The Enchantment of Enhancement

The Case against Perfection: Ethics in the Age of Genetic Engineering, By Michael J. Sandel, 152 pp., Belknap Press of Harvard University Press, $18.95

When the phone rang at my parents' house some years ago, our plumber was on the other end of the line. My father got more and more animated as he listened, then exclaimed loudly, obviously pleased and excited. When he hung up, he ran through the house, looking for my mother, shouting that he had just talked to John! (Not his real name.) John himself! Directly! Not his wife!

This was indeed an astonishing turn of events: Our friend and plumber had had profound hearing loss for most of his adult life. For years, all his business transactions had been relayed through his wife. But John had recently had a cochlear implant, and his whole world had been - happily, for him - turned upside down.

I knew what was coming next, and I doubted it would transpire so smoothly. Dad would press my deaf-from-birth sister to consider, once again, getting an implant. For him, the procedure was a simple matter of eliminating a terrible disability. After some long, painful exchanges, she finally capped the discussion by declaring, "I am proud to be deaf." And finally, that was the end of it. Their points of view were clearly, and irrevocably, incommensurable.

Michael J. Sandel's book, The Case Against Perfection: Ethics in the Age of Genetic Engineering, opens with the story of a deaf lesbian couple who deliberately chose to conceive a deaf child. They believed themselves to be part of a rich and vibrant culture, and they wanted, as do many straight, hearing couples, a child who was like them. Their story encapsulates, on the one hand, the same argument that raged at our house: deafness as disability or cultural identity. On the other hand, the "engineering" aspect of this couple's story added an additional complexity to that debate: deafness by design.

In this short and provocative treatise, Sandel, who is professor of government at Harvard and a member of the President's Council on Bioethics, takes on the question of why certain kinds of newly available genetic technologies make us uneasy. What is the moral basis of our acceptance of some technologies to "design" better babies, better athletes, better adults, and our rejection of others? What is wrong with doing everything possible to ensure a better future for our children, our society?

There is indeed something oddly mesmerizing in the contemplation of a world of endless possibility. Such a world is more than theoretically available to us. In sports, steroids and other performance enhancers, such as "artificial altitude training" for runners and cyclists, can create "superhuman" spectacles. Memory-enhancing drugs might eventually treat people who are cognitively impaired from diseases, so why not use them to prevent "normal," age-related memory decline? Why not give growth hormone to average-height children who simply want to be tall enough to play professional basketball?

Sandel says the questions he poses "verge on theology," but here he does not go far enough: These questions are actually at the core of theology, and perhaps they can be answered only in the context of religious belief. Humans are, at a fundamental level, created, contingent human beings. There is something irreducibly mysterious about how persons come into being, with particular characteristics, personalities, talents, and abilities. Not all of these can be controlled. But the great lie of technology is its inherent assumption that a vast array of traits and experiences, perhaps even an infinite array, can in fact be controlled. In theological terms, one might say that this view mixes up the created with the creator.

This false notion of control results from hubris, the Greeks' term for excessive pride that I waited for here, almost in vain. Finally, it appears, on the next to last page of the book. But hubris, and the wrongfulness of it - sin, perhaps? - is at the root of Sandel's "ethic of giftedness," an argument that more than verges on the theological, since it implies a giver. His ultimate stance is that "we would do better to cultivate a more expansive appreciation of life as a gift that commands our reverence and restricts our use." Sandel's book reminds us that the proper starting point for bioethics is not, 'what should we do?' but rather, 'what kind of society do we want?' And 'what kind of people are we'?

Faith McLellan is the North American Senior Editor of The Lancet.