Human Nature

Over Our Heads

The bioethics council gets a lesson in limits.

The President’s Council on Bioethics wraps up its second term in a ballroom at an upscale Washington hotel. On the agenda: the council’s future. The chairman, Leon Kass, is stepping down. Council members wonder what issue to discuss next. I wonder what I’m doing here. The rest of the country is consumed by the death and destruction in New Orleans. The idea of discussing medicine or duty in any other context feels absurd.

The people in this ballroom look nothing like those stranded in New Orleans. Three elegantly dressed women and 10 men in suits sit at the council table. Two of the 38 people in the room are black. The hurricane gets mentioned only with envy, as the sort of emergency we spend money on while neglecting long-term challenges like the one the council is discussing today: caring for an aging population.

To be fair, emergency management isn’t the council’s job. Its first responsibility, by executive order, is “fundamental inquiry into the human and moral significance of developments in biomedical and behavioral science and technology.” But inquiry can become so fundamental that it loses its human significance. Like the president who appointed them, the council members are big-picture people. Unlike him, they’re intellectuals. It’s a dangerous combination. One member says the council’s four years have been “like going to graduate school again. It’s been wonderful.” Her colleagues throw around words like “deep,” “rich,” and serious,” often congratulating themselves or belittling less-thoughtful people. Meanwhile, in New Orleans, corpses are floating in the only deep thing anyone cares about.

The council’s detachment worries some members. One frets that bioethicists spend too much time on “fun” cutting-edge issues like genetic engineering and not enough on everyday medical struggles. Another worries that the council’s language is unfashionable. Another complains that some of its best work has been “neglected, unremarked.” The youngest, philosopher Diana Schaub, urges her colleagues to do more public speaking instead of letting the council’s reports gather dust. The lone Asian-American, Francis Fukuyama, points out that the council’s emphasis on human moral uniqueness is a non-starter in the Hindu, Buddhist, and Shintoist countries leading the biotechnology revolution.

Nobody at the table meets Schaub’s suggestion with even a smile. They’re tired. Two council members shrug that professors should do what they’re good at—think, talk, and write—and let others worry about reaching the public. Kass bemoans journalists who read only the last page of the council’s reports. He fails to stifle a grin as a colleague points out the difficulty of educating a country of creationists. Despite his pleas, members resume old feuds. One gloats that the council has proved that liberal bioethicists such as Art Caplan are “washed up.” Never mind what’s washing up in New Orleans.

The debate over today’s topic, aging, breaks down along similar lines. The younger, more liberal faction wants to talk about allocation of resources. We spend too much money on sickness and not enough on prevention, they argue. Too much on keeping old Americans alive for two more months, and not enough on protecting African babies from AIDS. Too much on doctors, and not enough on safe air and water.

The older, more conservative faction wants to get beyond questions of allocation. Even if we can afford to extend life spans, should we? Where does it end? What’s the point of living once you’ve had your education, raised your kids, and finished your labors? What if you can’t think straight, recognize your family, or remember who you were? How many of your parts can we replace before your body no longer feels like it’s yours? Maybe life should be finite even if doesn’t have to be. Life is “not an absolute good,” the council’s gentlest speaker, Alfonso Gomez-Lobo, advises his colleagues. “There are moments in which we just have to open ourselves to the fact that we have to let go.”

The conservatives worry that extended life will become pointless and empty—an escalator to nowhere, as council member Bill Hurlbut puts it. They fear the loss of limits. Life-extending procedures “are going to become easier to do and relatively less burdensome,” says Kass. If “there’s no such thing as enough,” the obligation to prolong life will become “limitless,” defying the principle of “the life cycle, the accepting of limits.”

It’s a poignant anxiety. But it answers itself. If limits give our choices meaning, we should start our moral deliberations where the limits are: in allocation. Otherwise, bioethical debates meander into empty space without bearings, like the old age conservatives fear. This becomes clear as Hurlbut explains his concerns:

We’re using biotechnology to short-circuit that which we’ve always wanted to have in terms of immediate pleasures, sense of personal ideals of appearance and performance and so forth. That creates … the danger of desire magnifying our powers to get what we want, putting a preoccupation in our minds of what naturally is a positive desire but, unrestrained with biotechnology, becomes a preoccupation or vanity and even a selfishness. And with 30,000 kids dying on average every day in the world, it seems to me that we could use biotechnology to … enhance our own vanity rather than increasing our goodness in the world.

Hurlbut is a brilliant synthesist. But nobody can figure out what the hell he’s talking about until he gets to the part about the 30,000 kids. Nobody cares whether everyone in the AARP gets three face lifts, unless it costs us the money to vaccinate children or keep floodwater out of their homes. First things first.

Ben Carson, the council’s only black member, challenges the group to broaden its focus from labs and hospitals to pollution. We spend more and more money on cancer research, he points out, yet cancer rates are increasing. Maybe we should look at the air and water. Mary Ann Glendon, one of the three women at the table, asks her colleagues to turn their attention from old people, who have lots of political clout, to kids, who have none. Others agree. Kass, while resisting liberal language, comes around to the idea of studying what “a good community” owes “its members who are unable … to provide for themselves.” The waters of depth are receding. Soon the council will touch the ground.