Life Liberty & the Defense of Dignity: The Challenge for Bioethics (Encounter Broadsides) - Softcover

Leon R Kass MD

Leon Kass is the Addie Clark Harding Professor on the Committee on Social Thought at the University of Chicago and a founding fellow of the Hastings Center, the nation's first bioethics research center. Given these credentials, when Kass speaks, we should listen, particularly since August 2001, when President George W. Bush appointed him to chair the President's Council on Bioethics. It is not that one expects the administration to turn to this council for moral advice, but rather that Kass was chosen to vet its membership to ensure its compatibility with the President's political stands on the matters submitted to it -- most notably, on the propriety of stem-cell research. Thus, Kass's Life, Liberty and the Defense of Dignity is not merely another theoretical disquisition on bioethics but, rather, in my opinion, expresses the administration's likely positions on issues central to medicine and medical research. For that reason alone, it warrants close reading. What one discovers is disquieting. This is what Kass asserts about moral life in the United States and the role of science in its decay: It is hard to claim respect for human life in the laboratory in a society that does not respect human life in the womb. It is hard to talk about the meaning of sexuality and embodiment in a culture that treats sex increasingly as a sport and has trivialized gender, marriage, and procreation. It is hard to oppose federal funding of baby-making in a society that increasingly expects the federal government to satisfy all demands, that -- contrary to so much evidence of waste, incompetence, and corruption -- continues to believe that only Uncle Sam can do it. During the past few decades, we have heard claims of a right to health or health care, a right to education or employment, a right to privacy (embracing also a right to abort or to enjoy pornography, or to commit suicide or sodomy), a right to dance naked, a right to clean air, a right to be born, even a right not to have been born. In this atmosphere, we hear much about the ultimate rights claim, a "right to die." How persuasive are these allegations? The waste, incompetence, and corruption that brought us Enron, WorldCom, and Tyco occurred in the private, not the public, sector and arose from lack of government regulation. Right-to-lifers (professing reverence for life in the womb), not laboratory scientists, have assassinated physicians and health workers. Church officers, not federal officials or biologists, have covered up for pedophiles. Our society is imperfect, but most Americans are remarkably decent folks. Why, according to Kass, has the quality of moral life deteriorated to such an extent? His book traces the "dehumanization" to the very ideology of biologic science, not merely its techniques: The deepest threat to human dignity lies not in the techniques of biotechnology but in the underlying science itself, in an "objectified" treatment of life that fails to do justice to its subject. The sciences not only fail to provide their own standards for human conduct; their findings cause us to doubt the truth and the ground of those standards we have held and, more or less, still tacitly hold. The challenge goes even further than the notorious case of evolution versus Biblical religion. Is there any elevated view of human life and goodness that is proof against the belief that man is just a collection of molecules, an accident on the stage of evolution? . . . Does not the scientific world view make us skeptical about the existence of any natural rights and therefore doubtful of the wisdom of those who've risked their all to defend them? If survival and pleasure are the only possible principles that nature does not seem to reject, does not all courage and devotion to honor look like folly? . . . We are quite frankly adrift without a compass. Can contemporary bioethics save us? Not a chance. Its theories, based on analytic philosophy, are "hyper-rational." The bioethicist Kass most admires is the late Paul Ramsey, professor of Christian ethics at Princeton, whose principles were based on religious faith. But to build on faith in a pluralistic society is to build on sand. As John Locke noted four centuries ago, "Every church is orthodox to itself; to others, erroneous or heretical." Kass's book dismisses the rationalists who disguise themselves as bioethicists in these woeful times of ours: "Expert" professors of ethics or bioethics are . . . unequal to these tasks. They are tasks, rather, for families and for communities of worship, where cultural practices enable the deepest insights of the mind to become embodied in the finest habits of the heart. Not for nothing does the Good Book say that the beginning of wisdom is the fear [awe, reverence] of the Lord. The theoretical and rationalistic approach to ethics has grave weaknesses. . . . Though originally intended to improve our deeds, the reigning practice of ethics, if truth be told, has, at best, improved our speech. Would that it had improved speech! Language is not neutral; words have connotations. Labeling stem-cell research "human cloning" summons images of scientific Frankensteins creating monsters. Call the process "nuclear transfer" (introduction of the nucleus of an adult somatic cell into an enucleated egg allowed to multiply for no more than 14 days), and the project will hardly raise an eyebrow. Label it "stem-cell research," recall that the 100,000 or more fertilized eggs now in a frozen limbo are slated for destruction, and compassion urges their use for research to combat degenerative diseases. Kass insists that he is not a Luddite. Notwithstanding his disavowal, what other than a Luddite should we call a man who would ban not only stem-cell research, but also reproductive medicine itself? He writes: even the benevolent uses of humanitarian technologies often have serious unintended and undesired consequences. . . . The ability to intervene technologically in the human body and mind brings vexing dilemmas, anxious fears and sorrowful consequences -- about abortion, genetic manipulation, organ transplantation, euthanasia, and use and abuse of drugs and worst of all . . . the conquest of nature for the relief of man's estate could lead to severe dehumanization -- in C.S. Lewis's words, to "the abolition of man." We learn to prevent all genetic disease, but only by turning procreation into manufacture. We have safe and shame-free sex, but little romance or lasting intimacy. We live much longer, but can't remember why we wanted to. Kass professes to "sympathize with the plight of infertile couples," but it is difficult to discern anything resembling sympathy in his moral fulminations about extracorporeal fertilization: Any honest biologist . . . must be inclined, at least on first glance, to the view that a human life begins at fertilization. . . . The most sensible policy is to treat the early embryo as a pre-viable fetus, with constraints imposed on early embryo research at least as great as those on fetal research. . . . The need for a respectable boundary defining protectable human life cannot be overstated. The current boundaries, gerrymandered for the sake of abortion -- namely, birth or viability -- may now satisfy both women's liberation and the United States Supreme Court and may someday satisfy even a future pope, but they will not survive the coming of more sophisticated technologies for growing life in the laboratory. "Gerrymandering" by the Supreme Court has reduced the rate of death from abortion by 90 percent during the past two decades. Human lives outside the womb are less important to this philosopher than the Court's lack of precision about the boundaries of viability. He goes on to lament in vitro fertilization: "What is the significance of divorcing human generation from human sexuality, precisely for the meaning of our bodily natures as male and female, as both gendered and engendering?" As much as a third of infertility, Kass tells us, results from tubal obstruction secondary to gonococcal pelvic inflammatory disease. This belief leads to a savage comment: leaving aside any question about whether it makes sense for a federally-funded baby to be the wage of aphrodisiac indiscretion, one can only look with wonder at a society that would have Petri dish babies before it has found a vaccine against gonorrhea. . . . Much as I sympathize with the plight of infertile couples, I do not believe they are entitled to the provision of a child at public expense, especially now, especially at this cost, especially by a procedure that involves also so many moral difficulties. Kass then adds, with disgust: "A few years ago an egalitarian Boston-based group concerned with infertility managed to obtain private funding to pay for artificial insemination for women on welfare!" If Life, Liberty and the Defense of Dignity were simply another jeremiad about the decline of morality, there would be little reason for concern; as a blueprint for federal policy, it is alarming. It is not accidental that "the pursuit of happiness" is not to be found in the book's title: Kass elevates suffering to a moral virtue. Where moral analysis is called for, he provides moral exhortation. We are given cant, not Kant. Leon Eisenberg, M.D.
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