From eugenics to eugenics. (Books).

Playing God?: Human Genetic Engineering and the Rationalization of Public Bioethical Debate

Chicago, 2002. $21.99 (cloth).

It's hard to find a book that is really worth reading, let alone exciting, on any aspect of biotechnology. So much of what is on offer is nothing more than a thinly disguised sales pitch for biotechnology, by which I mean genetic engineering--not brewing beer or making bread or selecting seeds for next year's crop. It was therefore with great pleasure that I read John Evans's careful analysis and thoughtful description of the social and political construction of the professional activity called bioethics.

I was drawn to the book because when I glanced through it in the bookstore I saw names, dates and statements. It was clear that this book was not more determinist mystification but an account of how the content of bioethics got to be as "thin" and limited as it is today, and why the professional "ethicists" are not responsive to the public but actually in league with corporate sponsors and government bureaucrats while parliamentarians and legislators are reduced to spectators.

Before going into the substance of Evans's argument, a note about his method, which is explained in great detail in a twenty-one-page appendix: Evans's analysis is based on a bibliographic search to establish the "population" which has carried on the debate about human genetic engineering (he uses the acronym HGE throughout). He defines this "population" as all books and academic journal articles published on this topic from 1959 to 1995. From the more than 52,000 items identified, Evans creates a "universe" of 1465 items that constitute the database for his analysis. He then breaks these down into "communities" ("scientists," "theologians," "philosophers," "bioethicists") and places them into a series of carefully defined timeframes.

Evans begins with the 1960s when "reform eugenecists," as he refers to them, were promising to explain the meaning of life if they would be left alone to proceed with their biological program. The slogan of the fifties, "better living through chemistry," was being simplified to "better living" or "human betterment." The word "eugenics" was, of course, not used in public in the aftermath of Nazism.

But the tidy postwar suburban dream of perpetual progress shared somewhat equitably amongst a largely homogeneous and docile citizenry began to unravel in the mid-sixties. "Public confidence in technological development as the key to social progress," said Susan Wright in Molecular Politics (1994), "gave way to disenchantment"; and there was mounting dissatisfaction among the younger generations that were supposed to be the beneficiaries of Progress and a stable social order. The dirty anti-communist war waged by the U.S. against the Vietnamese exposed the nastiest side of the technology of progress (including massive defoliation by means of Monsanto's Agent Orange) and ignited a growing demand for public control of science.

Fearing that the public might spoil their unlicensed tea party, scientists began to mobilize to defend what they regarded as none of the public's business. Evans uses the words of Ward Madden in 1970 to express the anxiety of scientists: "Science is exuberantly flooding the world with knowledge...transforming both our minds and our daily existence...revolutionizing our concepts of the universe, life, man, and man's destiny...[and] producing a thoroughgoing technological reordering of our habits and activities. And yet, strangely, there is a counter current to the scientific tide...'a counter culture' [that has placed] science on the defensive, even in the midst of our success" (61).

At the same time, Evans points out, liberal theology--Catholic as well as Reformed--was at a highpoint of social influence and theologians were both vocal and visible in the debates about eugenics (the meaning and improvement of life) and genetic engineering. Karen Labacqz, at Pacific School of Religion at the time, was one who articulated the "radical" position: "God is understood [in liberation theology] to side with the poor and oppressed....The primary criterion [for] judging the uses of genetic engineering and related biotechnologies [would be] the impact of those technologies on the balance of power and the life prospects of those who are poor, oppressed, or deprived of power in our society" (119). The social character of liberal theology as expressed here contrasts sharply with the individualism of the evangelical theology that has subsequently supplanted it in popularity.

Along with its concern for social justice (as opposed to personal, individual justice), however, liberal theology brought with it a universalizing tendency expressing the U.S. "melting pot" approach to ethnic diversity, or what we might now refer to as human biodiversity. As an alternative to social and political democracy capable of recognizing and making space for a diversity of views and cultures, a universality and uniformity of the lowest common denominator was both sought and imposed. The Irish, Italian, and Puerto Rican immigrant enthusiastically (if only for public consumption) waved the American flag on the Fourth of July. The anti-communist hysteria of the Cold War decades made little space for serious expressions of diversity. But then, liberal democracy has always been more liberal than democratic.

Now, in the era of anti-terrorist tyranny that has taken the place of anti-communism (more useful, because the enemy can be whomever you want it to be and no evidence is needed), suspicion of diversity has been extended downward and outward from nationalities and states to individuals and religion. Social goals are not open to debate in wartime, and proponents of human genetic engineering taking advantage of the space provided to press toward their goals with state--and corporate--backing and without public debate.

Bioethicists, however, have their own explanation, according to Evans, for the thinness (formalism, formal rationality) of the contemporary debate on HGE. In the 1960s and '70s Americans recognized that they live in "a pluralistic society with many competing conceptions of the 'good life.' To accommodate these varying conceptions, Americans created a neutral 'thin' third language that was to be used in debates over policies that would affect all Americans, using values and forms of argument shared by all citizens. Each particular community...would still use the thick [substantive] debate among themselves, but would translate their thick debate to the thin shared language for use in public. Thus the debate has justifiably thinned as the U.S. has become a more democratic society" (5).

Evans does not accept this argument. The debate of HGE changed, he says, "not because of public demand, or for some inherent reason, but rather because the change forwarded the interests of some groups over others. The locus of the HGE debate was purposefully shifted away from the public to the bureaucratic state, resulting in a change in the operative political philosophy as well" (5). It is, one needs to remember, the bureaucratic state, claiming populist authority for doing so, that slips easily into the fascism of corporate and military rule.

So there was, in the early 1970s, a public debate (though not a broad public debate) about genetic engineering being carried on essentially between theologians and scientists on the ethics of what really had to be called eugenics--that is, the genetic "improvement" of human life. The issues with which we are familiar today--informed consent and safety--were not the subject of the debate thirty years ago. Nor was the debate about individual rights and choices. The debate was about social goals and benefits. It was thus a thick substantive debate about both means and ends that included non-rationality (values, theology, etc.) as part of the legitimate debate.

Thirty years later what we have is a thin formal "rationality" that excludes ends from the ethical debate on the grounds that not to do so would open the door to undemocratic cultural conflict and irrationality. This can also be described as the reduction of ethics to consideration of the most efficient means to forward the designated end, which is the "betterment" of the life of the individual without consideration of either the consequent social good or social harm.

This is a distinct departure from the ethical arguments of "substantive rationality" that only "portray individuals in the context of larger social groups or are not concerned with individuals except insofar as they are members of larger groups" (20).

Formal (thin) rationality holds that no means--no "technology"--is inherently wrong or unethical. It is wrong only if it does not further the already established end(s) and can be evaluated only in terms of safety, choice, and informed consent. This approach ignores any consideration of "interests, agents and powers" (21). Evans describes this as the "progress assumption" of bioethics that excludes any ethical (irrational, emotional) debate of whatever is labeled as technology. Technology IS progress.

Evans contrasts:

thick / thin

substantive / formal

irrational / rational

means & ends / means only

formal regulation (legislation) / advisory committees & commissions

In his first chapter, "Framework for Understanding the Thinning of a Public Debate," Evans provides a succinct summary of what he sees as the historic development of the profession of bioethics and the limitation of the ethical debate on HGE. In the 1960s eugenicist scientists sought to expand their authority and jurisdiction by offering to explain, through genetics, the meaning and purpose of life. In the process of doing this they intended to marginalize the theologians who traditionally offered the explanations of the meaning of life, but "when the scientists faltered, the theologians reasserted themselves as the primary competitor to the scientists for jurisdiction" (36).

With public concern aroused by the theologians and others, the scientists began to fear regulation by legislation and shifted strategy "They stopped claiming that they were going to forward the end of providing meaning for humanity and switched to safer, metaphorical links to means and ends from their home jurisdiction. They claimed that they should have jurisdiction over HGE because they were interested only in the more limited means of somatic 'gene therapy'...and wanted to forward the end of healing disease. Thus 'gene therapy' was born, not out of scientific discovery, but as a defensive maneuver to [counter] a jurisdictional threat" (36). A prominent advocate of genetic engineering, W.F. "French" Anderson went so far as to argue that "the establishment of a regulatory commission...could be most dangerous," because HOE "holds such promise for alleviating human suffering that no individual or group of individuals should take it upon themselves to make the decisions" (quoted by Evans, 81).

"By limiting the claim to the application of HGE to the bodies of patients" (75) and using "the term 'therapy' while referring to 'diseases' the scientists, whether employed by university, corporation or government, avoided arousing public ethical concerns and confined any debate that might take place to questions of individual benefit and safety. The social issues were deftly excluded and as early as 1970 there were efforts to counter public 'fears' by substituting the phrase 'gene therapy' for 'genetic engineering' " (78).

Completing the process, as described by Evans, was the move by a group of theologians and philosophers to create a suitable system of ethics "based on four universal, commensurable [measurable by a common standard] ends that could be universally applied to any problem: beneficence, nonmaleficence, and justice" (37). Such a system not only removed any temptation to apply ethical consideration to any technology or the ends to which it might be put, it had the added value of being compatible with the liberal consensus theory of democratic practice described above. The people who adopted this new form of discourse--or converted to it--began calling themselves bioethicists. Of course this all took time.

"If the public had retained decision-making authority over HOE--albeit through elected officials-the debate would have remained substantive," Evans argues. "Instead, the scientists, seeing that they were losing their jurisdiction over informing the public as to the ethics of HOE, sought to avoid the public determining the ends they should pursue, and successfully argued for the use of government advisory commissions that would determine the ends that the public held without consulting the public" (71).

These government advisory commissions 'eventually became the ultimate decision-maker for the ethics of HGE because the federal government...tended to follow the advice of these commissions in deciding what experiments were 'ethical' and thus fundable," and the advisory commissions were seen by the scientists not so much as bodies to advise them, but as the means for "preparing the public" for what the scientists intended to do anyway. That is, "the commissions would help mould the ends of society to accept the means being developed" (82).

The creation of the National Commission for the Protection of Human Subjects of Biotechnical and Behavioral Research by the U.S. Congress in 1973 might be described as the birthday of the bioethics profession and the following year the commissioners, at a retreat, set about establishing "clear and simple" principles that would provide the ethical basis for the regulation of HGE research. They worked their way down to three principles: "respect for persons, beneficience, and justice." They then came up with three procedures "to guarantee that the means would not violate the ends: 'informed consent' to guarantee respect for persons; 'risk/benefit assessment' to guarantee beneficence, and 'fair procedures for the selection of research subjects' to guarantee justice" (84). A more self-serving, confined and individualistic, if not outright anti-social notion of justice is hard to imagine.

As for the ends themselves, the commission recognized that they would have to be "portrayed as universally held by the citizens," but would have to be applied "without a method of determining empirically what the ends of the citizens were" (85).

Meanwhile, the National Academy of Sciences formed a carefully selected committee that eventually wrote a letter to the journal Science describing safety as the only potential problem with genetic engineering. Also in 1973 Paul Berg organized the high-profile meeting of scientists at Asilomar in which, as Evans comments, "the fear of public influence on scientific decision-making was pervasive" (96) but the scientists succeeded in minimizing the threat to their jurisdiction over HGE.

The National Institutes of Health Recombinant DNA Advisory Committee (RAC) was formed immediately after the Asilomar meeting and in 1976 the NIH released its guidelines for conducting research, based on the advice of the RAC, which had decided that nonmaleficence (safety) was the only end to be considered. By then the RAC had become the ultimate decision-maker on the ethics of genetic engineering of microbes.

The next commission on the scene was the President's (Carter) Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research in 1980. Its major report, "Splicing Life," was released in 1982 and did not find in the gene splicing being planned or undertaken the "fundamental danger" to human values, social norms, or ethical principles that alarmed the religious leaders. "Given this conclusion," Evans says, "there was then no reason to limit the research of scientists" (101).

"The executive director of the commission later wrote that one of the best features of the report was that 'by carefully dissecting the complaint that gene therapy amounted to "playing God," the report was able to differentiate important concerns about means and consequences from rhetorical claims'" (101).

As Evans puts it, the bioethicists no longer felt it necessary "to argue against theologians and other substantively rational authors, but simply labeled them as irrational-so far outside the consensus about legitimate arguments that their views should not be seriously considered" (153).

Very clearly, by this time, the debate about the ethics of HGE had become thin indeed, and anything that might have served to thicken up the debate was dismissed as a threat to the democratic consensus or irrational and thus beyond serious consideration. "Consensus in the commission, which was necessary to show that universal ends were being pursued, actually required that ends not be discussed" (114). The universal end that had gradually risen to preeminence was individual autonomy. This emphasis on the individual is also convenient because, as Evans points out, "it is more difficult to calculate either the effects on, or the ends of, humanity" (154).

The emphasis on calculability conveniently "restricts arguments to technologies that are imminent, and for which the effects are well known" (174), meaning that there is little inclination to ban anything because one never knows how it will work out: only with actual implementation of the technology will the ethical issues be evident, if there are any.

Gregory Stock, perhaps the most rational of contemporary writers selling the wonders of genetic engineering, candidly articulates this attitude: "As always, we will have to earn our knowledge by using the technology and learning from the problems that arise" (Redesigning Humans: Our Inevitable Genetic Future, 11). In this position, one can be quite sure that safety will be the only ethical issue considered rational and relevant. After all, it is not for either scientists or the bureaucratic state (including corporations) to decide on the substantive issues of the ends society wishes to pursue.

Stock calls us to "seize control of our evolutionary future" and let technology, unhindered, take us where it will. For him, the only unethical behavior is the restraint of genetic engineering. "The arrival of safe, reliable germline technology will signal the beginning of human self-design. We do not know where this development will ultimately take us, but it will transform the evolutionary process by drawing reproduction into a highly selective social process that is far more rapid and effective in spreading successful genes than traditional sexual reproduction and mate selection" (2-3).

Evans suspects that most bioethicists would claim that the shift from thick to thin (substantive to formalistic) debate about what is ethical came about as the consequence of an increasing commitment to democratic values. "What I am calling formal rationality they would call the overlapping consensus or the common ethical language that respect for pluralistic values in our society demands of us. From this viewpoint, the debate became more formally rational because we as a society decided to use only ends that were universally held. We stopped debating ends in the mid-1970s....Thus the rise of the bioethics profession.. is seen as natural-not the work of interested individuals, but simply part of the flowering of democracy in America" (175). But as Evans documents in great detail, "the real force was not a public demanding democracy, but rather scientists pushing for government advisory commissions, which led to commissions educating the public using commensurable ends" (176). These ends, as indicated earlier, were those of beneficence, nonmaleficence, autonomy, and justice, with autonomy of the individual emerging as the primary ethical end and safety as the sole ethical requirement of means to that end. The absence of any public debate about "social values that are not reducible to harms or wrongs to individuals' means that once cloning can be demonstrated to be safe, it will be considered ethical" (192, quoting NBAC Commissioner James Childress).

The question of consensus and democracy--or the lack thereof--recurs throughout Evans's analysis of the political process of constructing bioethics. It becomes clear through his analysis that the appeal for and use of consensus is not an expression of a commitment to democracy but an expression of a form of tyranny. In insisting that "respect for the pluralistic values in our society" demands basing our ethics only on values universally held, while there is no procedure in place, democratic or otherwise, to actually identify these universal values, bioethicists have, in effect, insisted that our society is a monoculture that adheres universally to the notion that individual autonomy ("choice") is the supreme good.

Of course this creates an antagonistic contradiction between the individual on the one hand and the society and environment in which that individual finds life on the other. There is, after all, no life without context. The loser in the short term is society. The loser in the long term will be both society and the individual.

"If autonomy becomes the only end, then ethics become individual, and what any individual wants to do about HGE is of no concern of anyone else" (195).

What this would seem to foretell is the steady thinning of bioethics to the point that it disappears altogether. Eugenics, perhaps under another name, would become the order (literally) of the day.

Brewster Kneen's most recent book Farmageddon: Food and the Culture of Biotechnology was published in 1999. A second edition of Invisible Giant: Cargill and its Transnational Strategies will be out this fall from Pluto Books.