Friday, January 16, 2004

Session 5: Toward a "Richer Bioethics"
Council's Report to the President

Release of Being Human: Readings from the President's Council on Bioethics

Panel Discussion: The Role of the Humanities in Bioethics

Bruce Cole, Ph.D., Chairman, National Endowment for the Humanities

Paul Cantor, Ph.D., Professor., Department of English, University of Virginia

Edmund Pellegrino, M.D., Emeritus Professor of Medicine and Medical Ethics, Center for Clinical Bioethics, Georgetown University

CHAIRMAN KASS:  Good morning.  We should get started.  This is the fifth session of the meeting devoted toward our project, "Toward a Richer Bioethics," celebrating the release of our - - let's call it a report - - fourth book, Being Human:  Readings from the President's Council on Bioethics.

This has been a relatively invisible project of the Council in the sense that it has been the subject of no formal Council discussions, though Council members have been consulted at all stages of the process to make suggestions of readings.  And, in fact, some of the readings in this volume have been explicitly discussed.  And probably 10 of the 95 have appeared either in comments made in the meetings or in previous publications.

This is a most unusual document for any government body to produce.  And I think it probably deserves some justification, but I don't want to steal time from the discussion that we are going to have here this morning.  The justification for it is given in the Chairman's introduction to the volume.

And although we are not anything like a congressional committee, if members won't mind, I would like to just insert some of those remarks into the record so they will be part of the official record of this meeting.  The people in the audience have a copy of the text; they can read it for themselves.

I think the Council members know why we care about this subject.  Questions of bioethics very often come to touch the deepest issues of our humanity.  And the readings from the humanities are among the best resources we have for thinking about those things and addressing those questions.

Before turning to the panel, I simply want to acknowledge the extraordinary work of our director of education, Rachel Wildavsky, who collected these essays, who served as the general editor of this volume.  Rachel, we're in your debt for a really, really beautiful project.

(Applause.)

(Chairman Kass asked and received unanimous consent to insert into the record the following prepared remarks, taken from his introduction to Being Human.)

BEING HUMAN:
AN INTRODUCTION
by Leon R. Kass, M.D.
Chairman, President’s Council on Bioethics

Why another thick book about bioethics? Why a bioethics reader? Why a reader on Being Human? And why a reader on being human from the President’s Council on Bioethics? The short answer is this: The Council believes that readings of the sort offered here can contribute to a richer understanding and deeper appreciation of our humanity, necessary for facing the challenges confronting us in a biotechnological age. The longer answer constitutes our introduction to this volume.

We begin at the beginning: What is “bioethics,” and why do we need it? Bioethics is a relatively young area of concern and field of inquiry, less than forty years old in its present incarnation—though many of the questions it leads to are in fact ancient. In the mid-1960s, following the disclosure of several abuses here and abroad, ethical attention first focused on the use of human subjects in medical experimentation. Intense public discussion established the importance of voluntary and informed consent, and institutional arrangements were subsequently developed to protect vulnerable patients against the potentially excessive zeal of otherwise worthy experimenters. Around the same time, it also became clear that advances in biomedical science and technology were raising—and would increasingly raise—more far-reaching and profound challenges to familiar human practices and ways of thinking, feeling, and acting.

By 1970, the effects of the so-called biological revolution were beginning to be felt. Oral contraceptives, tranquilizers, and psychedelic drugs were in use, as were cardiac pacemakers, respirators, and kidney dialysis machines. In vitro fertilization of human egg by human sperm had just been achieved and the first heart transplant had just been performed. People were developing a new “definition of death” that looked to brain activity rather than heartbeat or spontaneous breathing as the definitive sign of existing life. Scientists had discovered a “pleasure center” in the brain, and were exploring possible uses of implanted electrodes in this area for purposes of behavior therapy and control. Genetic screening and pre-natal diagnosis had just arrived, and scientific conferences were being held about coming prospects for gene therapy and even about genetically engineered improvements in the human race. There was great excitement about using the new knowledge and techniques to cure disease, overcome infertility, treat mental illness, and relieve much human suffering. Yet at the same time, people sensed that the new possibilities for intervening into the human body and mind would likely raise large questions, not only about safety and efficacy but also about human freedom and dignity, human self-understanding, and the kind of society we were bringing into being. No one had yet heard of bioethics or bioethicists. But their time had arrived.

Actually, the word “bioethics” was coined in 1970 by the biologist Van Rensselaer Potter—to designate a “new ethics” to be built not on philosophical or religious foundations but on the supposedly more solid ground of modern biology. But the term soon came rather to denote a domain of inquiry that examines the ethical implications of advances in biomedical science and technology for everyday life, as well as for law, social institutions, and public policy. Today, “bioethics” also names a specialized academic discipline, granting degrees in major universities and credentialing its practitioners as professional experts in the field.

Over the past thirty years, the field of bioethics has mushroomed. It has entertained discussions and debates on moral and policy issues connected with abortion, fetal tissue implantation, genetic screening (and privacy and discrimination), assisted reproductive technologies, surrogate motherhood, embryo and stem cell research, cloning, gene therapy and genetic “enhancement,” the use of mechanical hearts or animal organs in transplantation, the use of performance-enhancing drugs in athletics or psychotropic drugs for modifying and controlling behavior, living wills and “Do Not Resuscitate” orders, assisted suicide and euthanasia, and the merits of hospice care—among many, many others. Ongoing attention to research with human subjects has further refined the principles and procedures needed to safeguard subjects’ rights and well-being. Hospital-based ethics committees have been established to deal with difficult end-of-life issues regarding termination of treatment. Professional societies and biotechnology companies employ ethics committees to address specific issues as they arise—say, about whether to practice sex-selection, or how to insure fair access to the fruits of biotechnical innovation. Federal legislation has been enacted both to facilitate organ transplantation and to ban the buying and selling of the organs themselves. Debates continue regarding remedies for the inequities of heath care in the United States or the virtual absence of health care and public health measures in underdeveloped countries abroad. Today, bioethicists teach at most medical schools and universities, advise governments and corporations, and appear frequently in the media. Hardly a day passes without some topic of bioethical significance appearing on the front pages of the newspapers. And the President’s Council on Bioethics is but the latest in a series of national bioethics commissions charged with offering advice about this entire set of developments. Bioethics business is booming, and deservedly so, for there is much of importance at stake.

In creating this Council, President George W. Bush gave us a broad mandate and, among other charges, a somewhat unusual responsibility: “to conduct fundamental inquiry into the human and moral significance of developments in biomedical and behavioral science and technology.” We are also charged “to facilitate a greater understanding of bioethical issues.” Yet, as the Council noted when we first convened in January 2002, many of the deep and broad human implications of the coming age of biotechnology are not today receiving adequate attention. Perhaps it is because the field is so busy attending to the novel problems that emerge almost daily. Perhaps it is because attention to devising guidelines and regulations leaves little time to reflect on the full range of human goods that we should be trying to promote or protect. But it may also be that the concerns and concepts that have come to dominate the discussions of academic and public bioethics, for all their strengths, do not by themselves get to the deepest reaches of our subject.

The major principles of professionalized bioethics, according to the leading textbook in the field, are these: (1) beneficence (or at least “non-maleficence”—in plain English: “do no harm”), (2) respect for persons, and (3) justice. As applied to particular cases, these principles translate mainly into concerns to avoid bodily harm and to do bodily good, to respect patient autonomy and to secure informed consent, and to promote equal access to health care and to provide equal protection against biohazards. So long as no one is hurt, no one’s will is violated, and no one is excluded or discriminated against, there may be little to worry about. Fitting well with our society’s devotion to health, freedom, and equality, this outlook governs much of today’s public bioethical discourse.

Thus, we worry much that human cloning may be unsafe, but little about what it might mean for the relations between the generations should children arise not from the coupling of two but from the replication of one or should procreation come to be seen as manufacture. We worry much about genetic privacy and genetic discrimination, but little about acquiring godlike powers of deciding which genetic defects disqualify one for birth or about how we will regard our own identity should we come to be defined as largely a collection of genes. We worry much about issues of safety or unfairness when athletes use steroids or college students take stimulants, but little about the way these (and other mediating) technologies might distort the character of human activity, severing performance from effort or pleasure from the activity that ordinarily is its foundation. We worry much about the obstacles to living longer, but little about the relation between trying to live longer and living well.

In a word, we are quick to notice dangers to life, threats to freedom, and risks of discrimination or exploitation. But we are slow to think about the need to uphold human dignity and the many ways of doing and feeling and being in the world that make human life rich, deep, and fulfilling. Indeed, it sometimes seems as though our views of the meaning of our humanity have been so transformed by the technological approach to the world that we may be in danger of forgetting what we have to lose, humanly speaking.

To enlarge our vision and deepen our understanding, we need to focus not only on the astonishing new technologies but also on those (in truth, equally astonishing) aspects of “being human” on which the technologies impinge and which they may serve or threaten. For bioethical dilemmas, though generated by novel developments in biomedical science and technology, are not themselves scientific or technological matters. They are human dilemmas—individual, familial, social, political, and spiritual—confronted by human beings at various stages in the human lifespan, embedded in networks of meaning and relation, and informed by varying opinions and beliefs about better and worse, right and wrong, and how we are to live. Often, competing human goods are at stake (for example, seeking cures for disease versus respecting nascent life); in other cases, the evils we seek to avoid are deeply intertwined with the goods we ardently pursue (for example, eliminating genetic defects without stigmatizing those who have them). Moreover, both in practice and in our self-understanding, bioethical issues generally touch matters close to the core of our humanity: birth and death, body and mind, sickness and health, sex and procreation, love and family, identity and individuality, freedom and dignity, aspiration and contentment, the purposes of knowledge, the aim of technology, the meaning of suffering, the quest for meaning. A richer bioethics would attend to these matters directly and keep them central to all bioethical inquiry and judgment. A richer bioethics would feature careful and wisdom-seeking reflection regarding the full range of human goods at stake in bioethical dilemmas.

In all of its work to date, the President’s Council on Bioethics has tried to practice and foster such an approach. For the Council, “bioethics” is not an ethics based on biology, but an ethics in the service of bios—of a life lived humanly, a course of life lived not merely physiologically, but also mentally, socially, culturally, politically, and spiritually. Even as we have tackled specific issues such as human cloning or the uses of biotechnology that lie “beyond therapy,” we have sought to probe the meanings of the intersections of biology and biography, where life as lived experientially encounters the results of life studied scientifically. We have sought as best we can to clarify, promote, and defend “being human.”

Where might we seek help in thinking about “life lived humanly,” about birth and death, freedom and dignity, the meaning of suffering, or any of the other marks of a genuinely human experience? Since the beginnings of human self-consciousness, these matters have been the subjects of humanistic reflection and writing, capturing the attentions of great thinkers and authors. Works of history, philosophy, poetry, imaginative literature, and religious meditation have pondered and commented upon—and continue to ponder and comment upon—these matters. In the Council’s own discussions and reports, we have on several occasions looked to these works for their insights and instruction (roughly a dozen of the works included in this volume have explicitly entered the conversations at our meetings or the pages of our writings). And each of us individually, explicitly or tacitly, relies on what we have learned throughout our lives from texts such as these, as we grapple with the difficult bioethical issues before us. Early recognizing the value of such readings, we have featured many selections “From Our Bookshelf” on the Council’s website (www.bioethics.gov). Now, “to facilitate a greater understanding of bioethical issues,” we have collected and organized them in this volume in the hope that others may discover for themselves the help that is available from wise, sensitive, and thoughtful authors, many of whom come from other times and places. As we strive to stay human in the age of biotechnology in ever-better and fuller ways, we must take whatever help we can get in deepening our appreciation of “being human.”

We do not offer these readings as authoritative or as authorities. As readers will discover, they differ too much among themselves to constitute any single coherent teaching. Rather, we offer them in the wisdom-seeking—rather than wisdom-delivering—spirit, as writings that make us think, that challenge our unexamined opinions, expand our sympathies, elevate our gaze, and illuminate important aspects of our lives that we have insufficiently understood or appreciated.

Each reading is accompanied by a brief introduction directing readers toward the bioethical implications of the text, not by drawing conclusions but by asking questions. As any teacher knows, most good books do not teach themselves. We are all frequently lazy readers, who pass off what is puzzling or unfamiliar, and, even worse, who fail to see the depth in what is, by contrast, familiar and congenial. Often our prejudices get in the way. Sometimes, our inexperience blinds us to crucial subtleties and nuances. Accordingly, we have prefaced each reading with some observations and questions designed to make for more active and discerning reading. These questions should be suitable for discussion by groups reading together or for study by individuals reading alone. In some cases, where the text seemed more remote or where we thought it helpful, we have taken a more didactic tone, asking the reader to come at the text with certain questions and concerns in mind. We have done this with mixed feelings; we do not wish to get between author and reader, nor do we wish to imperil understanding of texts written by subtler and greater minds because of our limited understandings and specialized concerns. We thus encourage the readers to use the introductions if they find them helpful, but to treat them with the proverbial grain of salt.

Readers will note, though, that in our choice of readings we have not excluded texts that evince strong moral viewpoints or that are rooted in particular religious faiths. We have welcomed all valuable anthropological or moral insights, regardless of whether they are rooted in religious faith, philosophy, or ordinary personal experience. Respect for American pluralism does not mean excluding deeply held religious (or non-religious) viewpoints or sensibilities. On the contrary, with the deepest human questions on the table, we should be eager to avail ourselves of the wisdom contained in all the great religious, literary, and philosophical traditions.

One of the virtues of an anthology is that readers are free to pick and choose what they wish to read, skipping around in no particular order. Yet, as we will now indicate—and as the introductions to each of the chapters will make even clearer—there is method in our ordering, and we think there is additional advantage in following the text straight through.

It remains, therefore, only to sketch the structure of this volume. The (ninety-five) readings are divided into ten chapters; each chapter opens with a brief introduction, setting forth the topic at hand and providing a synoptic view of the readings that follow. The ten chapters are in turn arranged in three sections.

The first section, “Natural Imperfection and Human Longing,” introduces a central human question that lurks beneath the surface of many bioethical issues: Which is the proper human attitude or disposition in the world: molding or beholding? When and to what extent should we strive to change and alter nature and especially our own given nature, in an effort to improve or save it? When and to what extent should we strive to accept and appreciate nature and our own given nature, in an effort to know or savor it? This section, comprising three chapters, also introduces the means we have for acting upon these dueling impulses and longings: biomedical science and the art of medicine, both major players in the dramas of bioethics today.

In Chapter One, “The Search for Perfection,” readings explore the age-old human aspiration to improve our native lot, removing our imperfections and bringing our nature closer to our ideal. Does our flourishing depend on our ability to better our form and function? Or does it depend, conversely, on our ability to accept and even celebrate our natural limitations?

In Chapter Two, “Scientific Aspirations,” readings from biographies and memoirs of great scientists explore the motives and goals of scientific activity. Both as a mode of inquiry and as a body of knowledge, science has served both human aspirations—beholding and molding—although its utility as the basis of technological innovation is one of the central features of modern science. Yet science is also a human—and ethical—activity, the fulfillment of personal human desires. How do scientists themselves see the relation between theory and practice? What guides their own scientific quest?

In Chapter Three, “To Heal Sometimes, To Comfort Always,” we turn from the pursuit of knowledge to the age-old medical dream: by means of such knowledge, to bring healing to the sick and wholeness to the broken, and, in the limit, to perfect our vulnerable and mortal human bodies. Readings explore the purposes of medicine, seen from the perspective of doctor and patient, and examine a vocation not only to heal but also to care and comfort.

The second section, “The Human Being and the Life Cycle,” moves from aspirations of and for human beings to questions about human nature itself: What is a human being? And what sort of a life have we human beings been given to live? The four chapters comprising this section treat various aspects of these anthropological questions, many of them sorely neglected in much current bioethical discourse: the meaning for our identity of our embodiment; the tension between change and stability as we progress through the life cycle; the place of begetting and belonging in human flourishing, as we live with ancestors and descendants; and the meaning of mortality as the ultimate boundary of any human life. The relevance of these topics to contemporary bioethical arenas such as organ transplantation, assisted reproduction and genetic screening, and research to alter aging and the human lifespan needs only to be mentioned to be seen.

In Chapter Four, “Are We Our Bodies?” readings explore the puzzling question about the relation between our bodies and our minds (or souls). Are we mostly one or the other? Are we rather only the two of them together? How are our lofty aspirations related to our “fleshiness”? How crucial is our body to our identity and worth?

In Chapter Five, “Many Stages, One Life,” readings ponder what it means that we live in time, that we both change constantly yet continue always as “ourselves.” Is there a shape or meaning to our temporal journey? What sense are we supposed to make of life’s various “stages”? What unites the beginning of our lives with its end?

In Chapter Six, “Among the Generations,” we move from the life cycle of individuals to their connections to those who came before and those who come after. Readings explore the experience and significance of human procreation and renewal, as well as our obligations to ancestors and descendants. How important are biological ties to the work of human parenting and perpetuation? What is the significance of the family tree? What do the various branches owe to one another?

In Chapter Seven, “Why Not Immortality?” we move from procreation to a more radical response to our finitude: the quest for personal immortality. The readings consider various expressions of, and responses to, this ancient human longing. How does this longing affect the way we spend the time of our lives? What does it imply regarding the goodness of terrestrial life? Is mortality only a burden or also a blessing? Does the answer depend on the truth about an afterlife? Would our longing for immortality be satisfied by having “more of the same”? Do we long for an endless existence or for a perfected one?

The third section, “Cures, Improvements, and Their Costs: Virtues for a Richer Bioethics,” moves from the anthropological questions to the ethical and spiritual ones, with a special eye on possible excellences that may be enhanced or threatened in the age of biotechnology. The three chapters in this section deal with some of the deepest bioethical questions: the value, if any, of vulnerability and suffering; the importance, for living well, of unmediated and direct engagement with the world and with our fellow creatures; and the character of human dignity. Once again, these are matters that tend to be neglected in current bioethical discussions. Yet on reflection, their centrality is not difficult to recognize, especially in such matters as our use of heroic measures to save and extend life, our increased reliance on psychotropic drugs to handle the trials and tribulations of life, or our attempts to describe and explain human life and human freedom solely in terms of genes, hormones, or neurotransmitters.

In Chapter Eight, “Vulnerability and Suffering,” the readings consider the venerable question of why we suffer, and the further question of whether there is anything to be said on suffering’s behalf. Would eliminating all suffering be humanly desirable? Could it be that some forms of suffering are essential to our identities and our dignity? Or is this just a rationalizing effort, to make—quite literally—a virtue out of necessity?

In Chapter Nine, “Living Immediately,” the readings look closely at the character of human activities when these are engaged in at their peak. Of special interest are instances when we can be at-work in the world wholeheartedly and immediately, unencumbered by pain and suffering and not deflected by technological or other “intermediaries.” How can we take advantage of the powers technology bestows on us without hazarding distortions of the very activities these powers are meant to serve? What is required for genuine encounters with the world and with other people—for what some call “real life”—and what are the obstacles to their achievement?

Finally, in Chapter Ten, “Human Dignity,” we turn explicitly to the theme that has been tacitly present throughout the volume: the dignity or worth or standing of the human creature. Though the term, “human dignity,” has a lofty ring, its content is quite difficult to define. Or rather, to be more precise, many different authors and traditions define it differently, as the readings in this chapter make abundantly clear. Yet they are all struggling to reveal that elusive core of our humanity, those special qualities that make us more than beasts yet less than gods, the encouragement and defense of which may be said, arguably, to be the highest mission of a richer bioethics. Some readings will do so by argument, others by presenting instances and exemplars. Taken together, they should help us see the profoundly special character of human beings and the special virtue to which we may rise—with and without the help of biotechnology.

(End of Chairman Kass's inserted remarks.)

CHAIRMAN KASS:  To celebrate the release of this volume but also to subject our enterprise to some critical scrutiny, we have convened a really wonderful panel this morning to discuss with us the role of the humanities in bioethics.

We have, first of all, Professor Bruce Cole, distinguished art historian specializing in the Renaissance, with a keen eye for being human, who is now the eloquent Chairman of the National Endowment for the Humanities, the country's leading voice on the importance of the humanities for our general culture.

We have Professor Paul Cantor from the University of Virginia, a long and distinguished career as a teacher of literature who almost 20 years ago, I believe, did a book on the creator and creature on the romantic myths, including the discussion of Frankenstein.

Then we have Dr. Edmund Pellegrino, who is now Professor emeritus of medicine and medical ethics at the Center for Clinical Bioethics at Georgetown University School of Medicine.  I think it is fair to say that Ed Pellegrino has, for more than 50 years, been the most visible and most eloquent exemplar of the medical humanities in this country and a pioneer in this field.

Welcome to all three of you.  We're simply delighted that you would come and join us on this occasion.  And we look forward to your remarks.  We will go in that order after the presentations.  We will have either discussions amongst the panelists themselves or involving all of us.  Thank you.

And please, Bruce, would you like to start?

DR. COLE:  Thank you, Leon.

PANEL DISCUSSION: THE ROLE OF THE HUMANITIES IN BIOETHICS

DR. COLE:  It's an honor to be here and a pleasure to address this group on such an important occasion.  You began your discussions two years ago not with an assessment of the latest technology, a list of medical possibilities, or a survey of the policy together with a story.

Nathaniel Hawthorne's short story "The Birth- mark" illustrates both the timelessness and the dangers of the pursuit of human perfection and the revolt against limitations.  More than that, it shows how the stories, poems, philosophy, and thought of the past have something to say about our future dilemmas.  I think it also shows the unique and thoughtful approach of this Commission headed by my friend and colleague Leon Kass.

I want to thank Leon for inviting me here today and for the opportunity to speak to issues I believe are inextricably linked with the humanities.  I also want to thank Dean Clancy and the Commission staff for their work in making this meeting possible.  And I would like to congratulate all of the members of the White House Bioethics Commission on the release of your book, Being Human.

The National Endowment for the Humanities has sponsored numerous projects seeking to broaden understanding of these issues.  In the past four years alone, the NEH has spent over a million dollars on projects to extend bioethics research, establish endowments for bioethics study, and create fellowships and underwrite documentary films, studies, and even textbooks.

The NEH funded the Baylor College of Medicine's work, A History of Medical Ethics, a one- volume history of medical ethics from antiquity to the twentieth century.  It also provided special support for the Encyclopedia of Bioethics, the standard reference work in the field.  But today we are here to celebrate this Commission's new book.

Being Human accomplishes something important.  It sheds light on bioethics through the lens of the humanities.  To quote one insightful passage of the introduction, "We need to focus not only on the astonishing new technologies but also on those aspects of being human on which the technologies impinge.  For bioethical dilemmas, though generated by novel developments in the biomedical science and technology, are not scientific or technological matters.  They are human dilemmas, individual, familial, social, political, and spiritual, confronted by human beings at various stages of the human life span embedded in networks of meaning and relations and informed by varying opinions and beliefs about better or worse, right or wrong, and how we are to live," unquote.

Over the last several years, the argument that the realm of bioethics is the province of the medical field and technology industry appears to be gaining ground, not because it has been persuasive but because it has been assumed.

The advent of new technologies has been almost universally celebrated.  And questions about where those technologies may lead us have often been written off as irrational fears of Luddites or practitioners of an exotic faith.  Of course, advances in human knowledge are grounds for excitement, but such excitement only increases the need for a dispassionate consideration of where the applications of such knowledge takes us.

A purely medical or technical response is not a complete one.  It is all too easy to disregard the categorical imperative and assume a technological one.  I think it is fair to say that the allure of the technological imperative is particularly strong in our time and, as a result, the dangers of dehumanization more stark than ever.

New technologies are tools which can be used to help or harm, edify, or demean, protect, or destroy.  A knife can be used to perform life- saving surgery or murder.  New biotechnologies have the potential to do far more than merely save or end a life.

Cloning creates a new life in the form of a carbon copy.  Genetic advances hold out hope for designing our offspring according to our wish and promises to redefine what it means to be human.

The new discoveries and knowledge undergirding these technologies hold out promise and hope of curing disease, overcoming disability, and even extending life, but they also contain great dangers, the commodification of people, the reduction of human life to disposable resource, nor is this a distant danger, repellent as it is.  It requires that we take stock before taking action.  As Leon has said, there is often wisdom in repugnance.

President Bush charged this Council to "conduct fundamental inquiry into the human and moral significance of developments in biomedical and behavioral science and technology."  His instructions assumed that the ultimate significance of biotechnology was broader and deeper than its utility and that such an inquiry must include those outside the technology industry.  Without such an inquiry, we stand in danger of ambling blithely but blindly into a brave new world.  Ultimately, this inquiry is incomplete without the humanities.

The humanities are, quite simply, the study of what it means to be human.  The legacy of our past, the ideas and principles that motivate us, and the eternal questions that we still ponder, the classics and archaeology show us from whence our civilization came.

The study of literature and art shapes our sense of beauty.  And the knowledge of philosophy and religion gives meaning to our sense of justice and goodness.  At their core, issues of life and death, identity and connectedness, aspiration and limits, healing and death all pertain to what it means to be human and, thus, are questions for the humanities.

Not only do the humanities have profound implications for bioethics, but the reverse is true as well.  Many of the new technologies you discuss have the potential to fundamentally redefine what it means to be human.  Germ line manipulations, genetic engineering, and other procedures would alter DNA and human character.  It is hardly an exaggeration to say that the future of humanity has some implications for the future of the humanities.  We're all in this together.

I would like to make one last point.  As many of you know, I am an art historian by background and training.  I hope you forgive a plug for including great works of visual arts - - I can't give any remarks without mentioning art; I'm sorry - - in the survey of sources you consult in your studies here.

Before we had evidence of the written word, we had cave paintings.  There are millennias' worth of evidence that the instinct and drive to make art is a human universal, transcending time, place, culture, religion, language, and ethnicity.  Many of the great masterpieces in the history of art deal directly with issues you grapple with here:  human origins, dignity, death, limitations, and desire for perfection.

One of the great advantages of art is that it concretizes the abstract and gives it physical shape.  It provides a new and powerful way of looking at and learning from the wisdom of the ages.

This Commission has a difficult task.  I commend and congratulate it for its exceptional work and readiness to draw deeply from the humanities in delving into the perplexing dilemmas of biotechnology.

In a time when many are tempted or pressured to resolve bioethics questions by reference to market pressure or interest groups, it is essential for thoughtful citizens to consider the full implications of new technologies and knowledge.  Both the arts and the humanities give us a way to approach these great issues.  No inquiry worth the name is complete without them.

Thank you.

(Applause.)

CHAIRMAN KASS:  Thank you very much.

Paul Cantor?

DR. CANTOR:  It is a pleasure to be here this morning.  It is especially a pleasure to celebrate the publication of this wonderful anthology, extraordinary event.  I think the last time a government body produced an anthology of literature, it was under the orders of the Emperor Augustus.

So I'll sum up the importance of the humanities for the study of bioethics by saying science can tell us how to do things, but it can't tell us whether to do things.  And that's where the humanities come in.

The humanities help us to imagine the consequences of what we are doing with science.  This anthology is very good in raising the issue of immortality, for example.  The ultimate promise of modern science is immortality.  That's why it gets the big bucks when it comes to funding.

But literature can help us imagine what immortality might really be like and in the case of the Swift, Jonathan Swift, excerpt you have here, show that there might be a down side to the seemingly wonderful prospect of living forever.  And so that I think has been the great function of literature, the humanities in general.

I really applaud this anthology.  It has an extraordinarily wide range of selections.  That's one of its best features, I think.  There are some of the obviously great and profound authors, like Homer and Tolstoy, but I was very pleased to see an excerpt from Gattaca, from a film, reminding us that literature doesn't just cease with the printed word.  And that film, representative of the whole genre, really is one of the ways that helps us do this imagining.  I would have put Blade Runner in the book if I had had a choice.

Another wonderful selection was the one from J. M. Barrie on Peter Pan.  It made me go back and reread the original play.  I hadn't realized how serious it was in its own way.  Indeed, I now think there is no better way of confronting the problem of what it is to grow up and what the choices are between staying an eternal child, which many of us might like to do, and then facing responsibilities of adulthood.

So I think this anthology has a great deal to offer.  The selections were very well chosen.  And I hope it gets widely disseminated and people can draw upon it.

To pursue this question of the relation of the humanities to bioethics, I would like to concentrate on a period that I specialize in, the Romantic period, the early Nineteenth Century, say a few remarks about that because, in a way, this was the first period that confronted modern science and modern technology.  These are the first writers, around 1800, who are dealing with the beginnings of the Industrial Revolution.

They help us raise one question about turning to the humanities, a point that I think a lot of scientists might raise.  That is, who are these poets, who are these people, the humanities, to say anything about science?  We worry that they don't know anything about science.  And can they have anything reasonable to say if they argue?

Moreover, there is a kind of occupational tension between poets and scientists.  I'll talk about that in a few minutes.  There is a sense in which poets in the Nineteenth Century felt themselves being crowded out by science.  And maybe if they say warning things about the direction science is taking us, it's out of a kind of professional envy.

Well, I think if we actually look at this period in question, it turns out that a number of the Romantic poets and other writers of the time actually were quite knowledgeable about science.

We have the standard view that the Romantics were anti- technology - - and to a large extent, they were - - and that they were anti- science.  But, in fact, they were the first people to realize the imaginative possibilities of science.  It's no accident that, in effect, the first work of science fiction, Frankenstein, which I will speak about in a minute, grows out of this period, but even someone like Wordsworth was impressed by science.

I am going to read you a little sonnet he wrote called "Steamboats, Viaducts and Railways."  Now, we normally think about Wordsworth writing about daffodils, but he actually could get pretty turned on by railways as well. "Motions and Means, on land and sea at war with old poetic feeling, not for this, shall ye, by Poets even, be judged amiss."  As he starts off there, he knows that these new technologies are somehow at war with poetry, but he's not going to judge them negatively for that reason, "Nor shall your presence, howsoever it mar the loveliness of Nature, prove a bar to the Mind's gaining that prophetic sense of future change, that point of vision, whence may be discovered what in soul ye are.  In spite of all that beauty may disown in your harsh features, Nature doth embrace her lawful offspring in Man's art; and Time, pleased with your triumphs over his brother Space, accepts from your bold hands the proffered crown of hope, and smiles on you with cheer sublime."

"Sublime" was in a way the master word of the whole Romantic generation.  Again, we normally think of Wordsworth thinking of the great mountains of the Lake District as being sublime.  But here he can look at steamboats, viaducts, and railways and think of them as sublime.

And as the wave of the future, you see here that, in fact, this Romantic generation was quite impressed with the new possibilities of modern technology.  I bring that up just so that when they criticize it, we can say it wasn't simply out of ignorance or a kind of reactionary spirit.

Percy Shelley and Lord Byron are another example of Romantic poets who were quite knowledgeable about modern science, who were studying contemporary geology and biology and very much fired up and inspired by the new imaginative prospects raised by modern science and modern technology.

Nevertheless, this generation did put up a number of red flags of caution.  The greatest example of that is Mary Shelley's Frankenstein.  I want to speak about that.  I see, you know, the volume begins with "The Birth- mark."  "The Birth- mark" would not have been possible without Frankenstein, one of the works that inspired it.

Since you did discuss "The Birth- mark," I just want to show you that literary critics do have something to say I hope you noticed with the character Aminadab, spelled backwards, his name is bad anima, bad.  So I think that's a little clue to what is going on in that work.

Anyway, I really think you should have included Frankenstein somehow in this volume.  That's my one criticism.  It actually has gone on to become in the popular imagination the great example of a warning against the dangers of modern technology.

Most people know the story through the movie and are unaware of how literate the book is.  So I am going to read a couple of passages from this, which really show how prophetic Mary Shelley was in questioning some of the consequences of scientific enterprise set loose without caution.

This is from the chapter where Victor Frankenstein is recounting his original planning of his creature.  Unfortunately, this displays a great deal of insight into sometimes the lack of planning in scientific procedures.

This is what Victor says, "I doubted at first whether I should attempt the creation of a being like myself or one of simpler organization."  In other words, should he have started with a small project or go straight for creating human life?  Here he says, "But my imagination was too much exalted by my first success to permit me to doubt of my ability to give life to an animal as complex and wonderful as man.  The materials at present within my command hardly appeared adequate to so arduous an undertaking, but I doubted not that I should ultimately succeed.  I prepared myself for a multitude of reverses.  My operations might be incessantly baffled and, at last, my work be imperfect.  Yet, when I considered the improvement which every day takes place in science and mechanics, I was encouraged to hope my present attempts would at least lay the foundations of future successes.  Nor could I consider the magnitude and complexity of my plan as any argument of its impracticability.  It was with these feelings that I began the creation of a human being.  As the minuteness of the parts formed a great hindrance to my speed, I resolved, contrary to my first intention, to make a being of a gigantic stature; that is to say, about eight feet in height, and proportionably large."

Now, those last lines have the distinction of being quoted in Mel Brooks' Young Frankenstein, but they also sum up Mary Shelley's critique of Victor Frankenstein, "As the minuteness of the parts formed a great hindrance to my speed, I resolved, contrary to my first intention, to make the being of a gigantic stature; that is to say, about eight feet in height."

Now, here Victor does not consider the consequences for the creature of its being eight feet in height.  He's got a problem.  He can't find miniature parts.  He's in a real hurry.  So he scraps the original plan and says, "Well, I'll make it eight feet tall."  In some ways, all the problems that this poor creature has follow from this last- minute revision of the plans.

Any time scientists tell us, "Well, don't worry about the consequences.  We've just got to get this project underway.  It's really important to do it quickly.  We have to use what we have," I think this passage from Frankenstein should be read to them.

Moreover, it goes on to say, "Life and death appeared to be ideal bounds, which I should first break through, and pour a torrent of light into our dark world."  That again I think very well captures the spirit of modern science that any limits to human endeavor are merely ideal bounds.  And the great goal is to break through them.

And then, even more tellingly, Victor says, "A new speciess would bless me as its creator and source; many happy and excellent natures would owe their being to me.  No father could claim the gratitude of his child so completely as I should deserve theirs."  Now, why can no other father ever claim such gratitude?  Well, every other father somehow needed the help of a mother to produce a human being up until Victor Frankenstein's process here.

Here I think, as Shelley brilliantly focuses in on the will to power behind modern science, "A new speciess would bless me as its creator; many happy and excellent natures would owe their being to me," and then that desire to have the complete gratitude here.  It's interesting that Mary Shelley as a woman identified this masculine aspect of Victor Frankenstein's science that fundamentally he was turning against natural means of reproduction in order to be able to do something that he could get all the credit for himself.

Again, I think Frankenstein is a marvelous work for seeing the contribution the humanities can make to our understanding of these sorts of issues of bioethics.

Again, Mary Shelley's husband, Percy, was quite knowledgeable in science.  He almost blew up his room at Oxford with chemistry experiments.  People have said, Alfred North Whitehead I think was the one who said, that if Shelley had gone into chemistry, he would have been a genius, "a Newton among chemists," I think was his phrase.

So, again, Mary Shelley was not ignorant of science.  In fact, this work was way ahead of the science of her day.  She had studied a bit about Galvani and his battery experiments.  That was all part of the background to Victor Frankenstein.

But what she is able to do is imagine what the consequences would be to a being who was created this way.  That is the failure she shows on the part of Victor Frankenstein.  He is thinking only as the creator here.  He is thinking only of what will redound to his own glory.  That means doing things quickly and doing them immediately and with what is at hand.

He is not thinking through what it would feel like to be eight feet tall.  Remember, this is in a world with people who are mostly five feet tall and before the time of the NBA.  So the eight feet was not in any way going to be an advantage to this creature.

I am going to end now with a quote from Mary Shelley's husband, Percy Shelley, who wrote a marvelous essay called The Defense of Poetry, which, again, I really recommend to you.

The circumstances of its origin are relevant.  A man named Thomas Love Peacock had written an essay called The Four Ages of Poetry, in which he basically argued that science had made poetry obsolete in the Nineteenth Century, that science now had demythologized the world.  It was fine for Homer to write poetry when people believed in all of these Olympian gods, but he said something like, "How can you expect to find a water nymph in Regent's Canal today?  We don't believe these myths anymore."  He basically wrote an essay that obviously was very upsetting to early Nineteenth Century poets because he was trying to tell them that science had put them out of business.

Well, Shelley wrote a very eloquent and profound defense of poetry, as he calls it, which actually is one of the best statements on the relevance of the humanities to science because he does try to make this point that poetry can imagine what science cannot.

I will just end by a quotation from Shelley where he tries to tell us what poetry can do for science.  We are to "imagine that which we know; we want the generous impulse to act that which we imagine; we want the poetry of life; our calculations have outrun conception; we have eaten more than we can digest.  The cultivation of those sciences which have enlarged the limits of the empire of man over the external world has for want of the poetical faculty proportionally circumscribed those of the internal world, and man, having enslaved the elements, remains himself a slave."

In some ways, I can think of no better characterization of the current state of modern science, "our calculations have outrun conception."  I can think of no better warning than that "having enslaved the elements," man now "remains himself a slave."

(Applause.)

DR. PELLEGRINO:  Good morning.  Like my fellow participants, I am pleased to be with you, but I suffer under two particular encumbrances.  First, I am here because Richard Selzer has been ill.  And I stand, therefore, in the place of someone I could not possibly emulate, who is himself a personification of how literature and ethics come together in his own person and in his eloquent writing, too.

The second impediment is that as you look around the table, I am reminded of a story, which you probably know but I think is apposite sufficiently here for me to repeat it.  And that is a story of the man who went to heaven at a time when in heaven there was a requirement, as there has been for those who occupy chairs in universities, for an inaugural speech.  An inaugural speech could be on any topic the soul would like to address.  The man from Johnstown said, "I would like to talk about the Johnstown Flood."

St. Peter said, "Well, we are very liberal here.  We will allow you to talk about anything you want, but let me warn you Noah will be in the audience."

As I look around this table, I see clones of bioethical Noahs, friends of mine, sometimes colleagues, sometimes debating friends.  I am very, very much reticent to try to say much of anything in the presence of people who know so much more than I do about it.

My only advantage, as Leon said, was having been at this a long time.  So I will be saying something about paleoethics and hopefully bringing it up to something somewhat more contemporary.

What I have in mind is the following.  First, I would like to make a few quick comments about how much I applaud this effort of the Council and particularly in its latest volume.  The stories put forth there, the narratives, literature, are extremely useful and helpful and apposite in bringing the facts clearly to all of us with moral questions, moral problems, moral decisions.  All of them are unique and personal and embedded existentially in the lives of individual human beings.

That is something which is just beginning to be emphasized, although it has been known for a long time in the world of literature.  If you go back to the ending of The Iliad and the ending of The Aeneid, you find the tremendous moral challenge of what a victor does with the one he has vanquished.  On the one hand, in The Iliad, we have an example of mercy, respect for tradition, and the sparing of the enemy.  And in The Aeneid, we have the opposite:  the absolute application of what the hero thinks is justice.

So let me start then on the collection of the one or two points I want to make in the brief time allowed for me.  The collection itself illustrates beautifully, as I said, the enfleshment of moral issues and problems.

Note, though, that at the introduction of each of these episodes, there is a series of penetrating questions.  Those penetrating questions are questions which cannot be asked by returning to the story.  They are philosophical questions.  They illustrate beautiful what Italo Calvino said, that the point in the terrain at which literature and philosophy - - read ethics at this point - - meet is at ethics.

What I would like to do, then, is make three brief observations on the interaction between ethics and not just literature, but the humanities in general.  I do so under the rubric of the enrichment of bioethics, which is one of the aims, I gather, of this particular volume and I think a worthy one.

First, a quick historical look.  You couldn't avoid that with someone at my advanced age.  I will not give you anecdotes of my personal involvement.  So relax.

Second, a word about the central paradox, central ethical paradox that must be faced and which I think the Council has opened up.  I would venture to say that if the Council can pursue this question further and already has I think made a great contribution, your greatest contribution probably would be if you could advance this notion of the enrichment of bioethics because the questions that you deal with and we deal with are questions for the entire public.

What eventually must be faced is the enrichment of bioethics and the question which is running through the remarks my fellow participants have already made, what is it to be human?  A central fundamental question of philosophical anthropology or theological anthropology, what is man, what is woman, what is our purpose, what is our destiny?  And all of the other questions are peripheral.  But for many, many reasons, we have not been able to touch that question directly because of the pluralistic view we have of what it is to be human.  Nonetheless, we cannot avoid it.

And so my first point, historically, is simply this.  As you look at the history of bioethics, which really did not begin until, in my view as a bystander and not so innocent a bystander, as a matter of fact, at the beginnings of what current bioethics is, the development from a 2,500 year- old tradition of a very narrow but important topic, the ethics of the profession of medicine, began to change in the '60s, when, believe it or not, the humanities, bringing together ethics and human values, were put together as an enterprise by a group of, believe it or not again, campus ministers - - the record is clear on this - - who were concerned about the education of physicians wishing and hoping that they could somehow marry the technical prowess of medicine, which was then becoming very obvious with an understanding of what it is to be a human being and to use these techniques within the human existential framework.  An educational ideal, therefore, was the beginning.

This is a part of the history that bioethics has not written about.  It was only until the mid '60s that that particular thrust, which would have been very congenial to the very points you have been making here today, particularly since some of the volumes that you were talking about were being used.  Ten medical schools initiated programs, as a matter of fact:  ethics, human values, and the humanities.

Out of that grew a program supported by the National Endowment for the Humanities for a decade to stimulate the education and in- house training of faculty members in these 3 dimensions, which would enrich and broaden the medical ethics of 2,500 years, which was more or less a statement of norms without justification and norms without realization of the complexities of their application in the human situation.

It was not until 1972 when bioethics was baptized in two places, by the way, at the University of Wisconsin, as has been pointed out, but also at Georgetown, and baptized in two forms:  one, an interdisciplinary broad approach, which included the humanities; and the one at Georgetown, which emphasized strongly the philosophical approach, ethics as a formal discipline.

You know the current development.  Currently bioethics has become so broadened that it embraces almost every discipline in the humanities and in the humanistic end of the social sciences spectrum, so that we range from law to psychology to anthropology to economics, et cetera, et cetera, et cetera, because the problems involve those issues.  But the stories that one gets from each of these approaches bring us back to the kinds of questions which your anthology raises, how do we from the point of view of what it is to be human answer and respond to those questions?

Bioethics, therefore, has flourished.  It has grown.  And in its growing, paradoxically it has moved away from its central issue or the one that you have pointed out repeatedly, what is man, what are humans for, and can ethics be, again, as a phrase from your introduction says, can ethics be in the service of bios?

My second question, then, is, given that the move away from normative questions, from questions of a foundation - - and it's popular, as you know, today to resist foundations in philosophy.  To move away from foundations deprives us of some groundwork to which to return so that the questions you have asked here, those acute questions, will have some basis from which to work.

Now, the paradox is my second point.  The paradox, of course, is that we have no agreement on what it is to be human.  And, of course, all of the things we have been talking about contribute to that dialogue, but we need to return to the tackling of that question.  It is the most difficult question in a democratic, pluralistic society.  Yet, it cannot be avoided.

When one avoids it, bioethics becomes a matter of procedure, an abandonment of the search for the right and the good.  It becomes a matter of dialogue, a matter of whatever it is we can agree upon is the right answer to whatever decision we have facing us.

And that spirit runs through much of the bioethics literature today when it comes to the application to particular problems.  That, of course, can only be chaos unless one is willing to accept that the true and the good can be arrived at by plebiscite, by agreement, by compromise, by contract.

Talk about what it is to be human raises another paradox.  And this is the second one.  I'm coming close to my end.  And that is, which of the very ideas and images which emerge from your anthology should one select?  Does one select all of them to go in all directions at once?  Does one select an idea or an image?

An idea, if I may be permitted - - and I ask your forgiveness - - an idea in my view to use a more ancient kind of definition is an intellectual representation of the essence of a thing, what is it and why is it in a general and universal sense.  An image is a particularized existentially described, multiply examined, concrete human being.  Socrates is an image.  Jesus is an image in many ways.

Do we go the image route?  And I think here is where the humanities help us enormously by giving us images.  But then which image do we follow?  As I pointed out, does one go The Iliad route or does one go The Aeneid route and the most important question, let's say, of almost capital punishment, justice, or do we try to discern what it is about us as human beings that makes us different?  That question we have run away from since the Enlightenment.  There are people around this table who can say much more about that.

And I will say it further.  My purpose here is simply to raise the questions from the point of view of a long involvement in where we are and the great importance of carrying forward this notion of bringing together the humanities and the philosophy.

The last point is what can we do about it.  Everyone will talk about interdisciplinary programs, et cetera, et cetera, et cetera.  Yes, ethics is an interdisciplinary activity, but it has its particular contribution to make, the orderly, formal, systematic examination, in the light of the concrete existential situation, those two in dialogue with each other.  And I presume your volume does that, raising the questions, but does not go further from the resolution, not necessarily resolution but the fleshing out of those questions in a more advanced and formal way.

I think if we are to resolve satisfactorily the issues with which you are wrestling - - I was here yesterday as we heard about whether one should decide about one's granddaughter, should she be given ballet lessons or ice skating lessons, so on, which revealed to me a certain lack of understanding of this very question you are looking at.  Whether she, the granddaughter, has a PET scan which indicates that she would be a wonderful snowboarder is inconsequential.  Is this what she wants?  Is this how her life will develop given its particularities?  And here's where the humanities come in.

And then should one admit into the picture what the PET scan shows about her and the way her brain lights up when you talk about skating, as compared to running an automobile around a track at NASCAR?

So I want to end, therefore, by saying we need to - - and you have heard this over and over again.  Having been a university president and so on, I am rather skeptical about top- down organizations that have interdisciplinary programs.  They don't work or if they do, they come up with rather mundane answers to questions.  I do think we need to stimulate discussion among and across faculty members.

This causes me to end my comments with a little anecdote of the first time I met Richard Selzer.  We were both faculty members at Yale.  I had the temerity to organize a cross- campus colloquium with people from the humanities and those few in medicine who were interested in that engagement.  Richard was a member of that group.

On those occasions, we were always enlightened by his grasp of the existential and, on the other hand, by a philosopher like Maurice Nathanson asking the questions you're asking in the first part at each of these selections you have chosen.

Is it conceivable that somehow the faculty colloquia could be one starting point for this, which might spread to students, as it did in our particular instance, and actually end up in jointly tought courses.

This won't do it all.  The final comment I have to make is that no democracy can survive without a sufficient aliquot of its members instructed and able and capable of critical thinking on the questions that the liberal arts always emphasized, the questions of what is the right, what is the good, what is the true, and what is the beautiful.

These are not to be decided by leaders, by congresses, by democracies, or by anyone else.  They are the result of an educated populace entering into the dialogue and dialectic, a combination, therefore, of philosophy as well as ethics.

Thank you.

(Applause.)

CHAIRMAN KASS:  Chairman Cole has to leave now.  Bruce, thank you very much for being with us this morning.

(Applause.)

CHAIRMAN KASS:  Paul, do you want to comment in response before we simply throw it open?

DR. CANTOR:  No, not really.  I mean, I just - -

CHAIRMAN KASS:  You're content?

DR. CANTOR:  Yes.

CHAIRMAN KASS:  The floor is open for discussion.  Bill May?

DR. MAY:  I will just try to compete against the rally next door.

CHAIRMAN KASS:  Let me say a word about that.  You may be wondering what is going on there.

PROF. SANDEL:  They are cheering the report we issued yesterday.

CHAIRMAN KASS:  You are very close.  It is the staff retreat for the Washington Post, staff retreat.  Let the record show.

Bill May?

DR. MAY:  I take it what this book does is attempt to ratify what is already going on, which is an attempt to enlarge the canon.  So much of bioethics in the 30 years that I have been involved in it has attempted to draw on a limited canon.  And wonderful things were accomplished:  Aristotle, Kant, Mill, Nozick, and Rawls.  And it's been really quite impressive what ethicists have done pushing the discussion at issues of autonomy and so forth.

To include this rich range of literature that this volume does suggests that bioethics needs to enrich what goes on by working against at least two sources of abstraction in a society like ours.  One of the abstractions is science.  The other is the abstractions of politics.

Again, science accomplishes a great deal through the generalizations that it achieves, but the very procedure of acquiring knowledge in science requires so often the elimination of variables as one gets at something undistracted by its embeddedness in other things.

The poet Yeats once complained about the abstraction of H₂O by saying, "I would like a little seaweed in my definition of water."  That trafficking in images and metaphors and so forth, that is, the business the artist does, it insists that we are not simply in need of universals but sensitivity to universes, Michelangelo's Pietà, Antigone, and so forth.

A particular issue, no, not simply a particular issue, but an imbedded universe.  And, after all, in a clinical setting, physicians deal not simply with the abstraction of diabetes or prostate cancer, but they deal with this embedded in the human being, seaweed and all.  And so we really do need the work of the artist in carrying forward the work of those who wield this enormous power which science has helped to generate.

On the other hand, there is the problem of the abstraction of politics.  And there are tragic limitations to politics.  I do not want to dismiss its extraordinary importance.  It is a way of organizing people around ideas and ideals, which in certain ways extant political orders may have been insensitive to.

And so political causes arise in order to retrieve ranges of human experience and human suffering and human deficit that you need the society organized in such a way to attend to.  But at the same time, there is a price to pay.  Politicians perforce organize us around ideals, but eventually the idea of justice and so forth sloganizes.

And in the course of mobilizing people for action, which is so important, there is an abstraction from the full range of human experience.  There is an impoverishment of language that goes on which eventually yields an impoverishment of community.

And so what the artist does - - and this book is simply full of people who come out of especially the verbal arts - - is attempt to retrieve language from its constant perishing.  And in doing that, they're retrieving ranges of human experience that are out there in the culture at large but that have not yet been fully articulated and honored in the course of its needful recovery.

And so when the artist freshens language and freshens insight and articulates experience, it helps to compensate for the tragic limitation of politics and retrieve community from its constant perishing.

So I salute this accomplishment on the part of those in staff who have worked at it.

CHAIRMAN KASS:  Thank you very much, Bill.

Let me raise a question for you, Ed.  It's prompted by your remarks.  While embracing the contribution of imaginative literature to our deliberations for their ability to give us the concrete particulars, the enfleshments of various ideas in their particularity, to give us certain kinds of powerful images that are sometimes more vivid and compelling than abstract argument, you, nevertheless, I think - - and I think it is more evident in the paper that you gave us as background for the talk - - that you finally think that the court of last resort is philosophy or philosophy/theology but that finally the quest for the universals and the ideas has to take primacy.

Second, a second complaint about - - and this complaint could be registered not just about the imaging character of literature but could even be addressed to the history of philosophy as a whole, the belief that there must be a singular truth, but we have multiple opinions about what it is.  I wonder how you would respond to a kind of double- barreled, not such a critique but to an answer.

First, sometimes the idea and some kind of universal is absolutely best grasped through a particular in which you see through a particularly vivid image something that you couldn't possibly get in an argument but is, nevertheless, the case.

I am not sure that you could make an argument, you could make an argument that would capture the truth in the meeting of Achilles and Priam in Book XXIV.  You read it.  You see it.  You feel it.  And if you don't see it, there's something the matter with you.  No amount of argument is going to enable somebody to see the humanity of that moment where Priam embraces the killer of his son and both men weep.

So I am wondering whether you don't sell short the capacity of images to yield intuitions about truths that discursive speech can't produce for us.  That would be one point.

And then while I am not unfriendly to the quest for the answers to the great questions, we engage in it.  It seems to me if the history of philosophy has taught us anything, it is geniuses don't agree.  And it may very well be that it is sufficient unto the day to keep the questions alive and keep the most powerful alternatives in the conversation because the ultimate truth might, in fact, paradoxically embrace their differences and not find out which in the end is going to be successful.

So this is an argument that would say the presence of multiplicity of viewpoints - - sure, we have to act.  And there comes a time where you have to say, "This way" or "That."  But the complexity that people face when they face hard choices may very well be a reflection of the rather complicated truth of the matter and of these longstanding opponents.

Somebody who is interested in the kind of univocal truth would say with, say, Descartes, "I looked at the history of philosophy.  There isn't anything on which the great philosophers agree.  They must have been asking the wrong questions.  We're going to start over someplace else; whereas, it seems to me a wiser person would say when they read Lucretius, "He's got something here" and when they read Aristotle, "He's got something here" and one can hold these things in mind and maybe even have a richer view of what the truth of the matter is.

So these are two different ways to lean against I think what I heard you say or what I thought was implied.  And I wondered if you could come back on that.

DR. PELLEGRINO:  Well, there is a lot to come back on, Leon, but I will just take one or two points.  First, I in no way take exception with your point that when we actually make decisions, we may be making it very often intuitively without going through any rigorous analysis.

And that's why I think it's so important that there be this dialogue, the ecumenical model that I put forth on the paper that I gave you but I did not talk about here.  And that does not give priority to one or the other but assigns to each its particular task.

What I am propounding here, I suppose, is the Medieval notion of the formal object or the material object of a study.  And I see the differences between literature and what I called in the paper the sciences and the studies of particularity, being valid on their own, and the sciences of the generality of the universal or the abstract, having theirs to contribute.

I, therefore, applaud the difference.  My only concern with bioethics is that I see one facet of this dynamic equation being pushed out and people using psychological arguments, using images, stories, characters.

And I come back to my question, which of the images do you follow?  Do you follow Dostoevsky?  Do you follow Nietzsche?  Do you follow any of these figures in literature?  They're all interesting.  They all represent aspects of the human condition and, therefore, are extremely useful.

I happen to be an inveterate reader.  So I am continually torn by these images.  But one needs to have some apparatus to step back.  I am not suggesting that having the apparatus means that everyone will come up with the same answer.  What I really am saying is I want to reserve the critical faculty when looking at something which is emotionally moving.

I am firmly convinced that if I want to teach something about compassion, let us say, to medical students - - and, by the way, I am still teaching medical students and still seeing patients - - when I want to get that across, I don't do it, I can't do it by a speech.  I do it through the agency of a creative writer who can evoke in a young person who has never experienced death, sorrow, pain, suffering, can evoke that experience.  And then I can begin to work with that to say, "Well, now, let's step back and look at that experience."

So I do not see it as a mutually exclusive choice in any way.  Merely the concern I have is the push, strong push, when I hear about narrative ethics.  It's important.

But whose narrative do you believe?  How do you know the story is a good story and is a right story?  That's the question I am raising basically.  And I am sure this Council is aware of that.  I am belaboring the obvious, but it seems to me that it is a very important matter as you look at and make statements, as you will, undoubtedly, probably in the future, about what enrichment of bioethics entails and requires.

On Bill May's point of politics, Bill, again, I see the realities of politics in the decisions and so on, but I do think we need some order of priorities.  And politics, it seems to me, does not determine what is right or good unless you follow that particular theory of right and wrong.  There is, whether we like it or not, a theory of morals behind every one of those acceptances or images that we take to our own.

I am reminded of Alan Donagon's preface to his Theory of Morality, in which he talks about precisely something like this, Bill, his engagement with the social issue, the political issue, deep personal engagement, his reading of George Orwell, the entrance of literature into the picture, and then his saying to himself, "Now, wait a minute.  How do I decide for myself what is the probity of truth of Orwell's position in 1984?  How do I critique it?"  And so he became a philosopher and produced a wonderful Theory of Morality.

It doesn't mean everybody should go that way.  The point is here is literature stimulating the philosophical question.  Therefore, I see it, having been trained in chemistry and physical chemistry, being in my research bag - - the idea of the dynamic equilibrium, in which both sides of the equation are in constant reaction, one with the other, Bill, is the metaphor that I would use.

CHAIRMAN KASS:  Paul, could I draw you in on this?  Does the literature have something to say in response to this exchange or do you have something?

DR. CANTOR:  Well, I basically agree with Mr. Pellegrino that what it does is make these choices, these issues more concrete for us.  And that's why I was using Victor Frankenstein as a perfect example of a scientist who ignored the concrete.  I am just so much in agreement that there is not much to contribute.

CHAIRMAN KASS:  I have Gil and then Michael Sandel.

PROF. MEILAENDER:  First, maybe we could come up with some readings about how contemplative prayer is the essence of a retreat.

(Laughter.)

And we could put those forward for reflection by anyone who might be interested.

Apart from that, I wanted to comment on the two issues that you had raised, Leon, because in a sense, insofar as you and Ed are tilting in slightly different directions, I want to go with you on the first one and Ed on the second one.  I do think it's true that, at least sometimes, it may be possible that a piece of literature, for instance, actually gives us a kind of insight that discursive reason actually cannot.

So you read or see Oedipus, and there is a sense in which you see free will and fate, or determinism reconciled.  You sort of see it and taste it in a way that probably no theory has ever managed to work out satisfactorily, actually.

I do think that there is something to that.  I don't know how often that is true, but I think sometimes, at least, there is a kind of insight there that is just not available through simple discursive reason.  So I am with you there.

On the second point, though, I do think that keeping the questions alive, though a very important undertaking, - - I don't dispute its significance - - is not sufficient, not sufficient for this body, not sufficient for anybody in his or her life.  We need something more than that.

I think that it is a mistake for us to suppose that the model for living is the academy, where we really do just keep the conversation going sort of, but there is a reason you are an undergraduate for a certain number of years.  There's more to life than just that.

And there are moments when one really does have to decide, and your decision may be enriched in countless ways by the questions having been kept alive and kept alive in sort of fruitfully complex ways.  But that doesn't alter the fact that you can't just find yourself in the midst of a series of questions, but you, indeed, must act and decide.

CHAIRMAN KASS:  Michael and Frank.

PROF. SANDEL:  My question is for Professor Cantor, though I want to say first that I am sure we all appreciate your situating our work in the sweep of history from Emperor Augustine to Emperor Leon.

My question is about the Wordsworth passage that you read having to do with the relation between science and nature.  It was striking to find a Romantic poet affirming the link, rather than insisting on the opposition between them.

Often in bioethics arguments, people cast science and argue against a scientific intervention on the grounds that it is unnatural, whether it is flying to Mars or embarking on asexual human reproduction; whereas, other people reply, "Well, science is natural in the sense that it is an expression of human nature.  So it can't be cast as unnatural, whatever else might be wrong with it."

The passage from Wordsworth included a striking phrase, the one that you read, where he described science as "the lawful offspring" of nature.  Is Wordsworth telling us there that, whatever the pros and cons of a particular scientific pursuit, that no scientific pursuit can be condemned simply as being unnatural?

DR. CANTOR:  I don't know that he ever worked out his thoughts sufficiently on that, but it is interesting that he does see it as part, an integrated part, of the human enterprise.  Shakespeare does something very similar in The Winter's Tale when some characters complain about grafting, that the wrong bud has come out of the vine because grafting has taken place and it is unnatural.

Shakespeare's characters say something like "Art uses no means, but nature doth make those means," again that sense that art and nature are not radically opposed, that we are human beings and part of our nature is to create art and to pursue science.  And it is true.

Even in Wordsworth's famous Preface to Lyrical Ballads, he talks about the imaginative possibilities of science and predicts that someday there will be poets drawing their images from chemistry the way they have hitherto been drawing them from what we think of as the natural world, the world of trees and mountains and so on.

I brought up that one sonnet because it does fill out our picture of Wordsworth.  I mean, this is the same man who Ellsworth says, "We murder to dissect," a much more famous line from Wordsworth which shows a kind of kind of fear of science, particularly medical science, and where it draws its knowledge from.

I hesitate to put too many words into Wordsworth's mouth, but I think the example I cited from Shakespeare and this one sonnet show that there have been moments when even the most romantic of poets have tried to see the continuity between science and other human activities.

Now, I think the point that Wordsworth would make - - and he does gesture towards it in this Preface to Lyrical Ballads - - is that for us to see this connection, science needs to be integrated into broader human activities.  That's, indeed, the role that Shelley argues in his Defense of Poetry for the poet that science is potentially in harmony with poetry, but the two can diverge.

I do think that this romantic generation believed that there could be an unnatural direction to science.  Surely, that's the thrust of Frankenstein.

So I was just trying to correct what I think is a one- sided misperception, even of Romantic poetry, but it is really right to focus on that one line, which is so counter to what we normally think of the Romantics as doing.

CHAIRMAN KASS:  Ed Pellegrino and then Frank.

DR. PELLEGRINO:  I just wanted to add that I didn't mean to shortchange science in this dialogue.  For want of time, I concentrated on what I thought was to be the major focus of the anthology.

Again, I think just Colvino's thoughts happened to flip into my mind.  He pointed out on his dialogue between literature and philosophy that it was no longer a double- bed marriage.  It was a menage- a- trois.  And science was the trois.

Now, Bill would suggest it would be a- quatre, but I'm not sure that the bed is big enough for all of them.  So I would put science, philosophy, ethics, and literature into a dialogue or trialogue with each other.  And I think that is essential today.  So I don't want to lose that point at all.

I would see science, again, as among those disciplines of the particularity, science per se not being able to establish what we ought to do.

CHAIRMAN KASS:  By the way, people should know that there is a section of the reader called "Scientific Aspirations" in which we have accounts, in four cases I think first- person accounts, of the scientific aspiration as told by the practitioners and a fourth remarkable account of the life of Archimedes from Plutarch.  They don't all say the same thing, and even the modern ones don't say the same thing.  And they don't exactly say what, Paul, you have characterized to be the intrinsic aspiration of the activity.

Science's account of its own self- understanding is not excluded from the humanistic account because science is one of the human activities par excellence.  So I think we have tried to make a place for that here.

Frank, please.

PROF. FUKUYAMA:  I am disappointed for the way this has gone so far because Paul Cantor, if he is known for anything, is not known for his high- minded discourse on Wordsworth but his extremely acute observations on popular culture and what they tell us about the way we see ourselves.  He has written on The Simpsons and Star Trek.  His most recent book was on Gilligan's Island.

So I don't have a question so much as a Cantor- like observation about one of the popular culture points of reference that you mentioned, which I think is actually quite relevant to the discussion that we had on neuroscience yesterday, which is the movie Blade Runner.  Maybe you can react to this.

Those of you who have seen the Ridley Scott movie, it is a brilliant movie.  It's based on a book by Phillip K. Dick called Do Androids Dream of Electric Sheep?

Now, those of you who have seen the movie, it's about these replicants who are androids that are brought back from an off- world colony.  The whole theme of the movie is that they actually develop human emotions.  They are machines, but they develop human emotions.

There is a lot of religious symbolism as the end.  It turns out that they suffer and they feel empathy and pain.  In fact, there is an image at the end of the movie where there is a nail being driven through the hand of the chief replicant as he is being destroyed.  He kills his creator in a Frankenstein- like way.

What is interesting about that movie is that it is completely different from the underlying book, which made almost the exact opposite point.  If you read the original Phillip K. Dick, he was kind of a hack writer who wrote desperately to keep alive.  His writing, he is not a great stylist, but his imagined android was not one that had developed human characteristics but one that was missing empathy, was missing a key human emotion.

Actually, the replicants in that story try to undermine religion.  There is a religion called Mercerism that is based on the feeling of empathy.  And the replicants actually expose Mercer as a fraud and disabuse people of the need for religion and so forth.

It does seem to me that it points out a couple of things, that literature is actually extremely good for enabling us to picture both what it means to be human but also in a sense what it means to be inhuman.

So maybe, Rachel, now that you have completed this book, you can work on one called Being Nonhuman because in a sense, it might better articulate what some of the fears about the future are.

It also does seem to me the change between the Phillip K. Dick version and the Ridley Scott version in a way reflects the change in the broader culture, this greater confidence that our materialistic understanding of what it means to be a human being has somehow displaced an earlier, more religiously based one, which said that there is something in a certain sense unduplicatable through any mechanistic device that would actually truly replicate what it means to be a human being.  So I wonder if you might say something about that.

DR. CANTOR:  First of all, I would suggest the next volume would be called Being Inhuman, pursue that line.

I was trying to justify Leon Kass' choice of me by largely avoiding popular culture this morning, but I did praise the volume for including Gattaca and actually mentioned Blade Runner at that point.  Indeed, I do think it is relevant that the kind of inquiries represented by most of the selections in this volume are being continued in movies, in television, and, in fact, our popular culture is coming to grips with the very issue that is being raised here.  I would, in fact, put in a plug for that.

Half of my book Gilligan Unbound deals with The X- Files.  And nothing in our day has confronted more directly the very issues that you are talking about in this volume, the very same issues and what it is the human, with these aliens trying to imitate humans, the alien bounty hunter who can take the form of a human but doesn't have human emotions.

I think it is actually fascinating that one of the central motifs of our popular culture ever since Blade Runner has been the question of how you can distinguish human beings from various forms of androids.

Some of what is in the original Dick story does survive in the movie in that these replicants look like human beings.  They give them psychological tests to try to figure out if they are human beings or not.  And one of the things they are testing for is whether the being has empathy or not.

The entire Terminator series, I, II, and III, has raised this issue, especially the very strange Terminator II, where the Arnold Schwarzenegger character turned out to be a better dad than the real live human being dad that the Edward Furlong character had, and the very strange sense that, again, this machine that had to learn emotion and when Arnold generates a tear there at the end, we all know he is a very good actor.

(Laughter.)

DR. CANTOR:  So I have been fascinated by the - - he's playing a governor now, but - -

PROF. GEORGE:  Will he be better than the real live human being governor?

DR. CANTOR:  Who knows?  It really struck me how much our popular culture has tried to come to terms with specifically this issue.  As we increasingly enter an electronic and cybernetic, cybernautic age, we really have had an enormous series of images in movies and television that raise precisely this issue, what is the dividing line between a human being and a machine, when do computers develop consciousness.  That's been a tremendous theme going back to the Kubrick movie 2001.  It came up in a number of X- Files episodes.

So, in fact, I think there is quite a continuity between what we think of as high culture and our popular culture.  Again, that is why I praise the anthology for including something from Peter Pan and something from Gattaca.

CHAIRMAN KASS:  Dan Foster.

DR. FOSTER:  There is a huge movement to try to get some sort of marriage that's oftentimes used between science and religion, for example, or in the case here we're talking about some dialogue or interactions between ethics and philosophy and serious questions about what it means to be human.

There was a little book that Stephen Jay Gould wrote that I haven't found very many people read, but I read it and I thought it was pretty interesting.  It's called Rocks of Ages.  He wanted to address what he called the incorrectness of trying to marry these two disciplines, science and religion.

In several cute ways, he says science is about the ages of rocks and religion is about the rock of ages.  He coins a term which he calls "NOMAs, non- overlapping magisteria."  He took the term "magisterium" from the Roman Catholic Church, which decides what questions you can ask and what answers you can give.

His point is that the magisteria do not really overlap.  They ask different questions.  Science is interested in how the world began.  Religion is interested in who may have made it.  Science is interested in how do human beings come to be.  And religion, as has already been said, asks "What does it mean to be human?"  He says these are not overlapping questions.  I think that is something that we need to try to keep straight.

The disciplines are different.  And the focus is different.  In one sense, particularly on the scientific side, there is not much interest in the issues that we are talking about here.

Somebody asked me last night - - I can't remember - - do scientists in general, particularly the great scientists, have a sense of the solemnity of human life?

I would say in multiple conversations that I have had, that that rarely surfaces.  The sort of questions that we address here may surface in terms of personal disaster or risk.  If somebody gets sick or they're dying or something like that, they will ask sort of universal questions, but I think that it is a hard sell to try to say what occupies people in literature and philosophy to get the scientists to think about that in a serious way.  They're too much interested in the science itself and probably rightfully should be, just as the writers and so forth are fundamentally interested in what they write.

Now, there is a difference.  There is an imbalance here because my observations are that the people who are in the arts and philosophy and literature, almost everything that happens in science can do so enthusiastically, particularly if it looks like it might relieve suffering or save lives, so that the flow of information is essentially unilateral or close to unilateral.

Everything in science gets written up in the newspapers every week before you even get the journals to read.  So this flow, every one of the people sitting here from the other - - I'm not saying the "other side," but I mean in this dialogue - - will read and be interested in what science is doing.

But I can tell you that the scientists in general are not only - - this is a very big danger, and I've only talked to a few scientists.  So I don't want to generalize, but I think it is true that the scientists are not only particularly not interested in what something like the Council is doing, but they are fairly hostile toward it because they see it limiting the science.

So all I am trying to say is that it would be great if we could reverse some of the flow backwards, but I myself think that is relatively unlikely and that we are fooling ourselves and what we ought to try to do is to bring up these most serious of issues and say, "These are things that you ought to think about.  And some of the things that you are doing, we are doing in science, are wrong or should not be done" and get the attention there.

So I am very sympathetic to the late Gould's view that we need to be sensitive to the non- overlapping nature of the magisteria of these two very great things that occupy all human beings.

CHAIRMAN KASS:  Ed Pellegrino, do you want to respond?

DR. PELLEGRINO:  I very much agree with the reality of the ordinary, general scientist's response to these kinds of questions, having spent 25 years in the laboratory myself, having experienced that and felt it myself from time to time.

However, I think, as you know, from time to time, there is an upsurge of interest within some scientists.  The Asilomar Conference, for example, is an example of a perception of the fact that some things ought not to be done, even though there may be very good "scientific" reasons for doing so.  We have scientists who are concerned about atomic energy and atomic bombs.

So there are signs of hope among scientists that they will look at some of these questions as very pertinent to their own way of behaving.  I understand the scientists' concern.  And I very much believe in the difference in the approach and the methodology and the evidence, but I think it's the fusion between these three ways of looking at the world that is essential for the kinds of problems you are facing.  I would hope that, I believe, and I am seeing that more and more scientists are interested in these questions, quite honestly.

DR. FOSTER:  As I have said, I don't want to generalize.  I happen personally to be one person who is interested in both magisteria.  I think that most people I talk to at the very tiptop of science, like we've got four Nobel guys at our school and so forth and so on - -

DR. PELLEGRINO:  I would agree.

DR. FOSTER:  So they just are not as interested.  There are exceptions, and those are wonderful exceptions.  But I'm just trying to talk about the general reality here that I think that we need to take cognizance of.

DR. PELLEGRINO:  I think you are absolutely right, and that's true among medical students as well.  I would like to say that they have been nurtured on their mother's milk of logical positivism so that it is very hard to disengage them from that particular addiction to something a little broader.

CHAIRMAN KASS:  Last comment from Michael Gazzaniga.  Then we will break.

DR. GAZZANIGA:  I would just be curious to know, if we took Yale as an example, what percent of your professors in the liberal arts go to work wondering about right, good, true, and beautiful as their goal for their week's work.

DR. PELLEGRINO:  I am sorry.  I am suffering from a little bit of dysfunction of the auditory apparatus.  If you could say it a little louder, I would appreciate it.

DR. GAZZANIGA:  I'm sorry.  I'm sorry.  You had mentioned that traditionasl liberal arts goals included seeking right, good, true, and beautiful.  And I was just being a little bit playful here.  What percent of the Yale liberal arts faculty goes to work and has that on their mind as their week's endeavor?

DR. PELLEGRINO:  I have no illusions that we can arrive at a full perception of these concepts. In the concepts of idea and image as represented in literature and philosophy, we are wrestling with the question -- what is it to be human? This is a question the Council has properly and repeatedly raised. What is common to both literature and philosophy when each engages this question? We can approach the answer only asymptotically, but in doing so perhaps we can bring image and idea closer together. This we must do if we are to have a common notion of human existence against which to judge whether any particular biotechnological advance is a good for humans, as humans.

CHAIRMAN KASS:  Thank you, Paul Cantor.  Thank you, Ed Pellegrino.  Thanks to the Council.

We have a 15- minute break.  We will reconvene at 10:20.

(Applause.)

(Whereupon, the foregoing matter went off the record at 10:04 a.m. and went back on the record at 10:25 a.m.)