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SIX: Biotechnology, Human Enhancement, and the Ends of Medicine
- Georgetown University Press
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C H A P T E R S I X Biotechnology, Human Enhancement, and the Ends of Medicine Technology opens doors, it does not compel man to enter. —Lynn White Jr., Medieval Technology and Social Change ONE of humanity’s persistent dreams has been to seize control of nature ’s laws and eradicate the fragility and finitude of human life. For most of human history, this elusive hope resided only in the literary imagination. Writers fashioned a multitude of utopias free of strife, aging, disease, and death.1 Others just as zealously exposed the nightmares and follies of human attempts to outdo the Creator.2 From the sixteenth and seventeenth centuries on, however, science and technology began to place the means to control nature in human hands, and the elusive dream took on the air of reality. First to come under control was the physical world, culminating in the twentieth century in the conquests of space and atomic energy. In the last half of that same century, control extended to biology, to the secrets of human life itself. Twenty-first-century biotechnology in the form of molecular biology, genetics, nanotechnology, cybernetics, and psychopharmacology promises to eradicate disease, to go beyond mere therapy to enhance the quality of every facet of life.3 Beyond all this is the lure of transforming human nature itself to free it even from the vagaries of natural selection, evolution, and ecology.4 As a result, humanity’s recurrent dream has been revitalized. Today’s scientists, philosophers, and pundits see modern humanity freed of Biotechnology, Human Enhancement, and the Ends of Medicine 111 gods and God. Their unbridled enthusiasm scoffs at Ecclesiastes’ mordant wisdom. They dismiss that author’s pessimism about the vanity of all things under the sun because there is indeed something new under the sun—biotechnology. Humanity can become its own redeemer , as one of medicine’s sagest practitioners, the Canadian physician Sir William Osler, predicted in a moment of joyous adulation at early-twentieth-century medicine’s prowess.5 Osler scarcely could have envisioned that his beloved art would go beyond the eradication of disease to the satisfaction of every human desire, not just for health but for physical, physiological, and emotional perfection. To use Lynn White’s metaphor, biotechnology has indeed opened a wide, new, and confusing array of doors.6 Today we must decide which of those doors to enter, which to explore tentatively, and which to keep tightly shut. More than anything else, we must control our power to control who, and what, we are. Otherwise, we are in danger of becoming victims of our own ingenuity, in which we make our utopias into dystopias. Sadly, however, there is no historical evidence that technology can be limited by moral constraint, or that what starts as legitimate treatment of disease will not be used beyond therapy.7 To exert moral constraint requires grappling with what it is to be human. This is the crucial, first-order philosophical and theological question that creates the deepest fault lines in contemporary culture. The President’s Council on Bioethics has clearly recognized this fact.8 The council’s clarity in defining the deeper issues and its call for a ‘‘richer bioethics’’ are essential first steps. But this is just the beginning, for it is beyond this first step that the ethical quandary begins. Against this background, we examine the narrower question of medicine ’s relationship with biotechnology. To what extent should medicine and physicians become the vehicles for individual and societal access to technobiology’s promised benefits? In the realm of disease treatment, there is little question that physicians are the logical and necessary agents. But what about the ‘‘enhancement’’ of individual and social life, or the promises of perfection of human nature itself, beyond therapy? [3.15.143.181] Project MUSE (2024-04-17 18:22 GMT) 112 C H A P T E R S I X To what extent should medicine be biotechnology’s servant? Should medicine be redesigned to accommodate biotechnology? Should a new profession be created for this purpose? Are the aims of biotechnology ‘‘good’’ for patients or for humans as humans? How would being a Christian physician influence the responses to these questions? This chapter focuses on the relationships between biotechnology, enhancement, and the ends of medicine from both secular and Christian perspectives. We begin with the difficulties of attempting to define the key terms: health, disease, illness, and sickness. Given the variability of meanings, operating definitions are...