January 3, 2012
It was a sunny Monday in mid-December when Newt Gingrich arrived in the cafeteria of L-3 Warrior Systems, in New Hampshire. Because the company is technologically sophisticated, labor-intensive, military-affiliated, and close to the Manchester airport, it is an enticing venue for Presidential candidates. In honor of Gingrich’s visit, the tables had been removed, and the chairs were lined up in rows. A few months earlier, a Gingrich visit might not have required any rearrangement of the furniture: in June, after a slow and frustrating start to the campaign, most of his top staffers quit, and pundits couldn’t believe that Gingrich didn’t have the sense to quit, too. But in October, after a series of feisty debate performances, his poll numbers started improving; in late November he was endorsed by the New Hampshire Union Leader, the state’s largest newspaper; and by the time he arrived at L-3 Warrior Systems he was leading in the national polls. He was thrilled by his comeback, though not surprised. “I’m now, I think by a big margin, the front-runner,” he said, and he passed a pleasant half hour telling the assembled employees and reporters about his plans to debate President Obama into ignominy, thereby clearing the way for a transformative Gingrich Administration.
Gingrich has been a national political figure for more than thirty years, although he sees himself as a historian. He has a Ph.D. from Tulane, and was a history and environmental-studies professor at West Georgia College in the nineteen-seventies; he still has a knack, common to effective teachers, for making his listeners feel smart for keeping up with his train of thought. He speaks in a soft tenor, often tucking his chin and leaning toward his interlocutor—if he wore glasses, he would be constantly peering over them. When he arrived in Washington, in 1979, he was a new kind of Southern conservative. He represented Georgia’s Sixth District, the wealthiest in the state, and he combined the expected denunciations of the “corrupt liberal welfare state” with unexpected paeans to the emancipatory powers of information technology and galactic exploration. In 1984, Gingrich published a manifesto, “Window of Opportunity,” which has on its cover a space shuttle and a bald eagle; its author is advertised as “Chairman of the Congressional Space Caucus.” The preface, by the science-fiction writer Jerry Pournelle, declared, “It’s raining soup, and Newt Gingrich has the blueprints for soup bowls.”
A less original politician, or a humbler one, might have assumed that fierce partisan invective was incompatible with futuristic policy proposals. But Gingrich saw that these two kinds of provocation, combined, could form the basis of a crafty political strategy: the more sharply he criticized liberalism, the more freedom he had to depart from conservative orthodoxy. He described himself as a leader of a band of nuanced partisans. “We’re post-New Deal conservatives, not anti-New Deal conservatives,” he said.
Even by Washington standards, Gingrich was a rough infighter. He assailed the first President Bush for raising taxes, and, through ruthless maneuvering and a brilliant reinvention of congressional fund-raising practices, he engineered a Republican takeover of Congress: in 1995, he became the first Republican Speaker of the House in almost half a century. He presided over four tempestuous but productive congressional sessions—he was, he says, “fortunate” to be paired with President Clinton, and they collaborated to reform welfare and to balance the federal budget. But by 1998, when he announced his resignation, Gingrich had alienated many of his Republican allies, and his personal unpopularity probably hurt the Party in that year’s elections. When he returned to the campaign trail, after a highly remunerative decade in private life, he seemed remarkably unchanged: he is now sixty-eight, but he speaks and thinks with the same itchy impatience that charmed and horrified Washington in the nineteen-eighties.
When Gingrich finished his speech at L-3, he took a few questions and then allowed himself to be set upon by reporters. Someone asked about a recent statement from Mitt Romney, the protean former governor of Massachusetts, and a founder of Bain Capital, the private-equity firm. Ever since the race began, Romney has been the favorite, although he hasn’t inspired too much favor; the number of Republicans who expect him to win the nomination surely dwarfs the number who want him to win it. A few hours earlier and a few miles away, at a homespun Manchester restaurant called Chez Vachon, which is known for its poutine, Romney had criticized Gingrich for accepting nearly two million dollars in consulting fees from Freddie Mac, the government-sponsored mortgage company. Romney said that Gingrich was part of the “Washington crowd of insiders,” and he agreed when the interviewer suggested that Gingrich return the money.
As Gingrich listened to a reporter explaining Romney’s latest affront, he smiled like a boy about to unwrap a Christmas present. “I would just say that if Governor Romney would like to give back all the money he’s earned from bankrupting companies and laying off employees over his years at Bain, that I would be glad to then listen to him,” Gingrich said…
January 3, 2012
Does the enhancement of human physical and intellectual capacities undermine virtue?
In answering this question, we must first make a distinction between therapy and enhancement. Therapeutic technologies are meant to restore impaired or degraded human capacities to some more normal level. By contrast, any enhancements would alter human functioning beyond the normal.
We must also keep in mind that, whatever we think about them, enhancements are going to happen. Age-retardation or even age-reversal are prime targets for research, but other techniques aimed at preventing disease and boosting memory, intelligence, and physical strength will also be developed.
Much worried attention is focused particularly on the possibility of achieving these and other enhancements through genetic engineering; that will indeed one day happen. But the fastest advances in enhancement will occur using pharmaceutical and biomedical interventions to modulate and direct the activity of existing genes in the bodies of people who are already alive. These will happen alongside the development of human-machine interfaces that will extend and boost human capacities.
Contrary to oft-expressed concerns, we will find, first, that enhancements will better enable people to flourish; second, that enhancements will not dissolve whatever existential worries people have; third, that enhancements will enable people to become more virtuous; fourth, that people who don’t want enhancement for themselves should allow those of us who do to go forward without hindrance; fifth, that concerns over an “enhancement divide” are largely illusory; and sixth, that we already have at hand the social “technology,” in the form of protective social and political institutions, that will enable the enhanced and the unenhanced to dwell together in peace.
What is an enhancement? A good definition is offered by Sarah Chan and John Harris in a 2007 article in the journal Studies in Ethics, Law, and Technology: an enhancement is “a procedure that improves our functioning: any intervention which increases our general capabilities for human flourishing.” People will choose enhancements that they believe are likely to help them or their children to flourish. Of course, their knowledge of a benefit will be likely rather than certain because people choosing enhancements will recognize that there is always the risk that they are wrong about the benefit, or that the attempt at enhancement will go awry, such as with a treatment failure. After all, most medical and technological advances are riskier in their early stages.
Just as Dante found it easier to conjure the pains of Hell than to evoke the joys of Heaven, so too do bioethicists find it easier to concoct the possible perils of a biotech-nanotech-infotech future than to appreciate how enhancements will contribute to flourishing lives. One of the chief goals of this symposium is to think about the indispensable role that virtue plays in human life. The chief motivating concern seems to be the fear that biotechnologies and other human enhancement technologies will somehow undermine human virtue. As we will see, far from undermining virtue, biotech, nanotech, and infotech enhancements will tend to support virtue; that is, they will help enable people to be actually good.
Peter Lawler, in Stuck With Virtue (2005), agrees that “the unprecedented health, longevity, and other indispensable means for human flourishing will deserve our gratitude.” So far, so good. Then he goes on to claim, “But the victories that will be won [over nature] — like most of the victories won on behalf of the modern individual — will also probably be, in part, at the expense of the distinctively human goods: love, family, friends, country, virtue, art, spiritual life, and, most generally, living responsibly in light of what we really know about what we have been given.” In fact, according to Lawler, we don’t have to wait for future enhancements; modern technology is already making people less virtuous: as he has argued in the pages of this journal, “one of the downsides of living in an increasingly high-tech society is that both virtue and opportunities to act virtuously seem to be in short supply” [“Restless Souls,” Winter 2004].
Really? Thanks to modern technology, sanitation, better nutrition, and medical care, Americans are living much longer and healthier lives than people did just a century ago. Do longer lives mean that people today are less virtuous? Or, inversely, does this mean that when people lived shorter lives they were more virtuous? Harvard political philosopher Michael Sandel offered a tart and persuasive response to suggestions that enhancing life spans might result in a less virtuous world:
Are the background conditions in human self-understandings for the virtues just about right now at 78 years of the average life span, or such that they would be eroded and diminished if we extend it to 120 or 150, or 180? … Is it the suggestion that back when it was 48, rather than 78, a century ago … that the virtues we prize were on greater display or more available to us? And if so, would that be reason to aim for, or at least to wish for or long for, a shorter life span, rather than a longer one?
Sandel also wondered if people were more heroic when they could expect to live only to 48. If so, should we cut life expectancy from 78 in order to nurture the heroic virtues? For that matter, if an average life span of 48 produced people who were more committed and engaged than does an average life span of 78, is even that change in virtue desirable? After all, heightened engagement and commitment can easily become fanaticism and dogmatism.
Further, on what grounds do Lawler and others suggest that smarter, stronger, healthier, longer-lived people will care less about human goods like friendship, art, and the pursuit of virtue? As Elizabeth Fenton argued in a 2008 article in the journal Bioethics, “none of these capabilities (bodily health, imagination, emotion, practical reason, friendship, etc.) are in fact threatened by, for example, enhanced intelligence or athleticism.” Being stronger, healthier, and smarter would more likely aid a person in his pursuit of virtue and moral excellence. And the unspoken implication that the state should somehow aim at inculcating collective virtue is incoherent: the pursuit of virtue is whatindividuals do.
The Dangers of Immortality?
Age-retardation technologies are the “killer app” (so to speak) of enhancements — so deeply and self-evidently appealing that they would seem to sell the whole project of enhancement on their own. Nonetheless, there are those who oppose them. For example, Leon Kass, the former chairman of the President’s Council on Bioethics (PCBE) under President Bush, has asserted, “the finitude of human life is a blessing for every individual, whether he knows it or not.” And Daniel Callahan, co-founder of the Hastings Center, has declared, “There is no known social good coming from the conquest of death.” Callahan added, “The worst possible way to resolve [the question of life extension] is to leave it up to individual choice.” When asked if the government has a right to tell its citizens that they have to die, Johns Hopkins University political scientist Francis Fukuyama answered, “Absolutely.”
The PCBE’s 2003 report Beyond Therapy raised concerns that a society of people with “ageless bodies” might have significant downsides. Much longer lives would weaken our “commitment and engagement,” the Council fretted: Today, we live with the knowledge that we will soon die, and thus “aspire to spend our lives in the ways we deem most important and vital”; but this “aspiration and urgency” might flag because we would ask, “Why not leave for tomorrow what you might do today, if there are endless tomorrows before you?” Further, our “attitudes toward death and mortality” might shift dramatically because “an individual committed to the technological struggle against aging and decline would be less prepared for … death, and the least willing to acknowledge its inevitability.” Finally, age-retardation might undermine “the meaning of the life cycle” so that we would not be able “to make sense of what time, age, and change should mean to us.” The Council does admit that as “powerful as some of these concerns are, however, from the point of view of the individual considered in isolation, the advantages of age-retardation may well be deemed to outweigh the dangers.” Indeed.
But what about the consequences of longer human life spans to society as a whole? Beyond Therapy highlights three areas of societal concern. Significant age-retardation would disrupt the succession of “generations and families.” This succession “could be obstructed by a glut of the able,” the report suggests, since cohorts of healthy geezers would have no intention of shuffling off this mortal coil to be replaced by younger people. Longer lives could also slow down “innovation, change, and renewal” since “innovation … is … often the function of a new generation of leaders.” Finally, even if we are not aging individually, we will need to worry about “the aging of society” that would then result. Societies composed of people whose bodies do not age significantly might “experience their own sort of senescence — a hardening of the vital social pathways.”
Let us address each of these concerns in turn. First, we must deal with the notion of a nursing-home world. The point of anti-aging research is not to make people older longer, but to make them younger longer. So what about the concerns raised by the PCBE? Political scientist Diana Schaub, who also served on the Council, has made similar points. For instance, in an article in Cato Unbound, she asked, if people lived for a thousand years, “how would human relations be affected? How would monogamy fare? … Would there be enough psychic energy for ever-renewed love?”…
Imagine that on a Thursday next February, you get your annual physical in the major northeast city you call home. Friday, you catch a plane for a Colorado ski trip. Unfortunately, by late Saturday afternoon you’re in an emergency room staring at an x-ray of one of your legs after taking a bad fall on the slopes. Imagine now that your emergency room doctor has access not only to the x-ray and whatever personal information you provided upon being admitted, but to your entire medical history, including the summary of the physical you had roughly 48 hours ago. This is possible because your primary care physician entered the data from your physical into an “electronic health record” (EHR), which the emergency room doctor is able to access via a nationwide digital network.
While the above scenario is today possible in only a few parts of the United States, and even there only to a limited extent, the Obama administration has dedicated approximately $27 billion, under the Health Information Technology for Economic and Clinical Health Act (HITECH), to making it a nationwide reality. Aside from the convenience promised to our upscale vacationer, advocates of EHRs and other emerging health information technologies argue that ushering health care providers firmly into the digital age will result in less expensive, more efficient, and more effective health care services for all. With that goal in mind, the bulk of the HITECH funding, which was passed as part of the 2009 “stimulus” bill, is slated to be used to incentivize Medicare and Medicaid providers to switch from traditional paper to electronic records over the next five years.
Under the HITECH programs, Medicare providers considered “eligible professionals” can qualify for up to $44,000 over five years, beginning in 2011, while Medicaid providers can receive up to $63,750 over six years. For most providers, the incentives will cover only a fraction of the necessary overall investment.A recent study published in Health Affairs determined, in looking at the cost of implementing an EHR system in 26 primary care practices in north Texas, that “an average five-physician practice [will have an] implementation cost [of] an estimated $162,000, with $85,500 in maintenance expenses during the first year.” Policymakers hope, however, that providers will quickly realize the benefits of electronic records — in terms of both better care for their patients and more efficient management for their practices — and thus be willing to shoulder the larger, long-term cost.
To support providers who decide to take advantage of the HITECH incentives, $2 billion was reserved to enable the federal Department of Health and Human Services (HHS) to develop an array of research and technical support initiatives. Perhaps most important for the overall project are the “regional extension centers” that have been established to assist doctors and other health care providers with selecting and implementing EHRs in their practices. Sixty-two such centers were established in the months following the passage of the act, and to date nearly $700 million has been committed to the program.
Still other initiatives include the Beacon Communities Program, which has awarded several grants to health care providers across the country who have taken the lead in transitioning to new health information technology (IT); the Strategic Health IT Advanced Research Projects Program, through which grants have been awarded to researchers working to solve specific technical impediments to EHR adoption; and a number of programs aimed at both developing health IT-specific college curricula and expanding the number of training or certificate programs available to prospective health IT workers.
Qualifying for the HITECH incentives, however, is not a simple process. For several months following the initial passage of the act, federal officials deliberated over the specific “meaningful use” requirements that providers must meet in using their new EHRs in order to qualify for incentive payments. These requirements are meant to ensure that providers are using the technology to become more efficient and effective, providing health care that is better and more affordable. Stage 1 of the requirements was finally released in July 2010, and while HHS had planned on releasing Stages 2 and 3 in 2013 and 2015, many providers have pointed out the complexity of the requirements, leading policymakers to consider deferring Stage 2 until 2014.
The final major piece of the federal government’s efforts to promote the use of EHRs involves working with states and regions to expand the reach of new health IT so that patient information can be accessed far beyond the confines of a single practice or hospital. The goal is to develop the standards, services, and policies needed to form and sustain a nationwide network of “health information exchanges” so that patient information can be accessed anytime and anywhere. (These are not to be confused with the insurance exchanges that will be established under the health care reform law passed in 2010.) Ideally, access to a patient’s medical history — including past procedures, lists of chronic conditions, and specific allergies — will enable physicians to provide a consistent quality and thoroughness of care regardless of where the patient is being treated…
January 3, 2012
This image has been posted with express written permission. This cartoon was originally published at Town Hall.