The report of the President's Council on Bioethics, Beyond Therapy: Biotechnology and the Pursuit of Happiness, and a companion volume of edited readings, Being Human: Readings from the President's Council on Bioethics, are a welcome exception to this rule. The report's broad aim is to look at the uses of biotechnologies that go "beyond therapy," that is, "beyond the usual domain of medicine and the goals of healing, uses that range from the advantageous to the frivolous to the pernicious," as the report describes such techniques. The Council divides the report into several sections: Better Children (which covers techniques such as prenatal diagnosis, genetic testing, sex selection, and improving children's behavior using psychotropic drugs); Superior Performance (which uses sports as a lens through which to examine muscle- and performance-enhancing methods); Ageless Bodies (various techniques to retard aging); and Happy Souls (which assesses memory blocking and mood-altering drugs).
The most interesting nuggets are the ethical analyses at the conclusion of each section, which pose the kind of questions rarely seen in government reports. For example, the chapter on Ageless Bodies asks, "If we go with the grain of our desires and pursue indefinite prolongation and ageless bodies for ourselves, will we improve the parts and heighten the present, but only at the cost of losing the coherence of an ordered and integrated whole?" As well, the report covers familiar terrain in insightful ways. For readers who think there is little new light to shed on the question of children's Ritalin use and Attention Deficit Disorder, Beyond Therapy provides one of the most succinct and illuminating explorations of the issues at stake. Similarly, one needn't have seen the recent movie Eternal Sunshine of the Spotless Mind, which tells the story of a couple who have all recollections of their soured relationship expertly erased by a team of scientists, to have qualms about our ability to permanently alter and block memories, a topic taken up in the chapter on Happy Souls.
Beyond Therapy is a significant departure from previous investigations by government-sponsored bioethics groups. The National Bioethics Advisory Commission, created by President Clinton in 1995 and peopled largely with scientists and physicians, issued an informative but bland diet of reports on topics such as human-subject research and the ethics of conducting clinical trials in developing countries. The current Council contains more non-scientists, tackles broader questions about the ends of bioethics as well as the means, and uses hypotheticals, literary references, and poetry in place of the more antiseptic case studies that line the pages of bioethics textbooks and journals.
By pairing moral reflection with literature and ethical questioning, Beyond Therapy encourages us to examine human achievement in a new light. Also, the tone of the Council's report is not that of mandarins addressing the lumpen, but of concerned (if occasionally overly earnest) fellow conversationalists. The resulting report is neither prescriptive nor doctrinaire, but speculative, educational, and intellectually challenging.
New paths are not always easily carved out of existing terrain, of course, and the Council has sustained an unusually vitriolic amount of criticism for its work. Some of this is due, unfortunately, to the more hostile and polarized political culture we live in. But much of it is personal. In particular, some ill-tempered members of the bioethics community treat Leon Kass, the chair of the Council, as an intellectual carpetbagger; Glenn McGee of the University of Pennsylvania recently compared Kass to an assassin in the pages of the American Journal of Bioethics. In these moments, the bioethics profession appears to be engaged less in serious reflection than in a peculiar form of genuflection—catering to the public's seemingly limitless demands for new and improved therapies and enhancements and resisting, in the name of autonomy, any attempts to set limits on those often questionable demands.
By contrast, Beyond Therapy takes those demands as its starting point. In an elegant summary of the Council's sensibility, the report explains, "By structuring the inquiry around the desires and goals of human beings, we adopt the perspective of human experience and human aspiration, rather than the perspective of technique and power.... We can also see better how the new technological possibilities for going 'beyond therapy' fit with previous and present human pursuits and aspirations, including those well represented in the goals of modern medicine."
This approach works and suggests why the Council's critics are often forced to fall back on ad hominem attacks. Whatever weaknesses the Council has are those of the philosopher, not the ideologue—faith in the usefulness of thoughtful, serious inquiry, and perhaps too easy a trust in the better angels of our nature. But this sensibility is also its strength—especially in the world of bioethics, which is sorely lacking in an appreciation for human limits. In its unwillingness to accept the reasoning that "X is bound to happen sooner or later," the Council's work reveals how much of contemporary bioethics is dedicated to promoting what might, for lack of a better description, be called the philosophy of the grand shrug—"Why not?"
As Beyond Therapy argues, it is when we ask that question that we risk dangerous collisions of human desires and unrestrained scientific powers. "The benefits from biomedical progress are clear and powerful," Beyond Therapy notes. "The hazards are less well appreciated, precisely because they are attached to an enterprise we all cherish and support and to goals nearly all of us desire." Despite the still-hypothetical nature of many of these risks (such as people permanently erasing their bad memories), we should, the Council argues, begin the hard work of thinking about them now. Rational calculation of risk has never been Americans' forte, of course—if it was, we would drive more slowly, eat less often at McDonald's, and cease stocking our homes with antibacterial soaps and arsenals of "baby proofing" products. But we seem especially ill-equipped to assess future risks regarding biotechnology, lapsing either into fervid science fiction-like speculation or docile acceptance. Both the Council's report and the accompanying reader (composed largely of selections from literature and poetry) seek to avoid this tendency.
The report is not without a few difficulties. Inquiries of this nature are vulnerable to the charge that they raise more questions than they answer. It is also not entirely clear what larger purpose the edited collection of readings, whose wide net encompasses everything from Shakespeare to the screenplay of the movie Gattaca, is supposed to serve. Many of the selections are so heavily truncated that their context is diminished, and one is left wondering who is the intended audience for these literary nuggets.
More challenging is the report's assumption that there is a shared sense of purpose and thoughtfulness among the public for raising good children, leading moral lives, and generally pursuing excellence. What if (to play the role of skunk at the garden party) these impulses are not as widely shared as the Council supposes? What if, instead of pursuing a good life, Americans are more selfishly and narcissistically intent on pursuing merely their version of the good life? "We want to be happy," Beyond Therapy notes, "but not because of a drug that gives us happy feelings without the real loves, attachments, and achievements that are essential to true human flourishing." Really? The "quick fix" mentality is not lacking devotees in our society, as politics and popular culture regularly attest.
The report does concede that "the pursuit of happiness and self-esteem—the satisfaction of one's personal desires and recognition of one's personal worth—are much more common human aspirations than the self-conscious quest for perfection." But it doesn't pursue the implications of the flip side of this insight: that individuals' pursuit of happiness might also prove the major stumbling block to crafting a cultural consensus about the dangers of new biotechnologies.
It is at this point that greater historical grounding could have bolstered the otherwise commendable analysis provided by Beyond Therapy. The report notes, correctly, that once we gain the power to do certain things, "techniques and powers can produce desires where none existed before, and things often go where no one ever intended." But desires can be thwarted, either politically or culturally. An overview of how they have and have not been in the past—such as the one given in David and Sheila Rothman's recent book, The Pursuit of Perfection: The Promise and Perils of Medical Enhancement—might have added greater depth to the Council's work.
For example, one illustration of how swiftly cultural forces and human desires can turn therapy to enhancement is cosmetic surgery. Oddly, Beyond Therapy mentions cosmetic surgery only in passing, even though it is perhaps one of the best examples we have of the extremes to which medical techniques originally developed for therapeutic purposes can move well beyond them.
Still, these are minor quibbles with a report and a collection of readings that pose hard questions, prompt further investigation, and, most importantly, encourage the kind of patient moral reflection we need to engage in if we are going to use our new scientific and technical powers to promote human flourishing rather than undermine it. In the chapter on memory-blocking drugs, Beyond Therapy includes an unusual example to bolster its argument about memory—a selection from Jane Austen's novel, Mansfield Park. "If any one faculty of our nature may be called more wonderful than the rest, I do think it is memory. There seems something more speakingly incomprehensible in the powers, the failures, the inequalities of memory, than in any other of our intelligences." The Council's work in Beyond Therapy serves a similar goal. In our biotechnological age, it is an official contribution to our country's historical memory that takes a refreshingly unofficial approach, one that recognizes the often-incomprehensible force of human desires at the same time that it shows us the deeply important questions we should be asking about them.