On (Being) “Better Than Human” — Part 1

Recent posts have called for reflection on the “ends” of medicine. Though not directly addressed to the specific questions raised in those posts, this series will touch on related themes and so will be relevant to that larger discussion. With that in mind, I invite my readers and fellow bloggers to add their comments and observations into the mix, with a view toward drawing connections between these reflections and the broader questions under discussion on this site.

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As I noted in my recent posts (2/11/13 and 03/04/13), Allen Buchanan’s Better than Human: The Promise and Perils of Enhancing Ourselves is an extended argument to the conclusion that “[t]here are powerful reasons in favor of a society like ours embarking on the enhancement enterprise, and there are no objections to enhancement that are sufficient to outweigh them, at least at the present time” (p. 181). In advancing his case for this conclusion, Buchanan explicitly eschews an appeal to what he terms “religious assumptions”—not, he emphasizes, because he is “antireligious,” but because he is “trying to discuss enhancement in ways that are accessible to most people, whether they are religious or not” (p. 145). Along the way, however, Buchanan ends up committing himself to some fairly robust assumptions that may or may not be “accessible” to “most people,” especially those who approach these issues from an explicitly religious or theological standpoint. In this post—the first of a multi-part series—I want to spend some time identifying and considering the ramifications of at least some of these assumptions. We will also consider two other recently published works—Jonathan Glover’s Choosing Children and Michael Sandel’s The Case Against Perfection, respectively—with a similar objective of examining (some of) their underlying assumptions, and with a view toward bringing these works into conversation with one another.

I begin, first, with a brief synopsis of Buchanan’s argument. This will, of course, omit or gloss over many details and nuances of his argument as presented throughout the book. Nevertheless, the following summary encapsulates key elements of his larger project, points that will serve as a launching pad for reflection in this and subsequent posts. Toward the end of this post, I will very briefly focus in on a specific methodological issue, one that recurs throughout the book and which, in my judgment, renders the larger argument problematic at best. A more detailed discussion of that issue, however, will be deferred until the next post.

 

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In the first chapter, entitled “Breathless Optimism, Hysterical Loathing,” Buchanan sets out his overall objective—namely, the task of steering between the two extremes (“breathless optimism” and “hysterical loathing,” respectively) to which analyses of biomedical enhancement are frequently prone. By contrast, he aims to advance a pro-enhancement argument that nevertheless acknowledges and grapples with the risks inherent in the enhancement enterprise. In service of this objective, the first chapter provides an overview of the argument to be developed throughout the rest of the book; subsequent chapters are devoted to developing each of the major lines of reasoning to which Buchanan appeals in support of his thesis.

Buchanan opens this first chapter with the provocative statement that “It’s too late to ‘just say no’ to biomedical enhancements: They’re already here and more are on the way” (p. 3). As Buchanan notes, people already employ a whole host of biomedical enhancements. For example, some college students (particularly at elite American universities) have been known to take Ritalin to boost their cognitive performance, even though they do not themselves have Attention Deficit Disorder (ADD), the condition for which Ritalin is normally prescribed. Using a fictitious scenario in which two students at an elite American university (“Michelle” and “Carlos”) debate the propriety of this sort of cognitive “enhancement”—to which scenario Buchanan will return, in various iterations, throughout the book—he identifies two key issues that are highlighted by the fictional case scenario.

First, there is the issue of what Buchanan refers to as back door versus front door enhancements. An example of an enhancement of the “front door” variety would be if a drug were developed, approved by the FDA, and marketed explicitly for purposes of improving “normal” memory capacities. By contrast, the use of Ritalin by persons who do not have ADD, for the purpose of improving cognitive performance, would be an example of a “back door” enhancement. “At present,” Buchanan observes, “biomedical enhancements don’t come through the front door. They come through the back door, as spin-offs of efforts to treat diseases or disorders” (p. 7). Examples include the use of SSRIs (such as Prozac) by individuals who are not clinically depressed, in order to feel better emotionally; and the use of Viagra by young men “so that they can perform like the Energizer Bunny, even when they’re drunk” (p. 7). (Such is the “brave new world” we’ve inherited!)

As Buchanan notes, enhancement can also come about as an unexpected or unanticipated side effect of treatment for some condition. Modern prosthetics can, for example, potentially enable a runner to achieve faster speeds than his or her “able-bodied” counterparts (consider the controversy over Oscar Pistorius’ status in Olympic athletic competition; I will resist the urge here to pontificate on the more recent controversy that he finds himself in, except to note the obvious: “enhancement” of one sort—physical, emotional, cognitive, etc.—certainly doesn’t entail “enhancement” in the moral domain, and vice versa). Similarly, while undergoing modern laser eye surgery to correct a variety of vision problems, one can also opt simultaneously to improve or “enhance” one’s vision to a better-than-20/20 level.

The upshot of all this is that “[b]iomedical enhancements will keep coming in through the back door as long as we continue to make progress in treating diseases and disorders. So, just saying no to biomedical enhancements isn’t really an option—unless we want to stop medical progress” (p. 8). But, Buchanan goes on to say, “…if biomedical enhancements continue to come in through the back door, we’ll have serious problems.” For example, those individuals who take Ritalin to improve cognitive function (rather than to treat ADD) are taking a drug for a purpose for which it was not intended, where the safety and efficacy of the drug for that purpose has not been evaluated through clinical trials or other objective measures. These and other such “back-door” enhancements could potentially pose serious health or other hazards to individuals and/or the public at large. But “[s]o long as biomedical enhancements come through the back door, we won’t be in a good position to evaluate their safety or even whether they really work for everybody who takes them” (p. 8).

The second issue to which the “Michelle-Carlos” scenario draws our attention is the question of the relative “novelty” of biomedical enhancements, and the ethical issues raised by them, in comparison with other types of enhancements (particularly of a cognitive variety). Consider, for example, the fact that millions of us use two commonly available “cognitive enhancement” drugs on a daily basis—namely, nicotine and caffeine. Or consider some of the other major “enhancements” that, historically, have had the effect (among other things) of improving human cognitive capacities, resulting in wealthier societies and higher standards of living—e.g., “nonbiomedical cognitive enhancements” such as literacy, numeracy, and modern science; and “institutional enhancements” such as the market.

The problem, Buchanan observes, is that “…in current discourse, the term ‘enhancement’ is usually attached only to interventions that involve biomedical technologies. This blinds us to how pervasive enhancements are in our lives and how central they have been to the origin and evolution of our species” (p. 10). The lesson to be learned here, according to Buchanan, is that we need to resist the temptation of what he terms biomedical enhancement exceptionalism—“the dogmatic assumption that because an enhancement involves biotechnologies (pills, computers, fiddling with embryos, etc.) it’s somehow off the moral scale, that our ordinary moral tool kit is useless for coping with it.” Buchanan’s point is not that biomedical enhancement poses no moral challenges; rather, it is simply to observe that “human history—or at least human progress—is in great part the story of enhancement” (p.10), of which distinctively biomedical enhancement is simply one further iteration.

Of course, these observations do not stop critics of biomedical enhancement from claiming that there is something unique, something distinctively problematic about that form of enhancement over against others. Why might someone think that biomedical enhancement is unique in this way? Here, Buchanan considers four candidate arguments to that conclusion—namely,

(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; (4) biomedical enhancements are different because they amount to playing God (p. 12).

Each of the subsequent chapters of this book is devoted to investigating and responding in detail to one of these arguments. Here, I will simply set out the broad contours of Buchanan’s response to each of the arguments; in subsequent posts, I will go intro greater detail.

In response to the “playing God” objection (Ch. 4), Buchanan argues that this really amounts to a warning against hubris—being overly confident in our technological prowess and other capabilities. As an action-guiding principle, however, it is relatively uninformative and therefore unhelpful.

With respect to the “changing the human gene pool” objection (Chs. 2 & 5), Buchanan observes that the human gene pool is always changing, regardless of what we do. The real question, he says, is whether or not natural selection is “doing a good job of changing the gene pool.” We shouldn’t assume, from the outset, that changing the gene pool would always be a bad thing. Those who do assume this a priori, Buchanan suggests, are relying on an “unsupported dogma”—namely, a “pre-Darwinian understanding of nature as teleological” (p. 16), as a consequence of which they assume “that evolution is doing a good job and that our efforts are likely to make things worse” (p. 16).

Buchanan’s response to the “changing biology” objection (Chs. 2 & 3) runs along similar lines: since “our biology is a product of evolution” (p. 20), and is therefore always changing, the salient question is “whether we might have good reasons for deliberately changing our biology in some respects” (p. 20).

Finally, in responding to the “changing/destroying human nature” objection (Ch. 3), Buchanan notes, first, that on most accounts of human nature, including Christian and other theologically oriented accounts, human nature as we know it is, at best, “a pretty mixed bag,” one that includes both “awful as well as admirable features” (21). So, prima facie, it’s not immediately clear that “human nature” is necessarily something we should even want to preserve in its present form; perhaps, instead, we should try to improve human nature so as to get rid of, or at least to ameliorate, some of those “awful” features. Arguments to the contrary, Buchanan suggests, typically rely on what he terms the Extreme Connectedness Assumption (ECA), the notion that “…if we try to ameliorate the bad parts of human nature we will inadvertently destroy the good parts” (p. 22). But why, Buchanan asks, should we accept the ECA? In deciding whether or not to accept that assumption, he says, we should look at the “evidence” about what human nature is like. What sort of “evidence” would be relevant to this inquiry? For Buchanan, the answer to that question is obvious: we should look to “scientific evidence about what evolved organisms like us are like. In other words, we have to look to biology” (p. 22).

After having (in his view) dispensed with each of these objections, Buchanan then goes on to consider two additional types of arguments: (a) consequentialist arguments having to do with the potential for distributive injustice (Ch. 5, “Will the Rich Get Biologically Richer””); and (b) a virtue-oriented objection to the effect that the pursuit of enhancement is inherently morally corrupting (Ch. 6, “Is Enhancement Corrupting?”). Buchanan believes he has answers to these objections as well, and so arrives at the aforementioned conclusion that “[t]here are powerful reasons in favor of a society like ours embarking on the enhancement enterprise, and there are no objections to enhancement that are sufficient to outweigh them, at least at the present time” (p. 181).

 

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Detailed critical engagement with Buchanan’s argument will have to await the next and subsequent posts. By way of preview, I close this post with a crucial question regarding methodology. I noted above that, for Buchanan, the only source of relevant “evidence” is (evolutionary) biology. This trope—that the pronouncements of (evolutionary) biology are the only sources of data relevant to an inquiry concerning what human nature is like—recurs throughout Buchanan’s book. (It is, of course, a common theme found in much of the contemporary bioethics literature generally.) But, as a former professor of mine was fond of saying, “why think that?” Why think that evolutionary biology is the only relevant source for information concerning human nature? What about other possible sources, such as theology and philosophy? Surely these other domains of knowledge might have something to contribute to the discussion?

This question will be the subject of my next post.

 

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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.

Glover. J. (2008). Choosing Children: Genes, Disability, and Design (Uehiro Series in Practical Ethics). New York:

Sandel, M. (2007). The Case Against Perfection: Ethics in the Age of Genetic Engineering. Cambridge, MA: Harvard University Press.

When technology limits our choices

We usually think of technology in terms of freeing us from limits, increasing our freedom, opening up new possibilities. With technological advances, we can do more, enhance our comfort, treat more diseases, travel farther, access more information, access more information while we travel farther, etc.

But every new technology also limits freedoms and diminishes possibilities. When a new technology comes along and becomes accepted and widespread, the possibility of choosing not to use that technology is diminished. Think of how difficult it would be to choose to live without electricity, running water, cell phones, the internet, cell phones that can access the internet. . .

In many cases, this is not a bad thing. We are certainly much better off because water treatment and good sanitation are so ubiquitous. But there are technologies in medicine that we have a really hard time choosing not to use, yet whose benefit is questionable at best. For instance, continuous electronic fetal monitoring (EFM) is used in about 85% of live births in this country, despite the fact that in a low-risk pregnancy the potential harms vastly outweigh any potential benefits. However, for many in the medical field, laboring a patient without EFM is almost unimaginable. Or take prenatal genetic screening technology. When I first began practice, it was offered only to women at high risk of having a baby with a genetic defect. Now, it is routinely offered to all pregnant women. The American Congress of Obstetricians and Gynecologists (ACOG) has recommended that the newest such technology, cell-free fetal DNA screening, be offered only to women at high risk; but given our inability not to use a technology everywhere we can, how long will it be before it becomes the “Standard of care,” offered to all pregnant women regardless of risk? And when the test doesn’t show a perfect baby, how hard has it become to choose not to have that “therapeutic” abortion?

The list goes on and on: antibiotics for viral infections, screening tests for prostate cancer, antidepressants for everyone who is not outrageously happy, CT scans and MRIs for — well, just about anything. In fact, the difficulty of not using technology, the compulsion to use technology even when it is inappropriate, is so rampant that 41 medical specialties have joined forces to publish lists of instances when various technologies that are currently commonly employed should NOT be used.

Reflecting on some of last week’s posts on this blog that dealt with euthanasia, I begin to wonder, What if euthanasia becomes an accepted, widespread technology, the “Standard of care”? In a culture in which we warehouse the old and dying in nursing homes, in which people who require expensive treatments in a cash-strapped system might be seen as — who often see themselves as — a “burden,” will euthanasia in such cases subtly begin to be understood as an obligation? Will the option of living with an expensive, terminal illness be limited? Will the freedom to live without euthanasia be diminished?

Journeys of Transformation

In my last post, “A Preview of Coming Attractions” (02-11-13), I signaled the start of a multi-part series of review essays covering three recently published books addressing ethical issues surrounding enhancement technologies and practices. I had intended to launch that series with today’s post. Before starting that series, however, I want to go on a brief discursus, one that will, I believe, turn out to be relevant to the themes to be touched on in the forthcoming series.

Last week, I attended the annual “Christ and Culture” lecture at California Baptist University in Riverside, California. This year’s speaker was Ralph Winter, producer of the first three X-Men films and numerous other successful film projects. Using such recent films as Les Miserables, Toy Story, Avatar, and others as illustrative examples, Winter set out, in the broadest sense, to show “how the gospel is often displayed in… contemporary film.” The unifying theme in all these stories is what Winter referred to as a “journey of transformation.” In each of these stories, the main character/hero grows through experiencing some form of adversity, learns something important about him or herself, and is transformed positively in some way.

One of Winter’s central concerns in his lecture was to explore the general question of how Christians engage with the broader culture, and particularly with how they communicate their messages to that culture. Here, Winter contends that “Christian stories often fail because we’re afraid of the journey,” by which he means that “our stories often hide from pain”—they avoid addressing the painful, the difficult, the ugly, the uncomfortable aspects of life—and place an emphasis on propositional assent over against an embrace of the “transformational journey” that is the life of faith. That is to say, there is a tendency to focus on the destination (heaven) to the exclusion of the journey that we take along the way.

What does all of this have to do with bioethics? There are at least two central lessons to be learned here.

First, in the context of genetic enhancement technologies and practices, it is worth asking the question: to what extent is the “enhancement enterprise” (broadly speaking, the attempt to “improve” human capacities by way of genetic or other interventions and/or technologies, as well as the cultural push toward embracing that agenda) in fact driven by a deep-seated, underlying “fear of the journey”—that is, a fear of those aspects of the aging process that are ugly, uncomfortable, painful, and so forth? Put more simply, to what extent is the drive toward “enhancement” really a flight from the inevitable realities of our lives as embodied creatures? (I do not propose to answer this question here; I pose it, however, as an important background issue to be kept in mind when considering specific arguments regarding the enhancement enterprise.)

Second, and more generally, our bioethical reflections—whether on beginning of life issues, end of life issues, or whatever—must always be attentive to the lived reality of embodied human existence. In particular, we must be willing to face the sometimes harsh realities of pain, suffering, indignity, and so forth, that can accompany the experience of various medical and other conditions. This is especially pertinent at the end of life, where the dying process can (but does not necessarily) involve significant levels of pain, discomfort, and distress. In a word, our bioethical reflections must tell “stories” that are true to the lived realities of human existence. If we are not willing to face these sometimes difficult realities, our pronouncements on bioethical issues are likely to seem shallow, insensitive, or even irrelevant.

This is not to say, of course, that our arguments and other reflections on bioethical issues should be overly-negative or fatalistic. Indeed, a focus on truth mandates that we tell “the truth, the whole truth, and nothing but.” This means being attentive to the fact (for example) that while the aging and dying processes can be characterized by pain, discomfort, and suffering, they are not always so characterized (indeed, with the skillful use of pain management techniques, they rarely need to be—but that is a different post altogether). The aging and dying processes can also be characterized by peace, joy, personal growth and development, and a sense of fulfillment. In a phrase: these processes can themselves be “journeys of transformation.” From the perspective of Christian theology, of course, the entire human lifespan can be understood in this way as well. The key point for present purposes is simply this: our bioethical reflections and arguments must attend to the potentially transformational aspects of the experience of pain, suffering, and the like, in addition to other considerations having to do with rights, obligations, principles, and so on.

Human life, in other words, is as much about the journey as it is about the destination. And that fact can make all the difference when it comes to bioethics.

The return of Carter’s Little Liver Pills?

 

In 1868, a fellow named Carter formulated a patent medicine and named it after himself, the famous “Carter’s Little Liver Pills.”  It turned out, amazingly, that there were few human ailments these wonderful pills could not cure: sick headaches, biliousness, torpid liver, constipation and indigestion, sluggishness . . . the list went on and on. Truly Mr. Carter was a boon to humanity.

Except that, of course, the pills did little of what was claimed. They turned out to be pretty good laxatives; everything else was advertising hype. In 1959 the Federal Trade Commission (FTC) made the company drop the word “liver” from its name, considering it false and misleading advertising.

Today the Food and Drug Administration (FDA) does most of what the FTC did for Mr. Carter’s pills. It is apparently fairly easy to design a scientific-appearing study that will prove just about anything you want it to; as my father used to say, “Figures don’t lie, but liars figure.” Poorly-designed but impressive-sounding pseudo-scientific studies have been used to foist countless frauds on a public (and medical profession) that in general does not have the sophistication to tell a well-designed study from a sham (for an example, see the now thoroughly-discredited Wakefield study that purported to show a connection between the MMR vaccine and autism — and all the people, including medical professionals, that were taken in by it). Among other functions, the FDA strives to ensure that prescription drugs are supported by reliable studies showing that a medication’s benefits outweigh its risks for its intended purposes. Drug companies are not allowed to promote their wares for “off-label” indications, that is, maladies for which there is not good evidence that the drug in question does any more than a good sugar pill would.

But this consumer-protection function of the FDA is under attack. The February 6th JAMA relates the story of a drug company and its salesman who promoted their medication for numerous off-label uses, even claiming it was safe in elderly and pediatric patients, despite the label warning specifically stating that safety was not shown in those populations. They were investigated by the Department of Justice; the drug company pleaded guilty, the salesman didn’t and was convicted. He appealed his conviction on the basis of his FIrst Amendment right to free speech. The appeals court sided with the salesman.

This case will be appealed further, so there’s no telling how it will ultimately turn out. But it is conceivable, based on this verdict, that drug companies could start making marketing claims based on pseudo-scientific sleight-of-hand that physicians and their patients might have a hard time seeing through, all in the holy name of Free Speech.

But free speech used to make false claims about potentially dangerous substances should not be protected.  Nobody likes government regulation; but when dealing with medications with a great potential for harm as well as good, I would rather trust government-employed scientists charged with protecting the common weal than a bunch of slick salesmen charged with maximizing their companies’ profits.

After the Super Bowl: Reflections on “Perfection” and Enhancement

By the time you are reading this, many of us—myself included—are (or soon will be) in full “withdrawal” mode from the “high” of yesterday’s Super Bowl. We were amazed by the awesome displays of athletic prowess on the field and caught up in the drama of watching this year’s AFC and NFC champions battle it out to the very end for the right to be called “Super Bowl champions”—the very best in the game of football, at least for a short while. Who could not have been impressed by the on-field exploits of Joe Flacco, Ray Rice, Jacoby Jones, and Colin Kaepernick? Who could not have been touched by the soaring notes of Jennifer Hudson singing “God Bess America,” or the soulful tones of Alicia Keyes singing the national anthem?

In similar fashion, we find ourselves fascinated by the accomplishment of Olympic athletes, musicians, artists, intellectuals, and others at the “top of their game,” or their art, or their craft.

Truly, these are specimens of excellence—indeed, one might say, of a certain kind of “perfection.”

Or are they?

Perhaps these NFL players, “great” as they already are, could in fact be more than what they are now—faster, stronger, more agile, more powerful. Wouldn’t that be good for the game? Wouldn’t that make the game even more exciting, more engaging, more thrilling?

Suppose, by way of a taking a pill or getting an injection—Human Growth Hormone (HGH), for example—football players could develop stronger muscles and greater physical stamina.  Would we want them to do so? Would we consider their resulting on-field performances as genuine reflections of their actual athletic abilities, or more akin to “cheating the system”?[1]

Suppose, more generally, that we “mere mortals”—those of us who are not Super Bowl champions, famous musicians, acclaimed scholars, or Nobel prize-winning scientists—could take a pill that would improve our memory, make us more intelligent, or help us feel more confident? Would this be a good thing?

And, finally, suppose we could alter the human genetic code permanently, through genetic engineering, either to eliminate unwanted conditions (diseases, genetic disorders, and so forth) or to enhance certain desired, genetically-linked traits (intelligence or sociability, for example). Should we avail ourselves of such opportunities?

In the wake of the Human Genome Project and other scientific breakthroughs, each of these scenarios is increasingly moving from the realm of “science fiction” to “reality,” a fact that should prompt us to ask—and reflect upon—a number of important philosophical and theological questions, among them the following:

  • What does it mean to be an “excellent” specimen of something (a book, a table, a human being)?
  • What does it mean to “flourish” as a human being?
  • Should we seek to “enhance” ourselves? If so, are there limits to how far we should go in pursuing enhancement?
  • What, if anything, is the value in human limitation? Are there limits that we should never seek to surpass?

In subsequent posts, we will explore some of the issues surrounding enhancement (genetic and otherwise). For the moment, as we bask in the afterglow of this year’s Super Bowl, it is worth taking a few moments to reflect on just what it is about “great” athletic, musical, intellectual and other human achievements that we find so appealing, and whether “enhancement” would render those accomplishments more or less so.


[1] The NFL is reportedly looking seriously at introducing HGH testing prior to the start of the 2013 season. See http://www.nfl.com/news/story/0ap1000000133761/article/goodell-confident-hgh-testing-in-place-by-next-season

Dam bioethics (A lesson from history)

Between 1838 and 1852, a dam was built across the South Fork Creek in western Pennsylvania, creating a lake or reservoir about two miles long by a mile wide. In 1879, the dam was bought and repaired by the South Fork Fishing and Hunting Club; they stocked the lake and used it for fishing and sailing. On Memorial Day, 1889, during a heavy rainstorm, the dam burst, sending 20 million tons of water hurtling down the valley, erasing or nearly destroying several towns including Johnstown, and killing some 2209 people.

What does this have to do with bioethics? I just read a terrific book by David McCullough about the disaster entitled The Johnstown Flood, published in 1968. Towards the end of the book, McCullough makes the following pungent observations about the crucial mistakes made by those whose actions or lack of action contributed to the flood:

In the first place, they had tampered drastically with the natural order of things and had done so very badly.  .  .The point, of course, was not that dams, or any of man’s efforts to alter or improve the world about him, were mistakes in themselves. The point was that if man, for any reason, drastically alters the natural order, setting in motion whole series of chain reactions, then he had better know what he is doing. . .

What is more, the members of the club and most of Johnstown went along on the assumption that the people who were responsible for their safety were behaving responsibly. And this was the second great mistake . . .

. . .the director of the U. S. Geological Survey, Major John Wesley Powell, wrote that the dam had not been “properly related to the natural conditions” and concluded: “Modern industries are handling the forces of nature on a stupendous scale . . . . Woe to the people who trust these powers to the hands of fools.” (pp. 262-3)

We would do well to remember our past. The dams of the eighteenth century are the cloning, chimeras, and cyborgs of the twenty-first; the natural order that we are drastically altering on a stupendous scale is the stuff of biological life itself; and in our headlong rush to alter or improve the human condition, we are setting in motion a whole series of chain reactions that have the potential to affect far more than 2209 souls. And I am not convinced that the researchers responsible for our safety know what they are doing any more than did the members of the South Fork Fishing and Hunting Club.

A Couple of Other Bioethics Blogs Worth Checking Out

“Merry Christmas to all, and to all a good night….”

I am mailing it in on the holiday.  To do so, I thought I’d encourage readers of this blog to check out at least two other bioethics blogs that may not always be linked in the usual places.

One is Wesley Smith’s “Human Exceptionalism” blog at National Review Online.  Posts are reasonably frequent (although none in December 2012), with an emphasis on human dignity concerns (end-of-life, distinguishing human and animal moral status), biotechnology and risks of commoditizing human life, and the implications of the Patient Protection and Affordable Care Act (aka “Obamacare”).  Conservative, both socially and politically, as I take conservatism generally to be understood in today’s America.

The other is the “Over 65 Blog” at the Hastings Center website.  Organized by Daniel Callahan and colleagues, this blog focuses on reflections by senior citizens on health care, health policy, and generational issues raised by those and by the aging of our population generally.  The five stated goals are “a stronger role for seniors, self-determination, more care/less technology, confronting the cost problem, and the economic and family needs of the over-65 generation.”  The general perspective is more progressive or at least center-left.  Last week brought a really interesting post from Alicia Munnell, a management professor at Boston College, refuting the idea that older people working longer will mean taking jobs from the young.

I think both are thoughtful and authoritative, and welcome respites from the talking-point fiascos of broadcast journalism.

The Whitewashed Tombs of the Right

“Woe to you, scribes and Pharisees, hypocrites! For you are like whitewashed tombs, which outwardly appear beautiful, but within are full of dead people’s bones and all uncleanness.”– Matthew 23:27

I received several comments on last week’s post about Hubertus Strughold, so I thought I’d follow up with another post.  The fact that Strughold has been well-respected in American medical circles despite his leadership in medical experimentation in Nazi Germany may shed light on deep-seated philosophical problems that undergird America’s healthcare crisis.  It is no secret that the Allies marveled at the technological and scientific capabilities of the Germans as they marched through that country in the final days of World War II.  Though it used the scientists of the Third Reich to the ultimate success of putting a man on the moon, American medicine may also have adopted harmful philosophical ideas that cripple U.S. medicine to this day.  The technological and scientific accomplishments of American medicine may be the whitewash that hides the philosophical problems that are the dead people’s bones that affect patient care and make us incapable of solving systemic healthcare problems.

Dachau, notorious for its human experimentation

Several writers on this blog have commented on the failures of the “business model” of medicine.  Joe Gibes has written several posts on the subject (see his “Black Friday” post), and Steve Phillips has recently mentioned the “manufacturing efficiency” that has been brought to human reproduction.  It is well-known that many Americans sided with the National Socialists in Germany in the 1920s and 30s because they saw them as a bulwark against the tide of communism that seemed to be sweeping over Europe (Russia fell to the Communists in 1917).  In the culture wars in America the last two decades, it appears the right-wing has propelled the “business model” of medicine to the fore as a bulwark against the Left’s move to bring government-run healthcare to America.  It is a classic case of the end justifies the means.  Why Christians allied themselves with the right-wing to form the “Religious Right” in the 1980s I’ll never know.  But it looks like a deal with the Devil.

A Theology of Technology

with Chris Ralston, PhD

In our last post we noted that Baylor’s Technology and Human Flourishing conference underscored the need for, as we put it, a “robust theology of technology.” We thought we’d follow up with some reflections on what such a theology might look like.

In chapter three of their book entitled Bioethics: A Christian Approach in a Pluralistic Age,[1]Scott B. Rae and Paul M. Cox develop a helpful framework for thinking about “Medical Technology in Theological Perspective.” The following is a very brief synopsis of their discussion.

The golden leaves of the pecan in autumn in central Texas.

The starting point for thinking about medical technology in theological perspective is the creation narrative as recorded in Genesis 1 and 2—specifically, with what has been termed the “dominion mandate” and with the doctrines of general revelation and common grace. At the creation humankind was charged with a mandate to “subdue the earth and be its master” (p. 94). The fulfillment of this task was, however, complicated by the entrance of sin into the world. Consequently, the post-Fall mandate includes “working toward improving the creation, or reversing the effects of the entrance of sin” into the created order, a significant aspect of which is dealing with death and disease (p. 95). Importantly, the dominion mandate is constrained by our role as stewards of rather than masters over creation: “At creation, human beings were charged with both dominion and stewardship. Creation was theirs to use for their benefit, but it ultimately belonged to God and they were responsible to him for its proper care” (p. 95).

According to the doctrine of general revelation, God provides both the “natural resources” and the “human ingenuity and wisdom” requisite for human beings to fulfill the dominion mandate (pp. 95-96). The doctrine of common grace affirms the notion that “God’s grace… is bestowed commonly, or on all humankind, irrespective of one’s membership in the community of God’s people” (p. 97). (Consider, for example, the rain that God sends, which falls on the “just” and the “unjust” alike; cf. Acts 14:17.)

Taken together, God’s general revelation and common grace provide human beings with “the knowledge and skill that are necessary to develop the kinds of technologies that enable humankind to subdue the creation” (p. 97). This is no less true of medical technology than of other forms of technology.

Crucially, however, medical technology can achieve only a “partial and temporary” victory over death and disease—it can never conquer them entirely. Moreover, given the sinful nature of humanity, technology can be put both to good and evil uses, in service of both virtuous and vicious ends (pp. 98-99). Consequently, “[w]e must distinguish between the use of any particular medical technology per se and its intended or actual use in practice. That is, it is possible to see virtually any medical technology as a part of God’s common grace to humankind. But that does not exempt it from moral assessment of its uses” (p. 99).

Engaging in such “moral assessment” of technology—whether medical technology specifically or other forms of technology more generally—was one of the key tasks to which Baylor’s IFL conference was devoted.

In this vein, I (Cody) sensed that most of the attendees were wrestling honestly with how to use technology wisely and still be authentic in their Christian faith.  On several occasions people mentioned the desire to avoid a “Luddite” dismissal of technology altogether, as if separating from electronic gadgets offered a particular kind of spiritual purity.  Most understood that spiritual health is essentially a matter of the heart, and the external aspect of using technology may or may not indicate the status of the soul.  Instead, many Christians opt for a view of technology that stresses the fact that we use technology and technology should not “use” us.  When technology is no longer useful or, even worse, when it begins to sets us back or harm us as Christian people, we lay it aside.  Or as the Reformers might have put it, “Let us do all Soli Deo Gloria, For the Glory of God Alone.”

We’d like to close with a brief note about the notion of “virtual” technology.  A number of the speakers at the IFL conference dealt with this issue, from discussions of how a child’s involvement with outdoors activities or handicrafts can improve ADHD symptoms to the importance of the local gathering of believers as the body of Christ in church worship.  These ideas emphasize the importance of place, “being there” if you will.  As Kay Toombs mentioned in her talk, we can relay information about a spouse’s illness to many people via a Facebook status update, but this is very different from sharing this information in the presence of someone who can hold our hand.  And this is very directly related to our being ensouled beings, not just cerebral beings that communicate data but spiritual people who are there, in a particular place.  It’s nice that we are able to share with you some of this information over the Internet, but it might be even better if you can now go and discuss some of these heart-felt issues with a friend over a cup of coffee.

We invite further reflection on these topics from our readers.

 

 

 


[1] Eerdmans, 1999, pp. 91-127.

Technology and Human Flourishing, Baylor University

with Chris Ralston, PhD

I was honored to have Trinity colleague Chris Ralston come to Texas and join me for Technology and Human Flourishing, a conference of the Institute for Faith and Learning at my alma mater, Baylor University. We thought we’d give a quick run-down of some of the ideas presented.

On October 25-27, 2012, scholars, undergraduate and graduate students, faculty, and other interested individuals from across the globe gathered at Baylor University in Waco, Texas to discuss issues surrounding the relationship between technology and human flourishing. The conference featured a variety of individual paper presentations and plenary speakers, ranging across a broad spectrum of topics, from “Building Emotions into Machines” to “Interstellar Exploration and Human Flourishing.”

Many of the presentations engaged with a number of common themes, including the relationship between science and faith; epistemological questions about the sources of knowledge, in particular the question of whether or not science exhausts the domain of “knowledge”; and questions about the impact, for better or for worse, of technology on human dignity and flourishing. Some of the specific questions raised include the following: How does technology encourage us to think about ourselves? About human nature? As our capacities to manipulate the physical “stuff” of our bodily existence (DNA, genes, etc.) expand, will this encourage us increasingly to think of ourselves strictly in physicalist terms? Should we think of ourselves in such terms? And what would be the implications or consequences of so thinking about ourselves?

In addressing these and other related questions, one recurrent thought that emerged is the notion that technology should be assessed not only in terms of what it can do (what can be done with it), but also in terms of how it affects us as human beings, both individually and collectively. That is, how does technology and its various applications shape us, whether as individuals or as society? In this regard, the conference highlighted the need for a deep, robust theology of technology—one that avoids the twin dangers of Luddite rejection of technology on the one hand, and a naïve acceptance of “all things new” on the other. The challenge is to remain open to the potential blessings of technological development, while at the same time resisting what has been termed the “technological imperative”: the assumption that if it can be done, it should be done.

Ian Hutchison, a nuclear engineer at MIT, provided some excellent comments on scientism, much of it coming from his new book Monopolizing Knowledge. Hutchinson is an ardent proponent of the natural sciences, for they have been quite literally his “bread and butter” for many years. However, he made the argument that we are greatly mistaken if we think that scientific tools give us all there is to know about the universe.

At dinner, we had the honor of sitting at the same table with Dr. Hutchinson and one of my former philosophy professors, Dr. Kay Toombs, whose research and commentary on the experience of illness over the years I highly recommend. Dr. Hutchinson had concluded his lecture with a word about the counter-cultural nature of being a Christian and how simply re-discovering virtues about the wrongness of covetousness would be of great help. I made the comment over our salads that is seems strange that speaking against covetousness is thought of as a new idea, for in fact it used to a part of Preaching 101. He agreed that his ideas weren’t all that revolutionary but that we need to have the faithfulness to pursue them even in the face of opposition.

It seems fitting to have more than one MIT professor at a technology conference, and Rosalind Picard of the MIT Media Lab followed well in the footsteps of Dr. Hutchison. In the first place, her research bringing affective (emotional) components to computing and robotics is just plain fascinating, but its application to helping autistic adolescents is heart-warming as well. One could sense from her talk that she is a kind, Christian woman and that she brings a warmth and a Christian ethic to a field that is oftentimes cold circuitry.

For all you Kierkegaard fans out there, the IFL while be recognizing the bicentennial of his birth next year with a conference that includes Richard Bauckham in the line-up, and the 2014 conference on faith and film also promises to be worth the trip as well.