Erik Parens, Shaping Our Selves: On Technology, Flourishing, and a Habit of Thinking, Oxford University Press, 2014
Nancy M.P. King
Department of Social Sciences and Health Policy, Wake Forest School of Medicine
Center for Bioethics, Health, and Society and Graduate Program in Bioethics,
Wake Forest University
Winston-Salem, NC, USA
In Shaping Our Selves, Erik Parens offers both a personal history of bioethics and a cleverly clarifying lens to train on disputes in bioethics about emerging technologies. The question for readers is whether this lens, as useful as it is, leaves too much outside our field of vision.
Parens, born in 1957, comes from the first wave of bioethics scholars—those of us who still mostly happened into bioethics as a field, before it was sufficiently well-established to be identified as a career pathway. Bioethics enjoys a fascinating diversity of origin stories, and Parens’s is no exception. He began his studies at the University of Chicago’s pan-disciplinary Committee on Social Thought, one of a handful of less standard programs of undergraduate study, like St. John’s College (my own alma mater), that seems to have a natural affinity with the broad sweep of bioethics. In contrast, however, scholars entering the field today are at least somewhat more likely to come from a more narrowly focused disciplinary education and to cultivate a more narrowly focused area of empirical research. When Parens emphasizes that each of us comes to ethical debates “from somewhere in particular” (16), that important truth is as reflective of the differences in bioethics scholars’ origin stories as it is of the differences in perspective between scientists and philosophers that he addresses.
The central argument of this slim volume is the exhortation to develop “a habit of thinking about meaning questions” that Parens calls “binocularity,” or a way of integrating two sets of “apparently opposing insights” rather than championing one view over another in bioethics arguments (4-6). He focuses particularly on arguments about novel biotechnologies. He examines and discusses a set of paired insights-in-opposition: humans as subjects, choosing our paths freely, and as objects, influenced in important ways by the social and cultural contexts in which we live; perspectives of creativity and gratitude about human enhancement (that is, views of ourselves as shapers of our future and as accepting of what we are at present); and technology as value-free and value-laden. Beginning from deep reflection about his own disposition toward the enhancement debate, he carefully and slowly builds a persuasive argument that meaningful discourse must move beyond arguing for a position to embrace oscillation between opposing positions. To be genuinely faithful to the full value of the human condition, we need to view ourselves through his binoculars.
Parens’ writing is fluent and graceful. But as I’m not a philosopher, I’m less accustomed than others are to the measured pace at which philosophical argument in bioethics is often developed and articulated. Thus, my response to the notion of binocularity is itself binocular, oscillating between admiration and impatience. There is much to admire in a stance that abjures the application of traditional notions of expertise to “bioethicists”—a term that Parens and I both dislike (we may be among its few remaining critics). There is even more to admire in a view that emphasizes the importance of moving beyond advocacy for a position, despite ever-increasing pressures from the media, the public, research funders, academia, and all of the powers that be to demonstrate expertise through superiority of argument rather than through fostering productive discussion and meaningful examination of questions about meaning.
At the same time, however, binocularity may simply be a new and easy-to-grasp shorthand for perspectives that have long been fundamental, both in bioethics and outside it. One example is the instruction to clinicians: “Don’t just do something, stand there!”—an injunction to remember that being with patients is always important and sometimes must take precedence over doing to patients. Another example is Keats’s concept of “negative capability” (Rollins 1958, 193-4), which translates very loosely as comfort with uncertainty, and which has great salience for bioethics. Uncertainty itself—understanding it, embracing it, and exploring those questions of meaning that both excite us and torment us without needing to rush headlong into a single answer or action—is key to binocularity. To explain all this to students, I have often used an address given at St. John’s College by a classmate of mine who is now on the faculty. This short talk, entitled “What Do We Hope to Achieve in Discussion?”, notes that conversation is not competition, not just a debate in which the fittest argument survives, and not merely a way of determining THE right action, but is instead a process that both preserves respect for the meaning-making of conversation partners and has meaning in itself (Dink 1999). All these examples are alternate ways of capturing what Parens invokes as “binocularity,” but his term may well be the most “mediagenic” (Stephenson 1995).
Importantly, Parens’ claims are modest. This volume is certainly an ideal vehicle for undergraduate bioethics education, not only as a companion to teaching based on issues, cases, and even principles, but also as an introduction to a set of critical current issues arising from biotechnological developments. In my teaching experience, many medical students, for example, would benefit from being introduced, in a volume like this, to the expansive landscape that lies between “Here is the answer” and “It’s all just a matter of opinion.” Parens closely examines two arenas in which he has done extensive and exemplary work: surgically shaping children born with physical differences, and the broad sweep of controversy about enhancement technologies, including pharmacological enhancements. He draws together an impressive range of scholars and their views and introduces them to his audience, in order to demonstrate that it is more valuable to understand what a biotechnology is and is not than to win the argument for it or against it. And he successfully shifts the focus of the enhancement debate from “for” or “against” to the examination of what should be regarded as a “true” enhancement, that is, one that promotes human flourishing.
My biggest question about binocularity and its usefulness for bioethics is surely a little unfair, because there’s only so much one can do in fewer than 200 pages. Nonetheless, I think it an important question to ask, because a binocular view seems potentially to have implications that are quite different depending on whether the analysis is of individual decisionmaking or policy-level choices and actions. Parens acknowledges that although his “discussion of the informed consent process is relevant to the practical world of the clinic,” he says “very little that is relevant to the practical world of public policy making”—but he asserts that “a more binocular approach could be useful in that context, too” (172). So my question is simple: “How?”—which is of course nothing more than “Let’s take that next step now!”
Binocularity clearly helps in the clinic—for example, when examining the range of possible choices and outcomes for children born with ambiguous genitalia, craniofacial abnormalities, and other physical differences that can be ‘normalized’ with surgery. Parens presents young people whose choices are very different, and argues convincingly that the availability of a set of technological interventions cannot and therefore should not dictate or control the choices of individuals and their parents. He describes and celebrates choices both for and against surgery, based on individuals’ understanding of their own flourishing. So far, so good.
But let’s try another example of considerable current importance: gene editing. (The relevant literature is extensive and growing rapidly; for a good beginning, see, e.g., The National Academies 2015, Porteus and Dann 2015, Lander 2015, and Hurlbut 2015.) The CRISPR-Cas9 technique for snipping out deleterious mutations and replacing them is, first of all, a promisingly simpler and more effective investigational intervention to correct known genetic mutations than gene transfer has so far proven to be when applied to adults and children for somatic cell interventions. Changes to the germline—that is, changes that can be passed on to offspring and persist for generations—represent one way to eliminate certain mutations from the offspring of affected individuals and thus from the population. This could be accomplished by using in vitro fertilization (IVF) to create embryos, and then attempting to edit out the deleterious genes before implantation. IVF and the use of preimplantation genetic diagnosis (PGD) to select unaffected embryos to implant is the other way, currently in use, to accomplish the same end. In addition to correcting deleterious mutations in the offspring of those few couples all of whose offspring would otherwise be affected, this highly experimental technique could be used for genetic enhancement.
Is this complex, expensive and intensive, multifaceted experimental intervention sufficiently supportive of human flourishing that it should become part of the treatment armamentarium for those seeking to parent children who do not share their deleterious genetic mutations? If we examine individual choices only, the answer to that question certainly may be affirmative; as Parens thoroughly demonstrates, disagreement with the choice does not constitute morally valid grounds for seeking to prohibit a course of action that is freely offered, with appropriate consideration for safety and efficacy, by responsible professionals, and freely chosen by adults with the ability to pay for elective procedures. Both making this choice and pursuing other options, which include not only adoption but also IVF and PGD, can be authentic and valuable choices for individual couples. But shouldn’t we ask a policy-level question too? Is it possible that offering gene editing of embryos for couples other than those few for whom IVF and PGD cannot result in an unaffected embryo could promote a biotechnological solution that runs the risk of crowding out the parallel pathways presented by nontechnological solutions? This question applies equally to the prospect of gene editing for enhancement.
I don’t mean to argue that the resources (technology, time, personnel, finances, infrastructure) devoted to making gene editing possible will necessarily create a zero-sum game that makes other options impossible. But the availability of biotechnological solutions does necessarily change the contours of the “somewhere in particular” from which we all make our life choices. My point, therefore, is that binocularity works not only when we use a magnifying glass but also when we use a pair of binoculars. Both types of lenses are needed, so that it is possible to oscillate not only between one lens and another but between lens types—between near sight and far sight, between the object and its surroundings. We need to look a lot more carefully at where the objects of our binocular gaze fit in the entire field of our vision. At present, the gene editing debate is largely about how this exciting science can improve our understanding of human growth and development, especially because we know so little about the many interconnected functions of most genes. There appears to be agreement that more conversation is needed before editing should be attempted on human embryos intended for birth, but there is no apparent policy-level way to ensure or even encourage any such prohibition. This position is a nice example of the “value-neutrality” of technology, and, as Parens notes, a technology in and of itself may legitimately be viewed as both value-neutral and value-laden. Nonetheless, all human choices about any technology—to use it or not, and, more importantly, to develop it or not—are necessarily value-laden, even though enthusiasts and critics have different value perspectives about it. After all, science itself has values and exists in a field of social values, from knowledge for its own sake, to the importance of progress, to human flourishing.
Fundamentally, I’m worried that Parens’s argument cries out for further development, in order to lay the policy-level groundwork for genuine caution and the embrace of uncertainty; otherwise he may really just collapse into what he calls a technology “enthusiast” (a worry about which, I have no doubt, he will be surprised to read). All technologies, once developed, are employed to seek the resolution of uncertainty. The fact that this resolution is not always, or even often, achieved doesn’t necessarily matter in the long run. Thus, if binocularity has meaning, then bioethics’ role in fostering discussion about meaning questions has to engage those questions very early—while running alongside technological developments and keeping stride with the science.
In other words, Erik, don’t stop here—please write more.
Nancy M.P. King
Department of Social Sciences and Health Policy, Wake Forest School of Medicine
Center for Bioethics, Health, and Society and Graduate Program in Bioethics,
Wake Forest University
Winston-Salem, NC, USA
REFERENCES
Dink, Michael. 1999. “What Do We Hope to Achieve in Discussion?” Convocation address, St. John’s College Graduate Institute in Liberal Education. September 1999. Annapolis, Maryland. Text on file with author.
Hurlbut, J. Benjamin. 2015. “Limits of Responsibility: Genome Editing, Asilomar, and the Politics of Deliberation” Hastings Center Report 45(5): 11-14.
Lander, Eric S. 2015. “Brave New Genome.” New England Journal of Medicine 373: 5-8.
Porteus, Matthew H., and Dann, Christina T. 2015. “Genome Editing of the Germline: Broadening the Discussion.” Molecular Therapy 23: 980-982.
Rollins, Hyder E., ed. 1958. The Letters of John Keats. Cambridge: Cambridge University Press.
Stephenson, Neal. 1995. Zodiac. New York: Bantam Books.
The National Academies International Summit on Gene Editing, “On Human Gene Editing: International Summit Statement,” Dec. 3, 2015. Available at: http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=12032015a