Meeting Transcript
October 16, 2003

Ronald Reagan Building and International Trade Center
1300 Pennsylvania Avenue, NW
Washington, DC 20004

COUNCIL MEMBERS PRESENT

Leon R. Kass, M.D., Ph.D., Chairman
American Enterprise Institute

Rebecca S. Dresser, J.D.
Washington University School of Law

Michael S. Gazzaniga, Ph.D.
Dartmouth College

Robert P. George, D.Phil., J.D.
Princeton University

Alfonso Gómez-Lobo, Dr. phil.
Georgetown University

William B. Hurlbut, M.D.
Stanford University

Charles Krauthammer, M.D.
Syndicated Columnist

William F. May, Ph.D.
Southern Methodist University

Paul McHugh, M.D.
Johns Hopkins University School of Medicine

Gilbert C. Meilaender, Ph.D.
Valparaiso University

Michael J. Sandel, D.Phil.
Harvard University

James Q. Wilson, Ph.D.
University of California, Los Angeles


INDEX

• Welcome and Opening Remarks
  
  
• Session 1: "Beyond Therapy": Council's Report to the President
  
  
• Session 2: Toward a "Richer Bioethics": Chimeras and the Boundaries of the Human
                                                            
• Session 3 and Session 4: Biotechnology and Public Policy: Proposed Interim Recommendations, III and IV
  
  

Welcome and Opening Remarks

CHAIRMAN KASS:  Good morning.  Welcome to this, the 14th meeting of the President's Council on Bioethics.  Welcome to members of the Council, welcome to staff, welcome, membesr of the public.

This is the 14th meeting in 21 months, a rather hectic pace, and I want to thank all members of the Council for their heroic work in the weeks preceding this meeting on the multiple documents that we sent your way and for your careful attention and comments.

I recognize the presence of Dean Clancy, our Executive Director and Designated Federal Officer, in whose presence this is a legal meeting.

There are two announcements on the subject of renewal.  As I believe I mentioned in the memo to you, the Council has been renewed, I believe, for good behavior in an executive order signed on the 17th of September, announced in the Federal Register on the 23rd.  We, along with a whole host of other advisory commissions, have been renewed through the fiscal year of 2004 and five, that is to say, to the end of September 2005.

What this actually means concretely for our work schedule, we will be letting you know, but someone of the pace of our work over the last two years, especially this year, has been informed by some doubt as to how long we would be alive, and I think I can promise you that there will be not so many meetings and a more leisurely pace of work, and I trust that that will not be unwelcome news to those around the table.

Second, there is renewal of a more personal and human sort, and I'd like to announce the birth of Joseph Thomas Clancy on October 10th to Dean and Heidi Clancy.

(Applause.)

CHAIRMAN KASS:  It would be, I think, remiss for a body that spends so much of its time thinking about the dignity of human procreation in the abstract not to celebrate it in the flesh and in our midst.

All best wishes to you, Dean, and to the family.

Several of our members are unavoidably absent, send their regrets.  They have also in some cases sent in their comments for the later discussion, and I will read them.

Frank is abroad at a previously arranged meeting.  Mary Ann very late was named as part of the delegation to attend the 25th anniversary celebration of the Pontificate of John Paul, II.  Janet has a longstanding conference, and Dan Foster at the last minute had to cancel for family reasons.  He is okay.  Elizabeth will be with us tomorrow.

But we are a quorum, and I think we can proceed.

Session 1: "Beyond Therapy": Council's Report to the President

The purpose of this first session is to officially release a new Council report, a document entitled "Beyond Therapy:  Biotechnology and the Pursuit of Happiness."  Copies are at your desk.

It is the product of a 16-month project for us, an inquiry into the significance of present and potential uses of biotechnology that go beyond the healing of known disease to serve a variety of other human goals and satisfy widespread human desires.

In many ways, this report is quite different from anything that previous bioethics councils have done in the past, and also from other work that this Council has published and will publish in the coming months.  So I want to say a few words about just what this project is and why we have taken it up in the way that we have.

By all accounts, we are entering a Golden Age of Biotechnology.  Advances in genetics, drug discovery, and regenerative medicine promise cures for dreaded diseases and relief for terrible suffering.  Advances in neural science and psychopharmacology promise better treatments for the mentally ill.  Techniques of assisted reproduction have already allowed for over one million infertile couples to have their own children.

Without such advances, past, present, and future, many of us would lead diminished lives or not be here at all.

Yet it is pretty clear to everyone that along with the enormous promise and hope, the Age of Biotechnology will also bring with it some novel and really quite momentous challenges.  That's, after all, why we're gathered here.  It's a big part of the reason for the very existence of bioethics and for public advisory councils like this one.

We sense that there are serious challenges to contend with in this area.  Some of these, like those involving the safety of new techniques, the questions of equitable access, and the need to provide for informed consent and to protect the human subjects and research are of the sort that our society is fairly familiar with, and we have a basic starting sense of how to deal with them.

They are tremendously important and serious, and they deserve the public attention at the highest level, but they are connected with a set of basically agreed upon common ends in our society, the value of health and safety, of equality, and offreedom.

But it may well be that the most challenging and in some ways the most crucial questions we need to address in the coming age of biotechnology are not so much about what is safe or how to allocate resources or benefits or similar hard and important questions.  Rather, they might involve what we want to do with our new abilities and powers and how they might change our lives and those of future generations as individuals and as a society.

In short, these will be tough questions about the wisdom of our ends and the benefits and harms of pursuing our ends, even our worthy ends, by these new biotechnological means.

In the case of the new technologies employed in conventional medicine, the answers about ends are quite clear.  We want to heal the sick.  We want to relieve the suffering, and our new abilities might let us do so more effectively.

Some crucial questions of means remain, but we basically agree about the ends.  But the same technologies will have the power to reach far beyond the traditional domain of medicine and allow us perhaps to alter or improve our bodies and minds for ends other than a restoration of health.

To what ends beyond therapy should we put these technologies?  And what might be the consequences of pursuing those ends using our new biotechnical powers?

As I say, these may be the most vexing and most crucial questions posed for individuals and societies in the Age of Biotechnology, and they are questions that don't fit neatly into any of American categories of agreed upon ends.

They are also, I believe, a good part of the public's disquiet regarding the Biotechnological Age, worries that the new technologies may be used in ways that could undermine or degrade human life.  Beginning, therefore, to concretely pose these questions for ourselves and beginning to think seriously about what human life in the Age of Biotechnology might look like seem to us to be among the most important purpose of bioethics today.

And a body like this one, with a public charge of responsibility but without necessarily having to answer to every political pressure and exigency of the moment seem to us to make us the right body to do so, and I remind you that it does fit with the President's first charge to us, namely, to conduct fundamental inquiry into the ethical and human significance of advances in biomedical science and technology.

In educating ourselves to undertake this work, we had presentations from experts on drugs that affect mood, behavior, and memory.  We had presentations on drugs and genetic modifications that would alter physical performance, choose sex of children; that might modify the process of aging or extend the maximum human life span; that would produce genetic alterations of muscles, and also we had discussions of the possible enhancement uses of preimplantation  genetic diagnosis and directed genetic change.

We had many Council discussions on these subjects.  We had papers from some members, including wonderful papers from Michael Sandel and Gil Meilaender and Paul McHugh, and we had staff-prepared documents on all of these subjects.

Altogether we devoted over 20 Council sessions in public meetings to this subject and a lot more time and effort between meetings.

In working to present our reflections in this area, we decided to organize the presentation not around the technologies themselves, but rather around the desires and the goals that either drive our interests in these techniques or that will enlist the available powers they make possible, desires for longer life, stronger bodies, sharper minds, better performance, happier souls.

That way of approaching these matters enables us to think about how these new powers fit with previous and present human pursuits and aspirations, not necessarily mediated by technology, and I do think that it's one of the great benefits of regrouping them in this way, and it's one of the reasons for the unusual arrangement and approach of this report.  It made it much more difficult to write, but it is my hope that this way of presenting things will make it apparent that the fundamental issues here are questions of human character and desire and aspiration rather than just of new techniques and new knowledge.

The report, as you will see, takes up different scientific and technologic possibilities, but each in the context of one or another human desire that seems most likely to guide their application or use in the future at least beyond therapy.

The report is in six parts.  An introduction lays out the reasons for the study, covering in greater depth points I have just made.  Then there are four central chapters:  better children, superior performance, ageless bodies, and happy souls, in each of which we explore the meaning of the goal and evaluate the possible new means for achieving that goal and the ethical and social implications of possible success.  And there is a final chapter of general reflections, trying to put things together.

Under the heading of "Better Children," we've taken up new technologies that might enable us to improve both our children's native capacities through genetic knowledge and their behavior and performance through pharmacological intervention.

We already have today tests, techniques to test early embryos for the presence or absence of many genes.  Should we use these techniques only to prevent disease or also to try to get us better children by selecting for genes we believe might be related to some desired traits or aptitudes?

Should we choose for sex, which in technical terms is already relatively easy to do?

Or, talking now about behavior, we have seen the widespread use of behavior-modifying drugs in the treatment of attention deficit disorders in children, where the drugs are immensely valuable treatments.  But what would be the implications of using these same drugs for the general improvement of concentration or focus or behavior even in children who do not meet the diagnostic criteria for attention deficit disorder or any other?

Should they be used to aid test takers or to improve mental stamina?  And what would it mean if they became widely used?

This chapter on better children raises questions about the meaning and limits of parental control and about the character and rearing of children in the coming years, and it touches on issues of social control and conformity and the question of medicalization, of moral education, and finally, a larger kind of question about the meaning of childhood altogether.

I should point out that it is important in all exercises of this kind to try to separate fact from science fiction lest one stir up people's fears without cause.  In this discussion in the second chapter, we paid special attention to the much discussed prospect of genetically engineered designer babies in which parents might be able to select in advance and scientists might be able to provide children with the traits most desired.

But we conclude in fairly emphatic terms that this is rather farfetched prospect, and that people should relax.

The third chapter on superior performance takes up the issue of improving performance through biotechnical means and asks just what it means to seek superior performance using some of these technologies of either genetic or pharmaceutical enhancement, like injecting genes into muscles to dramatically improve their strength and physical ability.

In that chapter we use enhanced athletic performance as our prime example not because it is necessarily the most pressing area of concern, but because we thought it might most clearly highlight the issues at stake and enable us to explore the differences between more traditional methods of enhancing performance and some new and forthcoming biotechnical ones.

Looking at sports permitted us to ask about both the meaning of excellence and about the meaning of the humanity of excellent human activity, and to inquire how new approaches to superior performance might affect the way we act in the world and the way we conceive of our own bodies, our identities, and our own activity.

The fourth chapter deals with technologies that aim to satisfy our desires for ageless or ever youthful bodies.  It looks at the latest advances in aging research, including some astounding extensions of life in worms, flies, mice, rats, and other laboratory animals, and the potential implications of such work for extensions of human longevity and the maximum life span.

We considered techniques both modest and bold, possibly soon to be available interventions to increase the strength and vigor of muscles of the function of memory or various efforts, somewhat more futuristic to retard the general processes of biological aging and to increase the maximum human life expectancy.

This chapter asks if we should use the growing power to affect aging only to diminish the bodily and mental infirmities of old age or also to engineer larger increases in the maximum human life span.  We make clear the obvious and powerful appeal of such techniques, but try to think through how the human experience might be different in a world of substantially extended life spans and how longer life might affect individual outlooks, engagements, and motivations, as well as the dynamic character of society and the prospects for its invigorating renewal.

Finally, in Chapter 5 we look at what might be the most powerful desire, the desire for happy or contented or satisfied souls.  It's clear that we're already gaining new techniques for altering mental life affecting memory and mood, among other things.

At this point some of these techniques are being used to treat major depression and other very serious psychiatric conditions.  Alas, too many people who might benefit from such therapy still go undiagnosed in part because of the stigma that still attaches to mental illness.

But the potential for uses beyond such welcome therapeutic interventions is obvious since there are times when all of us wish we might have some help in being happy or more content in our lives, and some emerging techniques might offer that in the form of drugs.

Should we use these technologies only to prevent or treat mental illness or also to blunt painful memories of shameful behavior, transform a melancholic temperament, or to ease the sorrows of mourning and diminish the anguish and stresses of everyday life?

This chapter raises questions about the connection between experienced mood or self-esteem and the deeds or experiences that ordinarily are their foundation, as well as the connections between remembering truly and personal identity and other crucial aspects of our mental life.  And it wonders about what the availability of agents to correct our discontents will do to the nature of human aspiration or the character of our society more generally.

The report concludes with a final chapter of general reflections that seeks to tie all of this together and which I think makes the crucial point for understanding this report.  While we take up these individual technologies and these individual motivating desires one by one, the key is to see them all together affecting our world all at once and affecting one another.

They are part of one big picture, the pursuit of happiness and perfection in the new age of technology.  Taken together they raise these overarching questions:  how shall we live in years to come empowered by biotechnology?  What kinds of human beings and what sort of society are we likely to create and at what gains and costs to our humanity?

Let me say one word about the spirit of the enterprise to be clear about what this report is and is not.  Our aim in this project is primarily educational, not primarily political or practical.  This report contains no assessments of policy and  no particular recommendations for action.  We raise more questions than we answer.  We do not make ringing moral judgments.

There are more immediate policy oriented matters that we have been called upon to address as a Council, and we have certainly been working hard at those as our other work demonstrates.  But here we wanted to take a step back and to clarify in an educational way the character of some challenges that we as a nation will have to deal with.  These will very likely be pressing issues of policy in some form or another for some future bioethics council and certainly for the country as a whole.

And our ability to deal with this well into the future will be greatly helped if we begin now the work of thinking through the significance of new and coming advances. 

We do not pretend to see the future, and certainly there are differences of emphasis and some disagreements on particular questions of science and of ethics among us and the Council, and these are reflected to some extent in the document.

But this report, above all, tries to point up the crucial questions and to suggest some possible avenues for addressing them.  This is why we thought it was important for a body like ours to take up this subject now and why we have done so in the way that we have.  These issues are not simply futuristic.  Current trends make it perfectly clear that the push beyond therapy is already upon us, and we would do well to give this subject serious thought.

We hope by this report to spark some thinking and some conversation about what really have to be the fundamental questions in bioethics and truly critical questions for our country in general.  What goals are worth pursuing and what goods are worth defending with our new biotechnical powers and how shall we live well in the Age of Biotechnology?

Before turning over the floor to fellow Council members for any comments they might wish to make, I do want to express on behalf of all of you my gratitude to members of the staff who worked heroically on this project, beginning with memos to help outline the project, drafting multiple stages, and in the many, many months of drafting, redrafting, editing, et cetera.  Staff has been absolutely tremendous.

And I want to thank, in particular, some of our primary draftsmen, Yuval Levin and Eric Cohen; Dick Robin who did a lot of the drafting and worked on the science.  Adam Wolfson, no longer with us, did the work on sex selection.  Adam Schulman, not here today, did a lot of the editing.  Laura Harmon was the production manager who formatted everything and the hours to meet the production deadline sat at the computer with various prodders standing over her shoulder to make sure that everything was done properly.  Audrea Vann designed the cover, and Dean Clancy with his magisterial efficiency supervised the entire enterprise, and I want to thank them all very, very much for their heroic work.

I have comments from Frank and Mary Ann, but I will wait, and I would like to turn the floor over to anyone who would like to make some comment on this report or on something related to it.  The sad fate of the Cubs and the joys of the Red Sox are for another occasion.

Who would like to start, if anybody?  Alfonso.

DR. GÓMEZ-LOBO:  If you will allow me to read a brief written statement, I want to be very precise here, and this should convey my own thoughts and my own interpretation of the project.

Therapy is a word employed to identify an activity that since the ancient Greeks has been governed by a specific goal:  the good of health.  Although there have been theoretical challenges to the normative concept of health, physicians for the most part know what they're doing when they diagnose a physical illness.  They know how the healthy organ or system should function and are, thus, able to detect any failings or malfunctions.

To go beyond therapy is to move beyond health into a territory where at first sight there seems to be no univocal normative concept that provides a goal or target.  Biotechnology, as our report suggests, is already taking us beyond therapy and promises to take us deeper and deeper into the new domain.

Are we totally at sea within it?  Yes and no is our reply.  On the one hand, there are discernable trends in the use of specific measures.  People seek better children, superior performance, younger bodies, and happier souls.  These are in one sense worthy goals, but as the report shows, these are not goals that leave us at ease.

All of them have a mixture of questionable aspects:  domination of children, domination of agency, generational asymmetry, shallow feelings.

The biotechnology that is taking us beyond therapy is actually the latest and most striking form of a broader cultural phenomenon, the relentless advance of technology in general.  We live less and less in a world in which things grow on their own and more and more in surroundings manufactured by ourselves.  Indeed, the word "manufacture" is eloquent because it conveys the idea of something being made or produced by hand.

The human hand, however, is an instrument of the mind in its productive mode.  Reproduction, i.e., having children, for example, is increasingly becoming a manufacture, an operation the product of which is more and more an object of design.  The child's features thus become the result of reproductive choices.  Reproductive cloning if it is ever accomplished would be the ultimate imposition of design for it involves choosing the very genome of the child.

Technology proceeds, for the most part, by small steps each of which seems attractive and innocuous.  But when we stop to take stock, serious questions arise.

Each purchase of a car seems good and beneficial, but by now major cities around the world have become clogged with vehicles.

One case of IVF treatment seems to be a wonderful occurrence, but 400,000 frozen embryos is worrisome.  Choosing the sex of one's child appears to be a legitimate exercise of freedom, but the paucity of girls in certain countries can lead to undesirable social imbalances.

Technology cannot be stopped, it seems, and our report does not aim at doing that.  It includes, as Dr. Kass said, no policy recommendations.  It is rather an effort to call attention to the perils of going beyond therapy, but our report is not taking a negative attitude vis-a-vis the enterprise as a whole.

How does it accomplish this?  If I correctly understood the subtext driving the  meditation, the report ultimately postulates a goal analogous to the goal of health for therapy.  It is the age old ideal of the flourishing human life.  It is only from such a vantage point that we can start to evaluate and put in perspective such narrow goals of biotechnology as muscle strength, perfect babies or bodies that last indefinitely.

In one of the most eloquent passages in the report, which I am eager to highlight for our benefit and the benefit of the general public and which I dare say bears the imprint or our Chairman - I was about to say "glorious Chairman," but I'll omit that -

(Laughter.)

DR. GÓMEZ-LOBO:  The good life is sketched as follows, and I will end with this quotation.

"For us today, assuming that we are blessed with good health and sound mind, a flourishing human life is not a life lived with an ageless body or an untroubled soul, but rather life lived in rhythmed time, mindful of time's limits, appreciative of each season, and filled first of all with those intimate human relations that are ours only because we are born, age, replace ourselves, decline and die and know it.  It is a life of aspiration made possible by and borne of experienced lack of the disproportion between the transcendental longings of the soul and the limited capacities of our bodies and minds.  It is a life that stretches towards some fulfillment to which our natural human soul has been oriented, and unless we extirpate the source, will always be oriented.  It is a life not of better genes and enhancing chemicals, but of love and friendship, song and dance, speech and deed, working and learning, revering and worshiping."

Thank you.

CHAIRMAN KASS:  Paul.

DR. MCHUGH:  Well, Leon, I just want to say how much I appreciate this piece of work the Council has done, and with you want to thank the staff, and with the rest of the members of the Council thank you for bringing this out.

As I told you, I think this is going to be the most important aspect of our ethical considerations, following on the President's request that we spur public discussion on these matters, and it is in this area, in particular, that the public needs to have the kinds of information and the kinds of thoughts that are transmitted here.

I also though wanted to say a few words about the issues that relate to psychiatry.  Charles and I have frequently made points about our concerns about psychiatry, and some of them might be misread in this report, and I want to make sure that everyone appreciates that we think that psychiatry has made tremendous advances.  Certainly in both of our clinical lifetimes, we have seen wonderful advances from the psychiatry that we were taught at the beginnings.

We saw the advancing of a categorical system of diagnosis that brought some coherence to the field.  You'd have to appreciate what the field was like before there was this coherence to know how pleasantly and happily we greeted that partial step towards a more coherent discourse in psychiatry.

We also, of course, celebrate and continue to celebrate the discoveries in psychopharmacology, much of which are being discussed here as their extensions, but I do want to emphasize what particularly a discipline committed to the mentally ill and who had struggled with their advocacy for the mentally ill in their stigmatized and oft neglected states in hospital, what these medicines brought to us.

We had much, much success in helping very ill people, and continue to have considerable success.

I also want to remind you that many of those achievements in therapies were discovered by accident.  Lithium was discovered by accident.  The early antidepressants, still powerful tricyclic antidepressants were discovered by accident, and yet no one - Charles needs no reminding of this, but the rest of you have perhaps never worked in hospitals or with patients before these discoveries - really want to know what wonderful things they were.

But to some extent what you're speaking about here is that psychiatry has become a little bit of the victim of its own successes in these areas, and I think the public needs to talk about that because to some extent psychiatry and particularly organized psychiatry has become stuck in these conflicts.

Two dangers have turned up.  The one was that because we have this symptom-based diagnosis that is being followed with medications, we tend to ignore the individual to chase a symptoms.  Depression, for example, is a symptom.  It's not really a disease.  It's a symptom sometimes from a disease, sometimes from other kinds of things, and if we just chase it with a pill, then the patient now will be ignored and lost in his individual case.

And then, of course, there is this extension of the medications beyond their indications, as you mentioned, particularly things like Ritalin.  These successes have trapped psychiatrists in a couple of different ways.  We've become something of a hostage to the pharmaceutical industry in a couple of interesting ways.   I mean, you can't watch the ball games anymore without hearing about how if you're a little shy you ought to try Paxil.

This advertising for prescription drugs on our television, that has certainly changed my life as I have people coming in no longer asking so much for help as requesting from the waiter that I deliver a certain cocktail.

And, by the way, we've had some scandals, not so much scandals, but difficulties as we've seen scientific papers being published by distinguished psychiatrists who only later reveal, as was in the recent Nature, that they were receiving hundreds of thousands of dollars from the company of the drug that they were supporting there.

So we're a little trapped in these matters, and then finally, I think, many people in  America are concerned about the excessive use of certain psychopharmacological agents that we speak about here.  You've heard me say before that we should emphasize a new motto for America:  more recess, less Ritalin.

And ultimately what we are saying there is that the youngsters, particularly young boys who are vigorous and whose attention is only developing, they can be certainly held in their seats by Ritalin longer than they should, and in that way - longer than they would ordinarily, let's say - and they in that way are cheated somewhat of their boyhood and the like.

It's interesting that neuropsychology now can really start studying the attention span and how it expands with growth and development, and that interesting scientific discovery and work in neuropsychology has as yet, as far as I know, not influenced at all the pedagogical systems of our country.

Ritalin has come in long before real science has come in to talk about where we might go.  So I think, just to finish off - I'm going too long, I appreciate - but I just want to say how important this publication is and how it will, I think, help spur the public discussion on these important matters about what we mean by trying to treat people and how going beyond therapy could ultimately distort the pursuit of happiness.

Thank you.

CHAIRMAN KASS:  Bill May.

DR. MAY:  The book as you summarized it, Leon, explores the ways in which biotechnology may both serve medical needs, but also edge us out beyond therapy in the service of a series of very powerful human aspirations.

However, as you closed your remarks, you notice that it doesn't attempt to solve dilemmas or directly to influence the decisions and policies of practitioners, administrators, governors, judges, or legislators.  It cultivates the soil out of which some of these things may emerge, but it's dealing directly with the cultural soil rather than particular discrete policies.

As I see it, this book aspires to contribute not directly to public policy, but to public culture.  It is, frankly, a ruminative piece.  Its goal is educational rather than political.  Its contribution to politics will be at best indirect rather than direct.

It should supply resources for continuing deliberation, whatever the fate of particular pieces of legislation before Congress or controversy in the courts.

Now, I can well imagine here a turnoff, no hard news, no cues as to where powerful people will come down on this or that particular prohibition, regulation, or funding decision.  So I would like to offer a plea on behalf of a book that attempts to broaden and deepen public culture, the sensibilities of a people.

As I see it, such a book at its best can help compensate for the tragic limitations of politics.  I have a very high regard for politics.  I take it to be the uncommonly difficult art of pursuing the common good.

But politicians, like other leaders and administrators geared to action, find it difficult even when they have a very spacious sense of the common good, not to simplify and distort in the course of mobilizing people to act.

Even with the best of intentions, language, ethical reflection pointing towards programs and policies inevitably sloganizes.  It recoils in advertisers' horror from the full complexity of experiences.  It abstracts, and although its abstractions can clarify portions of the total consciousness of the people and help organize the government for action, they also distort, neglect, and marginalize other interests and ranges of experience and conviction.

Politics traffics only in the possible and the doable, not the altogether.  Its slogans inevitably denature reality.  They captivate some followers, but disconnect from other citizens.

Now, the almost inevitable distortions and sloganizing of politics or the organization of our common life led the philosopher R.G. Collingwood to argue that a society needs its artists as well as its politicians.  Through the exploration of image, metaphor and symbol, artists retrieve and freshen language and perception and, thus, enrich and clarify the public consciousness that political slogans leach and muddy.

In freshening language and consciousness, they help us recover community in its entirety which politicians risk sacrificing for the sake of immediate action.

Well, this book is hardly written by artists.  Nevertheless, this book seeks to freshen bioethics, to broaden sensibilities beyond the narrowing urgencies of legislative and court dockets.  It attempts to take some soundings on the human condition.  It seeks to contribute thereby to a public culture upon which the resiliency of our common life and our politics depends.

I hope it has a long life both on and off the shelf.

CHAIRMAN KASS:  Thank you very much.

Gil Meilaender and then Mike Gazzaniga and the Rebecca.

PROF. MEILAENDER:  I has already been noted by several people that this is in some respects an unusual document for a body like this to produce, unusual because it makes no recommendations; unusual also, I think, because it is actually constituted by a rather long, sustained, sometimes difficult philosophical argument.

And I want to say just a few words about what it seems to me the report can do and what it cannot do.

At several moments along the way in the drafting and redrafting of this report, I have thought that rather than beyond therapy it might better be titled toward perfection for the report is in some considerable measure about what it means to be the sort of beings we are with the limits inherent in our humanity, but also with limitless desires to surpass those limits in various ways.

And surpassing them is not always or necessarily a bad thing, as I recall every time I get novocaine at the dentists and marvel that people ever got along without it.  We are very fortunate to live in a age so marked by medical advance.

But we still have to think about whether there are sadnesses that it is good to experience in life, whether the decline of our bodies is to be avoided as much as we can, and whether control and mastery of the next generation is always a good thing. 

We can become inhuman in either of two ways:  by acting in ways that seem less than human or by striving to be what we might call more than human.

In our report on cloning and human dignity, this Council has paid at least some attention, even if inadequately, to the possibility that we might act in ways less than human, for example, in our treatment of the weakest and most vulnerable of human beings.

In this report we focus rather on the temptation to be more than human and on the difficulties, the really genuine difficulties of deciding when the desire to overcome the current limits of our humanity is enriching and admirable and when that desire becomes a dangerous temptation.

We offer no policy recommendations, in part, because it's a genuine difficulty; in part, because we are inviting our fellow citizens to think along with us and puzzle with us over what are some very puzzling matters of great importance for our future.

But we also offer no recommendations because at least in part the problem we are exploring, the limitless desire to be more than human, is not the sort of problem one solves with policy recommendations or even, alas, with philosophical reflection.  It goes deeper than that, a lot deeper, and will never be solved simply by clear thinking.

The solution is, in fact, beyond philosophy.  Hence, we offer not solutions to the problem of limitless desire, but what we are able, an invitation to think about what it really means to be human, and in so doing we recognize our own limits.

Thank you.

CHAIRMAN KASS:  This is terrific.  Who's next?  It's Mike Gazzaniga and then Rebecca.  Please, Mike.

DR. GAZZANIGA:  It's always dangerous to follow members of the Council, but I have a couple of observations, one of which is that I'm new to this ethics area, and I've noticed two things about it.  One is that it appeals to 17 year olds and 60 year old people.

(Laughter.)

DR. GAZZANIGA:  And there's this gap in between that we're trying to fill, and I think the book goes a long way to interesting the people who are otherwise too busy to worry about the consequence of their actions.  So I commend you, Leon, and the staff and all of us, I guess, for working on this.

I think it is important to put the caveat in that you have put in, and I know the laboratory scientists feel that this is not a scientific document.  As you have said many times, it is a document that discusses, I think, maybe many scientific issues, many scientific data, but not all scientific data, and as we had many experts here testifying about possible implications of a piece of work, we also didn't have everybody testifying here.

And so many of the issues raised could be discussed in documents of this length in and of themselves, and I think  we should be alert to that so that when people do get in and start to consider the ethical issues here, they know there's a lot of work to do because they have to continue to dig out the real substance of each claim.

And let me just close with the fact that I think all laboratory scientists are always worried about predicting the future because it never seems to work that way.  We all remember Thomas Watson's remark on computers that he thought he would be lucky if he sold four of them.

So with that caveat, I think there's a lot of good reading here.

CHAIRMAN KASS:  Yeah.  Thank you.

Let me just interrupt the queue for a moment to underline what Mike has said.  I mean, this is a document of ethical reflection in which the scientific points of departure are small, not thoroughly explored.  One of the possibilities for this Council in the future - indeed, it was in our minds when we laid this out to present this as one package - is that there might be one or another of these topics of sufficient interest and urgency that we could go into it and go into it at much greater depth and do much more on the science and do much more in the complexity of the ethical questions, and to satisfy Jim Wilson before he complains, even to think through how social science research might actually distinguish between speculations and facts.

Let's see.  I have Rebecca.  I have Rebecca.  We'll just go down the row.  Rebecca, please.

PROF. DRESSER:  Well, I wanted to say what a powerful and thought provoking document I think this is.  I think it's beautifully written.  It's often moving, and at times it's even poetic.

It does, as people have said offer reflections, not policy recommendations, and it takes a different approach to public bioethics.  Instead of a pared down account presenting the least controversial analysis, it's a detailed and relatively elaborate exploration of ideas bearing on a difficult set of issues.

Sound bites are absent from this document.  It is instead dense, full of insights about complicated questions.  Although it is not an easy read, it's well worth the effort, and I guarantee it will make readers think more about matters they thought they understood.

Besides serving as a valuable resource for scholars, teachers, and students interested in bioethics problems, "Beyond Therapy" should be helpful, I think, to individuals and clinicians who are trying to be thoughtful about the interventions the report discusses.

As individuals, we have to decide whether and, if so, under what circumstances we ought to seek the potential benefits offered by these interventions.  In this culture that so values autonomy, we should seek to make truly autonomous choices about whether an intervention is the best way to address particular problems in our lives.

Many of these interventions will be heavily promoted through advertising, which we can expect will exaggerate the potential benefits and downplay risks and failure rates.  We should demand accurate information on safety and success rates, and we should also try to understand the broader implications of our individual choices.

For example, what are the potential effects on biomedical research of heavy investments in measures to extend life and enhance characteristics beyond what's average for our species?

Should the skills of our scientists and our limited research resources be used to develop these areas when children and young adults remain vulnerable to many life-threatening diseases?

Clinicians will play a pivotal role in determining how available these interventions are, and we trust physicians and other health care professionals to define and set standards for their work.

We also subsidize the training and infrastructure that enables them to practice their professions.  In turn, I think that clinicians assume some responsibility to use their skills and resources to meet the legitimate health needs of society.  Clinicians ought to consider whether providing an intervention is an appropriate use of their talents and skills in light of the many urgent health needs commanding their attention.

So the temptations to go beyond therapy are and will be strong.  I think this report gives us an opportunity to reflect on and possibly to resist at least some of those temptations.

Thanks.

CHAIRMAN KASS:  Robby, Robby George.

PROF. GEORGE:  I cannot claim to have anything approaching Jim Wilson's experience on governmental commissions and agencies, but this is the second one on which I have served, and even apart from my own service on such commissions, I've had occasion to read many governmental reports, reports of agencies, and I must say that I have never seen a report of which the agency could be prouder.

Some reports are informative, but just informative, not especially analytical.  Some achieve the goal not only of being informative, but also of being analytical.  This one goes a step beyond.  It's not only informative, not only analytical, but also reflective, deeply reflective in a way that I think merits Bill May's fine characterization of the report as ruminative.

I believe that the key move which made this possible is precisely the one that Leon put his finger on, the decision not to organize as people might have expected around the specific technologies that we either have before us or in view not very far down the line, but rather to focus on questions of character and desire and aspiration, and the net result of that is a document which I think genuinely promises to structure and elevate public discussion and debate. 

It has already been noted.  It will be noted by the people who first examined what a council like ours does, that there are not political, there are not legislative recommendations or at least not direct legislative recommendations.  There aren't even a lot of norms announced.

That will cause some people who are simply interested in short-term politics to ignore the report, and that's a shame.  But I hope that many others, including if not members of Congress themselves, although I would hope they would, but congressional staff people, people in the Executive Branch; I hope that such people will read this report because they will be deeply informed by it in their own reflections on questions that they'll be facing soon enough.  I think they will be significantly enhanced.

Alfonso put his finger on something that I had noticed, but only dimly and which I'm very glad that he brought out in his remarks this morning.  There really is a powerful suggestion in this report, even though it doesn't make specific legislative recommendations; there's a powerful and important suggestion, and its' a suggestion about how we ought to think about the promise and peril of biotechnology, the promise and peril of going beyond therapy.

Alfonso rightly noted that it's a way of thinking that would be appropriate not simply to biotechnology, but to technology generally, but of course, we're here concerned with biotechnology and its promise and peril, and that is to think about these issues in light of an understanding of human well-being and flourishing.

I think if we as a culture do that, we are not guaranteed the right decision every time, but we are more likely to hit the mark than if we approach the matter in a piecemeal or in a utilitarian way.  So I hope that this powerful suggestion will be taken up.

Now, it's true that to try to think about the promise and peril of biotechnology in light of a conception of human flourishing does not settle the issue of what conception among the competing conceptions of human flourishing is the right one.

We on this Council and we in this culture would have disagreements, do have disagreements about the components of integral human flourishing, what counts as being an aspect of human well-being and flourishing.

And beyond that, of course, even to the extent that we can agree on the components of our own full living, our own flourishing, we would have disagreements about the implications of the integral directiveness of those components, of the norms by which we would live in order to honor human well-being in its variegated dimensions.

And the report doesn't solve any of those problems, doesn't pretend to solve any of those problems, but it invites us to think about those problems and structure our discussion of the promise and peril of biotechnology in light of those.

It also does more than merely hint at the concern that we ought to have for unintended social consequences.  Again, I'll follow Alfonso on an important point.  There are activities that seem harmless or even useful or even valuable when practiced for specific reasons on a small scale which, when they become widely disseminated throughout a society and become a norm or nearly a norm, can have unintended negative social consequences, even social consequences which manifest themselves in a falling away in the culture of the culture, of people in the culture, who constitute the culture, a falling away from cherished ideals, including the ideals that which taken together I think we would characterize as human dignity.

My own hope is that the report will help to reinforce or remind us as Americans of our commitment to treating the human being throughout his or her life as a subject, as a person possessing an intrinsic and inestimable worth and dignity and not as an object of manipulation whose worth is dependent or affected in any way by his or her strength or beauty or talent or intelligence.

Now, nobody wants to do away with that commitment.  No one would vote to do away with such a commitment, but of course, the worry is that in small steps, by practices that seem innocuous, harmless, even valuable, it may erode. 

I completely agree with everything the report says about the promise of biotechnology, about the value of certain therapies or even matters beyond therapy which are now on the horizon.  We certainly shouldn't be Luddites about these things.

But we should be aware and conscious of our own history and of unintended bad consequences of things that appear to be very promising when looked at abstractly and in advance.

So I more than welcome this report, Leon.  I think it's a great achievement of the Council, and I congratulate you and my colleagues and the staff for producing such an outstanding piece of work.

CHAIRMAN KASS:  Thank you.

Michael.

PROF. SANDEL:  I'd like to begin by congratulating the Chairman for embarking on this project, which might seem speculative, as merely philosophical speculation, but I think it does, as many people have said, enlarge the enterprise of bioethics, which traditionally had been concerned with weighing costs and benefits and with parsing consent, and this project enlarges bioethics by connecting it to big questions about the status of nature, the relation between human beings and nature, and the limits, if there are limits, to the project of mastery and control.

I would just point to two questions that the report raises, questions that are important to discuss in American public life.  One of them is the real puzzle, which is what is wrong with trying to use whatever means we can not only to cure disease, but to improve ourselves and our children.

There are lots of ways we try to improve ourselves, and especially our children and especially today, from hauling them to music lessons and soccer practices and SAT prep. courses to trying to in one case last year some guy manipulating a stock market valuation in order to please his boss who was trying to get his young kids into a prestigious preschool in Manhattan.

So there is a kind of drive to and a frenzy even to improve ourselves and the prospects of our children.  Why not use biotech if these other methods are okay?

And I think this report frames that question very powerfully, and lying in the background is an historic experience with improvement with genetic improvement, and that's eugenics.  And eugenics is a sordid part of the American past and has had a lot of attention lately when governors of a number of states have apologized for eugenic policies of forced sterilization just in the last two years.

And on the face of it, this is very different.  Biotech enhancement is different from eugenics because it's not coerced.  It doesn't involve forced sterilization, but it's similar in the sense that it aims at improving our genetic make-up, and the real question this report poses is:  well, what was wrong with eugenics in the first place?  Is it simply that it was forced, that it was coerced?

And now we can pose that question in the face of these technologies.  Suppose you remove the coercive aspect of eugenics and you have instead voluntary, free market eugenics, free market, consumer-driven eugenics.  That's the question of enhancement.

Is there an objection to it or was eugenics only wrong historically because it was forced and coercive?

So that's one interesting ethical puzzle that this report helps us think about, and it's one that seems to me that we as a society should think about.

And the second question that this report raises has to do - well, I think it prompts us to reflect on practices that are low tech, not high tech practices that are already widespread.  The aspiration to improve your children against the background of a meritocratic society where the pressures are ratcheted up in the last couple of decades in an unprecedented way.

The intensely competitive society that we inhabit is the background for the consumer driven eugenic project that biotech enhancement reflects, but there's a lot of lot tech hyperparenting that many of us find ourselves in the grip of, and what that suggests or the question that it raises is that the subjects this report deals with we often associate them with new biotechnological advances, as if technology is the occasion for this predicament.

And so we tend to think that the problem is set, the problem of genetic engineering and enhancement is set, by great, new biomedical advances that had inadvertent side effects that we need not think about, as if these developments came to cure disease, but stayed to tempt us with the prospect of genetic enhancement and engineering.

But that may be a mistaken way of looking at it.  It may be the other way around.  It may be that the intensely competitive society we inhabit with the drive for mastery and control and improvement and perfection that it fosters summoned these technologies into being, and so it may be that we need to attend, and this report can give us an occasion to reflect, maybe that we need to reflect on the drive for mastery and control and improvement and perfection in the public culture that we've created that may be the background and the occasion for these dilemmas rather than the technology as such.

CHAIRMAN KASS:  Thank you.

Bill, did you want to comment?  And then I think we should leave some time to open the floor for questions from the press before we break.

DR. HURLBUT:  Just a few added thoughts from a personal perspective.  I found this project very, very difficult, and I think the reason it was so difficult was both intrinsic to the subject and also because it seems like such an important subject.  The consequences of what we are talking about here are so significant.  It raises such fundamental questions about human nature and our place within nature, fundamental issues of meaning and purpose in human life, and this is not just at the personal level, but at the social level and even what one might call the species level.

These are really species issues.  Many of the issues we discussed here have implications that go beyond the present generation.  So they are truly issues for the whole human family, and one dimension of this project that I found very, very hopeful was that we extended our discussion beyond the borders of scientific and narrow bioethical reflection into realms that required us to think and converse with philosophers, theologians, and also the broader testimony of life as lived, the insight that the common person has living in the profound reality of their own personal existence.

I know I for one spent quite a bit of time talking with individuals from diverse backgrounds and perspectives to inquire as to their feelings about some of these potential transformations of human life.

Another difficulty of this subject that made it very broad for me was the fact that we're not talking about a transformation versus a static improvement or temporary reality, but something that is dynamic, that any change in one phase of life will affect the larger process of life, the overarching contour such that at least our reflection on what's going on here has to bear in mind the possibility that any one enhancement will affect all of the stages and phases of human life, disrupting its potential integrity and sense of personal identity and sense of continuity.

And so in the process of thinking through this subject, it drew me back as one trained in biology and medicine to think about the fact that interventions at such a basic level, a basic biological level require us to think about where our fundamental capacities came from in the first place.  What are our origins?  What can that tell us about what we might beneficially do to alter ourselves?

And this, of course, brings us back to some reflection on our evolutionary origins, and when one looks back, one can see that we have been both framed and constrained by evolutionary process, a hard fought battle of balance where desire is actually an agency that beckons us forward toward specific human goods, but within the context of constraint.

Michael spoke about the power of coercion.  It strikes me that when we go beyond those natural constraints, we open ourselves to a subtle sort of what you might call soft seduction of desire.  In a natural environment desires are directions that send us off in a hopeful direction, but they are not destinations in and of themselves.  When unconstrained by the limitations of nature, we have to be extremely careful how we use our technology when it's propelled by desire.

So the pursuit of happiness needs to be framed within some perspective of our natural origins.

It's equally true that we're a species that has adapted for adaptability, a kind of open indeterminacy, and that it's our very nature to, through art and technology, produce creative extensions.

And I think one of the problems in our current thinking is that we have just come out of century in which there have been absolutely dramatic transformations of human life through biomedical technology.  One can think of extensions of life span, basic interventions that break heretofore connected goods, such as sexual union and procreation; transformations of our surface through cosmetic interventions; and increasing transformations of human potential for performance.

I think the momentum of change is also causing a momentum of change of self-understanding of our whole relationship with nature, one another, and within ourselves, our aspirations and expectations.  But such a metaphorical extension of the notions of what happened in the 20th Century may be a danger in itself.  It may be true that cosmetic transformation is somehow intrinsically different than the kind of transformations that are now on the horizon.

It's one thing to manipulate the natural surfaces given for self-expression.  It may be quite another thing to go to the very core of the fragile frame of human freedom.

Just to mention a couple of dangers, there's certainly a danger of individual trivialization, self-degradation.  There's also the danger of increased confusion and conflict just simply by producing too much choice; that it is too far beyond the reach of our normal, intuitive relationship with how we are to manage our lives.

And of course, very deeply there's the danger of unbridled competition that's corrosive to community.  I think we shouldn't underestimate the dangers of intervening in our own biology.  In this season of the World Series, we might remember that old saying that Mother Nature always bats in the bottom of the ninth.

We've chosen in this report to talk about some very dramatic technologies, some of which I think will in and of themselves probably not be realizable.  Yet we use these as heuristic examples that are able to draw out deep lessons.  Some people will criticize us for speaking of things that are unrealistic, but they are very realistic in the sense that they are on the trajectory.  They help us to see and frame the issues.

Just one final thought, and that is that I for one think we're heading into very dangerous territory with our uses of enhancement technologies.  I think we shouldn't underestimate that.  In this regard, I think our document is a tremendous contribution to an essential dialogue.

In thinking about this matter, which I have already thought about for decades, but my thinking in this group process was enriched and deepened, and in the process I think I came more deeply to appreciate with a certain respect and reverence the natural frame of human existence.  It seems to me to truly be a privileged path to a deeper and more coherent life than the one we might micromanage into existence.

We have wonderful possibilities ahead with our advancing technology, but it's quite evident when one thinks about this arena that we're going to need the continuing ethical reflection that we've done with this document.  It's going to need to be an ethical reflection of the whole human family together as community, and it's only through that that we will open up a wonderful possibility of advancing biomedical science while at the same time preserving human dignity.

CHAIRMAN KASS:  Thank you very much.

Let me read very quickly and I don't want to neglect comments both from our colleagues, Mary Ann Glendon and Frank.  They are very brief, and then we'll have questions from the floor if there are any.

This is from Mary Ann.

"I regret that I cannot be present when the Council presents 'Beyond Therapy' at the October meeting.  I am sure I am not alone in believing that this report could have immediate and far-reaching effects by drawing public attention to some of the most neglected issues in bioethics.  My hope is that it will stimulate conversations in many fora, radio and television discussions, newspaper columns, colleges and universities, and study groups of all kinds.

"After months of hearing testimony from the best experts in the areas covered, we have provided a basis for a well informed, serious reflection on what it means for Americans individually and for American society to cross the admittedly hazy frontiers that separate ordinary medical uses of biotechnology from the unknown territory that lies beyond.

"The report goes a long way toward helping us all think clearly about the hazards as well as the promise of the new technologies and about the difference between technical advances and authentic human progress.  Sincere congratulations to you and the staff for putting this all together so eloquently and effectively."

And from Frank Fukuyama, "I apologize for missing this month's Council meeting due to a trip out of the country.  I am very pleased by the release of the Council's report 'Beyond Therapy.'  I have reviewed the various drafts of this document, and while there are individual areas that I might not completely agree with the text, I think it is a document of utmost importance.

"I believe that, to a much further degree than issues like cloning and stem cells over which we have spent a great deal of time, the issues raised in 'Beyond Therapy' get at the heart of what is most troubling about biotechnology both now and in the future.

"Human nature and the natural human condition provide important normative guidelines for everything from human rights to relations between friends and within families.  The ability of modern biomedicine to alter this condition, while of course not entirely new, will have enormous effects on our lives that we have not even begun to comprehend.

"Over the past two generations we have seen the growth of an enormous worldwide environmental movement dedicated to preserving as much of our natural environment as possible because we human beings feel deeply rooted in nature and incomplete as humans in its absence.  We should be all the more concerned with the husbanding of our human natures to which we should attribute, even if unconsciously, an even higher normative value.

"This report makes an excellent first stab at thinking through these questions.  It is unique in the history of prior bioethics panels and will make a real contribution to putting this issue on the map.  It points out that many aspects of what I have labeled a post-human future have already arrived in the form of personality altering drugs, and that there will be much more to come long before anything like germ line engineering becomes a possibility.

"The report also rightly argues at this point that these are issues for reflection and debate rather  than regulation and public policy.

"Staff should be congratulated for pulling this together as they did, and I am delighted that Council is sending a report forward at this time."

Thank you all for your very thoughtful, interesting, and generous comments.  We have a few minutes for questions from any members of the press or the media who would like to pose matters for discussion.

(No response.)

CHAIRMAN KASS:  There being no votes, there are no questions.

Let me make one final comment.  We'll take a break early and reconvene.  We are all mindful, I think, of the possible utility of this volume in various kinds of educational settings.  We have the leisure and the manpower, I think, to visit various college campuses where you people are in the course of the next six months to have some conversations about if you take one chapter or one theme.  I think there are members of the staff who would be willing to travel.

And if any of you would like to try to organize some things in connection with your own teaching or your own activities, I think we'd be delighted to cooperate and try to begin the process of letting the conversation develop with this as a starting point.

This is not newsworthy in any ordinary sense, the kind of timely sense.  If it's going to have an effect, it's going to be slow, and it's going to depend upon conversation.  You are not only the contributors to the volume, but seeds in your own places for carrying this conversation forward, and the Council and the staff stand ready to help you.

We'll adjourn.  We'll reconvene at a quarter of 11 to talk about chimeras.

(Whereupon, the foregoing matter went off the record at 10:23 a.m. and went back on the record at 10:52 a.m.)

Session 2: Toward a "Richer Bioethics": Chimeras and the Boundaries of the Human

CHAIRMAN KASS:  This will be a change of pace.  This session is entitled "Toward a 'Richer Bioethics':  Chimeras and the Boundaries of the Human," a discussion amongst ourselves.

Let me announce, by the way, that efforts are being made to move the starting time of dinner this evening from drinks at 6:30 and dinner at 7:00 half an hour early.  So drinks at 6:00, dinner at 6:30.  We'll have this confirmed by this afternoon, and if we have the usual problems with the checks, we have a substitute arrangement for those who have their addictions to attend to.

The reason for this session, I remind you, is, in part, at the last meeting when we were discussing the question of mixing animal and human gametes or blastomeres, it was suggested by Michael Sandel, amongst others, that we needed to have a more general discussion of this boundary question between the humans and the animals and whether it should matter to us, and whether it should matter to us ethically, aesthetically, politically and why.

Second, it is potentially a future topic for this Council since this is an area of increasing scientific interest and activities.  What with the growing number of experiments that are now putting human stem cells and their derivatives into animals to test them either for their pluripotency or, more interestingly, for their therapeutic potential.

It is an area of public disquiet for it touches on some rarely articulated, but perhaps not altogether articulable - Gil, I think that you'll like that - sense that these boundaries between man and the animals should not be breached.  Yet the boundaries have long been breached, what with vaccines and drugs that are produced from animal sources, with the use of transplantations from animals, whether heart valves or livers, with the growing transfer of human cells into animal bodies, the movement of genes, et cetera.

And there is the vexed question of, given the evolutionary continuity at the genetic level, what the difference is at least if you're thinking genetically between a so-called human gene and an animal gene, given the enormously high degree of correlation and correspondence between the human and our nearest neighbors, and indeed, a high degree of correspondence across some wide evolutionary gap.

There have been in the last couple of years already at least two major discussions amongst scientists themselves on the ethics of doing such things as producing a mouse-human hybrid.  There's a newspaper report in your briefing book about this, and there was a recent symposium on line at the American Journal of Bioethics on this topic.

For many of the scientists the question might be, to begin with, largely political.  They don't want to do anything that might upset the public, but for us the question is not in the first instance political, but what should we really think about this matter of mixing, about producing hybrid organisms in general, but most especially human and animal ones.

There is a definitional problem as to what you mean by a chimera or a mixture, and there is some material in the briefing book that touches on that.

It seems to me that there are at least the following questions that we would want to take up if we are not simply thinking politically, but fundamentally.  Do we care about the mixing of the human and the animal, and if so, why? 

And if we do care, how do we know when the boundary has been sufficiently breached to be worrisome?

And if the first question is the same, the second one is a kind of part and whole question.  Does it matter?  Is it a question of the amount?  Is a liver transplant okay, but a transplant of the monkey's paw would be a rather different matter?

And behind all of this is the larger question of whether the notion of species and natural limits and definition, whether these things are of moral and social importance, questions raised, I think, by that very thoughtful article by Mary  Midgley.

Finally, it seems to me this is a topic fitting for our interest in the richer bioethics.  Much of what we do here touches directly or indirectly on the question of what it means to be human, a question that has long been explored by a question of the difference between man and the animals and explored in ancient mythology not only amongst the Greeks, by these mixed creatures, the chimeras, the centaurs, the Minotaurs, the sphinx, the satyrs, all of which are in a way explorations of the monstrous, but as a means also of getting at the difference of the human and the difference that it makes.

It's not so much that science has raised new questions, but that it has made these old questions now urgent and very timely, and it seems to me it's desirable for us to spend some time on it.

The readings that you were given were not meant to be discussed, though they are fair game if anybody wants to introduce them.  It seems to me without expertise and without any kind of apparatus, we should probably plunge right in and ask maybe two questions.

Would we care about the production of "geep," that is, the cross between the goats and the sheep that was achieved in 1984, that chimera?

And more importantly, would we care about the production of a "humanzee" were it possible to do so?  This is not somehow to get us in trouble as prophets of an ugly future, but as a way of getting into the question of the boundary.

Let's take the radical form and then move backwards from that to questions of perhaps the merging of blastomeres or the production of hybrid embryos, which is much closer to the surface.  It seems to me if we start with the more radical and see whether there's something there that bothers us and why, then we might be able to look more narrowly at partial chimerization or at embryonic chimerization and take it from there.

So either:  do we care  about the production of goat-sheep chimeras?  And if so, why or why not?

And depending upon what we do with that, would we care about, should we care if we could produce a "humanzee," a full hybrid of a human being and a chimpanzee?

Michael, good.

PROF. SANDEL:  Well, I'm not sure I know the answer to either of those questions.

CHAIRMAN KASS:  Just don't change the question.

PROF. SANDEL:  Well, I can't make any guarantees.

One thing that might intuitively bother us about mixing, about the "humanzee," is that we somehow think that respect for human dignity is at stake, that it's imperiled by blurring boundaries between human beings and other creatures.   But the idea that there has to be a clean, hard, fast distinction between human beings and animals seems to depend on an idea that we've discussed here in another connection, that there is respect for humanity, kind of Kantian respect for human persons, on the one hand, and where human beings are not involved, it's perfectly all right to treat other beings and nature as objects open to use.

So this is the all or nothing dualism, and Kant gave it its clearest formulation between respect for humanity, on the one hand, and everything else in nature is open to use.  And it seems to me we have already considered reasons to call that hard and fast dualism into question when we were considering about intermediate notions of respect, never mind embryos, whether other parts of nature, the sequoia, works of art, and so on, that we consider worthy of respect, though not of respect as human persons.

And if we call into question that sharp dualism, persons are worthy of respect; human beings are worthy of respect, but the rest of nature is open to use; then I think there is a lot at stake in trying to avoid any blurring of the lines between human beings and animals because then the problem arises, well, if you have a chimp who has some human features, might we be mistreating it if we consider that creature open to use as animals are.

But if we consider there to be - if we reject the utilitarianism, the use orientation to nature and to animals and consider that there are certain modes of respect that are required in dealing with natural beings other than humans, then it seems to me there may be less at stake in insisting on a clear distinction between human beings and animals.

I think the motivation to insist on that distinction has a lot to do with this misplaced intuition, that there's respect for humanity and use toward every other part of nature.

CHAIRMAN KASS:  So you think that or are you suggesting - I'll point the question at you - but you're suggesting that people who had deep reverence for natural kinds shouldn't be bothered by "humanzees"?

PROF. SANDEL:  By "deep reverence for natural kinds," you mean people who don't -

CHAIRMAN KASS:  Who are not utilitarians with the rest of nature, who believe in evolutionary continuity, who believe, you know, that the sequoia and the gazelle and the cheetah and the chimpanzee are not simply there for our exploitation, but are to be regarded and appreciated; that if that's true, that species mixing is somehow less of a problem?

PROF. SANDEL:  Well, this is a suggestion that I'm offering, yes.  Yes.

CHAIRMAN KASS:  And then do I take it, therefore, that - well, let me ask you:  do you have problems with the "geep"?  "Geep," a cross between goats and sheep.

PROF. SANDEL:  I'm not sure that I do, though I'm open to persuasion if there's something wrong with it.  It would depend on whether we're frustrating, I think, any functioning that's important to - if we're impairing somehow the functioning of either goats or sheep by creating this crossbreed, that would raise difficulties in the way that we now create giant farm raised salmon that don't swim and don't exercise salmon-like capacities, or if we imagined cows that for human convenience we genetically engineered: blind cows to alleviate the anxiety and resistance they show on the way to slaughterhouse.  We would be impairing some fundamental capacity of a cow even though they might suffer less.

So that would trouble me, but unless the hybrid impairs some natural functioning, like the capacity for exercise, for roaming, for sight, and so on, then, no, the hybrid itself I don't think poses a problem.

CHAIRMAN KASS:  Okay.  Allow me one more time, and then I -

PROF. SANDEL:  The blind cow would.  The blind cow would bother me more than a cross between a goat and a sheep.

CHAIRMAN KASS:  A healthy "geep" on the Scottish highlands doesn't bother you.  What bothers you is exploitation and deformation.

PROF. SANDEL:  Right.  The blinded cow for our convenience, let's say.

CHAIRMAN KASS:  Fine.

PROF. SANDEL:  Or the pigs that might be genetically altered to lack tails and hooves and snouts so that we wouldn't have to discard all of this before turning them into -

CHAIRMAN KASS:  Okay.

PROF. SANDEL:  - meat.  That would bother me.

CHAIRMAN KASS:  Then the question would be free ranging "humanzees."  That won't bother you either, by analogy.

PROF. SANDEL:  No, but I -

CHAIRMAN KASS:  Not exploited, not made to run the elevators and collect garbage, but -

PROF. SANDEL:  But admitted to public schools and so on if their capacities warranted that kind of -

CHAIRMAN KASS:  Well, to "humanzee" public schools.

PROF. SANDEL:  Well, the question is whether we treat them in accord with their nature.

CHAIRMAN KASS:  Yeah.

PROF. SANDEL:  And so if it turns out that they have the capacity to learn, then they should be provided access to the schools that are appropriate to their nature.

Our worry, I think, is about underestimating their capacities, but if we don't underestimate their capacities and we treat them in accordance, then it's not clear to me what the objection is.

Frustrating their capacities, failing to treat them in accordance with their capacities for development, for learning, for speech, whatever it may be, chances are we wouldn't.  Chances are we would make them perform menial jobs or dangerous jobs and so on that might frustrate.  That would be an objection.

But suppose that weren't.  Suppose we didn't treat them that way.  Then I'm not so sure.

CHAIRMAN KASS:  He's all yours.

DR. KRAUTHAMMER:  Well, I'm just curious.  You talk about the "humanzee" as having fixed capacities, but clearly this would be a created creature.  We would be titrating how human or how chimp-like we'd want him to be.  It would be entirely a creature of our creation.  It would be the ultimate in manufacture, and I had assumed that you thought that manufacture, designer babies, the mastery of nature, was not a very good thing.

This is the ultimate in manufacture.

PROF. SANDEL:  Well, what's bothersome about manufacture is that we would be imposing our purpose on some creatures of nature in a way that for our convenience diminished or frustrated their capacities.  In this case, this case is more difficult because it's not clear that -

DR. KRAUTHAMMER:  It doesn't have capacities until we invent it.

PROF. SANDEL:  Well, it sounds like in this case -

DR. KRAUTHAMMER:  I mean its capacities are, in fact, our manufacture by definition.

PROF. SANDEL:  Well, I don't know.  I think we would still have - in this case, I assume this is a problem of enhancement.  We're enhancing a chimpanzee, and so it has capacities beyond what -

DR. KRAUTHAMMER:  Or we're degrading a human.  I mean, you could look at it either way.  I'm not sure it's - but I'm going back to your problem which you articulated extremely well.  We're talking about designing humans and cloning.  What is offensive here is the mastery, and this is the ultimate in mastery.

We're not talking about respecting the nature of a given creature.  We're creating it.  So its capacities are entirely in our design.  I'm amazed that you are not in principle opposed to this for precisely that reason.

PROF. MEILAENDER:  Just to tag onto that, so this cow doesn't have the capacity for sight because it was deliberately produced to be a different sort of beast.  That's not one of the capacities that it has.  That's sort of what Charles is pressing.

PROF. SANDEL:  So it's a violation of the telos of the cow.

PROF. MEILAENDER:  No, no, because what we have is Cow-X or something here that doesn't have the same teleological function.  It was deliberately made not to see but for some other purposes, and the maker has determined what those purposes are.  I think that's the kind of question you're asking, right?

DR. KRAUTHAMMER:  And that's what's intrinsically offensive about it, and in the same way I would expect you would be intrinsically offended by the "humanzee" for that reason as well.

CHAIRMAN KASS:  Jim Wilson, Rebecca, and Michael.

PROF. WILSON:  Let me approach this question from a more grisly standpoint.  In one of my other lives, I rounded up cows for a living and drive them to slaughterhouses, and it strikes me that the blind cow is much to be desired because as they round the corner, they know what's in store for them.

PROF. SANDEL:  Yes, exactly.

PROF. WILSON:  And it produces great terror.

PROF. SANDEL:  Yes.

PROF. WILSON:  The only difficult is with all blind cows, it's very hard to drive them because they don't know where the other cows are, and if they don't know where the other cows are, a few cowboys can't move 400 herd.

But I don't think that the issue is the telos of the cow's nature.  I think that the question is entirely practical, and that it is a practical because we distinguish between eating other creatures and not eating human beings, but there are in-between cases.

We kill a cow, kill sheep, kill pigs routinely.  Perhaps we could do it better.  I'm sure we could do it better, but Americans are not proclaiming a desire for preserving the telos of the animal, which is to say to snout, graze, and root about free from human intervention.

On the other hand, if we have a dog, killing it becomes extremely difficult and is done only, I can testify with some personal knowledge under extreme circumstances when you're convinced that you're saving him from very, very great suffering.  But it is almost impossible to kill a human being unless the human being can be certified clearly as brain dead and there is evidence produced by that person or the closest relatives that death is what they wish.

So that when we deal with species in extremis, at the end of their lives, we're attempting to set some boundaries.  I think a "humanzee" is a great mistake because we don't know what those boundaries are. 

We could create boundaries, 40 parts mankind, 60 parts chimpanzee, or the reverse, but it seems to me that this creates two difficulties.  We don't know what they are and, therefore, it's hard to know how to treat them, and by no supposition could they be called God's creatures.  God had nothing to do with creating them.  They are our creatures.

And to the extent they have human-like traits, by which I mean chiefly sociability and intelligence so that they could enter meaningfully into relationships with other people and accept the obligations of being a human, they're human.  But if not, if the titration has produced more chimpanzee and less humanity, it seems to me we are in a puzzle for which there is no easy solution, save the best solution, which is not to create them at all.

"Geep," on the other hand, that's not very different from breeding special kinds of cows.  I mean, you like black angus cows, and they're overpriced in the market right now because, in fact, they're not as good as many others, no better than many others, but people like them, so we're breeding black angus cows.  And you can breed all sorts of creatures.

You can breed.  We have bred dogs and cats to satisfy human desires, but it hasn't moved any of them into the realm of the human, save as our personal affection for them has made it difficult for us in recognition of our own desire to be human beings, to treat them with some degree of special respect.

But blind cows?  That's not a problem.  "Humanzees," that's a real problem.

CHAIRMAN KASS:  Does someone want to respond to Jim before we simply go in the queue?

He's given two reasons, right?  One is the ambiguity of not knowing what kind of creature this is and, therefore, whether it belongs amongst us or not and, therefore, a doubt about how to treat it.

And then the second point, maybe we should ask you to say a sentence more.  That these are not God's creatures but our creatures and what follows from that.

PROF. WILSON:  Well, I don't know what follows from that.  So I'm not going to add to the sentence.

(Laughter.)

PROF. WILSON:  Were I God I could answer.

CHAIRMAN KASS:  Someone want to join us?

DR. MCHUGH:  I could say just a couple of things to back up exactly what Jim is saying.  First of all, I think that one of the things that we speak about in relationship to our human dignity is the mystery of our origins.  We are a mysterious creature.  Even Darwin himself talking about us does say that he doesn't see the link between us and our capacities and what came before.

This mystery gives us an awe for our species that I would hate to see mismanaged by employing it and putting it into the parenthood of some other organism, this human lineage.

Secondly, and this comes to Charles' point again, what kind of creature would these be in relationship to human beings and human being reproduction?  Would they be mules and, therefore, infertile or would they be interactive with human beings sexually and reproductively with the contamination of the human gene pool being a real possibility there?

So we have both, I think, a serious scientific and biological issue, on the one hand, and also this other deeply special kind of sense of what we are and the mystery of our origins.

CHAIRMAN KASS:  Mike.

DR. GAZZANIGA:  I think this topic follows my 17/60 rule, that it would appeal to 17 year olds and people with a lot of time on their hands.  It doesn't appeal to me, and it certainly sets an inappropriate stage for the issue of whether embryonic stem cells should be allowed to be injected into mouse where we're considering the mouse simply to be a nice, convenient tissue culture to study the science of embryonic stem cells.  And there's a cross-species activation that is important to biomedicine and I think should be continued.

So I'm not sure the "humanzee," ta sort of Raelian example, deserves much more discussion.

CHAIRMAN KASS:  Michael.

PROF. SANDEL:  I'm neither 17 nor 60.  So I want to respond.

DR. GAZZANIGA:  But you're closer to one than the other.

(Laughter.)

PROF. SANDEL:  I was talking to a leading scientist the other day, and he said the most exciting question he thinks in this area is not stem cells, but putting human brain cells into other mammals, including monkeys, I guess to trace the genetic changes that correspond to these species' characteristics.  So I don't think it's all that farfetched.  This is work that has begun with mice and is, I think, continuing with monkeys.

I asked him whether he would be bothered if he went into the lab one day and the monkey spoke to him, and he said he wouldn't be.  And that seemed to me an odd response.  So I want to reconcile my sense of feeling that that was an odd response to this previous exchange.

I think that what's disquieting about that does have to do with the idea of telos.  Even though you could say that that monkey, that talking monkey would have been manufactured, I don't think it follows from that that its telos is just up for grabs, something for us to define by fiat because what's troubling about that is when the monkey speaks, we're not sure what capacities this creature has, and so we're not sure what counts as respecting this creature or what it would be to allow its capacities and purposes to unfold.  That's what makes it a strange scenario.

So even though we have manufactured, we haven't really manufactured this creature, Charles.  We've tweaked it by putting in the human nerve cells or brain cells, and we begin to notice certain human characteristics hypothetically.  But what's puzzling and still very mysterious and I think at the source of the unease is that we aren't and we don't conceive ourselves to have manufactured in a thoroughgoing sense that we've inscribed its telos or purpose or that we even can fully grasp it.

We might need to know; we might need to talk some to this monkey to get some glimmer or intimation of what its capacities and what its telos now consist in, and I think what's uneasy about it - and this goes to Gil's point, too - well, in the case of the blind cow it's clear.  And here I disagree with Jim.  I think there we have violated the normal, the natural functioning of the cow for the sake of cheaper steaks.  And that is a kind of hubris in violation of the kind of respect that nature is due.

In the case of the monkey, there may be something deeply troubling about it, but I think that it's not that we've simply reassigned its telos by definition.  It's that we now are in doubt about what its capacities are and, therefore, how to treat it, to which one response might be, well, err on the side of generosity.  Assume that it has the highest.

But still I think it's that we're puzzling, we're struggling really to figure out what sort of being this is, which is not to defend the practice, but it's to suggest that it's a complicated reaction that we have when we worry about this.

DR. KRAUTHAMMER:  Could I ask Mike a question just because he was telling us that this is not a serious subject?

What would you say to the implantation of human neuronal stem cells into embryonic animals of any kind in larger and larger proportions?  I mean, is that science fiction?

DR. GAZZANIGA:  No, that's going on.

DR. KRAUTHAMMER:  It's going on.  So what do you say about that?

DR. GAZZANIGA:  Nothing.  Let's do it.

DR. KRAUTHAMMER:  No limitation.  What if you replace all of the neuronal material of the animal with human neurons, and assuming that we have some success, that it doesn't abort and actually will develop?  Do you have any problem with that?

DR. GAZZANIGA:  I think you push it to the point where you're suggesting that some freak is going to emerge.  I don't think that there's any suggestion that that would ever occur.

DR. KRAUTHAMMER:  You're sure about that?

DR. GAZZANIGA:  I'm not sure about anything.

DR. KRAUTHAMMER:  But you would be willing to test it?

DR. GAZZANIGA:  That's not why they're doing it.  They're doing it to study the development of the cell and how it behaves in the neural setting, and it will come to a point where it wills top the process I would imagine should there be any suggestion of a freak being developed.

DR. KRAUTHAMMER:  Well, I'm sure that the overwhelming majority of people who are studying cloning are interested in embryology and in the science, but there are a few who actually want to take it to produce a cloned human, which most of us believe is abhorrent.

So by analogy, what if you had a scientist, unusual, maybe in the minority, who was interested not just in the biology, but in seeing where it takes us?  What is your judgment on his work?

You have none?

DR. GAZZANIGA:  These are all arguments by extreme, and I think we're trying to address a very limited, sober, biomedical question, and I don't find them helpful.

CHAIRMAN KASS:  Can I try with you?  Because we're the same age, and if age is determinative, maybe I don't have enough monkey cells or the reverse.

So to try to keep you on board, the point is not, it seems to me, to take this bizarre case as a likely possibility, but it was Michael's suggestion at the last meeting, endorsed by several others, that you couldn't really think terribly well about whether it's a good or bad idea not putting individual human cells into animal models, but whether it would be a good idea to produce the beginning of an organism by the mixing of gametes or of the merging of blastomeres.

That was the particular point at issue, and it's on our agenda for this afternoon.  Michael said, "Look.  How can I discuss that if we haven't sort of thought about the question of the human-animal boundary in general?" and that one of the ways to at least explore whether that boundary means something is through this thought experiment, a thought experiment which is made slightly less than a mere thought experiment by the kinds of reports that Michael offers or that you suggest here.

And I don't think there's any presupposition in the discussion that someone is going to conclude that it's somehow horrible to, you know, put pig heart valves into human beings or to put human stem cells, neurons, into mice brains.

But the question is:  if there's some sort of disquiet, it's somehow easiest to get at it, I think, if you take the kind of sharp and extreme case because if you can't articulate what the problem is there, you've got really nothing to go on, I think, when you get down.

That I think is the pedagogical strategy.

DR. GAZZANIGA:  I understand.

CHAIRMAN KASS:  And let's stick with it for a little longer to see if there's anything useful that we could bring to bear on the larger conversation.

DR. GAZZANIGA:  But just to follow up on that.

CHAIRMAN KASS:  Please, please.

DR. GAZZANIGA:  We sort of jump around these huge barriers with these sorts of arguments.  So a few meetings ago people were wringing their hands about potential long-term outcomes of IVF, and there may be slight percentage differences in the birth defects and so forth.  And the general belief that nobody in medicine wants to do harm, right?

Now all of a sudden we're talking about making a "humanzee" with God knows what neurologic, somatic, other issues are at stake.  I mean, it's like Mars.  On the one hand, we're titrating this little thing and worry about it, epidemiological studies, and in another thing we've got "humanzees" jumping around with big pharma, you  know, injecting them and testing them.  It's crazy.  It's all crazy.

It's not controlled by current reality.  I'm telling you it's people with too much time on their hands.

DR. MCHUGH:  I want to pitch in there.  Michael, you're so wonderful I don't know how to respond.

But you  know, people have, after all, discussed as perhaps one of the great novels of modern times the Frankenstein problem.  they've discussed it.  They've thought about what it means.  It perhaps and Jekyll and Hyde are the two perhaps new themes of modern life that have come out of the literature of our times.

And it doesn't seem to me that discussing how the horror that Mary Shelley created doesn't prepare us better to understand the nature of human life.  So give them a break is all I'm saying.

CHAIRMAN KASS:  By the way, on the subject of novels, let me mention - and Gil is next in the queue or Rebecca, I guess, at this point.  Excuse me - there is a novel exactly on this subject.  I haven't read it in 30 years  It's by a Frenchman.  The pseudonym is Vercors, V-e-r-c-o-r-s.  It's called You Shall Know Them.  It's really quite wonderful.

They found the missing link off the coast of New Zealand, and the question is when the Australians want to employ them in factories as sort of subhuman workers, a British journalist thinks that this is immoral, and to prove it he impregnates one of these females, has the child delivered in a London hospital, murders the child in the newborn nursery, turns himself in, and insists that the court determine whether this was murder or simply cruelty to animals.

And the bulk of the novel is, in fact, the discussion of the experts on the question what really is the decisive difference.  I was hoping to put my hands on it.  I lent it to somebody and I can't remember who, but I would have Xeroxed some pages that would have enriched us, but it's a terrific treatment of exactly this question.

Rebecca.

PARTICIPANT:  The title again?

CHAIRMAN KASS:  You Shall Know Them.

DR. GAZZANIGA:  What did the judge decide?

CHAIRMAN KASS:  I'm old enough not to remember.

PROF. MEILAENDER:  He said it was a silly question really.

(Laughter.)

CHAIRMAN KASS:  Vercors is the pseudonym, V-e-r-c-o-r-s.  It was written shortly after the Second War. 

DR. KRAUTHAMMER:  The judge was 61 years old.

(Laughter.)

CHAIRMAN KASS:  We've now developed a queue.  Rebecca, please, and we'll just go.

PROF. DRESSER:  Well, in regard to the "geeps," I wanted to throw out would people feel strongly differently about them than they do about mules?

Now, mules I know are bred and used for their abilities, and maybe they first arose in nature and people noticed it and noticed that they could do things that horses and donkeys couldn't do.  So maybe that's what sets them apart from "geeps," but I think "geeps" are also, other than the welfare considerations, aren't nearly as threatening because we morally treat goats and sheep similarly.  So it doesn't threaten our moral categories and status views.

Whereas the "humanzee" does, and as someone who thinks we don't give enough ethical consideration to our treatment of non-humans, I think a good effect of thinking about "humanzees" is to make us reflect on how we treat chimpanzees and remember that - I know it's constantly discussed - but I think the high 90s percent genetic similarity in those two species naturally, and again, it's controversial, but there are some people who think that chimpanzees can be taught to communicate with language and have lots of other high cognitive abilities naturally.

So I think one reason "humanzees" are more threatening is because they not only ask us to justify the high moral regard we give humans, but also to justify the low moral regard we give non-humans and makes us worry about maybe at least both or certainly the second part or should make us think more carefully about what we do.

CHAIRMAN KASS:  Gil, Alfonso, Bill Hurlbut, Michael, Bill May.

PROF. MEILAENDER:  I can't guarantee that what I'm going to say is going to make sense, but let me try because I want to try to connect this discussion of "humanzees" or whatever with what is the more immediate issue of kind of mixing of species at kind of much more kind of rudimentary levels, and it has to do with, I mean, the splicing and resplicing depends on thinking about organisms as essentially sort of collections of bits of material in a way.

And that's a view that however useful and fruitful for certain purposes cannot be lived at the level of lived human experience, and that's what I want to try to make sense of. 

Let me take a complete different example.  Suppose I say a man lusting after a woman and a man in love with a woman experience roughly the same physiological symptoms, and there's really no difference between the two experiences because it's a collection of the same symptoms.

You know, if I sort of hue to that line, there may be  nothing you can do to demonstrate to me that that's wrong, to prove to me that that's wrong, that is to say if I, you know, had some sort of theory that tells me that or if I've just never been in love.

On the other hand, someone who has actually had the lived human experience of being in love knows that the two experiences, even if characterized by the same physiological symptoms are not, in fact, the same, but you can't tell it if you for whatever reason insist on looking at the experience simply as a collection of symptoms.  You have to look at it as a kind of lived human experience.