The moral imperative for bioethics
A POWERFUL NEW technique for editing genomes, CRISPR-Cas9, is the latest in a series of advances in biotechnology that have raised concerns about the ethics of biomedical research and inspired calls for moratoria and new regulations. Indeed, biotechnology has moral implications that are nothing short of stupendous. But they are not the ones that worry the worriers.
Have you had a friend or relative who died prematurely or endured years of suffering from a physical or psychiatric disease, such as cancer, heart disease, Alzheimer’s, Huntington’s, Parkinson’s, or schizophrenia? Of course you have: the cost of disease is felt by every living human. The Global Burden of Disease Project has tried to quantify it by estimating the number of years lost to premature death or compromised by disability. In 2010 it was 2.5 billion, which means that about a third of potential human life and flourishing goes to waste. The toll from crime, wars, and genocides does not come anywhere close.
Physical suffering and early death have long been considered an ineluctable part of the human condition. But human ingenuity is changing that apparent fate. The past two decades have seen a 35 percent reduction in the per capita, age-specific disability-adjusted life-years lost to disease. The improvements, though geographically uneven, are worldwide: every continent has enjoyed massive gains.
Part of the improvement is a gift of economic development. Citizens of richer countries live longer and healthier lives because basic public-health measures and medical interventions have largely conquered the infectious, maternal, neonatal, and nutritional disorders which continue to take a toll (though a decreasing one) in the developing world. But not all the gains have been low-hanging fruit. Advances in drugs, surgery, and epidemiology have brought reductions in years lost to more recalcitrant diseases in every age range and in richer as well as poorer countries. As the treatments get cheaper and poor countries get richer, these gains will spread.
Biomedical research, then, promises vast increases in life, health, and flourishing. Just imagine how much happier you would be if a prematurely deceased loved one were alive, or a debilitated one were vigorous — and multiply that good by several billion, in perpetuity. Given this potential bonanza, the primary moral goal for today’s bioethics can be summarized in a single sentence.
Get out of the way.
A truly ethical bioethics should not bog down research in red tape, moratoria, or threats of prosecution based on nebulous but sweeping principles such as “dignity,” “sacredness,” or “social justice.” Nor should it thwart research that has likely benefits now or in the near future by sowing panic about speculative harms in the distant future. These include perverse analogies with nuclear weapons and Nazi atrocities, science-fiction dystopias like “Brave New World’’ and “Gattaca,’’ and freak-show scenarios like armies of cloned Hitlers, people selling their eyeballs on eBay, or warehouses of zombies to supply people with spare organs. Of course, individuals must be protected from identifiable harm, but we already have ample safeguards for the safety and informed consent of patients and research subjects.
Some say that it’s simple prudence to pause and consider the long-term implications of research before it rushes headlong into changing the human condition. But this is an illusion.
First, slowing down research has a massive human cost. Even a one-year delay in implementing an effective treatment could spell death, suffering, or disability for millions of people.
Second, technological prediction beyond a horizon of a few years is so futile that any policy based on it is almost certain to do more harm than good. Contrary to confident predictions during my childhood, the turn of the 21st century did not bring domed cities, jetpack commuting, robot maids, mechanical hearts, or regularly scheduled flights to the moon. This ignorance, of course, cuts both ways: few visionaries foresaw the disruptive effects of the World Wide Web, digital music, ubiquitous smartphones, social media, or fracking.
Biomedical research in particular is defiantly unpredictable. The silver-bullet cancer cures of yesterday’s newsmagazine covers, like interferon and angiogenesis inhibitors, disappointed the breathless expectations, as have elixirs such as antioxidants, Vioxx, and hormone replacement therapy. Nineteen years after Dolly the sheep was cloned, we are nowhere near seeing parents implanting genes for musical, athletic, or intellectual talent in their unborn children.
In the other direction, treatments that were decried in their time as paving the road to hell, including vaccination, transfusions, anesthesia, artificial insemination, organ transplants, and in-vitro fertilization, have become unexceptional boons to human well-being.
Biomedical advances will always be incremental and hard-won, and foreseeable harms can be dealt with as they arise. The human body is staggeringly complex, vulnerable to entropy, shaped by evolution for youthful vigor at the expense of longevity, and governed by intricate feedback loops which ensure that any intervention will be compensated for by other parts of the system. Biomedical research will always be closer to Sisyphus than a runaway train — and the last thing we need is a lobby of so-called ethicists helping to push the rock down the hill.
Steven Pinker is professor of psychology at Harvard University, and the author, most recently, of “The Sense of Style: The Thinking Person’s Guide to Writing in the 21st Century.”