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more peaceful. As Jürgen Habermas recently pointed out, there are in-
herent difficulties in wedding current interpretations of good science
and liberal philosophy, as is attempted in the dominant notions of most
biotechnologists.50 Together, these beliefs can tyrannize as much as they
liberate. Despite these warnings, a whole new field of nanomedicine is
being envisioned to exploit nanotechnology for medical purposes.51
Biotechnology and the
Physician Patient Relationship
Whether or not medicine should embrace biotechnology and to what
degree must take into account changes in the nature of the physician
patient relationship over the past half century as medicine has been al-
tered by scientific, economic, and social pressures to an extent yet to be
fully appreciated. Physicians have been urged to become clinical scien-
tists, entrepreneurs, resource managers, employees, and advocates of
society, not of individual patients. As a result, patients have been made
into objects of technical interest, customers, consumers, and a drain on
public funds. Although still viable with most physicians, their tradi-
tional role as healer has been seriously eroded.
As this debate continues over what it is to be a physician, we must
be careful that biotechnological opportunities for enhancement do not
130 CHAPTER SI X
further corrode the profession. At a time when professionalism is widely
thought to be in crisis, it is imprudent to accept a new role as enhancers
of personal and idiosyncratic desires. The augmentation and enhance-
ment of every facet of what it means to be human do not guarantee
that we will be more human. Being best at something, or more perfect
in some trait, does not guarantee happiness or health.
Despite all this, we must recognize that prominent bioethicists of a
more techno-utopian persuasion see few ethical problems even with
the most provocative techniques of brain manipulation. For example,
one prominent ethicist, Arthur L. Caplan, says I see nothing wrong
with trying to enhance and optimize our brains. 52 He rejects the no-
tion that enhancing some will disadvantage others, that brain manipula-
tion will make us less human, or that we will all be subject to coercion
to follow the lure of enhancement. Smart pills, improving memory, and
downloading the content of our brains on a computer (primary en-
hancement) are not analogous to using eyeglasses, artificial hips, or
insulin.
Questions of this type have already spawned a new subbranch of bio-
ethics called neuroethics to deal specifically with the questions that
emerge from the cybernetic, electromagnetic, and pharmacological ma-
nipulations of the human brain. The ethical issues of brain enhance-
ment have special moral significance because of the close association
of brain function with thinking, personhood, free will, and behavior.53
Sophisticated methods of brain scanning seem to suggest a biological
basis for mind, soul, and psyche, recalling Descartes hope of finding
the soul in the pineal gland. Though they might admit that the soul is
not in the pineal gland, many take the new evidence from neurophysiol-
ogy to support a monistic materialist reduction of human nature to an
epiphenomenon of the complexity of its molecular arrangements.
This is the modernist and secular humanist answer to the Psalmist s
question, What is man? (Pss. 8 and 144). But is it a defensible re-
sponse to the request of the President s Council on Bioethics for a
richer bioethics grounded in a better understanding of what it is to
be human?54 For the secular humanist, the materialist monist reduction
would suffice as the final reference point for judgment and inquiry, not
just for enhancement but for all bioethical issues.
Biotechnology, Human Enhancement, and the Ends of Medicine 131
This idea of humanity is of course directly in conflict with the philo-
sophical and theological anthropology of Christianity. The secular hu-
manist and Christian humanist anthropologies are thus set in more
intense opposition than ever before. This dissonance is further aggra-
vated by recent attacks on a central moral principle of Christian ethics,
namely, the principle of human dignity. One bioethicist, Ruth Macklin,
has summarily affirmed that dignity is a useless concept. She argues
that it is hopelessly vague and too closely related to its religious ori-
gins, particularly the Roman Catholic. Another author, Matti Hayry,
argues that there are four competing and conflicting meanings for dig-
nity namely, the Christian and the Roman Catholic, the Kantian, the
genetic, and that expressed in the UN Declaration of Human Rights.55
This author argues that should one or the other of these definitions
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