Bioethics in Wartime

In the midst of World War II, C. S. Lewis addressed a class of Oxford students on the question of “Learning in War-Time.” With so much uncertainty, so many peers dying in the trenches, so much suffering and destruction, why should any decent person spend his time reading and studying? Or doing anything else that men and women normally do: laughing, marrying, lighting Sabbath candles? With so much horror, what room can there be for happy pursuits? With challenges so obviously large, why worry about problems so seemingly small?

The answer Lewis gave, in his typical way, was both sharp and deep: “The war creates no absolutely new situation; it simply aggravates the permanent human situation so that we can no longer ignore it. Human life has always been lived on the edge of a precipice…. If men had postponed the search for knowledge and beauty until they were secure, the search would never have begun. We are mistaken when we compare war with ‘normal life.’ Life has never been normal.” It has always been an uncertain mix of greatness and misery, joy and heartache, long-term plans and sudden disasters.

This insight cuts two ways: We should still laugh, still marry, still light Sabbath candles — if laugh less loudly, marry more urgently, rest less easily. For these are the human things to do. But just as war should not evict everything beautiful, it does not excuse us from self-examination in the midst of self-defense. Our war — a different kind of war, we are often told — lacks the universal shadow of WWII (so far). But it still haunts us, at least occasionally. The dangers are more uncertain, but the threat still real. We, too, live on the edge of a precipice. And we, too, must try to live well.

Which leads us to the particular question: Why should we be concerned about bioethics in a time of war? With thousands of American troops in harm’s way, with grave threats to our nation’s life and limb, with the permanent possibility of another, even nuclear, September 11th — why should we worry about the fate of embryos so small we can only see them through the microscope, or the prospect of a few renegade scientists attempting to clone a human child, or the misuse of drugs that numb the pain of unwanted memories?

The first reason for engaging in bioethics during wartime is the simple fact that scientists are still engaging in science, often revolutionary science. This is, of course, mostly a good thing — good for the scientists, and good for the rest of us who benefit from their inventions. Indeed, doing science is part of the American answer to suicidal terrorism: an example of not succumbing to fear and paralysis, an example of our way of life at its best, seeking truth rather than worshipping death. So long as the labs are still standing, the American thirst for new discoveries and new technologies will proceed apace.

But some of this new science, especially the new biology, raises challenges and concerns. It involves new powers over the beginning of human life, and new powers over consciousness itself. Embryo research. Man-animal chimeras. Drugs that alter our understanding of the past and outlook toward the future. Genetic manipulations that transform the process of human aging. Such research requires not just the peer review of fellow scientists, and not just FDA protocols for ensuring safety and efficacy. It requires moral deliberation and democratic debate, and in some cases it requires the willingness to say “no,” “stop,” or “here but no further.” But if we are to set limits, we need arguments for why we need to set limits. We need to be aware of the moral ambiguities, often tragic ambiguities, involved in deciding what to do with our new powers over the body. But we also need moral arguments capable of defending those human goods or values that a limitless biotechnology might unravel or destroy.

The second reason for engaging in bioethics during wartime is the difference between living for something and living with something. C. S. Lewis, in his lecture, made this point well: “The rescue of drowning men is… a duty worth dying for, but not worth living for. It seems to me that all political duties (among which I include military duties) are of this kind. A man may have to die for our country, but no man must, in an exclusive sense, live for his country.” Our American soldiers — brave men and women that they are — may die in the war on terror. Or we may die because however well they fight, terrorism will never simply disappear. But our soldiers do not live for fighting terror, and we don’t live simply to avoid being killed by terrorists. They live with the duty to fight; we live with the burden of being vulnerable to attack; but all of us, as human beings, live for something beyond national security. We seek such security precisely so we may live, and live well.

And this question — what do we live for? — is perhaps the central question of bioethics. If biotechnology is driven by the desire to live better than we do now, then we need some idea of what a better life actually entails. We need some way to judge whether things have actually improved, especially if improvement means something more than simply living longer or being safer. And we need some idea of what human biology has to do with the good human life.

My best answer to this question — what do we live for? — is that we live for love and we live for excellence. The trouble is knowing what it means to love and what it means to be excellent. This dilemma is often made pointed by new biotechnologies. For example: Is embryo research an act of love, an effort to save the fathers and daughters who are suffering and dying? Or is embryo research a corruption of human love, undermining the respect for life and defense of the vulnerable that are love’s highest form and ultimate purpose? Likewise: Are new drugs that improve muscles or memory aids to human excellence — allowing us to achieve more, to do more, to break records, to beat rivals? Or are such drugs corruptions of human excellence — turning us into biological artifacts, as chemically dependent for our achievements as the drug addict is for his transient pleasures? These are — often if not always — very hard questions, but ones we must try to answer as best we can. To answer them requires having some idea of a human life well lived, especially a human life well lived in the age of biotechnology. Bioethics, rightly understood, has an important role to play in articulating this vision — in saying what we live for, not just what we must live with. We do no service to our soldiers or ourselves if we stay silent on these ultimate questions, or simply say (as bioethics often does) that everyone must decide for himself.

The third reason for engaging in bioethics during wartime is that it is, in a strange way, the best time to do it. A human life well lived is a life lived well in light of our human possibilities, but also our limits; our noblest aspirations, but also our mortality. And war reminds us, like nothing else, that we are mortal. This, too, was seen clearly by Lewis: “The only reason why the cancer at sixty or the paralysis at seventy-five do not bother us is that we forget them. War makes death real to us… All the animal life in us, all schemes of happiness that centered in this world, were always doomed to a final frustration. In ordinary times only a wise man can realize it. Now the stupidest of us knows. We see unmistakably the sort of universe in which we have all along been living, and must come to terms with it… If we thought we were building up a heaven on earth, if we looked for something that would turn the present world from a place of pilgrimage into a permanent city satisfying the soul of man, we are disillusioned, and not a moment too soon.”

Let me make this insight more specific: Bioethics is about bodies. And bodies are capable of the most wonderful things — dancing, embracing, thinking, conceiving, laughing, giving birth. But bodies also decline and die. To be biological is to be mortal. My body is mine, but I cannot control its every movement. My body is mine — I am my body — but I do not ultimately decide its beginning or its end, my beginning or my end. And so the things I live for cannot be severed from the things I must live with — excellence cannot be severed from decline; love cannot be separated from death, including the anguish that comes from losing those we love most. It is this truth about our natures that the grandest dreams of biotechnology too often forget, precisely because they seek bodies that never decline and souls that never sorrow.

But war (like disease) reminds us that we are mortal; and we are mortal because we are biological. The ultimate aspiration of biotechnology — or the biotechnology project — is to master and use the way our bodies work so that we might live as if we were not really bodies at all; or as if we could always make our bodies do what we want them to do without fail. Bioethics, at its best, reminds us of what it means to be biological — what it means to be born, to grow up, to make love, to have children, to grow old, and to die — always with the threat of having life suddenly taken away from us. In doing so, bioethics aspires to say what it means to live well as biological beings. It tries to connect what we must live with (suffering and death) to what we should live for (love and excellence).

And this leads me to the fourth (and final) reason why we should engage in bioethics during wartime. And here, I take my direction not from C. S. Lewis but from Winston Churchill, and also from Leon Kass, who made a similar point on the occasion of accepting the Bradley Prize earlier this year. For those of you who have never done so, I recommend you spend some time at the Cabinet War Rooms in London, the underground headquarters where Churchill directed the war and exhorted the spirits of his countrymen on national radio. For sale in the gift shop is the reprint of an old poster — a giant picture of Churchill’s face, with his finger pointing at us, and two words: “Deserve Victory.” If the war on terrorism is to be a just war, we must not only fight in a just way, but we must fight for a just cause. Our idea of civilization — the American idea of progress and democracy, freedom and prosperity, science and commerce — must be worth fighting for. And the greatest test for whether we will deserve victory in the years ahead may be how we deal with biotechnology, and whether we can steer our way through three sets of dangers.

The first danger is that in the desire to extend life we will become callous towards life, using the weakest among us as tools to keep us strong. This is the moral challenge of embryo research. The second danger is that in the desire to be happy or at least untroubled, we will seek a merely cosmetic consciousness, chemically divorced from the ups and downs of real life. This is the moral challenge of psychopharmacology. The third danger is that in the desire to have a child of “my own,” we will develop techniques that confound the very nature of biological origins, or that make normal sexual procreation a second-rate option. This is the challenge of new ways of making babies — including human cloning, preimplantation genetic screening, and the use of gametes derived not from mothers and fathers but from dead embryos and fetuses. Facing these moral challenges is the task of bioethics; and how we proceed will say much about the kind of civilization we are, and whether we are right to plant the seeds of our modern civilization in vineyards (or deserts) around the world.

With this in mind, I want to explore why this may be an important moment in the bioethics debate, and why this debate is uniquely important for understanding the prospects for American civilization in the years ahead. Some might argue that this debate is largely decided. We are already, in important ways, a “eugenic” or “cosmetic” society. We already tolerate or embrace surgical enhancements of our physical appearance, for no other reason than individual desire, and with no limit except our ability to pay. We already advertise, on billboards and in television commercials, drugs like Zoloft and Paxil that promise to make anxious people “happy” and imperfect lives more “perfect.” We already pick and choose the genetic characteristics of our offspring — male or female, healthy or sick — taking what we like and discarding what we don’t. To argue about new biotechnologies is to pretend that many questions of principle and practice are not already settled. And even as biotechnology advances, American life goes on — neither as terrible nor as wonderful as those in the bioethics debate often claim it is becoming. And for those interested in the state of American civilization, there are many other issues to worry about: the condition of marriage; the frequency of abortion; the state of the university; the abuse of the natural world. To focus on biotechnology is simply the ethicist’s effort to capitalize on a scientific novelty, while the real cultural fights — and harder cultural fights — lie elsewhere. There is some truth to all this, but it is not the entire truth. The biotechnology debate is important and timely for at least four reasons.

The first reason is simply the wave of biotechnological advances that have occurred over the last few years. In 1997 we cloned the first mammal; in 1998 we isolated human embryonic stem cells; in 2000 we completed the “first draft” of the entire human genome. And in the last few years, we have produced children with three genetic parents; cloned embryos using human DNA and rabbit eggs; and produced human embryos with mixed male-female genders. In the meantime, research proceeds apace on artificial wombs, on single-sex procreation, on drugs to control the contours of the human psyche with greater precision. Much of what was predicted in the 1970s — when the biotechnology revolution began in earnest — seems to be coming to pass, if not always as quickly or dramatically as many promised or feared.

The second reason why this is an important moment in the bioethics debate is that the uses of biotechnology for genetic and pharmacological “enhancement” are becoming more apparent, at least as possibilities. This is the subject of a recent report by the President’s Council on Bioethics — Beyond Therapy: Biotechnology and the Pursuit of Happiness — which is perhaps the single deepest reflection on how biotechnology will change the character of human life in the years and decades ahead. For while the new biotechnology sometimes appeals to the established goals of modern medicine — freedom from “the maladies both of body and mind” — it also points “beyond” them: not only healing ourselves but controlling the genetic make-up of our offspring; not only easing today’s suffering but chemically altering our identity; not only treating infertility but remaking the very idea of “being fertile.”

Taken together, the triumph of biotechnology “beyond therapy” implies the end of many ethical norms and human realities that we have long taken for granted. Whether biotechnology is the architect of such changes or simply a manifestation of them is hard to say, and ultimately insignificant. What matters is that biotechnology makes these transformations of human life both more plausible and more irreversible. It points to a post-medical age, where doctors serve desires rather than treat disease. It points to a post-sexual age, where the differences between men and women are no longer essential to reproducing the species, and where modern technique is a “better” way to make babies than having sex. And it points to a post-personal age, where individuals can remake their memories and temperaments to become the person(s) they always wished to be but never really were, and perhaps never really are.

The third reason why this moment is important in the bioethics debate is the growing use of new biotechnologies by illiberal regimes like China. Chinese eugenics and Chinese “medicine” — including mandatory abortions, state regulation of child-rearing, and the harvesting of organs from the living — are by now well known. But in our American optimism about biological and genetic progress, in our belief that the new technology is not dangerous but life-affirming, we have thought little about how our advances will be used by nations with less respect for human life than we now have; or whether the parallel between our science and theirs might suggest that something is amiss in the ethics of our own research.

In October, for example, we heard of an American scientist heading to China to engage in one of the first real genetic engineering experiments, involving the attempt to produce a child with three genetic parents, and ending in the gruesome death of multiple fetuses. Other Chinese experiments — experiments aided by our own basic science — include efforts to implant a female uterus into the abdomen of a man and to produce chimeric man-animal embryos. And can we doubt that as techniques improve for genetically screening offspring, or developing human fetuses inside animal wombs for research, or chemically altering the memory of prisoners and soldiers, that China will live by the maxim: all things possible?

The conventional American response to such wayward Chinese research is two-fold, and often circular. The first response is that it is not the research that is the problem but how it is used and who uses it; it is not the tools that matter but the ethics of the users. The second response is that you can’t stop progress: since countries like China are going to do these things anyway, so should we. And so, while we might pursue certain areas of research for what seem to us good reasons, our capacity to condemn biotechnology’s abuses — to make the case for human rights and human dignity against those regimes that ignore them — may one day be compromised if our experiments make us more like them, rather than them more like us. At the very least, it must strike us as strange that a tyrannical regime like China is seen by some researchers as a haven for free science.

The fourth (and final) reason why the bioethics debate is uniquely important is that it aggravates some of the fundamental divides within American politics. First are the divides within the two parties: between libertarians and social conservatives on the right, and between naturalists and quality-of-life liberals on the left. Naturalists and social conservatives believe that the new biotechnology sometimes threatens nature and human nature, and that government should regulate to prevent its misuse. Libertarians and quality-of-life liberals believe that the new biotechnology serves a more perfect freedom from all suffering and restraints, or a more perfect equality for the sick, disabled, and dissatisfied.

Second are the divides between the “two cultures”: in a word, between secular liberals and orthodox believers. For while there are many non-religious reasons to be concerned about where biotechnology might be taking us — reasons I’ve tried to articulate here — the truth is that most opposition to the “Brave New World” comes from people of faith, and mostly Christians. Such people make rational arguments in the public square — often more rational than secular scientists, who defend the morality of their experiments with largely emotional appeals — but they are moved to argue by their belief in God and His commandments, especially regarding the sanctity of life and the dignity of human procreation.

In aggravating these political and cultural divides, the biotechnology project cuts to the very foundation of the American project. It challenges our idea of equality, and raises the existential problem of inequality in new ways. Why do some people get sick and other people don’t? Why are some born with the capacity to be Olympic athletes and others aren’t? Those who oppose biological enhancement often argue, I think rightly, that the dignity of an Olympic runner would be lessened if that person were genetically or biologically enhanced. But one has to wonder about the meaning of appealing to human excellence to make the case against human enhancement; of looking to the best among us — the most gifted and most talented — to argue that we should not make ourselves artificially better. Most people — no matter how hard they work — will never have the genetic equipment to be Olympic runners. These natural inequalities, which seem inherent to being human, are even more pointed when it’s a matter not simply of mediocrity but disease; when one thinks of sick or dying children; when one comes to believe (understandably, but perhaps falsely) that such diseases are an injustice that we have an obligation to correct by any means possible.

And here we see the divide between secular liberals and orthodox believers most clearly. Part of the reason many people of faith (mostly Christian) are so willing to oppose aborting “imperfect fetuses” or destroying embryos in the pursuit of health is that their faith provides good answers to the problems of human limitation, suffering, and mortality. Biblical religion teaches that there is an inherent dignity that comes with creation, a dignity that all human beings possess at all stages of life, simply by virtue of being one of God’s creatures. And while people may suffer in this life — with disability, disease, imperfection, and death — they can be saved in the next one. Their wretchedness is a pilgrimage. Modern liberalism, by contrast, has a more difficult problem trying to explain why people are born with great natural inequalities; or why, later in life, we’ll all be unequal to the vigorous selves we once were. Without such answers, the temptation to become liberal eugenicists or libertarian seekers of eternal youth is very great.

Responding to these existential questions is perhaps the greatest dilemma Americans will face in the years ahead. The Declaration of Independence says that “all men are created equal,” but in some unfortunate ways this is clearly not so, and in some ways the American regime, on its own terms, doesn’t have a satisfying answer to the question of why it isn’t so. There is no American book of Job except the book of Job itself. Maybe biotechnology is our modern answer or solution. Maybe we’re going to make ourselves biologically more equal — especially more equal to pursue happiness. This seems to be the guiding sentiment of liberal humanitarians, both scientists and politicians, who defend research on embryonic stem cells. They want children born with grave diseases to live full lives — like everybody else. They want justice where fate or genes or both has denied it. They revolt as Job did — “The Lord denies me justice!” — but they do not look where Job looked for an answer.

The question is what are we willing to do in the pursuit of such justice, and to what extent can we force the world (the world of nations and the world of nature) to become “right.” Looking back, one is struck by the way the bioethics issues and the war on terrorism both came to dominate our public life at the same time — with President Bush’s stem cell speech delivered on August 9; the horrible attacks a month later on September 11. Both of these challenges have demanded a new moral and political seriousness; both raise questions about life and death, about the prospects for human happiness in modern democracies, and especially about our idea of the good life and good society. The bioethics debate — and biotechnology itself — is driven by our dreams of greater health and better lives; by our quest for greater control over the course of life from birth to death; and by the belief that our biotechnical ingenuity might eventually conquer the worst human diseases. And yet, the war on terror reminds us of the mortal fragility of life, and the permanent burdens of history that biotechnology alone will not likely conquer. As Lewis reminded us: “The war creates no absolutely new situation; it simply aggravates the permanent human situation so that we can no longer ignore it.”

But to be awakened to the permanent dangers and imperfections of life is also — hopefully — to be reminded of the good things that are endangered. And this brings us back from the current biotechnology moment to the deepest aspirations of bioethics: to connect what we must live with to what we should live for. To be biological is not simply — or most importantly — to be on-the-way to death. It is to be alive, and to be alive in a fittingly human way — embracing a spouse, running a race, laughing at a joke, singing a song, lighting a Sabbath candle. The philosopher of biology Hans Jonas understood this more deeply than anyone: “The fear of death with which the hazard of this existence is charged is a never-ending comment on the audacity of the original venture upon which substance embarked in turning organic.” In other words: the audacity of striving, aspiring, self-conscious human life. To see only mortality is to make bioethics an apology for suffering, a morose or sentimental tribute to human imperfection. To see only limitless possibilities is not to see man for what he really is, and thus to risk making him something less than he should be — like a barbarian, a machine, or a cow.

Which leaves us with one final (somewhat theoretical) detour: saying something positive about what human biology has to do with a good human life, and what the fact of our being finite has to do with the possibility of our being excellent. War is often the great arena of both these elements of our natures — our finitude and misery, our excellence and greatness. But it is not the only arena.

To understand the excellence of human beings — biological human beings — one must consider the double meaning of the fact that such excellence might not have happened at all: because the beings capable of being excellent might not have been at all; and because the beings capable of being excellent might not have performed excellently.There may never have been a Tiger Woods (with his body, proportions, coordination, desire), and Tiger Woods might never have cultivated his given (biological) possibilities. He might rise to the occasion or might be overtaken by it, and he might come back again next year or he might never return to his lost summit. The first insight points us toward the givenness of human excellence; it awakens gratitude for the beings we are, or resentment for the beings we are not. The second insight points us toward the madeness of human excellence; it awakens aspiration, nobility, and pride in one’s own agency and achievements, or despair in the face of one’s own failures. Both these intuitions stand in opposition to the spirit of the bioengineer, who seeks an excellence that is broken down to its parts (by himself; for his patients) and guaranteed to work (like a machine) every time.

To be biological is to live this double truth or two-sidedness of our nature: It is to experience one’s own accomplishments as one’s own doing. It is to be what one does in the very act of one’s own doing it. It is to be, in the deepest sense, a self-made man. But to be biological and to be human is also to realize the limits of becoming what one wills oneself to be by one’s own efforts. It is to will the healthy body even as it fails, or to will the graceful movement even as one is clumsy. We can imagine it — health, grace. We can imagine ourselves as having it — being healthy, being graceful. But we do not have it, and we cannot always (or ultimately) get it. The body fails.

On one level, this points to the unity of mind-and-body — to the fact that we are our bodies; our bodies are not simply tools for our use. It is not simply that the body fails us. It is that we, as bodies, fail. But on another level, it points to the experience of alienation inherent in being biological: realizing that our heart beats without our making it beat; being filled with gratitude for our own given biology; then realizing that just as the heart beats without our doing, it can (and will) stop without our doing. Our biology (our life) is both given and taken away. To experience this alienation is to look upon our bodies as if looking upon someone else or something else. This detachment is the basis for modern techno-science (mind working on body to shape body to mind’s will) and the basis of philosophical wonder and religious awe: We realize that our bodies are both ours and not ours, and that they do not obey our every command. And our capacity to realize this fact means that we both are and are not simply our bodies. We have the distance of self-regarding self-awareness, at the cost of not fully “living immediately,” like the animals do — but with the gain of aspiring to more than animals ever can. We will decline and disappear, and we know it. But we can also hope for something beyond what we are now. We can hope for life in another form — whether as post-biological minds without bodies or post-biological souls resting with God. Or we can simply take pleasure in the fact that we can imagine, with our own reason, the very types of perfection that we can never embody because we are bodies. And we can do our best to imitate such perfection, to live well knowing that we will never become perfect ourselves, to take pleasure in the rare animal-like moments when we can and do live immediately.

To be biological is to experience the alienation of one’s own desire to be more than biological — or even the desire to be perfectly biological, a desire that is ultimately paradoxical. It is to witness ourselves (our bodies) becoming something (declining into something) we wish they would not, and learning to accept that our agency is real but limited. The very things we do (or once did) as ourselves were always given possibilities and lost possibilities, once given and to-be-lost. But they are no less real and no less excellent for being finite. The possibility of decline also suggests the possibility of a summit from which we fall.

A true bioethics — on the precipice between life and death, finitude and excellence — wrestles truthfully with the meaning of our biological humanity. It seeks to explain what our nobility and our decline, our greatest doings and ultimate limits, our body gracefully at work and our body gracelessly not working, have to do with one another. Acceptance and aspiration. Surrender and never surrender. Gratitude and pride. Love of the beautiful and love of the needy. The love of excellence and the excellence of love. One should admire the Lance Armstrongs of the world who fight back from death’s brink with willful ferocity — who live to race and triumph again. And one should admire the wise old man, or the wise young man, who sits or lays down, waiting for death, neither seeking it nor seeking desperately to turn it away, neither so confident in what is coming nor so afraid that he seeks some blinding chemical remedy. This is, it seems to me, the kind of excellence — living with and living for — that bioethics must defend, and biotechnology can never produce. War reminds us of these great truths — the miseries of life and the greatness of life. But our limits and possibilities are always there if we have the wisdom to look, the will to act, and the capacity to endure life’s imperfections when we cannot justly change them.