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under the sun biotechnology. Humanity can become its own re-
deemer, as one of medicine s sagest practitioners, the Canadian physi-
cian Sir William Osler, predicted in a moment of joyous adulation at
early-twentieth-century medicine s prowess.5 Osler scarcely could have
envisioned that his beloved art would go beyond the eradication of dis-
ease to the satisfaction of every human desire, not just for health but
for physical, physiological, and emotional perfection.
To use Lynn White s metaphor, biotechnology has indeed opened a
wide, new, and confusing array of doors.6 Today we must decide which
of those doors to enter, which to explore tentatively, and which to keep
tightly shut. More than anything else, we must control our power to
control who, and what, we are. Otherwise, we are in danger of becom-
ing victims of our own ingenuity, in which we make our utopias into
Sadly, however, there is no historical evidence that technology can
be limited by moral constraint, or that what starts as legitimate treat-
ment of disease will not be used beyond therapy.7 To exert moral con-
straint requires grappling with what it is to be human. This is the
crucial, first-order philosophical and theological question that creates
the deepest fault lines in contemporary culture. The President s Coun-
cil on Bioethics has clearly recognized this fact.8 The council s clarity in
defining the deeper issues and its call for a   richer bioethics  are essen-
tial first steps. But this is just the beginning, for it is beyond this first
step that the ethical quandary begins.
Against this background, we examine the narrower question of med-
icine s relationship with biotechnology. To what extent should medi-
cine and physicians become the vehicles for individual and societal
access to technobiology s promised benefits? In the realm of disease
treatment, there is little question that physicians are the logical and nec-
essary agents. But what about the   enhancement  of individual and
social life, or the promises of perfection of human nature itself, beyond
To what extent should medicine be biotechnology s servant? Should
medicine be redesigned to accommodate biotechnology? Should a new
profession be created for this purpose? Are the aims of biotechnology
  good  for patients or for humans as humans? How would being a
Christian physician influence the responses to these questions?
This chapter focuses on the relationships between biotechnology,
enhancement, and the ends of medicine from both secular and Chris-
tian perspectives. We begin with the difficulties of attempting to define
the key terms: health, disease, illness, and sickness. Given the variability
of meanings, operating definitions are offered, especially for the newest
term: enhancement. These operating definitions are then related to the
ends of medicine, conceptually, and then at three points where biotech-
nology intersects with medicine: (1) in disease treatment, (2) in   en-
hancement  beyond therapy, and (3) in reshaping human society and
human nature. Each intersection is examined from the ethical, philo-
sophical, and religious points of view.
The Key Concepts: Conceptual and
Historical Difficulties
If the ends of medicine are to serve as boundary conditions for inclusion
or exclusion of any form of biotechnology within or beyond clinical
medicine, the vexations of defining certain concepts health, disease,
illness, healing, medicine itself, and the new term enhancement must
be confronted. The literature, both contemporary and historical, is vast.
The concepts and their associated issues are well represented in two
excellent collections of opinions, Concepts of Health and Disease: Inter-
disciplinary Perspectives, edited by Arthur L. Caplan, Tristram Engel-
hardt Jr., and James J. McCartney; and Health, Disease, and Illness:
Concepts in Medicine, edited by Arthur L. Caplan, James J. McCartney,
and Dominic A. Sisti.9
  Health  is the ultimate end of medicine as medicine for individuals
and for society. It is perhaps the most difficult of the key concepts to
Biotechnology, Human Enhancement, and the Ends of Medicine 113
define. The word health comes from the Old English word meaning
  wholeness.  Leon R. Kass takes this to be a static concept, in contrast
with the Greek idea of hygei and euexi,   a well way of living  and   well
habitness.  Kass prefers the Greek sense of health as   the well-
functioning of the organism as a whole . . . an activity of the body in
accordance with its specific excellences.  10
In the ancient world, health had a variety of meanings with subtle
differences between and among them. For the Pythagoreans, for exam- [ Pobierz całość w formacie PDF ]


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