For further comment on this topic see our editorial on page 12 of this issue.
A revolution is underway. Its long-range effects promise to be more dramatic than those of the Copernican, Industrial, and Darwinian revolutions. The combined results of research and application in genetics, brain physiology, pharmacology, and psychology present us with the prospects of fundamental changes in human values, functioning, and relationships.
The human engineering revolution refers to the modification of human beings through genetic, physiological, or psychological intervention. Human engineering could begin at four points: before conception; at conception; prenatally; postnatally.
Genetic Control
Prior to conception, controlling the number of births may be exercised through contraception or sterilization. When used with genetic screening, either of these procedures may also serve as quality control techniques. If genetic screening suggests that a baby might be defective, parents can choose whether or not to keep the child and whether they should try to reproduce at all. Such selective reproduction will affect the human gene pool and the occurrence of genetic defects.
Approximately 250,000 defective births occur annually in the United States, about 20 per cent of known genetic causes. More than 2,000 genetically distinct defects have been identified. The annual cost of institutionalizing people with Downs syndrome is $1.7 billion. About 5 million couples now need genetic counseling. Today, it’s the couple’s decision to risk having defective children. Tomorrow, it may be the government’s. Famine, overpopulation, and the cost of institutions may change who decides who can procreate.
Couples may end up childless if they are prevented from risking a defective child or if they choose not to reproduce. This is where some other techniques become attractive. Among those techniques being developed for use during the conception period are: artificial insemination; in vitro fertilization; and cloning.
Artificial insemination, an imprecise selection procedure, involves the mechanically assisted fertilization of the egg cell by a donor. It raises some thorny moral issues. If the donor is not the husband, is that adultery?
When an egg is removed from the ovary, fertilized in the laboratory, and returned to the uterus of a hormonally prepared female, the technique is in vitro fertilization. You get a “test-tube baby.” You have greater control over the product when you can choose which egg to fertilize. The mother may or may not be the original donor of the egg. The recent birth of Louise Brown in Great Britain shows that the procedure can succeed.
Cloning involves removing an egg cell, substituting any adult body cell nucleus for the original nucleus, and implanting the renucleated egg in a prepared uterus. Cloning is asexual reproduction; no father is required. The offspring is genetically identical with the donor of the body cell nucleus. We could have a cloned mammal by the end of this century.
The major techniques being developed for use during the prenatal period are: amniocentesis (with abortion); gene transfer or surgery; and ectogenesis. Of these procedures amniocentesis is currently being applied and ectogenesis is probably the farthest from realization.
Amniocentesis is the procedure of withdrawing a small amount of amniotic fluid from the uterus. Fetal cells are then removed from the fluid and a culture is done. Researchers estimate that more than 500 metabolic genetic deficiencies will be determined this way by 1980. Amniocentesis by itself is only a diagnostic device. If the fetus is defective, then a choice must be made between several options: The fetus may be allowed to develop and be born genetically defective; the fetus may be aborted; at some point in the future, genetic surgery may be performed; other medical treatments such as fetal blood transfusions or fetal surgery may be performed. The first three options raise a number of ethical issues.
Genetic surgery is the purest form of genetic engineering. It involves changing the genome by means of special enzymes and bacterial plasmids. Eventually, direct manipulation of human genes may be able to free people from genetic defects. In addition precise genetic changes toward some “ideal” human may become possible.
Ectogenesis is fertilization and gestation of a fetus in a special incubator. A baby “born” in this way would be the true “test-tube baby,” though the stainless steel apparatus being developed is larger and much more complex than a test tube. Spontaneously aborted fetuses have been kept alive for up to forty-eight hours in the fetal incubator, but waste disposal is a problem. The cost of developing ectogenesis would be generally prohibitive, though it could be used to help scientists develop more efficient fetal immunization and genetic engineering procedures by making the fetus more accessible to treatment.
Avariety of postnatal, genetically oriented techniques are also being developed, such as direct injection of a missing enzyme and implanting a missing enzyme under the skin so that small amounts leak into the bloodstream. Other procedures include nutritional control and organ transplants.
Psychological Control
In addition to genetically oriented procedures, there are eight psychological techniques by which human beings can have their attitudes, feelings, values, states of consciousness, or behavior modified. These techniques may be divided into two categories: biopsychological intervention and environmental manipulation.
Biopsychological intervention is accomplished through the use of psychosurgery, psychoactive drugs, or electrical stimulation of the brain. These procedures involve some form of direct physical intervention, focused primarily on the brain and involve changing the internal structure or state of the organism.
Psychosurgery refers to the destruction of a portion of the brain in order to modify undesirable behaviors or states of mind. Usually, healthy portions of the brain are destroyed through use of a cutting instrument of electrolytic lesion. Psychosurgery seems to affect a person’s general emotional state rather than controlling a specific behavior pattern. The most predominant use of psychosurgery has been to control pathological aggression or violent and uncontrollable behavior among children, epileptics, institutionalized prisoners, and mentally ill people. With the advent of modern psychoactive drugs, psychosurgery seems to have declined from over 70,000 procedures in the late 1940s to mid-1950s to about 500 to 700 per year currently in the United States.
Psychoactive drugs are chemical agents that affect the psychological state or behavior of the user. They are used as therapeutic agents, for recreation, and as performance-enhancers. As many as 37 million Americans legally and illegally each year use such sedatives as barbituates. They spend $2.5 billion annually on psychoactive drug prescriptions, and at least $2 billion more on illegal drugs. Psychoactive drugs have the highest rate of entry of any legitimate drugs. The National Institute of Mental Health lists more than 1,000, and the list is expanding rapidly. New research is producing drugs with more direct action and fewer side effects. These drugs include major tranquilizers such as Thorazine, such antidepressants as amphetamines and Ritalin, and such minor tranquilizers as barbituates.
There are many reasons for this startling increase in drug use. We have discovered that tranquilizers virtually eliminated the need for psychosurgery or strait jackets, substantially reduced the use of shock therapy, and made it possible to place patients in the community at much lower cost than long-term hospitalization. In addition, the “happiness ethic” of Americans has encouraged widespread drug use. We use drugs in wholesale fashion to cope with the more-or-less normal stresses of life, depression, and boredom. Many critics also argue that doctors, who are largely dependent upon pharmaceutical house ads for their information, have encouraged overuse.
The third form of biopsychological intervention currently being developed is electrical stimulation of the brain (ESB). This technique involves putting electrodes into specific regions of the brain and discharging electrical current. The electrical stimulation can be varied and controlled with or without the subject’s knowledge. ESB has not yet been accepted as a standard therapeutic technique but is likely to become more accepted because of its flexibility and non-destructive effects. The production or inhibition of rage, sleep, motor functions, peace, and sexual activity have all been demonstrated through ESB. The mood of schizophrenics seems to improve for several days. It can help relieve anxiety, depression, and epileptic seizures. It is important to note, however, that electrodes placed in a specific part of the brain do not always produce a particular behavior. The technique is still imprecise.
Information control provides selected information and we form and change attitudes and values, establish emotional responses, and direct our behavior on that basis. Information not only provides a basis upon which to act, but it also shapes self-concepts, which, in turn, strongly influences behavior. The two most powerful forms of information control are the educational system and mass media, especially television. Both technologies provide ideals and norms that are either directly or indirectly reinforced.
Biofeedback, primarily used to relieve stress, involves the monitoring and control of various autonomic nervous system responses by means of auditory or visual feedback provided by a machine to which the patient is connected by means of electrodes. Brain waves, heart rate, respiration rate, and other internal processes previously thought to be outside of conscious control can be controlled through use of biofeedback apparatus.
Conditioning, probably the most well-known psychological control technique, takes two forms: classical and operant. Classical conditioning involves pairing a previously neutral stimulus with an unconditioned stimulus that is biologically linked with a natural or unconditioned response. Through this association the previously neutral stimulus becomes capable of eliciting the conditioned response. The most well known example is the Pavlovian dog, which salivated at the sound of the bell after the sound of the bell and the sight of food had been associated. Operant conditioning is the positive or negative reinforcement of certain behavior. In general, positive reinforcement increases the probability and rate of a response; negative reinforcement decreases it. Operant conditioning has become widely and successfully applied in hospitals, schools, smoking clinics, diet clubs, and prisons.
“Brainwashing,” a complex mixture of information control, conditioning, and coercion, involves domination of the environment by the modification agents. To be effective it does not need to involve physical torture, psychoactive drugs, or invasion of the brain through surgery or stimulation. Rather, attempts to break down trust, the removal of personal emotional supports, physical exhaustion, implied or overt threats, positive reinforcement for compliance, repetition, and group pressures to conform are used to break down the defenses of the individual. The recruiting procedures of some new cults and the deprogramming that has tried to counter them are similar to classic brainwashing. Are they successful? Outside the controlled environment, many individuals seem to return to their original views.
Of all the psychological control techniques, psychoactive drugs and information control seem to have the greatest potential for mass use. At this point, behavior conditioning and biofeedback seem to be the most precise.
Basic Issues
The motivation behind human engineering research is, for the most part, commendable. The scientists want to alleviate suffering by the correction of genetic or behavioral defects; therapeutically control and rehabilitate those who are societally dangerous; and improve the overall functioning and future potential of the human race. Perhaps the techniques are inappropriate or we haven’t the right to do such things. But few people would argue with the goal of helping people to function better.
For many scientists the issue centers on the freedom of inquiry which, until recent years, was rarely challenged. Two premises underlie this freedom of inquiry, which, until recent years, was rarely challenged. Two premises underlie this ways in which their findings are applied; and that progress is the highest good, and it can only be guaranteed if we try to control our future. People on the other side argue that the right to know is not absolute, for the very act of investigation frequently raises moral issues. When progress is absolutized, people tend to justify unethical means to accomplish the ends. Those people who oppose human engineering research and application fear political abuse and the alteration of human beings in ways that violate human integrity and dignity.
First, with regard to political abuse, opponents usually point to the medical-political abuses of knowledge for what they considered a higher goal, that is, human perfection. In response to claims that this could only happen in a dictatorship, opponents point out that the vast majority of contemporary governments are dictatorships. Furthermore, the pressures of overpopulation, famine, and economic difficulties may force many remaining nondictatorships to become so in the future. Opponents of human engineering generally would concede that most scientists are not attempting to be malicious or oligarchical elitists. But they point out that scientists are not free of the desire for power.
Second, opponents also argue against human engineering because it poses a danger to the integrity and dignity of human beings. For example, the new genetic and psychological technology makes possible the apparently noncoercive control of persons. That is, a person could conceivably be unaware of being genetically programmed and thus controlled. Those people subjected to various electrical, chemical, and conditioning interventions might not know they are being externally controlled. Further, people might actually prefer the controlled state if it is found to be as pleasurable as some reports of psychoactive drug use and electrical stimulation indicate.
Ironically, the fundamental issue on both sides of the debate is control. Many scientists don’t want their activity controlled and the citizen doesn’t want his life controlled either. Within this context specific issues have emerged. These include informed consent; protection of the institutionalized; and review of proposed research.
The informed consent issue centers on the right of the individual to privacy and the exercise of political choice to protect himself from a scientist’s right to know. Is it ever possible for a layperson to be genuinely informed of technical procedures in such a way that he can reasonably assess personal risk? Is it possible to get true consent from mentally deficient persons?
Related to that is the protection of the institutionalized and minorities. The institutionalized groups under primary focus currently include prisoners, the mentally retarded, and those in mental hospitals. The issue of minority rights becomes involved, since the majority of prisoners are members of minority races. People in each institution tend to come from lower socioeconomic groups. How can the rights of religious, racial, sexual, and political minorities be protected if their beliefs and behaviors seem to be counter to the public good? What if human engineering could make them compatible? The procedures used in the Soviet Union to quiet dissidents by declaring them mentally ill, hospitalizing them for years, and subjecting them to abusive “rehabilitation” procedures, makes the issue a live one. Experimental medical procedures are often first tried on such populations. The distinction between therapy and experimentation frequently becomes murky.
A third, and related, issue is the review of research. Who should review scientific research and decide whether it is ethical and should be performed? Until recently these decisions were considered either the sole province of the individual researcher, or were subject only to a professional review committee. An increasing number of persons is demanding that experimentation involving human subjects or with significant human implications not only involve more rigorous institutional review, but that it also be subject to public review.
Value Implications
In addition to these specific issues, the technology of human engineering raises a number of important questions about traditional Western values. It has fundamental implications for our conceptions of the individual, the family, and the state. For example, cloning, genetic surgery, ectogenesis, and psychosurgery raise difficult questions regarding human nature. What does it mean to be human? Does psychosurgery create a new person? Is a test-tube baby a human being? Does a person on drugs or using ESB for pleasure become less of a person? Do these procedures violate human dignity and integrity? Do fetal research and abortion constitute murder?
The value of the individual is significant in the formation of ethical guidelines. It will largely determine which side the private-right versus the public-good issue a group will decide for. If people are individually valuable, ethics will focus on safeguarding individual rights. Any other view will subordinate individual good to the good of the state or of the greatest number.
The procedures of human engineering also raise basic questions about the nature of the family. How will asexual reproduction affect the husband-wife relationship? What about the parent-child relationship of an in vitro fertilization? Who are the child’s parents? Will amniocentesis and genetic screening strengthen or weaken family bonds?
To what extent will we eventually consider these techniques as essential for the attainment of such widely accepted values as progress, security (personal, family, and national), happiness, and life? Will they become rights for individuals? Will people be able to demand drugs, ESB, or genetic surgery in the name of the pursuit of happiness? Should they become individual rights? Should the government be allowed to invoke human engineering for the good of the people as a new kind of benevolent despotism?
Are happiness and freedom always compatible? Does the pursuit of happiness sometimes mean the decline of freedom? Or does the protection of individual freedom mean that certain human engineering techniques will have to be restricted?
At this point, the evangelical scientist and community should be actively involved in helping to develop an ethical framework, which would recognize the legitimate domain of scientific investigation but would also grapple with constructing appropriate guidelines to protect individual freedom dignity. The evangelical is committed to truth and ethics. Governmental and scientific bodies that ignore this are short-sighted.
On the other hand, evangelicals cannot arrogantly think that only their way will lead to the safeguarding of the human race. The traditional values derived from our Christian heritage are unlikely to be changed significantly. Concern about the ethics of human engineering experimentation and application provides a common meeting place for science and Christianity. Commitment to a conservative Christian theological position has characteristically carried with it some specific concerns about human research on people.
1. Protection of individual integrity and dignity. Basic human nature ought not be violated by research procedures or applications. Does it enhance or impair the person’s ability to relate to, worship, and glorify God? Does it enslave or enhance a person’s capacity to make choices?
2. Compatibility with creation ordinances. What implications do the procedures have for marriage, family identity, morality, fidelity, and loyalty? Does genetic engineering violate the boundaries of creation? Is man usurping God’s role?
3. Specific ethical guidelines. What are the biblical principles that will provide the basis for an ethic of human experimentation? The Bible does not seem to be against change. It does not even absolutize individual rights.
4. Manipulation and discussion. To what extent are human engineering procedures manipulative and dehumanizing? The scriptural pattern seems to establish discussion as the means for change. Should manipulative procedures that are used in some research be partially or totally opposed?
5. Improvement. Does God set any limits on biological or psychological movement toward perfection by technological means? Should such techniques be used to aid the development of the fruits of the activity of God’s Spirit?
6. Compassion and ambition. Does our biblical responsibility for human beings affect taking risks that may or may not have good results? Can we oppose the development and application of procedures that may relieve suffering just because of the risks? What are the demands and limits of compassion? How can we protect ourselves from the confounding of compassion and ambition?
Craig W. Ellison is chairman and professor of psychology and urban studies, Simpson College, San Francisco, California. He edited “Modifying Man: Implications and Ethics” (University Press of America, Washington, D.C.).
