BOOKS AND ARTS MAY 6, 2002
Our Posthuman Future: Consequences of the Biotechnology Revolutionby Francis Fukuyama(Farrar, Straus & Giroux, 272 pp., $25)
The word "unnatural" is never a compliment. You would not describe your best friend as having "a lovely, unnatural smile." No company would advertise its product as being "one hundred percent unnatural." But John Stuart Mill, writing in 1874, urged that it is a big mistake to think that things are better if they are natural. "If the artificial is not better than the natural," Mill asked, "to what end are all the arts of life? To dig, to plough, to build, to wear clothes, are direct infringements on the injunction to follow nature." According to Mill, "Nearly all the things which men are hanged or imprisoned for doing to one another, are nature's every day performances." And Mill went further. He urged that "the duty of man is the same in respect to his own nature as in respect to the nature of all other things, namely not to follow but to amend it." For Mill, "conformity to nature has no connection whatever with right and wrong."
Mill was not writing about modern science, which is the major domain in which people are now arguing about efforts to "amend" nature. Mood-altering drugs are prescribed to tens of millions of Americans to combat depression and anxiety--both of which are thought to have, in many cases, a genetic origin. As a result of in vitro fertilization, babies can be made not the natural way, but by placing sperm and egg in a plastic dish. Louise Brown, the first human being conceived outside the womb, was born twenty-three years ago; and more than two hundred thousand people have now been conceived in this way. Before very long, some scientists say, human beings will be able to create "designer babies," with physical and psychological characteristics meeting the specifications of parents.
Does this seem like science fiction? Recently a Chicago woman gave birth to a child who had been "pre-screened" for early-onset Alzheimer's disease, which ran in the family. Doctors examined a number of embryos before finding that one of them--the eventual child--was free of the early-onset Alzheimer's gene. The child is now doing well. If genetic screening already allows people to choose among embryos, might cloning be feasible, too? Consider the birth of little CC, the recently cloned cat from Texas, a genetically identical copy of Rainbow, a two-year-old female. (CC does not look much like Rainbow, because the womb environment led to different markings on her coat.) Some people think that it is morally monstrous to clone pets, in part because doing so is "unnatural." The overwhelming majority of Americans think that it is morally monstrous to clone people, in part for the same reason. Maybe Mill overstated his argument.
Francis Fukuyama is best known for an essay that he wrote in 1989, to mark the fall of communism, called "The End of History." He argued that liberal democracy had forever triumphed over its adversaries, which, in his view, had exhausted themselves. There were many problems with his argument, and in the aftermath of September 11 Fukuyama's claim seems less than plausible; but at least it was a bold essay with a striking thesis. Fukuyama's new book is not bold and it lacks a striking thesis. Fortunately, though, it has a rich and important subject.
One of Fukuyama's goals is to steer a middle position between those who are phobic about biotechnologies and those who think that regulation is both impossible and unwise. In Fukuyama's view, regulation is both possible and wise, above all so that we hold on to "human nature." But Fukuyama offers inadequate guidance to those who are uncertain about what exactly should concern us. His book is earnest, worried, informative, and responsible, but in key spots it is platitudinous and frustratingly vague. It is also, I think, fundamentally misdirected: Fukuyama goes wrong by relying on abstract claims about human nature, instead of exploring in concrete detail the likely consequences of new technologies for actual human lives. But I am getting ahead of the story.
Fukuyama begins with a competent, wide-ranging, but scattered survey of scientific developments. Even without modifying genes, doctors are now able to influence behavior through neuropharmacology, which is used to control various psychological ailments. Fukuyama emphasizes the "vast increase in scientific knowledge about the biochemical nature of the brain and its mental processes," a development that in his view has left Freud in the dust. "Freudianism might be compared to the theory developed by a group of primitive tribesmen who found a working automobile and tried to explain its internal functioning without being able to open the hood." Owing to modern neuroscience, we are now able "to peer, however tentatively, at the engine." Fukuyama focuses in particular on selective serotonin reuptake inhibitors (SSRIs), such as Prozac, Paxil, and Zoloft, which appear to constitute what he calls a "happiness pill." Low levels of serotonin in the brain are associated with depression and aggression, and by increasing serotonin levels, SSRIs seem to deliver huge benefits, even miracles. Twenty-eight million Americans--ten percent of the population!--are now using SSRIs.
Fukuyama is especially interested in the apparent fact that SSRIs increase self-esteem. This, he remarks, "refers to a critical fact of human psychology, the desire all people have for recognition." He thinks that this desire "has a biological base ... related to levels of serotonin in the brain." It is at this point that Fukuyama gets nervous. "Virtually all human progress has been the by-product of the fact that people were never satisfied with the recognition they received; it was through struggle and work alone that people could achieve it." For people who do not have a clear psychological illness, SSRIs start to mark a path that looks "uncomfortably like the soma of Aldous Huxley's Brave New World."
Fukuyama is similarly uncomfortable with Ritalin, which in his view "has come to play the role of an overt instrument of social control." Ritalin is prescribed for Attention Deficit Hyperactivity Disorder (ADHD), a "disease" (the quotation marks are Fukuyama's) associated with, though not limited to, young boys who have a hard time sitting still and paying attention. According to one account, as many as fifteen million Americans may be suffering from one or another form of ADHD. Fukuyama is skeptical. He thinks that the simpler explanation is that ADHD is really "just the tail of the bell curve describing the distribution of perfectly normal behavior." He fears that people with certain problems "would like to absolve themselves of personal responsibility for their actions." In his account, both parents and teachers are avoiding old-fashioned discipline and training, and resorting far too often to the view that even mildly wayward children suffer from a pathology.
Fukuyama goes further. Prozac is heavily prescribed "for depressed women lacking in self-esteem," giving them "more of the alpha-male feeling that comes with high serotonin levels." Ritalin, by contrast, is prescribed "largely for young boys who do not want to sit still in class because nature never designed them to behave that way." The result of the two drugs is to move boys and girls "toward that androgenous median personality, self-satisfied and socially compliant, that is the current politically correct outcome in American society."
Yet Fukuyama is far more concerned with what is to come. He thinks that more sophisticated, powerful, and targeted efforts will emerge before long, operating as techniques of social control, marketed by pharmaceutical companies, and exercised not by the state but "by parents, teachers, school systems, and others with vested interests in how people behave." Medicines that modify behavior are one route by which we might become "post-human." Another route, Fukuyama contends, involves longevity, which has grown dramatically in the last century. In 1900, the average life expectancy in the United States was in the late forties; it is now in the mid-seventies. Significant further increases may be possible--and if "a genetic shortcut to immortality exists, the race is already on within the biotech industry to find it."
What are the social and political consequences? One result is that "voting age populations in the developed world will be more heavily feminized, in part because more women in the growing elderly cohort will live to advanced ages than men, and in part because of a long-term sociological shift toward greater female political participation." Fukuyama also thinks that "biotechnology is likely to offer us bargains that trade off length of life span for quality of life." Eventually our relationship "to death will change," and "accepting death will appear to be a foolish choice, not something to be faced with dignity or nobility."
However dramatic this seems, Fukuyama insists that genetic engineering is "the most revolutionary technology of all." This technology is already being used in agriculture, producing insect-resistant corn and herbicide-resistant soybeans. "The next line of advance is obviously to apply this technology to human beings." Armed with an understanding of the functions of genes, researchers might well be able to affect intelligence, crime, even sexual orientation, for all of these have genetic components. Fukuyama predicts that the initial steps in this general direction will consist of pre-implantation genetic diagnosis and screening (as in the case of pre-screening for early-onset Alzheimer's). In his view, parents will routinely be able to screen embryos for a wide variety of disorders--and to implant in the mother's womb those with the preferred set of genes. He also thinks that human cloning will precede genetic engineering. The ultimate prize will be the "designer baby," meaning a baby with pre-selected characteristics such as "intelligence, height, hair color, aggression, or self-esteem." Fukuyama believes that genetic engineering "puts eugenics squarely back on the table."
What is wrong with all this? Fukuyama's answer is based on the idea of human nature, which he defines as "the sum of the behavior and characteristics that are typical of the human species, arising from genetic rather than environmental factors." This definition raises many questions. What does "typical" mean, and how can we figure out a "sum" of genetically determined behavior and characteristics? Fukuyama recognizes that human characteristics, such as height, are variable within the species and over time, but he stresses that nature determines "the overall degree of possible variance." Environmental factors "can change median heights," but they "cannot push human heights above or below certain limits." And what is true for height is true for intelligence as well. Fukuyama adds that there are "species-typical ways in which we perceive, learn, and develop intellectually." Language is central, as are certain values of parental love and reciprocity.
In his discussion of these matters, Fukuyama explores a number of philosophical issues, particularly the "naturalistic fallacy," that is, the idea that empirically based claims about human nature cannot furnish any guidance on what we should be doing. Hume, for example, is widely thought to have shown that one cannot get an "ought" from an "is." But Fukuyama thinks that the naturalistic fallacy is itself fallacious. In his opinion, you can get an ought from an is. To establish this point, he offers nothing less than a brief tour of the "Western tradition," beginning with Socrates and moving briskly through Rousseau, Kant, and Rawls. Fukuyama urges that "virtually all philosophers" who offer theories of rights "end up reasserting various assumptions about human nature into their theories." Thus those who contend that reproductive choices should be treated as special rights must think that such choices are "somehow more important than other kinds of rights, based on their importance for a median or average human individual."
To support the claim that human nature exists, and that it matters for purposes of policy, Fukuyama also offers some remarks about the idea of animal rights. He suggests that some such rights should indeed be recognized, simply because nonhuman animals "can feel pain and suffer." But the idea of animal rights grows out of "an empirical observation of what is typical for their species" and hence a "substantive judgment about their natures," which, for an opponent of the naturalistic fallacy such as Fukuyama, is an appropriate basis for establishing rights.
Fukuyama moves rapidly from human nature to human dignity, which derives from "some essential human quality underneath that is worthy of a certain minimal level of respect." He sees this idea as deeply egalitarian, because it "entitles every member of the species to a higher moral status than the rest of the natural world." With respect to biotechnology, he is concerned that social elites will be able to bypass the genetic lottery and ensure preferred characteristics for their children. Notwithstanding its random quality, or indeed because of its random quality, such a lottery has a kind of egalitarianism, "since everyone, regardless of social class, race, or ethnicity, has to play in it." But "when the lottery is replaced by choice, we open up a new avenue along which human beings can compete, one that threatens to increase the disparity between the top and bottom of the social hierarchy." Fukuyama fears that the belief in human dignity might be at risk if we are no longer bound to our (or his) notion of human nature.
What does Fukuyama propose to do? His argument is not for any particular law, but for institutions that will ensure a democratic check on biotechnology. "In the face of the challenge from a technology like this, where good and bad are intimately connected, it seems to me that there can be only one possible response: countries must regulate the development and use of technology politically, setting up institutions that will discriminate between those technological advances that promote human flourishing, and those that pose a threat to human dignity and well-being." Fukuyama hopes for both domestic regulation and international regulation. He wants to rely not on existing agencies, but on "a new agency to oversee the approval of new medicines, procedures, and technologies for human health." This agency should have authority "over all research and development, and not just research that is federally funded." In arguing for such regulation, he spends much of his time urging that we move beyond the polarized debate between libertarians who oppose any regulation at all and morally motivated critics of biotechnology as such.
Fukuyama is alert to an obvious question: who will oversee any new regulatory institutions? He responds that institutions should be controlled by "the democratically constituted political community," bringing its own judgments to bear on the key questions. Fukuyama also believes that "it is simply not the case that the speed and scope of technological development cannot be controlled." In many morally vexing matters, such as those involving human body parts and nuclear weapons, domestic and international regulation has been quite effective. While no regulatory system is entirely successful, controls are possible if enough people are committed to them.
Indeed, existing controls, mostly covering agricultural biotechnology, do a great deal. The problem is that in light of recent scientific innovations there are "gaping holes in the existing regime." But Fukuyama is unclear on the substantive content of any regulation, devoting only a few pages to the details. With respect to reproductive cloning, he takes a firm stand, arguing for a ban on both practical and moral grounds. The practical problem, he writes, "is that cloning is the opening wedge for a series of new technologies that will ultimately lead to designer babies." The moral problem is that "cloning is a highly unnatural form of reproduction that will establish equally unnatural relationships between parents and children," with a parent having to "nurture a younger version of his or her spouse."
Fukuyama is more ambivalent about the appropriate treatment of early embryos, which are the source of the ongoing controversy over stem-cell research. Early embryos--less than a few days old, just tiny clumps of cells--might be created and used to produce stem cells, which are highly adaptable, and which might be used for therapeutic and research purposes. Very recently, for example, stem cells were used to cure a mouse whose blood and immune system had been destroyed. Congress is now debating whether to ban cloning of human embryos for therapeutic and research purposes; and some people would like to ban stem-cell research altogether.
But in this matter Fukuyama does not offer a final judgment. In his view, it is morally relevant that an embryo "has the potential to become a full human being." It is entitled to less protection than an infant, but still "it has a higher moral status than other kinds of cells or tissue that scientists work with." For this reason, Fukuyama doubts whether scientists "should be free to create, clone, and destroy human embryos at will." He urges that "if we are to do things like harvest stem cells from embryos, we should put a lot of limits and constraints around this activity to ensure that it does not become a precedent for other uses of the unborn that would push the envelope further."
More generally, Fukuyama, with his emphasis on human nature, contends that it is important "to distinguish between therapy and enhancement," authorizing the former while restricting the latter. "The original purpose of medicine is, after all, to heal the sick, not to turn healthy people into gods." He knows that the distinction between therapy and enhancement is unclear and deeply contested, but he thinks that this is the sort of distinction that regulatory agencies can administer. His closing plea is not for any particular set of controls but for a new set of institutions, representing a higher form of freedom than the freedom recommended by those who argue for unfettered freedom of choice. "True freedom means the freedom of political communities to protect the values they hold most dear, and it is that freedom that we need to exercise with regard to the biotechnology revolution today."
Many of Fukuyama's positions are reasonable. He is right to insist that these scientific advances raise serious ethical issues. Prozac and Ritalin certainly do seem to be overused. It is sensible to restrict scientific experimentation with fetuses; even those who support the right to choose abortion should want to regulate the research uses of unborn children who have reached a certain stage of development. Fukuyama is also correct to criticize those who think that legal restrictions cannot possibly work. At the very least, such restrictions will reduce the level and the likelihood of the prohibited conduct. It is certainly reasonable for Fukuyama to want some democratic control of the emerging situation; no sensible person is opposed to that. But on the hard questions--those on which people are now disagreeing--Fukuyama says much too little, and what he says offers too little help. More important, his emphasis on the idea of "human nature" seems to me confusing and wrongheaded. This is not because human nature does not exist, or because it is irrelevant to politics, but because it offers us too little guidance for thinking about biotechnology, and because it does not support the distinction, crucial to Fukuyama, between "therapy" and "enhancement."
Let us turn to specific issues. Begin with stem-cell research. As I have said, Fukuyama concludes that the potential of a human embryo entitles it to a lower moral status than that of a human child, but a higher moral status than that of other cells. There is nothing wrong with middle positions, but what exactly is his argument here? Some people insist that embryos, even at a very early stage, have the same moral status as children. Other people believe that an early human embryo--smaller than the period at the end of this sentence--is entitled to no greater moral status than any other group of cells. Fukuyama offers his plausible centrist view, but he provides no argument against the views that he rejects.
Consider the following position. Stem-cell research promises to produce significant social benefits, including better treatment of many medical conditions, such as diabetes, Parkinson's disease, heart disease, paralysis, cancer, burns, and other conditions related to specific cell abnormalities. If scientists will be using and cloning embryos only at a very early stage when they are just a handful of cells (say, before they are four days old), there is no good reason for a ban. It is silly to think that "potential" is enough for moral concern. Sperm cells have "potential," and (not to put too fine a point on it) most people are not especially solicitous about them.
In any case, scientists are now permitted to experiment on grown animals; and if we want to prevent unjustified suffering, surely we should be more concerned about experiments on monkeys, pigs, and dogs than about research involving very early human embryos. Some people respond that if we allow such research, then we will encounter some hard line-drawing problems. They maintain that if we are to keep our moral convictions intact, then we must draw the line here and now. But if significant medical advances are likely, why not draw the line there and then? Fukuyama does not argue for a ban on stem-cell research; the problem is that his discussion provides no response to the opponents or the supporters of such research.
With respect to human cloning, Fukuyama's arguments are embarrassingly thin. In his view, cloning is an "unnatural form" of reproduction that might lead to "unnatural" relationships between parents and children. But artificial insemination and in vitro fertilization are unnatural, too; and I doubt that Fukuyama would want to ban them. Does Fukuyama object also to cesarean section? To anesthetizing women during childbirth? Believe it or not, Fukuyama seems worried that parents might develop inappropriate feelings toward their spouses' clones. (Maybe we should not abandon Freud quite yet.) Less ridiculously, he fears that if we allow human cloning, we will be on the way to "designer babies." But if we are to recoil at the prospect of "designer babies," why should we draw the line between in vitro fertilization (now permitted) and cloning, rather than between cloning and selecting for genetically programmed traits?
A great deal (though not all) of the opposition to human cloning seems to be rooted in ignorance, even in hysteria; and yet I do believe that human cloning should probably be banned, and for a simple reason. The reason--which is, astonishingly, not emphasized by Fukuyama--is that in its current form the technology creates significant risks of serious illness and early death for the children who would result. And it would impose risks on their mothers, too.
Unless the accompanying benefits are extraordinary, no technology should be permitted if it creates risks of this magnitude. It is also plausible to fear other concrete harms, such as adverse psychological effects on people who are genetically identical to one or another parent; but this is a speculative concern. The sheer risks of illness and death are enough to stay our hands for now. (But note that this argument does not support a ban on nonreproductive cloning, that is, the cloning of very early embryos for medical and scientific uses.)
Fukuyama is in favor of "therapy," but he is against "enhancement." He wants this distinction to serve as the basis for "draw[ing] red lines" between "what is legitimate and what is illegitimate" in many areas, including preimplantation diagnosis and screening. But surely this is a very fragile distinction; and if it pivots on the difference between "normal" health and better-than-normal health, it is not clear that the distinction has much moral relevance. Suppose that medical technologies could make ninety-five percent of Americans as healthy, physically and psychologically, as the most healthy Americans now are. That would seem to be an extraordinary advance that would greatly reduce human suffering. Would this be therapy or enhancement? Would it be wrong to use technologies that would make all of us as healthy as, say, the top one percent?
Fukuyama offers no argument against practices of this kind, and I am not at all sure that he would oppose or ban them. But now suppose that biotechnology could move people well beyond the top one percent--that it could make people healthier than anyone is today. This would undoubtedly qualify as enhancement. But what would be wrong with it, if we were not causing harm to anyone or discriminating against anyone? Should we really feel a strong moral allegiance to the "typical" characteristics of the human genotype? People with certain theological positions might have an affirmative answer, but Fukuyama is arguing on secular grounds. Anyway, how can we be so sure that God, who endowed us with minds, would not like us to improve our genetic capacities?
Fukuyama refers with approval to the claim, which he attributes to Leon Kass, that "there is a natural functioning to the whole organism that has been determined by the requirements of the species' evolutionary history, one that is not simply an arbitrary social construction." The claim seems correct. What is missing from Fukuyama's account, however, is an explanation of why human beings should not improve, if they can, on this "natural functioning." Why should the outcome of evolutionary history enjoy such special moral status?
At times Fukuyama seems concerned about inequality--not about an across-the-board increase in human health and abilities, but about a situation in which some people, and not others, are able to enhance the capacities of their children. The concern is perfectly legitimate, but here, too, Fukuyama just skims the surface. In vitro fertilization is expensive, and poor people are unlikely to be able to afford it--and yet it would be odd to ban it for that reason. It costs a lot of money to screen embryos for early-onset Alzheimer's: would Fukuyama prohibit such screening on equality grounds? Prozac and Ritalin are expensive, but if they help people they should not be forbidden on the ground that wealthy people are far more able to afford them. Of course much more should be done to improve medical treatments for people who lack money. But how are poor people helped by bans on therapy and even enhancement? On the contrary, any bans are most likely to hurt poor people, if only because scientific advances are driven in part by the profit motive, and such advances help most people, not just a few.
Perhaps this misses Fukuyama's real concern. If wealthy people are able to engage in genetic engineering, they might be able to bypass the genetic lottery and give their children special characteristics, with the result of placing less-wealthy people at a new and potentially massive social disadvantage. In his fascinating book Remaking Eden, which appeared in 1997, Lee Silver discusses the possible rise of a new kind of social stratification, with the rich creating a class of "gene-enriched" people. To be sure, there is a potential problem here worthy of sustained thought: rich people do receive the best medical treatments, and perhaps even larger social disparities will increase over time. But at present this possibility does not offer a reason for government to impose new regulatory controls. At most, this anxiety should be taken to suggest that the relevant technologies should be made available to many rather than to only a few.
Inequality is not at the heart of Fukuyama's argument. His real claim is on behalf of "human nature." He thinks that if we understand what human nature is, we will be better equipped to approach the ethical issues raised by biotechnology. There is a sensible and important point in the background. To see it, consider Fukuyama's brief but suggestive treatment of the rights of animals. Dogs, cats, and horses should indeed have the right to be free from cruelty and neglect; and they do have that very right under state law. Still, as Fukuyama urges, no one thinks that dogs, cats, and horses should have the right to vote or to participate in literacy programs. A claim about what a dog is entitled to has everything to do with the kind of creature that a dog is. The same is true for human beings. When we think about human rights, and about what makes those rights distinctive, we can make a great deal of progress by emphasizing distinctly human characteristics.
The problem is that Fukuyama confuses this point with a very different one that has to do with what he sees as the importance, for purposes of assessing biotechnology, of "behavior and characteristics that are typical of the human species, arising from genetic rather than environmental factors." Suppose that it is "typical" for members of the human species, on the basis of genetic factors, to fear flying in airplanes, to respond with violence when insulted, or to die from cancer or heart disease after a certain age. Surely Fukuyama would not object to cultural interventions that would counteract genetic predispositions to fear of flying or to excessive violence. Surely he would not oppose efforts to alter diet so as to counteract the genetic predisposition to die from cancer or heart disease. Why, then, should anyone object to medical technologies that would take people beyond the domain of the "typical"--by, for example, screening out genetic predispositions that lead to preventable illnesses and death? Or suppose that scientists can make human beings taller, healthier, faster, stronger, and smarter than is "typical." Why, exactly, object to that?
I do not think that Fukuyama has a good answer to that question. But I do think that he has an intuition. The intuition is nicely captured by his suggestion that Prozac makes girls more like boys and Ritalin makes boys more like girls, thus pushing members of both sexes "toward that androgenous median personality, self-satisfied and socially compliant, that is the current politically correct outcome in American society." The suggestion seems to me daft--but let us suppose for a moment that it is right. Suppose that some girls have a genetic predisposition toward depression and that some boys have a genetic predisposition toward excessive aggression, and that Prozac and Ritalin provide help on both counts. Suppose that the result is to make girls somewhat more self-satisfied and boys somewhat more compliant with social norms against aggression. Is this bad?
I think that Fukuyama's abstract interest in "human nature" and in what is "natural" prevents him from attending enough to what most matters: the concrete consequences, for actual human lives, of biotechnological advances. Sadness, anxiety, and aggressiveness should not be treated or screened out: bad and dark feelings are an essential part of good human lives. But if neuropharmacology can counteract crippling depression, which is far more dire than melancholy, surely it should be applauded. Human cloning should not be permitted if it would cause, for the children who result, serious illness and early death, or even serious psychological harm; but if stem-cell research promises to deliver significant benefits, surely government should encourage it. Mill was right. If science is able to make human lives healthier, longer, and better, then it is foolish to object in nature's name.
Cass R. Sunstein is a contributing editor at The New Republic.
By Cass R. Sunstein