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).

Lies, clones, and stem cells: the language of respectable evil

A breathtaking specimen of obfuscation (or was it just plain ignorance?) was published in the Wall Street Journal (WSJ) this week. The article, entitled, “Experiment Brings Human Cloning One Step Closer,” begins, “Scientists have used cloning technology to transform human skin cells into embryonic stem cells, an experiment that may revive the controversy over human cloning. The researchers stopped well short of creating a human clone.”

A little confusing, but it sounds innocuous, no? Transforming human skin cells into embryonic stem cells: that’s the ethical alternative to cloning a human for the purpose of destroying it and removing stem cells, right? At least they didn’t create a human clone, right?

Not so fast. If one refers to the original article published in the journal Cell this Wednesday, the title alone speaks volumes: “Human Embryonic Stem Cells Derived by Somatic Cell Nuclear Transfer.” Somatic cell nuclear transfer. That’s scientist-speak for cloning.

“The achievement is a long way from creating a cloned human embryo,” the WSJ article says.

Wrong again. The article in Cell describes, and the accompanying diagram shows, a process of creating a cloned human embryo, which at the blastocyst stage is “disaggregated” (destroyed) to remove embryonic stem cells. (If the WSJ didn’t think they created a cloned human embryo, how did they think they got embryonic stem cells from it?)

Not all the press coverage was as slanted/wrong as the WSJ coverage. The BBC, for example, reported it far more clearly.

I don’t know if the inaccurate reporting by the WSJ was motivated by ignorance; or by an ideology that says that “Embryos aren’t human and if you don’t implant it and grow a baby from it it’s not a clone”; or by a desire to confuse people by semantic sleight-of-hand so that they won’t understand what’s happening until it’s too late; or a combination of all of these, or something else altogether.

But just for clarity’s sake, let me paraphrase: We have clearly demonstrated, in a respectable, peer-reviewed journal (no National Enquirer here), that we as a society are willing to facilitate the development of human beings in a Petri dish, and then, when they are at their weakest, smallest, most vulnerable and voiceless, kill them and take their body parts in the hope that they might be useful for others of their species. We deliberately kill our young: not in a gas chamber or oven, as the Nazis did; not tied to an altar, as the Aztecs or Incas did; but in air-conditioned laboratories with bright fluorescent lighting and mild-mannered lab technicians and nice watercolor paintings on the walls in our most prestigious institutions of higher learning.

God help us.

Emergent Dualism and the Sanctity of Human Life

My wife and I spent May 10-11 at the annual conference of Biola’s Center for Christian Thought (CCT), where the theme for 2012-2013 has been “Neuroscience and the Soul.”  The plenary talks are not all on the web, yet, although some are on Facebook, but a number of discussions on the general topic may be accessed here.  I encourage readers of this blog to spend some time knocking around the CCT website.

The weekend (though perhaps not the year, more broadly) didn’t have much neuroscience in it.  Most of the time was spent talking about philosophical and theological anthropology—in particular, what is the soul?  As I have previously written on this blog, I am most attracted to a “Thomistic substance dualism” (after Thomas Aquinas) of the sort advocated by J.P. Moreland of Biola, who argues that the “soul” is a simple (it doesn’t have parts) nonmaterial substantial entity that contains all the ultimate capacities of an organism and which is intimately involved in directing that organism’s development and expression of those capacities.  The word “ultimate” is critical here, because, as we all know, not all members of the human race realize all capacities at all times.  Moreland’s development shores up some shortcomings of Aquinas’s dualism (e.g., the notion that human embryos acquire souls at either 40 [males] or 80 [females] days of prenatal development), while attempting to retain its merits.  It, and other approaches that reject equating mind with brain function, appeal to certain Cartesian intuitions, like those of self-awareness, the sense of “what it is like” to have an inward experience, and others.  The philosophers call these “qualia” of mental events, which make them non-identical with physical/biologic events.  At the same time, Moreland and those of like mind reject the radical Cartesian distinction between mind and body in favor of a more wholistic, as it were, view of what the soul is and does.

Now, this fits nicely with the biblical notion of the image of God, even if one rejects Moreland’s view that the image is what man is, not just what man does (tend the earth), or the relationship between man and God, or the “status and standard” of man relative to God, creation, and the ultimate perfection man.  But I would argue that Moreland’s Thomistic substance dualism is not just faith-based, but also supported by formidable philosophic arguments and accessible on the terms of general revelation.   As such, I think it provides the strongest support available for the sanctity of individual and collective human life.  One sees this in arguments most commonly employed (perhaps not surprisingly) by Roman Catholic thinkers like Robert George; to wit, “humans are the kind or sort of being that….”

Two criticisms of Moreland’s view are:

  1. It amounts to vitalism, an otiose idea long-ago relegated to the biology’s scrap heap of history.   Moreland’s rejoinder to this is to claim that bad, old-fashioned vitalism was too crude, and that a more modern view, “organicism,” is more promising.  (I can’t carry on about that, yet.)
  2. Evolution is irreconcilable with the Thomist view of the soul, because the latter requires that genus and species not be degreed properties, but be in a real sense, immutable.  I agree that the Thomist view pushes one there, and I think that (along with Moreland, I believe), as these critics claim, the Thomist view requires one to accept that God is progressively active in creation.  But these points are said to be unacceptable because of the science of human evolution.

So, as an alternative, some philosophers who remain sympathetic to the idea that mental phenomena are not reducible to physical processes, and in fact are different in ways that cannot be fully explained by appealing to physical processes, nonetheless inescapably depend on those processes and “emerge” from them.  However, they would hold, what is emergent is not just mental properties but an actual, and in a meaningful sense, substantial self.  So they are dualists about human nature—even, in a sense, “substance dualists,” but they are less ready to allow that the human soul might exist independently of bodily life and processes—particularly those of the brain.

Now, there is more to be said about this than I can say, here or elsewhere, but it seems to me that the appeal to a “degreed” nature of life or consciousness disallows categorical distinctions of moral status between individual people, or people in general, and other beings.  (It seems to me that the emergent dualist also conceives “soul” as too readily identified with higher mental properties than the Thomist view would insist on.)  It risks making “personhood,” or “dignity” or moral status a degreed property.  Should we be more concerned about an anencephalic baby, or a fetus with Down syndrome, than a fully-endowed and functioning gorilla, and if so, why?  Should we be troubled about creating a human/non-human hybrid, and if so, why?  Would a super-intelligent robot, if there could be such a thing, potentially be a rival of “natural” humans in competing claims for concern?

I tried this out on a prominent Christian emergent dualist at the conference, and he quickly dismissed my objections.  To be fair, I hit him with a “drive by” on the coffee break, but as it happened, when I pushed, he responded, in effect, we can’t base all our moral appeals on rational argument.  Sometimes we have to just demonstrate the truth of the gospel, and show people the choice between worldviews and their consequences, and ask them what do they really prefer?  And, as unfairly as this brief post may be posing the issues, that kind of rejoinder worries me.

Ultimately, some appeal to a “givenness” of human nature is necessary to defend boundaries in bioethics.  We might indeed appeal to the naturalist by counseling caution—evolution has, over millions of years, presented us with ourselves, including our common intuitions—and we ought to have a “default” position of “no-go” on the most “out there” ideas.  We might indeed present a “two views” picture, and ask people to choose what kind of world they really want and what sort of people they ought to be.  We might argue, as I take the German philosopher Jürgen Habermas to argue, that the interplay of human autonomy, human language, and human social relationships lead us to conclude that some technological interventions would tend fundamentally to destroy who we are in community, and so ought to be avoided.  But I think it’s harder to identify, on emergent dualist grounds, what if any specific maneuvers ought to be proscribed with “thou shalt not,” or words to that effect.

The emergent dualists might be right.  (I tend to agree with Moreland that the position is unstable, tending toward either his dualism on the one hand or functionalism on the other.)  If so, we should, as the philosopher I challenged told me, follow the inquiry where it leads.  (One approach that could be called into question is Francis Schaeffer’s approach of asking whether one can live with the consequences of one’s philosophy.)  But my efforts, at least, are still awfully preliminary.

Cesarean Delivery on Maternal Request (CDMR); an ethical option?

A growing phenomenon in recent decades is “Cesarean Delivery on Maternal Request” (CDMR) — the delivery of a baby via a scheduled cesarean section, not for any medical reason, but because the mother desires not to have a vaginal delivery.

Is this an ethically legitimate medical practice? There are different arguments for or against. When one weighs the potential benefits and risks to both mother and baby, the scales don’t tip overwhelmingly towards one side or the other. Not unexpectedly, the principle of autonomy is one justification given in support of the practice: if a woman understands the benefits and the risks, so the argument goes, she should be free to make a decision in accordance with what she wants. (This begs the question of, should doctors be obligated to do an unindicated medical procedure simply because a patient requests it?) The principle of justice is often cited as a reason not to do CDMR; on this account, the increased expenses of surgery and prolonged hospital stays constitute an unjustified use of finite resources.

One of my concerns with CDMR is that it represents another example of our tendency to place faith in a technique or technology, to uncritically accept what is gained by the technique, the good that it promises (e.g., not having to undergo labor; control; the convenience of scheduling); without stopping to consider either the idea embedded in the technique, or what is lost by adopting the technique. One idea embedded in CDMR is that Pregnancy is a Medical Condition, a Disease that needs to be treated and cured. Now it is clear that there are some pregnancies that benefit from medical intervention. However, we extrapolate and make every delivery a techno-medical event, to the detriment of many, performed in hospitals and replete with fetal heart monitors and IVs and all the other indispensables of the modern delivery suite. (We are so inured to this idea of pregnancy-as-disease that most of us are surprised when we hear of a delivery taking place at home; some might even question the sanity of a decision to have a home delivery!) CDMR only reinforces this idea, moving us further away from understanding pregnancy and delivery for the “natural” and very human events that they are. As for what is lost by the practice of CDMR, there is an irreplaceable mother-child bonding time that occurs immediately post-partum. Sometimes, when a cesarean section is medically necessary or the mother or baby are ill, this precious time must necessarily be relinquished; but to forgo it for no necessity minimizes an ineffably important and human experience.

Is this an ethically legitimate practice? It’s perhaps not as clear as some other contested issues. But it seems to take us another step down a path — the medicalization and technicalization of all human experience — a path to a world brave and new, a path we will rue after we have gone too far down it to turn back. Ethically legitimate? Barely, maybe. Wise? I don’t think so.

The Egg-Freezing Express

Oh, my.

The “Review” section of last Saturday’s Wall Street Journal (my paper of record) carried a piece by one Sarah Elizabeth Richards, entitled, “Why I Froze My Eggs (And You Should, Too).”  (Of course, she’s written a whole book about it.)

Egg cryopreservation has progressed to the point where human eggs do well enough in a freeze-thaw that subsequent success rates with IVF are, apparently, at least competitive with IVF using freshly-harvested eggs.  So a woman who doesn’t want to risk compromising her career, or who is having trouble finding a mate, can alleviate at least some of the pressure of the “biological clock” for procreation, and have her own eggs frozen and saved for future IVF when said mate has been found.  Ms. Richards reports that freezing her eggs helped her relax, seek a man interested in marriage, and look forward to raising a family within the bounds of what sounds like her hoped-for traditional marriage.  Apparently she has friends with similar experiences and intentions.  And she rejects the tyranny of the biological clock, while acknowledging that nothing is foolproof and motherhood can’t be postponed indefinitely in a woman’s life.

So, insofar as preserving fertility of, say, a young female cancer patient receiving chemotherapy, or—assuming you agree that IVF within the bounds of marriage is ethically acceptable—helping infertile couples, one might argue that egg freezing is a welcome development, a relatively small step that will enhance reasonable family planning and might actually discourage some couples from seeking eggs from a third-party donor.  So far, so good—or, maybe, “so far, so OK.”  (Oh, there was nothing much in the article about the process of inducing ovulation or hyperovulation with drugs, which is tacitly assumed to be risk-free.)

But of course there is no reason in principle for it to stop there.  Ms. Richards acknowledges that egg freezing can help single-mothers-by-choice, and, if a woman’s own eggs don’t survive the process, then “instead of paying tens of thousands of dollars [to an egg donor], [a woman] can buy her eggs piecemeal for a couple of thousand dollars each,” online, from one of several clinics selling eggs provided by some 300 donors.  Gee, I wonder how long before one can get a really great deal at Costco.

It all gives women power over the last area of their lives that limits their opportunity.  What’s not to like?

In an accompanying article, “The Ethics of Egg Freezing,” Christine Rosen of the New America Foundation raises concerns about complications of workplace accommodations for women and families, and she points out that the likely accompanying increase in the use of preimplantation genetic diagnosis will have people seeking “just the child [they] want by choosing its sex” or some other genetic traits.   The greater sense of control brings with it different expectations; viz., people will want the resulting child to match their expectations.  Ms. Rosen would not ban egg freezing, but she worries that if young women routinely freeze their eggs then our society “could develop very different attitudes about children and the arc of a human life.  The danger lies not in a particular technology but how it might allow us to indulge our hubris and pretend that we and our families are not subject to the relentless march of time.”

Check, check, check, check, and check.  Ms. Rosen is correct on all points.   Most people don’t believe in the providence of God anymore, but they do believe in the providence of man (and woman).  (Oh, BTW, over at his “Human Exceptionalism” blog, Wesley Smith recently took to task a recent New England Journal of Medicine piece promoting the sale of made to order embryos.  And Ms. Rosen didn’t comment—as well she might have—that such control, such ‘autonomy,’ could readily come under control of the state someday.  “Ms. Smith, do you have your government-approved pregnancy permit?”)

I don’t pretend that this freight train will stop.  And I would not try to ban egg freezing—for eventual use in, say, gamete intrafallopian transfer.  Old fashioned and inefficient, I know.  But I am convinced that human IVF was a line we ought never to have crossed.  Having crossed it, I agree with the Roman Catholic commentators who argue it is a practice of which followers of Christ ought to repent.  (I know I am at odds with received evangelical opinion here.)   And we must promote an attitude that children are a gift, not a product.  And we must raise our kids and encourage people in general that procreation is properly limited to true marriage—as describe by Robert George’s group, a complete union of husband and wife, body and soul, uniquely ordered for procreation and the raising of children, necessarily exclusive and permanent.

Let’s lean into that.

Figures don’t lie, but pharmaceutical manufacturers figure

On April 19th, the Office of Fair Trading, a UK consumer-watchdog agency, accused GlaxoSmithKline of delaying competition with its antidepressant drug paroxetine (Brand name Paxil in the US, Seroxat in the UK) by paying generic manufacturers to delay making a generic version of paroxetine.

If this is true, it is not the first — or worst — bit of subterfuge surrounding paroxetine and other antidepressants. Before the FDA approves a drug, it requires scientific evidence demonstrating that the drug is reasonably safe and actually does what it claims to do. However, when results from clinical trials have shown that their drugs work no better than placebo (sugar pills), antidepressant manufacturers have often chosen not to publish those results, or have published the trials but doctored the results to make them look like the drugs actually do something more than the placebo does.

An example from a 2010 article in Psychotherapy and Psychosomatics that reviewed the published and unpublished research on antidepressants: In one review of 74 trials, “According to the FDA scientific reviews . . . , only 38 trials (51%) found positive drug/placebo differences and 37 were subsequently published. The FDA judged the remaining 36 studies to be either negative (24 studies) or questionable (12 studies) – that is, no difference on the primary outcome but significant findings on a secondary measure. Only 3 (8%) were published reporting negative results, while the remaining 33 were either not published (22 studies) or published as though they were positive (11 studies) in contradiction to the FDA conclusions. ” (italics mine)

The problem? Physicians use evidence from different sources, including published studies, to make treatment decisions. If most of the studies that find no difference between drug and placebo are left out of the analysis or dressed up to make them favor the drug, then the physicians make recommendations based on skewed data that grossly misrepresents the efficacy of antidepressants. Not only are countless people harmed by medication side effects, countless more may be harmed by thinking that their problems in life can be cured with a pill, or that they’re at the mercy of a “chemical imbalance” in their brain.

A whopping 11% of the general population now take an antidepressant. If the decision to prescribe the antidepressant is based on published data, which is skewed to show a greater treatment effect for antidepressants than is warranted, then our health care systems pay an awful lot of money to pharmaceutical manufacturers for medications that many times work not because of anything in the pill, but because the patient believes the pill will work (i.e., the placebo effect).

The authors of the aforementioned review conclude, “The reviewed findings argue for a reappraisal of the current recommended standard of care of depression.” In a “Prozac nation” that values quick-fixes and “a pill for every ill,” where direct-to-consumer marketing is relentless and irrational, such a reappraisal may be a long time in coming.

A Place Where We Ought to Fear to Tread

The current issue of World magazine includes a brief article about this work going on in the United Kingdom: attempting to circumvent certain inheritable diseases by replacing the mitochondrial DNA in a mother’s oocyte with mitochondria from an oocyte of another woman.  The re-engineered oocyte is then fertilized in vitro, with subsequent implantation of the embryo, etc, etc.  The article’s provocative title was, “Heather has two mommies.”

If one accepts IVF and is inclined to observe the “therapeutic boundary” as placing limits on what genetic manipulations we should be willing to undertake, then this project would seem to qualify as treatment, rather than enhancement, before a new individual person is conceived, and could qualify as an acceptable use of reproductive technology.  And one can argue that the risk/benefit analysis, in a case like this, is clearly positive (perhaps requiring that all embryos so created are implanted with the intent to carry them to term).

But I’m not so sure that a line has not been crossed here.  Still, to object on grounds of “repugnance”—as I would—would seem to succeed only if said repugnance reflects deep, universal moral sentiments and intuitions that are expressions of a natural moral law.  And a lot of people would not find the case here repugnant.  To object—as, again, I would—on the grounds that the undertaking here is part of the transformation of procreation (and receiving of new life as a gift) into manufacturing seems to require that there is an objective, given, human nature and order of human life that must not be tampered with.  If life is God-given and humans are in His image, then it is more natural to make that kind of assertion, but by so doing I think we (I) accept the task of saying what that human nature is.  The image, in that case, needs to be more than just a “status and standard,” or to say that it grounds the human nature we shouldn’t mess with seems tautological.  Alternatively, on more naturalistic grounds, one might argue that evolution “gave” us a core genetic nature (“in its wisdom??”) that “ought not be disposed with,” a tack the German philosopher Jürgen Habermas seems to take in opposing PGD.  Or, we could even invoke a form of the much-maligned “precautionary principle” and claim that, when we start mixing and matching pieces of genomes in newly-conceived people, we don’t know what difficulties we might be wandering into, so we can’t define a risk-benefit ratio in the first place.

Anyway, I think a line something like this—there is, in a meaningful sense, a “core human nature” that must not be altered, and a natural moral law that grounds at least the most basic, primary moral precepts setting that limit—is the line that is necessary if one wants to claim that our biotechnologic grasp must stop somewhere.  And so I want to hold.  None of it suggests that the march of biotech will be slowed—it seems that somebody will try anything that becomes feasible—but it is a basis for asking people to stop and think, and getting perhaps some to turn back.  It is a basis for articulating a “presumption to forbear.”

A funny thing happened on the way to the ICU . . .

In the latter half of the last century, medical technology made huge leaps in the ability to sustain biological function. Suddenly we could replace lost kidney function and keep lungs breathing and hearts pumping for people who, but a short time before, would inevitably have died from their kidney, lung, or heart failure.

But something funny happened on the way to the ICU. These new technical means of medicine radically changed the calculus of the goals or ends of medicine. Our technical advances far outpaced our ability to think ethically about how to use our newfound abilities.

The new technological means allow us to keep bodily functions going when they would otherwise stop. For many patients, these are lifesaving and appropriate interventions. However, for others, these new treatments become treatments that treat — nothing. To put it another way, when there is some radical insult to a person’s body, the technical means to sustain vital functions such as breathing and circulation are an appropriate intervention that buys time for the body to heal in ways it obviously couldn’t if those vital function weren’t sustained, i.e., a body can’t heal if it’s dead. But there are some patients for whom death is imminent, inevitable, and no degree of healing is possible outside of a miracle. For these people, the technical means become an end in and of themselves. We sustain a person’s bodily functions, not as a means to allow any hoped-for healing to take place, but because we are able to. We may not even ask why we do it; we do it because we can. Sometimes we even think that if we can do it, we must. Thus a technical means becomes an end in and of itself.

This is one of the inevitable tendencies of technique (of which technology is a subset): the tendency to turn means into ends. If we can ethically control the expansion and use of techniques, then they can be our servants: powerful ones that we must keep a close eye upon, yet servants nonetheless. But we humans have a tendency to place faith in technology, to assume its goodness, and so to catalyze its tendency towards self-justifying expansion. To the degree that we allow this to happen, we end up serving our technology, rather than technology serving us. We end up doing things because we can: keeping the ventilator on because — well, because the patient’s on a ventilator; doing the scan or the blood test because, well, we have a patient here, and we have to do something, and we can, even if it doesn’t really serve the end of improving or preserving the health of the patient.

Of course, it is not only in the ICU that this automatic deferral to technology can occur, but in all areas of medical practice. In light of this apparent deficit of ethical reflection on and regulation of our technology, in light of the exchange of our control over technique for technique’s apparently autonomous self-propagation, I wonder whether the practitioners of the medical art are not in danger of transforming from professionals to technicians.

On (Being) “Better than Human” — Part 2

I ended my last post by identifying what I take to be an important methodological issue with Allen Buchanan’s pro-enhancement argument in his recent (2011) book entitled Better than Human: The Promise and Perils of Enhancing Ourselves. I want pick up on that point in this post, before moving on to other points of analysis in subsequent posts.

To recap briefly: for Buchanan, addressing ethical concerns regarding the “enhancement enterprise” requires, among other things, a consideration of what human nature is like. And the answer to that question, in turn, is to be found in the findings and pronouncements of evolutionary biology, as set forth in the “Darwinian worldview.” More to the point, for Buchanan, the only source of “evidence” relevant to answering the question of human nature is evolutionary biology. In other words, Buchanan’s approach here is significantly epistemically constrained—only certain sources of knowledge are considered legitimate for purposes of examining morally the enhancement enterprise. This methodological move is significant, for it has the effect of ruling out of court, from the outset, other potentially valuable sources of information regarding human nature, including, particularly, theological reflection.

The obvious question to ask here is: why accept this epistemic constraint in the first place? Presumably, a significant part of the reason for Buchanan’s insistence on this epistemic restriction is another major methodological commitment of his, to which I drew attention in my earlier posts—namely, his commitment to framing his argument in strictly secular, non-religious terms. As I have noted, Buchanan indicates (on one occasion) that he is adopting in this book a “non-religious” approach in order to advance arguments that can be “accepted” by non-religious as well as religious people. Given that methodological commitment, Buchanan presumably views the pronouncements of evolutionary biology—products of the “Darwinian worldview” to which contemporary science is (purportedly) committed, and in terms of which Buchanan seeks to couch his overall argument—as being beyond reproach, evidentially (and therefore epistemically) speaking.

What, then, does Buchanan think “modern evolutionary biology” actually tells us about human nature? In the book’s second chapter, entitled “Why Evolution Isn’t Good Enough,” Buchanan goes to great lengths to argue against what he terms a “pre-Darwinian” view of evolution, according to which “evolution is like a master engineer”— the idea that “organisms are like engineering masterpieces: beautifully designed, harmonious, finished products that are stable and durable (if we leave them alone)” (p. 27). If the “master engineer” analogy is correct, of course, it would seem to imply that we ought not to attempt to change what that “master engineer” has produced. As Buchanan acknowledges, “[i]f that’s what we are like, then biomedical enhancement is reckless indeed. Genetic enhancement—seen as an attempt to change the master design itself—seems especially ill-conceived. The master engineer analogy, if it is accurate, provides a strong augment against genetic enhancement and perhaps against biomedical enhancement generally” (pp. 27-28).

But this analogy, Buchanan says, is mistaken. Instead, he argues, “evolution is more like a morally blind, fickle, tightly shackled tinkerer” (p. 29). I will have more to say in a subsequent post regarding exactly what Buchanan means by this proposed alternative metaphor. For now, suffice it to say that the basic idea is that there’s no good reason to think that “natural selection” is currently doing a good job or that the results of evolution are “good”—either in the sense of being “beneficial” to us, or in terms of what we value as human beings—and therefore ought not to be interfered with. Evolution is, instead, more accurately thought of as being “morally blind”; the processes of natural selection are, more often than not, “nasty, brutish, and long”—displaying utter indifference to human suffering and quality of life. Moreover, rather than being a “master engineer,” evolution is more properly thought of as being a “fickle, tightly shackled tinkerer”–it operates inefficiently and frequently fails to achieve “optimal” design changes. Ultimately, Buchanan contends, “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 possibility of biomedical enhancement seriously” (pp. 47-48).

The bulk of Chapter 2 is devoted to defending and exploring the implications of accepting this metaphor for evolution over against the “master engineer” metaphor. A discussion of the specifics of Buchanan’s argument here will have to await another post. For now, what I want to emphasize is the conclusion Buchanan draws from this exploration—namely, that “[h]ow we think about evolution—or, if you prefer, nature—makes all the difference to how we should think about enhancement. Interfering with the work of a master engineer is one thing; selectively intervening in the work of a morally blind, fickle, tightly shackled tinkerer is quite another” (p. 29).

Or, as he puts it later in this chapter,

[t]he main point is that to come to grips with the challenges of biomedical enhancement, we need to consider it from the standpoint of evolutionary biology. Remaining stuck in the rosy old, pre-Darwinian view of nature stacks the deck against biomedical enhancement. As we’ll see in later chapters, there are a number of reasons to worry about biomedical enhancement, but the risk of damaging the work of the master engineer of evolution isn’t one of them (p. 51).

Now, to be clear: I don’t want to attempt here to litigate the creation-evolution debate—such a task would go well beyond what can be accomplished in a single blog post (or series, for that matter!). In particular, I do not intend in this post to delve into the disputes among adherents of non-theistic evolution, theistic evolution, and creationism (whether of the “old earth” or “young earth” variety). Rather, the key point I want to make here is that Buchanan’s claims about the evidentiary value of looking at (the products of) evolutionary biology actually cuts both ways, undermining his own argument as well as the position against which he argues. Buchanan wants to say that because the results of natural selection are best characterized as being, to borrow Tennyson’s famous phrase, “red in tooth and claw,” therefore we cannot say whether or not evolution is currently “doing a good job,” and therefore we cannot argue against the enhancement enterprise on the basis of an a priori assumption of a “pre-Darwinian,” “teleological” view of nature according to which our current biological condition is good and thus ought not to be (intentionally) altered. Fair enough. The problem for Buchanan now is, if the results of evolutionary biology are the only source for relevant data concerning “human nature,” this means that we also cannot appeal to evolutionary biology to argue in favor of the enhancement enterprise either. For simply looking at “the way we are” now biologically—whether that is understood as the product of unguided evolutionary processes, or the result of guided (“theistic”) evolutionary processes, or even the result of direct, special creation not involving evolutionary processes—will not be sufficient, by itself, to tell us how we ought to be biologically. After all, if our current biophysiological constitution is the result of “blind” evolutionary processes, then it is nothing more than a contingent historical accident—merely the result of unthinking, unknowing selective pressures, the consequences of which may or may not be “good” for us, and which certainly cannot be said to be the way things are “supposed to be,” in any meaningful sense of that phrase. If, on the other hand, our current biophysiological constitution is the result either of guided (“theistic”) evolutionary processes, or the result of direct, special creation—both of which would imply an intentional “design,” at least at the outset—we have no way of knowing, simply by observing our current state, whether and to what extent that state is in accordance with that original “design.” For all we know, simply through observation alone, our current condition may be very different than what was originally intended.

What these considerations highlight is the need for a broader normative framework within which to understand the significance of our current biophysiological condition and the implications, if any, that might flow from that state. We need some way of determining (a) whether or not our current biophysiological state is best understood as being a good, bad, or indifferent state of affairs; (b) whether or not attempting to “enhance” that state would be a good, bad, or indifferent course of action; and, accordingly, (c) how specific means of “enhancement” ought to be evaluated morally, in light of (a) and (b). Significantly, none of these questions can be answered simply by observing our current biophysiological condition.

To that end, theological reflection—and, specifically, Christian theological reflection—would seem to be, at the very least, a legitimate candidate for such a normative framework within which to think about and to evaluate the “enhancement enterprise.” Christian theology, in particular, proposes a coherent set of answers to such questions as who we are, how we got here, and where we are going—placing human beings in subordination to a God who designed, created, and sustains the universe and all that is in it, ordering it to His ends and for His purposes—thereby embedding human beings within the bounds of certain circumscribed limits that, arguably, are not rightly transgressed. Spelling out the details of this framework is beyond the scope of this post. The key point for present purposes is that this is the sort of framework that is needed to answer the relevant questions about the “enhancement enterprise”—crucial questions that a simple appeal to the “Darwinian worldview” cannot answer.

This is not to suggest that the Christian worldview is (necessarily) the only possible framework within which to think about these issues. Indeed, there may be numerous other possible such frameworks. The key point I want to emphasize here is that in limiting the legitimate sources for reflection on the enhancement enterprise to only that which can be said to fall within the purview of the “Darwinian worldview,” Buchanan is needlessly—indeed, one might argue, unfairly—excluding the sorts of resources that might be able to address the kinds of central questions about the enhancement enterprise that the Darwinian worldview is incapable of addressing in its own terms.

 

Works Cited:

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

 

Three Stem Cell Developments

The news this past week carried three reports related to developments in stem cell research.  Briefly, starting with the farfetched and ending with the “nearfetched”:

First, the Wall Street Journal reported on efforts to “grow” human organs in the lab.   People who try to “keep score” of therapeutic results with adult vs. embryonic stem cells may recall a case in recent years in which surgeons (in Germany, I believe) fashioned a new trachea, or windpipe, for a patient using that patient’s own adult stem cells.  The current report follows this track.  In its most daring application, a heart is “grown” in the lab.  Well, not exactly: it’s not like researchers expect a clump of cells to magically take on the full, functional form of a human heart in a Petri dish.  (I’m sorry, I should be serious, but I cannot but recall my late, lamented Weekly World News carrying the front page story that Hitler’s nose had been cloned in a Petri dish—complete with a photo of the darn thing, mustache included.)  Seriously, these researches take an approach similar to the windpipe case.  They obtain a donated heart from someone who has died (i.e., a cadaver heart), and strip off all the cells, leaving only the foundation of connective tissue, the scaffold on which the functional heart cells had rested.  Then, they take adult stem cells—the idea is that these come from a patient whose heart is failing, who ordinarily would need a transplant—and place those on the scaffold, taking steps to induce the cells to differentiate into heart cells.  It’s still very early, but in concept this approach to organ engineering looks promising.  The cadaver heart need not be fresh, as it must for a transplant as currently practiced.  That means that there is no urgency to harvest the heart immediately after death, and there would be no pressure on the definition of death, and no concern about over-eager transplant surgeons jumping the gun.  Also, the “scaffold” is not particularly immunogenic, so the patient’s immune system would “see” the immunologic type of the patient’s own cells.

Now, there are years—10, at least—of research needed to find out whether this will work, but the approach appears promising.  If it does pan out, it seems to me the principal ethical issue invoked will be justice:  how much will it cost, and who will be able to get it (i.e., will we socialize the cost)?  That is for another day.

Second, a federal court let stand a decision favoring the FDA over Cytori Therapeutics, in a case involving the company’s device that allows surgeons to separate out adult stem cells from a patient’s fat.  The initial application has been in breast reconstructive surgery, and I believe the device is approved in at least one country outside the U.S.  In the U.S., however, the FDA is going to insist that the company prove, in a large, randomized clinical trial (at least one of which is in progress) that the device is safe and effective.  This places the device in a high-risk regulatory category (like, for example, cardiac defibrillators), not a lower risk category that would allow the company to get fast approval simply by showing that the device is similar to a prior, or as the FDA calls it, a “predicate” device.  (There are further nuances, because in some cases, if the risk is low enough, FDA lets a new device without a predecessor serve as its own “predicate” device, but that is too far into the weeds for this post.)  In any event, the court sided with the FDA, and the company was not surprised—this has been going on for a while.  But it is consistent with FDA’s approach to adult stem cells in general, which is that the Agency views them as sufficiently manipulated to require full-blown development, as for new drugs—even if all a doctor does is take tissue from a patient, spin it in a centrifuge to pull out the stem cells, then re-inject the same stem cells, with no other doctoring, back into the same patient.  That, in turn, is what lay behind the State of Texas trying to circumvent the FDA in recent past, to let doctors use adult stem cells in some ways for their own patients.  But the FDA will win this, in the end.  The net effect will be to slow down the availability of treatments using adult stem cells, and to make it necessary that deep-pocket companies bear the costs of the research.  On the margin, as I have blogged in the past, I think the FDA’s maybe being a bit too conservative, but “it is what it is.”

Third, the California Institute of Regenerative Medicine (CIRM), the body that was created with several million dollars’ funding a few years ago, largely for the purpose of promoting research with embryonic stem cells—which require destruction of one or more embryos to be obtained—is establishing a stem cell bank—not with embryonic stem cells, but with induced pluripotent stem cells (iPSCs) and adult stem cells derived from them.  Cells will be obtained from people with a variety of chronic diseases that are priority areas for research supported by the CIRM.  Makes all the sense in the world from the standpoint of basic and translational (applied) research.  The takeaways?  The CIRM is following the science, and not all of the research it supports is ethically questionable (although some still is, and there are other issues with how the CIRM operates that I won’t go into here).

To close, a reminder to scientifically uninitiated social conservative types:  we are not “against stem cell research.”  We are against unethical research, including research that does not adequately protect human subjects (including the unborn), wherever it is proposed.