Steven Hyman: Questions about the ethics of ... biomedical issues 'are questions about our very humanity.'

April 13, 2006  When Leon Kass, chairman of the President's Council on Bioethics from 2001 to 2005, spoke at Harvard last fall, he argued that tinkering with traditional human reproduction through cloning would endanger and diminish human beings, families, and society.

Kass, who spoke as part of a new faculty seminar, "Between Two Cultures," co-sponsored by the Harvard Humanities Center and the Harvard Stem Cell Institute, provoked much disagreement among the faculty members in the audience, many of whom expressed their belief that under carefully controlled conditions, cloning techniques employed in stem cell research can be a powerful tool in the fight against disease and hold the potential for greatly enhancing human welfare.

Perhaps the most apt remark made during the presentation, the first of a projected series bringing together humanists and scientists for conversations on topics at the boundaries of their disciplines, was uttered by Provost Steven E. Hyman, who introduced Kass.

"Ultimately," Hyman said, questions about the ethics of cloning, stem cell research, and other biomedical issues "are questions about our very humanity."

Hyman's statement gets to the heart of why cloning, stem cell research, genetic experimentation, reproductive technology, and other biomedical issues provoke such widespread controversy. They challenge us to define ourselves as human beings and to make decisions about what, if any, limits to impose on our rapidly growing ability to manipulate the essential mechanisms of life.

Nor is biology the only area that poses challenging, complex ethical dilemmas. We are also torn over questions concerning the treatment of animals, the place of religion in a pluralistic democracy, society's obligations to the poor and disadvantaged, distribution of health care, protection of the environment, abortion, capital punishment, and many more.

Given the urgency of these questions, it would be surprising if America's scholars were not devoting time and energy to the quest for - if not answers - then at least greater clarity. At Harvard, faculty members in philosophy, literature, the study of religion, and other areas of the humanities are grappling with these obstinate problems. Scholars in the social sciences, law, medicine, and biology are working in these areas as well, but what unites all of them is their engagement with the great sources of human wisdom and expression - the art, literature, scriptural writings, and philosophical discussions produced by all the world's cultures, for it is here that one finds the most comprehensive and powerful statements about what being human truly means.

Michael Sandel: 'We must bring back into philosophy an older set of questions - about the moral status of nature and about the proper stance of human beings toward the 'given' world. To what extent should we aspire to unlimited dominion over the natural world, even to the point of remaking our own nature?' (Staff file photos Rose Lincoln/Harvard News Office)

The human condition

Michael Sandel, the Anne T. and Robert M. Bass Professor of Government, has been grappling with these issues for more than a quarter of a century - in books such as "Liberalism and the Limits of Justice," "Democracy's Discontent," and "Public Philosophy," as well as in the sometimes heated discussions he conducts in his classes. In Sandel's popular course "Justice," students try to adapt the ideas of Aristotle, John Locke, Immanuel Kant, John Stuart Mill, and John Rawls to the controversial issues of our day.

According to Sandel, most present-day thinking on ethics is informed by one of two dominant philosophical traditions. One of them is represented by Rawls, who taught at Harvard from 1962 to 1995 and whose 1971 book, "A Theory of Justice," building on Kant's ethical system, argued for a society based on equality and individual rights. The other tradition is utilitarianism, summarized by Jeremy Bentham's famous phrase, "the greatest happiness for the greatest number." But Sandel believes that neither tradition provides a sufficient basis for deciding the urgent problems we face today.

"That familiar debate between rights and utility doesn't enable us to answer the questions posed by the new biomedical technologies," Sandel said.

A Kantian would approach such questions by gauging the impact of the new technologies on the autonomy of those affected, while utilitarianism would weigh the happiness that the technologies confer against the costs to society. But according to Sandel, who is writing a book on ethics and biotechnology, neither approach adequately addresses the unease that is evoked by cloning or genetic manipulation.

"To make sense of that unease, it's necessary to think about more than utility and autonomy. We must bring back into philosophy an older set of questions - about the moral status of nature and about the proper stance of human beings toward the 'given' world. To what extent should we aspire to unlimited dominion over the natural world, even to the point of remaking our own nature? Oddly enough, these new biotechnologies may bring metaphysics and theology back to the center of moral and political philosophy."

The other person's shoes

Thomas Scanlon, the Alford Professor of Natural Religion, Moral Philosophy, and Civil Policy, also tries to look beyond conventional thinking in his approach to ethics. Author of the book "What We Owe to Each Other," Scanlon believes that relationships among humans is the first area to consider when confronting an ethical dilemma.

"I don't contemplate cloning with horror," he said. "When you say, as Leon Kass does, that cloning is changing the meaning of what it means to be human, it makes it sound very dramatic. But what does it come to? I would say that if there are objections to cloning, these must be based in claims about the risks to the individuals who are produced by cloning or problems about what it would be like to be a person who was produced in this way."

Scanlon focuses his inquiry on a person's responsibility toward others. As a result, certain ethical questions strike him as less interesting than others. Regarding sexual morality, for example, he believes rape or coercion is clearly wrong because it negates the autonomy of one individual, but he cannot see the activities of consenting adults as presenting a comparable moral problem. Insofar as there are problems of sexual morality that go beyond ordinary prohibitions against force and deception, the issue for Scanlon is not that certain actions such as sodomy are forbidden, but that people are encouraged to put a mistaken emphasis on sex and sexual attractiveness, which distorts their lives and leads them to behave badly toward others.

Similarly, the cloning of human embryos for research does not trouble him because these microscopic bundles of cells are at such an early stage of development that, he says, it is impossible for him to see them as individuals with full human rights. Rather than ask the seemingly unanswerable question, when does life begin, Scanlon would pose the problem in a way that fits the framework of mutual responsibility.

"I would put it more as, 'When does something become a being to whom I owe the sort of concern that defines morality?'"

Initially interested in math and science, Scanlon was attracted to philosophy because it gave him the opportunity to puzzle out why he felt one way or another about a given issue and whether that view could be logically justified. The impulse to systematically examine the bases of one's convictions is not something that everyone shares, he realizes, nor does he see it as a prerequisite for a fulfilling life. But he does believe that the kind of analysis that philosophers perform makes a positive contribution to society as a whole.

"What the philosopher offers is just the advantage of having thought about a subject thoroughly and being able to point out aspects of it that need to be considered. I think public debate is enriched by including people who've thought about things more than most people have time to do."

Ethics and imagination

Janet Gyatso, the Hershey Professor of Buddhist Studies at Harvard Divinity School, has taught courses on Buddhist ethics, as well as many other aspects of the Buddhist worldview, with a particular emphasis on the form of Buddhism that has evolved in Tibet. For her, as for scholars of other traditions, ethics is closely associated with the imagination.

Arthur Kleinman: 'In trying to train physicians in communicating with patients, the humanities can be a great resource.' (Staff file photo Jon Chase/Harvard News Office)

"Buddhist ethics emphasizes empathy and appreciation for the predicament of others. The texts train you to imagine the desires of other people, to exchange places with them. That's a standard Buddhist exercise. I think if we taught that to children in school, it would be something they could use for the rest of their lives."

Not only does the imagination play an important role in developing an ethical perspective, but it is also a crucial element in the vast literature that helps to support ethical training. Biographies and autobiographies, life stories of the Buddha, jataka (stories of the Buddha's past lives), and sutras (narratives of the Buddha's teachings) are all considered important in ethical training, Gyatso said.

"These texts demonstrate how to live a moral life. They present moral conflicts and show how people deal with them, and they show the values and virtues necessary for an ideal life."

Significantly, Gyatso sees imagination as essential not only in dealing with other people but also in learning about and appreciating other cultures. And for her, both have an ethical dimension.

"One of the important ethical aspects of learning about other religions and cultures is that it requires you to be able to imagine yourself in the text, to exercise the kind of empathy and identification that we often lack because we think of foreign cultures as 'other.' It's something that's hard to do well, because you also have to avoid projecting your own fantasies and misguided ideas onto the other culture."

The aim of such study, Gyatso said, is to prepare students to understand other cultures and traditions in a more responsible way, to steer a middle way between the assumption that foreign cultures are essentially incomprehensible and the simplistic belief that people the world over are basically the same.

Learning from the humanities

In certain contexts, using one's imagination to understand another person's point of view can be a life-and-death matter. This is particularly true in the doctor-patient relationship.

Arthur Kleinman, the Esther and Sidney Rabb Professor of Anthropology and professor of psychiatry and of medical anthropology at Harvard Medical School, has done pioneering work in the area of doctor-patient communication, exploring ways in which physicians can learn to empathize with the patient's experience of illness. Much of this work is based on insights and concepts from the arts and humanities.

"In trying to train physicians in communicating with patients, the humanities can be a great resource," he said.

Kleinman, who has done extensive anthropological research on illness and medical treatment in China, makes a distinction between the words "illness" and "disease." A disease is the diagnosis a physician arrives at based on an interpretation of a patient's symptoms. It is this diagnosis that determines the course of treatment. Illness is the patient's own experience of these symptoms.

Kleinman believes it is essential for the physician to pay careful and sympathetic attention to what the patient has to say, because within that subjective narrative there may be important clues to the nature of the disease. This sharing of stories is also important because, as research has increasingly demonstrated, psychological and religious factors can have a powerful impact on health. The humanities, Kleinman believes, can be of great help in training physicians to interpret patients' narratives.

"Doctors are not trained to analyze narratives. Narrative and rhetorical theories developed in the humanities can be used to prepare doctors to better comprehend the stories that their patients relate."

Kleinman calls this interconnection "medical humanities." It is a field he has helped found and one that overlaps in certain ways with the more specialized field of medical ethics, the use of moral and legal theory to make rational decisions about medical care. Medical humanities is broader in scope, more open-ended, and perhaps part of an even more profound shift in how we as a society respond to and care for our fellow beings.

"I've been doing anthropology and medicine since the early 1970s," said Kleinman, "and I believe something significant has happened during the past decade. There's been a greater understanding of the importance of the humanities and the social sciences to medicine and vice versa. We live in an increasingly interdisciplinary world in which whole fields are interconnected in ways they haven't been before. It will be one of the sterling achievements of the 21st century that many fields will be strengthened as a result of these interconnections."