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Bioethics in the Genetic Age: Can standard bioethics handle the genetic revolution?

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Bioethics in the Genetic Age: Can standard bioethics handle the genetic revolution?

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Content BIOETHICS IN THE GENETIC AGE:
CAN STANDARD BIOETHICS HANDLE THE GENETIC REVOLUTION?
by
Katherine Mary McReynolds
A Dissertation Presented to the
FACULTY OF THE GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(RELIGION AND SOCIAL ETHICS)
May 2001
Copyright 2001 Katherine Mary McReynolds
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UMI Number: 3027751
Copyright 2001 by
McReynolds, Katherine Mary
All rights reserved.
__ ®
UMI
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ABSTRACT
BIOETHICS IN THE GENETIC AGE:
CAN STANDARD BIOETHICS HANDLE THE GENETIC REVOLUTION?
The Human Genome Project and genetic enhancement
technologies raise some crucial philosophical and ethical
questions, including questions concerning the nature of
human being and the purpose of medicine. These questions,
in my opinion, should not be ignored. Standard bioethics
is incapable of dealing with these kinds of questions
because it participates, to one degree or another, in what
has come to be known as the Baconian project.
It is my argument that, those who are associated with
the development of biotechnologies ought to resist the
Baconian project that is embedded in standard bioethics
for three primary reasons. First, the Baconian project is
largely responsible for the marginalization of the crucial
ethical questions raised by new biotechnologies, such as
the human nature question and the purpose of medicine
question.
Second, the Baconian project is based on a
mechanistic view of the human being, a view that is
inadequate because it fails to take fully into account the
issues concerning personal identity, free agency, and the
moral significance and vulnerability of the human body.
Third, the Baconian project and its quest to relieve the
human condition gives an extraordinary amount of power to
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medicine, resulting in the "medicalization" of many
conditions which, at least from an Aristotelian
standpoint, are beyond the proper end of medicine.
Those who are associated with the development of new
biotechnologies ought to embrace what I refer to as an
Aristotelian-inspired ethic of vulnerability. An ethic of
vulnerability has four primary features: 1) It holds that
ethical reflection begins with the agent and not with an
"ethical dilemma," thus making the fundamental ethical and
philosophical questions raised by new biotechnologies
central rather than peripheral; 2) It is based on a
substance view of the human being, which adequately
accounts for personal identity and free agency; 3) It sees
the body not as an obstacle, but as an integral part of a
morally worthy life; 4) It views biotechnology as an
enterprise made to serve human beings and their moral
projects.
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UNIVERSITY OF SOUTHERN CALIFORNIA
THE GRADUATE SCHOOL
UNIVERSITY PARK
LOS ANGELES. CALIFORNIA 90007
This dissertation, written by
under the direction of hc£. Dissertation
Committee, and approved by all its m em bers,
has be en presented to and accepted by The
Graduate School, in partial fulfillment of re
quirements for the degree of
DOCTOR OF PHILOSOPHY
Dean o f Graduate Studies
D ate Ife x J v L . .2QS1.
DISSERTATION COMMITTEE
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ii
Table of Contents
Chapter 1: Bioethics in the Genetic Age
I. The Human Genome Project
II. Enhancement Technologies
III. The Problem
IV. My Position
V. But What About...?
VI. Is There Any Other Way?
VII. The Scope of My Project
Chapter 2: The Human Genome Project
I. A Brief History of Genetics
II. The Human Genome Project is Born
III. A Rough Draft and a Rough Road Ahead
IV. Instant Benefits
V. Society and DNA
VI. To Relieve the Human Condition
Chapter 3: Why Worry About Genetic Enhancements?
I. Introduction
II. But, Why the Concern?
III. The Treatment/Enhancement Distinction
IV. The Questions Which Beg to be Heard
Chapter 4: Francis Bacon and The Baconian Project
I. Introduction
II. Francis Bacon in His Time
III. The Mechanical Arts, Magic, and Alchemy
IV. Bacon vs. Aristotle
V. Bacon on the Human Being
VI. What the Ancients Knew that Bacon Denied
Chapter 5: The Human Being and the Ultimate Good:
Revisiting Aristotle
I. The Human Nature Question
II. The Scientific View of Human Being
III Some Concepts Challenged by the Scientific View
IV. Aristotle on the Human Being
V. Arguments Against Aristotle
VI. Arguments Supporting Aristotle
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Ill
Chapter 6: The End of Medicine: Rediscovering "Health" in
Aristotle
I. The End of Medicine?
II. Medicine - A Distinct End = Social Power
III. Aristotle and the End of Medicine
IV. Health as the End of Medicine
Chapter 7; An Ethic of Vulnerability
I. Ethical Reflection Begins with the Agent
II. The Human Body: Who Controls It?
III. Medicine as the Ally of Vulnerable Human Being
IV. What Ought We to Enhance? Bacon and Aristotle
Compared
Bibliography
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Chapter 1
Bioethics in the Genetic Age
The Human Genome Project
On June 26, 2000, Dr. Francis S. Collins, director of
the National Human Genome Research Institute, and Dr. J.
Craig Venter, president of Celera Genomics, announced at a
press conference held in Washington, D.C., that they had
successfully completed the first rough draft of the entire
human genome. President Clinton praised their work and
stated that, "Without a doubt, this is the most important,
most wondrous map ever produced by humankind."1
This rough draft is ultimately the result of a
federally funded program known as The Human Genome
Project. The Human Genome Project was originally intended
to be a 15-year effort to map the entire human genome.
But the map was completed several months ahead of
schedule, probably due to the sometimes heated competition
that came from Celera Genomics. In the end, however, the
two rivals made peace, but decided to remain independent.
As it stands now, both sides view this monumental event as
a shared success.
Understanding the genes that make up the human genome
is expected to revolutionize medicine in several ways.
Biologists hope to target dysfunctional genes and to
eventually prevent and cure diseases such as colon and
^ill Clinton, "White House Remarks On Decoding the Genome," New York
Times, 27 June 2000, 8(D).
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breast cancer, cystic fibrosis, and diabetes. Researchers
also expect they will eventually be able to develop
diagnostics and treatments tailored to individual
patients.
But this powerful knowledge is not without
significant risks. Many people have concerns about how
their individual genetic information will be used and who
will have access to it. Many fear the possibility of
discrimination if their insurance company or employer were
to gain access to their medical records and discover the
results of a genetic test that revealed a predisposition
to a particular disease. Indeed, long before the
announcement of the completion of the first rough draft of
the human genome in June 2000, there was some evidence
supporting the fact that these are legitimate concerns.
In 1990, The American Council of Life Insurance
formed a committee to explore the issues related to
genetic test information and insurance. Their primary
task was to develop policy guidelines to insure that
genetic information is kept confidential in order to
prevent discrimination based on genetic information.2 As
of 1998, laws have been established in more than half of
2The American Council of Life Insurance Subcommittee, Genetic Test
Information and Insurance: Confidentiality Concerns and Recommendations
(Washington D.C.: The American Council of Life Insurance, 1990).
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the states to prohibit health insurance companies from
discriminating based on genetic test information.3
The primary federal law prohibiting discrimination in
employment on the basis of health status is the Americans
with Disabilities Act, which was established in 1994.4 In
1995, the Equal Employment Opportunity Commission (EEOC)
issued an interpretation regarding the applicability of
the ADA to genetic discrimination. The EEOC argued that
an employer who discriminated against an individual based
on genetic information regarded that individual as having
a disability. Therefore, these individuals are covered by
the ADA.5
The concern is not only about what insurance
companies and employers might do with the information, but
also about what family members might do with it.
Katherine Schneider, senior genetics counselor at the Dana
Farber Cancer Institute in Boston, was interviewed in a
recent New York Times article and reported the following
story, which poignantly illustrates what can happen in a
family setting:
3See, for example, B.A. Trolin, ed., Mapping Public Policy for Genetic
Technologies: A Legislator's Guide (Denver: National Conference of State
Legislatures, 1998) .
4Americans with Disabilities Act, 42 U.S.C., 12101-12213 (1994).
5See, 2 EEOC Compliance Manual (CCH), 902-45 (March 14, 1995), reprinted
in Daily Labor Report (March 16, 1995), E-l, E-23 (citing definition of
disability); and M.A. Rothstein, "Genetic Discrimination in Employment and the
Americans with Disabilities Act," Houston Law Review. 29 (1992): 23-84.
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One woman who'd had ovarian cancer was
tested for the breast cancer gene
mutations mostly for the sake
of her two daughters. . . . But when
she told them she had it, they were so
devastated that they didn’t talk with
her for two years. They didn't want to
know. I tell that story a lot. There's
nothing easy about any of this. But
before testing, it's important to talk
not only about what the information will
mean for you, but what it might mean to
your sisters, your children your
cousins.6
Another New York Times article reported that a start
up company in California is seeking donors of DNA for a
"Gene Trust." "The knowledge we gain from the gene trust
has the potential to change medicine forever," says the
web site, DNA.com. "But we can't do it without your
help."7 But any one who hands over DNA information to a
gene trust could face dire consequences if that
information gets into the wrong hands.
As pressing as these privacy and confidentiality
concerns are, this new gene knowledge creates the
potential for a risk that may prove to be even more
unsettling. The genetic information uncovered by the
Human Genome Project could impact, for good or for ill,
our own self-conception. Nicholas Wade of the New York
Times observes that:
6Tamar Lewin, "Boom in Gene Testing Raises Questions on Sharing Results,"
New York Times. 21 July 2000, 1(A).
7As reported by Andrew Pollack, "Company Seeking Donors of DNA for a Gene
Trust," New York Times. 1 August 2000, 1(A).
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{T}he genome's writ reaches beyond
medicine and will in time redefine
knowledge of ourselves, our history, our
innate capacities and our relationship
to the rest of creation. The condition
of human existence, the reach of human
abilities, the purpose of life— at
least in a biological sense— have
boundaries that are engraved in the
genome's gnomic text.8
What Wade is claiming, in other words, is that this
new genetic information has tremendous potential to
redefine what it means to be human. However, this idea
that a scientific discovery has the potential to alter our
self-conception is not novel. The history of science
clearly demonstrates that new scientific knowledge has
always, to one degree or another, impacted our
understanding of ourselves.9
But the genetic revolution is different from the
scientific revolutions of the past in at least two
important ways. First, unlike any other time in history,
we have the technology to examine and understand our DNA,
the so called "building blocks" of life. Second, we are
quickly developing the technology to change and manipulate
our DNA. Taken together, these technologies have the
potential to impact our self-conception in ways not
previously known. For one thing, the temptation to
®Nicolas Wade, "Now, The Hard Part: Putting the Genome to Work," New
York Times. 27 June 2000, 1(D).
9See, for example, Warren S. Brown, Nancey Murphy, and H. Newton Malony,
eds., Whatever Happened to the Soul? Scientific and Theological Portraits of
Human Nature. (Minneapolis: Fortress Press, 1998), 1-29.
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understand the human being in strictly mechanistic,
reductionist terms is stronger than ever before.
But the researchers involved in the HGP are deeply
aware that these technological advances could lead toward
a genetic reductionist view of the human being. While
scientists call their work on the genome a "portrait of
who we are," they are just as quick to say that "people
are not, and never will be, mere products of their
genes. "10
Concerned about this trend toward reductionism, Dr.
Francis Collins says the following in a recent interview:
One of my concerns is that, as we begin
to glimpse some of the biological
contributions to certain personality
traits, in people's minds those
contributions will loom larger than they
should . . . and the notion of genetic
determinism will gather further momentum
that it doesn't deserve.11
Nevertheless, the tendency to equate the totality of
what it means to be human with DNA is evident in popular
and scientific literature alike. While researching for an
article on genes for the National Geographic, James
Shreeve went to the Affymetrix biotech company in Silicon
Valley, California. Wanting to get his own DNA analyzed
for first-hand experience, Shreeve had scientist, Kyle
O'Connor, draw his blood, mix it with some chemicals and
10Natalie Angier, "A Pearl and Hodgepodge: Human DNA," New York Times.
27 June 2000, 1(A).
nIbid., 1(A).
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7
put it on a computer screen. Shreeve describes what
happened next in the following words:
"Allow me to introduce you to yourself,"
says Kyle. For a disorienting moment I
am not sure which of us he is speaking
to. The notion that something as
complex as a human being can be
distilled into a test tube is of course
absurd. Nevertheless, the pale residue
in this vial does contain the chemical
guidelines that have informed the
development of my body and brain from
the moment I was conceived. It
holds a detailed record of my ancestral
past and to an uncertain extent a
forecast of my personal future. It is
virtually immortal, a thread tying
this one life to all life that has ever
lived or is yet to live. But it is also
the part of my anatomy most unerringly
myself. How much do the secrets in
that tube affect the way I look and act,
how I respond to the world, and how long
I will remain a part of it? To what
extent am I my genes?1 2
Even Shreeve's photographer, Karen Kasmauski, was
emotionally challenged by this article. Everyone she met
had "strong feelings about this subject because the
perception is that genes define us."13 There is further
evidence of this "reductionist" perception in two recent
Time Magazine articles which discuss the possibility of
identifying the "I.Q. gene and the personality gene."1 4
12James Shreeve, "Secrets of the Gene," National Geographic 196,
(October 1999): 48.
13Ibid., 48.
14J. Madeleine Nash, "The Personality Genes," Time Magazine 27 April
1998, 60-61; and Michael D. Lemonick, "Smart Genes?" Time Magazine 13
September 1999, 54-61.
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To one degree or another, current popular literature
only reflects what the scientific community has been
communicating about genes for years. Generally, the idea
being brought forth is that the genes hold the key to
unlocking the mysteries of human nature and human
behavior.
In his essay "Vital Language," Richard Doyle takes
seriously the language used by scientists and focuses on
the metaphors used in historically important documents in
DNA research which led to the idea that DNA contains the
"Book of Life." Doyle points out the power of metaphors
to shape our comprehension of knowledge even in such
seemingly objective scientific fields as biology.1 5
For example, there are three underlying metaphors
which support the work on the human genome. One is the
characterization of the gene as the essence of identity;
the second is the promise of prediction of human health
and behavior; the third is that the genome will reveal a
natural order. If geneticists can decipher and decode the
text, map out the markers, and read the instructions, they
may be able to understand, to a large extent, what it
means to be human.16
15Richard Doyle, "Vital Language," in Carl F. Cranor, ed., Are Genes Us?
(New Brunswick: Rutgers University Press, 1994), 52-68.
“Dorothy Nelkin and M. Susan Lindee, The DNA Mystique: The Gene as
Cultural Icon (New York: W.H. Freeman and Company, 1995), 1-18.
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In other words, unwittingly perhaps, the view often
presented to the public by the scientific community is
that, ultimately, the genes can give us the most accurate
and most intimate clues concerning what the human being
is. For the most part, to the public at large, this idea
is what makes genetic manipulation for both treatment or
enhancement purposes seem morally acceptable.
Increasingly, society is becoming more comfortable
with the idea of using genetic enhancements for non-health
related reasons. A recent poll indicates that 43 percent
of couples who were asked said they would use genetic
enhancements to improve the physical capabilities of their
children and 42 percent said they would use such
interventions to enhance their children's mental
abilities.17
For many bioethicists, however, there is a difference
between using genetic manipulation technologies for the
treatment of disease and using them for the enhancement of
what are considered to be "normal" human traits. They
argue that genetic manipulation for the treatment of
disease does not pose nearly as many moral quandaries as
that of manipulation for enhancement purposes.
It is important to point out here some of the
differences between somatic cell and germline cell genetic
17Gina Kolata, "Monkey Born With Altered Cells In Gene Engineering
Experiment," New York Times. 12 January 2001, 17(A).
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10
manipulation. Somatic cells are the entities which make
up the individual body; they are not passed on to
offspring. Therefore, somatic cell genetic manipulation
for either treatment or enhancement purposes affect only
the individual on which the technique is performed.
Germline cells, on the other hand, are the
reproductive cells. Genetic manipulation of these cells
for either treatment or enhancement purposes will affect
the next generation. For this reason, germline cell
genetic manipulation is considered more problematic than
somatic cell genetic manipulation.
This research project is limited to the ethical and
philosophical issues raised by somatic cell genetic
enhancement technologies. The reason for this is twofold.
First, somatic cell gene therapy for the treatment of
disease is already widely accepted.18 Second, germline
cell genetic manipulation raises questions concerning
autonomy and informed consent which go beyond the scope of
this work.
Enhancement Technologies
Soren Kierkegaard asked the following question:
Suppose we could relieve all of us of our sense of
18This does not mean, however, that there are no ethical issues raised by
somatic cell gene therapy for the treatment of disease. It will be pointed
out in Chapter 2 that the treatment/enhancement distinction used to justify
this technique has many conceptual problems associated with it.
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11
spiritual emptiness or alienation, of our feeling of being
disoriented and lost in the world. Would that be a good
thing?
Many bioethicists are beginning to ask these same
kinds of questions in light of the genetic revolution. In
the book, Enhancing Human Traits, Dr. Erik Parens tells
about a conference that took place at the Hastings Center
in New York in 1993. In a presentation he gave on
enhancement, LeRoy Walters asked his colleagues to imagine
the following four scenarios. The first involved a
genetic intervention that could "enhance" our ability to
resist disease. This inspired very little controversy.
If all persons were granted equal access to such
intervention, then it is difficult to discern a moral
problem.
The second scenario had to do with a genetic
intervention that could "enhance" our ability to be fully
alert with much less sleep. This raised some controversy.
Is less sleep a good thing? What would we do with our
extra time? The third scenario also raised concern.
Walters invited his colleagues to imagine a genetic
intervention which could increase long-term memory. But
would such an enhancement also mean that one would be
doomed forever to remember some things one would rather
forget?
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The fourth scenario nearly jolted some people from
their seats. Suppose there was a genetic intervention
aimed at reducing the ferocious tendencies of human beings
and increasing their generous tendencies. Such an
intervention could compensate for a tragic evolutionary
flaw in our species. But are we wise enough to know what
level of generosity we ought to achieve with a new genetic
technology? Are we so confident in our wisdom of our
conceptions of normality and perfection that we are
prepared to use new genetic technologies to achieve them?19
Increasingly, scientists and ethicists are raising
concerns about the possibility of using genetic
technologies to enhance human traits. After the apparent
successful use of gene therapy to treat a patient with ADA
Deficiency, French Anderson stated that "since it is now
possible to put a gene into a human being in order to
correct a problem as we did here, then the technology
exists to put a gene into a human being for any purpose."20
Anderson and others have expressed in many writings
their ethical concerns about enhancements. In 1995 The
Hastings Center received a grant from the National
Endowment for the Humanities to do a project on the
19 The Hastings Center scenario was taken from Erik Parens, ed.,
Enhancing Human Traits: Ethical and Social Implications (Washington D.C.:
Georgetown), vii-viii.
20French Anderson, "Genetic Engineering and Our Humanness," Human Gene
Therapy 5 (1994), 755.
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13
prospect of enhancing human capacities. One of the
outcomes of this project was the book mentioned earlier,
entitled, Enhancing Human Traits: Ethical and Social
Implications,21 edited by Erik Parens.
In 1999, Christian Bioethics devoted an entire volume
to enhancements and the quest for perfection.22 In Spring
2000, The Hastings Center announced that it was teaming
with Case Western Reserve University to consider the issue
of managing genetic enhancements. The project has
identified three critical challenges in this area: 1) the
lack of an adequate regulatory framework to manage the use
of genetic therapies; 2) the enforcement of ethical
standards once they are developed; 3) access to these
genetic interventions in locations outside of the United
States .23
In light of all the current discussions on
enhancement technologies, it is probably safe to say that
these concerns expressed by so many ethicists and scholars
about the use of such technologies will only be
exacerbated by the completion of the Human Genome Project.
The reason for this is that the vast amount of genetic
information generated by the Human Genome Project will
21Erik Parens, ed., Enhancing Human Traits: Ethical and Social
Tmpl1 nations. (Washington D.C.: Georgetown, 1998).
22Christ.ian Bioethics, vol.5, no.2., (1999).
23Centerpiece: The Newsletter of The. Hastings Center. Spring 2000.
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14
give insight into the function of both defective genes and
good genes. Hence, it is conceivable that technologies
will eventually be available to both replace the defective
genes and to enhance the good ones.
The Problem
While it is true that the Human Genome Project and
genetic enhancement technologies raise several ethical
issues related to present-day application, they also raise
some age-old philosophical questions as well: What does
it mean to be human? What ought we to become? What is
the purpose of medicine? How much control should
technology (in this case/ biotechnology) exercise over our
bodies?
Philosophers and theologians have wrangled with these
questions for centuries, without ever having come to any
consensus or resolution. But the Human Genome Project and
the prospect of genetic enhancement technologies have once
again brought these questions to the forefront, and many
bioethicists have felt a new sense of urgency to explore
them.
In an effort to wrestle with the questions concerning
the purpose of medicine and how much control it should
have over the body, Gerald McKenny, in his penetrating
book, To Relieve the Human Condition, discusses the
capacity of medicine to intervene into natural processes
to the extent that certain areas of life which were once
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15
subject to fate are now susceptible to human intervention.
According to McKenny, these areas include:
{T}he extension of medical authority
over new areas of our lives, the
expansion of technological control
of the body, the transformation of
questions about the place of illness and
health in a morally worthy life into
questions about which preferences
technology should fulfill, the
implications of pursuing the
Enlightenment hope of a progressive
elimination of pain and suffering from
human life.24
He argues that these and other effects raise several
pressing moral questions, the foremost of which is the
proper role of medicine in our lives. McKenny claims,
however, that standard bioethics has largely ignored these
issues. McKenny gives the following explanation for
standard bioethics' strange silence on these questions:
Standard bioethics, by which I mean the
family of secular approaches rooted in
the theories and principles of
analytical moral philosophy that are
dominant in the English-speaking world,
is a product of modernity, and the moral
task of modernity is to resolve
conflicts between competing interests in
order to secure social cooperation
without appeal to robust views of the
good. The agenda of standard bioethics,
at the risk of oversimplification,
follows accordingly: for every new issue
that arises in biomedical research and
care its task is to safeguard individual
autonomy, calculate risks and
harms, and determine whether or not a
just distribution will follow. It would
be foolish to deny the importance of
24Gerald McKenny, To Relieve the Human Condition: Bioethics. Technology,
and the Body. (Albany: State University of New York Press, 1997), 7.
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this agenda. Nevertheless . . . {Does
this silence} indicate a suppression of
questions that challenge a deep but
implicit moral agreement between
standard bioethics and the effort
to overcome the human subjection to fate
or natural necessity?25
The claim here is not that certain bioethicists who
adhere to standard bioethics have largely ignored the
ethical and philosophical questions raised by new
biotechnologies. This is clearly not the case because
"standard" bioethicists such as LeRoy Walters and Dan
Brock have on many occasions raised these questions.26
However, they have raised these questions not because
standard bioethical theory has prompted them to do so, but
because our conception of humans as responsible agents, a
conception that is rooted in the Greek/Judeo/Christian
tradition, compels them to do so. Walters and Brock
understand that the scientific view of human being and
human behavior threaten this foundation.27
The argument here is that standard bioethics— the
principles of biomedical ethics, which are derived
primarily from principle-based, common morality theories,
which in turn draw heavily from modern conceptions of
25Ibid., 8.
26See, for example, Parens' discussion of the enhancement conference
given by LeRoy Walters in Enhancing Human Traits, vii-x, and Dan Brock's
article entitled, "The Human Genome Project and Human Identity" in Robert F.
Weir, Susan C. Lawrence, and Evan Fales, eds., Genes and Human Self-Knowledge
(Iowa City: University of Iowa Press, 1994), 18-31.
27See, for example, Brock, "The Human Genome Project and Human Identity"
in Genes and Human Self-Knowledge. 23-28.
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17
deontological and utilitarian ethical theories— largely
ignores the age-old philosophical questions raised by the
genetic revolution.
According to McKenny, one of the reasons standard
bioethics ignores such questions is that its main agenda
is to "safeguard autonomy, calculate risks and harms, and
determine whether or not a just distribution will follow."
All of these contribute to the effort to relieve human
suffering and expand human choice.
McKenny contends, then, that there is indeed an
agreement between standard bioethics and the effort to
overcome natural necessity. One of his main arguments is
that a moral discourse that relates the health of the body
and its susceptibility to illness and suffering to broader
conceptions of a morally worthy life is replaced by a
moral discourse characterized by efforts to eliminate
suffering and expand human choice and, in so doing,
overcomes human subjection to natural necessity.28
The overall result is that standard bioethics
participates in the search for technological utopianism,
an idea which began with the writings of Francis Bacon and
is often referred to as the "Baconian Project." That
Bacon's scientific method influenced the development of
medical ethics as we know it today is evident in the
28Ibid., 9.
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18
writings of the Scottish physician-philosopher John
Gregory (1724-1773).
Gregory lived at a time when medical practice was
broadly characterized as chaotic and corrupt. In
eighteenth century Britain, physicians ruthlessly competed
with one another, and the consequences for failing to
compete successfully included loss of income, status, and
power.29 Physicians would create their own remedies and
keep them secret in order to deny their competition access
to them. In this fierce market place, a physician did
what he could to stand out.
Gregory thought that the competitive, self-interested
world of medical practice was scientifically and morally
corrupt.30 In an effort to correct what he believed was
the physician's immoral quest for money and power, Gregory
adopted the Baconian scientific method and used it to
advance patient well-being.
According to McCullough, the Baconian scientific
method required the capacity of diffidence, "the capacity
for observation of natural experiments as they occur, free
of bias, especially the pernicious bias that "interest"
(i.e. self-interest) introduces."31 Skepticism was
29Lawerance B. McCullough, "Laying Medicine Open: Understanding Major
Turning Points in the History of Medical Ethics," Kennedy Institute of Ethics
Journal Vol. 9, No.l (1999), 9.
30Ibid., 11.
31Ibid., 11.
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19
required of all knowledge claims until they could be
proven to be valid. Bacon provided a detailed
prescription of how the scientific method was to work, and
Gregory applied it to his cause. His words are
illuminating:
A physician who has been educated upon
this {Baconian} plan, whose mind has
never been enslaved by systems, because
he has been a daily witness of their
insufficiency, instead of being assuming
and dogmatical, becomes modest and
diffident. When his patient dies, he
secretly laments his own ignorance
of the proper means of having saved him,
and is little apt to ascribe his death
to his disease being incurable. There
are indeed so few diseases which can be
pronounced in their own nature,
desperate, that I should wish you to
annex no other idea to the word, but
that of a disease which you do not know -
how to cure. How many patients have
been dismissed from hospitals as
incurables, who have afterward
recovered, sometimes by the efforts of
unassisted nature, sometimes by very
simple remedies, and now and then by the
random prescriptions of ignorant quacks?
To pronounce diseases incurable, is to
establish indolence and inattention, as
it were, by law, and to skreen ignorance
from reproach. This diffidence of our
own knowledge, and just sense of the
present imperfect state of our art,
ought to incite us to improve it, not
only from a love of the art itself, but
from a principle of humanity. I
acknowledge, however, that such a
diffidence as I have described, if it be
not united with fortitude of mind, may
render a physician timid and unsteady
in his practice; but, though true
philosophy lead to diffidence and
caution in forming principles,
yet, when there is occasion to act, it
shews how necessary it is to have a
quickness in perceiving where lies the
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20
greatest probability of success; to
be decisive in forming a resolution, and
firm in carrying it to execution.32
Gregory also incorporated David Hume's principle of
sympathy into his medical ethics. According to
McCullough, principles such as sympathy and beneficence,
thought to be constitutive of human nature, had become an
object of scientific inquiry, following the Baconian
scientific method.33 Thus, both Hume and Gregory, in
accordance with the spirit of their day, endeavored to
write a science of human nature and a science of morals.
When we consider Gregory's purpose in adopting
Bacon's scientific method into medical ethics from the
perspective of our technology-driven medical world, there
is apparent a strange sort of irony. Whereas Gregory used
the scientific method to curtail the power of physicians
in his day, physicians have gained extraordinary power
from scientific institutions in our day.
McKenny affirms this notion when he says that "our
obsession with bodily perfection occurs under a moral
imperative that originated with the rise of modern
technology and that, in the writings of Francis Bacon and
Rene Descartes, looks to medicine for its actualization.34
32John Gregory, Lectures on the Duties and Qualifications of a Physician.
(London: W. Strahan and T. Cadell Publishing, 1772), 209-10.
33McCullough, 15.
34Ibid., 2.
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21
Indeed, several scholars agree with McKenny and argue that
both Baconian ideas of technological utopianism and of the
human being as a machine are so entrenched in biomedicine
today that no one even questions such notions.35
The primary problem, then, is that, in standard forms
of bioethics, we lack a context from which we can fully
address the critical, age-old philosophical and ethical
questions raised by the genetic revolution in general and
by genetic enhancement technologies in particular.
My Position
It is imperative that questions concerning the
purpose of medicine be explored in light of the goals of
the Human Genome Project and that questions concerning the
nature of the human being be examined in light of the
future possibilities of genetic enhancement technologies.
But the very fact that these foundational questions are
still being raised and hotly debated shows that definitive
answers to them are difficult, if not impossible.
Needless to say, then, this work will not pretend to
resolve all the questions once and for all.
What this work will do, however, is offer an
Aristotelian-inspired perspective in which the
35See, for example, Richard Connell, Substance and Modern Science.
(Houston: Center for Thomistic Studies, 1988); Nancy Pearcey and Charles
Thaxton, The Soul of Science. (Wheaton: Crossway Books, 1994); Mark J. Hanson,
"Indulging Anxiety: Human Enhancement from a Protestant Perspective,"
Christian Bioethics, vol.5 no.2 (1999), 121-138; Joel Shuman, "Desperately
Seeking Perfection: Christian Discipleship and Medical Genetics," Christian
Bioethics. vol.5 no.2 (1999), 139-153.
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22
philosophical and ethical questions raised by new
biotechnologies are central rather than marginal. My hope
is that this perspective will lay the necessary conceptual
groundwork needed to further ethical reflection on the
ways in which new genetic technologies, especially genetic
enhancements, ought to be used.
I believe that Aristotle, understood in his
historical setting, provides a solid basis for proper
ethical reflection for two reasons. First, there are many
parallels between the ancient Greeks' pursuit of bodily
perfection and our own. In fact, to a large extent, our
desire to enhance human capacities in a variety of ways
can ultimately be traced back to the Greeks.
Second, Aristotle's teachings on the human being,
the moral life, the vulnerability of the body, the
fragility of goodness, and the purpose of medicine,
provide, I think, a firm foundation for resolving some of
the current ethical issues involved in genetic
enhancements.
In the process of exploring Aristotle's teachings, it
will become clear just how much we have in common with the
Greeks. There is, however, one glaring difference between
us and them, one that is communicated by Plato in Book III
of the Republic. Discussing the kinds of people who would
make up his ideal city, Plato addresses the role that
medicine should play in their overall development.
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23
Plato's underlying concern in addressing this issue
is the ways in which the pursuit of health can be managed
so that medicine serves rather than hinders our moral
projects.36 In other words, it seems as though he wants to
be sure that the pursuit of a healthy body does not
interfere with moral development.
This is a concern that ought to be taken more
seriously in contemporary biomedicine and bioethics. But,
currently, it is not. McKenny makes this insightful
comparison between the Greeks' attitude toward the place
of medicine in human life and our own:
Our contemporary preoccupation with
enhancements, then, recalls those
historical periods in which medicine
. . . was at the center of highly
contested ethical debates about what
kind of activities or way of life one
should cultivate. So far, then, it
appears that the chief difference
between the ancients and ourselves is
not the attention we give to enhancing
the body but the fact that medicine,
philosophy, and to a large extent even
religion have, in our world, largely
abandoned the task of articulating and
debating views of the good life. Hence
we and the ancients seem to be alike in
our practice of enhancements, differing
only in that we, unlike them, have no
framework or discourse within which to
judge which enhancements will contribute
to a morally worthy life and which will
detract from it.37
36For more insight into Plato's views on medicine and the body, see
Plato's Republic. Book III, especially 403c-407a and McKenny's discussion in
To Relieve The Human Condition, 1-3.
37Ibid., 224-225.
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My primary goal in this research project, then, is to
take seriously McKenny's claim concerning the lack of
moral discourse concerning the good life in standard forms
of bioethics and offer an ethical framework by which
genetic enhancements can be evaluated in light of which
will "contribute to a morally worthy life and which will
detract from it." In my opinion, this framework must
begin with a view of the body that sees it not as an
obstacle to be overcome, but as an integral part of the
moral life.
Hence, my overall argument can be summed up in this
way. The Human Genome Project and genetic enhancement
technologies raise some age-old philosophical and ethical
questions. These questions include: What does it mean to
be human? What ought we to become? What is the purpose
of medicine? How much control should we allow biomedicine
to exercise over the body? These questions, in my
opinion, should not be ignored.
Standard forms of bioethics do not fully allow for an
exploration of these kinds of questions because they
participate, to one degree or another, in what has come to
be known as the Baconian project and its pursuit of
technological utopianism. In light of this, what is
needed is an ethical framework in which these ancient
questions are central and not peripheral.
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In my opinion, those who are associated with the
development and application of genetic enhancement
technologies ought to resist the Baconian project that is
embedded in contemporary biomedicine and bioethics for
three primary reasons. First, the Baconian project is
largely responsible for the marginalization of the most
fundamental ethical and philosophical questions raised by
new biotechnologies.
Second, the Baconian project is based on a
mechanistic (physicalist) view of the human being, a view
that is inadequate because it fails to take fully into
account the issues concerning personal identity, free
agency, and the moral significance and vulnerability of
the human body.
Third, the Baconian project and its quest to relieve
the human condition gives an extraordinary amount of power
to medicine, resulting in the "medicalization" of many
conditions which, at least from an Aristotelian
standpoint, are beyond the proper end of medicine.
Those who are associated with the development and
application of genetic enhancement technologies ought to
embrace what I refer to as an Aristotelian-inspired ethic
of vulnerability. An ethic of vulnerability has four
primary features: 1) It holds that ethical reflection
begins with the agent and not with an "ethical dilemma,"
thus making the fundamental ethical and philosophical
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26
questions raised by new biotechnologies central rather
than peripheral; 2) It is based on a substance view of the
human being, which adequately accounts for personal
identity and free agency; 3) It sees the body not as an
obstacle to, but as an integral part of a morally worthy
life; 4) It views biotechnology as an enterprise made to
serve human beings and their moral projects.
In essence, what I am saying is that there is no
question that Bacon's overall objectives were important
and laudable, and the outcomes of his objectives have been
extremely beneficial to us in our day. Indeed, new
biotechnologies have improved the quality of life for many
people and these have more or less been a result of
Bacon’s work.
However, in his endeavors, Bacon largely ignored many
of the questions raised above because his views on the
"true" sources of knowledge lead him to reject the
Aristotelian notions of form and telos, the notions which
essentially inspire these questions and place them at the
center of intellectual and ethical inquiry. This
dismissal of the Aristotelian ideas of form and telos has
had other important implications which I am sure Bacon did
not intend, including the extraordinary power and
domination which science and technology has today.
Consequently, because standard forms of bioethics
participates in the Baconian project, these foundational
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questions are marginalized and are not given serious
attention. Because of the enormous ethical and social
implications of new genetic technologies, however, it is
my opinion that these questions should not be ignored.
Therefore, Aristotle's ethical theories ought to be taken
seriously in discussions about the use of new
biotechnologies because, unlike standard bioethics, these
questions are central to ethical inquiry.
Aristotle, who was concerned with both essence and
function, built his ethical theory upon a substance view
of the human being. He took into consideration the human
being's vulnerability to fate and natural necessity. He
also understood medicine to have a particular end.
Therefore, I think his theories concerning the human being
and the ultimate good offer valuable insight needed today
for proper reflection on the ways in which genetic
enhancements should be used.
In saying all of this, I want it to be clear that
this research project is not a diatribe against technology
nor is it a plea to return to a pretechnological era.
This would not be possible nor would I advocate doing such
a thing. Rather, this work is simply an invitation to
view the genetic revolution from an Aristotelian-inspired,
"pre-technological" perspective. Aristotle, understood in
his historical context, will, I think, help us to evaluate
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which genetic enhancements will contribute to a morally
worthy life and which will not.
But What About . . . ?
The problem with defining human nature. Our great
learning over the past several centuries has not yielded a
definition of human nature in which there is unanimous
agreement. As was stated earlier, philosophers and
theologians have been debating about this topic for
centuries with no resolution.
However, in recent decades, there has emerged a
scientific view of human nature which has come to dominate
in Western society. Tracing its roots back to Bacon,
Descartes and to many thinkers in the Enlightenment era,
this view understands the human as a physical organism
whose complex functioning gives rise to higher capacities
such as emotion, morality and spirituality. It is argued
by those who hold this view that the recent developments
in genetics and the neurosciences support this
interpretation of human nature.
For example, Malcolm Jeeves, Honorary Research
Professor of Psychology at the University of St. Andrews
in Scotland, points to a recent report which seems to
confirm the idea that the more that is learned about the
brain, the more we will understand human behavior, thought
and emotion:
Fundamental discoveries at the molecular
and cellular levels of the organization
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29
of the brain are clarifying the role of
the brain in translating
neurophysiologic events into behavior,
thought and emotion. . . . The study of
the brain involves the multi
disciplinary efforts of scientists from
such diverse areas as physiology,
biochemistry, psychology, psychiatry,
molecular biology, anatomy,
medicine, genetics, and many others
working together toward the common goal
of a better understanding of the
structure of the brain and how it
affects our development, health, and
behavior. . . .3 8
However, while it is true that scientific advances in
medicine have led to remarkable discoveries in DNA and
brain function, it does not necessarily follow from them
that human beings must be understood in purely physical
terms. There are many aspects of human nature such as the
will, personal identity, and perhaps spirituality that
cannot adequately be explained by physical properties.
Moreover, this scientific view of human nature, which
is at the root of the Baconian project, does not address
in a serious manner the moral significance of the body.
In other words, it does not fully take into account the
body's vulnerability and susceptibility to fate and
natural necessity.
38Joint Resolution presented in the House of Representatives in the U.S.
Congress, March 8, 1989. For more discussion on recent advances in the
neurosciences and the physicalist view of human being see, Jean-Pierre
Changeux, Neuronal Man: The Bioloav of the Mind. (PrinCeton: Princeton
University Press, 1997); Richard Restak, The Modular Brain. (New York: Simon
and Schuster, 1994); Office of Technology Assessment, Biology. Medicine, and
the Bill of Rights. (Washington D.C., GPO, 1988);
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For this reason, the scientific explanation of human
being is insufficient, I think, to deal with the most
fundamental questions raised by the genetic revolution.
Aristotle, however, if he is understood in his historical
setting, offers a view of the human being and the moral
significance of the body that better equips us in our day
to deal with the essential, foundational questions.
For example, if the scientific view of human being is
accurate, then it follows that an ultimate end for human
being, as Aristotle describes it, cannot rightfully exist.
The scientific view affirms that there is nothing inherent
within human nature to move it toward a telos. It follows
then that a human being's purpose (if human beings could
be understood to have a purpose) must be defined by and
derived from cultural norms and values.
And since, unwittingly or not, our culture values to
some extent the idea of technological utopianism, there is
no good reason why it should not be pursued. In other
words, under the scientific paradigm of human nature,
technological utopianism ought to be pursued at all costs
because, from our society's perspective, vulnerability and
suffering are pointless and serve no purpose. But, as it
will be pointed out later, this overall viewpoint
ultimately creates a fundamental tension between pursuing
and not pursuing genetic enhancements.
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Questions concerning what it means to be human and
the purpose of medicine do not hold the same significance
under the scientific paradigm of the human being because
the scientific answers to these guestions and cultural
values are in harmony with one other.
But if Aristotle’s theory of human being could be
established as a reasonable view, then it follows from his
teachings that human beings do have an ultimate end.
Human beings, according to Aristotle, are moved toward an
ultimate telos by a "form or substance" inherent within
them.
If, as Aristotle argues, this telos is happiness,
then the virtues are an intricate part of it. If
happiness has this strong moral component, then
contingency is also a crucial aspect of it. Under this
paradigm of human nature, genetic enhancements could pose
moral problems if they undermine happiness and virtues as
understood in this context.
Whereas standard forms of bioethics are rooted in the
Baconian project, which in turn is based on a
scientific/mechanistic view of human being, an ethic of
vulnerability is based on an Aristotelian view of human
being. As a result, under the former paradigm, the
ethical issues surrounding genetic enhancements do not
hold the same significance that they do in the latter.
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32
The problem with Aristotle’s theories. Aristotle
pictures the world as a vast organism. Based on this
observation, Aristotle concludes that all natural
processes are directed by a goal or purpose, which he
calls the object's Form. To understand the Form and to
give it a concise, logical definition is, for Aristotle,
scientific knowledge.
In the Middle Ages, Thomas Aquinas adapted
Aristotle's teachings into the major doctrines of the
Catholic Church. By the end of the Middle Ages,
Aristotelianism had become a comprehensive worldview.
According to Pearcey and Thaxton, it embodied the
following teachings:
It taught that the earth is located at
the center of universe. Around it
revolve the planets and the sun, each in
its own circular orbit. Earth is the
realm of imperfection, populated by
bodies composed of the four elements—
earth, air, fire, and water. Heaven is
the realm of perfection, populated by
bodies composed of an incorruptible
element-- the "quintessence," or fifth
sense.39
Beginning in the pre-Enlightenment era, several
aspects of Aristotle's physics and astronomy were debunked
by discoveries made by many scientists, including Galileo,
Copernicus, and Newton. Philosopher David Hume attacked
and criticized Aristotle's view of substance, which is key
not only to his teachings on physics and astronomy, but
39Pearcey and Thaxton, The Soul of Science, 61.
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33
also to his ethical theory. As a result, Aristotle's
ideas are basically viewed with mistrust today.
But Aristotle has made a lasting contribution to the
field of biology. This makes sense in light of the fact
that biology was the source of his most fundamental
concepts. Important figures in the scientific revolution
such as Andreas Vesalius (1514-1564), the father of modern
anatomy, and William Harvey (1578-1657), who discovered
the circulation of blood, owe much of their success to
Aristotelian theories.40
There is a view that scientific progress came through
a repudiation of the ancients. To the contrary, however,
Harvey insists that his discovery of the circulation of
blood "does not shake but much rather confirms the ancient
medicine."41 Following the Aristotelian tradition, many of
Harvey's analogies of the human heart come from human
society. He writes about pathways of blood in the
following words:
{It} returns to its sovereign, the
heart, as if to its source, or to the
inmost home of the body, there to
recover its state of excellence or
perfection ... {it becomes} a kind of
treasury of life. . . . The heart,
consequently, is the beginning of life,
the sun of the microcosm . . . it is the
household divinity which, discharging
40Ibid., 61.
41William Harvey, On the Motion of the Heart and Blood in Animals.
trans. R. Willis, rev. and ed. Alex Bowie (Chicago: Henry Regnery, Gateway
Edition, 1962), 5, 13.
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34
its function, nourishes, cherishes,
quickens the whole body, and is indeed
the foundation of life, the source of
all action.42
It is important to note that none of Harvey's
analogies are mechanical. Rather, in an Aristotelian
style, they draw heavily from everyday human endeavors
such as politics, domestics, and economics. Harvey uses
this language in all his notes pertaining to his
experiments. We can conclude from this, then, that at
least in biology, Aristotle's concepts are still accurate
and representative of the facts.43
Also, Aristotle's wrong assumptions in physics and
astronomy do not automatically discount his ethical theory
or his view of human nature.
The problem with virtue ethics. In their work,
Principles of Biomedical Ethics, Beauchamp and Childress
discuss the criteria for theory construction. They state
that for any ethical theory to be considered adequate, it
must meet the following eight conditions: 1) Clarity;
2) Coherence; 3) Completeness and Comprehensiveness;
42Ibid., 85.
43For more recent support of Aristotle's concepts in biology see, James
E. McClellan III and Harold Dorn, Science and Technology in World History.
(Baltimore: John Hopkins University Press, 1999); William A. Dembski, Mere
Creation: Science. Faith & Intelligent Design. (Downers Grove: InterVarsity
Press, 1998); Jeremy Campbell, Grammatical Man: Information. Entropy. Language
and Life (New York: Simon and Schuster, 1982); Ernst Mayr, The Growth of
Biological Thought: Diversity. Evolution, and Inheritance (Cambridge: Harvard
University Press, 1982).
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4) Simplicity; 5) Explanatory Power; 6) Justificatory
Power; 7) Output Power; 8) Practibility.
On this account, an ethic of vulnerability, which, in
its basic elements, is essentially a virtue ethic, would
be considered an inadequate ethical theory and, for this
reason, unable to fully address the ancient philosophical
questions and current ethical issues raised by the Human
Genome Project and genetic enhancements.
I concede that an ethic of vulnerability would fall
short, especially in some aspects concerning completeness,
comprehensiveness, and practibility. Rules, codes, and
right-claims often provide an adequate form of bottom-line
moral protection. And it is doubtful that any
specification of virtues would ever be sufficient to guide
all conduct.
Nevertheless, when it comes to issues concerning
whether or not we ought to use genetic enhancements, the
questions do not turn on what would be the right action in
a given situation; rather, the central questions concern
who we are, what we ought to become, and what role
biomedicine should play in the process. Seen in this
light, standard forms of bioethics, with their focus on
action rather than on the agent, are inadequate to deal
with such questions. Therefore, it seems evident that an
ethic of vulnerability or a virtue ethic is needed in this
ethical context.
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36
Is There Any Other Way?
James Gustafson: Ethics from a Theocentric
Perspective. It is safe to say that no other thinker in
theological ethics is more in tune with the benefits and
drawbacks of the Baconian project and its goal to relieve
the human condition than James Gustafson. This is evident
in his monumental work, Ethics from a Theocentric
Perspective, when he explains to his readers why the
biosciences have taken so much of his attention:
Over the past twenty years I have, in a
lay person's way, attempted to grasp the
main lines of genetic and neurological
research because I believe that in
biology these have the widest
implications for future human
participation. Man, in my judgment,
will come closer to being the ultimate
orderer of life through the uses of
these investigations than through the
matters that preoccupy so much of the
attention in clinical medical ethics.
Of course in practice it will not be
"man" but those persons and
institutions that have the power to
control the use of such
investigations.4 4
For Gustafson, two questions are central to ethics:
What is God enabling and requiring us to be and do? What
is the normatively human? His answers to these questions
largely have to do with vocation. In his volume, Theology
and Christian Ethics, Gustafson states the following:
{T}o be human is to have a vocation, a
calling; that it is to become what we
44James Gustafson, Ethics from a Theocentric Perspective, vol.2: Ethics
and Theology (Chicago: University of Chicago Press, 1984), 281-282.
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37
now are not; that it calls for a
surpassing of what we are; that apart
from a telos, a vision of what man can
and ought to do, we will flounder and
decay.45
Vocation gives the moral and theological justification
for use of and control over nature, including human
nature. This mandate also includes the use of technical
skills to improve the quality of ordinary life. This
human capacity to exercise control over nature, including
human nature and the limitations and consequences of this
capacity, is the issue Gustafson seeks to address in his
ethics.
In light of this description of human capacities,
Gustafson makes the following observation about human
nature:
One of the persistent characteristics of
human beings since the dawn of
consciousness is that our species
extends the range of its domination over
forces and powers deemed at first beyond
its control, for the sake of greater
security to individuals and
communities.46
Other purposes for human beings to seek control,
according to Gustafson, are to relieve suffering and
improve health. It is important to note here that for all
Gustafson has done to repudiate Baconian ideas, in his
45James Gustafson, Theology and Christian Ethics. (Philadelphia: United
Church Press, 1974), 244.
46James Gustafson, Ethics from a Theocentric Perspective, vol.l: Theology
and Ethics. (Chicago: University of Chicago Press, 1981), 78.
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38
essential description of human nature, he is Baconian.
McKenny points this out in the following statement:
Gustafson has identified a
characteristic of human
nature and activity that occupies a
determining role in his ethics. Human
nature and activity are not described in
Aristotelian terms (the pursuit of
the virtues in the life of the polis),
Augustinian terms (the orientation of
the will of God), Hobbbesian terms (the
pursuit of individual happiness) or
Kantian terms (the governance of life
by autonomous reason). Rather it is
essentially Baconian: technological man.
. . . The most significant feature of
human beings is their remarkable
capacity to intervene into nature,
including human nature.47
Gustafson offers invaluable insight into the
consequences and limitations of the Baconian project.
However, in light of his position on the primary
characteristics of human nature, I do not believe
Gustafson goes far enough in resisting the Baconian
project to fully engage in the ethical issues raised by
the HGP and genetic enhancements.
Feminist Bioethics. There are about as many
approaches to feminist bioethics as there are feminist
bioethicists. But the one thing that almost all feminists
agree upon is methodology. Their methodology usually
begins with the following questions: "Why is man the Self
and women the Other? Why can man think of himself without
47McKenny, To Relieve the Human Condition. 78.
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39
woman, whereas she cannot think of herself without man?
Why is this man's world, not woman's world?"48
According to Rosemarie Tong, asking the woman
question helps to raise both men's and women's
consciousness about the ways in which gender oppression
permeates our society.49 Most feminists agree that
"consciousness-raising is the major technique of analysis,
structure of organization, method of practice, and theory
of social change of the women's movement."50
Some feminists also share in common a "care" approach
to bioethics. In this paradigm, attachment is one of the
main organizing principles. Detachment, which is one of
the main features of the "justice" (male) approach, is
seen as the moral problem. The feminist ethics of care
seeks grounds for understanding the complexities of
relationships, and it focuses on the "other."
Unlike the justice approach, which holds autonomy as
supreme and engenders an ethics of rights, the care
perspective upholds the primacy of relationships and
produces an ethics of responsibility. The persons
involved in an ethical dilemma are encouraged to embrace
4SRosemarie Tong, Feminist Approaches to Bioethics: Theoretical
Reflections and Practical Applications. (Boulder: Westview Press, 1997), 90.
49Ibid., 91.
50Catharine A. MacKinnon, "Feminism, Marxism, Method and the State: An
Agenda for Theory," Signs 7, no.3 (Spring 1982): 519.
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40
their role in the relationship and, on this basis, to
acknowledge responsibility.
This ethics of care approach is commendable and
offers a valuable alternative to the justice model of
exploring ethical dilemmas in medicine. However, the
feminists who embrace the ethics of care approach do not
engage in any direct way the Baconian project and its
implications for the genetic revolution.
In fact, in her thought-provoking essay, "Braveheart,
Babe, and the Contemporary Body," Susan Bordo has
indicated that some "agency" and "power" feminists
actually endorse some of the ideas embedded in the
Baconian project. According to Bordo, by accepting
cosmetic enhancements and claiming that such technologies
"empower" them by giving them choice and by eliminating
suffering, some feminists, unwittingly or not, are
embracing the consumer culture that is permeated with the
idea of technological utopianism.
She makes the following observation:
Freedom. Choice. Autonomy. Self. Agency.
These are powerful words in our culture,
fighting words. But they are also words
that are increasingly empty in
many people's experience. ... I think
about the pain and self-doubt, the
compulsions and disorders that
often accompany our efforts at becoming
what culture awards. . .. Then I
listen to the rousing cries of
"power feminism" in both its commercial
and its academic formulations: "Just Do
It!" "Take Control!" "Go For It!"
There is a discordance for me between
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41
the celebration of "agency" and
empowerment and what I see going on in
people's lives today.51
Bordo beautifully pinpoints an attitude prevalent in
at least some aspects of present-day feminism, which makes
it inadequate to fully address some of the critical
philosophical and ethical questions raised by genetic
enhancements. Many feminists may not even find the issues
very important because they reflect the concerns of a
"man's world." Nevertheless, as Bordo's "voice" has
clearly demonstrated, a woman's question would be
invaluable in this arena.
Postmodern Bioethics. Postmodern bioethics denies
that there are any objective bioethical rules. Tristram
Engelhardt, a well-known postmodern bioethicist, argues
that rational communication about moral issues is no
longer possible in a pluralistic society. He argues
further that standards for bioethics have been sought "in
the content of moral thought, in the form of moral
reasoning, or in some external reality."5 2
But Engelhardt contends that these three avenues will
not work for three reasons: 1) an appeal to any particular
moral content begs the question of the standards by which
the content is selected, 2) an appeal to formal structure
51Susan Bordo, "Braveheart, Babe, and the Contemporary Body," Enhancing
Human Traits. 213-14.
52Tristram Engelhardt, The Foundations of Bioethics. 2nd ed. (New York:
Oxford University Press, 1996), 8-13.
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42
provides no moral content and therefore no content-full
moral guidance, 3) an appeal to an external reality will
show what is, not what ought to be or how what is should
be judged.53
The bottom line is that Engelhardt holds that though
each of us may think we know right from wrong, discovering
an objective basis for our beliefs is impossible. We
learn what is right from wrong from our own community.
Therefore, we are forced to rely on our own moral
perceptions as they have been passed down to us from our
own community.
Nevertheless, bioethics in a postmodern setting has
two principles that everyone can acknowledge regardless of
his or her community:54 the principle of permission and the
principle of beneficence. The principle of permission or
consent is a necessary condition for the possibility of
moral discourse. The principle of beneficence must apply
or there could be no moral deliberation at all.
Thus, according to Engelhardt, with these principles
as the only standards, there must be Christian bioethics,
Islamic bioethics, Gay and Lesbian bioethics, Feminist
bioethics and so on. Each bioethical system would carry
53Ibid., 41-42.
54It is not within the scope of this essay to discuss some of the
philosophical problems with this viewpoint. But see Tong, 72-74, for more
discussion.
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43
weight within the community which endorsed it.55 For
Engelhardt, this is the only kind of ethics possible in a
postmodern society.
While postmodern ethics offers some valuable insight
into the ways in which communities differ in their ethical
reflections, it is insufficient, I think, to address some
of the old philosophical questions and present-day ethical
issues raised by the HGP and genetic enhancements.
The reason for this is twofold. First, as is the
case with standard bioethics, the fundamental
philosophical questions raised by genetic enhancement
technologies are marginal rather than central in
postmodern ethics. To put it another way, the main agenda
in postmodern ethics is very similar to what it is in
standard bioethics. Therefore, it is incapable, I think,
of shedding any light on which genetic enhancements would
contribute to or detract from our moral projects.
Second, the principles of permission and beneficence
could be interpreted by certain communities to support
genetic enhancements under any condition, or they could
not. These two principles alone do not seem to allow for
an exploration of the underlying philosophical and ethical
issues related to genetic enhancement.
Although there are many differences among theocentric
bioethics, feminist bioethics, postmodern bioethics, and
55See Tong, 73. She points out some of the problems with this view.
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44
the ethics of vulnerability I seek to develop, there is
one common thread. None of them are considered mainstream
theories. They all are marginalized. Nevertheless, an
ethic of vulnerability, based as it is on a robust view of
human nature, could just be a pathway to the mainstream
for all of these theories.
The Scope of My Project
This argument is limited to philosophical and ethical
issues concerning the genetic revolution, spurred on by
the HGP, and genetic enhancements. It is also limited to
issues concerning mainly somatic cell genetic
enhancements. Although I think many of my arguments may
apply to ethical issues related to cosmetic surgery and
psychopharmacology, I do not address these areas
explicitly.
This argument also does not address many of the other
ethical issues related to genetics such as privacy,
confidentiality, discrimination, and social justice.
These important issues have been discussed in numerous
other writings.56 While I think some of my arguments may
certainly apply to these topics, the correlations are not
developed in this study.
56For instance, see Thomas H. Murray, Mark A. Rothstein, and Robert F.
Murray, Jr., eds., The Human Genome Project and the Future of Health Care.
(Bloomington: Indiana University Press, 1996; Ted Peters, ed., Genetics:
Issues of Social Justice. (Cleveland: The Pilgram Press, 1998).
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45
The plan of this research project is as follows. In
the first two chapters I discuss the history and goals of
the Human Genome Project and explore the issues related to
enhancement technologies. In chapter 4, I illustrate how
Francis Bacon influenced modern science and medicine and
how that process has shaped standard forms of bioethics.
I also explain why I think Aristotle must not be
discounted in discussions about biotechnology.
In chapters 5 and 6, I explain Aristotle's view on
the human being and the ultimate good and some of his
notions on the purpose of medicine. In chapter 7, I lay
out an ethic of vulnerability based on my understanding of
Aristotle and his views on the human being and on the
purpose of medicine. I then discuss genetic enhancements
in the moral, intellectual and physical spheres and show
how an ethic of vulnerability functions to shed light on
which enhancements contribute to a morally worthy life.
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Chapter 2
The Human Genome Project
A Brief History of Genetics1
In 1866, Gregor Mendel, an Austrian monk, put forth
the idea that heredity units, called factors, are passed
down through family lines and produce traits. Later,
these factors came to be known as "genes." In 1910,
Thomas Hunt Morgan, while studying the fruit fly, proved
that genes are situated on the chromosomes. In later
studies, he showed that these genes are arranged in such a
way that they are able to be mapped.
In 1926, Hermann J. Muller discovered that X-rays can
cause genetic mutations in fruit flies. This was an
extremely important development in the field of medicine.
After this discovery, there was concern for patients who
underwent X-rays, and extra measures were taken to protect
them.
In 1944, several researchers at the Rockefeller
Institute proved that genes are made of deoxyribonucleic
acid. They discovered this by mixing pneumonia bacteria
with foreign DNA to induce inheritable traits. It had
previously been thought that proteins were the genetic
material.
1This brief history of genetics is adapted from an article
written by Steve Duenes, "Journey to the Genome," New York Times.
27 June 2000, 4(D) & 5(D).
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47
In 1953, a monumental event took place which changed
the field of genetics forever. James D. Watson and
Francis Crick, together with Rosalind Franklin and Dr.
Maurice Wilkins, uncovered the structure of the DNA
molecule: two strands of nucleotides wrapping around each
other in a "double helix." It was determined that this
shape allows the molecule to "unwind" for replication and
transcription.
In 1960, Sydney Brenner, Matthew Meselson, and
Francois Jacob detected the existence of messenger RNA,
the transcript that carries the genetic message from DNA
to the cell's protein-making region. In 1961, Brenner and
Crick determined how DNA instructs cells to make specific
proteins. The code is the same in virtually all organisms
studied so far.
In 1970, a restriction enzyme was discovered which
severs DNA in specific locations. In an experiment done
in 1973, a restriction enzyme was used to cut animal DNA.
Then this enzyme was spliced into bacteria, where the
gene's function was carried out. These genes that are
transferred into bacteria reproduce abundantly which
allows the gene's function to be studied in detail.
In 1977, Frederick Sanger and Walter Gilbert
independently developed a technique to read the chemical
bases of DNA. The first organism to be sequenced using
this technology was a virus. In 1983, Kary Mullis
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48
developed the "polymerase chain reaction," which allows
researchers to generate billions of DNA copies within a
few hours.
In 1984-1986, the Department of Energy presented
their proposal to map and sequence the entire human
genome. At that time, the proposal received serious
consideration. Then in 1988, James D. Watson became the
director of the Office of Human Genome Research at the
National Institutes of Health and proposed to decode the
human genome by 2005 at a cost of $3 billion.
The Human Genome Project is Bornt
During the early 1980's, there was much discussion in
the scientific community concerning basic biology.
Scientists had to concede that even though they had made
great strides in their understanding of medicine, their
knowledge of biology, the study of life itself, was quite
limited. It was decided at that time that the best way to
remedy the situation was to attempt to understand the DNA
molecule, which up to that point was still shrouded in
mystery. The initial plan was to map and sequence the
entire human genome.
2The information for this brief overview is gleaned from The
Office of Biological and Environmental Research, U.S. Department
of Energy, A Vital Legacy: Biological and Environmental Research
in the Atomic Acre (Washington D.C. : DOE, 1997), 1-20. This is a
50 year progress report on the program that initiated the Human
Genome Project.
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49
This lofty goal fueled a debate in the scientific
community as to whether, given the current state of
technology, it could be accomplished. In 1988, the
National Research Council of the National Academy of
Sciences (NRC) and the Congressional Office of Technology
Assessment (OTA) released key reports suggesting that the
plan was attainable and that it would be a worthwhile
endeavor. In 1990, Congress backed the effort by
allocating funding (3 billion dollars) for what came to be
known as The Human Genome Project (HGP).
To oversee this enormous undertaking, a new
organization was established at the National Institutes of
Health (NIH) called the National Center for Human Genome
Research (NCHGR). A smaller portion of the project was
given to the Department of Energy (DOE). Thus, the
government's goal to map and sequence the entire human
genome was going to be a joint effort by the NIH and the
DOE.
NIH support for the project is understandable given
its interest in and funding for biomedical research. But
why would the DOE be interested in such a work? More to
the point, why were DOE officials among the first to
suggest the need for mapping and sequencing the human
genome? By 1987, the DOE had already spent $4.2 million
dollars on human genomics.
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50
The DOE's interest in human genetics in general had
to do with its concern about the effects of nuclear
radiation on human populations. For this reason, the DOE
(formerly known as the Atomic Energy Commission) became
one of the major funders for genetic research in the early
post-war years.
DOE scientists argued that the sequencing effort
might help them to understand the nature of the genetic
damage suffered by the survivors of the Hiroshima bomb.
The DOE's handbook describing the mission of the Human
Genome Project states that a major goal of the DOE's
health effects program is to develop capacities to
diagnose individual susceptibility to genome damage
imposed by energy-related factors.
The HGP has given genetic research many advantages.
1) It has attracted additional funding from private
organizations; 2) It has attracted public attention to the
possible benefits of genetic technologies; 3) It has also
alerted the public to the possible abuses of genetic
technologies.
These aspects play an important role in the overall
goals of the HGP.3 From the very beginning, one of the
primary goals of the HGP has been to address in advance
the ethical, legal, and social issues raised by human
3The information on the goals of the HGP was gleaned from
The U.S. Department of Energy, Human Genome Program Report Part I.
Overview and Progress (Washington D.C.: DOE, 1997).
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51
genetic research. To accomplish this, three to five
percent of the HGP funds were allocated to establish the
Ethical, Legal, and Social Issues Program (ELSI).
The founders of the HGP have insisted that the
ethical, legal and social issues be dealt with before the
technology was available. Then social policy could begin
to be developed, not as a reaction against abuse, but as a
commitment to circumvent potential future harm.
Aside from this ethical dimension, the two primary
scientific goals of the HGP are to sequence and map the
entire human genome. In light of this, it is important to
this discussion to have some basic scientific
understanding of the process of genetic sequencing and
mapping. The following is a brief analysis of these two
processes:
A person's heredity is determined by the DNA that is
provided through the mother's egg and the father's sperm.
The egg and the sperm each carry 23 chromosomes. A new
embryo, therefore, contains a total of 46 chromosomes in
each of its cells. These 46 chromosomes contain the
entire genetic code called the "genome."
A chromosome is a long stretch of DNA that is tightly
coiled and surrounded by certain proteins. DNA is
composed of two strands of sugar and phosphate molecules
that are wound around each other in a double helix
configuration. Each of these backbone strands is studded
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with a string of molecules called "nucleotides," which are
composed of one of four molecules: adenine, thymine,
guanine, and cytosine. Each nucleotide molecule is
chemically bonded to another nucleotide on the other
strand. Together the two nuleotides make up a "base
pair." Adenine (A) always pairs with thymine (T), and
guanine (G) bonds with cytosine (C). Once the bases on
one strand are known, the sequence on the other strand can
be deduced quickly due to the constant pairing of A with T
and C with G.
The sequence of base pairs carries the genetic
information contained with the DNA molecule. There are
three billion base pairs in the human genome. The
biologic machinery of the cell translates a certain
sequence of base pairs into a sequence of another set of
molecules called RNA. RNA, in turn, is translated into a
sequence of amino acids, which are the building blocks of
proteins. Through this mechanism, a specific sequence of
DNA will produce, or "code for" a specific protein.
Proteins do the yeoman's work for the cell by providing
the raw materials for cellular structures and by creating
enzymes that facilitate the tens of thousands of chemical
reactions that are essential to life. Since DNA controls
the type, amount, and sequence of proteins produced in a
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53
cell, it earns the title of "mastermolecule" or "blueprint
for life."4
"Genes," which are located on the chromosomes, are
the stretch of DNA base pairs that code for the production
of a specific protein. Much to their surprise and
amazement, scientists have recently discovered that there
are only about thirty thousand genes which make up the
human DNA. It was originally estimated that human DNA
contained at least 80,000 to 100,000 thousand genes.5 But
only a small portion of DNA codes for protein. The
function of the "non-coding" DNA is not presently known
and it often referred to as "junk" DNA.
An abnormal gene sequence is called a "mutation."
There are many different mutations which can occur in a
single gene. And there are many internal and external
factors which can play a part in gene mutation.
Conditions such as sickle cell anemia which require two
abnormal copies of a gene (one from the mother and one
from the father) to produce the disease are termed
"recessive." Conditions such as cystic fibrosis which
only require one abnormal copy of a gene are called
"dominant."
4Paraphrased from Maxwell J. Mehlman and Jeffrey R. Botkin,
Access to the Genome. (Washington: Georgetown University Press,
1998), 9-10.
5Nicolas Wade, "Reports on Human Genome Challenge Long-Held
Beliefs," New York Times. 12 February 2001, 1(A).
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54
The goal of sequencing, then, is to identify in the
proper order the three billion base pairs that make up the
human DNA. The goal of a genome map is to establish
landmarks throughout the genome that can be used as
reference points to locate genes in their vicinity. A map
is created by identifying sequences, called "markers" that
are positioned along each of the 4 6 chromosomes. Once the
map is constructed, each gene can be located in terms of
its position relative to a marker.6
The ELSI Research Planning and Evaluation Group
(ERPEG) has laid out five goals for the next five years of
the Human Genome Project:
1. Examine the issues surrounding the completion of the
human DNA sequence and the study of human genetic
variation.
2. Examine issues raised by the integration of genetic
technologies and information into health care and public
health activities.
3. Examine issues raised by the integration of knowledge
about genomics and gene-environment interactions into non-
clinical settings.
4. Explore ways in which new genetic knowledge may
interact with a variety of philosophical, theological, and
ethical perspectives.
5. Explore how socioeconomic factors and concepts of race
6Ibid., 16.
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55
and ethnicity influence the use and interpretation of
genetic information, the utilization of genetic services,
and the development of policy.7
A Rough Draft and a Rough Road Ahead
In 1994, a complete genome map was accomplished.
This was a huge milestone for the Human Genome Project.
But on June 26, 2000, Francis Collins and J. Craig Venter
announced the successful completion of the first ever
working draft of the entire sequence of the human genome,
finished at least four years ahead of schedule. With this
completion of the Human Genome Project, biology had
entered what has been commonly referred to as "Big
Science."8
This Big Science era began with the Manhattan Project
in 1939. The aim of this project was to build an atomic
bomb. In 1954, Europe launched a project called Cern.
Its task was to perform high-energy particle physics
research. In 1969, the Apollo program succeeded in
putting the first man on the moon.
In 1979, NASA and the European Space Agency aimed to
put a powerful optical telescope in orbit. On April 25,
1990, the Hubble Space Telescope was launched. In 1987,
7The National Human Genome Research Institute,
http://www.nhgri.nih.gov/98plan/elsi.
8The following compilation is adapted from Hannah Fairfield,
"With the Human Genome Project, Biology Joins the Ranks of Big
Science," New York Times. 27 June 2000, 3(D).
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56
the plans were put in motion to begin the Human Genome
Project. With this incredible project complete, biology
has decisively joined the ranks of Big Science.
While there are still holes scattered throughout the
sequencing in the rough draft, its overall integrity is
such that an analysis of the human genome, which is the
next complex phase of work, can begin. But this step will
prove to be the most difficult.
Researchers are currently interested in four types of
analyses.9 The first involves identifying the genes. It
is unknown how many genes are actually on the human
genome, and many of the genes whose sequences have been
determined have functions that are as yet unknown. But
there are many techniques currently being used to locate
genes and determine their functions.
The second analysis involves comparing organisms.
Certain animal genomes provide a model from which the
human genome can be analyzed. The DNA processes in
animals are so similar to those in humans that the studies
have yielded remarkable knowledge about the human genome
long before the completion of this first draft.
The third type of analysis entails the mapping of
proteins. The genes contain the instructions for making
proteins. To understand these proteins is extremely
9Sarah Slobin and Steve Duenes, "Now, the Hard Part: Putting
the Genome to Work," New York Times. 27 June 2000, 1(D). The
following information is adapted from their article.
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57
important because they become the structural components of
cells and, through many chemical processes, cause changes
in the body. The ability to produce a protein will allow
scientists to eventually understand how a cell behaves.
The final type of analysis involves a comparison of
humans. Slight variations in our genetic code is what to
some degree makes us unique. Changes in one base unit in
a gene's sequence, called single nucleotide polymorphisms
(SNPs), can cause one individual to become susceptible to
a particular disease. By comparing certain variations,
scientists eventually will be able to identify defective
genes, which in turn may lead to diagnosis and treatment.
In light of the arduous work that still lies ahead,
it may appear that any practical benefit to be derived
from the Human Genome Project is in the distant future.
However, there are some recent developments that indicate
that the project, though still in many ways incomplete, is
already paying off.
Instant Benefits
When Dr. Charles Zuker, professor of biology and
neurosciences at the University of California in San
Diego, and his colleagues wanted to uncover secrets about
bitterness receptors, they went to "this wonderful
resource of databases of human sequences."10
10Kenneth Chang, "Incomplete, the Project is Already Paying
Off," New York Times. 27 June 2000, 7(D).
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58
According to Dr. Zuker, genetic research has two
phases: 1) find the gene; 2) understand the gene function.
Because the HGP has been able to produce several gene
data- bases, it has already shortened years of research
from the first phase so that the focus can be on the
second phase. Zuker observes that:
The hard labor was involved in the first
phase . . . while really, ideally where
you want to put your effort is into
understanding the function of the
gene. {These data bases} will allow you
to concentrate your effort into what is
going to have the greatest effect in
biomedical research.1 1
When researchers at SmithKline Beecham, a
pharmaceutical manufacturer, endeavored to search for the
enzyme, beta-secretase, which slices up a protein into
toxic fragments in Alzheimer's patients, they too
consulted the HGP-generated gene databases. The
researchers knew of the enzyme's existence because of the
damage it left behind, but they had yet to pinpoint it.
Several scientists purported to have found the
enzyme, but time inevitably proved them wrong. The
SmithKline researchers scanned the databases and came up
with two candidate genes: one on Chromosome 21 and one on
Chromosome 19. The gene on Chromosome 19 turned out to be
n Ibid., 7(D).
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59
the right one because it encoded an enzyme that matched
the profile of beta-secretase.12
Because of the vast amount of genome information
generated by the HGP, several drug companies are changing
the way they develop drugs. The traditional way to
approach drug development involves choosing a disease,
finding a gene defect associated with the disease, and
then developing a drug to counteract the defect.
Now, drug companies such as Johnson & Johnson look
for genes that appear favorable to drug treatment and then
try to find out what diseases those drugs might cure. The
problem with the traditional way is that finding a gene
often produces no easy way to correct a defect. The new
way looks for genes that will respond to treatment easily
and thus make the endeavor more profitable.13
While this explosion in genome information is proving
to alleviate many hours of tedious laboratory research, it
is also affirming the fact that most illnesses are a
matter of more than one gene, meaning more complex
research studies lie ahead.
For example, on February 26, 1987, a group of
scientists announced that they succeeded in locating a
gene for manic depression in a large Amish family. The
finding was published in the Journal, Nature, and was
12Ibid., 7(D).
13Ibid., 7(D).
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60
quickly deemed a significant proof that a specific gene
mutation underlies psychiatric illness.
A few years later, however, the researchers had to
concede that their announcement was premature. A new
analysis of the data showed that the gene on Chromosome
11, the location originally pinpointed, could not possibly
be correct. Since this time, several studies on the
genetic components of mental illnesses have been
conducted, and they all seem to overwhelmingly indicate
that more than one gene is involved.14
Having said all of this, it is clear that the
information generated by the Human Genome Project is being
utilized by physicians and scientists in exactly the
manner in which the original supporters of the project had
envisioned; that is, as a tool to eventually prevent and
cure disease. But what about society? How is society
interpreting the information about the human genome?
Society and DNA
In a thought-provoking article in the Kennedy
Institute of Ethics Journal, Paul Root Wolpe points out
our nation's obsession with genes:
The Genetic Age is upon us. Genetic
images grace the covers of news magazines
and supermarket tabloids, evening news
analyses and soap opera plots, science
journals promising miracles and social
journals predicting disaster. We hear
14Erica Goode, "Most Ills Are a Matter Of More Than One
Gene," New York Times. 27 June 2000, 1(D).
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61
claims of a genetic basis for
homosexuality, for obesity, and for
intelligence. Scientists announce that
genes help to explain incidence rates of
breast cancer, manic depression, and
Alzheimer's disease. People talk of
selfish genes, pleasure-seeking genes and
thrill-seeking genes, violence genes,
adultery genes, celebrity genes, couch
potato genes, depression genes, genes for
genius, genes for saving, and genes for
sinning.15
In August, 1994, Time Magazine ran a cover story
entitled, "Infidelity: It May Be in Our Genes." In the
article, Robert Wright (also the author of the book, The
Moral Animal: Why We Are The Way We Are: The New Science
of Evolutionary Psychology) argues that, according to
evolutionary psychology:
The human mind, like any other organ, was
designed for the purpose of transmitting
genes to the next generation; the
feelings and thoughts it creates are best
understood in these terms . . . our
everyday, ever shifting attitudes toward
a mate or prospective mate-- trust,
suspicion, rhapsody, revulsion,
warmth, iciness— are the handiwork of
natural selection that remain with us
today because in the past they led to
behaviors that helped spread genes.16
In a lengthy article for The Atlantic Monthly, Dr.
Edward 0. Wilson makes a forceful argument for the
biological basis of morality. He favors a "purely
15Paul Root Wolpe, "If I Am Only My Genes, What Am I?"
Kennedy Institute of Ethics Journal (September 1997): 216.
16Robert Wright, "Infidelity: It May Be In Our Genes," Time
Magazine. 15 August 1994, 46.
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62
material origin of ethics, and it meets the criterion of
consilience: causal explanations of brain activity and
evolution, while imperfect, already cover most facts known
about behavior we term "moral."1 7
These above examples demonstrate that perhaps society
is more comfortable than geneticists are with the idea
that genes control much of who we are. Eric Lander,
director of the Whitehead Institute Center for Genome
Research, admits that he detects what he refers to as "a
naive biological determinism in some popular writings on
genetics, stretching the science far beyond the data."18
But Landers also confesses somewhat shamefully that
many of his close colleagues are "already proposing ways
to "re-engineer" what they view as an "imperfect" human
genome— to prevent cancer, slow aging, or enhance memory-
- by modifying the human germline."19
These current ideas of biological determinism
apparent in both the popular and scientific realms is
reminiscent of an earlier time in American history when
these kinds of ideas blossomed into a full-blown eugenics
movement. Eugenics was a term coined by Francis Galton
(cousin of Charles Darwin) in 1883. He defined eugenics
17Edward Wilson, "The Biological Basis of Morality," The
Atlantic Monthly (April 1998): 54.
18Eric Lander, "In Wake of Genetic Revolution, Questions
About Its Meaning," New York Times. 12 September 2000, 5(D).
19Ibid., 5(D).
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63
as "a study of the agencies under social control that may
improve or impair the racial qualities of future
generations, either physically or mentally."20
In the United States, from the turn of the twentieth
century through the 1930's, eugenics became a popular
political movement. It counseled the government on an
array of social issues including abortion, penal reform,
and psychiatric asylum. Eugenics was initially designed
to be "preventive medicine" with the goal of eliminating
human genetic illness before it could spread. In Germany,
racial hygiene, the German equivalent of eugenics, was
considered one of the major dimensions of responsible
medical care.
Eugenicists had four major concerns: 1) "racial
poisons" were threatening the health of the human race; 2)
welfare and medical care for the weak were beginning to
erode the competitive struggle that normally maintains the
fitness of the human race; 3) compassion was allowing
"subnormals" to survive and reproduce who otherwise would
have never lived to do so; 4) strong biological measures
were needed to ensure that the weak did not reproduce and
that the "fit" were encouraged to do so.
The practical outcome of these concerns was
threefold: 1) negative eugenics would eliminate the weak
20Francis Galton, Inquiries into the Human Faculty. (London:
MacMillian, 1883), 44.
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64
by sterilization; 2) positive eugenics would promote the
healthy by giving to the "strong" financial incentives; 3)
preventive eugenics would safeguard the human genome by
limiting exposure to mutagens such as x-rays and lead.21
One of the primary tenets of eugenics ideology is
biological determinism. Eugenicists exaggerate to a large
extent the role biology plays in human behavior, disease,
and institutions. They also believe that certain races
are more susceptible to particular diseases than others.
There are at least three lessons to be gleaned from
the eugenics movement: 1) advances in genetic technology
combined with certain political agendas can deprive
persons of freedom and liberty; 2) geneticist’s support of
certain political ideologies can give them an air of
legitimacy; 3) advances in genetic technology can promote
prejudices.
It is important to understand that when we speak of
the advances in genetic technology and the knowledge which
bolstered the eugenics movement of the 1920's and 30's, we
do not mean that this field of study was scientifically
sound. This entire movement was influenced to a large
degree by racism, myth, and pseudo-scientific knowledge,
which was used by some very powerful people for political
purposes.
21
The information on the major concerns and outcomes is
gleaned from Robert Proctor, Racial Hygiene: Medicine Under The
Nazis (Cambridge: Havard, 1988), 10-63.
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65
After World War II, when the atrocities of Nazi
Germany which took place in the name of racial hygiene
were discovered, the eugenics movement in America lost
most of its credibility. Eugenicists were cast out of the
limelight and forced to find another way to make a living.
During the postwar years, however, as government
agencies expressed concern about the health effects of
atomic radiation, these eugenicists/geneticists re-
emerged. They found employment with the U.S. Atomic Bomb
Commission (DOE) and began to explore the biological
consequences of radiation-induced mutagenesis.22
There is a natural, yet uncomfortable, flow between
the study of genetics and eugenics. Both have emerged
when people have believed that talents, abilities, and
behaviors are largely rooted in the genes. With the
completion of the HGP, there is some fear that a new
eugenics movement could surface.
But this renewed concern about the possibility of a
new eugenics movement is not a concern that a movement
similar to the one of the past will surface. Nelkin and
Tancredi, for example, point out that there are signs that
diagnostic genetic testing is being used to support the
social policies of a more sophisticated version of
eugenics.
22Department of Energy, A Vital Lecracv. 6.
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66
The new eugenics which has surfaced over the past 20
years "has avoided generalizations about class and race,
focusing instead on the individual benefits which follow
from genetic research."23 More to the point, the new
eugenics focuses on individual rights and responsibilities
in reproductive fitness.
In other words, the new biology should assure the
quality of all babies. Indeed, it could be argued at some
point in the near future that no parents have a right to
burden society with "unhealthy," "unfit" babies.
With the anticipation of new genetic knowledge coming
from the HGP, several statements such as the "pollution of
the gene pool," "genetically healthy societies," and
"optimal genetic strategies" have already appeared in the
scientific journals of the 1980's and early 1990's.24
In 1988, the OTA in discussing the social and ethical
dimensions of the HGP made the following statements:
Human mating that proceeds without the
use of genetic data about the risks of
transmitting diseases will produce
greater mortality and medical
23D. Nelkin and L. Tancredi, Dangerous Diagnostics: The
Social Power of Biological Information (New York: Basic Books,
1989), 13.
24
See for example, D. Koshland, "Sequences and Consequences
of the Human Genome" Science 246 (October 1989): 189; and D.
Koshland, "The Rational Approach to the Irrational" Science 250
(October 1990):189. These articles were also referenced by Judith
Swazey, "Those Who Forget Their History: Lessons from the Recent
Past for the Human Genome Quest," in George J. Annas and Sherman
Elias, eds., Gene Mapping (New York: Oxford Univeristy Press,
1992), 56.
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67
costs than if carriers of potentially
deleterious genes are alerted to their
status and encouraged to mate with
noncarriers or to reproductive
strategies. . . . New technologies for
identifying traits and altering genes
make it possible for eugenic goals to be
achieved through technological
as opposed to social control.25
Where society stands on possible endeavors to
"improve" our species will be the telltale sign as to how
deeply we are presently committed to these new eugenic
goals. Needless to say, these eugenic aims are deeply
intermingled with the goals of the Baconian project to
eliminate human suffering and expand the range of human
choice through biotechnological advances.
Be this as it may, the supporters of the Human Genome
Project are openly committed only to the original goal of
the project, which is to prevent and cure disease.
To Relieve the Human Condition
Dr. Francis Collins, director of the National Human
Genome Research Institute, made the following statements
about the purpose of genetic medicine in general and about
the Human Genome Project in particular:
Indeed, the genetics revolution has
arrived. Now genetics is becoming the
central science of biomedicine because
nearly all human disease, except
physical injury, is influenced by
heritable changes in the structure or
function of DNA. Efforts to understand
and treat disease processes at the DNA
25Annas and Elias, Gene Mapping. 12.
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68
level are becoming the basis for a new
type of "molecular" medicine. By going
directly to the source of human illness,
molecular medicine strategies will allow
health care providers to customize
prevention and treatment strategies based
on the unique genetic constitution of an
individual. These tactics will apply not
only to classic, single-gene hereditary
disorders, but increasingly to more
common, multi-gene disorders, such as
cancer, heart disease, diabetes, and
psychiatric disorders.26
The Human Genome Project was designed in
part to make this process of discovery
{whether or not we have a particular
disease} achievable for the thousands of
diseases that afflict us.... Without
the kind of maps and sequence information
provided by the Project, we would never
understand the genetics of most
diseases ,21
Based on the above comments, it would not be an
exaggeration to say that the overarching, primary aims of
the Human Genome Project are to eliminate human suffering
caused by disease. However, it would also not be an
overstatement to say that, unwittingly or not, the Human
Genome Project necessarily moves within the orbit of the
Baconian project.
This claim is based on the fact that, inescapably, at
the root of these laudable aims of the Human Genome
Project lurks the Baconian drive to relieve the human
26Nancy Touchette and others, eds. Toward the 21st Century:
Incorporating Genetics into Primary Health Care. (Cold Spring
Harbor: Cold Spring Harbor Press, 1997), 87.
27Francis S. Collins, "The Human Genome Project," in John F.
Kilner, Rebecca D. Pentz, and Frank E. Young, eds., Genetic Ethics
(Grand Rapids: Wm. B. Eerdmans Publishing Co., 1997), 98.
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69
condition through technological advances by rescuing the
body from contingency and natural necessity.
Indeed, the elimination of human suffering and the
expansion of human choice are admirable goals, but only if
they are pursued within a moral framework that allows for
questions concerning which kinds of suffering should be
eliminated and which choices are best. In the above
quotes, Dr. Collins refers to the treatment of cancer,
diabetes and other gene-linked diseases. There is no
question that these ought to be eliminated.
But, without a moral framework that considers the
kinds of suffering that should be eliminated and the kinds
of choices that are best, biomedicine could be called upon
to eliminate "whatever might be considered a burden of
finitude."28 This could ultimately lead to the new, full
blown eugenics movement discussed above.
Standard forms of bioethics, with their own
involvement in the Baconian project, are, necessarily,
silent on these moral questions. Because of this,
standard forms of bioethics do not provide an adequate
moral framework from which to properly examine the goals
of the HGP because both the HGP and standard forms of
bioethics participate in the Baconian project.
The reason why this is so important is that our
culture is consumed with a desire for bodily perfection.
op
McKenny, To Relieve the Human Condition. 2.
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70
Increasingly, too, especially with this explosion in
biotechnology, our culture is looking to biomedicine to
fulfill its longing for bodily perfection.
And biomedicine, with its incredible capacity to
intervene into the body, holds out tremendous promise that
it will eventually be able to meet our culture's demands.
This is nowhere more evident than in the possibility of
the development of genetic enhancements. We turn now to
consider some of the specific issues surrounding this
technology.
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Chapter 3
Why Worry About Genetic Enhancements?
Introduction
Stephen Hawking, distinguished professor of physics
at Cambridge University, was asked recently on The Larry
King Live Show if he would have chosen physics as his life
work if he was beginning his career in 2000. His answer
was intriguing. He said that if he were to begin his
career in 2000, he would choose to study molecular
biology.
Hawking's reason for such a choice is that he firmly
believes that to explore the complicated and unseen world
of DNA is the wave of the future. New discoveries in
molecular biology, he mused, will cause us to ponder anew
the question of what it means to be human. There can be
no more fundamental question than this when it comes to
this line of work.
Much to Larry King's surprise, Hawking also expressed
with certitude that human genetic engineering is
inevitable. This prompted King to ask Hawking toward the
end of the interview for his thoughts concerning the
future of humanity. His response was that if humanity is
to survive in the future, we must use genetic engineering
to remove the aggressive tendencies of humans. "If not,"
Hawking warned, "we certainly will destroy ourselves."1
1The Larry King Live Show, CNN, May 16 2000.
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72
Stephen Hawking's comments about molecular biology
point out some of the tensions associated with
technological advances in this field. On the one hand, it
is a fascinating new discipline, full of mystery and
intrigue. On the other hand, it raises many philosophical
and ethical questions concerning human nature and human
destiny.
Now, in the context of this interview, Hawking did
not discuss some of the ethical issues surrounding genetic
engineering for non-medical purposes. But it is the topic
for discussion amongst many bioethicists and geneticists
today because, according to French Anderson, the RAC has
recently approved a somatic cell genetic enhancement for
hair restoration for adults.
While many ethicists and physicians are in agreement
about the future reality of many more genetic
enhancements, there is not a consensus among them
concerning how widespread the demand for enhancements will
be or how dangerous such a demand will be for individuals
and society. The Royal Commission of Canada, for
instance, sees many social risks associated with genetic
enhancements and has issued the following statement:
A caring society values people for
themselves and for their uniqueness. Our
ethical principles tell us that all
individuals should be valued equally.
Genetic enhancement raises the prospect
of a society where some people would be
accepted only if they were "improved"-
they would not be acceptable as
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73
themselves. This is a form of
commodifying individuals- people are
treated as things that can be changed
according to someone else’s notions of
human perfection. This shows a lack of
respect for human life and dignity and
intolerance for human diversity, which is
likely to lead to discrimination against
and devaluing of certain categories of
people. Any use of genetic enhancement
raises troubling and potentially
discriminatory judgements about what
sorts of enhancements would be allowed
and who would have access to them. In
the case of gene therapy, the issue of
who should receive the alteration is
clear- those with a severe disease
should be eligible for medical
treatments. But in the case of genetic
enhancement, the selection process, by
definition, cannot be based on medical
need. It must therefore be based on
other, as yet unspecified, criteria.
Would it be a lottery or, more likely,
those most able to pay?2
French Anderson is among those physicians who foresee
considerable dangers associated with enhancements. In
1990, he demonstrated that somatic gene cell therapy can
be successful when he used the procedure on a child with
ADA Deficiency.3 But he warned at that time that this
opens the door to genetic engineering for enhancements.
His prediction has now come true:
But successful somatic cell gene therapy
also opens the door for enhancement
genetic engineering, that is, for
supplying a specific characteristic that
individuals might want for themselves
2Royal Commission on Reproductive Technologies, Canada,
"Proceed with Care," Human Gene Therapy 5 (1994): 603-614.
3French Anderson, "Genetic Engineering and Our Humanness,
Human Gene Therapy 5 (1994): 755-760.
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74
(somatic cell engineering) or their
children (germ-line engineering) which
would not involve the treatment
of a disease. . . . Somatic cell
enhancement engineering would threaten
important human values in two ways: It
could "be medically hazardous, in that
the risks -could exceed the potential
benefits and the procedure therefore
cause harm. And it would be morally
precarious, in that it would require
moral decisions our society is not now
prepared to make, and it could lead to an
increase in inequality and discriminatory
practices.4
William Gardner also expresses concern that the
demand for enhancements will be widespread and dangerous
to society:
It is widely feared that human gene
therapy is at the top of a slippery
slope, such that therapeutc engineering
of human genes will generate
technological change of such momentum
that it will force the adoption of
genetic enhancement. . . . Are we
falling toward a future of genetic
enhancement? . .. If it becomes
possible to produce genetically
enhanced children with attributes desired
by parents, can we successfully prohibit
parents from doing so? ... My concern
is that the future may descend to
genetically enhanced reproduction because
enhancement would be a rational choice
for competitive parents and cultures.5
Maxwell Mehlman envisions a future so inundated with
a demand for genetic enhancement technologies that he
4French Anderson, "Genetics and Human Malleability,"
Hastings Center Report. (January/February 1990): 22-23.
5William Gardner, "Can Human Genetic Enhancement Be
Prohibited?" The Journal of Medicine and Philosophy. 20 (1995):
65-84.
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75
argues it could jeopardize liberal democratic society as
we know it. He first points out the special nature of
genetic enhancements and then discusses the ways in which
they could negatively impact society:
Yet in a number of important respects,
genetic enhancement does differ from
previous agents of inequality and
unfairness. Taken together, these
differences justify a significantly
heightened level of concern, if not
outright alarm. . . . The
characteristics of genetic enhancement
that threaten to destablize liberal
democratic government are the
features that distinguish genetic
enhancement from other forms of self-
improvement: its high cost, which may
place it beyond the reach of all but the
very wealthy; the broad and fundamental
nature of the traits that it could
enhance. . . . While it is impossible
to predict with certainty what effect
wealth-based genetic enhancement will
have on society, what is clear is that it
creates not only a moral challenge but a
political threat. Somatic enhancement
alone could dramatically widen the gap
between the have and have-nots, and
crippling class warfare would ensue.
Germ line enhancement could create, quite
literally, a master race. A future as
bleak as this is not perhaps inevitable,
but it is unquestionably within the realm
of possibility. The question then
becomes whether there is any practical
way to prevent this.6
Contrary to these views which predict danger and
mayhem from the use of genetic enhancements, David Resnik
anticipates no moral quandaries or political threats from
6Maxwell Mehlman, "The Law of Above Averages: Leveling the
New Genetic Playing Field," Iowa Law Review. 85 no. 2 (January
2000): 535, 550, 554.
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76
them at all in the future. He argues that genetic
enhancements need not be unethical or unjust. If genetic
enhancements are governed by proper regulation and are
coupled with adequate education, they need not violate
recognized principles of morality or social justice:
It seems clear that . . . HGLGT {human
germ-line genetic technologies} could
lead to social injustices. But parental
autonomy concerning the genetic make-up
of offspring should not be restricted on
the grounds that it could lead to social
injustices, since we accept many
practices which could have this effect,
such as private education, European
vacations, fraternities, and so on.
Parental autonomy with regard to HGLGT
should be restricted only if we have good
reasons to believe that it probably would
lead to grave social injustices. So is
genetic enhancement likely to generate
grave social injustices? Although
pessimists will argue that once we start
conducting genetic enhancements, we can
only advance down a path that leads to
genetic castes, aristocracies, and
"master races," I think we have good
reason to side with the optimists.7
Nils Holtug of the University of Copenhagen agrees
with Resnik's assessment of genetic enhancements, but
takes the argument a step further. Justice, Holtug
maintains, may provide us with a reason not only to treat
diseases, but also to genetically enhance certain
characteristics in people. He sums up his argument in the
following way:
7David Resnik, "Debunking the Slippery Slope Argument
Against Human Germ-line Gene Therapy," The Journal of Medicine
and Philosophy 19 (1994): 36.
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77
I have argued that a plausible and
influential line of reasoning that
supports compensating people who
have severe diseases because of their
misfortune in the genetic lottery also
speaks in favor of genetic enhancements.
Justice requires genetic enhancements
in the sense that it provides a pro tanto
reason to make such enhancements
available to (some) victims of the
genetic lottery.8
Whether any of these predictions becomes a reality or
whether any of these positions has merit remains to be
seen. Nonetheless, what these observations do point out
is that concern about the impact of genetic enhancements
on both individuals and society is both real and
legitimate.
But, Why The Concern?
Those who express concerns about modern technological
forms of enhancement are met with a reply similar to the
one made by David Resnik: Human beings have always sought
to enhance their natural abilities with whatever means
available. So why be concerned about genetic
enhancements? In fact, Erik Parens makes the following
remarks concerning our enduring desire for enhancement:
Yet if it is true that humans cannot now
significantly enhance their capacities
with genetic technology, it is also true
that they always have sought to enhance
- their capacities with whatever means
available. For example, we enhance our
intellectual capacities with education,
our bodily capacities with exercise, and
8Nils Holtug, "Does Justice Require Genetic Enhancements?"
Journal of Medical Ethics 25 (1999): 137-143, 142.
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78
our capacity to attract sexual partners
with a variety of cosmetic techniques.
From this I infer two things: (1) that
it would make no sense to argue that the
enhancement of human capacities is, in
itself, a bad thing; and (2) that when
genetic technology gets to the point
where enhancement is possible, there will
be a powerful drive to employ it.9
Parens also goes on to argue that, while there are
good reasons to move in the direction of enhancements,
there are also good reasons for our society to "exercise
extreme caution as it contemplates such a move."10 The
problem, however, is that, by and large, modern society
does not take into consideration the moral difference that
new biotechnological means can make.
Dan Brock argues that "in many valued human
activities, the means of acquiring the capacities required
for the activity are a part of the very definition of the
activity and transforming them transforms the activity
itself."11
Means, as Parens points out, can make a difference in
less obvious ways. For one thing, it is indeed odd to be
concerned about enhancing human capacities. After all,
why worry about the ability to make human beings better?
Since enhancing human capacities is taken to be a self-
9Erik Parens, "The Goodness of Fragility," Kennedy
Institute of Ethics Journal. 5 no.2 (1995): 141-142.
10Ibid., 142.
nDan Brock, "Enhancements of Human Function: Some
Distinctions for Policymakers" in Enhancing Human Traits. 48-69.
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79
evident good, concerns about it are often dismissed as
being unnecessary. Parens refers to these arguments used
to dismiss such anxiety as arguments from precedent.
Its structure looks something like this: We have
always used means A to achieve end A; means B also aims to
achieve end A; therefore means B is morally unproblematic.
For example, we have always tried to watch our diet and
exercise (means A) in order to enhance health and
longevity (end A); a genetic enhancement to slow or stop
the aging process12 (means B) also aims to achieve health
and longevity (end A); therefore using a genetic
enhancement to slow or stop the aging process is morally
unproblematic.
One of the primary problems with this "means B"
approach, however, is that it gives a tremendous amount of
power to biomedicine. These new means that work on our
bodies instead of our character may incline us to ignore
our responsibility with regard to our own health and
longevity. They may also lead us to deny, on some
unconscious level at least, our vulnerability and
susceptibility to contingency.
Genetic enhancements that work on our bodies in this
way clearly reflect the influence of the Baconian project.
12There is much research focused on trying to locate the
"aging" gene. See, for example, Nicolas Wade, "Searching for
Genes to Slow The Hands of Biological Time," New York Times. 26
September 2000, 1(D).
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80
For this reason especially, 1 believe we ought to be
concerned about these kinds of genetic enhancements. To
pursue genetic enhancements that may possibly incline us
to relinquish our responsibility for our health and
longevity and to unconsciously resist our vulnerabilities
may lead us, I think, into further confusion concerning
what it means to be human.
This does not mean that I think that every kind of
genetic enhancement would cause this kind of confusion nor
does it mean that I believe genetic enhancements in any
capacity should not be pursued. What I mean is that I
believe genetic enhancements ought to be developed which
encourage us to face our responsibility for our own
health13 and to embrace our vulnerabilities, two aspects
which I think are crucial to a reasonable understanding of
what it means to be human.
Nevertheless, in light of the possible social and
ethical problems genetic enhancements may cause, which
were delineated in the previous section, it is,important
to discuss one of the primary methods used by many
bioethicists to try to deal with any future dilemmas.
The Treatment/Enhancement Distinction
As was pointed out earlier, French Anderson
recognizes the dangers of pursuing genetic enhancements.
Because of the threat of eugenics, he argues, we should
13What I mean by "health" will be discussed in Chapter 5.
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81
avoid this pursuit by drawing a line between treatment and
enhancement:
We must face the issue of eugenics, the
attempt to make heredity "improvements."
The abuse of power that societies have
historically demonstrated in the
pursuit of eugenic goals is well
documented. Might we slide into a new
age of eugenic thinking by starting with
small "improvements"? It would be
difficult, if not impossible, to
determine where to draw a line once
enhancement engineering had begun.
Therefore, gene transfer should be used
only for the treatment of serious disease
and not for putative improvements. Our
society is comfortable with the use of
genetic engineering to treat individuals
with serious disease. On medical and
ethical grounds we should draw a line
excluding any form of enhancement
engineering. We should not step over the
line that delineates treatment from
enhancement.14
The treatment/enhancement distinction is often used
in the context of arguments about what falls within and
what falls outside the proper goals of medicine. This
naturally raises questions concerning the meaning of
health. While there is no universally accepted notion of
health, two definitions have come to be widely recognized:
1) health is freedom from disease; 2) health is a state of
complete physical, mental, and social well-being.
The treatment/enhancement distinction, which is more
or less a tool forged out of the "health as freedom from
disease" approach, was actually developed to some extent
14French Anderson, "Genetics and Human Malleability," 24.
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82
to undermine the "health as a state of complete physical,
mental, and social well-being" approach.15 Many believe
that the latter description of health encourages
physicians to administer "treatments" that go far beyond
the proper limits of medicine.
Norman Daniels, for example, has argued on many
occasions that there must be a way to ensure that medicine
does not go beyond what he considers to be medicine's
proper boundaries.16 For Daniels, the health as freedom
from disease approach, because it allows for a
treatment/enhancement distinction to be made, is a
reasonable way to make sure medicine stays within its
proper limits.
Norman Daniels is perhaps one of the most
enthusiastic defenders of the "freedom from disease" view.
On this view, "disease and disability are seen as
departures from species-typical normal functional
organization or functioning."1 7
According to the normal function model, the central
purpose of health care is to maintain, restore, or
15More will be said about these two concepts of health in
Chapter 5.
16See, for example, James E. Sabin and Norman Daniels,
"Determining 'Medical Necessity' in Mental Health Practice,"
Hastings Center Report 24 no.6 (1994), 5-13.
17Norman Daniels, "The Genome Project, Individual
Differences, and Just Health Care," in Timothy F. Murphy and Marc
A. Lappe, eds., Justice and the Human Genome Project (Berkeley:
University of California Press, 1994), 110-32.
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83
compensate for the restricted opportunity and loss of
function caused by disease and disability. One of the
roots of this view is the conviction that the primary aim
of health care is to provide people with normal function
so that they can have an equal opportunity to pursue life
plans.
To put it another way, the normal function model
accepts that people are unequally endowed with respect to
traits and talents; it accepts that by nature individuals
are not equal competitors. The normal function model
insists, rather, that those unequal competitors are
entitled to an equal opportunity to pursue their life
plans within the limits set by those natural endowments.18
Thus, according to Daniels, there are at least two
uses of the treatment/enhancement distinction. The
primary use is as a tool to articulate what just health
care entails. For Daniels, a just and basic package of
care would include treatments but not enhancements.
The second use is as a tool in the fight against
medicalization. The normal function model helps to
declare the proper domain of medicine, such that some
forms of disease are beyond its proper reach.
Consequently, according to the normal function model,
complete physical, mental, and social well-being is beyond
the proper domain of medicine.
18Parens, Enhancing Human Traits. 3-4.
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84
By and large, the normal function model accepts that
people are born with different traits and talents. Hence
it is a tool to fight against medicalization. It enables
us to remember that there are certain natural differences
which medicine ought not to erase.19 However, the
treatment/enhancement distinction is not without some
conceptual difficulties.
To begin with, Eric Juengst has pointed out that a
line can be drawn between treatment and enhancement, only
if one is willing to accept two rather primitive claims.
First, health problems are best understood as if they were
entities in their own right, identifiable as processes or
parts of a biological system, with as much objectivity as
the functions they disrupt.
Second, legitimate preventive genetic health care
should be limited to efforts to defend people from attack
by these entities, rather than changing their bodies to
evade social injustices.20 Not many experts, however, are
willing to accept these two premises. But even this
understanding of the treatment/enhancement distinction
does not rescue it from all its conceptual problems.
19This discussion was adapted from Erik Parens, "Is Better
Always Good? The Enhancement Project," in Enhancing Human Traits.
3-5.
20Eric Juengst, "Can Enhancement Be Distinguished From
Prevention in Genetic Medicine," The Journal, of Medicine and
Philosophy 22 (1997): 125.
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85
The treatment/enhancement distinction can be
confusing because both treatment for disease and
enhancement for performance are improvements.
Inoculations against certain diseases improve the immune
system while an injection of human growth hormone can
improve athletic performance. Thus, this "improvement
factor" on both sides of the distinction makes the concept
confusing.
Another problem with the treatment/enhancement
distinction is that it elevates the "normal." According
to Anita Silvers, this distinction presupposes that to
"promote equality of opportunity we must create a system
that restores inferior individuals to average
competence. "21
She argues further that:
{0}ur normal modes and levels of
functioning are socially relative
constructions rather than independent
biological facts. Adjusting the
environment so anomalous individuals can
better flourish can be as compensatory as
leveling them. Macro biomedical ethics
must therefore overcome its fatal
attraction to normalizing in order to
open itself to other strategies for
advancing justice.22
The treatment/enhancement distinction can also appear
arbitrary. An example has been used of a boy with growth-
21Anita Silvers, "A Fatal Attraction to Normalizing: Treating
Disabilities as Deviations from "Species-Typical" Functioning," in
Enhancing Human Traits. 95-121.
22Ibid., 120-121.
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86
hormone deficiency resulting from a brain tumor and a boy
born who was going to be "naturally" shorter than average.
Would it be just to give growth hormone to the boy who is
sick and not to the other boy? Some argue that this would
be unjust. But I believe this is one of the strengths of
Daniel's model and the treatment/enhancement distinction
in that it tends to ward off medicalization.
The treatment/enhancement distinction does not offer
much clarification for public policy matters either. Dan
Brock makes the following observations:
One might hope that a relatively simple
classification of enhancement
technologies might be possible for the
purposes of developing public
policy guidelines for them . .. no such
simple classification or guidelines are
possible because of several kinds of
complexities. . . . First, there are
too many different kinds of enhancements
. . . for example, many common activities
of parents or social institutions are
designed to enhance the capacities
of individual humans, although we may not
think of them as technologies, such as
music lessons or sports camp for
children. Second, too many different
policy responses, are possible to
different enhancement technologies.
. . . Third, there are simply far too
many morally important features of
enhancement technologies, as well as
moral considerations and arguments that
bear on the appropriate policy responses
to them.23
Another kind of problem associated with the
treatment/enhancement distinction is seen in several
23Dan Brock, "Enhancements of Human Function: Some
Distinctions for Policymakers," in Enhancing Human Traits. 48.
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87
research contexts where genetic enhancement is actually
being developed for treatment of disease. Paulina Taboada
points out that there are uses of genetic engineering to
"bolster immune function, to improve the efficiency of
DNA repair, to add cellular receptors to capture and
process cholesterol, and to enable the patient's bone
marrow cells to resist the non-intended effects of
chemotherapy. "24
Hence, the multi-drug resistance (MDR) protocol
currently being used is a kind of human enhancement gene
transfer which does not seem to raise ethical questions.
Juan Manuel Torres demonstrates this in the following
remarks:
In fact, what we would be doing through
the MDR protocol, more specifically,
through the insertion of an additional
MDR gene, is to increase a natural
trait of some of our cells; such
increment is precisely what is ordinarily
meant by enhancement in the framework of
human gene transfer. In other words, by
means of an additional MDR gene we are
improving the defense of our cells
against foreign agents, such as anti
cancer drugs, and providing our organisms
with a property that may well continue to
exist beyond the requirements of the
treatment itself. . . . I n the case of
the MDR protocol, an enhancement of the
natural resistance of our hematopoietic
24Paulina Taboada, "Human Genetic Enhancement: Is It Really a
Matter of Perfection? A Dialog With Hanson, Keenan and Shuman,"
Christian Bioethics 5 no. 2 (1999): 191.
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88
stem cells to anti-cancer drugs is a
fundamental part of therapy.25
Torres is deeply concerned about the intent in the
use of genetic enhancement. So he draws the line between
treatment and enhancement somewhat differently:
Any enhancement of natural traits by
means of gene transfer techniques is to
be considered moral and legitimate
insofar as such enhancement constitutes a
necessary condition for the success of
treatment designed to suppress the
causes, symptoms of effects or a severe
pathology.26
Torres' definition raises another question concerning
the meaning of enhancement. First, it is important to
point out that there are at least two primary kinds of
distinctions to be made with regard to enhancements: 1)
genetic enhancements that are chosen by consenting adults
can be distinguished from those chosen by parents for
their children; 2) somatic cell enhancements can be
distinguished from germ-line enhancements.27 In each
category, one distinction is more problematic than the
other.
Second, it is important to understand that there are
at least three spheres which genetic enhancements may
25Juan Manuel Torres, "On The Limits Of Enhancement In Human
Gene Transfer: Drawing The Line," The Journal of Medicine and
Philosophy 22 (1997): 46-47.
2SIbid., 48.
21LeRoy Walters and Julie Gage Palmer, The Ethics of Human
Gene Therapy (New York: Oxford University Press, 1997), 111.
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89
effect: 1) the physical, including size, sleep, and
longevity; 2) the intellectual, including memory; 3) the
moral, including attitudes and behaviors.28
With regard to meaning specifically, Eric Juengst
points out that enhancement is used in at least two
contexts. One is in discussions concerning the proper
limits of biomedicine and the other is in discussions
concerning the ethics of self-improvement. Juengst
defines his position in the following way:
In discussions of biomedicine's domain,
enhancement usually functions as a moral
boundary concept . . . {E}nhancment
interventions fall outside of
medicine's proper domain of practice:
patients have no role-related right to
demand them of the profession, and
physicians who do provide them bear
a burden of justification for doing so
that does not apply to medically
necessary interventions. By
extension, the enhancement boundary
concept can be called upon to help define
the social role of the medical
profession, demarcate the proper sphere
of biomedical research, and help set
limits on health care payment plans.
In discussions of people's personal
decisions to improve themselves or their
children, enhancement plays a different
role. Here, the concept functions
normatively like paternalism. It does
not mark a clear moral watershed, since
we can think of many examples in which
the behavior it refers to is morally
justified and even obligatory. . .. In
these discussions, enhancement is less a
boundary marker than a signpost, allowing
travelers to orient themselves within the
several moral boundaries relevant to
28ibid., 108.
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90
their location. This orientation makes
it possible to judge the ethics of
personal and parental practices, and, by
extension, to develop public policies
regulating enhancement that are
independent of the rules that regulate
biomedicine.29
The claim here is not that plastic surgeons or weight
specialists, those who are typically associated with the
self-improvement domain, are not considered part of the
biomedicine domain. Clearly they are in that their work
often extends beyond self-improvement procedures (i.e.
reconstruction for burn or accident victims and
nutritional advice and guidance for heart and diabetes
patients).
The claim, rather, is that the treatment/enhancement
distinction, although it has some conceptual problems, at
least makes some sense in the biomedical domain. In the
context of society, however, it does not. And this is the
context in which we will increasingly have to have this
discussion.
In the context of society, one cannot contend against
a particular genetic enhancement intervention on the
grounds that it is not a treatment. In this context, if
one wants to claim that a given "improvement" will in some
instances be morally problematic, then one will have to
29Eric Juengst, "What Does Enhancement Mean?" in Enhancing
Human Traits. 29-31.
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91
argue that it is inconsistent with or undermines an
important human goal or value.30
But this is a difficult argument to wage in our
culture today. One of the reasons for this is the
following: Through science and medicine, the technological
utopian ideas which were ultimately inspired by the
Baconian project have permeated every aspect of our
society. The explosion in the demand for cosmetic
surgeries demonstrates that we are generally quite at ease
with the fact that technological advances in medicine can
"improve" us. This also illustrates our culture's
willingness to look to medicine to meet our desires for
"true happiness."
For I think it is clear that society will demand
genetic enhancements, especially the ones that could
impact size, sleep, longevity, and memory for any and
every reason, including the desire to compete in the
marketplace and to keep up with cultural trends. The way
I see it, the problem here is that the use of
biotechnology to relieve every aspect of the human
condition (including "cultural discomfort") is such an
accepted and desirable practice in our society that it is
difficult to justify not using such means for such ends.
30Erik Parens, "Is Better Always Good? The Enhancement
Project," in Enhancing Human Traits. 11.
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92
Indeed, in my opinion, because of its participation
in the Baconian project, standard bioethics does not
provide either physicians or society with a sufficient
justification not to use genetic enhancements for any and
every reason. This, I believe, is a major problem.
Because of the tremendous influence of medicine and
science in our culture, I believe it is incumbent upon
those who work in these fields to adopt a moral framework
that puts the questions concerning the ultimate good for
human beings and the ultimate end of medicine at the
center of its inquiry. Only in this way can they provide
a justifiable reason for society to pause and reflect on
the ways in which genetic enhancements ought to be used.
The Questions which Beg to Be Heard
I think it is safe to say that the
treatment/enhancement distinction is standard bioethics'
attempt to solve the moral problems associated with
genetic enhancements. This is clear from the ethical
concerns noted by ethicists and physicians in this field.
They see a need to safeguard individual autonomy, to
calculate potential harms and risks, and to determine
whether or not a just distribution could follow. These
are classic, hallmark issues for standard bioethics.
But I think one of the main reasons why standard
forms of bioethics have failed in their attempt to solve
the ethical issues involved in genetic enhancements is
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93
that, ultimately, they are incapable of dealing with the
questions which lie at the heart of this issue: What does
it mean to be human? What ought we to become? What is
the purpose of medicine?
Standard bioethics' participation in the Baconian
drive to eliminate human suffering and expand the range of
human choice through technological advances have
marginalized such questions. But the "human nature"
question cannot be avoided in this context. Even French
Anderson has freely admitted the importance of this
question in the following statement:
Manipulation of the very core of our
being, our genetic endowment, is a cause
of concern. And one element of this
concern is that we worry as to whether or
not that kind of manipulation might alter
what we are as human beings, our
humanness. . . . Before we ask the
question- "Can we alter our humanness by
genetic engineering?"- we have to
define "humanness." ... I agree that
the obstacles to precisely defining a
human— what is a normal human being—
are almost insuperable. But I think
an attempt has to be made.31
Before I investigate this human nature question, both
from a Baconian and Aristotelian viewpoint, it is
imperative to explore some of the theories of Francis
Bacon and to examine how he came to be known not only as
the father of modern science, but also as the defender and
champion of progress and technology.
31French Anderson, "Genetic Engineering and Our Humanness,"
755.
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C h a p te r 4
F r a n c i s B a c o n a n d T he B a c o n ia n P r o j e c t
Introduction
When discussing the ethical matters concerning genetic
enhancements and other biotechnologies, Gerald McKenny
points to the Baconian project as one of the primary
problems associated with these issues and, as such, it is
something that needs to be unmasked and overcome. McKenny,
who basically popularized the phrase, is one of the leading
proponents of a movement against the Baconian project
because he sees that it has already influenced standard
bioethics in such a way that it does not allow for adequate
reflection upon the philosophical and ethical questions
raised by these new technologies.
As was also discussed earlier, one of the reasons why
it is so difficult to oppose the Baconian project is that
its primary aims— to rescue human beings from fate and
natural necessity by eliminating human suffering and
expanding the range of human choice through technological
advances— are praiseworthy, self-evident goods, which
standard forms of bioethics support and defend. Many
bioethicists, therefore, are cautious to say anything
against such laudable goals.
Nevertheless, McKenny's concerns about this project are
beginning to influence the views and arguments of other
ethicists. Mark Hanson of the Missoula Demonstration
Project describes four themes that inform the current trend
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95
toward the development of genetic enhancement technologies.
One of them is the Baconian project:
When progress and the liberal self have
conceived, the result is the third theme-
- what has been called the "Baconian
project." On this account, modern
biomedical technology is "infused with a
certain kind of moral purpose," which has
at its heart "the relief of human
subjection to fate or necessity."
It combines historical ambitions of the
conquest of nature with confidence in the
development of biomedical technologies.
Vulnerability, contingency, and the
resistance of the body to human
purposes are viewed as mere obstacles,
rather than as constitutive of the self-
and other-regarding components of the
moral life. . . . Under this moral
purpose, all suffering is defined as
essentially pointless and thus the proper
subject of elimination.1
In his article, Desperately Seeking Perfection:
Christian Discipleship and Medical Genetics, Joel Shuman of
The Divinity School at Duke University argues that, with the
rise of nominalism and the views of Francis Bacon, there was
a paradigm shift concerning the proper place of men and
women in the created order.2 Human dominion was "redefined
as power, property, active right, and absolute
sovereignty."3
xMark J. Hanson, "Indulging Anxiety: Human Enhancement from
a Protestant Perspective," Christian Bioethics 5 no.2 (1999):
125.
2Joel Shuman, "Desperately Seeking Perfection: Christian
Discipleship and Medical Genetics," Christian Bioethics 5 no. 2
(1999): 142.
3John Millbank, Theology and Social Theory. (Cambridge: Basil
Blackwell, 1990), 12.
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96
According to Shuman, this redefinition of human
dominion as the exercise of the will and control of the
created order constitutes the beginning of a secular
understanding of human beings with regard to their purposes
and possibilities.
But just how did Bacon's view create such a paradigm
shift in the understanding of the purpose and destiny of
human beings? And, how did his views come to be packaged as
the all-encompassing Baconian project? In order to answer
these questions, we must briefly examine the time and
circumstances in which Bacon lived.
Francis Bacon in His Time
Bacon was born on January 22, 1561, at York House, in
the Strand, London. He was educated at Trinity College and
at Cambridge University. Elected to the House of Commons in
1584, he served until 1614. He wrote several letters of
advice to Queen Elizabeth I, but his suggestions were never
implemented and he completely lost favor with the Queen in
1583, when he opposed a bill for royal subsidy.
With the succession of James I to the English throne,
Bacon regained the respect of the Court. He proposed
schemes for the union of Scotland and England and
recommended measures for dealing with the Roman Catholics.
For these efforts he was knighted on July 23, 1603, was made
a commissioner for the union of Scotland and England, and
was given a pension in 1604.
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97
In 1616 Bacon became a "councillor," and in 1618 he was
appointed lord chancellor and raised to the level of Baron
Verulam. On January 26, 1621, shortly after his Novum
Organum was published, Francis Bacon was created Viscount
Saint Albans.
As busy as he was as a statesman, his schedule did not
keep him from his academic interests. He was highly
motivated and excited by the intellectual upheaval of his
day. The Occamist concept of knowledge as experience and
nominalism, which questioned many aspects of Scholasticism,
were taking hold in English culture. Occam's notion of
experience was inspiring a new science of nature and a new
form of religious belief which was hostile to
Aristotelianism and Thomism.
Also, Bacon witnessed in his seventeenth century
England a revival of the classics, an anti-clerical revolt,
and the English humanist's rejection of certain theological
teachings and their acceptance of a religious movement that
endeavored to reveal the practical aspects of the Gospels.
This taken together points to a radical, overall change of
attitude toward the traditional corpus of metaphysical
doctrines, especially Aristotelianism.
It is only against this backdrop that Bacon's
philosophy can be fully understood and appreciated. For he
was in the midst of rapid intellectual change in England, a
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change that gained momentum through his own writings and
reached its apex with Newton.
Bacon is commonly referred to as the first modern
philosopher, the father of empiricism, a rationalist, a man
who practiced magic and alchemy, a man who was deeply
hostile toward Scholasticism, and a man who vigorously
endeavored to develop a cooperative science and scientific
institutions.
However, for all that Bacon did to realize his dreams,
there is not a single scientific discovery that can be
attributed to him. Nevertheless, "an awareness of the
social importance of scientific research, an amelioration of
the conditions of human existence, and organized scientific
collaboration were all consequences of his teachings."4
Bacon was in many ways a product of his culture,
relying heavily upon many well-known disciplines of his day
in order to develop his teachings. These disciplines
included the mechanical arts, magic, and alchemy.
The Mechanical Arts, Magic, and Alchemy
Bacon's philosophy emphasized the belief that people
are the servants and interpreters of nature, that truth is
not derived from authority, and that knowledge is the fruit
of experience. Bacon is credited with having contributed to
4Paolo Rossi, Francis Bacon: from Macric to Science.
(Chicago: University of Chicago Press, 1968), xiii.
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99
logic the method known as ampliative inference, a technique
of inductive reasoning.
Ancient Greek logicians had practiced induction by
enumeration, that is, drawing general conclusions from
particular data. Bacon's method was to infer by use of
analogy, from the characteristics of the larger group to
which the data belonged, leaving to later experience the
correction of any evident errors. Because this method
contributed significantly to the betterment of scientific
hypotheses, it was considered a fundamental advancement of
the scientific method.
Bacon's Novum Organum influenced the acceptance of
accurate observation and experimentation in science. In it
he argued that, in order to practice "true" science, all
prejudices and preconceived ideas, which he called "idols,"
must be abandoned. It did not matter whether they were the
common property of human beings due to common modes of
thought, or the unique possession of an individual; whether
they arose from too great of a dependence on language, or
from reliance on tradition. All preconceived notions were
to be set aside.
The basic principles laid down in Novum Organum had a
tremendous influence on the later development of empiricist
thought. But, in order to fully comprehend many of the
implications of Bacon's new philosophy, it is important to
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100
see the connection between it and his acceptance of the
mechanical arts and his belief in the practice of magic.
There was a growing interest in the mechanical arts in
the sixteenth and seventeenth centuries. Sciences such as
chemistry and geology were beginning to see the benefits of
combining scientific and technical knowledge. With this
marriage between the two fields, it was not long before
scientists began to realize that theories ought to be tested
before they were accepted. This practice also revealed the
shortcomings of traditional scientific methods when
scientists discovered that they did not yield the practical
benefits so clearly associated with the mechanical arts.
In light of these benefits associated with the
mechanical arts, Bacon concluded that traditional learning
must be replaced by a study of the mechanical arts. Mankind
had a need to be more connected to reality, a need that was
not being met by traditional methods of learning. So, in
direct opposition to traditional learning, Bacon contended
that the facts gathered from nature are a means of study,
and not the objects of pleasure and curiosity.
Overall, Bacon was just voicing the opinions of his day
when he "strove to rehabilitate the mechanical arts,
denounced the sterility of Scholastic logic, and planned a
history of arts and sciences to serve as the foundation for
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101
the reform of knowledge and of the very existence of
mankind."5
Bacon's philosophy was ultimately based on an exact
analysis of technical procedures and was meant to include
sciences that, up to that time, had been excluded. In fact,
he saw the progressive and collective aspects of the
mechanical arts as the features that both distinguish it
from magic and that set it apart as a model for research in
other fields of knowledge.6
With regard to magic, it is not easy to decipher from
Bacon’s writings just what he thought of it. On the one
hand, it seems clear that he was heavily influenced by the
magical arts. On the other hand, he flat out rejected it
because of its "non-progressive, non-collaborative" stance.
This ambivalence apparent throughout his work makes it
difficult to discern his views on reality.
For instance, there is both magical and mechanical
conceptions of reality represented in Bacon's physics. In
the New Organum and in the History of Life and Death, he
affirms that a spiritual body is contained in all substances
(a magical/alchemist viewpoint).7 However, at another point
in these works, he declares that human beings have no
5Ibid., 9.
6Ibid., 9.
7See Thomas Fowler, ed., Bacon's Novum Oraanum (Oxford:
Oxford University Press, 1889), 227. And Bacon's His tori a densi
et rari, Sp.II, 256 and Historia vitae et mortis. Sp.II, 215.
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102
greater purpose than to "generate or superinduce" new
natures on a given substance, and he endeavors to find a
"true and perfect rule of operation" for discovering primal
natures for this end (this reveals his mechanist leanings).8
Rossi points out that Bacon was so heavily influenced
by magic and alchemy that he borrowed from them several
basic theories to develop his new philosophy:
Now that we have seen how greatly Bacon
was involved with the alchemical
tradition it will be easier to
understand some of the better-known
aspects of his alchemical tendencies such
as his assumption that matter could be
reduced to two elements: mercury and
sulphur. Also the notion of the
convertibility of air to water. His bent
for astrology— an interest he would not
give up though he condemned its effect.
And his belief in the possibility of
prolonging human life indefinitely. Two
other basic theories of Bacon's
philosophy can also be traced to
Renaissance magical and alchemical
sources: the ideal of man's scientific
domination of nature, and the idea of man
as nature's servant and interpreter,
as opposed to the traditional definition
of man as "reasoning animal."9
Another basic theory of Renaissance philosophy was the
idea that human beings lacked a specific nature, allowing
them to acquire a nature of their choice. But this theory
never appealed to Bacon because he understood human nature
to be bound by the laws of nature. For this reason, human
beings must adapt themselves to nature, submit to its
8See Bacon's Novum Oraanum. Book II, 1, 4.
9Ibid., 16.
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103
commands, and assist in developing its operations. Only in
this way could human beings gain mastery over nature
because, in order to dominate nature, human beings must
become its servant and interpreter.10
While the influence of magic and alchemy on Bacon is
evident from his writings, he ultimately separated himself
from them when he set up as a paradigm for his new science
the mechanical arts, with their progressive and
collaborative procedures. Rossi observes that Bacon found
magic and alchemy flawed precisely because they lacked these
two main features associated with the mechanical arts:
According to Bacon, magic endeavors to
dominate and to improve nature; and for
this it should be imitated. Where it
needs revising is in its claim to use one
man's inspiration instead of the
organized efforts of the human race, and
to make science serve individual ends
rather than mankind. . . . {H}e also
refuted its nonprogressive, non-
cooperative methods. . . . Bacon
explicitly declared that his new
scientific method would leave
little scope for individual talent for it
was to be a leveller of intelligences.
. . . What debars magic and alchemy from
the status of science, continues
Bacon, is precisely the burden they
entrust to individual judgement and
skill.11
It is clear that Bacon saw the integration of science
and the mechanical arts as a new and exciting event. Most
importantly, he realized that this new technological
10See Novum Oraanum. Book I, 1, 3.
“Ibid., 32-33.
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enterprise enabled him to critique and repudiate some of
Aristotle's theories, especially his theory concerning the
relation of nature to art.
Bacon vs. Aristotle
In his theory of the species, Aristotle maintains that
the products of nature such as a plant or a tree possess a
primal "form." This characteristic distinguishes natural
products from artificial, man-made products which possess
only a "secondary form." Only nature, according to
Aristotle, has the infinite principles of motion.
Bacon found Aristotle's explanation of the species to
be not only inadequate, but also dangerous. In contrast to
Aristotle, Bacon argues that both natural and artificial
objects possess the same kinds of form and essence and
differ only in their cause.12
The precise meaning of form in Bacon's writings is
somewhat controversial. What is clear, however, is that he
rejects Aristotle's idea of substantial form and his
conception of final causality.13 Bacon also denies the
importance of material and agent causes, describing them as
"merely vehicles, or causes which convey the Form in certain
cases. "14
12See Fulton H. Anderson, The Philosophy of Francis Bacon
(Chicago: Chicago University Press, 1948), 193ff.
13See, for instance, Novum Oraanum. Book I, 51; Book II, 1-3,
20.
14See Novum Oraanum. Book II, 3.
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105
Bacon understands art to be human nature added to
nature. The mere fact that different causes are involved in
art and nature does not mean they are of a different form.
The rationale Bacon gives for his view is that human beings
can only influence nature by manipulating nature in various
ways in order to fit their needs.15 For Bacon, this idea
gives sufficient proof that nature and art are of the same
form.
By putting art and nature in distinct categories,
Aristotle, and those who followed in his tradition, were led
to believe that art is a mere adjunct to nature. The
consequences of this view are that human beings "despair of
ever being able to influence and improve the conditions of
[their] existence."16
In his work, Masculine Birth of Time, Bacon articulates
in no uncertain terms his complete displeasure with
Aristotle's theory and with those who defend it:
Baleful star! Plague of the Human race!
You would have us believe that only
Nature can produce true compound. You
snatch at the notion that the heat of
the sun and the heat of fire are
different things and parade this opinion
with the malicious intention of lessening
human power wherever you can and
15See Bacon's Preface to The Great Instauration and Novum
Oraanum. Book I, 1, 3.
16Rossi, Francis Bacon. 26.
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106
bolstering ignorance to all eternity
through despair of any improvement.17
Science, for Bacon, is an enterprise for the common
good of all. Therefore, he views Aristotle's theory of the
species as an impediment to this goal. Scientific research
is meant to improve the conditions of human existence; but
this can only be accomplished by collaboration and by the
founding of institutions to perform such work. William
Rawley, one of Bacon's biographers, writes about this
attitude which so motivates Bacon:
Whilest he was commorant in the
university, about sixteen years of age,
... he fell into the dislike of the
philosophy of Aristotle; not for the
worthlessness of the author, to whom he
would ever ascribe all high attributes,
but for the unfruitfulness of the way;
being a philosophy . . . only strong for
disputations and contentions, but barren
of production of works for the benefit of
the life of man; in which mind he
continued to his dying day.1 8
Bacon believes that a new era is at hand and, in light
of this, what had been understood and ascertained in the
past through ancient Greek philosophy pales in comparison to
what can be learned in the future. This new era requires
17"Temporis Partus Masculus" in B. Farrington, The Philosophy
of Francis Bacon. An Essay on its Development from 1603 to 1609.
with New Translation of Fundamental Texts. (Liverpool: Liverpool
University Press, 1964), 78.
18William Rawley, "The Life of the Honourable Author," in
R.L. Ellis, J. Spedding, and D.D. Heath, The Works of Francis
Bacon. Volume 1, (London: Longmans and Co. & Virtue and Co, 1887-
92), 4.
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107
a new philosophy, a philosophy that is built upon the
recognition of the errors committed by ancient philosophers.
But Bacon, unlike Descartes19, does not want to abolish
the whole past; rather, he wants to expose its "hidden
poverties," which he believes make the ancient philosophies
useless. Thus, in The Advancement of Learning and in De
Augumentis, Bacon develops a method of historical inquiry,
presenting each ancient philosophy in its entirety in order
to lay bare its deficiencies.20
According to Bacon, in order to build a new philosophy
equipped to meet contemporary needs, it is necessary to
first acquire a complete understanding of the one we want to
replace. Thus is the justification Bacon gives for his
historical approach.
Now, after all that has been said about Bacon and his
criticisms of the ancients, there is some controversy
concerning whether Bacon actually commends or condemns
certain aspects of ancient philosophical traditions.21
However, perhaps the most credible interpretation of Bacon's
view on the ancients is the one put forth by Rossi, who has
argued persuasively that Bacon does not attack the arguments
19See Decartes, The Preface to Principia ph.i losophiae.
20See De Aucrumentis, Sp.I, 5 64; and The Advancement of
Learning. Sp.III, 365-366.
21See, for instance, Benjamin Farrington, Francis Bacon:
Philosopher of Industrial Science (New York: Henry Schuman,
1949), 147-148.
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108
made by the ancients or try to replace them by others based
on the same principles.
Rather, in Bacon's new philosophy, traditional
arguments have no place; for his new philosophy implies a
new relationship between human beings and nature, with
purposes diametrically opposed to traditional philosophies:
Traditional arguments, {Bacon} submitted,
were not fallacious, but they were
devised for a definite end which was not
that of the "new" philosophy; it is
this end which Bacon attacks. Plato,
Aristotle, and even the Scholastics were
therefore entitled to Bacon's praise in
so far as they were intelligent, witty,
or able; but such qualities could not
make their influence less pernicious in
his eyes; if anything they made them more
dangerous and added weight to his
attacks.22
There is some evidence to support Rossi's claim in the
Preface to the New Organum. In it, Bacon recognizes the
value of Platonism and Aristotelianism within the "old"
tradition, but still he criticizes their aims:
Two things occur to me of which, that
they may not be overlooked, I would have
men reminded. First . . . that the
honour and reverence due to the ancients
remains untouched and undiminished; while
I may carry out my designs and at the
same time reap the fruit of modesty. For
if I should profess that I, going the
same road as the ancients, have something
better to produce, there must needs have
been some comparison or rivalry between
us (not to be avoided by any art of
words) in respect of excellency or
ability of wit; and though in this there
would be nothing unlawful or new (for if
22Ibid., 68.
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109
there be anything misapprehended by them,
or falsely laid down, why may not I,
using a liberty common to all, take
exception to it?) yet the contest,
however just and allowable, would have
been an unequal one perhaps, in respect
of the measure of my own powers. As it
is however, my object being to open a new
way for the understanding, a way by them
untried and unknown, the case is altered;
party zeal and emulation are at an end;
and I appear merely as a guide to point
out the road.23
Many scholars do agree with Rossi that, throughout
Bacon’s writings, it is evident that he criticizes and
rejects Platonism because it reduces philosophy to a
rhetorical argument and denigrates scientific inquiry by
mixing it with mystical and religious symbols. He also
disparages and dismisses Aristotelianism because the
contentious, systematic knowledge it encourages stifles the
advancement of learning.
However, while it seems clear that Bacon builds his new
philosophy upon the repudiation of the ancient Greek
philosophies (especially some aspects of Aristotle's theory
and medieval Aristotelianism), he also borrows from the
Greeks the idea that every valid philosophy is built upon a
certain conception of the human being.
Bacon on the Human Being
Bacon's view of the rational faculties and internal
senses of the human being is quite different from that of
23Francis Bacon, "Preface to the New Organum," in Ellis,
Spedding, and Heath, Volume IV, 41.
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110
typical medieval thought. Thomas Aquinas, a medieval
Catholic theologian who adapts many of Aristotle's theories
to fit Christian theology, recognizes three internal senses:
common sense, memory, and imagination; and he identifies
three rational faculties: understanding, reason, and
will.24
Bacon criticizes this division of the rational
facilities and internal senses because it reflects the
Scholastic's tendency to speculate abstractly in order to
arrive at the essence of the faculties.25 Bacon's overall
purpose is different from that of the Scholastics. He wants
to advance the human being's ability to know and to use
knowledge. Therefore, he is much more concerned with
function than with essence.
So, based on his purpose to advance human knowledge and
his emphasis on function over essence, Bacon recognizes the
following rational faculties: reason, imagination and
memory.26 These are sufficient for the workings of the
mind, but they need the help of the appetite and the will to
secure action.
24See Robert P. Goodwin, ed., Selected Writings of St..
Thomas Aquinas, (Indianapolis: The Bobbs-Merrill Co., 1965).
25Karl Wallace, Francis Bacon on the Nature of Man. (Urbana:
University of Illinois Press, 1967), 155.
26See Bacon's De Augumentis. II, 1 and James Spedding, Robert
Ellis, and Douglas Heath, eds., The Works of Francis Bacon. Baron
of Verulam. Viscount St. Alban, and Lord High Chancellor of
England. (London: Longmans & Co., 1879), Vol.4, 292.
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Ill
Bacon also considers the human being to be a whole.
But, like all other forms of nature, the human being can be
divided into "parts" for the sake of study and analysis.
The faculties are parts, but they are related in two ways.
First, they share a common material basis, which is "spirit"
always in motion. Second, the faculties depend on each
other, interacting constantly with each other.
The materials supplied for one aspect of the faculties
became the material for another. The senses, imagination,
reason, and understanding interact with memory, and memory
interacts with them. The functions of the rational
faculties and emotions are not possible without memory, the
repository of experience.27
In a manner similar to the ancients, then, Bacon builds
his new philosophy and intellectual system upon his
understanding of the human being. And, his view of human
beings is that they are comprised of "material" that can be
studied through the senses.28 Wallace comments that:
His belief that the material basis of
organic and inorganic life was to be
found in ceaseless movements of spirits
led Bacon to expect the discovery of
ultimate elements of units of
movement ... he was convinced that
there existed some kind of submicroscopic
world of minute particles in motion which
once known would furnish a more exact
27Wallace, Francis Bacon on the Nature of Man. 156.
28See De Auaumentis, III, 4; IV, 2-3; Spedding, The Works.
IV, 380, 398.
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112
basis of scientific knowledge than had
ever been possible.29
Bacon believes that this kind of discovery can only
happen if the traditional methods of research are completely
discarded. The old methods are tied to what human beings
already know and are developed by logic, grammar, and
rhetoric. Therefore, in some sense, they are permanently
bound to language.
But, if human beings are ever going to plunge the
depths of nature's riches, if they are ever going to gain
new knowledge of the physical world, "[they] must abandon
old ways of search and inquiry and must devise new ways of
querying nature directly."30 Human beings need a new method
of induction, and this is what Bacon intends to provide.
What is interesting about this new method of induction
is that not only is it built upon Bacon's conception of the
human being, but this conception itself is built upon a
rejection of Aristotle's three sciences. For Bacon's three
rational faculties: memory, reason, and imagination were
intended to replace Aristotle's three sciences: theoretical,
practical, and productive.
Bacon considers Aristotle's classification to be
fallacious because the theory of physics and mathematics is
put into practice in mechanics and in magic, making speech
29Wallace, Francis Bacon and the Nature of Man. 157.
30Ibid., 157.
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113
nondistinct from action. Bacon also rejects Aristotle's
principle of abstraction as a means of classifying knowledge
and as a means of transitioning from physics to metaphysics.
For Bacon, the function of metaphysics is to define the
universal laws of natural phenomena. He ascribes to physics
a more limited role than does Aristotle who expounds
theories of matter/form and power/action, and treats physics
as a form of logic, while logic itself is endowed with the
power to create the world by a series of verbal definitions.
Primary philosophy, according to Bacon, as distinct
from metaphysics, defines the principles and rules
pertaining to the different spheres of physics. But these
rules are not concerned with existence as such.31 Thus, a
new theory of induction replaces Aristotle's "old" method.
Rossi makes the following observations concerning the
significance of this shift:
Logic as a method of verbal definition, a
■ rational process, or a study of
linguistic forms for the definition of
existence, is replaced by a logic as
the instrument and means of controlling a
situation. It is possible, by a series
of complex procedures, to control the
various transitions from the empirical
elements of natural history to the
formulations of laws, and to a perception
of forms permitting the execution of an
unlimited number of operations. Finally
Bacon substitutes his theory of the
congruity of natural and artificial
31This discussion of Bacon's use of Aristotle's three
sciences is taken from Rossi, Francis Bacon. 61; and from Fulton
Anderson, The Philosophy of Francis Bacon (Chicago: University of
Chicago Press, 1948), 139.
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114
phenomena for Aristotle's theory of art
as imitation of nature.32
Bacon's effort to make the source of true knowledge the
senses puts him in direct opposition with the traditional
teachings of his day. The ancient philosophies held that
human understanding was at its best and in accordance with
its true character when it was completely divorced from the
senses. The senses obstructed true understanding. Thus,
for the ancients and medieval Christians, "[t]he highest and
best state of contemplation was at the highest level of
abstraction, and the purest thought was that which was
farthest from the world of objects and events."33
Confronted with these long-standing, culturally
ingrained views of human understanding, Bacon has to show
the benefits that can be gained by an intellect disciplined
by sensory experience. He does this by repudiating the
traditional philosophies and by building a new philosophy on
a foundation of a new conception of human nature. By this
method, he emulates the ancients who also shape their
philosophies on a particular conception of the human being.
As history has borne out, Bacon's conception of the
human being, his use of the mechanical arts to further
scientific inquiry, and his empirical methods have had a
tremendous impact on the institutions of science. But the
32Rossi, Francis Bacon. 61.
33Wallace, Francis Bacon and the Nature of Man. 164.
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115
question still remains: Does Bacon's philosophy prove the
ancient Greek philosophies to be of no practical use in a
technology-driven society?
What the Ancients Know that Bacon Denies
While Bacon sharply criticizes the ancients on several
points, he also learns many things from them. Jerry
Weinberger points out that Bacon first learned from the
ancients that the ambition to technology is the primary
source of dogmas, which are either idealistic or
materialistic in nature. Second, he learned that such
ambition is rooted in human nature itself.
Third, Bacon discovers from the ancients the causes of
the scientific claims of reason to harmonize nature and
human action either by art or by absolute, demonstrable
knowledge. Finally, from the ancients he realizes that
managing such dogmatic claims is indeed difficult.34
Though Bacon recognizes the problems associated with
reason, dogmatism, and the pursuit of technology, he is much
more a supporter of these concepts than he was an unbiased
observer. For he rejects ancient philosophical dogmatism
only to make way for his own version of demonstrable
34Jerry Weinberger, Science. Faith, and Politics: Francis
Bacon and the Utopian Roots of the Modern Acre (Ithaca: Cornell
University Press, 1985), 21.
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116
certainty. It is important to see how he does this by
contrasting classical and modern utopian thought.36
Classical utopian thought reveals nature and political
life in light of one human possibility: the life of restful
contemplation. In doing so, it shows the limits of human
attainments. Reason can disclose ends that determine human
excellence, but human nature has neither the spontaneity of
nonhuman nature nor the permanence of its forms. To the
contrary, human nature must meet its ends by way of art,
which is always changeable and less than perfect.
While ends can be revealed, they cannot be inherent in
practice, and therefore they cannot be demonstrated as ends
with the certainty required for practice. For this reason,
ends are objects of contemplation and wonder. Weinberger
makes some insightful comments about the ancient's
understanding of this tension between theory and practice:
Precisely because nature differs from and
yet is tied to art, theory disappoints
the practice that so needs theory. When
classical utopianism imagined what
political life would be like if it were
modeled not on contemplation and wonder
but on certain knowledge of the highest
human excellence, it did so not for the
sake of producing such a life, but to
35The following section contrasting classical and modern
utopian thought was derived from selections in Plato's Republic.
369b-373a, 504d-505d; Plato's Statesman. 226c, 269c-272d
Aristotle's Nicomachean Ethics. 1094a; Aristotle's Politics.
1252a-1253a; Aristotle's Metaphysics. A; Bacon's Instauration. 7-
8,23-24; Bacon's Novum Oraanum. Book I, 3; Book II, 1-4; Bacon's
Advancement of Learning in Spedding, 294-295, 475; and Thomas
Hobbes, The Elements of Philosophy in William Molesworth, ed., The
English Works of Thomas Hobbes of Malmsbury. 11 vols. (London:
John Bohn, 1839-1845).
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117
show the crucial tension between theory
and practice. Classical utopia disclosed
the comedy of practical hopes for the
sake of moderation. And it disclosed the
limits of knowledge for the sake of a
kind of piety. Knowing about the being
of justice, the political virtue, could
never lead to perfectly just practice
because such knowledge could never be
comprehensive or clear enough to satisfy
the demands of practice. Unlike gods or
the self-sufficient objects of
contemplation, men are always subject to
needs whose urgency outstrips their
knowledge of justice.36
The ancients teach that these needs are caused by more
than material scarcity or changeable circumstances. They
are caused by the need that practice has for knowledge and
by the tension between them. They arise because human
beings are characterized by both reason and art. As
rational creatures, human beings can distinguish between
need and self-sufficiency. As artful creatures, they strive
to become self-sufficient and whole.
These two characteristics open the human being to the
possibilities of freedom. But the ancients view freedom as
dangerous, and therefore it is not part of their
prescription for society. In contrast, the classical
utopian thinkers take society to be an order of several arts
pursued by persons who, unlike animals, act not out of mere
necessity but for the sake of the good, for self-
sufficiency.
36Weinberger, Science. Faith, and Politics. 22.
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118
If human beings do not strive for self-sufficiency, if
they only attend to immediate needs, they are no different
from the animal who practices no arts. Therefore, human
society is an order of arts that produces luxuries: things
that remove us from the immediate demands of the body;
however, though they appear to provide self-sufficiency,
they are really only instances of meeting bodily needs.
Were all human beings to learn the truth about
luxuries, that they only provide merely apparent self-
sufficiency, they would pursue a life of contemplation and
wonder. But, to some degree, society can only exist when it
is deluded about luxury. For every art is pursued as if
self-sufficient wholeness consists in the most of what it
can produce. And each art's desire for the good is an
aspiration to an impossible freedom from need because, to be
self-sufficient, it assumes the service of all other arts.
Classical utopianism, then, is quite realistic. It
teaches that because of the relationship between reason and
art inherent in the human being, human society as an order
of arts always produces political claims that incline toward
a naive utopianism because a single productive art's
tendency is to forget its dependence on other arts. Thus,
for the ancients, "the very existence of society depends
upon the artful pursuit of perfect freedom and justice, but
this is always the most dangerous delusion."37
37Ibid., 23.
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119
This delusion is most keenly seen in the human being's
idea of what constitutes a "perfect" society. The perfect
society is usually understood to be one that is free from
scarcity. But the ancients boldly point out that it is not
scarcity that causes injustice and need, but the longing to
be self-sufficient like the gods. And, this pursuit of
self-sufficiency, which is an inherent part of human nature,
is expressed in the productive arts that make up human
society.
Bacon makes it clear that his new philosophy requires a
rejection of classical utopian thought because it impedes
the power of human beings to conquer nature and fortune and
to discover principles of justice. He contends that the
ideal of restful contemplation actually shows contempt for
experience and the practical arts, which are so necessary
for the conquest of nature in action.
So, through his philosophy, Bacon promises the human
conquest of fortune and a freedom for humanity as a whole.
No such promise can be further from the worldview of the
ancients. They believe that such a promise could only be
dogmatic and dangerous.
From the ancient's viewpoint, Bacon's philosophy
reflects the dangerous and deluded belief that injustice,
dependence, and need come from the scarcity of what only the
productive arts know how to make. The idea that is implicit
in this view is this: by focusing on "realistic"
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120
(scientific) rather than "golden beginnings" (abstract
ideas), it is possible to effect the golden dream of every
art.38
Weinberger points out some of the benefits of the
ancient's analysis of reason and art:
{T}he course of this project, from
Machiavelli's realism to Bacon's science
of nature, and from this to Hobbes'
science of perfect justice and thence to
the idealistic doctrine of freedom, could
have been predicted from the ancients'
analysis of the dogmatic possibilities of
reason and art.39
Hence, what the ancients knew that Bacon denies is that
the human being can never become completely self-sufficient
or become completely free from need and natural necessity
because these characteristics are consistent with human
nature. They have, in other words, a more realistic view of
the possibilities and limitations of human nature.
Also, the ancients know that reason and art inherent in
human nature allow for the development of the productive
arts. These arts are for the ancients an imperfect
"imitation" of nature, but they serve human beings in two
important ways: 1) they create an "illusion" of self-
sufficiency, which the Greeks viewed as necessary for
society; 2) they move human beings toward their ultimate
38This discussion contrasting classical utopian thought with
Bacon's philosophy was derived from and inspired by Weinberger,
Science. Faith, and Politics, 22-27. I am indebted to him for his
valuable insights on this subject.
39Weinberger, Science. Faith and Politics. 27.
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121
end, which they believe is happiness (and this happiness is
inextricably related to the virtues).
In contrast to the ancients, Bacon understands human
nature not from the standpoint of its essence, but from the
viewpoint of its function. He is not concerned with the
inherent limitations of human nature because he believes
that, through the productive arts, human beings can conquer
any limitations nature bestows upon them.
As was mentioned earlier, Bacon argues that the arts
are not a "secondary" form to nature, but of the "same form
and essence." Therefore, the productive, mechanical arts
can be used as tools to improve human existence precisely
because they are of the same form as nature, and they are
essential to it. As such, the only way human beings can
conquer nature is to manipulate nature by the arts. This
viewpoint, I think, is directly related to Bacon's emphasis
on function, rather than essence.
One of the possible consequences of this Baconian
understanding of human being is that the conquest of nature
by the technological arts can mean the conquering of human
nature as well. If we are not careful, one of the practical
results of this idea could be that, rather than the
technological arts serving the needs of human beings, human
beings could be made to serve technological ends.
For as human beings become the "servants and
interpreters" of nature through the manipulation of nature
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122
by the arts, so human nature is subject to this same kind of
manipulation- This could ultimately lead to the body being
viewed as an "object" rather than as a subject.
To put this in the context of genetic enhancement
technologies, the Baconian project creates a fundamental
shift in the relation of the body to the pursuit of the
good, and therefore in the view of the ethical significance
of the body. McKenny points out how this shift represents a
change from the ancient to the modern view of the human
being:
Traditional techniques of enhancement
required one to cultivate virtues such as
moderation, so that the process by which
one attained human fulfillment
constituted an important part of the
fulfillment itself. By contrast, to the
extent that our technologies make it
possible to enhance the self by acting
directly on the body, they bypass the
acting subject. And to that extent,
human fulfillment, the realization of our
aims and ideals, becomes a product rather
than also a process, and the body a
mere means rather than an integral
component of self-formation.40
So, Bacon's philosophy, his "project," is to rescue
human beings from fate and natural necessity by eliminating
human suffering and expanding the range of human choice
through technological advances. This represents a
fundamental shift from traditional to modern modes of
thought.
40Gerald McKenny, "Enhancements and the Ethical Significance
of Vulnerability," in Enhancing Human Traits. 226.
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123
Ambitions to replace traditional views with new ones in
order to meet contemporary demands is as strong today as it
was in Bacon's day. For instance, it is assumed that the
technological developments over the past several decades
have radically changed the way medicine is practiced. The
moral issues raised by these technologies are believed to be
unprecedented, rendering traditional ethical systems
obsolete. Technology has made it possible to intervene into
nature in ways not anticipated by these systems, thus,
creating moral dilemmas they are unable to solve.41
However, the way I see it is that it is modern/standard
forms of bioethics which are unable to solve the "moral
dilemmas" created by new biotechnologies because they have
marginalized the most fundamental questions associated with
such technologies: What does it mean to be human? What is
the purpose of medicine?
I think it is clear from this brief examination of
Bacon's philosophy that these questions are not central to
his agenda because his concern is not with essence, but with
function. His goal is to advance the human being's ability
to know and process knowledge, especially the knowledge of
nature, so that they can become the servants and
interpreters of nature. And, with the help of the arts,
human beings can become just that.
41McKenny, To Relieve the Human Condition. 11.
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124
As I said before, there is no question that Bacon's
overall aims are important and laudable and his efforts have
been extremely beneficial to us in our day. Indeed, new
biotechnologies have improved the quality of life for many
people and these have been a direct result of Bacon's work.
But he largely ignores many of the questions raised above
because his views on the "true" sources of knowledge lead
him to reject the Aristotelian notions of form and telos,
the notions which essentially inspire these questions and
place them at the center of intellectual and ethical
inquiry.
Consequently, because standard forms of bioethics
participate in the Baconian project, these foundational
questions are marginalized and are not given serious
attention. Because of the enormous ethical and social
implications of this technology, it is my opinion that these
questions should not be ignored. Therefore, Aristotle's
ethical theories are useful to discussions concerning the
use of new biotechnologies because, unlike standard
bioethics, these questions are central to ethical inquiry.
Aristotle, who is concerned with both essence and
function, builds his ethical theory upon a substance view of
the human being. He takes into consideration the human
being's vulnerability to fate and natural necessity.
Therefore, I think his theories concerning the human being
and the ultimate good offer valuable insight needed today
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125
for proper reflection on the ways in which genetic
enhancements should be used. We now turn to explore his
theories.
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126
Chapter 5
The Human Being and the Ultimate Good: Revisiting
Aristotle
The Human Nature Question
If I have succeeded in presenting my argument so far,
it should be abundantly clear by now that I believe that
the human nature question is inescapable in discussions
concerning technological advances in modern genetics. As
I have pointed out in the previous chapters, many scholars
and bioethicists have also alluded to the importance of
this question, and some have even sought to provide a
detailed, cogent definition of human nature.1
French Anderson, for instance, identifies eight
categories that can be used to quantitatively define a
human being: 1) Physical; 2) Mental; 3) Emotional; 4)
Spiritual; 5) Social; 6) Biological; 7) Cultural; 8)
Legal. Anderson also identifies a second component of
humanness, which he refers to as the "soul" or "that non-
quantifiable, spiritual part of us which makes us uniquely
human. "2
But, in referring to an immaterial part of the human
being, Anderson recognizes that this is a hotly debated
xIf I may point it out again, it is not standard bioethics
that prompts these ethicists to raise the human nature question,
but the view of human beings as responsible agents, a view which
is inspired by the Greek/Judeo-Christian tradition.
2French Anderson, "Genetic Engineering and Our Humanness,"
757-758.
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127
subject, and that not many in the sciences believe such an
entity exists.
In the context of discussions concerning the use of
genetic engineering, James Gustafson also talks about the
matter concerning what is the distinctively human. He
identifies four principal questions related to this topic:
1) "How do we adequately describe and explain what is
distinctively human?" 2) "What do we value about the
human?" 3) "What ought we to value about the human?" 4)
"How are our descriptions and explanations on the one hand
related to our valuations on the other?"3
In order to show the pervasiveness of the quest for
answers to these questions, Gustafson quotes many authors.
For instance, he refers to Reinhold Niebuhr, who opens his
1939 Gifford Lectures with the following line: "Man has
always been his own most vexing problem. How shall he
think of himself?"4 He also mentions Margaret Mead who
writes, "What must we do to be human is a question as old
as humanity itself."5
Finally, he cites Melvin Konner in his penetrating
work, The Tangled Wing:
3James Gustafson, "A Christian Perspective on Genetic
Engineering," Human Gene Therapy. 5 (1994), 750.
4Reinhold Niebuhr, The Nature and Destiny of Man. Vol.2
(New York: Charles Scribner's Sons, 1941 and 1943), 1.
5Cited in Carl N. Degler, In Search of Human Nature (New
York: Oxford University Press, 1991), 3.
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128
Why we are what we are, why we do what we
do, why we feel what we feel; these
questions have been on the
minds of philosophers and theologians,
medical men and medicine men, actors,
diplomats, poets, and of
course scientists, beginning with the
first glimmer of human thought itself.6
In a manner similar to Anderson and Gustafson, Paul
Ehrlich, a professor of biology and population studies at
Stanford University, argues that there is indeed a
pressing need to deal with the human nature question in
light of biotechnological advances. But his focus is
entirely different.
In his new book entitled, Human Natures: Genes,
Cultures and the Human Prospect, Ehrlich seeks to
counterbalance the popularity of neo-Darwinism and
behavioral genetics with a recognition that culture should
not be ignored in our effort to understand who we are,
where we are going, and what we are doing:7
A main theme of the book was to emphasize
the gigantic role that cultural evolution
plays in making individual different, and
in making groups different. I’m hoping
to counter a view that I'm afraid is all
too common among the American public,
that all of our behavior is controlled by
our genes, and that there are genes that
code for aggressiveness, acquisitiveness
6Melvin Konner, The Tangled Wina. (New York: Harper
Collins, 1982), xi.
7Natalie Angier, "On Human Nature and the Evolution of
Culture," New York Times. 10 October 2000, 1 (D) .
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129
and so on. The truth is, you can never
remove culture from the mix.8
In this new book, Ehrlich has, perhaps unwittingly,
pinpointed something that is extremely important to
discussions concerning the human being in the genetic age;
that is, the scientific/genetic understanding of human
being is something that either needs to be
"counterbalanced" by a more serious consideration of
cultural influences, or perhaps it is something that needs
to be reconsidered altogether.
The Baconian9 View of Human Being
As I stated in Chapter 1, the Baconian view of human
being understands the human as a physical organism whose
complex functioning gives rise to higher capacities, such
as emotion, morality and spirituality. This is
unquestionably the dominant view of human nature in the
Western world. About four hundred years of historical,
cultural, and intellectual changes have contributed to the
development of this view. But, by far, the most
significant contributions have come from the writings of
8Ibid., 2(D).
9I refer to the Baconian view of human being as the
"scientific view" because that is the language that is primarily
used to refer to the modern view of human being. However, it
should be known that the Aristotelian view of human being is also
scientific in that it was based on observation. What is reflected
here are two different views of "scientific."
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130
Bacon, Hobbes, and Descartes, and from scientific
advancements in the neurosciences and genetics.
Bacon is highly influenced by several pre-Socratic
naturalists.10 Thales of Miletus, a Greek who lived in the
sixth century B.C. was one of the first
philosophers/scientists to propose a theory of materials.
He holds that natural entities are "all made of water and
that all differences in their properties are founded upon
one primary quality, the relative density of the water in
them."n
Contrary to Thales, Empedocles, another pre-Socratic
philosopher/scientist, claims that there is not one
elementary material, but four that can be considered
elementary materials: earth, water, air, and fire. This
ancient theory is founded upon what we know as the
gaseous, liquid, and solid states that are the qualitative
conditions under which natural "stuffs" exist. Fire is
considered an elementary material because it is needed to
produce the changes.
For Empedocles, then, "natural production and
destruction were processes of combining and separating,
10See Francis Bacon, Novum Oraanum, Book II.
uRichard Connell, Substance and Modern Science. (Houston:
Center for Thomistic Studies, 1988), 39-40.
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131
and the specifying property of things was the proportion
of the materials constituting them."12
These two pre-Socratic theories of materials regard
these materials as "continuous." In other words, they do
not hold that "stuffs" are constituted of indivisible
units called atoms. However, early Greeks, Leucippus and
Democritus, postulate that atoms are the ultimate
realities out of which all things are made. Bacon is most
heavily influenced by these early atomists.13
These three different pre-Socratic theories of
materials hold in common two assumptions about the origin
of things. First, all three theories hold that any thing
which comes to be, comes to be from an already existing
thing. Second, all three theories maintain
that natural entities are property-things.
A property-thing is an entity, existing as a loosely
unified aggregate of externally related parts. There is
no underlying bearer of properties existing otologically
prior to the whole, and no internal, defining essence that
diffuses, informs and unites its parts and properties. It
is a collection of parts standing in external relation to
12Ibid., 41.
13See Francis Bacon The Wisdom of the Ancients, vol. 6.
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132
one another, which gives rise to a bundle of properties
determined by those parts.1 4
Bacon's conviction that human beings are comprised
entirely of materials that can be studied through the
senses and his belief that one day the "units" (atoms)
that make up all living organisms will be discovered
through the advancement of scientific knowledge reflect
the enormous influence these pre-Socratic Greeks have on
him.15
One of the reasons why Bacon so despises Aristotle's
theories on substance and the origin of species is that
they are diametrically opposed to these pre-Socratic views
on materials. Bacon relies heavily on these theories in
order to shape his views on human nature and, in turn, to
develop his new philosophy.
While it is unclear whether or not Thomas Hobbes knew
Bacon or was familiar with his writings, it is evident
that he was an acquaintance of Rene Descartes and well
versed in the writings of the early Greek naturalists.
Hence, Hobbes was one of the earliest philosophers to
define the human being in purely mechanistic terms.
14J.P. Moreland and John Mitchell, "Is the Human Person a
Substance or a Property-thing?" Ethics & Medicine 11:3 (1995),
50.
15See chapter 3 and also Rossi, Francis Bacon and Wallace,
Francis Bacon on the Nature of Man.
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133
In his work, Leviathan, Hobbes describes human
artefacts as artificial animals:
Nature, the art whereby God hath made and
governs the world, is by the art of man,
as in many other things, so in this also
imitated, that it can make an artificial
animal. For seeing life is but a
motion of limbs, the beginning whereof is
in some principal part within; why may we
not say, that all automata (engines that
move themselves by springs and wheels as
doth a watch) have an artificial life?
For what is the heart, but a spring; and
the nerves, but so many strings; and the
joints, but so many wheels, giving motion
to the whole body, such as was
intended by the artificer?16
It is clear that, for Hobbes, living organisms are
like machines; or, in other words, they are property-
things. Descartes, though committed to the same mechanist
view, describes the human being somewhat differently from
Hobbes. For Descartes, the human body is an organization
of materials that is moved by a soul that is external to
the body.
Because of the enormous influence Descartes has had
on the scientific view of human being, it is important to
make note of his description in a fuller context:
These {hypothetical} men shall be
composed as we are, of a soul and a body;
. . . the body is nothing else than a
statue or machine of clay which God
forms expressly to make it as nearly like
as possible to ourselves, so that not
only does he give it members, but also he
puts within it all the parts necessary to
16Thomas Hobbes, Leviathan. (New York: The Crowell-Collier
Publishing Co, 1962), 19.
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134
make it walk, eat, breathe and, in
fine, imitate all those of our functions
which may be supposed to proceed from
matter and to depend merely on the
arrangement of organ. . . . The
particles of blood which penetrate to the
brain . . . serve not only to nourish and
support its substance, but chiefly, also
to produce there a certain very subtle
breath, or rather flame, very active and
very pure, which is called the animal
spirits. . . . The nerves of the
machine that I am describing to you
may very well be compared to the pipes of
the machinery of these fountains, its
muscles and its tendons to various other
engines and devices which serve to move
them, its animal spirits to the water
which sets them in motion, of which the
heart is the spring, and the cavities of
the brain the outlets. . . . And
finally, when the reasonable soul
shall be in this machine, it will have
its principal seat in the brain, and it
will be there like the fountain-maker,
who must be at the openings where all the
pipes of these machines discharge
themselves, if he wishes to start, to
stop, or change in any way their
movements. . . . Consider that all
these functions follow naturally in this
machine from the arrangement of its
parts, no more nor less than do the
movements of a clock or other automata,
from that of its weights and its wheel
17
So, Descartes views the human being as an arrangement
of parts moved by a rational soul, which is an immaterial
substance external to the body. Because Descartes asserts
that human beings have a separate, rational soul which
controls their bodies, he is technically a dualist. But,
his position makes the whole human being, body and soul, a
17Ralph M. Eaton, ed., Descartes Selections. (New York:
Charles Scribner's Sons, 1927), 350-354.
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135
property-thing constituted by an arrangement of parts,
standing in external relation to one another.18
Descartes also reduces the soul to the mind. This
reduction of the soul to the mind has brought about in
modern times the identification of the person with a
purely conscious substance. This view has gained
considerable momentum with the recent advances in the
neurosciences.
Current research in the neurosciences revolves around
the mapping of regions in the brain and the study of the
functions of these various regions. Many argue that these
studies provide an abundance of evidence for the
scientific understanding of human being (physicalism).19
As neuroscientists associate more and more faculties once
attributed to the soul with the functioning of certain
regions of the brain, it becomes more reasonable to equate
those faculties strictly with brain functioning.20
Likewise, advances in genetics have lead many authors
to claim to provide accounts of distinctively human traits
in strictly biological terms. For example, Edward .0.
18Connell, Substance and Modern Science. 49.
19See Warren S. Brown, Nancey Murphy and H. Newton Malony,
Whatever Happened to the Soul? Scientific and Theological
Portraits of Human Nature. (Minneapolis: Fortress Press, 1998)
and Robert H. Blank, Brain Policy: How the New Neuroscience Will
Change Our Lives and Our Politics (Washington D.C.: Georgetown
University Press, 1999).
20Ibid., 13.
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136
Wilson maintains that there is ample evidence to support
an argument for a biological basis for morality:
The empiricist argument holds that if we
explore the biological roots of moral
behavior, and explain their material
origins and biases, we should be able
to fashion a wise and enduring ethical
consensus. The current expansion of
scientific inquiry into the deeper
processes of human thought makes this
venture feasible. . . . The empiricist
view concedes that moral codes are
devised to conform to some drives of
human nature and to suppress others.
Ought is the translation not of human
nature but of the public will, which can
be made increasingly wise and stable
through an understanding of the needs and
pitfalls of human nature.21
This understanding of human nature is a materialistic
one. It is an understanding that reflects the
contemporary view of the primacy of DNA. This genocentric
view maintains that DNA provides all that is needed to
produce an organism. Organisms are the vehicles for
passing on genes from one generation to the next.
The genocentric view is an expression of a property-
thing conception of organisms in that organisms are like
molecular machines, ordered aggregates assembled by the
activity of the DNA, which itself is an ordered aggregate.
There are at least three arguments to support this view:
1) DNA can replicate itself and is, in fact, passed on
from one generation to the next. So it follows that it
21Edward. 0. Wilson, "The Biological Basis of Morality,"
The Atlantic Monthly. (April 1998), 54, 58.
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137
plays a causal role in specifying and controlling an
organisms development.
2) Because a mutation in a single gene can cause change in
an organism's structure, genes must contain all the
information for making that organism.
3) Since evolutionary theory explains the origins of life,
then bottom-up causation must constitute the correct
etiological account of origins. DNA seems to be the best
candidate for the correct causal entity.22
In summary, the writings of Bacon, Hobbes, and
Descartes, and the scientific advances in the
neurosciences and genetics have provided an enormous
amount of evidence to support a strictly materialistic
(property-thing) understanding of human nature. This
evidence calls into question some long-held, traditional
views about the nature of human being. We turn now to
consider some of them.
Some Concepts Challenged by the Baconian View
Free Agency. One of the traditional concepts
challenged by the Baconian view of human being is free
agency. In his essay "The Human Genome Project and Human
Identity," Dan Brock notes that our conception of
ourselves as responsible agents could be threatened by new
22J. P. Moreland and Scott Rae, Body and Soul: Human Nature
and the Crisis in Ethics (Downers Grove, IVP, 2000), 210.
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138
genetic knowledge. He discusses some of the consequences
in the following words:
{T}he view of people as responsible
agents is embodied in a wide range of
attitudes toward ourselves and others, as
well as in important social and legal
practices. This view could hardly be
more important to our conceptions of our
identity as human beings. Yet to the
extent that it comes under pressure from
the knowledge that the HGP may yield,
those attitudes and practices will be
seen as resting on untenable foundations.
. . . {T}o come to believe that these
attitudes and practices have lost
their foundations— even if we are unable
to give them up— will place us in an
intellectually uncomfortable and unstable
position, the full consequences of which
are likely to be profound however
difficult to predict they may not be.23
But, many who hold to the Baconian view of human
being assert that causal determinism is not incompatible
with our view of ourselves as responsible agents.24
However, the very fact that this debate continues reflects
what even many compatibilists acknowledge: "a lingering
worry that their defense of our practices of moral and
legal responsibility may not fully answer all of the
incompatibilists1 concerns."25
23Dan Brock, "The Human Genome Project and Human Identity,"
in Genes and Human Self-Knowledge: Historical and Philosophical
Reflections on Modern Genetics. 27.
24See Daniel C. Dennett, Elbow Room: The Varieties of Free
Will Worth Wanting (Cambridge: MIT Press, 1984), 101-102.
25Brock, Genes and Human Self-Knowledge. 28.
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Personal Identity. A second age-old concept
challenged by the Baconian view of human nature is
personal identity. The Bacon view holds that living
organisms are property-things. A property-thing is a
passive medium through which energy passes and whose parts
enter into causal chains. The parts move to accomplish a
function that stays in the designer's mind and that is not
part of the being of the property-thing.26
While property-things have a deeper unity than a heap
of materials, they have different, lesser kinds of unity
than true substances. One of the implications of this is
that property-things do not maintain sameness through
change. A property-thing is an enduring merelogical
compound that maintains no absolute sameness and strict
identity through part replacement, loss, or gain.
On this view, then, it is clear that human beings
cannot have any true, enduring personal identity because:
1) All living organisms are property-things.
2) Property-things do not maintain sameness through
change.
3) Therefore, human beings cannot maintain sameness (or
identity) through change.
Those who hold to the scientific understanding of
human being use, however, three main arguments to support
a particular view of personal identity.27 First, there is
26Moreland and Rae, Body and Soul. 78.
27Ibid., 180-181.
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a general consensus that both natural things and artifacts
are property-things. This means that personal identity
comes in degrees, is partial, and is basically just a
matter of custom.
Second, there is general agreement that personal
identity is not analyzable. A person is like a process in
that a person is a series of person-stages related to each
other in the appropriate way. Hence, a theory of personal
identity is meant to clarify what the relationship is
between various person-stages that makes all the stages
the same person.
Third, there is general concurrence that there is no
substantive soul or mind. Such an entity is prescientific
and not accessible to the senses. Therefore, because the
supposedly immaterial part of human nature is not open to
scientific inquiry, it is not a factor taken into
consideration in an understanding of human nature.
Problems for genetic enhancements. The scientific
(property-thing) view of human being poses an enormous
tension with regard to genetic enhancements. On the one
hand, if this view is correct, then it follows that we
ought to exercise extreme caution when it comes to genetic
enhancements because our humanness can be altered by both
positive (e.g. enhancing a kindness gene) and negative
(e.g. turning off an aggressive gene) genetic
enhancements. If it is indeed the case that we can alter
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141
our humanness through genetic enhancements, we could find
ourselves venturing down an exceptionly questionable,
morally sticky path if we proceed.
On the other hand, if the scientific view is correct,
then it also follows that we ought to do all we can to
pursue the Baconian mandate to protect humanity from fate
and contingency through biotechnologies in the same way
that we, through various other technological means, seek
to preserve our "things" (artifacts) from natural
necessity.
It is fairly self-evident that we do all we can to
protect our possessions, such as cars, bikes, and homes
from natural necessity through various technological
means. For example, we use polish to protect our vehicles
from weather and we build homes on sturdy foundations in
order to insure that they withstand earthquakes.
In the same way, if, as Bacon argues, nature
(including human nature) and artifact are both of the same
essence (property-things), then it follows that chance and
uncertainty can and ought to be overcome through any and
every technological means available. The reason for this
is clear: suffering and vulnerability serve no purpose for
artifacts, ordered aggregates, or property-things.
I believe that these challenges to traditional
conceptions of human nature presented by the scientific
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142
view are serious enough to warrant a careful consideration
of Aristotle's view of human being.
Aristotle on the Human Being
For Aristotle, the human being is not a property-
thing, but a substance. The "soul" (or substance) is an
"individuated essence that makes the body a human body and
that diffuses, informs, animates, develops, unifies and
grounds the biological functions of its body."28
Aristotle thinks of the soul not as an entity, but
more a as life principle, that aspect of the person that
provides the powers or attributes characteristic of the
human being. Plants and animals also have souls,
nutritive and sensitive souls, which give them the powers
to grow and reproduce and to perceive, respectively.29
Humans souls are organized hierarchically and
incorporate the nutritive and sensitive powers; but,
unlike plants and animals, human souls have rational
powers. Aristotle illustrates the relation of soul to
body with an analogy: if the eye were a complete animal,
sight would be its soul.
Aristotle's conception of the soul and body fits well
into his general "hylomorphic" conception of reality. All
material things are composed of matter and form. Form is
28 Ibid., 202.
29Aristotle, Nicomachean Ethics. trans. by David Ross,
(Oxford: Oxford University Press, 1925), 1-48.
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143
an immanent principle that gives things their essential
characteristics and powers. ' The soul is but one type of
form.30 On this view, function determines form and not
vice versa.
There are five primary features to the Aristotelian,
substantive view of the human person:
1) The organism as a whole is ontologically prior to its
parts.
2) The parts of the organism's body stand in internal
relations to other parts and to the soul's essence.
3) The operational functions of the body are rooted in
the internal structure of the soul.
4) The body is developed and grows in a teleological way
as a series of developmental events that occur in a
lawlike way, rooted in the internal essence of the
human soul.
5) The efficient cause of the characteristics of the
human body is the soul.3 1
Since the pre-Enlightenment era, at least two major
arguments have been levelled against Aristotle's
substantive view of human being. We turn now to consider
them.
Arguments Against Aristotle
Hume’s Denial of Substance. In his work, A Treatise
of Human Nature, philosopher David Hume rejects
Aristotle's idea of substance:
30Brown, Whatever Happened to the Soul?. 3-4.
31Paraphrased from Moreland and Rae, Body and Soul. 206.
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144
We have, therefore, no idea of substance,
distinct from that of a collection of
particular qualities, not have we any
other meaning when we either talk or
reason concerning it. The idea of
substance as well as that of a mode is
nothing but a collection of simple ideas,
that are united by the imagination,
and have a particular name assigned them,
by which we are able to recall, either to
ourselves or others, that collection.
But the difference betwixt these ideas
consists in this, that the particular
qualities, which form a substance, are
commonly referr'd to as an unknown
something, in which they are supposed to
be closely and inseparately connected by
the relations of contiguity and
causation.32
Hume denies the idea of substance as a substratum and
claims that there exists only a "collection of qualities."
This naturally has an impact on his view of properties:
The notion of accidents is an unavoidable
consequence of this method of thinking
with regard to substances or substantial
forms: nor can we forbear looking upon
colours, sounds, tastes, figures, and
other properties of bodies, as
existences, which cannot subsist apart,
but require a subject of inhesion to
sustain and support them. For having
never discover'd any of these sensible
qualities, where, for the reasons above
mention'd, we did not likewise fancy a
substance to exist; the same habit, which
makes us infer a connection betwixt cause
and effect, makes us here infer a
dependence of every quality on the
unknown substance. The custom of
imagining a dependence has the same
effect as the custom of observing it
wou'd have. This conceit, however, is no
more reasonable than any of the
foregoing. Every quality being a
32David Hume, A Treatise of Human Nature. Selby-Bigge, ed.
(Oxford: The Clarendon Press, 1975), 16.
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distinct thing from another, may be
conceiv'd to exist apart, and may exist
apart not only from every other quality,
but from that unintelligible chimera
of substance.33
So, Hume insists here that the properties of bodies
are only imagined to exist in a substratum; but they have
no such dependence in reality. Assigning them to a
substratum is simply a habit of mind.3 4
Hume's rejection of substance also has implications
for his doctrine of personal identity in that it leads him
to deny the existence of a true self:
It must be some one impression that gives
rise to every real idea, but self or
person is not any one impression, but
that to which our several impressions and
ideas are supposed to have a reference.
If any impression gives rise to the idea
of self, that impression must continue
invariably the same, thro' the course of
our lives; since self is suppos'd to
exist after that manner. But here is
no impression constant and invariable.
. . . But farther, what must become of
all our particular perceptions upon this
hypothesis? All these are different, and
distinguishable, and separable from each
other, and may be separately consider'd,
and may exist separately, and have no
need of anything to support their
existence.35
Hume's argument can be summed up in the following
way:
1) Qualities are real.
33Ibid., 222.
34Connell, Substance and Modern Science. 18.
35Hume, A Treatise of Human Nature. 251.
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2) Qualities do not exist in a substratum.
3) Therefore, since qualities fulfill the definition of
substance, they are all substances.36
Hume's theories on the mind and on human nature in
general and his arguments against substance in particular
have had an enormous impact on the development of science.
They are naturally compatible with many scientific
theories.
The Theory of Evolution. Many scientists and
philosophers assert that the theory of evolution has made
belief in substance quite implausible. In his book,
Populations, Species, and Evolution, Ernst Mayr says, "the
concepts of unchanging essences and of complete
discontinuities between every eidos (type) and all others
make genuine evolutionary thinking impossible. I agree
with those who claim that the essentialist philosophies of
Aristotle and Plato are incompatible with evolutionary
thinking.1 , 37
Philosopher David Hull echoes these same sentiments
in his book, The Metaphysics of Evolution. His
observations are worth noting:
The implication of moving species from
the metaphysical category that can
appropriately be characterized in terms
of "natures" to a category for which such
characterizations are inappropriate
36Connell, Substance and Modern Science. 24.
37E. Mayr, Populations. Species, and. Evolution. (Cambridge:
Harvard University, 1970), 4.
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are extensive and fundamental. If
species evolve in anything like the way
that Darwin thought they did, then they
cannot possibly have the sort of natures
that traditional philosophers claimed
they did. If species in general lack
natures, then so does Homo Sapiens as a
biological species. If Homo Sapiens
lacks a nature, then no reference to
biology can be made to support one's
claims about "human nature." Perhaps all
people are "persons," share the same
"personhood," etc., but such claims must
be explicated and defended with no
reference to biology. Because so many
moral, ethical, and political theories
depend on some notion or other of
human nature, Darwin's theory brought
into question all these theories. The
implications are not entailments. One
can always disassociate "Homo Sapiens"
from "human being," but the result is a
much less plausible position.38
The Baconian view of human being is viewed by these
thinkers as much more compatible with evolutionary theory
in that it explains the human being strictly in terms of
physical processes and bottom-up causation.
While Hume's position and evolutionary theory are
important claims to consider, they do not altogether
discredit Aristotle's theory of substance. We turn now to
examine some of the arguments in support of Aristotle.
Arguments Supporting Aristotle
The Implausibility of Hume’s Position. Hume's theory
on substance (or lack thereof) falls short in three
fundamental ways:
38David Hull, The Metaphysics of Evolution. (Albany: State
University of New York Press, 1989), 74-75.
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1) If every reality were a substance, one reality could
not modify another, as shape modifies clay and as
motion modifies a ball.39
2) The observed unity of properties cannot be explained.40
3) His theory of personal identity presupposes a
substantive self.
This last point is most crucial to this discussion;
so it warrants some elaboration. There are essentially
three major criticisms against Hume's view of personal
identity: 1) His presentation of the non-existence of the
self seems to presuppose its very existence; 2) It is not
clear how causality, resemblance, and memory are connected
to create a fictitious entity; 3) His theory of the self
is inconsistent with his theory of virtues.
First, Hume's explanation of identity presupposes the
idea of a subject of experience. Hume argues that when we
attribute identity we are creating a fiction. In reality,
we are in fact making a mistake because we are taking
something to be what it is not. Who, then, is making the
mistake? Who is imposing identity on a succession of
perception?
"How is it that there can be a 'presentation' of
perceptions, mistakenly conceived, in a context where it
39Connell, Substance and Modern Science. 24.
40Ibid., 24.
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is claimed that only perceptions themselves exist: for to
whom or to what are these perceptions presented?"4 1
Secondly, it is unclear how resemblance enables the
mind to move smoothly from one perception to another. The
same is true for causality. Consider the following
example. I walk through my front door in the evening and
find toys scattered from one end of the room to the other.
I walk into the kitchen and see the sun shining through
the window. Next, I hear the telephone ring at the house
next door. Then, I change my baby's diaper. After this,
I read my mail.
If I later reflect on all the events of the evening
in order to discern whether they belong to the same
"bundle of experiences," there are no relevant causal
connections to help me to put them together. "Thus, the
general picture of human experience is of a whole sea of
perceptions, causally generated by all sorts of extraneous
factors, but not systematically connected by any intrinsic
causal relations."42
There are other important questions related to these
issues which Hume does not attempt to answer: 1) How can
we know that a bundle of experiences reflect a single
mind? 2) What does it mean to say that a particular bundle
41John J. Jenkins, Understanding Hume. (Edinburgh:
Edinburgh University Press, 1992), 114.
42Ibid., 116.
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150
of perceptions are mine? 3) Why does Hume hold that
identity emerges out of diversity? And, more importantly,
how does identity emerge out of diversity?
The third criticism of Hume's view of the self is
that it is inconsistent with his theory of virtues. He
defines a virtue as "a quality of the mind agreeable to or
approved of by every one who considers or contemplates
it." In other words, the virtues are mental traits
discovered by the special feeling of moral approval which
is directed upon them.
Hume states further that "we do not infer a character
to be virtuous, because it pleases: But in feeling that it
pleases after such a particular manner, we in effect feel
that it is virtuous.43 According to Hume, then, both moral
distinctions and personal merit fall wholly within the
realm of feelings or sensations. It is worth noting his
comments on these two aspects.
On moral distinctions:
Examine it in all lights, and see if you
can find that matter of fact,, or real
existence, which you call vice. . . .
The vice entirely escapes you, as long as
you consider the object. You never can
find it, till you turn your reflection
into your own breast, and find a
sentiment of disapprobation, which arises
in you, towards this action. Here is
a matter of fact; but it is the object of
feeling, not of reason. It lies in
yourself, not in the object. So that
when you pronounce any action or
43Hume, Treatise. 471.
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151
character to be vicious, you mean
nothing, but that from the constitution
of your nature you have a feeling or
sentiment of blame from the contemplation
of it. Vice and virtue, therefore,
may be compared to sounds, colours, heat
and cold, which, according to modern
philosophy, are not qualities in objects,
but perceptions in the mind. . . .4 4
On personal meriti
We shall consider every attribute of
mind, which renders a man an object
either of esteem and affection, or of
hatred and contempt; every habit or
sentiment or faculty, which, if ascribed
to any person implies either praise or
blame, and nay enter into any panegyic or
satire of his character and manners . . .
he needs only enter into his own breast
for a moment, and consider whether or not
he should desire to have this or that
quality ascribed to him.45
This theory of the virtues presents a problem for
Hume in that it presupposes the existence of a self.
Since a virtue is not an object in itself, but is only an
object of the sentiment of moral approbation, then a self
is needed in order for virtues to exist. According to
Hume, there would be no moral distinctions if human beings
did not exist. Therefore, his theory of virtues is not
logical without a personal identity.
Hume argues that there is "nothing about the nature
of the perceptions of experiences that 'pass before the
44D.D. Raphael ed., British Moralists: 1650-1800.
(Indianapolis: Hackett Publishing Co., 1991), 18-19.
4SA.I. Melden, ed. Ethical Theories: A Book of Readings.
(Englewood Cliffs: Prentice-Hall, 1967), 276.
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152
mind' that can in itself dictate that there must be a soul
or self standing behind them." However, his own theory of
virtues demands that a self must be "standing behind
them."
Hence, in reality it seems that Hume's entire moral
philosophy falls to the ground if there is no self. It is
evident, then, that there are many difficulties associated
with Hume's view of personal identity, many of which he
himself had reservations about.
Substance and DNA. With the recent genetic
revolution, there has been a renewed interest in
Aristotle's theory of substance. In the 1970's, Max
Delbruck delivered an address entitled, "How Aristotle
Discovered DNA." In his talk, he argues that "the
Aristotelian concept of Form is remarkably similar to the
modern concept of a genetic program-- a preimposed plan
according to which the embryo develops into an adult."46
B.C. Goodwin of the University of Sussex points out
that Aristotle understands that a living thing cannot be
grasped from an analysis of its physical parts alone.
Instead, it must be understood in terms of a "principle of
organization," a Form that governs the development of that
organism.
46Quoted in Nancy Pearcey and Charles B. Thaxton, The Soul
of Science. (Wheaton: Crossway Books, 1994), 236.
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153
Goodwin goes on to state that "Aristotle was correct
to insist that something like formative "ideas," different
in some sense from ordinary physical matter, must guide
the intricate and extraordinary varied formative processes
of organic nature."47
Ernst Mayr comments that philosophers and physicists
are "completely deaf to the assertions of naturalists such
as Aristotle that something more than the laws of physics
was needed to produce a frog from a frog egg or a chicken
from a chicken egg."48 Praising Aristotle further, Mayr
says,
Only when the dual nature of living
organisms was fully understood in our
time was it realized that the blueprint
of development and activity, the
genetic program, represents the formative
principle which Aristotle had
postulated.49
Jeremy Campbell also gives Aristotle credit for
anticipating information theory. "Plan, purpose, and
information were among the active forces Aristotle saw at
work in nature. DNA represents a coded model of a
biological goal. ... It is the form of the matter."50
47B.C. Goodwin, "Biology and Meaning," in Towards a
Theoretical Biology vol.4, ed., C.H. Waddington (Edinburgh:
Edinburgh University Press, 1972), 269.
48Ernst Mayr, The Growth of Biological Thought: Diversity.
Evolution, and Inheritance. (Cambridge: Harvard University Press,
1982), 88-90.
49Ibid., 88-90.
50Jeremy Campbell, Grammatical Man: Information. Entropy.
Language, and Life (New York: Simon and Schuster, 1982), 16.
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154
Both dated and recent scientific literature on
modern genetics show that some biologists and philosophers
have seriously considered the possibility that Aristotle
may have been correct in his view of substance.51 The
organcentric view, as it is commonly referred to in the
literature, holds that living organisms are irreducible
wholes in which are the fundamental units of
morphogenesis, the autonomous centers of action and
creativity.
On this view, DNA plays the role of specifying the
patterns for making the material (proteins) to be used in
assembling the organism. Genes play a role in stabilizing
certain aspects of the spatial and temporal order of
development, but they do not generate that order.52
There are at least two arguments which seem to
support the organcentric view. First, the functions of
DNA require the coordinated activity of several complex
molecules, and these functions can occur only within the
context of an entire cell. "The feedback process between
51See, for example, J.M. Barry, "Informational DNA: A Useful
Concept?" Trends in Biomedical Sciences 11 (1986): 317-318; Brian
C Goodwin, "What Are The Causes of Morphology?" BioEssays 5
(1985): 32-36; Michael Locke, "Is There Somatic Inheritance of
Intracellular Patterns?" Journal of Cell Science 96 (1990): 563-
567; Michael Polanyi, "Life's Irreducible Structure," Science
160 (June 1968): 1308-1312; Richmond T. Prehn, "Cancers Beget
Mutations Verses Mutations Beget Cancers," Cancer Research 54
(October 1994): 5296-5300; Jonathan Wells, "The History and Limits
of Genetic Engineering, " International Journal on the Unity of
the Sciences 5 (Summer 1992): 137-150.
“Moreland and Rae, Body and Soul. 211.
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155
DNA and the rest of the cell is species-specific: it is
unique to each species, and it depends on the nature of
the specific organism for its distinct activity."53
Second, within a single-cell zygote, there is
copresent with DNA an extra "material" without which the
DNA is biologically inert.54 This finding has led many
biologists to consider that the organcentric view may have
some plausibility.
Free Agency. When it comes to morality, it is
difficult for the Baconian view of human being to make
sense of moral obligation and responsibility. If this
view is correct, then determinism seems to be true as
well. The reason for this is if we are just a physical
system, there is nothing in us that has the capacity to
freely choose to do something.
Those who hold to the Baconian view of human being
seem to presuppose the freedom of the will. But, if this
view is correct, then it seems to require a radical
revision of our common sense notions of freedom, moral
obligation, and responsibility.
What is required for libertarian free will is agent
causation. Aristotle's view of human being can account
for agent causation because the agent is the substance
53Ibid., 211.
54Jonathan Wells, "The Dogma of DNA," Bible Science News
31 no.8 (1993), 13.
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156
that stands under and informs our physical component to
complete any and every action or thought.
Personal Identity. Unlike the Baconian view of human
being, Aristotle's understanding of human being points to
the existence of an absolute personal identity. There are
two basic arguments that support this idea that an
absolute personal identity exists. First, there is a
basic awareness of the self. If we pay attention to our
own consciousness, we are aware of our own self as being
distinct from any particular mental experience we have.55
The second argument has to do with the idea that the
first person is not reducible to the third person. No
amount of third person descriptions completely captures
our own subjective, first person acquaintance with
ourselves. When we use the term, "I," it usually refers
to our own self; it does not refer to, as Hume argued, any
mental property or bundle of mental properties. Rather,
"I" usually refers to our own self with which we are
directly acquainted and which we know to be the possessor
of our mental states and our bodies.56
Aristotle's theory of substance supports the idea
that persons do maintain absolute personal identity
through change. As J.P. Moreland points out, "this is
55J.P. Moreland and David M. Ciocchi, Christian Perspectives
On Being Human. (Grand Rapids: Baker Book House, 1993), 71.
56Ibid., 71.
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157
because they have, in addition to their bodies and current
mental experiences or mental capacities a soul that
remains constant through change, and personal identity is
constituted by sameness of soul, not sameness of body or
mental abilities like memory."57
Genetic Enhancements. Whereas the Baconian
understanding of human being creates a tension with regard
to the use of genetic enhancements, Aristotle's view does
not seem to encounter the same kinds of problems.
From an Aristotelian perspective, what is distinctly
human (e.g., the soul and the properties belonging to the
soul) cannot be altered by genetic engineering because the
self is a substance that cannot be changed by any kind of
manipulation. As French Anderson points out:
If what is uniquely human about us is
something beyond our physical structure—
if it is not our body, or our mind, or
any collection of measurable traits, but
rather something profound and
unmeasurable— then, since genetic
engineering can only alter our physical
structure, we cannot alter that which is
uniquely human, i.e., our soul, by
scientific technology.58
However, this does not mean that what is done to our
physical structure does not have an effect on the
immaterial part of us. Whatever happens to the body does
influence the immaterial part of us; but manipulation of
57Ibid., 70.
58French Anderson, Genetic Engineering and Our Humanness.
758.
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158
bodily parts does not change our essence, as would be the
case if we were strictly physical beings.
Also, vulnerability plays a vital role in Aristotle's
overall ethical framework. For Aristotle, vulnerability
is an essential part of what it means to be human. Since,
therefore, vulnerability is an integral part of what it
means to be human, it should not be resisted. Fate and
contingency, which expose our vulnerabilities, are not to
be feared or avoided, but embraced. For Aristotle, in
some deep sense, the vulnerabilities that are exposed by
natural necessity are what make happiness, our ultimate
end, possible.
The point is that Aristotle's entire ethical theory
is based on his understanding that human beings are
substances which have an ultimate end. The will, which is
a property of the substance, cannot be genetically
enhanced. The will is the key factor in enabling human
beings to reach their true end (e.g., perfect virtue and
therefore happiness).
From an ethical standpoint, this has enormous
implications for the body. The human body is not just a
system of externally related parts, but a whole unit of
internally connected parts moving toward an ultimate end.
To put it another way, happiness (in the Aristotelian
sense) is actually a part of the internal structure of the
human being.
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159
Standard forms of bioethics, on the other hand, are
informed by and participate in the Baconian project, which
is based on the Baconian view of human being. On this
view, human beings are not internally guided by an
ultimate end. The human body, then, does not have the
same moral significance that it does in the Aristotelian
perspective. Vulnerabilities and the contingencies that
expose them are generally viewed as pointless and seen as
things to be resisted. In this Baconian framework,
genetic enhancements can be seen as one form of salvation
from unnecessary suffering.
To sum up, one of the fundamental differences between
the Aristotelian theory and standard forms of bioethics is
the view of human being. The overall goal of the former
is happiness as the full development of moral and
intellectual virtue; the overall aim of the latter, having
no structured end in view, is relief from human suffering
and the expansion of human choice.
While the Baconian understanding of human being is
the dominant view today, the strengths associated with the
Aristotelian view make it reasonable to assume that an
ethical theory based on the latter could provide some
solid moral guidelines for the use of genetic
enhancements. The Aristotelian view also has implications
for the purpose of medicine. We turn now to consider
them.
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Chapter 6
The End of Medicine: Rediscovering "Health" in Aristotle
The End of Medicine?
To speak about a proper end of medicine almost seems
out of place today. The rapid advances in medical
technology have made it seem nearly impossible to consider
that medicine could serve one particular end. To take it
one step further, Leon Kass has contended that the way in
which medicine is explicitly studied and practiced today
makes it difficult to argue that medicine is inherently a
moral activity.1
Kass further points out that, in light of the
incredible technological advances in medicine today, it
might be legitimately argued that medicine, like any other
technique or skill or art, is morally neutral; that it
does not itself bind character. It can be used for good
or for bad, depending on the character of the one who uses
it.
Proof for this claim that medicine is morally neutral
could be found in the fact that our modern medical
sciences of the workings of the human body do not even
tell us that health is good and disease is bad. According
to the scientific view of nature, disease is just as
1Leon Kass, Toward a More Natural Science. (New York: The
Free Press, 1985), 216.
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161
natural as health in that they both obey the laws of
nature.2
For these reasons, modern medicine could possibly be
considered morally neutral. That is to say that modern
medicine could be considered not to have a proper telos.
The Principles of Ethics adopted by the American Medical
Association seems to lend some support to this idea in
that they contain no mention of a proper end:
I. A physician shall be dedicated to providing
competent medical service with compassion
and respect for human dignity.
II. A physician shall deal honestly with patients
and colleagues, and strive to expose those
physicians deficient in character or
competence, or who engage in fraud or
deception.
III. A physician shall respect the law and also
recognize a responsibility to seek changes
in those requirements which are contrary to
the best interests of the patient.
IV. A physician shall respect the rights of
patients, of colleagues, and of other health
professionals, and shall safeguard patient
confidences within the constraints of the
law.
V. A physician shall continue to study, apply
and advance scientific knowledge, make
relevant information available to patients,
colleagues, and the public, obtain
consultation, and use the talents of other
health professionals when indicated.
VI. A physician shall, in the provision of
appropriate patient care, except
emergencies, be free to choose whom to serve,
with whom to associate, and the environment
in which to provide medical services.
2Kass, Toward a More Natural Science. 216.
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162
VII. A physician shall recognize a responsibility
to participate in activities contributing to
an improved community.3
These AMA Principles primarily deal with the
physician's relation to society: respect for law, respect
for rights within the law, and obligations to improve
communities. These statements really coincide with the
view that modern medicine is a morally neutral set of
skills and services whose only internal standard is
technical competence and whose moral standards must come
from the outside.
It is important to point out here that the omission
of any reference to an end of medicine in these Ethical
Principles reflect in an uncanny way the enduring impact
of the Enlightenment era on science and technology. In
fact, it is relatively safe to say that modern medicine's
rejection of ends can be traced back directly to Bacon's
arguments about the relationship between the technical
arts and nature.
As was pointed out in previous chapters, Bacon (and
many after him) basically understood two things about the
technical arts: (1) they are of the same essence or "form"
as nature (although he really rejects the Aristotelian
notion of form and focuses instead on function) and (2)
3American Medical Association Principles of Medical Ethics,
as published in the 1996-1997 Edition of the "American Medical
Association Council on Ethical and Judicial Affairs Code of
Medical Ethics: Current Opinions with Annotations."
http://www.physics.swin.edu.au/studes/ethics/AMA-EthP.html
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163
they are to be used by human beings to conquer nature in
order to better human lives. (Indeed, for Bacon, if
nature and art are not of the same essence, then art could
not be used for the betterment of human lives.)
In order to conquer nature through the arts, human
beings need to become the servants and interpreters of
nature. In other words, for the conquest of nature to be
feasible, it must be open to interpretation and
manipulation from the outside. If nature has a telos,
then interpretation and manipulation from the outside is
not possible.
The same is true of the technical arts. If medicine
(a technical art), for instance, has a distinct end which
it is meant to serve, then interpretation and manipulation
from the outside is not possible. This, in turn, means
that the ambitious goals of the Baconian project cannot be
achieved. Nature must be conquered in order to relieve
the human condition; but it cannot be conquered if nature
and the technical arts have distinct ends.
So, in light of this, it makes sense that large
segments of modern medicine would deny the idea of ends.4
In fact, it could be argued that medicine could not have
4This is not to say that all physicians have denied that
there is a proper end of medicine. See, for example, Eric
Cassell, The Nature of Suffering and the Goals of Medicine. (New
York: Oxford University Press, 1991) ; Edmund Pellegrino and David
C. Thomasma, The Virtues in Medical Practice. (New York: Oxford
University Press, 1993); David C. Thomasma and Judith Lee Kissell,
eds., The Health Care Professional as Friend and Healer.
(Washington D.C.: Georgetown University Press, 2000).
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164
advanced to this point if it was understood to have a
particular end. Advances in medicine have made enormous
strides in the effort to relieve the human condition and
have improved the lives of many people. Who could argue
that this is not good?
Indeed, no one could deny the good that has been
accomplished through modern medicine. However, when the
purposes of medicine, especially biomedicine, are open to
the dictates and agendas of society, there are bound to be
problems.
Medicine - A Distinct End = Social Power
Bacon and Descartes foresee that biomedical advances
play an important role in the effort to overcome natural
necessity. But, because these biomedical advances have
entered society through the practice of medicine, the
potential dangers associated with them are less apparent.
The problem, however, is not biotechnology per se,
but the capacity of biotechnology to intervene into human
nature through the control of the body. This makes it
almost impossible to derive from nature what constitutes
the ultimate human good. Consequently, we have no reason
not to welcome the new biotechnologies and their control
over the body as tools of our desires and wishes.
The danger here, however, is that, being untutored by
any conception of natural human excellence, we have no way
to ensure that our biotechnologies will serve, rather than
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165
destroy, human nature.5 The upshot of this is that we as
a society have given modern medical science an enormous
amount of power. I believe this problem can ultimately be
traced back to two of Bacon's major claims: 1) Form and
telos do not exist; 2) There is no distinction between
nature and art.
What is interesting to point our here is that, to
some degree, Bacon's denial of form and his blurring of
the distinction between nature and art have not allowed
human beings to fully "dominate" nature as he intended.
Instead, in a strange ironic twist, the consequence of his
two assertions is that, in our day, technology exercises
an extraordinary amount of power over human beings.
Consider that we as a society have defined the
purpose of biomedicine and have to a large degree used it
for our benefit. Biomedicine, in turn, however, has
exercised authority over us to such an extent that we have
allowed it to define who we are in relation to those
purposes. For if both nature and art lack a distinct
telos and are open to interpretation and manipulation from
the outside, this irony is really unavoidable.
The incongruity is also apparent in that Bacon's
blurring of the distinction between nature and art has
actually created a distinction between the two, one in
5Basic idea derived from McKennv. To Relieve the Human
Condition. 109.
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166
which the technical arts gain the upper hand. For there
seems to be little question that in our day we have given
science and technology tremendous power over our self-
understanding .
Anne Foerst, a theologian and researcher for MIT,
recently appeared on CNN's Talk Back Live. In the wake of
the success of the Human Genome Project, she and several
other scholars were discussing issues related to the human
genome, religion, and ethics. At one point in the
conversation, Foerst points out the extent to which
science and technology have exercised power over the
American people:
This society is so keen on science and
technology. And a lot of people give
science and technology so much power over
their self-understanding that now, with
all this hype about the human genome,
they tend to think that scientists really
tell us what it means to be human, what
it means to be a person.6
Two of the most prominent definitions of health even
reflect this enormous power we have given to medical
science and technology. As I mentioned in Chapter 2,
while there is no one universally accepted conception of
what health is, the following two views have come to the
forefront: 1) Health is a state of complete physical,
6Talk Back Live, June 26, 2000.
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167
mental, and social well-being;7 2) Health is freedom from
disease.8
The first definition seems to equate health with
happiness. If this is a correct assumption, then it can
be safely deduced that it is the duty of medicine to
maintain our happiness. If we become unhappy, either
physically, mentally, or socially, then it is medicine's
job to make sure that we become happy again. Needless to
say, this gives medicine a tremendous amount of control
over our lives.
The second definition also gives medicine immense
power over our lives, but in a much more subtle way. The
focus of this definition is on disease. In general,
difference, abnormality, and/or deviancy are often equated
with disease. In other words, it is often thought that
difference, abnormality, and/or deviancy are an indication
of disease.9
Many medical sociologists have examined this "disease
as deviancy" model and fear that it reflects a trend in
which medicine is beginning to take responsibility for far
7A paraphrase of the WTO's definition of health.
8As I discussed in Chapter 2, Norman Daniels is perhaps one
of the most enthusiastic defenders of the "freedom from disease"
view. On this view, "disease and disability are seen as
departures from species-typical normal functional organization or
functioning."
9Even Norman Daniels view that, "disease and disability are
seen as departures from species-typical normal functional
organization or functioning" is essentially the understanding that
disease is deviance from the normal.
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168
too many deviant behaviors. Thomas Szasz makes the
following observations:
Starting with such things as syphilis,
tuberculosis, typhoid fever, and
carcinomas and fractures we have
created the class, "illness." At first,
this class was composed of only a few
items all of which shared the common
feature of reference to a state of
disordered structure or function of the
human body as a physical-chemical
machine. As time went on additional
items were added to the this class. They
were not added, however, because they
were newly discovered bodily disorders.
The physician's attention has been
deflected from this criterion and
has become focused instead on disability
and suffering as new criteria for
selection. Thus, at first slowly, such
things as hysteria, hypochondriasis,
obsessive-compulsive neurosis and
depression were added to the category of
illness. Then with increasing zeal,
physicians and especially psychiatrists
began to call "illness" . . . anything
and everything in which they could detect
any sign of malfunctioning, based on no
matter what the norm. Hence agoraphobia
is illness because one should not
be afraid of open spaces. Homosexuality
is an illness because heterosexuality is
the social norm. Divorce is illness
because it signals failure of
marriage.10
Considering this disease as deviancy model from a
sociological standpoint reveals some interesting insights
10Szasz, Thomas, The Myth of Mental Illness, rev. ed. (New
York: Harper and Row, 1974), 44-45. See also Bryan S. Turner,
Medical Power and Social Knowledge. (London: Sage, 1987) ;
Regulating Bodies: Essavs in Medical Sociology, (London:
Routledge, 1992); The Body and Society. 2nd ed. (Oxford:
Blackwell, 1996).
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169
into the ways in which a definition of health, which
focuses on disease, can translate into social power.
In his highly complex and thought-provoking book, The
Social System, Talcott Parsons argues that sickness is
dysfunctional or deviant because the person who is sick is
removed from normal social responsibilities:
Certainly by almost any definition health
Is included in the functional needs of
the individual member of the society so
that from the point of view of
functioning of the social system, too low
a general level of health, too high an
incidence of illness, is dysfunctional.
This is in the first instance because
illness incapacitates for the effective
performance of social roles.11
Parsons claims further that the function of the
medical system in society was to reduce this deviancy or
dysfunction and change the conditions which interfere with
conformity to social norms. In order to more clearly
communicate this idea, Parsons introduces the idea of the
sick role. This concept ultimately grew out of his larger
analysis of the function of medicine in society.
Heavily influenced by Durkheim's functionalist theory
of society, Parsons seeks to show how social systems,
including the system of medicine, were connected to
systems of personality and culture and how they worked
together to create social order.
nTalcott Parsons, The Social System. (New York: The Free
Press, 1951), 430.
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170
In light of this, Parsons argues that a sick person
violated social norms, but not in the same way as a
criminal. A criminal violates social norms voluntarily
while a sick person cannot help it. There are four
components to the sick role:
1) The sick person is exempt from "normal" social roles.
2) The sick person is not responsible for his or her
condition.
3) The sick person should try to get well.
4) The sick person should seek technically competent help
and cooperate with the physician.1 2
In order to develop his view on the role of the
physician within this idea of the sick role, Parsons draws
from Max Weber's understanding of the role of the
priesthood. Weber's definition of the priest includes two
parts: 1) a priest is part of a permanent social
enterprise in which he/she influences the gods; 2) a
priest is equipped with "special knowledge, fixed
doctrine, and vocational qualifications."13
These two aspects give the priest enormous power over
the laypeople. Not only does he/she represent God, but
also he/she is given the responsibility to make sure the
common people behave according to God's commands. That
12Parsons, Social System. 436-437.
13Max Weber, Sociology of Religion (Boston: Beacon Press,
1922), 28-29.
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171
is, because of his/her unique qualifications, the priest
is perceived as the moral authority, one who is to be
obeyed and respected.
Parsons utilizes Weber's description of the priest by
applying it to the role of the physician. The physician
is part of the medical institution; therefore, he/she is
invested with the function of social control and
responsible to control deviance. The physician also has
special knowledge and unique qualifications. Thus,
physicians have been given the duty to correct the
abnormality and restore the person to their social roles.
Now, it can be argued that Parson's concepts are not
valid in the contemporary medical setting because the
physician does not hold the same kind of authority that
he/she once did. In the modern medical scheme, the
paternalistic model of the physician/patient relationship
has been replaced by a more egalitarian approach. In
fact, the preeminence of the principle of autonomy would
seem to support this argument.
While this may be true to some extent, Anne Foerst's
observations concerning society's sustained willingness to
give medical science and technology power to such an
extent that we look to these institutions for our self-
understanding cannot be ignored. In fact, it can almost
be argued that it is a self-evident fact that there are
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172
large segments of society which willingly bow to the
authority of medical science and technology.1 4
In summary, then, it seems to be clear that one of
the major consequences of Bacon's two claims, 1) Form and
telos do not exist; 2) There is no distinction between
nature and art, is that modern medical science and
technology have a tremendous amount of social power.
The possibility of abuse of such power, especially in
the arena of genetic enhancement technologies, is serous
enough, I think, to warrant a consideration of Aristotle's
view of the purpose of medicine.
Aristotle and the End of Medicine
From the outset, it is important to point out the two
primary challenges posed by modern science and
biotechnology to an Aristotelian (teleological) concept of
nature. First, as it was pointed out in the previous
section, modern science dismisses the idea of form by
explaining the workings of nature strictly in terms of its
mechanical and chemical dynamics. Second, Darwin's theory
of evolution explains "form" simply as the preservation by
natural selection of chance variations.15
“There are, however, many activists groups which openly
challenge medicine and its authority.
lsFor a more in-depth discussion on these two challenges
posed by modern science, see McKenny, To Relieve the Human
Condition. 120-123.
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173
Two things can be said about this. First, the
discussions on form in the previous chapters are
sufficient to show, I think, that the Aristotelian
understanding of the essence and function of form is that
1) it is distinct from matter; 2) it is vital to the
existence and flourishing of living organisms.
Darwin's explanation reduces form to the preservation
by natural selection of chance variations. These
variations, according to Darwinian theory, "create"
individual organisms and species. Not only does this
explanation of form fail to capture the Aristotelian idea
of form, but it is really no different than explaining
organisms in strictly materialistic terms.
To put it another way, on Darwin's view, there really
is no distinction between form and matter. They are
essentially one in the same thing in the sense that they
are both used interchangeably to explain nature in terms
of the materials and mechanisms which make up nature.
Furthermore, this blurring of distinction between form and
matter does not actually disprove the Aristotelian idea of
form, but is simply another way of describing nature in
materialistic terms.
Second, pre-Enlightenment thinkers such as Bacon,
Descartes, Hobbes, and Hume drive form (or teleology) from
our ordinary conception of nature not because evidence
proved it was untenable to hold to such an idea, but
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174
because their new philosophies requires a nature devoid of
form. That is, it required a nature that would be open to
human interpretation and manipulation.
After all, if there is in living organisms a form
leading to an ultimate end, as Aristotle asserts, then it
follows that nature (including human nature) is not open
to interpretation and/or definition from the outside.
This, in turn, means that conquest, domination, and
manipulation of nature for human purposes is not truly
possible.
To put it more succinctly, if there is no form in
living organisms, then it follows that there is no
ultimate telos. Nature, then, is open to interpretation
and manipulation for human purposes. If this is the case,
then the Baconian goal to conquer nature in order to
overcome fate and natural necessity is an actual
possibility.
Since the pre-Enlightenment thinkers had as one of
their main objectives the conquest of nature, the
Aristotelian idea of form had to be rejected. But this
rejection was based not on valid proof that form did not
exist, but on the grounds that their new philosophies
required a nature devoid of form.
Leon Kass also traces this problem of the "nature" of
nature back to these pre-Enlightenment thinkers. In his
book, Toward A More Natural Science, he asserts that
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175
modern science, with its emphasis on efficient and
material causes (how things work), makes it impossible to
derive moral significance from nature. This is because
modern science ignores formal and final causes (what and
why things are). Thus, Kass argues for the primacy of
Aristotelian forms because the "what" of a being and the
"why" of individual beings are crucial to a proper
understanding of nature.16
The weaknesses associated with the strictly
materialistic understanding of nature which were
identified in the previous chapters seem to leave open the
door for a consideration of an Aristotelian viewpoint.
But some questions still remain: Is an Aristotelian ethic
of vulnerability capable of deriving from nature
guidelines for determining which genetic enhancements are
in accordance with human fulfillment and which take away
from it? Is it capable of deriving from nature ethical
content substantive enough to ground a view of human
flourishing?
16See Leon Kass, Toward A More Natural Science. (New York:
The Free Press, 1985), 1-42.
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I believe that it is.17 In order to examine the
validity of such an argument, we must first consider
Aristotle's claim that medicine aims at health.
Health as the End of Medicine
In Nicomachean Ethics, Aristotle confidently claims
that medicine aims at health:
Now, as there are many actions, arts, and
sciences, their ends also are many; the
end of the medical art is health.
. . . Let us again return to the good we
are seeking, and ask what it can be. It
seems different in different actions and
arts; it is different in medicine, in
strategy, and in the other art likewise.
What then is the good of each? Surely
that for whose sake everything else is
done. In medicine this is health
18
In the Aristotelian tradition, Leon Kass, one of the
leading proponents of applying an Aristotelian viewpoint
to biomedicine, asserts that "the healthy human being is
the end of the physician's art."19 He points out, however,
that many argue that health is not the only reasonable
goal for medicine. But Kass regards these other goals as
false goals and their pursuit as perversions of the art.
17I must qualify this statement and say that I believe
Aristotle's ethical theory provides a necessary, but not
sufficient grounds for a comprehensive ethical consideration of
genetic enhancements. I think religion plays a vital role in
determining whether or not a particular genetic enhancement is
ethical. But a treatment of religious considerations is beyond
the scope of this essay.
18
Aristotle, Nicomachean Ethics. trans. David Ross
(Oxford: Oxford University Press, 1925), 1094a, 1097a. Emphasis
mine.
19Kass, Toward a More Natural Science. 159.
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Ill
According to Kass, happiness is a false goal for
medicine. We saw in the previous section that one of the
primary definitions of health (health is complete
physical, mental, and social well-being) can be equated
with happiness. For Kass, however, happiness, or what
might best be called "pleasure," is the idea of
"gratifying or satisfying patient desires, producing
contentment."20 The aim of medicine should not be the
satisfying of a patient's reasonable wishes. For those
are acts not of medicine but of some sort of indulgence in
that they aim at pleasure and not at health.
Social adjustment, obedience, or moral virtue is also
a false goal for medicine. These are jobs for parents,
legislators, the clergy, and the community as a whole, not
to mention individuals themselves. Kass doubts that the
physician has the authority and competence as a physician
to complete these goals.21
The alteration of human nature is, for Kass, another
inappropriate end for medicine, "whether it be a proposal
by a psychologist for pills to reduce human
aggressiveness... the suggestions of some geneticists for
eugenic uses of artificial insemination, or the more
futuristic and radical visions of man-machine hybrids."22
20Ibid., 159.
21Ibid., 160.
22Ibid., 161.
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Theses goals are not the proper goals for the healing
profession.
Finally,, Kass claims, with some misgivings, that one
more false goal of medicine is the prolongation of life or
the prevention of death. While this is a prominent and
popular goal for medicine, Kass suggests that doctors keep
their eye on their main business, "restoring and
correcting what can be corrected and restored, always
acknowledging that death will and must come, that health
is a mortal good, and that as embodied beings we are
fragile beings that must snap sooner or later, medicine or
no medicine."23
To sum up, then, Kass makes the following
observations about health and the end of medicine:
Health is different from pleasure,
happiness, civil peace and order, virtue,
wisdom, and truth. Health is possible
only for mortal beings, and we must seek
it knowing and accepting, as much as we
are able to know and accept, the
transience of health and of the
beings who are healthy. To serve health
and only health is a worthy profession,
no less worthy because it does not serve
all other goods as well.24
The next question which naturally flows from the
above discussion is this: What is meant by health. In
keeping with the Aristotelian tradition, Kass describes
health in the following way:
23Ibid., 163.
24Ibid., 164.
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Health is a natural standard or norm—
not a moral norm, not a "value" as
opposed to a "fact," not an obligation—
a state of being that reveals itself in
activity as a standard of bodily
excellence or fitness, relative to each
species and to some extent to
individuals, recognizable if not
definable, and to some extent attainable.
. . . Health is the well-working of the
organism as a whole, or again, an
activity of the living body in accordance
with its specific excellences.25
The English word "health" literally means
"wholeness." This definition of health is basically
derived from two Ancient Greek words: hygieia and euexia.
Hygieia, from which we derive the English word, hygiene,
means "living well" or "well way of living." Euexia
literally means "well-habited-ness" or "good habit of
living. "26
This Greek view of health corresponds to the Greek's
understanding that human beings are "whole" organisms.
Probably the best evidence that human beings are wholes is
our amazing ability to self-heal. In fact, all living
things display remarkable powers to heal wounds or breaks.
This incredible inner drive to self-heal apparent in
nearly all living organisms is ultimately a move toward
wholeness.
Medicine has long made use of the human body's own
healing powers. Vaccines, for example, work by boasting
25Ibid., 173-174.
26Ibid., 170.
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180
the body's immune system. But there is a new medicine on
the horizon, which the new discoveries in genetics and
stem cell biology is making possible. Regenerative
medicine, as it is sometimes referred to by the experts,
would put to use some of the same agents the body uses to
repair itself: cells and chemical signals.
Ronald McKay, an expert on neural stem cells at the
National Institutes of Health, claims that the body's
tissues are "self-assembling, once their source or stem
cells are given the right cues."27 Based on this
observation, McKay makes the following prediction:
In a few months it will be clear that
stem cells will regenerate tissues.
... In two years, people will
routinely be reconstituting liver,
regenerating heart, routinely building
pancreatic islets, routinely putting
cells into the brain that get
incorporated into the normal circuitry.
They will routinely be rebuilding all
tissues .28
Much more than traditional medicine, then,
regenerative medicine is based on the idea that the human
body has a tremendous capacity to heal itself. This lends
strong support to the notion that living organisms are
wholes and to the concept that health is the well-working
of the organism as a whole.
27Nicolas Wade, "Teaching the Body to Heal Itself," New
York Times. 7 November 2000, 1(D).
28Ibid., 1(D).
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As strong as this support may be, it is important to
point out here that two primary objections could be raised
against the use of a Greek view of health in modern
medicine: 1) Health is relative not only to the age of the
person, but also to external circumstances.29 2) The
Aristotelian definition of health assumes a "Greek"
question.
The relativist view understands the concept of health
to be dependent on time and circumstance, and on custom
and convention. In other words, "health" is based on
human valuation, not on some natural norm.
In his article, Illness: Mental and Otherwise, Peter
Sedgwick, a strong supporter of the relativist view,
claimed that "all sickness is deviancy" and that illness
and disease, health and treatment are "social
constructions." Although he made these comments in the
1970’s, the view is still held by many in the medical
field today. Therefore, his words are worth quoting:
All departments of nature below the level
of mankind are exempt both from disease
and from treatment. The blight that
strikes at corn or at potatoes is a human
invention, for if man wished to cultivate
parasites rather than potatoes (or corn)
there would be no "blight" but simply the
necessary foddering of the parasite-crop.
Animals do not have diseases either,
prior to the presence of man in a
meaningful relation with them.
. . . Outside the significance that man
voluntarily attaches to certain
29Kass, Toward a More Natural Science. 168.
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conditions, there are no illnesses or
diseases in nature. . . . Out of his
anthropocentric self-interest, man has
chosen to consider as "illnesses" or
"diseases" those natural circumstances
which precipitate the death (or the
failure to function according to certain
values) of a limited number of biological
species: man himself, his pets and other
cherished livestock, and the plant-
varieties he cultivates for gain or
pleasure. . . . Children and cattle may
fall ill, have diseases, and seem as
sick; but who has ever imagined that
spiders or lizards can be sick or
diseased? . . . The medical enterprise
is from its inception value-loaded; it is
not simply an applied biology, but a
biology applied in accordance with the
dictates of social interest.30
Sedgwick's views are ultimately rooted in the
Enlightenment notion that ends do not exist. Therefore,
his argument essentially rests on the view that all goods
are good because they are valued and values are always
tied, to one degree or another, to either a culture or an
individual. Now, it is true to a certain degree that
different cultures have somewhat different notions of
diseases and of what constitutes health. However, the
mere fact that cultures all over the world practice some
form of medicine strongly suggests that health and disease
are not simply social constructs. On the contrary, it
30Peter Sedgwick, "Illness: Mental and Otherwise," Hastings
Center Studies. 1 (1973): 30-31.
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seems to imply that health is valued because it is a good,
and not something that is good because it is valued.31
The second objection to the use of a Greek view of
health in modern medicine points out that this definition
assumes a Greek question. This is quite true. However,
as I pointed in Chapter 1, when it comes to certain
ambitions and certain pursuits of perfection, there are
many parallels between us and the Ancient Greeks.
Furthermore, if "healthy" still essentially means
what it did in Ancient Greece, if the desire of the ill to
be whole is no different, and the relationship between
physician and patient is basically the same, then the
Greek view of health can still be considered valid in
modern medicine.
It is important to point out here, however, that even
if health is the end of medicine, we may have to go beyond
medicine in order to find the best means for attaining
it.32 In other words, the soul and its care is integral to
the health of the body.
In Plato's work, Charmides, Socrates criticizs Greek
physicians for neglecting the soul when attempting to heal
the body. He asserts that "just as one must not attempt
to cure the eyes without the head or the head without the
31My basic argument was derived from insights gleaned from
Kass, Toward a More Natural Science. 169.
32This is a conclusion reached by Kass in Toward a More
Natural Science. 174.
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body, so neither the body without the soul."33 The
argument is that if one intends to have a healthy body,
one must first care for the soul. If the soul is well-
ordered, it will not be difficult to attain health. But
if the soul is disordered, health will be difficult to
achieve.
Now, when Kass considers Socrates' claim, he rightly
points out that Socrates did not say that excellence of
soul and excellence of body are the same thing. Health
and moderation are clearly distinguished from one another.
Rather, the argument is that "health is at least in large
part affected by or dependent upon virtue, that being well
in body has much to do with living well, with good habits
not only of body but of life."3 4
Needless to say, the Greeks were well aware that fate
and natural necessity could bring great harm and illness
to even the most virtuous person. But the point is that
we are to a large degree responsible for our health.
Because of this, the virtues (especially moderation) play
an important role in our pursuit of health.
There is quite a bit of evidence to support the idea
that moderation does contribute to health. Dean Lester
Breslow and his colleagues at the UCLA School of Public
Health investigated various health practices on health
33Plato, Charmides. 156d-157a.
34Kass, Toward a More Natural Science. 175.
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185
status. They discovered, empirically, seven independent
rules for good health: 1) Don't smoke; 2) Get plenty of
rest; 3) Eat breakfast; 4) Watch your weight; 5) Exercise
regularly; 6) Drink in moderation; 7) Don't snack.35
Many of the diseases plaguing Americans today such as
diabetes, certain forms of colon and lung cancer, and
obesity are related to one degree or another with
lifesytle choices. Even if there is a genetic link to
these conditions and physicians are one day able to
perform genetic engineering to cure them, lifestyle
choices will always, to some extent, play an important
role in maintaining good health.
Now, this idea that the virtues and health are
intricately related is naturally linked to the Greek
notion that human beings are comprised of both form and
matter. Thus, both form and matter are factored into the
Greek definition of health.
In summary, then, the Ancient Greeks held that the
end of medicine is health. Health is defined as
"wholeness" or "a well way of living." Medicine's role is
to heal or make whole the person which is impaired or less
than whole. To claim that medicine has such an end is to
presuppose not only that medicine is an inherently moral
art, but that it is also a special activity.
35See William Cockerham, Medical Sociology. (Upper Saddle
River: Prentice Hall, 1998), 84-101; also see Kass, 176-177.
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In order to support this point, let us consider for a
moment the computer technician, the auto mechanic, and the
physician. All three of these skilled persons seek to
restore his or her "patient" to wholeness. All three of
their diagnoses will depend upon a good history, physical
examination and possibly some sophisticated tests. In
light of this, how can it be legitimately argued that
medicine is a special activity, an activity which is
different from these other skilled arts?
The difference between medicine and these other "fix-
it" arts36 is that medicine "fixes" living organisms; the
other arts fix ordered aggregates (or property-things).
As I mentioned earlier, under the Greek paradigm, the
human being is not an ordered aggregate, but a living
organism comprised of both form and matter. The human
being's ultimate end is happiness, which is intricately
related to the virtues. Precisely because of this, the
Greek picture of human beings includes the fact that they
vulnerable and susceptible to fate and natural necessity.
Under the Greek paradigm, then, the physician is
aware that he or she "shares the patient's vulnerability
and mortality, not only because the art of medicine rubs
his or her nose in the multifarious fragilities of the
flesh, but also because of his or her own humanity."37
36A term used by Kass in Toward a More Natural Science. 218.
37Ibid., 219.
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Hence, because medicine cares for living organisms,
and not for ordered aggregates, it can legitimately be
considered a special art, an art that should be guided as
much by the Hippocratic Oath as by the AMA Ethical
Principles. In saying this, I am not implying that those
who reject a Greek view of human being and of medicine are
incapable of identifying with the vulnerabilities of their
patients. Indeed, there are numerous examples in modern
medicine of physicians who hold very different worldviews,
but who can and do identify with their patient's
weaknesses.
What I am saying is that, by and large, modern
medicine and biotechnology view the human being as an
ordered aggregate. This is one of the primary reasons why
medicine is largely considered to be like any other "fix-
it" art. This is also why conversations about an end to
medicine seem so out of place in the modern medical
setting.
The influence of the Baconian project in this context
cannot be denied. If this is true, then the Baconian
drive to rescue humanity from fate and natural necessity
through biotechnological advances could prove to be too
much of a temptation to overcome.
The problem is that standard bioethics, because of
its participation in the Baconian project, may not be able
to provide an adequate context in which proper ethical
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188
reflection on biotechnologies such as genetic enhancements
can take place. What is needed, I think, is an ethic of
vulnerability, which has as its foundation the Greek
notion of the human being and of medicine.
I believe an ethic of vulnerability could be
beneficial in at least three ways: 1) It could provide a
rich context through which we can judge which genetic
enhancements would serve our moral projects and which
would not; 2) It could ensure that biotechnologies serve
human beings rather than vice versa; 3) It could provide a
safeguard against medicalization and an abuse of power in
the biomedical arena.
We turn now to explore these issues.
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Chapter 7
An Ethic of Vulnerability
Ethical Reflection Begins with the Agent
Dr. Rick Montz, a renowned gynecologic oncologist at
John Hopkins University, was asked in a recent interview
about how he perceived his role as a physician. The
following are his comments:
When I introduce myself to someone, I
say, "Hello, Mrs. so and so. I'm Rick
Montz. What can I do for you?" They
know I'm a doctor. But I wasn't born
with that name. It's not on my birth
certificate. It's not on my baptismal.
It's not on my confirmation. The title
is something I earned because my dad was
willing to write some checks and I was
willing to suffer. But I'm still a human
being. And that's who they come to.
They want the human being.1
It is safe to say, I think, that Montz is pointing out
the fact that women who have been diagnosed with some sort
of gynecologic cancer do not need first and foremost a
physician who will tell them their prognosis and his plan of
action. What they need is the sympathetic ear of a fellow
human being, even if that human being happens to be a male.
They want someone who can relate to them in their weakness
and vulnerability. As Montz has said, "They want the human
being."
Although his comments pertain primarily to his
understanding of his role as a physician, his focus on the
human being and on our needs and vulnerabilities is not
1ABC's Hopkins 24/7, September 13, 2000.
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190
unlike that of Aristotle's. For as the "human" aspect
stands at the center of Montz's theory of the
physician/patient relationship, so the human being is
central to Aristotle's ethical theory.
In her thoughtful book, The Morality of Happiness,
Julia Annas endeavors to show how a historical study of
ancient ethics, especially that of Aristotle, can be a
source of fresh insight into areas neglected by most modern
moral philosophies. In ancient ethical theories, the
agent's life as a whole, which includes character and
choice, practical reasoning and emotional responses, is
central rather than marginal. Annas makes some further
observations:
Ancient ethics ... is not based on the
idea that morality is essentially
punitive or corrective, the notion that
morality is a life harassed and
persecuted everywhere by imperatives and
disagreeable duties, and that without
these you have not got morality. Its
leading notions are not those of
obligation, duty and rule-following;
instead of these imperative notions it
uses attractive notions like those of
goodness and worth. Ancient ethical
theories do not assume that morality is
essentially demanding, the only
interesting question being, how
much does it demand; rather, the moral
point of view is seen as one that the
agent will naturally come to accept in
the course of a normal unrepressed
development.2
2Julia Annas, The Morality of Happiness. (New York: Oxford
University Press, 1993), 4-5.
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191
Aristotelian ethics, then, as a part of this genre,
centers on notions of happiness, of virtue, and of the
agent's deliberations about his or her life as a whole. The
fundamental question in this context is: How ought I to
live?
There are at least three major differences between the
Ancient Greek's understanding of ethical reflection and
standard bioethics.3 First, whereas the Ancient Greeks
began ethical reflection with the agent, standard bioethics
is really the product of several ethical traditions. Both
the principles of biomedical ethics and the principle-based,
common morality theories have drawn heavily from deontology
and consequentialism.
Now, as I stated in Chapter 1, ancient virtue ethics
does not provide us with a complete alternative ethical
framework. Therefore, rule-following, the notion of duty,
appeal to what is beneficial or useful does have a place
within Aristotelian virtue ethics. Beauchamp and Childress
point out, for example, the compatibility between the
principles of biomedical ethics and many of the moral
virtues. Respect for autonomy, nonmaleficence, beneficence,
and justice correspond nicely with respectfulness,
nonmalevolence, benevolence, and fairness.
3These three differences were derived from Annas, but I apply
them in very different ways. However, the basic outline of
differences was derived from her insights in The Morality of
Happiness, 7-10.
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However, the level of significance of these principles
is very different in Aristotelian ethical thought than it is
in standard bioethics. In Aristotle, questions concerning
how one ought to live would almost always take precedence
over questions concerning what one ought to do in a
particular situation. But, what is important to point out
here is that an Aristotelian ethic should not lead us to
reject notions like rule-following and appeal to benefit;
but it should cause us to rethink the role they ought to
play in ethical theory and the ways in which they relate to
virtue and goodness.
The second difference between Aristotle and standard
bioethics is that the latter makes a number of demands that
the former does not make. Standard bioethics often sees it
as a demand that it be able to give answers to hard cases in
a straightforward manner. The demand is that we identify
and systematize out of our moral thinking certain methods
for coming to ethical conclusions. This demand, in turn,
rests on the demand that ethics become more like the
physical sciences.
Aristotelian ethics makes no such demand. Hence,
because ancient virtue ethics fails to meet the modern
demands on casuistry, it fails to meet all our demands for
an ethical theory. However, it may just be shown that the
demand itself is a mistaken one, and that the methods of
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193
ethics are meant to be totally different from the methods of
science.
The third difference between Aristotle and standard
bioethics is that the latter is considered hierarchical and
complete while the former is not. Therefore, the former
cannot be considered an ethical theory per se. Annas
defines hierarchical as the idea that "some set of notions
is taken as basic, and the other elements in the theory are
derived from these basic notions."4 Consequentialism, for
example, "takes as basic the notion of a good state of
affairs, and then defines the notions of duty, and of the
admirable kind of person, in terms of this."5
Annas defines complete as the idea that "the theory
claims to account for everything in its area in terms of the
basic concepts and of other concepts insofar as they are
derived from the basic ones."6 Consequentialism, for
instance, "accounts for judgments we make about someone's
being cowardly, or hostile, in terms of good states of
affairs, and in terms of character insofar as that is seen
as a producer or inhibitor of the production of good states
of affairs."7
4Ibid., 7.
5Ibid., 7.
6Ibid., 8.
7Ibid., 8.
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Ancient virtue ethics is not hierarchical and complete.
The ideas of the agent's final end, of happiness and of the
virtues, the essential features of ancient ethical theory,
can be called primary, as opposed to basic. Annas
brilliantly describes the difference between primary and
basic. Her comments are worth quoting:
The notions of the agent's final end, of
happiness and of the virtues are what can
be called primary, as opposed to basic.
These are the notions that we start from;
they set up the framework of the theory,
and we introduce and understand the other
notions in terms of them. They are thus
primary for understanding; they establish
what the theory is a theory of, and
define the place to be given to other
ethical notions, such as right action.
However, they are not basic in the modern
sense: other concepts are not derived
from them, still less reduced to them.
For example, all ancient theories
understand a virtue to be, at least, a
disposition to do the morally right
thing; but the notion of the morally
right thing to do is not defined or
justified in terms of the disposition to
do what will produce or sustain the
virtue. We need to grasp in its own
right what is the morally right thing to
do. Indeed, if we do not do this, we
will not have understood what makes this
disposition a virtue, rather than some
disposition which does not involve
morality.8
In summary, then, a key idea in Aristotelian virtue
ethics is the agent's final good or telos. This is achieved
through the agent's reflection on his or her life as a
whole. The agent's ultimate end is taken to be happiness.
8lbid., 9.
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And, the virtues are central to happiness, according to
Aristotle.
A virtuous person is not just a person who does the
morally right thing, with the right feelings, or even one
who does the right thing stably and reliably. He or she is
also a person who understands the principles on which he or
she acts and can defend his or her actions. According to
Annas, then, "in an ethics of virtue, initial interest in
what we ought to do moves to an interest in the kind of
people we are and hope to be, because the latter is taken to
be the best way of understanding the former."9
For this reason, questions concerning what it means to
be human and what we ought to become, the major ethical
questions raised by genetic enhancement technologies, are
central to Aristotelian ethical theory. Because they
involve care for the human being, questions concerning the
purpose and aim of medicine are also fundamental.
In contrast to standard bioethics, an ethic which
begins with the agent and his or her reflection on his or
her life as a whole welcomes and embraces the kinds of
ethical and philosophical questions raised by genetic
enhancement technologies. Thus, notions of the agent's
final end, of happiness, and of the virtues form the
foundation of an Aristotelian ethic of vulnerability. What
I see as two of the primary features of this ethic include a
9Ibid., 113.
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196
view of the moral significance of the human body, and a
conception of medicine as an ally of the vulnerable human
body.
The Human Body: Who Controls It?10
As I have discussed in previous chapters, Bacon and
Descartes clearly see that in order to realize the aims of
expanding choice and eliminating suffering, control of the
body is absolutely necessary. It is safe to say, I think,
that both modern medicine and standard bioethics are clearly
committed to these same goals. This, of course, has had an
enormous impact on society.
One of the ways in which we form our moral identity is
by monitoring, acting on, and watching over our bodies. In
other words, taking control over our bodies is an integral
part of learning moral responsibility. Modern medicine,
with its tremendous capacities to intervene into the body,
has become, for good or for bad, an intricate and
indispensable part of our vigilance over our bodies. This
could not be seen more clearly than in the explosion of
cosmetic surgeries.
In my opinion, the problem here is twofold. First,
large segments of society do not question nearly enough
whether or not it is a good thing to allow medical
10I am indebted to Gerald McKenny for his insights on
technology and the control of the body. I derived many ideas from
his work, To Relieve the Human Condition, but I have applied them
in a different way.
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technology to exercise such control over our bodies.11
Second, as McKenny points out, the attempt to render our
bodies free from suffering and to make them wholly subject
to our choices is morally impoverishing both to the self and
to others.
McKenny has vigorously argued that the aims to
eliminate suffering and expand choice require a vigilance
over the body which "produces subjects who are incapable of
understanding the nature and meaning of embodiment, of
recognizing and accepting the limits of medicine, of caring
adequately for those who embody those limits and fall victim
to efforts to deny them, and of rightly ordering the goods
of the body {including those made possible by
technology} . "12
This problem is ultimately the result, I think, of a
denial of proper ends in both nature and art. For this
denial inevitably gives technology, the tools of humanity,
the power to gain control over the human body and to dictate
its purposes. And, indeed, as I stated before, we have
given science and technology such extraordinary power, not
only over our own wishes and desires, but even over our own
self-understanding.
U I realize that alternative medicine has become a booming
business which seeks to challenge medical technology. But, by and
large, I still think society as a whole is extraordinarily
comfortable with biotechnological interventions.
12McKenny, To Relieve the Human Condition. 219.
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But, nothing strikes at the heart of Baconian ambitions
more than the twofold conviction that not all suffering is
pointless and that some kinds of suffering can actually
serve our moral projects. Consider the following quote. In
his article, The Nature of Suffering and the Goals of
Medicine, Eric Cassell explains his understanding of the
nature of suffering:
For the purposes of explanation, I have
outlined various parts that make up a
person. However, a person cannot be
reduced to their parts in order
to be better understood. Reductionist
scientific methods, so successful in
human biology, do not help us to
comprehend whole persons. My intent was
rather to suggest the complexity of the
person and the potential for injury and
suffering that exists in everyone. With
this in mind, any suggestion of
mechanical simplicity should disappear
from my definition of suffering. All the
aspects of personhood— the lived past,
the family's lived past, culture and
society, roles, the instrumental
dimension, associations and relationship,
the body, the unconscious mind, the
political being, the secret life, the
perceived future, and the transcendent
dimension— are all susceptible to damage
and loss.13
Aristotelian ethical theory basically supports
Cassell's position on the nature of human being and on
suffering and contingency. Aristotle clearly understood
that every human being is vulnerable and susceptible to many
kinds of suffering, both in body and soul. But there is a
13Eric Cassell, "The Nature of Suffering and the Goals of
Medicine," The New England Journal of Medicine. 306 no.11, (March
1982): 643.
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blaring difference between Cassell and Aristotle. Whereas
Cassell saw little value in suffering, Aristotle viewed
suffering as an occasion for growth in moral virtue.14
The point is that, in an Aristotelian framework, the
shared experience of suffering can actually serve, rather
than hinder our moral projects. For example, from an
Aristotelian viewpoint, it is precisely because of this
common experience of suffering that we need each other.
In fact, it can be extrapolated from a study of Nicomachean
Ethics that achievement of our final end requires certain
kinds of common experiences (like suffering) because they
create close relationships.15 And growth in moral virtue
can only take place within the context of close
relationships.
According to Julia Annas, Aristotle gives two reasons
for his position. First, close relationships assist in
self-knowledge. Only in other people can we find a
reflection of ourselves that will give us an objective
assessment of ourselves. Second, only in close
relationships are we provided with the degree of intimacy we
14In his integration of Aristotelian ethical philosophy and
Catholic doctrine, Aquinas fully developed the idea that suffering
can have a moral purpose. But the seeds of this idea are in
Aristotle's discussions on friendship in Nicomachean Ethics.
“Aristotle, Nicomachean Ethics. Books VIII and IV.
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200
need to find out anything deep and lasting about
ourselves.16
As Annas points out, "if our final end involves moral
activity, and moral activity is the exercise of moral
character which has been developed in a specific social
context, how can our final end demand moral activity outside
of that context?"17
In other words, because our final end has a moral
component, close relationships are vitally important in
achieving that end. Close relationships are often built
upon common experiences such as various kinds of suffering.
This entire process makes us vulnerable because our
happiness, our final end, is not fully in our control. It
is subjected to forces outside of ourselves.
The irony here is that it is precisely because our
happiness is subject to forces outside of ourselves that
some forms of suffering are inevitable. The point is that
there are some forms of suffering that can serve our moral
purposes. They can make us the kind of people who
understand the nature and meaning of embodiment, who can
recognize and accept the limits of medicine and technology,
and who can adequately care for those who embody those
limits.
16Annas, The Morality of Happiness. 251.
17Ibid., 251.
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This is not to say that medical technology should not
try to alleviate the suffering associated with disease and
illness. Indeed, it should. However, I do not believe, as
Eric Cassell does, that the "ends" of medicine should be
directed toward the relief of suffering per se.
The reason for this is twofold. First, implicit in
this "relief of suffering model" is the idea that all
suffering is pointless. I have tried to show that, from an
Aristotelian viewpoint, some forms of sufferings are not
pointless; but they can in fact serve a moral purpose.
Second, the goal to relieve suffering gives medical
technology an extraordinary amount of power over the body.
As I discussed in the previous chapter, the end of medicine,
from an Aristotelian viewpoint, is health, not the
elimination of suffering. And, in the Aristotelian
framework, persons, not medicine, are largely responsible
for their own health.
Thus, the bottom line is that, in the Aristotelian
context, it is the person who controls the body, and not
medicine. This is one of the fundamental differences
between ancient and modern notions of the body and who
controls it. In the ancient Greek paradigm, the person is
seen as the primary controller and medicine is understood to
be its ally.
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202
Medicine as an Ally of Vulnerable Human Being
As I have discussed in Chapter 1, I believe that
certain virtues and values are a part of the very nature of
medicine so that if those in the medical profession are not
trained in these virtues and values, they may not be
practicing medicine, but only technology— a technology that
is imbued by the Baconian project and its pursuit of
technological utopianism.
In my opinion, the Hippocratic Oath, the oldest and
most well-known code articulating ethical principles for
medical practice, embodies the virtues and values necessary
to ensure that the physician is indeed practicing medicine
and not just technology.18 The Oath, which originated in
Ancient Greece sometime around the fifth or sixth century
B.C., was for centuries taken by physicians as the essential
model of medical conduct.
As I stated in Chapter 6, the reason why I find the
Hippocratic Oath still applicable today is because I believe
that, despite the enormous advances in medicine and
biotechnology, health and wholeness largely mean today what
they did in Ancient Greece. The following is the Oath in
its most common form:
I swear by Apollo Physician and Asclepius
and Hygieia and Panaceia and all the gods
18I am indebted to Leon Kass for his insights on the
Hippocratic Oath. I derived many ideas on the Oath from his work,
Toward a More Natural Science, but I have applied them in a
different context.
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203
and goddesses, making them my witnesses,
that I will fulfill according to my
ability and judgment this oath and
covenant: To hold the one who has taught
me this art as equal to my parents and to
live my life in partnership with him, and
if he is in need of money to give him a
share of mine, and to regard his
offspring as equal to my brothers in male
lineage and to teach them this art— if
they desire to learn it— without fee and
covenant; to give a share of precepts and
oral instruction and all the their
learning to my sons and to the sons of
him who has instructed me and to pupils
who have signed the covenant and have
taken an other according to the medical
law, but to no one else. I will apply
dietetic measures for the benefit of the
sick according to my ability and
judgment; I will keep them from harm and
injustice. I will neither give a deadly
drug to anybody if asked for it, not will
I make a suggestion to this effect.
Similarly I will not give to a woman an
abortive remedy. In purity and holiness
I will guard my life and my art.
I will not use the knife, not even on
sufferers from stone, but will withdraw
in favor of such men as are engaged in
this work. Into whatever houses I may
enter, I will come for the benefit of the
sick, remaining clear of all voluntary
injustice and of other mischief and of
sexual deeds upon bodies of females and
males, be they free or slave. Things I
may see or hear in the course of the
treatment or even outside of treatment
regarding the life of human beings,
things which one should never divulge
outside, I will keep to myself holding
such things unutterable. If I fulfill
this oath and do not violate it, may it
be granted to me to enjoy life and art,
being honored with fame among all men for
all time to come; if I transgress it and
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204
swear falsely, may the opposite of all
this be my lot.19
Now, my claim here is not that modern physicians do not
find the Hippocratic Oath applicable in any way. Indeed,
the principle of confidentiality, for example, was derived
from this Oath and is very much a part of medicine today.
Rather, my claim is that there seem to be large segments of
society that view modern medicine as far too technologically
advanced to be considered a profession that could be guided
by some internal ethical code like the "ancient" Hippocratic
Oath.
As I pointed out in the previous chapter, modern
medicine is generally considered to be an institution
without a specific end, one that is guided ethically from
the outside. Thus, the AMA Principles of Ethics, which
define the physician in terms of competence in certain
skills and in terms of his or her relation to society, is
the guiding code.
But, I believe there are some grounds to warrant a
claim that medicine is a moral art and that the subjects
addressed in the Hippocratic Oath are sufficient to define
proper medical conduct. To examine all of these subjects
goes beyond the scope of this research project. Therefore,
19Oswei Temkin and C. Lilian Temkin, eds. Ancient Medicine:
Selected Papers of Ludwig Edelstein. (Baltimore: John Hopkins
University Press, 1967), 6.
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I will limit my discussion to some issues raised in the
treatment and decorum paragraphs.
In the treatment paragraphs, there is an emphasis on
dietetic and/or nutritional measures. These are materials
the body naturally needs and uses to maintain balance and
health. This emphasis seems to indicate the conviction that
the body is by and large its own healer and that the
physician is a cooperative partner who supplies what the
body needs, whether it be vitamins, hormones, insulin, or
antibiotics, in order to fight off the things which cause
illness.
My claim here is not that all diseases and illnesses
can be dealt with in this way. Nor is my claim that certain
medical techniques such as gene therapy cannot be used to
cure genetically inherited diseases. Instead, what I mean
to point out is that I agree with Leon Hass' observation
that the Hippocratic Oath seems to imply that medicine is a
cooperative rather than a transforming art. He states the
matter in the following way:
Rather, I mean to emphasize the
Hippocratic Oath's tacit assertion that
medicine is a cooperative rather than a
transforming art, and that the physician
is but an assistant to nature working
within, the body having its own powerful
(even if not invincible) tendencies
toward healing itself (e.g. wound healing
and other regenerative activities, or the
rejection of foreign bodies and the
immune response). Though our current
technical prowess tends to make us forget
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206
these matters, does not the Oath speak
truly?20
The point is that, in the Hippocratic Oath, the
physician is portrayed as nature's cooperative ally and not
its master. This is a fundamentally different view
concerning the role of medicine and the task of the
physician than is found in today's largely Baconian-driven
biotechnological medicine.
However, as I pointed out in Chapter 6, researchers of
stem cells and their functions are beginning to recognize
and actually work with the body's own healing powers. In
fact, studying the body's healing powers has enabled
researchers to develop some stem cell technologies at a much
faster pace.21
In the decorum passages we are told that the physician
enters a household for the benefit of the sick. In this
context, the physician is exposed to the most private,
intimate, and vulnerable parts of human lives. Kass gives
some valuable insight into this situation:
The physician is both privileged and
burdened by this exposure of
vulnerability. He has the opportunity,
rarely given to other human beings, to
see without illusion the darker side of
the human condition, and to see humanity,
unprotected and stripped of pretense,
struggling gamely to preserve itself. He
is privileged to receive the trust
20Kass, Toward a More Natural Science. 233.
21See Nicolas Wade, "Teaching the Body to Heal Itself," New
York Times. 7 November 2000, 1(D).
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207
implied by admission to the house, to the
inner sanctum of the patient's
lifeworld.22
Two things can be said about this. First, because his
practice took place primarily within the home, the
Hippocratic physician was perhaps more keenly aware of human
vulnerability than is his modern counterpart. The Ancient
Greek physician's admittance into the home allowed him to
experience firsthand the intimate, private, and fragile
world of his patients.
Second, because his calling as a physician allowed him
to enter into the life-setting of the patient, the
Hippocratic physician seemed not as willing to deny or defy
vulnerability as we are in our modern medical arena, where
the patient enters into the physician's office or hospital.
In the modern medical setting, there is a subtle, yet real,
notion that technological advances have made it so that we
do not have to accept the many vulnerabilities the
Hippocratic doctor encountered.
This is certainly true to some degree. But I believe
there is a much deeper issue here. At the risk of
oversimplification, I believe the issue is the following: I
think that the modern physician's attention has been shifted
from the idea of healing, which was the Hippocratic
physician's concern, to the goal of relieving and
22Kass, Toward a More Natural Science. 238.
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208
eliminating suffering of every kind.23 This, I think, is
clearly seen when you consider the cosmetic surgery industry
and genetic enhancements.
I believe this fundamental shift of focus has
contributed to the resistance in modern medicine to accept
certain human vulnerabilities. The contemporary idea that
most suffering is pointless and the modern notion that
medicine has no specific end (and therefore can be useful in
the elimination of both physical and cultural suffering) has
also contributed to medicine's unfavorable attitude toward
vulnerability.
To put it another way, in a strange sort of irony, the
elimination of all kinds of suffering is a primary goal in
the modern medical setting because suffering is not an
accepted or essential aspect of the contemporary medical
paradigm. Because of this, transformation of, rather than
cooperation with the fragile human condition has become a
primary focus of modern biomedicine.
But the Ancient Greek notion that medicine is a moral
art whose ultimate end is health recognizes on the one hand,
the amazing healing powers of the human body, and on the
other hand, the inescapable fragilities of the human body.
23An argument could be made that antibiotics and certain
surgeries are certainly intended to heal and not just to relieve
suffering. But the difference, I think, is that antibiotics and
surgeries work with the body's self-healing processes and for this
reason could be considered cooperative medicine. Cosmetic
surgeries and genetic enhancements are certainly intended, I
think, to relieve certain emotional or cultural sufferings and,
therefore, could be considered transformative medicine.
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209
In other words, suffering and vulnerability were a
fundamental part of the ancient medical model. Because of
this, cooperation with, rather than transformation of the
human condition was the ultimate aim of medicine.
Having laid this essential groundwork, then, I turn now
to consider, in its light, genetic enhancements.
What Ought We to Enham.ce? Bacon and Aristotle Compared
As I have pointed out in Chapter 3, there are at least
three spheres which genetic enhancements may effect: 1) the
physical, including size, sleep, and longevity; 2) the
intellectual, including memory; 3) the moral, including
attitudes and behaviors.
Now, the primary question is not whether we ought to
enhance, for certain enhancement technologies are already
available; the fundamental question concerns what kind of
enhancements we ought to pursue. While there has been much
discussion concerning moral genetic enhancements, recent
research has focused mainly on the physical and intellectual
spheres.
Human growth hormone, for instance, is being widely
considered for use as a non-health related physical genetic
enhancement because it is already being used in
approximately 20,000 children in the United States who are
growth-hormone deficient.24 Another enhancement technique
being considered is one which could reduce one's need for
24Walters and Palmer, The Ethics of Human Gene Therapy. 113.
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210
sleep by 50%, with no adverse effects during waking hours.
But, by far, the physical enhancement technique that is
attracting the most attention and research is the one which
can add years to our normal life-span.
Dr. Leonard Guarente, a professor of biology at MIT,
studies the genes that control aging. On September 22,
2000, after a nine-year pursuit, he reported a finding that
may explain exactly how very low calorie diets, the one
intervention known to prolong life in certain organisms, may
allow people to enjoy a maximum lifespan of 170 years. It
is a very complicated process in which an "aging gene" is
silenced by the interaction of certain enzymes.25
In the intellecutual sphere, there is an interest in
developing a technique that can genetically enhance general
cognitive ability; that is, intellectual abilities that can
be measured by standardized tests such as the Wechsler
Intelligence Scale and by newer tests which are designed to
measure how the brain processes information.26
There is also a growing interest in an intellectual
genetic enhancement that can enhance the efficiency of long
term memory. A person with enhanced memory capacities would
not be able to remember everything he or she ever saw.
25Nicolas Wade, "Searching for Genes to Slow the Hands of
Biological Time," New York Times. 26 September 2000, 1(D).
7 f >
See, for example, Lon R. Cardon, "Genetics of Specific
Cognitive Abilities," in Robert Plomin and Gerald E. McClearn,
eds., Nature. Nuture. and Psychology (Washington DC: American
Psychological Association, 1993), 99-120.
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211
Rather, that person would acquire an ability similar to
those who naturally have a photographic memory. In other
words, a person with genetically enhanced long-term memory
capabilities would increase his or her ability to retain
what he or she sees, hears, or reads by at least 50%.27
In the moral sphere, there has been much discussion
concerning the ways in which moral genetic enhancements
could be used to curb antisocial behaviors.28 Moral genetic
enhancements are, by far, the most controversial. Leroy
Walters’ talk on genetic enhancements made it clear that
many of his colleagues were deeply disturbed by the prospect
of moral genetic enhancements.29
Nevertheless, there are some scholars who endorse them.
LeRoy Walters and Julie Gage Palmer, for example, argue that
"moral enhancements by genetic means would be a useful
adjunct to other important programs like social and economic
reform and education about ethinic, racial, and national
groups different from one's own."30 Steven Hawking also
27For a more in-depth discussion on long-term memory, see,
Joaquin M. Fuster, Memory in the Cerebral Cortex: An Empirical
Approach to Neural Networks in the Human and Nonhuman Primate
(Cambridge: MIT Press, 1995), 12-22, 211-216.
28For more discussion on this issue, see, Gregory R. Bock
and Jamie A. Goode, eds., Genetics of Criminal and Antisocial
Behavior (Chichester and New York: Wiley Publishing, 1996).
29See Chapter 1.
30Walter and Palmer, The Ethics of Human Gene Therapy. 127.
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212
argues that genetic engineering in the moral sphere is
necessary if the human race is to survive.31
One of the reasons why genetic enhancements in the
moral domain are considered so controversial is that the
human nature and purpose of medicine questions appear much
more urgent and crucial.32 Nevertheless, it is safe to say,
I think, that the human nature and purpose of medicine
questions are equally important in all three spheres.
As I pointed out in the previous chapters, in the
Baconian/modern biomedical paradigm, the human being is
generally considered to be an ordered aggregate or a
property-thing (or, in other words, human beings are
understood not to be driven toward an ultimate end by an
immaterial substance or form). Medicine is also understood
to be too complex to have a specific end. Thus, in
accordance with the Baconian mandate, biomedicine and
standard bioethics have had as their ultimate concern the
elimination of all kinds of human suffering, and the
expansion of human choice through biotechnological means.
For instance, in their ground-breaking, new book, From
Chance to Choice: Genetics & Justice, Allen Buchanan, Dan
Brock, Norman Daniels, and Daniel Wikler make it clear that
their primary objective is to make a contribution toward
31See Chapter 3.
32The other crucial issue associated with all types of
genetic enhancements is safety. For the sake of this discussion,
I am assuming that they would all meet safety guidelines.
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213
answering what they consider to be the single most important
question with regard to genetic interventions:
What are the most basic moral principles
that would guide public policy and
individual choice concerning the use of
genetic interventions in a just and
humane society in which the powers of
genetic intervention are much more
developed than they are today?33
Indeed, this is a very important question which needs
to be addressed, especially where genetic intervention for
the treatment of disease is concerned. To see that there is
a fair distribution of such valuable medical goods is
paramount. The point here, however, is that this question
is driven by standard bioethics primary agenda: to safeguard
autonomy, assess risks and benefits, and determine whether a
just distribution will follow. This agenda, in turn, is
ultimately driven by the Baconian mandate to relieve human
suffering and expand the range of human choice through
technological means.
This agenda, in my opinion, marginalizes the human
nature and purpose of medicine questions— the questions
which I hope I have shown are central to the genetic
revolution— because the major concerns for standard
bioethics are, first and foremost, autonomy, choice,
elimination of suffering, and a just distribution.
-5-3
Allan Buchanan and others, eds.. From Chance to Choice:
Genetics and Justice (Cambridge: Cambridge University Press,
2000), 4.
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214
In light of this, the current emphasis on physical and
intellectual genetic enhancements— to be taller, to sleep
less, to live longer, and to have increased cognitive
abilities-- are consistent with biomedicine's and standard
bioethics' overall goals. To enhance height, wakefulness,
longevity, and memory is to give some people who perceive
themselves as "suffering" and who feel "socially
disadvantaged" a competitive edge in the marketplace.
In my view, there are at least two major problems
associated with this Baconian ambition to relieve all kinds
of suffering through biotechnological means such as physical
and intellectual genetic enhancements. First, all of these
physical and intellectual genetic enhancements give an
extraordinary amount of power to biotechnology. With
physical and intellectual genetic enhancements, the
recipients are merely passive receivers and are not
responsible for the outcome (e.g., the individual does not
have to be educated or does not have to develop good habits
or be trained to be taller, to sleep less, to life longer,
or to remember more if it is just a matter of "silencing" or
"tweaking" a gene).
Not only do physical and intellectual genetic
enhancements increase biotechnology's control over the body,
but they also serve to solidify the power science and
technology already have over society. A related problem is
that society is becoming so accustomed to the ways in which
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215
medicine and technology can intervene into the body that
these kinds of physical and intellectual genetic
enhancements can seem only "natural."
The second major problem associated with physical and
intellectual enhancements is that they can lead people to
believe that the good life (or happiness) can be acheived
without personal responsibility. To put it another way,
they can lead people to think that the good life is either
something you can buy or something that is owed to them
(e.g. a "right") by institutions such as biomedicine.
From an Aristotelian perspective, however, the good
life (or happiness) is not something that can be bought nor
is it something that is owed to us. The good life, rather,
is something that is intentional. It is the virtuous life,
and happiness has to do with constantly developing habits
that contribute to a morally worthy life.
In the first six books of Nicomachean Ethics, Aristotle
makes his argument that the ultimate good (or the ultimate
end) for human beings is happiness. And, happiness,
according to Aristotle, can only be acheived by a virtuous
life. He went on to state that moral virtue, like the arts,
is acquired by repetition of corresponding acts:
Virtue, then, being of two kinds,
intellectual and moral, intellectual
virtue in the main owes both its birth
and its growth to teaching (for which
reason it requires experience and time),
while moral virtue comes about as a
result of habit . . . but the virtues we
get by first exercising them, as also
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216
happens in the case of the arts as well.
For the things we have to learn before
we can do them, we learn by doing them,
e.g. men become builders by building and
lyre-players by playing the lyre; so too
we become just by doing just acts,
temperate by doing temperate acts, brave
by doing brave acts.34
Now, in light of our present discussion on genetic
enhancements, it could be argued at this point that, if the
good life is really found in the virtuous life, then moral
genetic enhancements could enable us to achieve it.
"Habit," in the Aristotelian understanding, is no longer
necessary. Indeed, from a Baconian perspective, where the
human being is generally understood to be a property-thing,
moral genetic enhancements could be viewed as a good
alternative to moral training. In this Baconian framework,
all that is needed in order to achieve the good life is to
change a few of the physical conditions through genetic
intervention.
However, from an Aristotelian viewpoint, moral genetic
enhancements could not help us acheive the good life because
the will, and the virtues as a function of the will, cannot
be genetically enhanced. The reason for this is that, in
Aristotelian thought, the will is a property of the soul (or
form) and, therefore, it is not subject to genetic
enhancements. The will, in other words, is not something
that is ultimately controlled by genes or neurons; it is not
34Aristotle, Nicomachean Ethics. Book II, Paragraph I.
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217
an emergent property of higher brain function (as it is
generally understood to be in the Baconian notion of human
being); it is something that resides in the soul, out of the
reach of genetic intervention.35 And the will is the key
factor in enabling human beings to reach their true ultimate
end (e.g. perfect virtue and therefore happiness).
So, the primary question is this: From an Aristotelian
perspective, which genetic enhancements ought we to pursue?
I believe this question can be answered in the following
way. On the face of it, we ought not to pursue moral
genetic enhancements because, ultimately, morality has to do
with the will-- with human freedom and human choice— and
the will cannot be genetically enhanced. Seen in this
light, then, it is erroneous, perhaps even delusional to
think that happiness or the good life could be acheived
through moral genetic enhancements.
What about physical and intellectual genetic
enhancements? Ought we to pursue them? Let me say first of
all that I believe there is a deeper question here, and that
is: Will physical and intellectual genetic enhancements
relieve suffering (that is, in the Baconian sense)? I think
the answer is clearly yes. Physical and intellectual
genetic enhancements can alleviate all kinds of sufferings,
This, of course, does not mean that the will cannot be
influenced by physical interventions. Indeed, it can. The point
here is to reiterate the distinction between Aristotelian and
modern views of human being.
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218
including those caused by disease and those caused by
"cultural or social discomfort." Let me say here that I
think we should do all we can to ease the suffering caused
by certain genetic diseases.
However, the important point here is that, from an
Aristotelian standpoint, physical and intellectual genetic
enhancements can never fully enable us to attain our true
end. This is because our true end has to do with moral
virtue, which, in turn, is a function of the will, and the
will cannot be genetically enhanced.
This, I believe, is the key issue. There is a serious
lack of discussion about "ends" in biomedicine and standard
bioethics today. This, I think, contributes to standard
bioethics' inability to fully address the crucial issues
raised by the genetic revolution. For when the ideas of
form and telos are rejected, both human being's and
institution's purposes are ultimately determined by society
and culture.
In other words, at the risk of oversimplification, our
society, which is deeply influenced by science, technology,
and medicine, looks to these institutions as authorities on
life and the decisions effecting it. Hence, biomedicine's
and standard bioethics' focus on the body (and brain), on
the elimination of all kinds of human suffering, and on the
expansion of human choice through technological means can
lead us to believe that escape from vulnerability and
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219
achievement of unrestricted power are consistent with our
ultimate purposes.
From an Aristotelian perspective, however, to pursue
freedom from suffering as an ultimate objective is not going
to bring about the deeper, richer life we are intended to
experience. In fact, to pursue freedom from suffering as an
ultimate objective can actually lead us astray from our true
end. For Aristotle, our true end is happiness, and
happiness has to do with living a morally worthy life, and
this life is not one that can be free from vulnerability.
By having the human nature and purpose of medicine
questions central to its agenda, an Aristotelian-inspired
ethic of vulnerability can bring clarity to these crucial
issues in a way that standard bioethics cannot. The reason
for this is that standard bioethics has come to regard
reflection on ends and the ultimate good as unnecessary.
An Aristotelian-inspired ethic of vulnerability enables
us to sense the urgency of these questions whereas a
Baconian approach as standardly implemented, in my opinion,
does not. If it did, I believe these technologies would not
have been developed in the first place.
An Aristotelian ethic of vulnerability , I think, gives
valuable insight into many of the issues I have identified
in this research project, including issues involving human
nature and the nature of medicine, and problems surrounding
the Baconian project, biomedicine, and standard bioethics.
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220
As I stated before, I think standard bioethics, with
its focus on risks and benefits, rule-following, and
distributive justice are necessary, but not sufficient for
dealing with the philosophical and ethical questions raised
by genetic enhancement technologies. Therefore, I find an
ethic of vulnerability to be vital to issues concerning
genetic enhancements because of its emphasis on the agent
and character. Unlike standard bioethics, this ethic, I
believe, encourages reflection on the fundamental
philosophical questions raised by genetic enhancements.
Hence, I believe that those who work in the fields of
biotechnologies should resist the Baconian project, the
driving force behind standard bioethics, and embrace an
ethic of vulnerability. This is an ethic in which the
agent's life as a whole, which includes character and
choice, practical reasoning and emotional responses, is
central rather than marginal. Those who work in the fields
of biotechnologies should understand this ethic to apply not
only to patients, but to themselves. In other words, it
should effect the choices he or she makes in the
type of genetic technologies he or she chooses to develop.
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221
Bibliography
Anderson, French, "Genetics and Human Malleability,"
Hastings Center Report, (January/February 1990), 21-24.
________. "Genetic Engineering and Our Humanness," Human
Gene Therapy 5:755-760 (1994).
Anderson, Fulton, ed. The New Organon and Related Writings
(New York: Liberal Arts, 1960).
_____ . The Philosophy of Francis Bacon (Chicago:
University of Chicago Press, 1948).
Annas, Julia, The Morality of Happiness. (New York: Oxford
University Press, 1993).
Annas and Elias, Gene Mapping: Using Law and Ethics as
Guides (Oxford: Oxford Press, 1992).
Aristotle, Nicomachean Ethics.
Bacon, Francis, Advancement of Learning. Novum Oroanum,
New Atlantis (Chicago: Encyclopedia Britannica, Inc.,
1952) .
Beachamp, Tom and James Childress, Principles of
Biomedical Ethics (New York: Oxford University Press,
1994) .
Blank, Robert, Brain Policy (Washington D.C.: Georgetown,
1999) .
Brock, Dan, "Broadening Bioethics Agenda," Kennedy
Institute of Ethics Journal. Vol.10, No.l, (March 2000),
21-38.
Brown, Warren, Nancey Murphy and H. Newton Malony,
Whatever Happened to the Soul? (Minneapolis: Fortress
Press, 1998).
Buchanan, Allen et al., From Chance to Choice: Genetics
and Justice (Cambridge: Cambridge University Press, 2000).
Campbell, Jeremy, Grammatical Man: Information. Entropy.
Language, and Life. (New York: Simon and Schuster, 1982).
Cassel, Eric, "The Nature of Suffering and The Goals of
Medicine, The New England Journal of Medicine. (March
1982), Vol.306, No.11, 639-645.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
222
Cockerham, William, Medical Sociology Seventh Edition
(Upper Saddle River: Prentice Hall, 1998).
Connell, Richard, Substance and Modern Science (Houston:
Center for Thomistic Studies, 1988).
Conrad, Peter, "The Discovery of Hyperkinesis: Note on the
medicalization of Deviant Behavior" Social Problems,
23:12-21.
Conrad and Schneider, Deviance and Medicalization: From
Badness to Sickness (St. Louis: Mosby, 1980).
Degler, Carl, In Search of Human Nature (New York: Oxford
University Press, 1991).
Devey, Joseph, ed. Works of Lord Bacon (London: George
Bell and Sons, 1894).
Durkheim, Emile, The Elementary Forms of Religious Life
(New York: The Free Press, 1995).
Engelhardt, Tristram, "Genetic Enhancement and Theosis:
Two Models of Therapy," Christian Bioethics. (1999),
Vol.5, No.2, 197-199.
Farrington, Benjamin, The Philosophy of Francis Bacon: An
Essay on Its Development from 1603-1609 (Liverpool:
Liverpool University Press, 1964).
________. Francis Bacon: Philosopher of Industrial Science
(New York: Henry Schuman, 1949).
Galton, Francis, Inquiries into the Human Faculty
(London: MacMillian, 1883).
Gardner, William, "Can Genetic Enhancement Be Prohibited?"
The Journal of Medicine and Philosophy 20:65-84, (1995).
Gustafson, James, "A Christian Perspective on Genetic
Engineering," Human Gene Therapy 5:747-754 (1994).
________. Ethics from a Theocentric Perspective, vol.1:
Theology and Ethics (Chicago: University of Chicago
Press, 1981).
________. Ethics from a Theocentric Perspective, vol.II:
Ethics and Theology (Chicago: University of Chicago
Press, 1984) .
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
223
Haggard, Howard, Mystery, Magic, and Medicine (Garden
City: Doubleday, 1933).
Hanson, Mark, "Indulging Anxiety: Human Enhancement from a
Protestant Perspective," Christian Bioethics. (1999),
Vol.5, No.2, 121-138.
Holland and Kyriacou, Genetics and Society (Wokingham:
Addison-Wesley, 1993).
Holtug, Nils, "Does Justice Require Genetic Enhancements?"
Journal of Medical Ethics, Vol.25, No.2, (April 1999),
137-143.
Heme, David, A Treatise of Human Nature.
Heme, David, An Inquiry Concerning Human Understanding.
Juengst, Eric, "Can Enhancement Be Distinguished From
Prevention in Genetic Medicine," The Journal of Medicine
and Philosophy 22:125-142, (1997).
Kass, Leon, Toward a More Natural Science, (New York: The
Free Press, 1985).
Keenan, James, "Whose Perfection is it Anyway?: A Virtuous
Consideration of Enhancement," Christian Bioethics,
(1999), Vol.5, No.2, 104-120.
Khushf, George, "Thinking Theologically About Reproductive
and Genetic Enhancements: The Challenge," Christian
Bioethics, (1999), Vol.5, No.2, 154-182.
Kilner, John, Rebecca Pentz, and Frank Young, eds. Genetic
Ethics (Grand Rapids: Paternoster Press, 1997).
Konner, Melvin, The Tangled Wina (New York: Harper
Collins Books, 1982).
Koshland, D., "Sequences and Consequences of the Human
Genome" Science 246:189, Oct. 13, 1989; "The Rational
Approach to the Irrational" Science 250:189, Oct. 12,
1990.
Kuhn, Thomas, The Structure of Scientific Revolutions
(Chicago: University of Chicago Press, 1996).
Lamm, Richard, "Redrawing the Ethics Map," Hastings Center
Report. Vol.29, No.2, (March/April 1999), 28-29.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
224
Leffel, Jim, "Engineering Life: Human Rights in a
Postmodern Age," Christian Research Journal. (Summer
1997), 39-44.
Mayr, Ernst, The Growth of Biological Thought: Diversity.
Evolution, and Inheritance (Cambrige: Harvard University
Press, 1982) .
McClellan, James and Harold Dorn, Science and Technology
in World History (Baltimore: John Hopkins University
Press, 1999) .
McCullough, Lawrence and Warren T. Reich, "Laying Medicine
Open: Innovative Interaction Between Medicine and the
Humanities," Kennedy Institute of Ethics Journal. Vol.9,
No.1 (Mar.1999), 8-23.
McKenny, Gerald, "Enhancements and the Quest for
Perfection," Christian Bioethics. (1999), Vol.5, No.2, 99-
103.
_____ . To Relieve the Human Condition (Albany: State
University New York Press, 1997).
McKenzie, Michael, "Genetics and Christianity: An Uneasy
but Necessary Partnership," Christian Research Journal.
(Fall 1995), 12-14.
Mehlman and Botkin, Access to the Genome: The Challenge to
Equality (Washington: Georgetown University Press, 1998).
_____ . "The Law of Above Averages: Leveling the New
Genetic Enhancement Playing Field, Iowa Law Review.
Vol.85, No.2, (Jan.2000), 517-593.
Moreland, J.P., "Is the Human Person a Substance or
Property-thing?" Ethics and Medicine. Journal of The
Center for Bioethics and Human Dignity. Vol.11:3 (1995),
50-55.
________. Body and Soul: Human Nature and the Crisis in
Ethics (Downers Grove: Intervarsity Press, 2000).
________. Love Your God With All Your Mind: the Role of
Reason in the Life of the Soul (Colorado Springs:
NavPress, 1997).
Niebuhr, Reinhold, The Nature and Destiny of Man vol. II
(New York: Charles Scribner's Sons, 1941, 1943).
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
225
Nelkin and Lindee, The DNA Mystique: Gene as Cultural Icon
(New York: Freeman and Co., 1995).
Nelkin and Tancredi, Dangerous Diagnostics: The Social
Power of Biological Information (New York: Basic Books,
1989) .
Nelson, Robert, On The New Frontiers of Genetics and
Religion (Grand Rapids: Eerdman's Publishing, 1994).
Nussbaum, Martha, The Fragility of Goodness, (Cambridge:
Cambridge University Press, 1986).
. The Therapy of Desire (Princeton: Princeton
University Press, 1994).
Parens, Erik, ed. Enhancing Human Traits: Ethical and
Social Implications (Washington D.C.: Georgetown, 1998).
. "The Goodness of Fragility: On the Prospect of
Genetic Technologies Aimed at the Enhancement of Human
Capacities," Kennedy Institute of Ethics Journal, Vol.5,
No.2 (1995), 141-153.
Parsons, Talcott, The Social System (New York: The Free
Press, 1951).
Pearcey, Nancy and Charles Thaxton, The Soul of Science
(Wheaton: Crossway Books, 1994).
Plato, The Republic.
• Charmides.
Proctor, Robert, Racial Hygiene: Medicine Under the Nazis
(Cambridge: Harvard, 1988).
Resnik, David, "Debunking the Slippery Slope Argument
Against Human Germ-line Gene Therapy," Journal of Medicine
and Philosophy 19:23-40, (1994).
Rossi, Paolo, Francis Bacon: from Magic to Science trans.
by Sacha Rabinovitch, (Chicago: University of Chicago
Press, 1968).
Shuman, Joel, "Desperately Seeking Perfection: Christian
Discipleship and Medical Genetics," Christian Bioethics,
(1999), Vol.5, No.2, 139-153.
Spedding, James, Robert Ellis, and Douglas Heath, eds. The
Works of Francis Bacon 14 vols. (London: Longman and Co.,
1857-1874) .
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
226
Szasz, Thomas, The Myth of Mental Illness rev. ed. (New
York: Harper and Row, 1974) .
Taboada, Paulina, "Human Genetic Enhancement: Is It Really
a Matter of Perfection? A Dialog with Hanson, Keenan, and
Shuman," Christian Bioethics. (1999), Vol.5, No.2, 183-
196.
Torres, Juan Manuel, "On The Limits of Enhancement in
Human Gene Transfer: Drawing the Line," The Journal of
Medicine and Philosophy 22:43-53, (1997).
Turner, Bryan, Medical Power and Social Knowledge
(London: Sage, 1987).
________. Regulating Bodies: Essays in Medical Sociology
(London: Routledge, 1992).
. The Body and Society 2nd ed. (Oxford: Blackwell,
1996).
Twaddle, Andrew, "Health Decisions and Sick Role
Variations: An Exploration" Journal of Health and Social
Behavior. 10:105-114.
U.S. Department of Energy, "A Vital Legacy: Biological and
Environmental Research in the Atomic Age" (The Office of
Biological Environmental Research, September 1997).
U.S. Department of Energy, Human Genome Program Report
Part I, Overview and Progress, 1997.
Wallace, Karl, Francis Bacon on the Nature of Man (Urbana:
University of Illnois Press, 1967).
Walters, LeRoy and Julie Gage Palmer, The Ethics of Human
Gene Therapy (New York: Oxford University Press, 1997) .
Weber, Max, The Sociology of Religion (Boston: Beacon
Press, 1922).
Weinberger, Jerry, Science. Faith, and Politics: Francis
Bacon and the Utopian Roots of the Modern Aae (Ithaca:
Cornell University Press, 1985) .
Weir, Robert, Susan Lawrence, and Evan Fales, eds., Genes
and Human Self-Knowledge (Iowa City: Iowa University
Press, 1994) .
Wilson, Edward 0., "The Biological Basis of Morality" The
Atlantic Monthly. (April 1998), 54.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
227
. "Back from Chaos/' The Atlantic Monthly, (March
1998) / 42-62.
Whitney, Charles, Francis Bacon and Modernity (New Haven:
Yale University Press, 1986).
Wolpe, Paul Root, "If I Am Only My Genes, What Am I?"
Kennedy Institute of Ethics Journal, September 1997,
pg.216.
Wright, Robert, "Infidelity: It May Be In Our Genes" Time
Magazine, August 15, 1994, pg. 46.
Zola, Irving, "Culture and Symptoms— An Analysis of
Patients' Presenting Complaints" American Sociological
Review, 31:615-630.
Web Sites
The National Human Genome Research Institute,
http//www.nhgri.nih.gov/98plan/elsi.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.

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Asset Metadata

Creator McReynolds, Katherine Mary (author)

Core Title Bioethics in the Genetic Age: Can standard bioethics handle the genetic revolution?

School Graduate School

Degree Doctor of Philosophy

Degree Program Religion

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag OAI-PMH Harvest,Philosophy,religion, general

Language English

Contributor Digitized by ProQuest (provenance)

Advisor [illegible] (committee chair), Crossley, John O. (committee member), Lloyd, Sharon (committee member), Willard, Dallas (committee member)

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c16-103721

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Legacy Identifier 3027751.pdf

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Rights McReynolds, Katherine Mary

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