In December 2010, Sherif Girgis sat down with Arthur Caplan, a professor at the University of Pennsylvania and unofficial “dean” of liberal bioethicists, and Robert P. George, a professor at Princeton University and a conservative member of President Bush’s Council on Bioethics, to discuss the current state of bioethics in America. Today we present the second part of an adaptation of that interview. Part one may be read here. – Ed.
AC: In the early days of bioethics, we had these conferences at the Hastings Center, where I began my bioethics career, where Alasdair MacIntyre, Paul Ramsey, Leon Kass would come and talk about issues. And I began to form an idea of what bioethics’ role was—and I still believe it to this day: My philosophical idol is Socrates. He worked frequently in the pubic sphere. I think as a bioethicist you try to alert the public, you warn people, you push to see what’s true, but at the end of the day, bioethics gets out of the way. You don’t issue final judgment; you must resolve issues in the political sphere. If Robby’s guys get elected all the time, and they ban embryonic stem-cell research, I’ll scream and yell, but if that’s what people decide, that’s what people decide. I favor bioethics commissions that raise issues, clarify them, and then give them to the polity to resolve.
RG: Well, it’s true that President Bush’s council on bioethics, on which I had the honor to serve, sometimes went beyond advising the president of the United States himself. But it’s worth remembering that the Executive Order creating the Council included a mandate to “provide a forum for a national discussion of bioethical issues.” The collected readings we published were an effort at large-scale public education. I think that kind of work can easily be defended, and the best defense is that by doing it under the auspices of a commission, and especially an ideologically diverse commission like ours, it is possible to draw attention to the basic values issues that Americans should think about when they consider bioethical questions. I doubt that it would be possible to do it as well in reports issued by, say, Princeton University, or even the premier center for bioethics here at the University of Pennsylvania. If the commission is not the place, where, then? Because the universities aren’t doing it very well, and perhaps can’t.
AC: So it’s funny you should say that, because I’ve also thought—and I don’t know how to make this happen, exactly—but if I had a politician ask me for advice on something, I’d like to be able to bring Robby in—really—and say, “I’ll tell you my advice, and you can listen to the minority, distorted, bizarro other opinion…”
RG: Soon to be the majority! [Laughter]
AC: But here it is, listen to the other view, and you’ll get more from a conversation than you might from me just talking to you.
RG: Art is absolutely right on this. I was asked by three Republican presidential candidates in the run-up to the 2008 election for briefings on embryonic stem-cell research. Senator McCain, Governor Romney, and Mayor Giuliani. Mayor Giuliani did it differently than the other two. He invited me and an advocate of embryonic stem-cell research from one of the New York-based patient advocacy groups to discuss the question with him. Essentially, it was a debate in front of Mayor Giuliani. And I do think that it was more fruitful than the other two briefings, where I had my little captive audience, but would just give my best answer when they asked, “Well, why do the people on the other side think what they think?” And I’d try to give the argument, but I think I was probably less effective in giving the argument than someone who actually believed it.
Let’s have one of those exchanges now about a big issue in bioethics: eugenics. You have people like Professor Kass, who are warning that it is popping up again in the availability of certain options for improving the gene pool or selecting for or against early human life that has certain defects and so on—but that the “new eugenics” are disguised as opportunities for practicing autonomy, and that, as a result, they are viewed as morally okay. Do you think that’s happening, as a factual matter? And is even uncoerced eugenics wrong in principle? Was eugenics in the 1930s, say, wrong only because it was coercive, or also because it was eugenics?
RG: You’ve heard me make the argument about human dignity without any appeal to religious authority or biblical revelation or theological premises. But the most vivid expression of that idea is that man is made in the image and likeness of God. Whether or not that’s literally true, I would still hold that human beings have a certain dignity that distinguishes them from other material objects that we know about. There may be other creatures in the universe that possess a rational nature, and I would say that if there are such beings, they too are of inherent and equal dignity and cannot be reduced to the status of mere means or property. In the end, this is really the only reason to oppose something like slavery, or to consider that domination and conquest are a bad thing. So people who oppose these evils have to embrace some notion of the special worth—we can use the word “dignity” or “sanctity”—of a human being. But that means there are some ways you can’t treat human beings. You can’t treat them as instruments, or just the way you treat cows and horses. That is true even when it comes to breeding, or to improving the quality of the race. Or treating them like products—this is what Leon Kass is so worried about. He’s worried about reducing human beings to the status of products of manufacture. And he’s absolutely right to be concerned about that. That is incompatible with our dignity as human beings. Which leads me to think that the problem with eugenics is eugenics itself. It’s not just that the eugenics practiced by the Nazis was coercive. The idea predated the Nazis. The book Die Freigabe der Vernichtung Lebensunwerten Lebens (Allowing the Destruction of Life Unworthy of Life) was not written by the Nazis. It was written by German progressives in the Weimar period, Karl Binding and Alfred Hoche, who were, respectively (as I recall), a jurist and a medical doctor. And they weren’t thugs like the Nazis; they were well-educated, well-intentioned, polite people—the kind of people that you’d be pleased to have dinner with. But I believe they embraced a very bad idea that was easily taken by the Nazis as a justification for the atrocities that they committed. So I would like to see eugenics itself, and not just the Nazi version of it, relegated to the ash-heap of history. Today we are seeing a revival in eugenics, this time under the cover of (and often in the name of) autonomy. People say, for example, that so long as it is parents who are choosing to abort a Down syndrome baby, or failing to treat a handicapped newborn, and it’s not the state mandating it, then it’s okay. That, I believe, represents the abandonment of something precious in our civilization and in our polity. And that’s the idea of the equality and dignity of all human beings. This treasure of our civilization is the idea that, in some fundamental sense, all of us are created equal.
AC: So, I think that the coercion is, historically, really what made the Nazis’ position absolutely wrong. They practiced government-mandated negative eugenics. They killed involuntarily as social policy to improve the German genome. So put that aside, that’s just an issue of making sure you know when you’re going to use the metaphor—it’s not just eugenics, it’s that kind of eugenics. So to me, I think that intervening to try to improve health and function is part of what medicine does. And there’s some role for medical engineering and cellular engineering to achieve those goals. I think when you start to slide into the aesthetic and cosmetic improvements—I’m not sure that’s something that society or the public has to fulfill. But do I think we will someday try to alter a genetic message to get rid of certain diseases? Yes. Do I think that we’re likely to see the selection of certain types of gametes that might avoid certain clear-cut disease states? Yes. Do I think that the state has to be in the business of affording the opportunity for everyone to have a 6’5” basketball-playing mathematician? No. For me, there is some role for what I’ll concede as eugenics—if you want to take eugenics as just trying to improve the overall hereditary health of the public. For example, if you could fix the child with Tay-Sachs, I don’t think it takes away from the dignity of the child with Tay-Sachs.
RG: I agree. But would you draw the line at intelligence as trying to enhance—
AC: I do. I think intelligence is so complicated that you don’t know what the hell you’re doing. If someone came to me and said, “Well, I’m going to try to enhance memory,” that may be good and that may be bad. It’s tricky business, number one. And number two, that isn’t a disease. So I’ve never been a proponent of allowing sex selection. We don’t allow it at Penn, actually. We could do it instantly. It’s not that hard. And other places do it. But gender is not a disease. If you come to us and say, “Could I use gene therapy”—as I said, “for Tay-Sachs, or to try to improve muscular dystrophy”—I’d be first in line to say, “I think that’s great, and we have to test it, and there may be some risk to that, but I’m okay with it,” even though some in the disability community might say, “Well, then, your goal is to get rid of disability, isn’t it?” And I might concede at that point, “Yes—if I could do it.”
RG: But not by getting rid of the disabled.
AC: Oh, no, no, no.
RG: Because that’s the key distinction.
AC: I agree, but some in the disability community hear inferiority, lack of respect, when you say, “I’d prefer people who could function more.” I’ve heard this with the deaf community. To me, hearing is better than not hearing. And it’s pretty clearly a function you’re supposed to have. It’s true that you can sign, and that there is a deaf community. And I get that there’s Gallaudet College. I’m not proposing to close them; I think you should fund them. But at the end of the day, if I’m the child of a deaf couple, I’d rather be able to hear and sign, and decide what I’m going to do from there. I’m not going to make a deaf baby because the couple says, “We want a kid like us.” No steps should be made to honor that kind of autonomy—things that will harm or set back people. I’m worried for that reason about things like intelligence or athletic ability. You’re narrowing futures, deciding what the kid is going to be, raising expectations, instead of allowing them to be more open. So I favor, if you will, ‘eugenics’ on the disease-elimination front, but I am not so crazy about performance-enhancement or the behavioral meliorism.
So it sounds like both you have two distinctions you want to draw. One is between enhancement and therapy—
AC: Right. And many say you can’t, but I think you can at the extremes.
And the other is between negative and positive, between destroying life that has the therapeutic problems versus—
AC: Trying to engineer it away. Medicine does that now, right?
RG: I think Art’s reminding us of the ends of medicine: the goal of medicine is the restoration of healthy functioning of the organism and its parts, within the bounds of ethical norms. I mean, you don’t restore health by murdering someone conveniently to get a heart for somebody else who happens to need a heart transplant. We understand that. That’s just a plain violation. But my point is that when we treat medical professionals as people who are supposed to enhance our lifestyle choices—the kind of kids we want to have, whether our kids are good at math, whether they’re basketball players and 6’5”—it causes medicine to lose track of its mission and places at risk its commitment to ethical norms shaped by that mission.
