One of the often noted anomalies of our society is its capacity to develop extraordinary new technologies while failing to find ways to perform elementary services in a minimally decent fashion. Nowhere is this truer, or more painful, than in medical care. Hospitals visit tawdry indignities on patients even while their bills reach unimaginable levels; medical services are increasingly bureaucratized and depersonalized; competent doctors, nurses, and paraprofessionals are in short supply and not where they are most needed. In these circumstances a new theme has emerged to dominate the discussion of the moral and social responsibilities of medicine. It is not how to humanize medicine but how to re-engineer the human race.
The occasion for this preoccupation—which has affected the curricula of medical and law schools, led to the creation of new institutes and to proposed legislation in Congress,1 and produced a stream of sociological, moral, and philosophical reflection2—is the advent of “biomedicine,” a package of dazzling biological discoveries and new medical techniques. Biomedicine, we are told, is the harbinger, or portent, of the day when man will be able to say of himself, meaning it entirely, that, at last, he is his own greatest creation, and has got the weight of that other Creation off his back. Existentialist philosophers have accustomed us during the past generation to phrases like “man invents himself.” But they have meant these dark utterances metaphorically, metaphysically. Biomedicine, it would appear, gives them a literal meaning. If what is said about it is true, mankind is on the verge of being able to make itself, in a quite physical sense, its own principal artifact.
If what is said is true. Biomedicine has been well publicized, and all sorts of people—geneticists, doctors, theologians, philosophers, social planners—have found it personally advantageous or socially desirable to talk the subject up and paint its importance in lurid colors. One who is not a geneticist or physician must speak with diffidence, but I am not myself persuaded that all the miracles that have been announced as at hand are really about to materialize. Nevertheless, even a restrained account of recent developments will suggest why people not excessively given to utopian or apocalyptic solemnities believe that biomedicine poses unprecedented issues. Indeed, whether or not biomedicine's immediate practical significance has been exaggerated, the hopes, fears, plans, and prophecies it has provoked are themselves an illuminating avenue of entry into some of the more important fads and fallacies of current moral outlooks.
The excitement that biomedicine arouses begins with its fundamental achievement, the breaking of the genetic code, an accomplishment as stunning for its intellectual brilliance, and as important, in all probability, for the history of science as the first discoveries in nuclear physics. The manner in which the genes send out the “messages” that control the development of the organism is now basically understood. A large part of what used to be called “the secret of life” is therefore open for investigation, and presumably for manipulation and redesign. Human cells growing in tissue culture, for example, have been made to undergo inheritable changes when infected by a virus or treated with foreign genetic matter. To take another example, the first week of human fetal life has been reproduced entirely under laboratory conditions: sooner or later, we are told, test-tube babies will materialize.
Together with these fundamental discoveries, an array of experimental and clinical techniques has been developed that change practical perspectives on birth, maturing, aging, dying, sexuality, and the relations of parents to children, and that can alter or undermine the private rights hitherto associated with the most intimate areas of human experience. Prenatal diagnostic procedures have been discovered which permit the determination of the sex of the fetus and the presence in it of hereditary abnormalities. With the advent of legal abortion “planned parenthood” has thus acquired a new dimension: it comprises control not simply over the number of children but over their sex and physical and mental quality. At present it is possible through prenatal diagnoses to detect sixty genetically-caused defects, among which the best known and most widespread is probably mongo-loidism, and it is expected that in a few years the list will be almost doubled. The advent of these diagnostic procedures has led to new ideas about the opportunities and responsibilities of preventive medicine and public-health programs. In a program of mass screening of pregnant women, for example, women diagnosed to be carrying genetically defective children would be advised—or, in some plans, required—to take corrective action, ranging from dietary changes through chemical therapy to abortion.
Methods of genetic diagnosis are now so advanced, indeed, as to permit the envisaging of systems of universal genetic examination, instituted well before pregnancy, to permit the detecting of individuals who, although themselves healthy, are the carriers of dangerous genes in a recessive state. Such people could be advised to stay away from people of the opposite sex who carried the same recessive genes; an alternative would be to recommend that they adopt children or have them by artificial insemination. Stronger measures could also be advised or required. The suggestion has been made by advocates of compulsory population control, for example, that boys and girls be inoculated against fertility at puberty.3 A more modest variation would be to inoculate the carriers of recessive genes for certain diseases.
By such techniques the long-range purpose of reducing the proportions of troublemaking genes in the collective human gene pool could be accomplished. The pursuit of this purpose, according to many geneticists, is an increasingly urgent imperative. The advances in medicine over the past century have decreased the significance of “natural selection” in keeping the genetic heritage of mankind relatively uncontaminated. People afflicted by inheritable diseases live to pass them on, as do people who carry mutant genes. The result, some generations away, will be a “genetic load” of abnormalities and deficiencies painful and expensive for the species to bear. Fortunately, however, the scientific progress which has caused this problem also has presented us, it is pointed out, with the potential solution. The planned production of children is the alternative, in this perspective, to the degradation of the human stock. Nor need a sufficiently motivated society restrict itself to genetic planning for wholly negative purposes like reducing the contamination of the human gene pool. The technical capabilities already exist, enthusiasts for genetic planning point out, to set about systematically to improve the human breed. Artificial insemination using stored sperm is a well established procedure. Thus, all that is needed is a proper system of social planning, and women a hundred years from now will be able to have children by Nureyev or Henry Kissinger.
Other developments loom. In the near future, it is prophesied, it will be possible with relative ease to transplant a fertilized human egg from the womb of its biological mother to that of a foster mother who will bring it to birth. Working women will be able to have someone else bear their babies. Childless women will be able to have the experience of giving birth to their adopted offspring. Moreover, techniques are being perfected which will permit, it is hoped, the modification of an individual's genetic inheritance. There is evidence, for example, that the action of the gene for sickle-cell anemia can be suppressed by activating or deactivating other genes to which its functioning is linked. Again, experiments have been performed indicating the possibility of making up for genetic deficiencies by implanting the needed genes. Gene therapy, chemical or surgical, thus appears to be a quite possible, if not immediate, medical procedure.
Nor do the achievements in genetics and biomedicine quite exhaust the advances being made toward the understanding of the human organism, and the possible refabrication of it. Parallel to the discoveries that I have mentioned are those in the surgery of organic transplants, the pharmacological alteration of personality, and the study of the brain and nervous system. Electromicroscopy, in the words of Sir John Eccles, “gives us a look at the components of the brain, the living nerve cells, and the connections between them, the synapses, at a level that is commensurate with their properties,” and neuropharmacology “gives us an exquisite understanding of the way the synapses are working with regard to the chemical transmitters and their antagonists, so that we have the potentiality to control the operation of the nervous system in a carefully designed manner.”4
Finally, the story cannot be complete without mention of “cloning,” a process which permits an indefinite number of genetically identical beings to be produced from a single individual, without blessing of sexual fertilization. Whether the cloning of human beings will be technically feasible in the near future is a matter of dispute, but the experiment has been performed successfully with frogs, from whom no complaint has been heard. Cloning would permit people to reproduce themselves in the literal sense, to duplicate themselves genetically with exactness, a more fulfilling procedure, it must be supposed, than the messy process of ordinary procreation, which leaves so much to the random fall of the genes. Since advancing research also indicates that aging is a genetically controlled process, and that the rate of aging can be significantly slowed by diet, drugs, and genetic recoding, a new prospect opens: a world populated by centenarians in glistening health, surrounded by preselected carbon copies of themselves of assorted ages. Gone are those children with the unexpected traits that make a man or woman wonder out of what nest they came. At last we will have the young just how, and where, we want them.
Whatever the potentialities of biomedicine, it is easy to see why it arouses the interest that it does. The subject forces a confrontation with Good and Evil: it is like the story of Dr. Faustus, or Adam and Eve's encounter, all over again, with the Tree of Knowledge. For it implicitly asks, what shall the human species make of itself? And in asking that question it. exposes our ultimate convictions.
Most important technological innovations, to be sure, raise the same question about the designs of the human species on or for itself. As C. S. Lewis once observed, in discussing technology's so-called conquest of nature, “In every victory, besides being the general who triumphs [man] is also the prisoner who follows the triumphal car.”5 Even technological innovations that do not involve direct probings inside the human body produce changes in human thinking, feeling, and conduct. They present us with new options or enhance our powers to achieve old goals, but they also foreclose options, change our goals, reduce our powers. Technology, in general, is not only an extension of human power over nature but an experiment with human nature, a test of the modifiability of the human physique, mentality, and emotional equipment, and of the costs and consequences of placing new loads on them. Nevertheless, biomedicine differs in significant ways from other kinds of technology.
First of all, we have the experience of the past, which suggests that, of all forms of scientific and technological innovation, medical discoveries—the circulation of the blood, anesthesia, antiseptics, malaria control, the Pill—have had the swiftest and most far-reaching effects on people's lives and moral horizons. Even if we discount by a prudent amount the significance of the last generation's achievements in biomedicine and related subjects, they still represent a considerable change in some of the basic parameters of human existence. To take a simple example, the classic discussion of the roles of heredity and environment may be turned upside down. It has always been thought that the “environmental” explanation of traits like intelligence, for example, was the more liberal, hopeful, forward-looking. But the day may not be that far away when genetic manipulations to improve intelligence will be a cheaper and more practical means to get results than environmental reforms, which have already been proved to be more difficult to bring about, and more disappointing in their consequences, than was supposed. Under such circumstances, environmentalists would be the preachers of pessimism, inegaliitarianism, and allied heresies, and hereditarians would be the bearers of glad tidings.
Secondly, biomedicine involves introducing changes in the human creature different in a fundamental respect from those that have followed technological and scientific innovations in the past. People did not intend to reduce the average height of the British lower classes when they introduced the factory system, and they had no plan to change the formative experiences of adolescence when they welcomed the Model T. Biomedicine, in contrast, involves the deliberate, not incidental or inadvertent, modification of the human organism; and it involves, besides, the making of changes that will be irreversible. Rightly or wrongly, people in the past could make decisions about the introduction of technologies without thinking about the consequences. In the case of biomedicine that fine freedom is gone. Its various techniques may be widely adopted, and the consideration of consequences may be minimal, but the process will involve a conscious and deliberate refusal to think. Biomedicine has eliminated the insouciance with which most people have embraced technological progress. It forces consideration not simply of techniques and instrumentalities but of ends and purposes.
It is, therefore, a disorienting science. The reactions to it have been like the reactions of the contemporary American mind to other disorienting events. There have been calls for additional research; interdisciplinary teams and public commissions have been created; objurgations on the guiltiness of a nation that knows no limits have multiplied; and evangelistic utterances that at last renewal has come, and the greening of America, or of all mankind, may be at hand, have also been heard.
The evangelisms have a familiar sound. On the back of Amitai Etzioni's Genetic Fix there is a blurb written by Betty Friedan. Mr. Etzioni, in the book, approaches the social and moral problems of biomedicine with finickiness, but Mrs. Friedan is less cautious: “Beyond the fantastic implications of Genetic Fix itself, Amitai Etzioni's existential act of courage in writing this book seems to me to point the new political road we must all map for ourselves now—beyond scholarly dispassion, passive compliance, or radical rhetoric mechanically fixed to the past—to take active personal responsibility for the human future.” Perhaps too much should not be read into a blurb. The words are entirely conventional. But conventional indeed they are.
They express an idea that weaves through large parts of contemporary intellectual culture, uniting B. F. Skinner's scheme for salvation through operant conditioning to Herbert Marcuse's version of Freud and Marx, and joining the programs of radical feminists with those of the theorists in international affairs who held, not so long ago, that with a proper dosage of social science plus the existential courage to use advanced machinery, Vietnam could be pushed, pulled, or pulverized into the modern world. The idea is that of a human animal wholly malleable; of differences between the old and the young, between the sexes, between nations and individuals with varying life experiences, as essentially superficial, like the dirt on a shirt collar that comes out in the wash. Society, the thought goes, entirely forms men and women. Provided only that people are willing to recognize the Good and do it—“to take active personal responsibility for the human future”—society is capable of wholly re-forming them. All that is needed, as used to be said about Vietnam, is the will. The great “breakthrough” of the last five years, I heard it flatly announced by a colleague from a department of literature at a recent university meeting, is the discovery that we are all born androgynous, and that the difference between the sexes is purely cultural—a concept which led me to wonder whether instruction in obstetrics should be transferred from the medical school to the department of sociology.
The new genetics, though it stresses heredity, has paradoxically proved to be capturable by this idea of the omnipotence of society. “Society” will simply engineer heredity. In the words of the late Hermann Muller, a Nobel laureate, programs of planned eugenics provide the opportunity to guide human evolution, to make “unlimited progress in the genetic constitution of man, to match and re-enforce his cultural progress and, reciprocally, to be re-enforced by it, in a perhaps never-ending succession.”6 Such hopes justify a certain impatience in the methods used to achieve them. With the harshness of a Lenin or Trotsky, Hermann Muller complained, for example, about the carelessness with which society allows people to procreate freely, and then deals with the unhappy consequences by therapy, surgery, or the abortion of defective fetuses. Soft methods such as these, in his opinion, were “a calumny on the rationality of the human race. It would be like supposing that in some technically advanced society elaborate superhighways were constructed to avoid defiling hallowed domains reserved in perpetuity for their millions of sacred cows.”7 Another Nobel laureate, Linus Pauling, not much more merciful to sacred cows, has recommended that people diagnosed as carriers of genes associated with serious diseases like sickle-cell anemia be prevented from marrying and be conspicuously marked so that they will be warned against falling in love.8
To be sure, Professor Pauling gives no guidance about what to do if, in this corrupt age, such people have children without marrying, or, though one hates to contemplate the possibility, without even falling in love. Nor does he discuss in detail the complications that would follow from the adoption of his proposal in a society guaranteeing certain basic liberties to all, regardless of their hereditary category. Nevertheless, such ideas should not be dismissed out of hand as so obviously simpleminded as not to be taken seriously. Simplemindedness is not a handicap in the competition of social ideas, and although the explicit supporters of an idea like Professor Pauling's may be few, the assumptions that produce it are widely prevalent.
There are mounting signs that the eugenicists' dream of a remade human breed, so long in disgrace in consequence of Nazi forays into the field, may be on its way to a comeback. (It has never, in fact, quite died. A few hundred compulsory sterilizations are performed each year in the United States, and about half the states still have compulsory sterilization laws, although they have not been actively enforced.9) In 1969 the legislature of liberal Oregon passed a law providing for a “State Board of Social Protection” to administer a sterilization program. The federal government is empowered under law to pay for the sterilization of minors—under certain conditions without the consent of their parents. And public discussion, on TV and elsewhere, of the desirability of sterilizing women on welfare increases. The notion has become respectable. Indeed, existing practices provide a setting in which the idea of broad eugenic planning may seem hardly more than an extension of what is known and accepted. We endorse compulsory vaccination and chest X-rays for school schildren. Why not mass genetic screening or other methods for avoiding the transmission of hereditary defects or for accomplishing the improvement of the human stock?
A host of gathering trends in our society favors this easy transition: the pressures for population control; the declining death rate; the growing costs of supporting the old, the sick, and the handicapped; the size of the welfare population and the resentments caused by its existence; the altered standards regarding abortion; the movements in law and morals which, with accelerating force over the last generation, have facilitated the decline of the family and of the marital idea. And to these must be added the growing disappointment or cynicism about the possibility of social improvement through institutional reform. On the Right, people can look with sympathy on eugenics, envisaging the program's being tried on others, not on themselves. And on the Left, biomedicine speaks to the hope, ever rising from the ashes, that the human race can still be made over by proper planning.
There are others who have responded to biomedicine with the view that it hasn't changed anything at all except man's chance to do evil: the old moral absolutes remain as valid as ever and had better be reaffirmed. The position taken by Father Robert Drinan on the specific issue of abortion is typical of the reactions of traditional moral absolutists to the more sweeping issues raised by biomedicine:
The integrity, the untouchableness, the inviolability of every human life by any other human being has been the cardinal principle and the centerpiece of the legal institutions of the English-speaking world and, to a large extent, of every system of law devised by man. . . . It will be a tragedy beyond description for America if the question of legislation on abortion is resolved on sentiment, utilitarianism, or expediency rather than on the basic ethical issue involved—the immorality of the destruction of an innocent human being carried out by other human beings for their own benefit.10
Rabbi Immanuel Jakobovits has been equally unbending in expressing the Orthodox Jewish view of the biomedical issue of aborting fetuses known to be seriously defective:
Most authorities on Jewish law are agreed that physical or mental abnormalities do not in themselves compromise the title to life, whether before or after birth. Cripples and idiots, however incapacitated, enjoy the same human rights . . . as normal persons. Human life being infinite in value, its sanctity is bound to be entirely unaffected by the absence of any or all mental faculties or by any bodily defects: any fraction of infinity still remains infinite.11
Rabbi Jakobovits acknowledges that Jewish law has become a little more permissive recently, and that lenient decisions have been taken by the head of the Jerusalem Rabbinical Court. He believes, however, that these “rather isolated” developments do not change basic Jewish law as stated by the Association of Orthodox Jewish Scientists of America in 1971: “Jewish law prohibits abortion when its sole justification is to prevent the birth of a physically deformed or mentally retarded child. Abortion ‘on demand’ purely for the convenience of the mother or even of society is strictly prohibited and morally repugnant. . . .”
There is a less explicit, but probably even more influential, form of absolutism than that advocated in orthodox theological circles, which is espoused by a good many people who would use words like “liberal” and “progressive” to describe themselves. I do not know how large a portion of the literature on biomedicine produced in the last few years consists in the rehearsal of the fears expressed in Brave New World, but it must be quite large. There hovers about biomedicine the scent of ancient taboos broken, of entry into forbidden territory. It stirs to life fears that go back to the oldest myths in our civilization, and revives religious attitudes about sin, trespass, and tinkering with the delicate harmonies of the Creation that lie just below the level of consciousness even in agnostics and atheists. And so there is an impulse simply to condemn the dark powers that have brought the evil thing to be.
A few years ago it was a rare day when one heard the suggestion openly made within the university world that certain kinds of purely theoretical research should be banned. But nowadays that recommendation is made daily, without apology or obfuscation, and among the avenues of inquiry nominated for this honor biomedicine rates very high. Its emergence is among the phenomena responsible for the heating up of the hostility to technology and science, and for the reawakening of suspicion toward the basic principles of intellectual freedom and rational thought.
Biomedicine, in sum, has psychic and moral reverberations that go far beyond its immediate subject matter. On the one side, it reawakens the impulse to regulate and control, to suppress the unplanned, the random, the offbeat. On the other side, it arouses the desire to stand on the unchanging truths of the ages, and to fear and resist the play of the mind for its own sake. The discussion of biomedicine has a hidden agenda as significant as its explicit one.
There are some cautionary considerations which I have found helpful in interpreting the significance of biomedicine.
Despite advances in genetics, first of all, the debate about the relative significance of heredity as against environment remains unsettled with respect to the most important human traits. Moreover, settling it is impeded by the difficulty of separating environmental from hereditary influences. Is the slow-witted child of a slow-witted mother who ignored it when it was an infant a victim of heredity or environment?
Even when we know that traits are wholly inherited, like blue eyes, or partly inherited, like height, the recent developments in genetics do not necessarily put us in a position to produce inheritable traits by plan. Most of the most interesting of these traits are “polygenic”: it is the co-presence of a number of genes, not any single gene, that is responsible for them. Rectifying these traits is therefore a complex matter, and runs the risk of affecting whole clusters of traits in undesired ways.
There is, in addition, a fundamental difference between “negative eugenics” and “positive eugenics.” “Negative eugenics” aims only to eliminate a genetic defect. It has a definable target, and the evil it seeks to combat is reasonably unequivocal. “Positive eugenics,” in contrast, aims to produce a new breed possessing, for example, “on the physical side, more robust health; on the intellectual side, keener, deeper, and more creative intelligence; on the moral side, more genuine warmth of fellow feeling and cooperative disposition; on the apperceptive side, richer appreciation and its more adequate expression.” (I borrow the shopping list from Hermann Mullet.) Apart from the fact that we do not know that these characteristics are primarily genetic in origin, they represent intellectual pigs in the poke
“Keener, deeper, and more creative intelligence” covers a variety of possibilities ranging from Mozart to Napoleon; “cooperative disposition” often shows itself in warmth of fellow feeling for one group and indifference or hostility to people in others; even “robust health” has a variety of meanings: shall we aim, in our eugenics program, at heavyweight prizefighters, or at wiry, resilient little men with the power to spend long hours at their desks without falling ill? In sum, “positive eugenics” aims at gross targets, and, in practically every case, at ill-defined and incoherent ones.
Moreover, “positive eugenics” makes no sense unless it is practiced on a broad social scale. It thus involves, at the least, the use of high-pressure propaganda methods, which its devotees are likely to call “education for social responsibility,” and it probably necessitates legal coercion. It has the further inconvenience of inviting people to think of themselves as stud animals.
Even in the case of “negative eugenics,” a distinction has to be drawn between individual action and a general program directed at cleaning out the human gene pool. It is one thing to say that people should have the right to make an informed choice concerning whether they will have a child suffering from Tay-Sachs disease; it is quite another thing to engage in genetic counseling or other measures with a view to reducing the proportion of Tay-Sachs genes transmitted to the human gene pool by people who carry them in a recessive state. The latter is surrounded by complications.
For example, some genes responsible for serious diseases are, in their recessive states, also beneficial. The gene for sickle-cell anemia appears to have been associated with heightened resistance to malaria. Further, the “dirtying” of the gene pool, as it is called, is a long-term process, for which medical progress may be expected to provide some remedies. Diabetes, a hereditary disease, is no longer commonly a lethal one. Most important of all, to speak of “undesirable” genes is to use an environment-relative term. Diabetes is a dangerous disease when diets reach a certain level of richness; it was not usually disabling for primitive hunters.
The lesson to be drawn is an old one, but it is characteristic of fashions in ideas to neglect such lessons: probably the greatest biological resource of the human species is its variety of genetic strains. Unless we can know precisely what the future environment will contain in the way of foods, germs, climate, work, and numberless other aspects of life, caution is advisable with regard to the adoption of plans for the elimination of genetic traits whose present disutility may be a passing phase.
But if the facts of genetics make the effort to recast the human species inadvisable, the facts about human desires make it doubly so. For people are probably wisest, they understand their desires best, when they are aware that they do not know what they desire human beings to be forever and ever. In time of war, the qualities sought are resilience, discipline, loyalty, physical courage; in time of peace, people praise flexibility, independence, moral courage. Assuming that we had the requisite powers, shall the moods and needs of a decade or half-decade be permitted to affect the permanent temperament of mankind?
More prickly still is the consideration that a kind of systematic doubletalk infects most descriptions of morally desirable characteristics. “He is stubborn,” I say, describing behavior which, in my own case, I call “acting on principle.” “Cooperativeness” is a common candidate for moral praise; still, those who cooperated with the Nazis are called “collaborators.” “Initiative” is praised but not “aggressiveness,” “individualism” is admired but not “egoism.”
As Aristotle observed in his Ethics, virtues are contextually defined. An action which, in one set of circumstances, is courageous is, in another set of circumstances, foolhardy. It is the characteristic of a fully virtuous man to know when, and to what extent, to give a particular disposition or attitude its expression. Judgment and emotional imagination are the crucial ingredients in this. Anyone who has a list of simple, unambiguous moral traits by which he would define the good man reveals that he lacks precisely these qualities. Yet they are the indispensable prerequisites for planning the future.
Indeed, even if people's moral desires were more easily definable than they are, there would still be a problem. They are woefully inconstant. The hopes for the regeneration of the race nurtured by enlightened people have moved from object to object over the last fifty years—the Russian Revolution, the war in Spain, Cuba, China, psychoanalysis as a cure for politics, politics as a cure for psychoanalysis, the encounter movement) the youth movement, the black movement, the women's movement. In 1935 Hermann Muller offered Lenin and Marx as examples of the kind of people whose genetic types should be propagated. Twenty-five years later, after the Lysenko affair, he took them off the list, and the names of Einstein, Pasteur, Lincoln, and Descartes appeared on it. Despite such changes of mind, his confidence that people knew what they were doing when they planned the genetic future of mankind remained unshaken. The intellectual and spiritual peregrinations of educated people in the last half-century do not inspire confidence in any plans they may develop for the remodeling of the species. “Oh, doctor, doctor!” says Jennifer in Shaw's The Doctor's Dilemma, “you . . . think you are a little god. How can you be so silly?”
Finally, all of these considerations say nothing about the classic political problem of distributing burdens and benefits. Biomedicine's techniques, however refined, cannot solve this problem. Consider even the relatively simple and easy-to-define issue of eliminating recessive genes for specific diseases from the human gene pool. A hundred such diseases will shortly be diagnosable by genetic screening, and many more, presumably, after that. A very large proportion of the human beings alive, perhaps all, will be found to be carriers of this or that dangerous characteristic. Who shall submit to biological nullification and who shall not? Genetic planning introduces a new reason for human quarrels but gives us no logic for solving them.
If these considerations have any merit, there are no reasons for abandoning established principles of freedom of individual choice where biomedicine is concerned. The deliberate broad-scale regulation of man's pro-creative life requires powers of intelligence, imagination, and emotional perspective not within the human range. The observation applies equally, I believe, to those who would redesign the human species through eugenics and those who would place absolute barriers in the way of using biomedical knowledge to alleviate individual woes. In both cases, it seems to me, people are being asked to sacrifice the direct and immediate emotions that surround the procreating and bringing up of children to an abstract idea. It is not a prudent policy or a feeling one. Beyond the point of simpler economic budgeting, the ethical-political maxim that the present generation ought to sacrifice itself for an unidentified posterity has usually led to suffering not only profound but useless. People regularly do pay attention to the future, and make sacrifices for it, but for reasons of specific affection: they care for their children and grandchildren. I am inclined to think this a surer and sounder basis for choice than the hope for a new breed or the fear that absolute moral principles will be sullied.
I may appear unfair to apply these strictures against unrestrained abstractionism to people like Father Drinan or Rabbi Jakobovits, who seem to wish only that new scientific knowledge not be permitted to tear us loose from firm and tested ethical moorings. I confess that I feel considerably more sympathy with their views, with their creature caution, their sense of knowing what they know and preferring it, than I do with any eugenic Grand Design. Yet the reactions of Father Drinan and Rabbi Jakobovits seem to me unrealistic. Positions like theirs are not likely to prevent the acceptance and widespread use of biomedical techniques; but they are likely, through their intransigence alone, to impede efforts to deal with biomedicine with prudent restraint. And most directly related to the present point is the consideration that, like eugenicists' plans, they allow an idea to soar away from any identifiable context. “The sanctity of human life,” for example, undoubtedly expresses a value, but it doesn't exist alone. The duty not to cause avoidable suffering surely also makes a claim on us. So does the duty to use limited human resources discriminatingly. This sometimes involves making distinctions among kinds of life, including, if necessary, a fetus's life from an infant's. Recognition of the plurality of human duties is not properly described by words like “sentiment,” “utilitarianism,” or “expediency.”
I do not find persuasive the first principle Father Drinan or Rabbi Jakobovits suggests—“the immorality of the destruction of any innocent human being carried out by other human beings for their own benefit.” Like all such principles it fails as a guide in all cases. How does this principle apply to just wars, for example? Does it say there are none? Or that in war there are no innocents? How does it apply to common peacetime enterprises, like coal mining or bridge building, to which civilized and decent people give support every day, and which involve the predictable deaths of some human beings for the benefit of others? Admittedly, there is always, as classic arguments maintain, the danger of “the slippery slope.” It can be said that once the decision has been taken that a fetal life can be aborted because it is unwanted, we are moving down the slippery slope that will lead to the taking of innocent adult lives because they are unwanted. But there are other slippery slopes. It seems to me also arguable, and somewhat more convincingly, that when people permit otherwise avoidable suffering to take place in the name of such speculative possibilities, they are halfway down the slippery slope that leads to the righteous punishment of their fellows for the sake of an abstract creed.
The fact is that any principle has its slippery slope. One meets that danger by combining it with other principles and not allowing oneself to be guided by it alone. Thomas Aquinas, no enemy to absolute values but not a moral innocent either, observed in the Summa (Qu. 94) that the law of nature, “as far as general first principles are concerned,” is the same for everybody, but that when we get down to particular cases “it can admit of exceptions,” and is applicable unchanged “only in the majority of cases.” Few people who have looked closely at the concrete situations, each different from the next, in which, let us say, the parents of predictably mongoloid children have to decide about abortion, have been capable of coming up with unbreakable rules on the matter. Catholic and Jewish clergymen, even of orthodox views, have not invariably been as uncompromising in practice as their statements in theory would lead one to expect.
As for the notion of suppressing biomedical research because it involves playing with the ultimate secrets of nature, the impulse to adopt such a view is understandable but not the ease with which some members of the intellectual world are giving in to it. That biomedicine has given mankind powers which it is capable of using for ill is evident. Technologies of extraordinary power have been turned loose in contemporary society without even the simulacrum of thought about the consequences, and now we have one more. But the research that leads to test-tube babies is also the research that leads to a better understanding of cancer. Inquiry goes where nobody can predict, and technologies are useful for good and ill. These are truths that sound tired from being repeated, but they remain true and it is sad that they so often have to be repeated. For while technology is equivocal in its consequences, one thing is not—the damage that ensues, almost always very quickly, when a field of inquiry is banned because it is said to conflict with higher moral laws. The number of subjects that can come under this ax is indefinitely large. The character of the people who have ever wielded this ax is not reassuring.
Nor is the naiveté of eugenics planners. Professor Pauling, in a society that has run into some trouble in consequence of its habit of categorizing people by race, proposes that people be visibly marked when they carry bad genes! And others from Hermann Muller down envisage the planned production of a new human breed without facing the implications for their plan of the persistence of national sovereignties. Redesigning the species is not possible except under the strongest of world governments. If it were known that the object of such a government was to make a new breed, the arguments over which present breed should be the principal model would be likely to be considerable. There would probably be words like “genocide” thrown around. This would not facilitate the attainment of such a government, which, even under present circumstances, is not precisely easy to create.
The most astonishing question of all posed by the advent of biomedicine, probably, is why adults of high intelligence and considerable education so regularly give themselves, on slight and doubtful provocation, to unbounded plans for remaking the race. The factor responsible is not biomedicine; something else can be the catalyst tomorrow. It is the larger idea which has shaped the major traumatic events of the last three hundred years of modern history. What unites the Puritan radicals, the Jacobins, the Bolsheviks, the Nazis, and the Maoists is the deliberate intention to create a “new man,” to redo the human creature by design. That is the modern idea of Revolution, an idea not entertained in the ancient world except as a matter of faith, miracles, and the destruction of temporal things. It is what has lifted revolution in the modern world above purely mundane concerns like overthrowing tyranny, or putting more capable or decent people into power, and has made it a process of transcendent meaning, beyond politics or pity, and justifying any sacrifice. These are the accents with which Sir Francis Crick, still another Nobel laureate, speaks, when he states his belief that no newborn infant should be declared human until it has passed certain tests regarding its genetic endowment, and that if it fails these tests it forfeits the right to live.
The partisans of large-scale eugenics planning, the Nazis aside, have usually been people of notable humanitarian sentiments. They seem not to hear themselves. It is that other music that they hear, the music that says that there shall be nothing random in the world, nothing independent, nothing moved by its own vitality, nothing out of keeping with some Idea: even our children must be not our progeny but our creations.
1 A bill providing for the establishment of “A National Advisory Commission on Health, Science, and Society,” introduced by Senator Walter Mondale, was passed unanimously by the Senate in the 92nd Congress, but failed in the House. It has been reintroduced once more in the present session of Congress.
2 For recent examples, see Amitai Etzioni, Genetic Fix (Macmillan, 276 pp., $7.95), and Daniel Callahan, The Tyranny of Survival (Macmillan, 284 pp., $6.95).
3 Edgar Chasteen, “The Case for Compulsory Population Control,” Mademoiselle, January 1970.
4 “Science and Freedom,” the Humanist, September/ October 1972.
5 The Abolition of Man (1965), p. 71.
6 “The Guidance of Human Evolution,” in Muller, Studies in Genetics (1962), p. 590.
7 “The Guidance of Human Evolution,” in Perspectives in Biology and Medicine, 3 (1959), p. 37.
8 “I have suggested that there should be tattooed on the forehead of every young person a symbol showing possession of the sickle-cell gene or whatever other similar gene, such as the gene for phenylketonuria, that he has been found to possess in single dose. If this were done, two young people carrying the same seriously defective gene in single dose would recognize this situation at first sight, and would refrain from falling in love with one another. It is my opinion that legislation along this line, compulsory testing for defective genes before marriage, and some form of public or semi-public display of this possession, should be adopted.” (“Reflections on the New Biology,” UCLA Law Review, Vol. 15, No. 3 , p. 269.)
9 See William, T. Vukowich, “The Dawning of the Brave New World—Legal, Ethical, and Social Issues of Genetics,” University of Illinois Law Forum, Volume 1971, No. 2 (1971).
10 “The Right to Be Born,” in David F. Walbert & J. Douglas Butler, eds., Abortion, Society, and the Law (1973), p. 137.
11 “Jewish Views on Abortion” ibid., pp. 109, 118-19.