POLICY FORUM BIOETHICS
Is Biomedical Research Too Dangerous to Pursue? Arthur Caplan
particular ethical stance, utilitarianism, has guided science policy in the United States for more than 50 years (1, 2). The moral argument that investing in science and technology extends life and improves the quality of life, despite exacting a toll in harms and risks, has long dominated debate in American science policy. This ethical framework is now under sustained attack from many quarters (2–10), not because of doubts about the benefits scientific knowledge can bring, but because of the belief that important values will of necessity be compromised if biomedicine continues in its current direction (3–10). Some making this argument have the ears of those at the highest levels of government (7–9). During the past year, a rash of writings has appeared that reject the view that benefit alone should determine whether to proceed with the biotechnology revolution. As the bioethicist Daniel Callahan argues, those concerned about where biotechnology may take us do not and should not accept the framing of the debate in utilitarian talk of “progress,” “cures,” and “a better life” (3). Worries about the loss of our humanity, the value of life, and the meaning of human experience are at the core of their fears. Perhaps the most outspoken and influential critic of the utilitarian justification for research is the chair of President Bush’s Council on Bioethics, Leon R. Kass. Kass has long been concerned about the ways in which biotechnology undermines or shifts our understanding of the nature of family, marriage, sexual relations, aging, and parenting (11). Recent developments in cloning, stem cells, genetic testing, pharmacology, anti-aging research, and the neurosciences have only intensified his concerns. Appeals to a utilitarian ethic—the benefits to be gained from biomedical research— have been the overarching ethical ethos grounding U.S. science policy. But, the suggestion that science policy in the United States has not recognized limits to utilitarianism is a straw man. Patient and subject
The author is in the Department of Medical Ethics and director, Center for Bioethics University of Pennsylvania, Philadelphia, PA 19104–3308, USA. Email: [email protected]
rights, respect for privacy, and the need to have research reviewed by appropriate third parties are examples of such limits. Current critics want to go far beyond limits, in some cases, to outright bans or prohibitions. The case they offer is far from persuasive. Their moral worries fall into three areas (7–10). First, biomedical research cannot continue on its present course without significantly altering human nature. Second, if, in the name of more cures, longer life, and improved quality of life, we continue on our present biomedical research course, we will commodify and objectify human life (7, 10). Third, too much biomedical tinkering will produce a loss of authenticity and meaning in human experience (4, 6). We may someday feel better because of powerful drugs or immersion in a world of computer-generated stimuli, but we will be far less healthy because our sense of wellbeing will have become programmed, artificial, and inauthentic. Must progress in biomedicine distort who we are? Has a case been made to slow or stop the biomedical research enterprise? I believe not. Biomedical knowledge may lead us to tinker with the genes, neurons, or physical bodies that we understand today as essential to defining human nature. But human nature itself has changed drastically in response to technology. Even the most basic ideas about who we are—how we see the world; how we walk, run, and move; whom we interact with, befriend, and love; what thrills us and threatens us—are all the result of complex interactions between the world, technology, and our bodies (12). Nor is there any reason to glorify a particular phase in the evolution of human nature and declare it sacrosanct. Human nature is not static; it lacks any recognized “essence” and has elements that have proven maladaptive in the past. Similarly, although we may imperil the value of humanity by seeing ourselves as portable sources of marketable organs or by using technology in order to ensure optimal reproductive success, choosing such objectified or commodified visions is not an inevitable result of biomedical progress. Social and political choices, not scientific
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advances, will determine how our dignity and autonomy are to be squared with the prospect of birthing from artificial wombs or enhancing our mental capacities through genetic or neuronal engineering. Self-esteem need not be a victim of progress. Those born as a result of the application of forceps, neonatal intensive care units, in vitro fertilization, or preimplantation genetic diagnosis do not appear to suffer from undue angst about having been artificially “manufactured.” Nor should they. There is not anything obviously more dignified about being “made” in the back seat of a car than there is having been conceived from a pipette and a sperm donor. Finally, the concern that advances in biotechnology will come at a terrible price— the loss of authentic happiness, the loss of what makes life meaningful—struggle, suffering frailty, finitude, and death (4, 6, 7, 9, 10) do not seem to square with what we have already experienced in the wake of biomedical progress. Do those who use glasses, insulin injections, wheelchairs, inhalers, oxygen tanks, hearing aids, or prosthetic limbs feel inauthentic or overcome by a loss of meaning in their lives? If I use a calculator, a computer, or the Internet to solve a problem, do I feel that I have been cheated out of a more authentic experience enjoyed by my grandparents, who used pen and paper calculation, visited a library, or mastered the plication table? There is little evidence for the dour view that we can only be happy when we have earned our happiness. When the stakes are enormous—continued premature death, disability, chronic suffering—then much more is required of those who would challenge the wisdom of the aggressive pursuit of biomedical knowledge that is the only hope of solving these terrible problems. References and Notes 1. B. L. R. Smith, American Science Policy Since World War II (Brookings Institution, Washington, DC, 1990). 2. D. S. Greenberg, Science, Money, and Politics (Univ. of Chicago Press, Chicago, 2001). 3. D. Callahan, What Price Better Health? (Univ. of California Press, Berkeley, CA, 2003). 4. C. Elliott, Better Than Well (Norton, New York, 2003) 5. S. Krimsky, Science in the Private Interest (Rowman & Littlefield, Lanham, MD, 2003). 6. B. McKibben, Enough: Staying Human in an Engineered Age (Times Books, New York, 2003). 7. L. Kass (President’s Council on Bioethics), Beyond Therapy: Biotechnology and the Pursuit of Happiness (HarperCollins, New York, 2003). 8. A. Wolfson, New Atlantis 2003 (no. 2), 55 (2003). 9. W Kristol and E. Cohen, Eds., The Future Is Now: America Confronts the New Genetics (Rowman & Littlefield, London, 2002). 10. F. Fukuyama, Our Posthuman Future (Picador, New York, 2002). 11. L. R. Kass, Publ. Interest 26, 18 (1972). 12. E. Tenner, Our Own Devices (Knopf, New York, 2003).