Biotechnology and the unpleasant alternatives.
This is the second dispatch of a two-part series. To read the first dispatch, click here.
Friday afternoon's portion of the bioethics conference at the University of Pennsylvania begins with a panel discussion moderated by Art Caplan, the gregarious director of Penn's Center for Bioethics. The participants repeat complaints we heard at lunch from Penn's president, Amy Gutmann, about the media's sound-bite culture. The panel is a self-caricature of academic diversity: both genders, two colors, several religions, a range of ages, one basic outlook. When Caplan asks about taking brain-enhancing drugs before a college exam, nobody at the table objects in principle.
The conference breaks into smaller groups, and I head upstairs to hear a talk on cyborg technologies by Paul Wolpe, one of this morning's speakers. At first, Wolpe seems trapped in the liberal echo chamber. He cites the Terri Schiavo case as evidence of the power of illogic. People who opposed the removal of her feeding tube "were extraordinarily emotional," he says, whereas "the people who were for letting her make the decision, they were completely calm." But Wolpe, the son of a rabbi, recognizes the dogmas of his colleagues. He repudiates as an "incredible oversimplification" this morning's speech by philosopher Greg Pence dismissing moral objections to the alteration of humanity. Wolpe marvels at the prospect, through brain-wave monitors, of mind-to-mind communication between humans. Until now, such communication has occurred only between man and God, he tells the students. It's called prayer.
An hour later, we board buses to hear Caplan's evening keynote lecture in a gorgeous wood-paneled hall at Philadelphia's College of Physicians. Caplan is incensed by Holocaust analogies in the Schiavo case. There's no comparison, he says. The gravest error of Nazi doctors in the concentration camps was rationalizing that "you can always sacrifice the few for the many." The Nazis thought some people posed intolerable economic burdens. "Those aren't factors that get much into American bioethical debates," he says. My eyebrows go up. In the Schiavo case, he continues, "Nobody has seriously proposed we should pull her feeding tube because she's a burden on the economic viability of the United States." Nobody? I've heard comments in that direction from two people at my own magazine.
Caplan draws a wise lesson from the Nazi doctors: Beware the human weakness for moral rationalization. But part of that weakness is the illusion in each of us that we have escaped it. Caplan, for instance, is a utilitarian. In medical experiments under certain conditions, he's willing to sacrifice the few for the many. He thinks this philosophy is insulated from the Nazi-doctor mentality by a requirement of consent from those whose lives are risked. I think of the priests I met four weeks ago at a bioethics conference in Rome. They would ask how many embryos consented to be destroyed for their stem cells, and how many fetuses for their tissue. But none of those priests is in this room. The only tough question comes from a student who wonders how the growing use of genetic tests to weed out marginally defective in vitro embryos differs from what the Nazis did. German eugenics was "government-based and coerced," Caplan explains. "We have a kind of eugenics, but it's individual choice." That doesn't make it right, he tells the student. "But that's what makes it different."
Caplan, like Wolpe, strikes me as a mensch. As a fellow Jew, I trust him to take his own life before he'd do what the Nazi doctors did. But I don't trust utilitarianism, and this is what rattles me about many liberal bioethicists: They fear absolutism so much that they don't see its opposite, utilitarianism, as another ideology. They think subjecting everything to cost-benefit analysis is just common sense. I don't think an embryo is a person, but when I read about healthy embryos being weeded out by genetic tests just because they can't provide tissue for transplants or because they carry an unexpressed gene for deafness, I wonder where the hell we're going—and whether anyone other than the absolutists is paying attention.
Just as I'm about to close my laptop and head back to Washington, Wolpe steps to the podium, and the lights dim. Up on the projection screen, horrifying images appear, one after the other. They aren't the work of the concentration camps. They're the work of nature, preserved downstairs in the College's Mutter Museum. A two-headed fetus. A one-headed fetus with two bodies. "They are not excused; they are not explained. They are simply for you to see," Wolpe tells the students. This is the reality we can't stand to look at, he says—"the way our own embodiment can be perverted by nature."
I head downstairs. There they are, suspended in jars in glass cases. Two fetuses wrapped in a hug that became a double-faced head. Another pair locked in a kiss that swallowed both faces. A twisted little mermaid whose abdomen disappears into a stump. Collapsed half-heads. Noses protruding where eyes should have been. A child's skeleton with a skull three times too big. They didn't all die in the womb.
I think of John Paul II, riddled with Parkinson's and fever, a tube through his nose. A giant of history crumpled into a speechless form waiting to die. He told us to respect nature and human dignity. I wish I could respect what nature did to him. I wish I could see the human dignity in these jars. But I can't. I wrestle with the biotech liberals because I'm one of them. Nature can't always guide us. We will have to guide ourselves.
Will Saletan covers science, technology, and politics for Slate and says a lot of things that get him in trouble.