Commentary Magazine

Beyond Therapy by the President’s Council on Bioethics

Beyond Therapy: Biotechnology and the Pursuit of Happiness
by the President’s Council on Bioethics
Regan. 352 pp. $14.95 (paper)

In his recent State of the Union address, in between announcing new initiatives for abstinence-based sex education and drug-testing in schools, President Bush took a moment to inveigh against the use of steroids in professional sports. “The use of performance-enhancing drugs . . . is dangerous,” he declared, “and it sends the wrong message.” Most Americans would probably agree. At the same time, it seems safe to say that most Americans would not consider the spread of performance-enhancing drugs a pressing concern, which makes their inclusion in the State of the Union address somewhat incongruous.

But there may be more to the President’s anodyne exhortation than meets the ear. Consider his language: he cautioned against the idea that steroids are “shortcuts to accomplishment,” and that “performance is more important than character.” Surely this moral injunction applies to more than just drug use by athletes. Should we not be similarly wary of other substances—say, stimulants like Ritalin, which can enhance alertness and concentration even in people already functioning within the normal range? Or mood-brightening agents like Zoloft and Paxil, which (when used by people who are not mentally ill) produce contentment and self-esteem without the hard work of self-improvement? Or the panoply of as-yet-undeveloped biotechnologies, both pharmacological and genetic, that promise to make us stronger, or smarter, or happier?

If this inference seems a stretch, it is worth noting that precisely the same comparison to steroids is made in Beyond Therapy, the latest report of the President’s Council on Bioethics, chaired by the physician and bioethicist Leon Kass. Unlike the Council’s previous report, which dealt with the topical and politically contentious issue of human cloning, Beyond Therapy addresses a diffuse and sometimes abstruse set of concerns: namely, the implications of using biotechnology not only to correct defects and infirmities but to alter and augment normal biological processes like muscle growth, memory, and mood. When should we embrace the powers that technology offers to us, and when should we be wary of them? What are the costs to society and to the individual? As the President intimated, such ethical challenges are certain to multiply within the next generation.



The Council’s report tackles four major topics, corresponding to our desires for (1) more perfect children; (2) excellence in athletic, artistic, or intellectual performance; (3) longevity and perpetual youth; and (4) a happy life, free of psychic pain. Each of these can be pursued by any number of biotechnological avenues, some of which are likely to prove more accessible than others.

The report points out, for example, that genetic techniques for producing children according to certain specifications—the “designer baby” scenario—are theoretically possible but would probably prove impractical. We do not know which genes are responsible for shaping desirable qualities like intelligence and creativity, and even if we did, they are likely to be too numerous and multifunctional to be manipulated easily.

On the other hand, fertilization clinics already screen embryos in vitro for various genetic diseases (as well as, in some cases, for sex). It is hardly unimaginable that they will one day screen for more benign genetic characteristics like height, obesity, or perfect pitch, allowing parents to avoid having offspring with a high potential to be short, fat, or tone-deaf. Parents also may have the option of “improving” their children pharmacologically with agents that enhance intelligence or athleticism—just as, indeed, many parents and physicians now seek to modify children’s behavior with stimulants to make them more attentive and compliant.

Even these seemingly less drastic interventions pose serious ethical questions. Parents may have the right to make decisions related to their children’s welfare, but do they have the right to make arbitrary “improvements” to which their children cannot consent (and might not, if they could)? Does the deliberate creation or endowment of children with certain aptitudes impose unreasonable—even tyrannical—expectations? Does the artificial enhancement of a child’s abilities and performance demean the effort and integrity of achievement? Will it make the child more reliant on such assistance in the future?

Similar concerns punctuate the report’s other chapters, each of which moves from the dilemmas posed by currently available biotechnologies to the more serious problems we might encounter in the years ahead. The increasing life expectancies made possible by modern medicine have already begun to have a profound impact on society, as evidenced by the rising cost of pensions and the rising incidence of Alzheimer’s, various cancers, and other diseases of old age. More radical changes in the human lifespan or life cycle might have concomitantly more radical effects, ranging from reduced social mobility for the young to an increasing unreadiness for death among the old.

In the same vein, the current explosion in the use of drugs like anti-depressants might anticipate a more far-reaching turn to managing our moods with pharmaceuticals. If that occurs, will we lose the ability to cultivate happiness based on genuine accomplishment alone? We can already boost athletic performance with steroids; potentially safer and more powerful techniques, like inducing muscle growth through gene therapy, appear to be in the offing. Do these threaten to erode the link between training and achievement, determination and performance, intention and action?



Beyond Therapy is far from the typical product of a committee operating under the auspices of the federal government. It contains no trace of jargon or bureaucratese, and is written with considerable panache, in an elevated (if sometimes overwrought) style. The report lays out its ethical analyses in a frank and forthright manner, acknowledging that thoughtful people might still not be convinced. And it avoids alarmism, repeatedly reminding readers that most biotechnologies have been and will be developed with the admirable intent of treating debilitating illness.

Perhaps the most impressive thing about Beyond Therapy is the systematic way in which the members of the Council sift through concerns about the uses of biotechnology, attempting to separate those that possess a larger moral dimension from those that do not. Yes, the report acknowledges, there is reason to worry about the health and safety of these new techniques; but many are likely to prove harmless, or worth the risk, and anyway, safety concerns are hardly unique to biotechnology (think of airplanes and microwaves). And, yes, though it might be unfair that some people will gain an advantage from artificial enhancements, does this represent a more profound injustice than the fact that some people are just naturally taller or smarter?

For the authors of Beyond Therapy, such issues are serious—and should make us think twice about embracing biotechnologies—but they do not rise to the level of essential concerns. What is essential, in the Council’s view, is the possibility that biotechnological enhancement may somehow impinge in a fundamental way on human dignity. At the heart of this argument, in turn, is the idea that there is a sphere of activity in which human beings can genuinely flourish or attain happiness, a sphere defined by an awareness of the link between our ends and the means we use to achieve them.

We can intuit, for example, the connection between months of endurance training and the ability to run a marathon, and the connection between the successful completion of a marathon and the sense of satisfaction produced by that accomplishment. We cannot intuit, by contrast, why a drug like a serotonin reuptake inhibitor might produce a similar sense of contentment. And even if scientists understood the mechanism by which this occurs (as at present they do not), it would still unfold outside of our conscious awareness, robbing the experience of its human meaning.

The Council’s approach assumes, in short, that human beings have a particular nature that is both unique and worth preserving. As it happens, many academic bioethicists and their devotees reject this point of view, insisting that there is nothing of intrinsic moral value about the human experience—as opposed to, say, the experience of a platypus or a chimpanzee. It is precisely on these grounds that the Council’s chair, Leon Kass—whose imprint on Beyond Therapy is deep and unmistakable—has often been criticized in the past.

Fortunately, it is not just academic bioethicists who will decide how to answer the questions posed by the emerging uses of biotechnology. All of us will have to consider what is at stake. As the Council points out, it is not possible for a democratic society to restrict many of the objectionable practices that go “beyond therapy.” A moral consensus can emerge, however, and exert a powerful influence.

This is already the case with steroids. The abuse of such performance-enhancing drugs may be widespread, but athletes caught using them suffer disgrace, and for reasons that go far beyond concerns about dangerous side effects or unfair advantages. As President Bush rightly pointed out—echoing, perhaps, the analysis of the Council he appointed—our real concern is to preserve the meaning and integrity of human accomplishment. Beyond Therapy gives eloquent voice to this concern, and provides a solid foundation from which to approach the ethical and moral dimensions of our still nascent biotechnological revolution.


About the Author

Kevin Shapiro is a research fellow in neuroscience and a student at Harvard Medical School.

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