From the conference Biotechnology and Ethics: A Blueprint For The Future

Keynote: Setting and Communicating the Limits in Biotechnology

Daniel Callahan
President, Hastings Center

I am going to talk about a variety of ethical problems concerning biotechnology, and one of the things I'd like to do is to frame some of these issues to provide background concepts and perhaps some helpful ways of thinking about them. I think that the issues of biotechnology are among the most daunting, fascinating, troublesome and difficult of all ethics. Certainly, biotechnology as a whole has been the subject of enormous claims.

We have to decide to what extent we want our society to encourage or discourage research and development in this area. We have to look at the question of limits. Are there limits here, if so, how do we discover them, how do we accept them and how do we enforce the limits? We have to decide who is to make the decisions. Which decisions are appropriate to be left for individuals or to individual scientists. Which decisions have to be decided collectively and dealt with by matters of legislation and public policy. I think the particular complexity of biotechnology issues, if I may use a genetic analogy, many ethical issues are single gene problems. For instance, abortion; when does life begin, problem with brain death, physician assisted suicide, problem of informed consent. What you have are one or two centrally hotly debated moral issues where people can fundamentally divide, but you don't have a lot of them, you have a few and, in some ways, that makes them more difficult when they're up for debate because it's either yes/no, or for or against and not much room to compromise. Biotechnology issues I liken to certain to polygenic issues. That is to say, they encompass a whole range of problems. They are not reducible for the most part to one fundamental moral dilemma, but frequently present a variety. In many ways, to talk about biotechnology in general is not helpful because we are really talking about problems concerning human beings, problems concerning plants, animals and environment. There is a great range of issues and topics encompassed under the term bioethics. It seems to me there are some moral problems that are apologetic and to sort them means sorting out other issues at the same time.

I think it is also the case with biotechnology issues that they are new. That is rather an obvious thing to say, but it makes a great difference in thinking of the ethical problem because we don't have much history or precedent to work with. If you take the issue of abortion or the issue of euthanasia, you have long history's, you have theological or philosophical debates in some cases for centuries. You've got a lot of resources to work with, but in the case of many of the biotechnologies we have no history, we have no precedent. That's a further complication. It often leaves a lot of room to maneuver, for inventiveness. We are not burdened by the past.

What I'd like to suggest in the way of thinking about these issues is that there are at least three levels of analysis that come to bare. One very fundamental question is what is the cultural, social, political context in which we will be thinking about these issues? That is to say, what is the background and culture of which we are a part that is likely to shape and lead us in one direction by virtue of social, economic, political pressures. What is the setting of the biotechnology issues and ethics?

Secondly, how do we personally respond? What does our gut tell us about these matters? How do ordinary citizens respond to these issues?

Thirdly, how do we sort out and make sense of the moral issues? I want to reserve time to introduce the notion of moral policy. Just as we think of public policy usually involving a set of laws, regulations, procedures, perspectives on issues, I think one can also talk of moral policy as not simply a matter of particular ethical rules and principles, but rather certain fundamental stances toward moral problems.

First of all, I think we should be aware that we are in a culture which is heavily biased in favor of science and technology and extraordinarily optimistic. This means that when ethical problems are raised, and there are worries and doubts, there is a great struggle to get these worries and doubts out in great part because the momentum is so powerful to go forward. The main footnote I would add here is that we also seem to be an enormously risk averse society. I am struck by the fact that the Europeans aren't quite so zestful about scientific progress and technological innovation. On the other hand, they are not so worried about risk as we are, and tend to have more lax regulations and oversight review. We are a funny combination of a very positive attitude toward scientific progress, but also labored by risk aversion. We are obviously an individualistic culture, and we also want a great deal of freedom for individuals to ask from science what will satisfy their person. I think the following axiom is true for our society, that is to say, if somebody wants something in our society and science can give it to them, it is going to be an enormous burden on society to say no to that request unless you can demonstrate some very direct and obvious flaw in society which usually, in the case of biotechnology, is difficult to do. The best we can do is speculate, but it is very difficult to prove that something would be harmful. Whereas, if some individual wants something, you can make the case that they would be satisfied and happy if they were given it by science, reduction of their infertility, or whatever people want. That's much easier to carry. The burden usually is on the rest of us to say no. We are a society which is heavily dependent upon technology and scientific progress for money. A recent story in the paper, NIH is getting a slight budget increase, rather surprising given our conservative congress. Obviously, the market is a powerful institution in our society. There is at least a belief, and a growing reality that there is a lot of money to be made in biotechnology. That provides a powerful motivating force. We also have a society which is obsessed with health. Much more so than many other societies. People don't want to be sick, they want to be well. They want risk reduced. We have a medical perfectionism. That is to say we don't want to save most lives, we want to save every life. We want to relieve all suffering. We have a very expensive health care system. One which at least until yesterday is highly addicted to rather expensive technology and medicine. We like technology. We have not balked too much at paying for that high technology, and we look to scientific and technological innovation as the key to improve health.

As any epidemiologist will tell you, the key to improving population health is rarely better medical care, much less more technological innovations, but the background items such as income, education, a whole host of environmental things actually are likely to make more of a difference as to whether people live long and healthy lives.

We live in a culture that pushes us in the direction of more; more science, more innovation, which I think on the whole provides a very favorable background in culture for the developments of biotechnology. As much as scientists moan and groan about regulation, and that the religious right wants to get them, by and large they are doing o.k. For the most part, this is a very powerful express train, very much encouraged by American culture.

How do people respond to these issues? I think the biotechnology issues have a rather special feature. There is no doubt that many, if not most ethical issues, provoke emotion. Look at the issue of abortion or euthanasia. People get very heated about these issues. They choose up sides, and fight and argue, get nasty and struggle, but for the most part, people know what values they are standing for and what values they are struggling or fighting for. It's seems to me, with many of the issues of biotechnology, there is a kind of inchoate anxiety and worry where people are edgy and sometimes upset, but they can't quite pinpoint or articulate why that is. I think in great part, it is the sense that somehow we are delving deeper and deeper into nature. That nature is full of mysteries. We may do ourselves some harm or we may be introducing some very fundamental changes in human health, agriculture or our environment. There is a kind of sense of fear and trembling with these issues which is rather a different kind of emotion. To me, the interesting question is what to make of peoples response here. A long-standing question in ethics is the extent to which people take seriously their emotional response to the issues. I suppose there are some hard nose philosophers who would argue that emotions don't count. Good ethics, is simply good reasoning, but I think you could find a theses by Aristotle that one ought to listen to ones emotions, pay attention to them. They may tell you something. Even if you're not quite sure why your intuitions or your feelings have made you wonder. Perhaps there is more there than even you are aware of and thus, this ought to be taken seriously. I think it is an important fact to take into account because, in great part, when worries and anxieties arise, it is not because people have specific things they are worried about, but rather they are in general worried about this as a movement which may be introducing some fundamental changes in life of the kind we have never seen before.

Let me get to my notion of moral policy. I think the first thing we have to worry about is the cultural background of which we think about these issues. Secondly, we have to worry about how people personally respond. The third way concerns how we develop our moral values and moral responses. I want to use the term moral policy and I mean by moral policy that set of dispositions, predisposition's, biases, inclinations, perspectives that tend to lead in one way or the other when we are faced with the moral dilemma or difficult moral choice. I think there are really two ingredients to moral policy. One involves some of the traditional language and techniques of ethics. YouÕll hear more about this tomorrow, but of course people have more than 2,000 years in the west arguing about ethics. We have religious traditions and ethical codes, and we have philosophical traditions. One can distinguish Aristotelian ethics which has been very much oriented toward practical wisdom, seeing what wise people do and try to make reasonably wise practical judgments.

We have utilitarianism, a much more modern movement, which really says the way you make your moral judgments, look at the consequences, what will happen or how do you maximize pleasure and minimize pain and suffering. Greatest good to the greatest number. In other words, you can go at the world by asking what are the consequences of ones actions, and then try to decide how you measure those consequences.

Or you have the tradition of deontology, which basically says, that there are some things that are ostensibly right and wrong. Are there some things one ought do or not do regardless of the consequences? I think most of us would say you shouldnÕt grind up innocent babies in the laboratory just because you might get some interesting scientific results. You say, that's just bad. You canÕt do it. DonÕt tell us all the wonderful benefits that might result.

I think behind some of those debates in ethics which are important, and they are certainly pertinent, the broader, deeper world views come into play with biotechnology. I call them world views because they involve taking a stance on the world in general or issues in a very broad sort of way.

First, should we consider scientific progress an inherent good? We can say yes, and there are some people who are enormously enthusiastic about progress. There are those who say no. People who say we have not improved our state of well being or our happiness by virtue of scientific progress, and who wouldnÕt care a bit if we simply stopped or rolled back the clock.

There are some who say scientific progress is a wonderful thing, but it has given the world nuclear weapons, environmental problems and pollution, and keeps people alive much longer than they want to be alive. Scientific progress is a double edged sword. It does good things and bad things. Maybe the best attitude is not the kind of enthusiasm we have in this country, maybe it would be better to have some weariness and skepticism.

A second issue. Should we assume that whatever offers medical help for some individuals is worthy of pursuit. We get down to the question of individualism. There are many who would say that any medical progress is a good thing and ought to be pursued because every life is of infinite value. Some would say yes, if it's going to help some people, fine. It doesn't matter if it's a few. There may be some financial problems. Others would say no, what are the social benefits?

A third question. In matters of great uncertainty, how should we proceed forward? Boldly? There are surely some buccaneers in the world who say let's go ahead and seize it. That's a part of human adventure. We can, on the other hand, proceed nervously. In matters of uncertainty, we should go very slowly, step by step. I think this is a particularly interesting issue because for the most part the advances in biotechnology are going to involve uncertainty. We don't know whether we will be better or worse off. Who could have imagined when the first automobile was introduced what it would to our culture. Automobiles didn't just change transportation patterns, it changed work patterns. They changed all sorts of things we could not have seen. In the case of biotechnology, the changes may be even more fundamental and far-reaching.

Still another issue. Should we only introduce in the health care systems those biotechnologies that promise to hold down or reduce health care costs? In thinking about the introduction of biotechnology in the health care system, how do we think about the control of costs and the justice in how we allocate our resources. Some might say no to technologies to our health care system unless they have been proved in advance to be a financial benefit. There are those who say the important thing is to get the technologies out there then we can evaluate them. A more conservative view would say we need to be much tougher gatekeepers. It's no good to get the technologies in, test them and then try to evaluate them because it's impossible to turn back the clock.

Should we assume that nature, over many millions of years, including our own human nature, knows best? Is it the case that we ought to follow nature or be sensitive to nature in trying to judge the impact of our biotechnologies. In the environmental field, nature is taken very seriously. A great deal of worry about respecting nature and nature's way and not disturbing balances of nature. Medicine, particularly, the bioethics part of medicine has little interest in nature. It is not worried about nature. It doesn't see nature as a potential guide. We might well ask of nature, should we intervene at all? Should we think of nature as tough and resilient which is the way the adventurers think of nature. Others take the view that nature is delicate, fragile and we ought to be very careful. Evolution knows what it is doing. Or some say a little bit of both. In any case, how do we look at nature?

Should we think only of bringing people up to some level of normalcy. Should the aim be to reduce illness, pain, suffering or ought we think of the possibility of using the biotechnologies to improve on human nature. Should we think of these technologies to normalize or optimize?

Should the fact that the great profits to be made influence our thinking about the ethical issues here. There are some people for whom money is a bad thing. They are worried about the influence of the market, worried about putting a price tag on everything. Others think their market may be nasty, it may be insensitive. What difference does money make here? How do we want to think about money?

What I'm trying to suggest about these issues is that all of them are very difficult, but they push us one way or the other. Ought we be optimistic about scientific progress? It's not easy to resolve questions of this kind. There are very few ethical means which are going to help answer these questions. In great part, a lot of them are determined by experience by the different ways people evaluate the world, and their own experience, and their own society. If one is weary of progress, if one thinks money is generally a bad thing, if one looks for social rather than individual benefits, if you put together a cluster of those values, you are likely to be resistant to biotechnology. On the other hand, you can take another set of values and move biotechnology forward. It's going to make a great deal of difference when you get down to specific ethical issues. Which set of background values, perspectives, or biases or moral policy you bring. In this respect, I like to use the term moral policy because I don't think many of these issues are resolvable by means of a simple moral equation. What you have to do is decide upon a certain range of acceptable or unacceptable activities. You have to be prepared to let experience teach you over a period of time. We are in for a long struggle on these issues because we need the history. We have to have a backlog of experience.

Finally, the issue of setting limits. Everyone would agree that there are probably some things we ought not do. There are some things that should have limits. The difficulty is knowing which are which in making those decisions. I think it fair to say that some people don't like regulation, don't like oversight. It is unlikely that we will be able to do everything we want to do safely or to maximum benefit. Therefore, right from the start we have to deal with the notion of limits. Over time, we change our notion of limits. Twenty years ago, there was unanimous opposition to any kind of germ line therapy. The notion that we might introduce genetic changes which would be transmitted down through the generations was absolutely rejected by people from ethics and science as well. Over the past two or three years, that's beginning to crack. People are coming along and saying this isn't such a bad thing, and we shouldn't have such a closed mind. There hasn't been new evidence that we know something now that we didn't know earlier. There is a different attitude toward the notion of limits. One long term consequence of the debate went back to the late seventies. That debate was marked by a great deal of worry and anxiety that all the bad things are going to happen. Nothing happened. As time has gone on there is less anxiety.

In the end, I see biotechnology as a great experiment. We really don't know yet where it is going. We don't know what it will do for us or to us. We ought to treat it as an experiment. My own bias would be somewhere in the middle. If there are benefits, we will get to them eventually.

Center for Biotechnology, biotech@nwu.edu
Ph: (847)467-1454, Fax: (847)467-2180
Northwestern University