A MORE PERFECT HUMAN: THE PROMISE AND PERIL OF MODERN SCIENCE. Dr. Leon Kass, a physician and scientist engaged for more than 30 years with ethical and philosophical questions raised by biomedical advances, explored how modern science’s pursuit of “human perfection” paved the way for Nazi programs to eliminate the “unfit.” Dr. Kass addressed the persistence of biological “idealism” in contemporary scientific and medical thinking at the U.S. Holocaust Museum on March17,2005 US Holocaust Musuem

Transcript:
I am honored to have been invited to speak in this series linked to the Holocaust Museum’s important exhibit, “Deadly Medicine: Creating the Master Race.” Yet I find myself intimidated as I have never been before and, truth to tell, somewhat ashamed actually to be speaking publicly about this subject and in this awe-inspiring place. Opening one’s mouth about unspeakable evil risks making it seem banal. And where speech cannot produce intelligibility, sacred memory counsels reverent silence. Yet as the very existence of this memorial museum implies, some homage to the victims of the Holocaust might yet be rendered if, in remembering their catastrophe, we can also learn something about and for ourselves, gaining both knowledge and resolution to ensure that this will never happen again. In this spirit, I will tonight speak little about the abominable uses that the Nazis made of science and medicine. I will concentrate instead on the scientific outlook and aspiration that they inherited and exploited, an outlook and an aspiration that dwell robustly among us today.

The “Deadly Medicine” exhibit actually invites this attention, because of where it starts and how it is structured. The first of the exhibit’s three parts, devoted to pre-Nazi Weimar eugenic ideas and practices, is entitled “Science as Salvation.” The next two parts display, first, “The Biological State,” through which those eugenic ideas were turned into Nazi racial hygiene (1933-1939), and, last, “The Final Solution,” through which Nazi racial hygienic practices became (1939-1945) mass murderous. The exhibit thus locates the Nazi medical atrocities in the company of an idealistic science that preceded it, and it asks us to ponder whether there is any deep connection between the beauty of the glass man and the night of broken glass, and the horrors thereafter. The true power of the exhibit is the question it tacitly poses regarding the relation between the last phase and the first: What, if any, is the connection—not only historical but also logical—between the final solution and the disposition to look to science for salvation? How, if at all, are the optimistic dreams of building a more perfect human through science and medicine related to the actual building of death camps in which real human beings, deemed worthless and worse, were exterminated like so much vermin?

Now nothing in the exhibit suggests that the idealistic science of Weimar produced, or even necessarily led, to the final solution, though we learn here that the former sowed the seeds that were later used to grow the murderous fruit. And it is surely not the exhibit’s even subliminal intention to suggest that noble science need elsewhere become, however unintentionally, the handmaid of bestiality or, further, that genetics or medicine or psychiatry—now as well as then—should come under suspicion of lending strength to deadly inhumanity. Yet, and on the other hand, the exhibit—to its great credit—does not allow us lovers of science and progress to rest comfortably with the belief that the Nazis simply corrupted and perverted science, or that their science wasn’t really even science or that their nefarious purposes were worlds apart from the humanitarian aspirations of modern medicine. The exhibit compels us to consider whether the Nazi use of medical science might have been less a perversion of science, more a monstrously evil yet also logically fitting conclusion from certain dubious premises and attitudes in the scientific outlook itself and especially from the prevailing assumptions about the role of science in human affairs. Is there perhaps something wrong—even deadly wrong—in seeing science as our salvation? If so, then we might need to be on our guard when this siren song is sung to us, as it is today being sung by an ever larger, louder, and much more competent chorus.

To reach the ghastly result, the eugenic and perfectionist vision of Weimar had to be politicized by the Nazis, and in a most particular way. The project for the final solution depended decisively on the presence of a nearly omnicompetent totalitarian and tyrannical state, enforcing state-sponsored racial and ethnic hatreds, and assaulting the traditional teaching of the irreducible and equal dignity of every human individual. God willing, we shall not see such a regime again. Compassionate people like ourselves, who enjoy the protections of liberal democratic institutions, strong cultural prejudice favoring the individual against the collective, and, however much diminished, the invaluable Judeo-Christian belief in the sanctity of human life, can reasonably believe that “it cannot happen here”; and I agree with this conclusion. But—and this is the first important point I wish to make—the explicitly Nazi elements of tyranny and race hatred are not absolutely necessary for producing a deadly medicine, even if it never again becomes a “holocaust.” A free people, choosing for ourselves, can and very likely will produce similar deadly fruit from the same dangerous seeds, unless we are ever vigilant against the dangers. The rest of this talk seeks to identify some of the deadly dangers that lurk in the seductive ideas and practices of science as salvation.

The essence of the peril lies, ironically, in the zealous pursuit of the more perfect human.

Since most of my talk will concerns the perils of modern science—it needing more attention than the promise—this is a good place for me to acknowledge with celebratory gratitude the great achievements of modern biology and medicine, both to our understanding and to our health. Since the latter third of the last century, most human beings living in technologically advanced countries have been living healthier and longer lives than even the most fortunate individuals in prior human history. And we have every reason to look forward eagerly to new discoveries and new medical blessings. But the question before us is not the goodness of science and medicine, but the goodness of looking to science and medicine as the solution for the human condition, for the relief and salvation of man’s estate. Having offered in advance this sincere refutation of possible charges that what follows next is “anti-science,” I now proceed forthwith to articulating the perils of such an orientation.

The first two images from the exhibit pose the problem and set the stage for all my reflections: the glass man and the photographs of the survivors of the First World War.

The exhibit opens with the stunning glass man, first displayed at the German Hygiene Museum in Dresden in 1930. Though many of us have become familiar with transparent models of the human body—they are today widely marketed as science toys for school children—it is difficult to exaggerate the excitement that those original models created. For the first time, the common man could glimpse a life-like model of his insides, organ by organ, artery by artery, nerve by nerve, seeing with illuminated brilliance all the parts that made him run. Far from looking ashamed or diminished by this anatomizing invasion of his inner being, the glass man stands fitly and proudly, arms uplifted in a gesture of triumphant appeal for heavenly applause, a model of human perfection not to say apotheosis. Moreover, this perfect man clearly came not from the hand of God but from an even more perfect man, the scientific and medical visionary who would someday soon help humankind collectively achieve the healthful perfection here modeled in glass.

Make no mistake, this is serious business. For the glass man was willy-nilly the emblem of a new religion: In place of the God who became man, we have here the man become as god. In place of the suffering Christ, arms stretched in crucifixion, we have the impervious glass man, arms elevated in self-exaltation. And creatively behind the scene, in place of a God who it is said sent his son who would, through his own suffering, take away the sins of the world, we have the scientific savior who would take away the sin of suffering altogether. The glass man, in loco crucifixis, is the perfect icon for salvific science.

The dream of perfect health and fitness, itself quite ancient, had acquired a new prominence owing to the Great War, only recently ended. Images from the aftermath of that war, the second display of the exhibit, provide the counterpart to the glass man and in part explain his great social appeal. Human deformity, from loss of limbs to loss of mind, came home from the war to Germany (and to all of Europe) by the tens and hundreds of thousands. The maimed and the enfeebled had rarely if ever been seen in such numbers, and the response of the German mind, humiliated in the War, did not take the most compassionate turn. On the contrary, fear and loathing of the deformed and the defective found their expression, as hatred of imperfection grew up with and encouraged the desire to imitate the perfection of the glass man. In 1920, well before the Nazi period, a distinguished jurist, Karl Binding, and a distinguished physician, Dr. Alfred Hoche, published a chilling booklet entitled “On Permitting (or Authorizing) the Destruction of Life Unworthy of Life (Lebensunwerten lebens).” Beginning innocently enough with a defense of the moral acceptability of suicide and assisted suicide, Binding and Hoche moved cunningly to a defense of killing those whose miserable condition of body or mind calls for the “healing remedy” of premature death from the hand of medical science. Contemplating the battlefield strewn with thousands of dead youths and comparing this with the mental hospitals dedicated to the long term care of the demented and the mentally ill, Binding comments:

And Dr. Hoche ends his part of the booklet with a paean to the dawning of a new age:



A vigorous society, comprising only healthy and fit members, is more than justified in doing battle with the evils of deformity and disability by cleansing society of the disabled and the deformed themselves.

These twin goals—the positive goal of seeking perfection, the negative goal of removing imperfection—are nothing new. They are of ancient pedigree. Indeed, they inspire much of the good that we do in life, and not only in medicine. We pursue virtue or excellence; we stifle vice and correct mediocrity. To be sure, there is always the danger that we will turn our opposition to deficiency into a rejection of those who bear it, that, for example, the battle against ignorance or impairment will translate into a hatred for the ignorant or the impaired. Indeed, by calling them after their imperfection (“He is a paraplegic,” “She is a Down’s), we show our penchant for not distinguishing between the sin and the sinner. But this age-old tendency gallops in an age that also extols and exhorts to perfection, and, more important, gathers the scientific means to pursue it. So, just as the loathing of imperfection fuels the search for perfection, so the search for perfection makes imperfection all the more intolerable. Such is the inner meaning of science seen as salvation, informed by a new idea of human perfection that has in the end little patience with human frailty and disability. That attitude is once again gaining strength, and this time it comes with first-rate science and powerful and precise technique. And it speaks in the seductive voices of freedom, compassion, and self-improvement.

The technologies of interest touch all aspects of human life, from beginning through middle to end. Even as we stand only at the dawn of the new age ushered in by deciphering the entire human genome, we already are widely practicing genetic screening and prenatal and pre-implantation genetic diagnosis, capable of identifying and rooting out the genetically unfit before they can be born. And advances in genetics, developmental biology, and neuroscience promise us all sorts of enhancements in human nature that would make us “better than well,” both in body and in mind. On the negative side, the prime targets for correction and elimination are mental retardation and mental illness, severe bodily deformity and disability, and, later in life, dementia and enfeeblement—serious imperfections all. On the positive side, the prime targets for improvement are memory, muscularity, mood, temperament, intelligence, and—the Holy Grail—increased lifespans through the conquest of biological senescence. Time does not permit a proper examination of even one of these promises. Instead, let me just list some of the more obvious sources of danger, moral hazards that are especially difficult for us to recognize because our practices appear to be governed not by coercive state policy but by unconstrained free human choice. There are two sorts of moral hazards: dangerous practices and dangerous thoughts.

In the early days of the genetic revolution, the 1960s and 1970s, both the positive and the negative eugenic goals were enunciated with great gusto. The distinguished molecular biologist, Robert Sinsheimer, enthused that



About the same time, the president of the AAAS, the gentle geneticist Bentley Glass enunciated a new right, “the right of every child to be born with a sound physical and mental constitution, based on a sound genotype.” Looking ahead to the reproductive and genetic technologies that are today rapidly arriving, Glass proclaimed, “No parents will in that future time have a right to burden society with a malformed or a mentally incompetent child.”

Nowadays, we hear almost no such bold eugenics talk from mainstream scientists, though it is bruited about the margins by a small group of bio-prophets summoning us to a post-human future. But eugenic vision and practice are gaining strength, all the more so because they grow out of sight behind the fig leaf of the doctrine of free choice. We are largely unaware that we have, as a society, already embraced the eugenic principle, “Defectives shall not be born,” because our practices are decentralized and because they operate not by coercion but by private reproductive choice. Genetic knowledge, we are told, is merely providing information and technique to enable people to make better decisions about their health or reproductive choices.

But our existing practices of genetic screening and pre-natal diagnosis show that this claim is at best self-deceptive, at worst disingenuous. The choice to develop and practice genetic screening and the choices of which genes to target for testing have been made not by the public but by scientists—and not on liberty-enhancing but on eugenic grounds. Many practitioners of prenatal diagnosis refuse to do fetal genetic screening in the absence of a prior commitment from the pregnant woman to abort any afflicted fetus. Many pregnant women who wish not to know prenatal facts must withstand strong medical pressures for testing.

Practitioners of pre-natal diagnosis, working today with but a fraction of the information soon to be available from the Human Genome Project, already screen for a long list of genetic diseases and abnormalities, from Down’s syndrome to dwarfism. Possession of any one of these defects, they believe, renders a prospective child unworthy of life. Persons who happen still to be born with these conditions, having somehow escaped the spreading net of detection and eugenic abortion, are increasingly regarded as “mistakes,” as inferior human beings who should not have been born. Not long ago, at my own university, a physician making rounds with medical students stood over the bed of an intelligent, otherwise normal ten-year-old boy with spina bifida. “Were he to have been conceived today,” the physician casually informed his entourage, “he would have been aborted.” A woman I know with a child who has Down syndrome is asked by total strangers, “Didn’t you have an amnio?” The eugenic mentality is taking root, and we are subtly learning with the help of science to believe that there really are certain lives unworthy of being born.

Not surprisingly, in the face of these practical possibilities, prominent intellectuals are now providing justification for this view of life. The current journals of bioethics, no less, are filled with writings that sweetly sing the song of Binding and Hoche, albeit it without the menacing German accent. But not all are so reticent. Here for example are remarks from the writings of Peter Singer, DeCamp Professor of Bioethics in the University Center for Human Values at Princeton, on the question of killing infants with serious, yet manageable, diseases such as hemophilia:



In a recent magazine interview, Singer was asked, “What about parents conceiving and giving birth to a child specifically to kill him, take his organs, and transplant them into their ill older children?” Singer replied: “It is difficult to warm to parents who can take such a detached view, [but] they’re not doing something really wrong in itself.” The interviewer then asked: “Is there anything wrong with a society in which children are bred for spare parts on a massive scale?” The Princeton Professor of Bioethics replied, “No.” Do not underestimate what it means for us that such coolly lethal opinions, regarded since 1945 as barbaric, are today again treated with seriousness and honored with a chair at Princeton.

Similar ideas and practices are coming into vogue at the other end of life. The practice of physician assisted suicide and euthanasia has been legal in Holland for several decades, and more recently in our own state of Oregon. After several quiet years, the campaign is heating up again, and the legislatures in California and Vermont are reportedly going to be considering Oregon-type legislation this year. For a variety of reasons, an age of legalized euthanasia is likely to be soon upon us. Few are going to speak openly, like Peter Singer, about ending worthless lives. But like him, they will promote the deadly practice under the banner of autonomy and choice, graced with slogans of a dignified death. To be sure, large familial and social difficulties of a mass geriatric society are already upon us, destined to become much more severe as the baby boomers enter upon their seniority—and, alas, senility. Although vast numbers of old people are today healthier and longer-lived than ever before, the price many of them are paying for the extra decade of vigorous old age between seventy and eighty is often another decade between eighty and ninety of enfeeblement, debility, and dementia.

Today, over 4.5 million Americans are afflicted with Alzheimer disease, a number that is predicted to triple before mid century. Thanks to our ability to treat acute illnesses and crises, roughly 40% of us can expect to spend roughly ten enfeebled and demented years at the end of our lives, incapable of caring for ourselves in a world of fewer and fewer familial caregivers and, in most cases, without resources to purchase decent home or institutional care. Already we hear the dire statistics about the amount of health care costs spent futilely on the last six months of life. Already we hear the call for rationing, for not wasting resources on persons with “low quality of life”—a gentle Americanism for the German “life unworthy of life.” I do not minimize the ethical anguish that often confronts patients and families when loved ones linger on, their memories gone, their lives little resembling anything like the one they enjoyed. But I still shudder when I hear the call for a technical quick solution to the need for long-term care, for I know what we have to fear when a shallow notion of death with dignity enlists deadly medical force to solve society’s demographic and economic problems.

In Holland, we have seen a foretaste of the future. There the “right to die” has flowed down the slippery slope to its most radical meaning and then some: from a right to refuse treatment, to a right to control one’s own dying, to a right to assistance in “becoming dead,” to a right to voluntary euthanasia, to a right to be mercifully dispatched by one’s doctor should he decide that you are “better off dead.” The descent into unauthorized euthanasia is confirmed by official reports from Holland, with roughly a third of Dutch doctors, speaking under immunity, confessing that they have been practicing nonvoluntary euthanasia, without patient knowledge or consent, including on a significant number of patients who were mentally totally competent. Just this month, the Dutch issued a protocol for euthanizing severely ill newborns. If this can happen among the liberal and tolerant Dutch, are we so sure that it cannot happen here?

But the battle against imperfection by eliminating the imperfect is only part of our current story. Much more vigorous is our scientific and biotechnical quest for human improvement, for doing nature one better and making a more perfect human being. Embryos that are now screened for the presence of disease-causing genetic abnormalities may also soon be screened for the presence of certain desirable genetic traits, from perfect pitch to greater height to calmer temperament, even perhaps someday, to higher IQ. And although precise genetic engineering of designer babies seems to me to be pure science fiction, human cloning does hold out the prospect of trying to perpetuate tested superior genotypes. Genetic engineering of adults holds out the prospect of enhancing muscle bulk and performance. Psychoactive drugs are being developed to increase concentration, to erase troubling memories, or to alter personality. And there is active research to increase the maximum life expectancy, from hormone treatments to stem cell based transplantable tissues to the ultimate weapon, the control of the genes that determine the rate of aging and the age of death. There is also active research on human-computer interactions, beginning with attempts to enable the deaf to hear and the blind to see, but issuing perhaps in computer implants in the brain that would enable us to download entire libraries at the click of mouse.

Apart from a few zealots such as the immortalists or the bionics boosters around Wired Magazine, most people exploring these prospects are not trying to build a superman or a post-human being. They are, by their own lights, just trying to enhance human performance by these more effective biotechnical means, offering a psychophysical route to human improvement that could supplement and extend the improvements we cultivate for ourselves through education or personal training. And there is no question but that such enhancements will be widely desired and used to satisfy the age-old personal human dreams of better children, superior performance, ageless bodies, and happy souls. They may even be enlisted to advance certain social goals—enabling soldiers and pilots to go without sleep, or school teachers and prison wardens to pacify the unruly. We have only begun to consider the momentous ethical and social questions in store for us as we head down this road, and our Council’s report, Beyond Therapy: Biotechnology and the Pursuit of Happiness, (available online at www.bioethics.gov or commercially in two trade editions) is an early effort to articulate our unease at these prospects—I strongly commend this book to your attention. But in a word or two, we are right to be concerned about the meaning of pursuing venerable human goals by these “magical” technical means, just as we are right to be concerned about the wisdom of trying to transcend through technology the parameters of our given nature, the delicately balanced product of eons of gradual evolution.

Will human life really be better if we turn to biotechnology to fulfill our deepest human desires? There is an old expression: to a man armed with a hammer, everything looks like a nail. To a society armed with biotechnology, the activities of human life may come to be seen in purely technical terms, and more amenable to improvement than they really are. Worse, we may get more easily what we asked for only to realize it is vastly less than what we really wanted.

We want better children—but not by turning procreation into manufacture or by altering their brains to gain them an edge over their peers. We want to perform better in the activities of life—but not by becoming mere creatures of our chemists or by turning ourselves into bionic tools designed to win and achieve in inhuman ways. We want longer lives—but not at the cost of living carelessly or shallowly with diminished aspiration for living well, and not by becoming people so obsessed with our own longevity that we care little about the next generations. We want to be happy—but not by means of a drug that gives us happy feelings without the real loves, attachments, and achievements that are essential for true human flourishing.

The pursuit of these perfections, scientifically defined and technically advanced, not only threatens to make us more intolerant of imperfection. It threatens to sell short the true possibilities of human flourishing, which are to be found in love and friendship, work and play, art and science, song and worship. The question for the human enhancers and the post-human futurists is this: what knowledge of the good do you have that entitles you to gamble the human future on your hunches that these proposed alterations will in fact produce improvement? It is a question that science and technology simply cannot provide.

A few words, then, on dangerous thinking.

Part 2