The president's bioethicist.

Life, Liberty, and the Defense of Dignity The Challenge of Bioethics Leon R. Kass Encounter Books, $26.95, 300 pp.

Leon Kass, who currently chairs the President's Council on Bioethics, has for more than thirty years been a perceptive and eloquent spokesperson for the deeper questions of human identity, meaning, and purpose raised by issues in bioethics. When the field began in the late 1960s, it was not shy about addressing such questions, in large part because many of its founding fellows--Paul Ramsey, Joseph Fletcher, Richard McCormick, Jim Gustafson, and others--worked in theology and religious studies. It is a sign of how much bioethics has changed--and Kass has not--that his discussion sounds so alien to what passes for conventional wisdom in the field. Given our much vaunted commitments to diversity and the drift toward moral relativism in the academy and beyond, perhaps that shift in focus has been inevitable. It is far easier, after all, to speak of who has the right to decide than about what constitutes a morally justified decision. It is less troubling to focus on procedures that safeguard individual autonomy than to discuss what a morally responsible freedom requires. It is simpler to celebrate the merits of pluralism than to focus on matters of the common good or general human flourishing. By contrast, in each instance, Kass asks the harder sort of question.

This book continues Kass's exploration of the substantive moral and metaphysical issues that bioethics has largely bracketed. His appointment as chair of the President's Council is viewed as a politically conservative choice. Of greater importance than a political label, Kass's intellectual and moral project is a literally conservative one. Bioethics, like other fields in applied ethics, too often suffers from the sin of "presentism." It tends to analyze novel developments in medicine and biotechnology piecemeal, without seeking to frame them in larger historical and philosophical context. Kass eschews that temptation. While the book covers the waterfront of particular issues--new reproductive technologies, organ transplantation, genetic engineering, cloning, euthanasia, the quest to conquer aging--it embraces these topics as occasions for deeper conversation. What makes our lives and our choices distinctively human? What does responsible freedom require of individuals in community? How do issues in biotechnology, especially the ongoing revolution in genetic engineering, pose challenges to human dignity?

Despite his conservatism, Kass is no Luddite. He regards "modern science as one of the great monuments to the human intellect, and the field of modern biology as unrivaled in the wonderful discoveries it can and will increasingly offer us." Nonetheless, he is deeply skeptical of any version of scientific truth that smacks of mere scientism or the tendency to see progress as both inevitable and "unqualifiedly good in its results." Throughout his discussion, he uses a different and darker language than the optimistic tones one hears from the avid acolytes of progress. For Kass, there is ample reason to worry about where our medicine and technology may take us: "The heart of the possibility of tragedy is that human glory and human misery are linked, that the triumph of human achievement contains intrinsically the source of human degradation. And the likelihood of suffering tragedy increases with a hubristic belief that we have everything under control."

Consider the broad themes captured by his title. For Kass, human life should not be reduced to the ruggedly unencumbered individualism at the heart of consumer culture. He critiques claims for access rights to any and all new reproductive possibilities. As he observes, "Clarity about who your parents are, clarity in the lines of generation, clarity about who is whose, are the indispensable foundations of a sound family life, itself the sound foundation of civilized community." On that basis, he recommends "no encouragement of embryo adoption or especially of surrogate pregnancy."

Concerning liberty, Kass emphasizes an embodied freedom rather than the naked celebration of Cartesian will, with our choices limited by the facts of our embodiment in important ways. He worries about our willingness to view the body as alienable property and argues forcefully against utilitarian arguments for a market in organs and tissues. For Kass, such commodification would erode important social attitudes and intuitions: "The idea of commodification of human flesh repels us ... because we sense that the human body especially belongs in that category of things that defy or resist commensuration--like love or friendship or life itself."

Much of Kass's discussion, for all its richness, is suggestive rather than systematic, and those of a more analytic bent will likely find his allusiveness elusive. He may be least persuasive in his regular but largely inchoate appeal to the concept of "human dignity" as the core value threatened by current approaches and attitudes in bioethics. Dignity has a wonderful resonance, but it draws its historical strength from particular theological commitments that Kass seems to realize no longer have dispositive force in our pluralistic culture. To be fair, he employs biblical language and imagery at strategic points along the way. For example, when discussing assisted suicide and euthanasia, Kass reflects on how the stories of Cain and Abel and the establishment of the Noahide covenant shed light on the general proscription of murder. Yet, as he admits, many will "rightly express suspicion" at his appeal to particular biblical texts to support a "universal ... explanation of the taboo against murder." Many more may fail to see the immediate relevance of arguments against murder to policy choices about voluntary assisted suicide or consensual euthanasia. Indeed, once formal appeals to God and his purposes are set aside, it is hard to know exactly what the idea of human dignity implies for specific practices. Is it more or less dignified to engage in genetic engineering, more or less dignified to assist actively in the deaths of consenting others, more or less dignified to seek to live ever longer lives or even to overcome aging itself? Although Kass's account of dignity is eloquent and impassioned, I am not persuaded that it improves upon the usual bioethics vocabulary of rights and duties, risks and benefits, which he finds wanting.

Such reservations about the language of dignity aside, the book deserves a wide audience. Kass's erudition is everywhere in evidence, and his thoughtfulness is that of a deeply committed humanist. James Gustafson has recently described four modes of bioethics discourse: the vocabularies of public policy, of theoretical ethics, of prophecy, and of narrative. Kass's work is best viewed as a combination of the latter two approaches. He reads the signs of the times and reminds us of the potential for tragedy in our best intentions. He tells us the tale of our vulnerabilities as well as our powers, and finds both equally vital to our sense of shared humanity. n

Andrew Lustig directs the Program on Biotechnology, Religion, and Ethics, which is cosponsored by Rice University and Baylor College of Medicine.