Foreword by Leon R. Kass, M.D.

Bioethics and Scientific Process: Cautions about debates involving ethics and science

Introduction by William Safire

About the Authors of the Foreword, added Comments, and Introduction

Beyond Therapy: Biotechnology and the Pursuit of Happiness

Letter of Transmittal to the President

Members of the President’s Council on Bioethics

Council Staff and Consultants

Preface

Biotechnology and the Pursuit of Happiness

I The Golden Age: Enthusiasm and Concern

II The Case for Public Attention

III Defining the Topic

IV Ends and Means

V The Limitations of the “Therapy vs. Enhancement” Distinction

VI Beyond Natural Limits: Dreams of Perfection and Happiness

VII Structure of the Inquiry: The Primacy of Human Aspirations

VIII Method and Spirit

Endnotes

Better Children 

I Improving Native Powers: Genetic Knowledge and Technology

An Overview

Technical Possibilities

Prenatal Diagnosis and Screening Out

Genetic Engineering of Desired Traits (“Fixing Up”)

Selecting Embryos for Desired Traits (“Choosing In”)

Ethical Analysis

Benefits

Questions of Safety

Question of Equality

Consequences for Families and Society

II Choosing Sex of Children 

Ends and Means

Preliminary Ethical Analysis

The Limits of Liberty

The Meaning of Sexuality and Procreation

III Improving Children’s Behavior: Psychotropic Drugs

Behavior Modification in Children Using Stimulants

What are Stimulant Drugs?

Behaviors Inviting Improvement Through Stimulant Drugs

The “Universal Enhancer”

Ethical and Social Concerns

Safety First

Rearing Children: The Human Context

Social Control and Conformity

Moral Education and Medicalization

The Meaning of Performance

IV Conclusion: the Meaning of Childhood

Appendix: Diagnostic Criteria for Attention-Deficit/Hyperactivity Disorder

Endnotes

Superior Performance 

I The Meaning of “Superior Performance”

II Sport and the Superior Athlete

Why Sports?

The Superior Athlete

Different Ways of Enhancing Performance

Better Equipment

Better Training

Better Native Powers

III Muscle Enhancement through Biotechnology

Muscles and Their Meanings

Muscle Cell Growth and Development

Opportunities and Techniques for Muscle Enhancement

IV Ethical Analysis

How Is Biotechnical Enhancement Different?

Fairness and Equality

Coercion and Social Pressure

Adverse Side Effects: Health, Balance, and the Whole of Life

The Dignity of Human Activity

The Meaning of Competition

The Relationship between Doer and Deed

Acts of Humans, Human Acts:

Harmony of Mind and Body

Superior Performance and the Good Society

Endnotes

Ageless Bodies 

I The Meaning of “Ageless Bodies"

II Basic Terms and Concepts

III Scientific Background

Targeting Specific Deficiencies of Old Age

Muscle Enhancement

Memory Enhancement

General (Body-Wide) Age-Retardation

Calorie Restriction

Genetic Manipulations

Prevention of Oxidative Damage

Methods of Treating the Ailments of the Aged

That Might Affect Age-Retardation

Hormone treatments

Telomere research

IV Ethical Issues

Effects on the Individual

Greater Freedom from Constraints of Time

Commitment and Engagement

Aspiration and Urgency

Renewal and Children

Attitudes towards Death and Mortality

The Meaning of the Life Cycle

Effects on Society

Generation and Families

Innovation, Change, and Renewal

The Aging Society

V Conclusion

Endnotes

Happy Souls 

I What are “Happy Souls”?

II Memory and Happiness

Good Memories and Bad

Biotechnology and Memory Alteration

Memory-Blunting: Ethical Analysis

Remembering Fitly and Truly

The Obligation to Remember

Memory and moral Responsibility

The Soul of Memory, The Remembering Soul

III Mood and Happiness

Mood-Improving through Drugs

Mood-Brightening Agents: an Overview

Biological and Experiential Effects of SSRIs

Ethical Analysis

Living Truly

Fitting Sensibilities and Human Attachments

What Sorrow Teaches, What Discontent Provokes

Medicalization of Self-Understanding

The Roots of Human Flourishing

The Happy Self and the Good Society

IV Conclusion

Endnotes

“Beyond Therapy”: General Reflections 

I The Big Picture

II Familiar Sources of Concern

Health: Issues of Safety and Bodily Harm

Unfairness

Equality of Access

Liberty: Issues of Freedom and Coercion, Overt and Dubtle

III Essential Sources of Concern

Hubris or Humility: Respect for “the Given”

“Unnatural” Means: The Dignity of Human Activity

Identity and Individuality

Partial Ends, Full Flourishing

IV Biotechnology and American Society

Commerce, Regulation, and the Manufacture of Desire

Medicine, Medicalization, and a Stance “Beyond Therapy"

Biotechnology and American Ideals

Endnotes

Bibliography

Index

About the Dana Foundation

Other Books and Periodicals from Dana Press

Credits

"Most government reports...are guaranteed to put you to sleep at night.  This one will wake you up."

-Alan Murray, Wall Street Journal

"...draws attention to the power of commercial enterprise to shape people's desires."

-Nicolas Wade, The New York Times

"Groundbreaking."

-The Christian Science Monitor

What is biotechnology for? Why is it developed, used, and esteemed? Toward what ends is it taking us? To raise such questions will very likely strike the reader as strange, for the answers seem so obvious: to feed the hungry, to cure the sick, to relieve the suffering—in a word, to improve the lot of humankind, or, in the memorable words of Francis Bacon, “to relieve man’s estate.” Stated in such general terms, the obvious answers are of course correct. But they do not tell the whole story, and, when carefully considered, they give rise to some challenging questions, questions that compel us to ask in earnest not only,

“What is biotechnology for?” but also, “What should it be for?”

Before reaching these questions, we had better specify what we mean by “biotechnology,” for it is a new word for our new age. Though others have given it both narrow and broad definitions,* our purpose—for reasons that will become clear—recommends that we work with a very broad meaning: the processes and products (usually of industrial scale) offering the potential to alter and, to a degree, to control the phenomena of life—in plants, in (non-human) animals, and, increasingly, in human beings (the last, our exclusive focus here). Overarching the processes and products it brings forth, biotechnology is also a conceptual and ethical outlook, informed by progressive aspirations. In this sense, it appears as a most recent and vibrant expression of the technological spirit, a desire and disposition rationally to understand, order, predict, and (ultimately) control the events and workings of nature, all pursued for the sake of human benefit.

Thus understood, biotechnology is bigger than its processes and products; it is a form of human empowerment. By means of its techniques (for example, recombining genes), instruments (for example, DNA sequencers), and products (for example, new drugs or vaccines), biotechnology empowers us human beings to assume greater control over our lives, diminishing our subjection to disease and misfortune, chance and necessity. The techniques, instruments, and products of biotechnology— like similar technological fruit produced in other technological areas—augment our capacities to act or perform effectively, for many different purposes. Just as the automobile is an instrument that confers enhanced powers of “auto-mobility” (of moving oneself ), which powers can then be used for innumerable purposes not defined by the machine itself, so DNA sequencing is a technique that confers powers for genetic screening that can be used for various purposes not determined by the technique; and synthetic growth hormone is a product that confers powers to try to increase height in the short or to augment muscle strength in the old. If we are to understand what biotechnology is for, we shall need to keep our eye more on the new abilities it provides than on the technical instruments and products that make the abilities available to us.

This terminological discussion exposes the first complication regarding the purposes of biotechnology: the fact that means and ends are readily detached from one another. As with all techniques and the powers they place in human hands, the techniques and powers of biotechnology enjoy considerable independence from ties to narrow or specific goals. Biotechnology, like any other technology, is not for anything in particular.

Like any other technology, the goals it serves are supplied neither by the techniques themselves nor by the powers they make available, but by their human users. Like any other means, a given biotechnology once developed to serve one purpose is frequently available to serve multiple purposes, including some that were not imagined or even imaginable by those who brought the means into being.

Second, there are several questions regarding the overall goal of biotechnology: improving the lot of humankind. What exactly is it about the lot of humankind that needs or invites improvement? Should we think only of specific, as-yet-untreatable diseases that compromise our wellbeing, such ailments as juvenile diabetes, cancer, or Alzheimer disease? Should we not also include mental illnesses and infirmities, from retardation to major depression, from memory loss to melancholy, from sexual incontinence to self-contempt? And should we consider in addition those more deep-rooted limitations built into our nature, whether of body or mind, including the harsh facts of decline, decay, and death? What exactly is it about “man’s estate” that most calls for relief? Just sickness and suffering, or also such things as nastiness, folly, and despair? Must “improvement” be limited to eliminating these and other evils, or should it also encompass augmenting our share of positive goods—beauty, strength, memory, intelligence, longevity, or happiness itself?

Third, even assuming that we could agree on which aspects of the human condition call for improvement, we would still face difficulties deciding how to judge whether our attempts at improving them really made things better—both for the individuals and for the society. Some of the goals we seek might conflict with each other: longer life might come at the price of less energy; superior performance for some might diminish self-esteem for others. Efforts to moderate human aggression might wind up sapping ambition; interventions aimed at quieting discontent might flatten aspiration. And, unintended consequences aside, it is not easy to say just how much less aggression or discontent would be good for us. Once we go beyond the treatment of disease and the pursuit of health, there seem to be no ready-made or reliable standards of better and worse available to guide our choices.

As this report will demonstrate, these are not idle or merely academic concerns. Indeed, some are already upon us. We now have techniques to test early human embryos for the presence or absence of many genes: shall we use these techniques only to prevent disease or also to try to get us “better” children? We are acquiring techniques for boosting muscle strength and performance: shall we use them only to treat muscular dystrophy and the weak muscles of the elderly or also to enable athletes to attain superior performance? We are gradually learning how to control the biological processes of aging: should we seek only to diminish the bodily and mental infirmities of old age or also to engineer large increases in the maximum human lifespan? We are gaining new techniques for altering mental life, including memory and mood: should we use them only to prevent or treat mental illness or also to blunt painful memories of shameful behavior, transform a melancholic temperament, or ease the sorrows of mourning? Increasingly, these are exactly the kinds of questions that we shall be forced to face as a consequence of new biotechnical powers now and soon to be at our disposal. Increasingly we must ask, “What is biotechnology for?” “What should it be for?”