thing, as we have seen, natural selection leaves in place a whole range of negative traits, what Buchanan terms “Pleistocene hangovers”[4]: traits that were presumably an “adaptation” at one point in time in the past but are not necessarily so now—and, indeed, that we would now consider to be “negative” traits that we would rather do without. Possible examples of such “hangovers,” Buchanan says, include such things as (a) our “predilection for sweet, salty, and fatty foods,” (b) the tendency of stepfathers to abuse their stepchildren, (c) xenophobia, and, perhaps, (d) the condition we now term Attention Deficit Disorder (pp. 35-36).

The important point that these and other such cases illustrate, Buchanan says, is that identifying a trait as an “adaptation” is a statement about the past—at some point in the past, trait X conferred a reproductive advantage—but says nothing about the present: “Yesterday’s advantage may be today’s liability, so the fact that a trait is an adaptation doesn’t mean it’s a good thing” (p. 35). Consequently, “[b]ecause the environment we live in now is so different, some of the traits we have that are adaptations… may be maladaptive today” (p. 35). But won’t natural selection eventually weed out such problematic traits? Not necessarily. It would, Buchanan says, be a “mistake” to make this assumption, for such traits

can cause serious problems for those of us who have them without reducing our reproductive fitness disastrously enough to get winnowed out. In other words, the mesh of the filter may not be fine enough to stop the genes responsible for them from being passed on and on. And even when they do have a negative impact on reproductive fitness, the evolutionary cure may be excruciatingly slow—taking many thousands of years (p. 36).

Here again, Buchanan suggests, IGM may offer a solution to the problem of Pleistocene hangovers: “In principle, IGM could clean up the ‘unwanted residue’ much more quickly and effectively. Less radically, drugs could be used to counteract the effects of Pleistocene hangover genes. Perhaps that’s what Ritalin does” (pp. 36-37).

UGM is not only a problem with respect to negative traits; it is also problematic when it comes to traits we consider to be positive. As Buchanan explains it, beneficial mutations spread only by way of a “nasty, brutish, and long” process (pp. 37-41). This is due to a number of features that are built into the process of natural selection. First, natural selection can only operate by way of “vertical gene transfer,” as opposed to “lateral gene transfer.” The former type of gene transfer occurs when a trait is passed down from one generation to the next, via sexual reproduction; the latter occurs when a gene is “incorporated” by an organism without having inherited that gene—as, for example, when a bacterium “grabs” a “beneficial” gene that happens to be “in the neighborhood” (p. 40). Generally speaking, organisms are only able to work (so to speak) with the genes they inherited from their parents—in other words, UGM is (with rare exceptions) limited to vertical gene transfer. As a result, the process of unintentional genetic modification, even when ultimately beneficial, tends to be “nasty, brutish, and long.”

By contrast, IGM opens up the possibility of introducing new genetic material for an organism to work with—a form of lateral gene transfer—and thereby, in turn, speeding up the process of genetic modification. Thus, instead of waiting for the “tightly shackled” workman—UGM—to do his work (a project that might take thousands of years and might never be completed), “[w]ith IGM, the workman can throw off his shackles and pick and choose what he needs” (p. 41).

A further problem with UGM is that “valuable” genes can be lost permanently, either through species extinction or through the reduction of genetic diversity that the process of natural selection inevitably brings about (recall the earlier point about natural selection acting as a “gene filter”). And that, Buchanan says, is “an unfortunate fact about UGM, because some genes that are irrevocably lost may be of great value for improving human life or even for preserving it in the face of new threats, whether natural or man-made” (p. 42). Here again, Buchanan sees IGM as potentially coming to the rescue: noting the establishment of seed banks and other similar “preservation” techniques, Buchanan suggests that “IGM, when combined with prudent preservation, can avoid the irrevocable loss of valuable genes” (p. 42).[5]

Yet another built-in limitation of the process of UGM is what has been termed “local optimality traps”—the difficulty that because natural selection can operate only incrementally, it may not be possible to get from one state of development (reproductive fitness) to another, “higher” state of development (reproductive fitness) given the incremental steps that would be required to get “from here to there” in order to achieve that higher degree of “optimality.” The concept is technically complicated, but can be understood (as Buchanan relates it) in terms of an analogy to a three-dimensional “fitness landscape” (pp. 44-45), where relative height represents relative reproductive fitness. Suppose a species (say, human beings) has arrived at a certain “peak” of optimality—picture this as a mountain peak—such that it has greater reproductive fitness than other species that have not reached as high an elevation in the “fitness landscape.” From the vantage point of that “peak,” it may be possible to see in the distance a higher peak, some state of development that would represent a greater degree of reproductive fitness. The problem now is that, in order to reach that higher peak, the species in question would have to traverse a deep “valley,” representing a diminishment in reproductive fitness, in order to be able to ascend that higher peak. In such a case, that species would be stuck in a “local optimality trap.” The upshot, if we think of our own species as being in such a situation with respect to a given trait, is that “[w]e can’t increase our reproductive fitness, not because there are no biologically possible changes that would improve it, but because we can’t get there from here. Because natural selection is incremental, it can’t reach over the valleys to reach the higher peaks” (p. 45). This, Buchanan tells us, illustrates yet another way in which the “tinkerer is “tightly shackled”: “Because he works only incrementally, some improvements that are of enormous potential value are forever beyond his reach” (p. 45). IGM, on the other hand, might (at least in principle) be able to overcome this difficulty, by introducing “nonincremental” genetic change at the embryonic stage of human development (p. 45).

Finally, there is what Buchanan views as UGM’s “biggest limitation”—namely, the fact that “UGM selects for reproductive fitness, not human good” (pp. 45-48). Ultimately,

[f]rom the standpoint of evolution, to say that a trait is optimal means that no further incremental changes in the organism’s genes can improve the trait’s contribution to reproductive fitness. Optimal doesn’t mean unimprovable. It only means ‘the best that can be done, from the standpoint of reproductive fitness, given that this is where we are now and that we have to proceed incrementally’” (pp. 43-44).

In other words, “optimal” does not equal “best”—it simply means “most conducive to reproductive fitness” (p. 45). And, as we saw above, to say that X now has trait Y is not (necessarily) to say that Y is currently conducive to an organism’s reproductive fitness; it is, rather, to say that Y was conducive, at some point in the past, to the reproductive fitness of the species of which that organism is an instance. Furthermore, natural selection as such is indifferent to what we as a species value—that is, to the human good. It is, instead, merely concerned with the reproductive fitness of a given species, not with ensuring, for example, that human beings survive with a certain standard of quality of life. In other words, as Buchanan puts it, “reproductive fitness is about quantity, not quality” (p. 46). Given the foregoing, then, there are two erroneous inferences that must be resisted: (1) the inference from “X now has trait Y” to “Y must therefore now be contributing to X’s reproductive fitness,” and—importantly—(2) the inference from “conducive to X’s reproductive fitness” to being “good for X” (p. 46).

With this distinction between “reproductive fitness” and “human good” in place, Buchanan says, we can—and should—go on to ask ourselves the following crucial question: “In what sense, if any, is the existing version of humanity optimal?” (pp. 46-47). To which query he offers the following reply: “[i]f we answer this question on the basis of an accurate understanding of evolution, here’s what we can’t say. We can’t say that current human beings are the best, if this means best in terms of what we rightly value” (p. 47). In fact, “we can’t even say that we are best in terms of reproductive fitness; in fact, all we can say is that we’re doing well enough that the human population is increasing, not decreasing” (p. 47). Consequently, he concludes, “we have to steadfastly resist the common tendency to think that the latest product of the evolutionary process is the best, either biologically speaking, or in terms of human values. We can’t say we are the best in either sense, and that’s why we should take the prospect of biomedical enhancement seriously” (pp. 47-48).


Needless to say, there are numerous points to be made by way of critical engagement with the foregoing material. In the interest of keeping this post to a reasonable length, I will briefly mention just one of them here, and then follow up in this series’ next entry with a more detailed elaboration on this and related points of analysis.

Continuing a theme to which I have drawn attention in previous posts, I want to close this post with the observation that Buchanan’s reliance on the “limitations” of UGM as providing reasons for why we should consider it preferable, in at least some instances, to pursue IGM rather than leaving the development of the human species up to UGM alone runs into a serious epistemic difficulty. Specifically, the epistemic problem is this: given that, for Buchanan, evolutionary theory and the resultant “products of evolution” constitute the only permissible sources to which we can turn for information about human nature, how could we ever be in a position to know that we were actually improving or enhancing the human species by way of intentional genetic modification? If we are as epistemically limited as Buchanan says we are, then it’s hard to see how we could ever know either (a) what would be good for us (in the long run, at least) to aim for, or (b) whether, in the long run, IGM is likely to be either (i) more effective or (ii) more beneficial to us. For all we know, UGM and IGM might be equally effective and/or beneficial, or UGM might turn out to be more effective and/or beneficial in the long run, present appearances aside. In the end, we just don’t know—and that, in turn, may very well favor a strong presumption in favor of caution over against enthusiasm regarding the enhancement enterprise


Works Cited in this Post:

Buchanan, A. (2011). Better than Human: The Promise and Perils of Enhancing Ourselves (Philosophy in Action Series). New York: Oxford University Press.


[1] As the reader will recall, Buchanan defines these two terms as follows: “UGM is evolution as usual, what Darwin called ‘descent with modification,’ where a driving force of the modification is natural selection. UGM, in other words, is evolution without intentional modification of human genes by human beings. IGM is intentional modification” (p. 31).

[2] For the sake of clarity here, it should be recalled that when Buchanan refers to the “master engineer,” he is referencing what he terms the “master engineer analogy,” where “natural selection” assumes the place, in the post-Darwinian era, that “God” held previously in “Intelligent Design” or “pre-Darwinian religious” views of nature. (p. 28).

[3] See my post on 03/25/13 for more on the “historical nonbiomedical enhancements.”

[4] Referring to the “Pleistocene era” (approximately 100,000-150,000 years ago), the period to which evolutionary biologists trace the emergence of most of our current biological traits (p. 35).

[5] To the objection that this might run the risk of creating a “monoculture,” Buchanan responds by observing, first, that UGM itself reduces genetic diversity, and that, second, the use of IGM may turn out to be our only way of countering such loss of diversity. In the end, he concludes, “if we value genetic diversity, we should worry more about UGM and less about IGM” (p. 43).

On (Being) Better than Human, Part 3A

As I noted in Part 1 of this series (see my 03/25/13 post), in Better than Human Allen Buchanan considers four major lines of objection to the “enhancement enterprise.” As Buchanan summarizes them, each of these objections claims that biomedical enhancement is “different” in morally significant ways from other kinds of (nonbiomedical) enhancement. Specifically, these objections assert that:

(1) biomedical enhancements are different because they change our biology; (2) biomedical enhancements are different because (some of them) change the human gene pool; (3) biomedical enhancements are different because they could change or destroy human nature; [and] (4) biomedical enhancements are different because they amount to playing God (p. 12).

In Chapter 2, Buchanan takes on the second and third of these objections—that is, the “changing the human gene pool” and “changing human nature” objections, respectively.

The heart of Buchanan’s discussion in this chapter is a consideration of two competing analogies in terms of which one might understand evolutionary biology—or, alternatively, “nature” (p. 29)—and its processes: the “master engineer” and the “grim tinkerer” analogies, respectively. On the former analogy, “organisms are like engineering masterpieces: beautifully designed, harmonious, finished products that are stable and durable (if we leave them alone)” (p. 29). On the latter, evolution is “morally blind,” “fickle,” and “tightly shackled” (p. 49)—it produces “cobbled-together, unstable works in progress, and then discards them” (p. 28).

Evolution is disanalogous to a master engineer, Buchanan says, in two key respects. First, “natural selection never gets the job done” (p. 28). Environments are constantly changing, and organisms are constantly adapting both to their environments and to each other, in “a ceaseless round of adaptation and counteradaptation” (p. 28)—resulting in further changes both to organisms and their environment, in a process that never arrives at a terminus. So rather than being “the end points of a process whereby they climb a ladder to perfect adaptation to their environment,” organisms instead exist in a state of perpetual instability, one that belies the “finely balanced” nature implied by the master engineer analogy (pp. 28-29). Second,

unlike a master engineer, evolution doesn’t design what it produces according to a plan that it draws up in advance. Instead, it modifies organisms in response to short-term problems, with no thought of long-term effects. Evolution has no overall game plan for any species, and the results show it. What’s useful for solving today’s problems can cause new problems—and even extinction—down the line (p. 29).

In the final analysis, Buchanan contends, “evolution is more like a morally blind, fickle, tightly shackled tinkerer” than a master engineer. The burden of the rest of the chapter is to provide reasons why (on Buchanan’s view) we ought to accept this analogy over against the master engineer analogy.

In order to adjudicate between these two analogies, Buchanan says, we need to grasp certain key aspects of the mechanisms of evolution (p. 29). The first thing to notice in this regard is that nature is replete with instances of “suboptimal design” (pp. 30-31), which Buchanan takes to be prima facie evidence that the master engineer analogy is problematic at best. Examples of such “design flaws” include, inter alia, the fact that in male mammals the urinary tract “passes through (rather than being routed around) the prostate gland, which can swell and block urinary function,” and the “hasty shift from quadruped to biped, which resulted in back and knee problems and a birth canal that passes through the pelvis, resulting in greatly increased risks to both mother and child in the birthing process” (p. 30). Numerous additional examples could be cited (and Buchanan cites several other illustrative examples here).[1] “Design flaws” such as these led Darwin to develop his theory of natural selection, with which, Buchanan informs us, “Darwin debunked the argument from intelligent design, one of the traditional arguments for the existence of God, by cataloguing the ‘clumsy, blundering, wasteful’ works of nature” (p. 30).

To show more clearly why nature is not best thought of as a “master engineer,” Buchanan introduces at this point a distinction between what he terms “Unintentional Genetic Modification” (UGM) and “Intentional Genetic Modification” (IGM). UGM is “evolution as usual, what Darwin called ‘descent with modification,’ where a driving force of the modification is natural selection”—in other words, “evolution without intentional modification of human genes by human beings” (p. 31). IGM, then, in the context relevant to our discussion, is intentional modification of human genes by human beings.

Buchanan’s aim here is actually two-fold: first, he wants to provide reasons why we ought to reject the “master engineer” analogy in favor of the “grim tinkerer” analogy, and second, he wants to give us reasons for considering the possibility that it may be preferable, in at least some circumstances, to actively pursue IGM rather than simply leaving the development of the human species entirely to UGM. His subsequent discussion in the remainder of this chapter is designed to accomplish both of these aims simultaneously. To that end, he begins by enumerating some of the built-in limitations of UGM, and then goes on to describe some ways in which IGM might be employed to overcome those limitations.

In the next post in this series, we’ll finish up our explication of Buchanan’s argument, and then develop some critical observations regarding that argument. By way of preview, three major limitations of UGM to which Buchanan draws our attention are the facts that (1) UGM is “insensitive” to post-reproductive quality of life (pp. 32-37); (2) in UGM, beneficial mutations spread only by way of a “nasty, brutish, and long” process (37-45); and (3) UGM selects only for “reproductive fitness, not human good” (pp. 45-48). Critical remarks will focus, in turn, on several epistemological, ontological, and moral issues raised by the way Buchanan frames and develops his argument in this chapter.


[1] A bonus for the philosophy buffs out there: In the context of this discussion of “design flaws,” Buchanan offers an arresting image in answer to Nagel’s famous query regarding what it’s like to be a bat. As Buchanan explains, “bats spend a good deal of their time hanging upside down, closely packed together, with their feces pouring down over their bodies to their heads. (Imagine yourself holding a toothpaste tube upright and squeezing it until the contents cover your hands. That’s what it’s like to be a bat.)” (p. 31).

The Fragility of Life: Some (Very Brief) Musings Occasioned by Recent Events

If the events of recent weeks and months—last week’s bombing in Boston; the explosion at the fertilizer plant in West, Texas; and the Newtown massacre, to name a few—remind us of anything, it is that life is fragile. Death, suffering, pain, and struggle can come to us unbidden, at any time, and can forever alter the trajectory of our lives. Experiences such as these undermine our well-established and carefully fortified illusions of control, of mastery over our lives. There is, in the end, so little that we can directly control. We would do well to heed these much-needed reminders of our mortality and vulnerability.

Unfortunately, our culture largely proceeds on the basis of unexamined assumptions about the nature of our lives, of what it means to be “truly human.” To a large extent, it seems we have bought into the notion that the core of what it means to be human has to do with “selfhood” and “agency”—that we are, in the end, makers of our own meaning; controllers of our own destinies; independent, rational, agents of choice whose “rights” to “freedom,” “individuality,” and “self-expression” are of paramount importance. To be sure, freedom, self-expression, and the like are not illegitimate in and of themselves. Yet we lose something crucial when we give in to the temptation to think of ourselves exclusively or even primarily as fully-autonomous, atomistic “selves” rather than as members of larger communities, with whom we exist in relationships of interdependence rather than pure self-reliance.

The dialectic between these various ideas is of relevance to many issues in contemporary bioethics, including questions surrounding enhancement. To what extent does the “enhancement enterprise,” for example, reflect our illusion of control, of self-mastery—we will be the masters of our own destinies; we will assert our own visions of the “good life”; we will, perhaps, even “cheat” death (at least temporarily) by radically extending the length of our lives?

The events of the recent past helpfully remind us, once again, that even our best-laid plans, the ambitions “of mice and of men,” frequently come to naught.

The question, in light of that reality, is: how then shall we live now – todayin the present?