Beyond Therapy: Biotechnology and the Pursuit of Happiness
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BBBEEEYYYOOONNNDDD TTTHHHEEERRRAAAPPPYYY BEYOND THERAPY BIOTECHNOLOGY AND THE PURSUIT OF HAPPINESS A Report of The President’s Council on Bioethics Washington, D.C. October 2003 www.bioethics.gov v CONTENTS LETTER OF TRANSMITTAL TO THE PRESIDENT xi MEMBERS OF THE PRESIDENT’S COUNCIL ON BIOETHICS xv COUNCIL STAFF AND CONSULTANTS xvii PREFACE xix 1 BIOTECHNOLOGY AND THE PURSUIT OF HAPPINESS 1 I. THE GOLDEN AGE: ENTHUSIASM AND CONCERN 4 II. THE CASE FOR PUBLIC ATTENTION 7 III. DEFINING THE TOPIC 10 IV. ENDS AND MEANS 11 V. THE LIMITATIONS OF THE “THERAPY VS. ENHANCEMENT” DISTINCTION 13 VI. BEYOND NATURAL LIMITS: DREAMS OF PERFECTION AND HAPPINESS 16 VII. STRUCTURE OF THE INQUIRY: THE PRIMACY OF HUMAN ASPIRATIONS 20 VIII. METHOD AND SPIRIT 21 ENDNOTES 24 2 BETTER CHILDREN 25 I. IMPROVING NATIVE POWERS: GENETIC KNOWLEDGE AND TECHNOLOGY 28 A. AN OVERVIEW 28 B. TECHNICAL POSSIBILITIES 30 1. Prenatal Diagnosis and Screening Out. 32 2. Genetic Engineering of Desired Traits (“Fixing Up”). 35 3. Selecting Embryos for Desired Traits (“Choosing In”). 38 C. ETHICAL ANALYSIS 42 1. Benefits. 44 vi CONTENTS 2. Questions of Safety. 45 3. Questions of Equality. 49 4. Consequences for Families and Society. 51 II. CHOOSING SEX OF CHILDREN 55 A. ENDS AND MEANS 57 B. PRELIMINARY ETHICAL ANALYSIS 59 C. THE LIMITS OF LIBERTY 64 D. THE MEANING OF SEXUALITY AND PROCREATION 66 III. IMPROVING CHILDREN’S BEHAVIOR: PSYCHOTROPIC DRUGS 69 A. BEHAVIOR MODIFICATION IN CHILDREN USING STIMULANTS 72 1. What Are Stimulant Drugs? 75 2. Behaviors Inviting Improvement through Stimulant Drugs. 77 3. The “Universal Enhancer.” 81 B. ETHICAL AND SOCIAL CONCERNS 83 1. Safety First. 84 2. Rearing Children: The Human Context. 85 3. Social Control and Conformity. 86 4. Moral Education and Medicalization. 89 5. The Meaning of Performance. 90 IV. CONCLUSION: THE MEANING OF CHILDHOOD 92 APPENDIX: DIAGNOSTIC CRITERIA FOR ATTENTION-DEFICIT/ HYPERACTIVITY DISORDER 93 ENDNOTES 96 3 SUPERIOR PERFORMANCE 99 I. THE MEANING OF “SUPERIOR PERFORMANCE” 100 II. SPORT AND THE SUPERIOR ATHLETE 104 A. WHY SPORT? 104 B. THE SUPERIOR ATHLETE 105 C. DIFFERENT WAYS OF ENHANCING PERFORMANCE 106 1. Better Equipment. 107 2. Better Training. 108 3. Better Native Powers. 108 III. MUSCLE ENHANCEMENT THROUGH BIOTECHNOLOGY 109 A. MUSCLES AND THEIR MEANINGS 109 B. MUSCLE CELL GROWTH AND DEVELOPMENT 111 C. OPPORTUNITIES AND TECHNIQUES FOR MUSCLE ENHANCEMENT 113 CONTENTS vii IV. ETHICAL ANALYSIS 121 A. HOW IS BIOTECHNICAL ENHANCEMENT DIFFERENT? 122 B. FAIRNESS AND EQUALITY 129 C. COERCION AND SOCIAL PRESSURE 133 D. ADVERSE SIDE EFFECTS: HEALTH, BALANCE, AND THE WHOLE OF LIFE 135 E. THE DIGNITY OF HUMAN ACTIVITY 138 1. The Meaning of Competition. 139 2. The Relationship between Doer and Deed. 141 3. Acts of Humans, Human Acts: Harmony of Mind and Body. 143 F. SUPERIOR PERFORMANCE AND THE GOOD SOCIETY 149 ENDNOTES 155 4 AGELESS BODIES 157 I. THE MEANING OF “AGELESS BODIES” 158 II. BASIC TERMS AND CONCEPTS 161 III. SCIENTIFIC BACKGROUND 166 A. TARGETING SPECIFIC DEFICIENCIES OF OLD AGE 166 1. Muscle Enhancement. 166 2. Memory Enhancement. 167 B. GENERAL (BODY-WIDE) AGE-RETARDATION 170 1. Caloric Restriction. 171 2. Genetic Manipulations. 172 3. Prevention of Oxidative Damage. 175 4. Methods of Treating the Ailments of the Aged That Might Affect Age-Retardation. 176 a. Hormone treatments 176 b. Telomere research 177 IV. ETHICAL ISSUES 179 A. EFFECTS ON THE INDIVIDUAL 181 1. Greater Freedom from Constraints of Time. 184 2. Commitment and Engagement. 185 3. Aspiration and Urgency. 185 4. Renewal and Children. 186 5. Attitudes toward Death and Mortality. 188 6. The Meaning of the Life Cycle. 189 B. EFFECTS ON SOCIETY 190 1. Generations and Families. 191 2. Innovation, Change, and Renewal. 193 3. The Aging of Society. 194 V. CONCLUSION 195 ENDNOTES 200 viii CONTENTS 5 HAPPY SOULS 203 I. WHAT ARE “HAPPY SOULS”? 208 II. MEMORY AND HAPPINESS 212 A. GOOD MEMORIES AND BAD 216 B. BIOTECHNOLOGY AND MEMORY ALTERATION 219 C. MEMORY-BLUNTING: ETHICAL ANALYSIS 223 1. Remembering Fitly and Truly. 226 2. The Obligation to Remember. 228 3. Memory and Moral Responsibility. 229 4. The Soul of Memory, The Remembering Soul. 231 III. MOOD AND HAPPINESS 232 A. MOOD-IMPROVEMENT THROUGH DRUGS 237 1. Mood-Brightening Agents: An Overview. 238 2. Biological and Experiential Effects of SSRIs. 240 B. ETHICAL ANALYSIS 249 1. Living Truly. 250 2. Fitting Sensibilities and Human Attachments. 253 3. What Sorrow Teaches, What Discontent Provokes. 255 4. Medicalization of Self-Understanding. 258 5. The Roots of Human Flourishing. 261 6. The Happy Self and the Good Society. 263 IV. CONCLUSION 266 ENDNOTES 269 6 “BEYOND THERAPY”: GENERAL REFLECTIONS 273 I. THE BIG PICTURE 273 II. FAMILIAR SOURCES OF CONCERN 277 A. HEALTH: ISSUES OF SAFETY AND BODILY HARM 277 B. UNFAIRNESS 278 C. EQUALITY OF ACCESS 279 D. LIBERTY: ISSUES OF FREEDOM AND COERCION, OVERT AND SUBTLE 281 III. ESSENTIAL SOURCES OF CONCERN 284 A. HUBRIS OR HUMILITY: RESPECT FOR “THE GIVEN” 285 B. “UNNATURAL” MEANS: THE DIGNITY OF HUMAN ACTIVITY 288 C. IDENTITY AND INDIVIDUALITY 291 D. PARTIAL ENDS, FULL FLOURISHING 293 CONTENTS ix IV. BIOTECHNOLOGY AND AMERICAN SOCIETY 299 A. COMMERCE, REGULATION, AND THE MANUFACTURE OF DESIRE 301 B. MEDICINE, MEDICALIZATION, AND A STANCE “BEYOND THERAPY” 303 C. BIOTECHNOLOGY AND AMERICAN IDEALS 306 ENDNOTES 309 BIBLIOGRAPHY 311 LETTER OF TRANSMITTAL TO THE PRESIDENT The President’s Council on Bioethics October 15, 2003 The President The White House Washington, D.C. Dear Mr. President: I am pleased to present to you Beyond Therapy: Biotech- nology and the Pursuit of Happiness, a report of the Presi- dent’s Council on Bioethics. The product of more than sixteen months of research, re- flection, and deliberation, we hope this report will prove a worthy contribution to public understanding of the impor- tant questions it considers. In it, we have sought to live up to the charge you gave us when you created this Council, namely, “to undertake fundamental inquiry into the human and moral significance of developments in biomedical and behavioral science and technology” and “to facilitate a greater understanding of bioethical issues.” Biotechnology offers exciting and promising prospects for healing the sick and relieving the suffering. But exactly because of their impressive powers to alter the workings of body and mind, the “dual uses” of the same technologies make them attractive also to people who are not sick but who would use them to look younger, perform better, feel happier, or become more “perfect.” These applications of biotechnology are already presenting us with some unfamil- iar and very difficult challenges. In this report, we consider such possible “beyond therapy” uses, and explore both xii BEYOND THERAPY their scientific basis and the ethical and social issues they are likely to raise. We have structured our inquiry around the desires and goals of human beings, rather than around the technologies they employ, the better to keep the important ethical ques- tions before us. In a quartet of four central chapters, we consider how pursuing the goals of better children, superior performance, ageless bodies, or happy souls might be aided or hindered, elevated or degraded, by seeking them through a wide variety of technological means. Among the biotechnical powers considered are tech- niques for screening genes and testing embryos, choosing sex of children, modifying the behavior of children, aug- menting muscle size and strength, enhancing athletic per- formance, slowing senescence, blunting painful memories, brightening mood, and altering basic temperaments. In a concluding chapter, we consider together the several “be- yond therapy” uses of these technologies, in order to ask what kinds of human beings and what sort of society we might be creating in the coming age of biotechnology. On the optimistic view, the emerging picture is one of unmitigated progress and improvement. It envisions a soci- ety in which more and more people are able to realize the American dream of liberty, prosperity, and justice for all. It is a nation whose citizens are longer-lived, more competent, better accomplished, more productive, and happier than human beings have ever been before. It is a world in which many more human beings—biologically better-equipped, aided by performance-enhancers, liberated from the con- straints of nature and fortune—can live lives of achieve- ment, contentment, and high self-esteem, come what may. But there are reasons to wonder whether life will really be better if we turn to biotechnology to fulfill our deepest human desires. There is an old expression: to a man armed with a hammer, everything looks like a nail. To a society armed with biotechnology, the activities of human life may seem more amenable to improvement than they really are. Or we may imagine ourselves wiser than we really are. Or we may get more easily what we asked for only to realize it is much less than what we really wanted. LETTER OF TRANSMITTAL TO THE PRESIDENT xiii We want better children—but not by turning procreation into manufacture or by altering their brains to gain them an edge over their peers. We want to perform better in the ac- tivities of life—but not by becoming mere creatures of our chemists or by turning ourselves into tools designed to win or achieve in inhuman ways. We want longer lives—but not at the cost of living carelessly or shallowly with diminished aspiration for living well, and not by becoming people so obsessed with our own longevity that we care little about the next generations. We want to be happy—but not be- cause of a drug that gives us happy feelings without the real loves, attachments, and achievements that are essen- tial for true human flourishing.