Scientific progress from an ethical perspective. The remedy and the disease
Gonzalo Herranz, departmentde Bioética, Universidad de Navarra
lecturedelivered at the Centro Cultural Ibercaja, Huesca, 12 January 1990.
I. Ambiguity of technical progress
II. Technological imperative and ethics
(a) Virulence of micro-organisms
First of all, I would like to thank the Centro Cultural de la Caja de Ahorros y Monte de Piedad de Zaragoza, Aragón y Rioja, and especially its Director, Doña María Teresa Arroyo, for her invitation to come here again. I could not say no, despite my purposeto restrict my trips outside Pamplona as much as possible. But the fact is that I am here and very happy.
I. Ambiguity of technical progress
My purposethis afternoon is very simple. I want to plant in the minds of all of you, especially in the minds of young academics, an idea: that it is necessary to question the ethical significance of scientific advances. It will become less and less excusable to refrain from weighing up the consequences for human and moral values of what are often called the achievements of science and technological progress. In other words, we cannot avoid the question of calculating how much each of these advances costs us in terms of freedom, dignity and respect for one another.
This approach may seem, at first glance, a little exaggerated, almost the resultof a pessimistic and cowed vision of the future. And yet it is not.
In the first place, a critical attitude towards science is compatible with a positive and grateful adherence to it, by virtue of the immense benefits it has brought us. Moreover, as a matter of justice, we are obliged to such adherence. I believe that an overwhelming majority, if not all of us, have this logical favourable, even enthusiastic, disposition towards scientific progress. It makes us live very well and from astonishment to astonishment. A new computer model staff , whose performance we have to rub our eyes because we do not believe it; or the revolution that is being prepared thanks to recent discoveries about superconductors, which is keeping researchers and captains of business awake at night; or the designof new vaccines through engineering Genetics, so astutely applied that one is left smiling for hours in admiration of how far human ingenuity is reaching: all these things make us vibrate and feel lucky to have been born in time to witness so many wonders. One of the reasons for wanting to go on living and losing our fear of old age is the conviction that, just around the corner of the time in which we live, we will find marvels that science, that fairy godmother of our time, will have brought forth with her magic wand. There are very few who are still nostalgic for "pre-war things", who long for the good old days. There is a vast majority of us who look confidently ahead and who take on the typically progressive attitude of hoping that everything will be better, that the future will bring us many good things. reservation.
But there is every reason to believe that not everything is rosy. That same progress, so effective and surprising, gives us a few scares from time to time. Our usual justified confidence in scientific progress is sometimes shaken and weakened by news that startles us.
And so, for example, we learn that neurosurgeons everywhere are transplanting immature nerve cells taken from human embryos into the brains of some patients, without this decision having a solid scientific basis. It was necessary to put a stop to new interventions, which many wanted to carry out in order to show that they too were state-of-the-art and capable of performing them. After a few hundred cases, it is not yet clear whether the transplantation of embryonic nerve tissue brings any benefit or acts as a placebo, very costly in economic or ethical terms.
We have learned that, faced with the need to do whatever it takes to alleviate the anguish caused by the fatal evolution of AIDS, some governments or public agencies have repealed the requirementssafety checks required to authorise the administration of vaccines and drugs to humans, thereby running risks that could not have been calculated. For years, medical and pharmaceutical institutions have been clearing our pharmacies of products with zero or positively harmful efficacy and have established mechanisms to ensure that all new medicines are recommended by stringent safety controls. Now, taking advantage of the gap in the system opened up by the urgency to treat AIDS with whatever is at hand, will it not be possible for agents of more than dubious efficacy against cancer, for example, to slip into our pharmacies? That would be a tremendous regression.
Much of this alarming information is published only in scientific journals, which are usually read by a very restricted readership. But there is also no shortage of news in the newspapers that we all read about the unsafety of such types of nuclear power plants, or about the contamination of food by additives and preservatives that damage our cells or cause cancer, or about the criticisms from environmentalists that remind us that the problems of environmental degradation continue to overshadow any more active use of natural resources. The growth of issueof those in advanced countries who vote for the Greens means that the issueof those who are quite shocked by the price to be paid for technological progress is increasing.
There are, indeed, some reasons for reasonable concern. But it is perhaps not these accidents or unforeseen events that we should be concerned about. Such mishaps serve, ordinarily, as a cry of alarm to take due precautions to avoid them in the future. It is in the nature of man to learn certain things only as a lesson.
The problems that should concern us, it seems to me, are made of other materials. The problems that justify, not a suspicious attitude, but a calm and critical consideration, are those that come from the immediate and tangible possibility that we have today, with the instruments that scientific progress has given us, to manipulate man himself: today we can produce human beings on the laboratoryto destine them to live or to sacrifice them for the sake of the research; we can select them through the application of gene probes, to allow the life of those who pass the quality tests and destroy those who are stigmatised as undesirable; we can, through the management of certain drugs, drive them mad to punish their political dissidence or gratify them with a paradise of psychopharmacological pleasures.
Little or nothing was known about this a few years ago. Scientific progress, it is clear, is a vehicle of formidable power and enormous versatility. Depending on who gets behind the wheel of the machine, it will go one way or another. And, on its course, it may respect man and serve him, or it may run him over. Progress, with all its wonders, is blind. Rather, it is ambiguous: it is the instrument and cause of countless benefits, but it can also be the instrument and cause of domination and destruction.
II. Technological imperative and ethics
We have to ask ourselves why this is so, why progress is ambiguous. Last year, at a medical congressin a Scandinavian country, a Lutheran theologian was invited to offer the participants some ethical considerations on a fascinating topic: the prenatal treatment of foetuses with alterations of the developmentnervous system. He began his lectureby recalling the words of President Kennedy: "If anyone asks why we want to go to the moon, the answer is simple: because we can. No other answer is needed. These words, in the eyes of our theologian, represent the culmination of a process that began, 300 years earlier, when Francis Bacon declared that human reason, thanks to the new logic, had come of age. Reason was emancipated to undertake on its own the improvement of the world and the unfolding of its power over nature. For Bacon, Adam's fall had meant the loss of both his state of innocence and his dominion over creation. The life of mankind since then, thought the chancellor of James I of England, is the story of attempts to repair these two tremendous losses: the loss of innocence through religion, the loss of mastery of the world with the financial aidof science and craft.
But Bacon's optimistic forecasts have resultfailed. There is ample evidence of this, the most eloquent of which is the dominance of some people over nuclear energy. It should be stressed: the problem is not so much that the liberation of atomic energy has been achieved. What is worrying is that only a few people are the masters of status. We have no part in this. The vast majority of people are oblivious to the magnitude of the threat of nuclear holocaust that hangs over us all. It only takes a few seconds of reflection to conclude that the answer to the question, "If someone were to ask why we stockpile nuclear weapons", cannot be: "because we can. No other explanation is needed". Many explanations are needed.
This, and many other situations, clearly show us that the technological imperative - it is morally permissible to do what it is physically possible to do - is a sourceof misfortune, even if we try to disguise it under the guise of unquestionable progress.
There is no need to insist on topicand to make an inventory of threats unfortunately linked to progress. I have already given a small sample a moment ago. I prefer to pause for a moment to consider the causes of this statusand the remedies we can apply to it. Science is blind to ethical values. The natural sciences cannot be the foundation on which an ethics or even a biosociology can be built: the apple tree cannot bear strawberries.
In my opinion, in order to give an explanation of the blindness of scientific progress to moral values or disvalues, we can start from Bacon's phrase quoted above. He speaks of the twofold loss of Paradise: the loss of innocence and the loss of dominion over nature. Each has its specific remedy: one, religion, the other, science. But it is evident that he and those who succeeded him in the cultivation and application of the sciences were more concerned with regaining mastery over things, which is where material progress has come from, than with restoring order within their consciousness and recognising that there are things that come first and others that come later. Scientists have been so absorbed by their workof dismantling, analysing and recombining, that they have not had time to spend on reconquering innocence, starting with their own. That is, by neglecting the primary task of learning to do no harm, which means innocence, the capacity for moral judgement of many cultivators of science has atrophied. But then, in direct proportion to this neglect, the adventure of mastering nature ceases to be an unequivocal advantage and becomes ambiguous, a tree that bears both sweet and bitter fruit.
It is not easy to convince very intelligent colleagues that the natural sciences without the guideof Ethics are lost, without orientation; that the scientist, if he does not want to go astray, must insistently ask himself about the ultimate meaning of the things he does and applies. Many of them declare that their creed is science, but their faith seems to be no more enlightened than that of the charcoal-burner. They are naively persuaded that, in the twentieth century, science has won the day over religion in every field in which they have clashed. If it is a matter of working wonders, they tell us, there are so many diseases conquered; there is the genuine multiplication of the loaves of bread that is the green revolution; there is the miracle of information technology. If the purposeof religion is to bring all men together in a communion and fuse them into a unity, there are, among so many products of progress, the news or travel agencies that have turned the world into a handkerchief, or Coca-Cola, or billions of television viewers watching the Olympic Games. What is really important, however, is to know whether science is better than religion in preparing us to lead an intense and abundant moral life, not relegated to the back of the mind, but present in every moment in which we relate to things or people.
One can answer this question about the relative capacity of Science or Religion to elevate us morally by saying that, fortunately, things are changing for the better, for, in recent years, Ethics and its representatives - theologians, philosophers and Bioethics practitioners - have burst with great force into the laboratories of Universities and Industries, in hospitals and Sociology offices, in Ministries and in Foundations that finance research. This is true. But, I insist, Ethics is the great absentee. Concern for it is neither sufficiently strong nor extensive. I will adduce a couple of examples from today, with the aim purposeto make everyone's sensitivities raw.
(a) Virulence of micro-organisms
Many weeks, the back page of the British Medical Journal features a articlein the Scientifically Speaking series by signatureBernard Dixon. The articlewhich appeared in a recent issuecommented on an International Symposium held in Zurich on Biosafety. The Symposium brought together scientists and philosophers to study together some issues of public interest, the kind that too easily escape the attention of "narrow-minded experts".
The Symposium, in Dixon's view, failed miserably. The philosophers talked about Philosophy, without landing on familiar ground for the biologists, while the biologists talked, with their infinite capacity for small details, about contamination of bioreactor tanks, safety measures in recombinant DNA experimentation laboratories and so on. But it seems that the desired meetingdid not take place, nor was there any discussion of the ethical aspects of the problem, which was the purposethat had inspired the meeting.
Now comes the example: Dixon tells of the astonishment provoked by the speechof a German groupwho has elucidated the factors that govern the virulence of Escherichia coli. In a fascinating work, they have revealed how these germs, ordinary and peaceful inhabitants of our bodies and those of many other animals, become rabidly aggressive and cause very serious diseases when certain gene-mediated pathogenicity factors coincide. Researchers at groupin Würzburg have been able to clone some of these genes and have succeeded in converting previously harmless strains of E. coli into aggressive and virulent ones using the precise tools available to molecular biologists at laboratory. It seems to be working like a charm. The way is open for the men of laboratoryto produce terribly aggressive germs and even to add deadly toxin-producing genes to them.
Well, what surprised Dixon is that in the face of this astonishing, and alarming, finding, no one in Zurich sounded the alarm. This is an extraordinary omission: not a word, either in the course of the Symposium discussions or in the published conference proceedings, about the possible consequences of work like this subjectfor the odious official documentof biological warfare. No one there seemed concerned about a threat, compared to which the bombs loaded with Yersinia pestis, the bubonic plague-producing agent, that the biological warfare laboratories prepared in the 1960s are an amateurish fudge. The atmosphere of international détente that we are now happily experiencing may alleviate many of our fears and alarms. May it last and consolidate and culminate in the destruction of those aberrant products of scientific researchthat are conventional weapons as well as chemical, biological and thermonuclear weapons. But how difficult it will be to prevent hatred from disappearing and, with it, the determination to use science as an instrument of domination and destruction.
I return to Dixon's example. The indifference of these scientists - all of them university students, pure academics, not in the pay of industry or politics - to the consequences of their programs of study; their almost one-dimensional field of vision and their determination to extend knowledge, disregarding its consequences for man, is a sampleof the tremendous and alarming dissociation between the ability of the wizards of manipulation to dominate nature Genetics(today with bacteria, tomorrow with man) and their rudimentary concern to recover their innocence, to limit their capacity to do harm. This example sample, moreover, shows how often scientists forget, probably unintentionally, ethical values. This is what researcherdoes, focusing only on the problems that can be solved at the table of his laboratory.
But there are episodes that lead us to suspect that there is not only indifference or neglect of ethics: there is also hostility to it. For reasons that are not easy to prove, many officials in international health ministries or agencies deliberately seek to eliminate any ethical considerations in the application of scientific progress. Nothing that is not scientifically validated, nothing for which we do not have controlled and verified evidence, can be applied in the name of science. Ethics being debatable and uncertain, it cannot be the subject of a recommendation. Sometimes there is such an obsession to exclude all "moralising" ethical considerations, such a prejudice in favour of ethical neutrality, that those who conduct science policy prevent themselves from reaching sensible biological conclusions. Let us look at a second example.
Although it is less talked about now than it was two or three years ago, people are still quite frightened by the AIDS epidemic. When, in the absence of protective vaccines or therapeutic remedies and in view of the deadly nature of the disease, scientists and, much later, politicians became aware of the threatening dimensions of the epidemic, they decided to do something very reasonable: promotelarge-scale health information campaigns and Education. This is excellent in principle. But they imposed the requirement that such a Educationcannot be moralising. It is true that no one in their right mind would seriously think that AIDS is a punishment from heaven for the immoral behaviour of its victims or a retaliation of nature against those who pervert the natural order. People, all of us, without distinction, get sick because of our genes, because of micro-organisms that attack us, because of substances we ingest or inhale, and so on. From an ethical point of view, illness, any illness, can be an irrelevant event or it can be offered to us as something that completely dominates our existence. And then, it can be an occasion for self-improvement or moral degradation.
However, it is one thing to reject the far-fetched idea that AIDS is a punishment by Nature to avenge moral permissiveness, and another, equally irrational, thing to refuse to recognise that sexual promiscuity is not only morally wrong in the eyes of a great many people, but also, and above all from the point of view that interests us now, biologically bad, epidemiologically disastrous.
Richard V. Lee, whose regular contributions to the American Journal of Medicine are not exactly characterised by their prudishness, commenting on the epidemiology of sexually transmitted diseases, and in particular AIDS, at the International Infectious Diseases congressin Cairo, writes: "The story of human disease caused by the retrovirus and manifested in this epidemic of malignant immunosuppression, lymphoreticular tumours and exotic superinfections is a shocking one. Not simply because of the desperate prognosis of these manifestations, but because of the widespread impression that the effective treatment of this new scourge will not come exclusively from science.... But, curiously, none of those who spoke there referred to the need to change people's behaviour".
This echoes the slogan "No moralising". The doctor is nullified as a moral agent. To state an empirical reality by saying that promiscuity is biologically wrong may be taken as an offence staffby sexual liberation activists. Insisting, out of good epidemiological sense, that marital fidelity, or if you will, the monogamous relationship, is the only "safe sex", is seen as an assault on civil and political rights. Among health authorities, the idea that recommending monogamy is a reprehensible and uneducated intrusion on the freedom of consciences seems to have become widespread. It also seems that the only way out to avoid offending people's feelings is to limit oneself to recommending certain hygienic precautions in the sex trade, since it seems that the intangibility of the sociologically paradigmatic "lifestyle", which includes premarital promiscuity, the frequent resourceprostitution, homosexuality, etc., has been agreed upon. But to declare that lifestyle as unobjectionable is in its very essence a moral conclusion (even if many are inclined to call it immoral). And the "official" package of hygienic recommendations is as moralising in nature (even if it has to be labelled immoral) as the most earnest calls for continence or marital fidelity. Morality for morality's sake, whichever is biologically safer is preferable here, for the deliberate exclusion of good biological sense causes problems. The educational campaigns of some Ministries of Health constitute a serious lack of good biological sense. We will have to wait for datafor the demographic evolution of the epidemic: for the time being and unfortunately, the prevalence figures have not yet started to decrease.
Enough examples. Let us move on to the conclusions.
I said at the beginning that the purposeof this lecturewas to invite everyone, but especially the youngest, to take an interest in the ethical implications of scientific advances. It will be up to them, of course, to observe the wonders - and also the risks - of these advances in the middle of the 21st century, when the knowledgeof the molecular materials of which the fabric of the human body is made will be incredibly richer and when the capacity to dominate man's mood, opinions and spiritual and less spiritual appetites will have multiplied to an unsuspected extent.
People's lives will be increasingly influenced by scientific and technological progress. Judging them is therefore an obligation for all of us, and one which we cannot neglect. It would be much more comfortable for people - and much more irresponsible - to entrust the solution of moral problems to experts. Just as a plumber is called in to repair a broken tap, we could entrust the experts to solve ethical problems. But, basically, there can be no experts in ethics. Some of us read and reflect and write about what is written about the history of our ethical notions and their philosophical and theological foundations, about the solutions that some people propose for such complicated ethical problems, and so on. In particular, we try to be on the list of people who are invited to participate in symposia or to give lectures on medical problems covered with thorny moral questions.
But ethical decisions have to be taken by each individual. Monsignor Escrivá de Balaguer insisted that spiritual counsellors, experts in moral questions, must give advice, inform, educate: but they must respect the conscience of those they are advising, they cannot usurp their freedom. "But committeedoes not remove the responsibility staff. It is we, each one of us, who have to decide in the end and we will have to give an account of our decisions to God" (Conversations, 96). No one can ethically mortgage his or her responsibility and make moral decisions, blindly relying on the committeereceived.
The same is true in the world of public ethics and bioethics as in spiritual life. One cannot transfer one's responsibility staffto the experts. All of us, if we are truly responsible, have to go through the sometimes severe ordeal of taking sides, of deciding the dilemmas we face, of being an active agent in the fields of ethical tension, where the fate of mankind is being decided day by day. To put it another way: when it comes to making moral decisions, to making ethical judgements, we are all equal, we are all equally expert, each one of us is the only one who is decisively important.
We are, first and foremost, at a sociological and political level. In a democratic state, we can intervene - in the very modest, but invaluable, measure marked by the principle of "one man, one vote" - in the decisions that shape the direction of science and the applications of technology. In contemporary democracies, bioethical issues (health care costs, legislation on scientific technology, family and human reproduction, regulation of the practice of medicine, etc.) are becoming one of the most significant chapters in electoral programmes. It is not enough to say to someone else: go to positionand decide for me. We are all involved, through our non-transferable corporeality, in decision-making.
It is profoundly staffand non-transferable. In his speechacceptance of awardNobel Prize for Literature in 1987, Joseph Brodsky stated that the subdivision of society into a ruling classintelligentsia and everyone else is unacceptable. This statusis comparable to the subdivision of society into rich and poor, into masters and servants. There are, no doubt, still physical reasons, cultural circumstances that favour the existence and perpetuation of social inequality. But, by nature, we are all installed on a plane of absolute intellectual equality, which makes each of us a potential enjoyer of literature. While a piece of music," Brodsky said, "still allows one to choose between the passive role of occasional studentand the active role of performer, a literary work, on the contrary, forces one to play the role of performer.... A novel or a poem is not a monologue, but a conversation of a writer with a reader, a conversation, I repeat, that is very private, that excludes all others.... And while that conversation is going on, the writer is equal to the reader, and vice versa, regardless of whether the author is one of the greats or not. This equality is the equality of consciousness. What is read stays with the person for the rest of his or her life in the form of a memory, nebulous or precise. And, sooner or later, for better or for worse, it conditions the person's conduct". So much for quotationof Brodsky's speech.
We must persuade ourselves that in the times in which we live, we must assume our share of responsibility. As moral subjects, none of us is worth less than a Member of Parliament, a Minister or the King. But the Members of Parliament that we elect are passing laws that affect us directly in our human essence and in our relations with others, laws that were not included in the electoral programmes or were included in a very vague way. They are dictating laws, approved not after the public discussionin the hemicycle of congress, but behind closed doors by consensus of a commission, without having been subject to the moral discussion that would make them genuinely representative. Do the Spanish people have a defined idea about what a "pre-embryo" is and whether it is legitimate to deprive the human embryo less than 14 days old of its human condition? What decision will be taken in Spain about our participation in the project"Genoma" and what uses will be authorised for the enormous amount of information that the mapping of human genes and, in due course, the sequencing of the human genome will provide us with?
Out there, it is said that people have to be, if not erudite, at least knowledgeable, in DNA, they have to know what the programs of studyand research that scientists do in their laboratories mean for each other and for society. Only with knowledgeis it possible to judge in conscience. Nothing good will come out of abstention. There are people who think that it is not within their reach to reach an adequate knowledgeof the very complex biological sciences; or that the biological sciences are something very solid and goal, which cannot be discussed as one discusses religion or politics, areas in which it is said that everyone can give his or her opinion as he or she pleases. This idea of the immutability, the solidity, the almost absolute objectivity of the natural sciences is a widespread error, as it creates a diffuse social tendency towards abstention that leads people to abdicate to the experts. And this error is not only widespread among ordinary people. It is equally widespread among teachers. Lewis Thomas has argued that our ignorance of the sciences, the preliminary nature of our knowledge of any district of them, should be the subject of specific courses that would cure us of the risk of pedantry and make us humble people, persuaded that "there are more than seven times seven kinds of ambiguity in science, waiting to be analysed".
I am afraid. As is proper in Ethics, I will end by giving some advice. The remedy for the disease. Let us assume our responsibility staff, each of us our own. Let's take an interest in bioethics, because we have a great deal at stake here. Let us discuss the news in the newspaper with each other, after having given it some thought. Let us draw each other's attention and practise that very human official documentof contrasting opinions on problems in which serious aspects of our future are at stake. No one has spoken more forcefully or more lucidly on the subject than the Holy Father John Paul II. In point 15 of Redemptor hominis there are some lines which are a whole programme for awakening our responsibility and leading it wisely. Words that will keep us awake, that will help us to reach the desirable balance of being habitually confident and habitually critical in the face of progress and researchof the sciences:
"The first concern relates to the essential and fundamental question: does this progress, of which man is the author and maker, make man's life on earth, in all its aspects, more human; does it make it more worthy of man? There is no doubt that in many respects it does. However, this question must stubbornly be asked again with regard to what is really essential: whether man, as man, in the context of this progress, really becomes better, that is to say, more spiritually mature, more aware of the dignity of his humanity, more manager, more open to others, particularly to the neediest and the weakest, more availableto give and lend financial aidto all". So much for John Paul II's quotation.
We see, in the light of this illuminating text, that we must be concerned, because there are certain fruits of progress that can be poisonous, that can do harm to man. Scientific progress is ambiguous, it lacks the capacity for ethical self-regulation. It has to be guided. Someone has to take it by the hand. And I have the impression that, although some scientists are very interested in the ethical implications of their work research, especially in the field of biomedicine, this attitude does not seem to be sufficiently strong or widespread among scientists.
This is why we must all, without distinction, help in this task. Fortunately, the benefits of scientific progress are becoming an increasingly important part of the election manifestos of political parties and also of the means and aims of the thousand Structuresof our society. It is our duty to ask ourselves tenaciously, obstinately, about the human significance of scientific progress, about its ultimate meaning and its relation to what is really important. The ambiguity of progress is, at final, a stimulus that will always keep us on our guard and enrich our intelligence and our moral sensitivity.
Thank you very much.