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Fall 2006
Volume 06, Number 1

Newsletter on Philosophy and Medicine

Articles

In Praise of Fairy Godmothers: A Limited Defense of Medicalization

Felicia Nimue Ackerman
Brown University

"Who would be sick, and he might be whole?"1

Around Thanksgiving 2004, I posted the following puzzle on an Internet lateral puzzle forum.
Fairy Godmother: A Thanksgiving Puzzle

All our lives, millions of people, including me, have had a two-pronged wish that seemed grantable only by a fairy godmother. Half of that wish has come true!! Although I am (& fervently believe in being) a "glass is half-empty" rather than a "glass is half-full" type, I must admit that this is something to be thankful for. What is it????2

For those unfamiliar with lateral puzzles, such puzzles are descriptions of situations that are paradoxical or peculiar but have logical explanations, which are uncovered through a series of yes-or-no questions. A woman quickly guessed the wish: to be able to eat everything you want without gaining weight. In case you are wondering how you could have missed this astonishing development, keep in mind that I said only half of the wish has come true. Why, after all, do people want to avoid gaining weight? Primarily for two reasons: people want to be healthy, and they want to look good. We have yet to discover the magic pill that will keep overeaters from getting fat or make fat people beautiful. But—incredibly—we now have magic pills that can take much of the medical risk out of seven-layer cake, ice cream sundaes, Big Macs, potato chips, and pizza. You can eat all you want of these delights and still have a better blood lipid profile than if you lived unmedicated on fish, tofu, and broccoli. Just take a statin to raise your good cholesterol and lower your bad cholesterol. You may think I am starting to sound like a statin commercial, but statins are the only product I know of whose advertisements understate their effectiveness. An advertisement for Lipitor gives the following advice.

Along with your medicine, remember to follow these healthy living tips to help lower your cholesterol3:

* Follow a cholesterol-lowering diet

* Make exercise a part of your life

* Lose weight, if you are overweight

* Quit smoking

In fact, however, as I happily told the forum, if you take Lipitor and ignore the advice, the pill may give you a great lipid profile all by itself. I have found a cholesterol-lowering diet totally unnecessary for this purpose.
Upon reading the responses to this cheery information, I almost wondered whether I had inadvertently typed in "cocaine" rather than "Lipitor." Some of the disapproval was that intense. Several people made reasonable, practical points, such as that statins do not keep your weight down; so if I indulged myself enough to get fat, Lipitor would not protect me from such obesity-related health risks as diabetes. But some of the disapproval seemed ideological. Some people simply seemed hostile to the idea that you can have a great lipid profile without having to struggle for it. Couldn’t I see how decadent it was to want to have my cake and my low cholesterol, too? Why was I taking the easy way out? For the same reason I turn up my thermostat in winter rather than chopping my own firewood—I thought that answer was obvious. But when I checked the bioethics literature, I was surprised to find bioethicists who defended an outlook similar to what I had encountered on the lateral puzzle forum. This paper will discuss their reasons.

Clearly, this issue falls under the heading of "medicalization." The President’s Council on Bioethics defines "medicalization" as follows.

"Medicalization," a term coined by sociologists, means in the first instance

a way of thinking and conceiving human phenomena in medical terms, which then guides ways of acting and organizing social institutions. More fully, it is the tendency to conceive an activity, phenomenon, condition, behavior, etc., as a disease or disorder or as an affliction that should be regarded as a disease or disorder [in that] (1) people suffer it (the essence of patient-hood), or it befalls them; they are victims of it (hence, not responsible for it; (2) the causes are physical or somatic, not "mental" or "spiritual" or "psychic"; (3) it requires (needs) and demands (has a claim to) treatment, aimed at cure or at least at relief and abatement of symptoms; (4) at the hands of persons trained in the healing arts and licensed as healers; and (5) this conception of the condition will be supported by the society, which will also support efforts at treatment out of its interests in the health (as opposed to the morals or the education) of its people.4

This definition invites several objections. For example, considering something a disease neither entails absolving the patient of responsibility for it nor entails believing he has a claim to treatment. AIDS is a disease even according to those who think people who contract it through drug use or sex are responsible for contracting it, and heart disease is a disease even according to those who think obese people and smokers have no claim to treatment. Of course, in making this point, I am not endorsing these unsavory views. Furthermore, even if costs make it unfeasible for everyone to have a claim to every medical treatment, Andrew Stark points out that "the cost of treating a condition should have nothing to do with the question of whether it is legitimately a medical one."5 But these are side issues for this paper, where my aim is to defend a limited form of medicalization—a form that "medicalizes" high cholesterol in the sense of deeming it altogether fitting and proper for people to seek treatment in the form of a "magic bullet" instead of changing their personal habits. This limited claim clearly does not entail that medicalization is appropriate for all conditions where the medicalized person seeks it, let alone where he resists it, as when someone who is satisfied with his unconventional personality and lifestyle has a diagnosis of mental illness thrust upon him.

Why would any bioethicist object to statins? As with my fellow puzzle forum members, some of the reasons can be practical. People can point to the side effects of the drugs or to the fact that, unlike lifestyle changes, statins do not address such risks as diabetes. These points are reasonable, but I will get them out of the way quickly, as philosophically they are much less interesting than the ideological objections. Obviously, people should not count on a drug to address problems outside its sphere. Most unfortunately, this means that statin-users still need to restrict their total calorie intake. Periodic cake, cookie, and candy sprees interspersed with dieting work fine for me. Those who object that this illustrates how drugs are used to compensate for unhealthy eating habits invite the reply that statins prevent such eating habits from being unhealthy, just as central heating prevents spending the winter in Minneapolis from being unhealthy. Admittedly, statins have had very bad side effects—primarily muscle and liver problems—for some people, who should stop taking these drugs. Fortunately, these muscle and liver problems are generally detectable before they can become irreversible. A more insidious problem is the possibility of long-term side effects that can surface years or even decades after new drugs are introduced. This danger needs to be assessed against the possible long-term dangers of going without the drugs. Moreover, drugs can have unexpected long-term benefits as well as unexpected long-term harms.

Far more interesting are the ideological objections to magic bullets. That is part of why bioethicists who discuss medicalization often imagine that such treatment has no side effects, in order to think "about what medicine should do in a world without technological limits."6 For the rest of this paper, I will follow this supposition, as well as Stark’s suggestion to "[i]magine that money is no object."7 Stark’s objections to the easy way out are ideological. Thus he denigrates "a change—a new individual trait or achievement [as] not genuine [when] it comes too easily."8 Stark puts forth what he calls a Kantian view that "cure should never diminish a person’s genuine, struggle-born achievement, whatever it may be,"9 where by "struggle" Stark means "the most effective action that an individual can take…as long as that action necessitates exertion or difficulty."10 Not being a Kant scholar—to put it mildly—I will not try to decide whether Stark is giving an accurate account of how Kant would handle the cases at issue here. Instead, I will call the view Stark’s view. Stark’s book explores the ramifications of the view. I am interested in assessing the view on its own merits. What is wrong with abandoning struggle once it becomes unnecessary for the goal in question?

Stark’s view sees struggle as constitutive of a person’s genuine self. He says, "Every doctor swears to do no harm to the person. But the Kantian doctor additionally swears to do no harm to the subject"11 and that diminishing someone’s struggle counts as diminishing him as a subject. Stark even says his ideal Kantian doctor will not administer a cure if it will diminish a patient’s struggle. Stark’s view holds that someone who, struggling to diet and exercise, wants a magic bullet for obesity (or, presumably, cholesterol), must promise his doctor that he will redirect his struggles to some other arena, for example, by working for Amnesty International.12 Stark’s ideal Kantian doctor thus resembles a Catholic doctor who, considering himself pledged to do no harm not only to the person but also to the immortal soul, refuses to prescribe contraceptives. In both cases, the objection to such medical practice is almost too easy. The doctor is imposing his own contestable ideology on a competent adult patient. Stark’s view mandates a level of intrusion far beyond what current medical practice countenances. By contrast, consider the mainstream view of Ezekiel K. and Linda L. Emanuel. The Emanuels favor what they call the deliberative model of the physician-patient relationship, in which "[t]he aim of the physician-patient interaction is to help the patient determine and choose the best health-related values that can be realized in the clinical situation. …The physician’s objectives include suggesting why certain health-related values are more worthy and should be aspired to."13 This sort of doctor will be attractive to some rational patients. But other rational patients, who have well-defined values and who value independence of judgment, will regard such a doctor as intrusive. Personally, I am about as interested in my doctor’s opinion of my values as I am in my dry cleaner’s opinion. But the Emanuels add that "the [deliberative] physician aims at no more than moral persuasion; ultimately, coercion is avoided, and the patient must…select the ordering of values to be espoused."14 The Emanuels’ approach is far less intrusive than Stark’s view. The role of the Emanuels’ deliberative physician does not include withholding a medically unproblematic magic bullet if his attempts at persuasion fail, let alone requiring its user to redirect his struggle to some other cause, such as Amnesty International.

Even apart from the Kantian doctor’s authoritarianism and intrusiveness, the question remains of what is so terrible about ending avoidable struggle. It may be tempting to reply by treating struggle as (to use George Bernard Shaw’s phrase) "a moral gymnasium,"15 in the sense that struggle that is unnecessary in a particular case may serve to may build one’s character so that he will be better equipped to struggle in cases where struggle is genuinely necessary to achieve a desirable end. The President’s Council on Bioethics says that
healthy people whose disruptive behavior is "remedied" by pacifying drugs rather than by their own efforts are not learning self-control; if anything, they may be learning to think it unnecessary. People who take pills to block out from memory the painful or hateful aspects of a new experience will not learn how to deal with suffering or sorrow.16

This begs the question against the view that learning to take a pill is itself a way of learning how to deal with suffering or sorrow. Furthermore, to the extent that pacifying drugs are both effective and desired by the user, self-control may be unnecessary. In practice, however, people who take such drugs are likely to have plenty of other opportunities to learn self-control. And the council acknowledges that some "people, suffering from certain neuro-psychiatric disorders, become capable of learning self-control only with the aid of medication addressed to their disorders."17 Stark himself acknowledges that the struggle against obesity may deflect one’s attention from other causes. Moreover, even to the extent that the "moral gymnasium" defense is factually accurate, for Stark’s view it is beside the point. His view rejects "a utilitarian justification for struggle."18 Why isn’t unnecessary struggle just pointless make-work or analogous to the make-work that might be given to children, or worse yet, prisoners, to keep them out of trouble? Stark’s answer seems to be that the

genuine self—otherwise known as the "subject"—constructs my life. It does so by working over the years to improve some of [my] characteristics and attributes…to discard others, and to preserve still others. When and as this genuine self does so…it transfers its own genuineness to the new attribute. That new trait…becomes…part of my genuine self, not something beyond it, because it was attained by my self’s own acts: its discipline, perseverance, and effort.19

So why does Stark’s view countenance struggle-free cures for someone who has been struggling against his obesity and promises to redirect his struggles elsewhere? Why doesn’t it hold that such cures would prevent the person’s new slimness from being part of his genuine self? The answer is that it is struggle in general that Stark’s view connects with the genuine self. Accordingly, if someone who has been struggling to bring his weight down asks his doctor for a magic bullet for obesity but promises to redirect his struggles toward a political cause, "[h]e is asking the doctor to allow him not to shrink the acreage that his genuine self covers, only shift it."20

Stark’s view is disrespectful of the variety of human temperaments that can give rise to genuine selves and worthwhile lives. James Lindemann Nelson distinguishes between Margaret Walker's notion of a career self, who "sees his life (aspirationally, in any event) as a unified field in which particular enterprises, values, and relationships are (in principle) coordinated in the form of a ‘rational life plan’…or a ‘quest’…or a ‘project’"21 and a "seriatim self," deriving from Hilde Lindemann Nelson's concept of "living life seriatim," where life is seen "less as an overall unified project and more as a set of fits and starts."22 He adds that the seriatim self "may live a life…more shaped by contingencies than by the expression of personal agency"23 and may "place a greater importance on the goods of relationship."24 Sue Donaldson suggests that meaning in life can come not only from striving but also from savoring "the intrinsic fascinations of the external world."25 Appreciation of beauty, love, and friendship all seem a worthwhile part of the genuine self. Not only can they occur without struggle, but, as I will argue presently, a struggle to love may undermine love’s authenticity. Even scientific and technological achievement can arise less from struggle than from ingenuity. When I was in grade school, my class put on a play called "The Laziest Man in the World." The title was Benjamin Franklin’s self-description. He was too lazy to work, he said, so he invented labor-saving devices.26 Perhaps Stark would reply that Franklin was being ironic and that inventing Franklin’s labor-saving devices required much exertion on his part. Perhaps it did. What if it didn’t? What if it was almost 100 percent inspiration and almost no perspiration, or if the struggles Franklin’s inventions enabled him to avoid exceeded his struggles to invent them? It would still seem unreasonable to consider Franklin’s labor-saving devices as other than genuine products of his genuine and unique mind. And people who choose to use such devices, like people who choose to take statins, are exercising the uniquely and genuinely human rational ability to choose to improve one’s life by profiting from the advances of civilization.

Now consider another objection to magic bullets. The President’s Council says

the "naturalness" of means matters. …In most of our ordinary efforts at self-improvement, whether by practice, training, or study, we sense the relation between our doings and the resulting improvement. …There is an experiential and intelligible connection between means and ends; we can see how confronting fearful things might eventually enable us to cope with our fears…

In contrast, biotechnical interventions act directly on the human body and mind to bring about their effects on a passive subject, who plays little or no role at all. He can at best feel their effects without understanding their meanings in human terms. Thus, a drug that brightened our mood would alter us without our understanding how and why it did so, whereas a mood brightened as a fitting response to an arrival of a loved one…is perfectly, because humanly, intelligible.27

This passage is as open to objections as the ones I quoted earlier from the same source. For one thing, taking a drug does not preclude understanding how it works, nor does it entail passivity. The drug-taking subject may be quite active in developing this understanding as well as in trying to acquire information about what drug will work best for him. If he lives in a world where most doctors are of Stark’s persuasion, he may even have to struggle to find a maverick who will give him a magic bullet. Still, when it comes to changes in one’s mental life, there is a grain of truth in the quoted passage. This has to do with the reference to a "fitting response." Feelings, beliefs, and attitudes can have reasons; so there may be a sense in which it is inauthentic to have a pill change one’s feelings, beliefs, or attitudes when one sees no reason that justifies the change. Carol Freedman argues, "When an emotional problem is sourced in our interpretation or reasons, then we should have a basic commitment to addressing it with insight and understanding. …For central to our maintaining the idea of a self is the commitment to regard some of our actions and attitudes as justified by our reasons."28 We can also have a legitimate interest in evaluating other people’s mental lives in non-mechanistic terms. As Bonnie Steinbock asked in correspondence, "Would you be happy to discover that your devoted lover fell in love with you after taking a love potion?"

But more objections arise. First is the possibility that not all facets of everyone’s unmedicated mental life are authentic. If a depressed person has no identifiable reason for being unhappy, why would it be inauthentic for him to lack a reason in which to ground lifting that unhappiness? As I have indicated, even the President’s Council endorses certain uses of psychoactive drugs.29 Note also that even when the claim about reasons applies, it does not necessarily point in the same direction as Stark’s view. Although Dan Brock remarks that "altering a fundamental character trait or psychological feature by a ‘quick fix’ of ‘popping a pill’ seems to some people too easy and less admirable than changing that trait or feature through hard-earned insight psychotherapy,"30 insight therapy that enables someone to understand his new feelings in terms of his reasons for them need not in principle be hard-won at all. A flash of insight—what psychologists call the "ah ha" phenomenon—is just as "humanly intelligible" as insight that is difficult to achieve in that it is just as much a matter of understanding the meaning of one’s feelings in human terms in the sense of understanding them in terms of one’s reasons for them. Note also that struggle can sometimes make feelings seem less authentic. Steinbock’s rhetorical question about love prompts me to ask another one: Would you be happy to discover that your devoted lover fell in love with you after a long struggle to do so? The recent spate of books and courses offering instruction in how to "make marriage work" invites the suggestion that we take the word "work" as a noun rather than a verb, so that "[i]t’s probably just what those self-help books do, turn your marriage into a chore."31 Finally, and most importantly for this paper, the distinction between reasons and causes applies only to mental life. It makes sense to want to understand one’s feelings, beliefs, and attitudes in terms of one’s reasons for them. There is no parallel with respect to a physical process of lowering one’s cholesterol.

But here is how the President’s Council follows up the passage I quoted about the importance of understanding "in human terms":

And not only would this be true about our states of mind. …Human experience under biological intervention becomes increasingly mediated by unintelligible forces and vehicles, separated from the human significance of the activities so altered. The relations between the knowing subject and his activities, and between his activities and their fulfillments and pleasures, are disrupted.32

These remarks cry out for critical scrutiny. Although the Council acknowledges that biological intervention is intelligible in scientific terms, it uses examples such as steroids in sport to argue that "from the athlete’s perspective, he improves as if ‘by magic’, without the self-conscious or self-directed activity that lies at the heart of better training…he risks a partial alienation from his own doings, as his identity increasingly takes shape at the ‘molecular’ rather than the experiential level."33 In reply to the obvious objection that "[e]ven in the most self-directed activities, we remain ignorant, on the level of experience, of what is transpiring chemically in our bodies,"34 the council says the difference "is not absolute but a matter of degree."35 But, as Stark points out, "an athlete is no more conscious of the ways in which training, exercise, or diet alter her body—the molecular processes at work do not enter her consciousness—than she is of the way in which steroids accomplish the same end."36

The council contends that

things essential to sport—such as aspiration, effort, activity, achievement, and excellence—are essential also to many aspects of the good human life.

Examining the significance of performance-enhancing biotechnical powers for human sport may help us understand the significance of such powers for excellent human activity more generally.37

But an analogy with sport impedes understanding the issues at stake with statins. While reasonable people can disagree about the relative importance and value of effort and natural talents in athletics, sport is clearly an area where it is true that "the ‘naturalness’ of means matters,"38 as does effort. As Brock points out, "sometimes a valued human activity is defined in part by the means it employs, not just by the end at which it aims."39 A ball’s falling into a basket is not an intrinsically desirable end in isolation; means and context are what make it desirable and give it significance. An activity that required no effort for anyone could hardly be a sport at all. A prize could be given to the person who best met some standard regardless of method, but this would no more involve athletic competition than would awarding a prize for being the tallest person in a room. The crucial distinction is between activities that are valued as achievements, so that the means is a central part of the activity, and those where what matters is the result, provided that the means are not themselves immoral. For most people, scrubbing the bathroom floor is a means to a clean floor rather than an opportunity to develop and display their floor-scrubbing skills. That obviously does not make it acceptable to scrub one’s floor with someone else’s face, but it makes it irrelevant to worry about using unnatural means or taking the easy way out. Rejecting such a worry is likewise reasonable when it comes to lowering one’s weight or cholesterol.

So we have two distinct ideological objections to magic bullets. First is Stark’s objection that they might diminish the subject by diminishing his struggle. Second is the objection that they are in some sense "unnatural," in the sense of being unintelligible in human terms. These objections are logically independent. The President’s Council says, "the point is less the exertions of good character against hardship but the manifestation of an alert and self-experiencing agent making his deeds flow intentionally from his willing, knowing, and embodied soul."40 And, as I have indicated, Stark’s view can allow magic bullets as long as they do not diminish the subject’s total struggle. He might have yet another ideological objection, though. This arises from the fact that he would consider a drug "artificial enhancement," hence taboo, if it brought its users to a level no one had reached by non-medical means such as diet.41 He introduces this stipulation in response to Joseph Rosen’s remark that "were he given permission by a medical ethics board, he would try to engineer a person to have wings."42

I am unsure whether statins get anyone’s cholesterol level below what Stark calls "a populated social ideal"43 that has been achieved by means he deems non-medical. But why would it be so terrible (rather than so wonderful) if they did? For that matter, why would it be so terrible if Joseph Rosen engineered wings for people in a world where neither money nor biological side effects were a problem? The conservative approach of the President’s Council stresses "the danger of degradation in the designed, considering how any proposed improvements might impinge upon the nature of the one being improved"44 and maintains that "to have an identity is to have limits."45 But Ray Kurzweil aptly suggests that the essence of being human lies not in our limits but "in our ability to supercede our limitations."46 What, after all, could be more distinctively human than our human intelligence and rationality, which is precisely what enables us to supercede our limitations? This is not to deny that our human ingenuity could lead to our destruction, for (hackneyed) example, through a nuclear holocaust. But the objections the President’s Council levels against limit-breaking biotechnology have little to offer people who do not already subscribe to the council’s quasi-religious worldview. And Leon Kass’s slogan, "shallow are the souls that have forgotten how to shudder,"47 prompts a reply that I have given elsewhere, "narrow are the souls that cannot comprehend that different souls shudder at different things. I shudder at the thought of being denied lifesaving technology because it violates Kass's particular conception of dignity."48

I end by returning to the sport analogy. Some people may choose to treat weight and cholesterol reduction as resembling sports, in that the magnitude of the achievement as an achievement becomes at least as important as the magnitude of the result. I’ll stick with Lipitor. I’m just waiting for my fairy godmother to grant the second half of my wish and come up with a pill that will let me eat everything I want without gaining weight. If she could grant the first half, why not the second? And for the sake of smokers, who rival fat people for the non-athletic title of America’s number one pariahs, I hope their fairy godmother comes up with a magic bullet to neutralize the effects of nicotine. And do you know what else? If Joseph Rosen ever gets permission to engineer a person to have wings, then, to paraphrase a line from a famous song of the civil rights movement, I’ll be flying right there.

Once upon a midnight dreary, while I pondered weak and weary,
Over many rich delights that I was greatly longing for:
Chocolate ice cream, then a truffle, chocolate cake with chocolate ruffle,
All the cravings I must muffle, muffle, though it pained me sore.
"Eat some broccoli," I muttered, "even though it pains you sore―
Only this, and nothing more."
Ah, distinctly I remember it was in the bleak December,
But the following November opened up a bolted door.
So that now when I am eating ice cream, I'm no longer cheating,
And my joy's no longer fleeting, fleeting as in days before.
Lush dessert is not beyond me, as it was in days before.
What's the secret? Lipitor!

Endnotes

1. Sir Thomas Malory. Le Morte D’Arthur (London: Penguin, 1969), 74.

2. Lateral Puzzles 2004, http://www.lateralpuzzles.com/discus/index.htm (searched 6/24/06)

3. http://www.forcholessterol.com/cwp/appmanager/lipitor/lipitorDesktop?_nfpb=true&_pageLabel=lipitorBenefits (searched 6/24/06)

4. President’s Council on Bioethics. Beyond Therapy: Biotechnology and the Pursuit of Happiness (New York: ReganBooks, 2003), 305. Italics in original.

5. Andrew Stark. The Limits of Medicine (Cambridge: Cambridge University Press, 2006), 2.

6. Ibid.

7. Ibid., 1.

8. Ibid.

9. Ibid., 93.

10. Ibid., 91.

11. Ibid., 96.

12. Ibid., 131.

13. Ezekiel J. Emanuel and Linda Emanuel. "Four Models of the Physician-Patient Relationship." In Ethical Issues in Modern Medicine, Fourth Edition, edited by John D. Arras and Bonnie Steinbock (Mountain View, CA: Mayfield, 1995), 57-76.

14. Ibid.

15. George Bernard Shaw. Man and Superman. In Plays by George Bernard Shaw, forward by Eric Bentley (New York: New American Library, 1960), 262-405.

16. President’s Council on Bioethics, 291.

17. Ibid.

18. Stark, 222 n.18.

19. Ibid., 90.

20. Ibid., 131.

21. James L. Nelson. "Death’s Gender." In Mother Time: Women, Aging, and Ethics, edited by Margaret Walker (Lanham, MD: Rowman & Littlefield, 1999), 113-29.

22. Ibid., 122.

23. Ibid., 123.

24. Ibid., 124.

25. Christine Overall. Aging, Death, and Human Longevity: A Philosophical Inquiry (Berkeley: University of California Press, 2003), 175.

26. Eric Chester. 2005. http://www.generationwhy.com/whysarch/0305-e.htm (searched 6/27/06).

27. President’s Council on Bioethics, 292. Italics in original.

28. Carol Freedman. "Aspirin for the Mind?" In Enhancing Human Traits: Ethical and Social Implications, edited by Erik Parens (Washington, D.C.: Georgetown University Press, 1998), 145.

29. President’s Council on Bioethics, 291.

30. Dan W. Brock. "Enhancements of Human Function: Some Distinctions for Policymakers." In Enhancing Human Traits: Ethical and Social Implications, edited by Erik Parens (Washington, D.C.: Georgetown University Press, 1998), 58.

31. Felicia Ackerman. "Entertain the Thought," Witness, 16.1 (2002): 50.

32. President’s Council on Bioethics, 292.

33. Ibid., 128.

34. Ibid., 130.

35. Ibid. Italics in original.

36. Stark, 87. Italics added.

37. President’s Council on Bioethics, 107.

38. Ibid., 292.

39. Brock, 58.

40. President’s Council on Bioethics, 292-93.

41. See Stark, 58-61, 207 n.9, 222-23 n.33, and 22b-27 n.82.

42. Ibid., 31.

43. Ibid., 53.

44. President’s Council on Bioethics, 290.

45. Ibid., 294.

46. Ray Kurzweil. "Chasing Immortality: The Technology of Eternal Life." Interview by Craig Hamilton. What Is Enlightenment? 30 (2005): 67.

47. Leon Kass. Life, Liberty and the Defense of Dignity: The Challenge for Bioethics (San Francisco: Encounter Books, 2002), 150.

48. Felicia Nimue Ackerman. Letter to editor. The Progressive (July 2005): 6.

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Fall 2006 Volume 06, Number 1

Fall 2006
Volume 06, Number 1