Playing God (2001)

PLAYING GOD1 I Introduction II Secular and Religious Applications III The Moral Presupposition IV Applications in Bioethics V Applications in Genetics VI Conclusion ______________________________________________________ Key words abortion, enhancement, eugenics, euthanasia, genetic engineering, genetic ethics, playing god, religious ethics, reproductive technology. Glossary DNA (deoxyribonucleic acid). The basic molecular code of genetic information which determines the structure, attributes, development and continuing function of organisms. Enhancement engineering. Also called positive (or eugenic) genetic engineering, aims to improve character traits of organisms, for example increasing disease resistance, robustness or fertility. Genetic engineering. The deliberate alteration of the structure or hereditary characteristics of organisms, especially by the direct modification of DNA. Germ cells. Ova and sperm cells which contain one half of the DNA coded genetic information which determines the structure, attributes, development and continuing function of organisms. Modifications to an organism's germ cells are passed on to its descendants. Hubris. Human overconfidence, arrogance, or overweening pride. Somatic cells. All cells apart from germ cells which constitute the body and its organs (muscle cells, brain cells, liver cells, etc.) which are generated and maintained in the complex process of growth, development and continuing metabolic function. Modifications of an organism’s somatic cells are not passed on to its descendants. RNA (ribonucleic acid). A molecule similar to DNA containing ribose rather than deoxyribose. RNAs play crucial roles in protein synthesis and other cell activities. Therapeutic engineering. Also called negative (or corrective) genetic engineering, aims to rectify some defect, disease or disability. ______________________________________________________ Synopsis "Playing God" is a phrase used to describe acts or decisions about matters which the speaker believes should either be treated with extreme caution or left well alone. It frequently presupposes a divinely ordained order in the moral universe which it would be reckless or impermissible to transgress. The phrase is often used in bioethics, especially in connection with decisions about the termination of life and genetic manipulation. “Playing God” implicitly appeals to an underlying moral principle but if that principle is not explicitly stated then the phrase merely serves as a rhetorical device which obfuscates rather than illuminates moral deliberation. 1 Authored by William Grey, to appear in the Encyclopedia of Applied Ethics, 2nd edn (ed) Ruth Chadwick (forthcoming 2010) I Introduction The phrase “Playing God” is often used to express misgivings or disapproval of an act or a proposed course of action which the speaker believes involves significant moral hazard. This is often, as the phrase suggests, because the act in question transgresses some principle which is grounded in religious beliefs. There are also secular uses in which the phrase is used metaphorically to indicate that the consequences of an act are exceedingly serious or far-reaching and must therefore be deliberated with great care. The phrase is also used to describe autocratic and oppressive decisions made by individuals in positions of power. The most familiar applications of the phrase "playing God" are found in bioethical discussions, especially in connection with decisions about the termination of life, such as abortion or euthanasia. These are decisions which have serious and irreversible consequences. The expression is also used to describe proposals for genetic manipulation, especially in discussions about the permissibility of modifying human germ cells. What is common to all of the disparate uses of "playing God" is the idea that there is a natural order or structure, perhaps divinely ordained, and that proposals to exceed the limits which this natural order defines should be rejected out of hand—or at least considered carefully. Whenever a phrase or evaluative term is used to characterize an action or behavior as morally blameworthy, there is an implicit appeal to some underlying moral principle. It is crucial to state the principle explicitly if the legitimacy of its application is to be properly evaluated. The main problem with the accusation of "playing God" is the danger that the underlying moral principle remains unstated, so that the phrase operates as a rhetorical device which serves to obfuscate rather than to illuminate moral deliberation. There is an onus of justification of anyone who uses the charge of “playing God” as an objection to an act, or a proposed course of action, to spell out exactly what moral principle (or principles) are being ignored. II Secular and Religious Applications The phrase "playing God" is usually encountered in contexts in which acts or decisions are challenged because of a perceived inconsistency with religiously grounded ethical convictions. However there are also secular uses of the phrase to characterize acts or decisions which involve arrogating power or control over matters of profound or farreaching importance. Often the phrase is deployed rhetorically to indicate that the topic under discussion raises momentous issues which must be addressed with great care. It is this sense that it is often used in book titles, such as Playing God: The New World of Medical Choices. Doctors who have to allocate scarce life-saving medical resources, or decide which fetuses to terminate in unsustainable multiple pregnancies, for example, face invidious decisions which may be characterized as "playing God". A somewhat different colloquial use of the phrase is to describe the inflexible exercise of authority or "laying down the law", for example when a supervisor insists on a particular approach to a task, perhaps riding roughshod over the feelings or suggestions of subordinates. These rhetorical and secular uses of the phrase "playing God" must be distinguished from its use to mark out a zone of choices which supposedly involve overstepping a boundary of legitimate human activity. In such cases the expression is used pejoratively to condemn a particular domain of practice. This pejorative sense is used, for example, in the title of Ted Howard’s and Jeremy Rifkins’s book Who Should Play God? which raises concerns about genetic engineering. Often a proposed course of action is found objectionable because, according to some religious conviction, the action is believed to involve a morally culpable or hubristic transgression into the prerogatives of the deity. As well as being used in this way to indicate that a supposedly divinely ordained limit has been transgressed, the phrase is also used to indicate a "natural" order. When appeal is made to naturalistic considerations, it is implied that the act would upset some supposedly natural cosmic or world order which, it is supposed, should be left undisturbed. In these cases the suggestion is typically that we have the power to act which is not matched by the knowledge required to act wisely. The accusation of “playing God” however is unhelpful and almost invariably serves to darken rather than to clarify discussion. If it is being used as shorthand to indicate the will of God then an immediate problem is posed by the abundant diversity of opinions about God and the moral order which supposedly receives God's sanction. It is not helpful to be told that an action transgresses the prerogatives of the deity unless we know what these prerogatives are. "Playing God" is equivocal and unhelpful precisely because divine prerogatives are conceived so disparately by different religious authorities. Gerald Larue, for example, has recorded an immense diversity of religious opinion both between and within Christian and non-Christian denominations concerning the acceptability of euthanasia or physician-assisted suicide. There is in general no unified Christian, Jewish or other denominational position on this issue. Appeals to divine authority as a basis for moral principles are in any case problematic. Objections to this sort of strategy for establishing secure foundations for morality go back at least as far as Plato's Euthyphro. III The Moral Presupposition Because there is no agreement among the authorities about which acts are divinely sanctioned, there may be argument about whether a particular course of action is serving or usurping the will of God. The confusion generated by the accusation of playing God is well illustrated by the fact that it can be confidently deployed by both sides of a dispute. It can be used for example to criticize a decision to withhold life-saving medical treatment as well as to criticize the decision to administer heroic life-saving medical treatment. This situation shows that an appeal to a divinely sanctioned principle by itself is unhelpful and that it is necessary to further inspect the basis of the moral proscription and to state that principle explicitly if its probity is to be properly evaluated. Serious uses of the phrase "playing God" thus presuppose a moral framework or appeal to a moral principle, and to surmount vagueness and to avoid confusion it is therefore important for the presupposed principle to be stated explicitly. Only then can its application be properly assessed. The importance of stating the underlying principle can be illustrated by uncovering the implicit moral principle which lies behind the application of the phrase in its central applications, which occur in the domains of bioethics and genetic engineering. IV Applications in Bioethics The most widespread application of the charge of playing God is in connection with medical technologies, in particular those involving decisions to terminate human life. Most theologies speak of the sanctity of human life. The most significant procedures criticized for not paying proper respect to God's law are euthanasia and abortion, and sometimes also, associated with the latter, prenatal testing. The charge of playing God has also been levelled against the use of new reproductive technologies concerned with establishing pregnancy, such as in vitro fertilization (IVF) and gamete intra-fallopian transfer (GIFT). A common basis for objections to applications of medical technology is the belief that allowing something to happen, even though we can control it technically, is to leave it to God's providence and that is to acknowledge that exercising control wisely in some circumstances is beyond our power. It is difficult however to provide a rational justification for this position. After all, much of modern medicine aims precisely to prevent mortality and morbidity which would eventuate if left to providence. Suffering is reduced by the elimination of noxious pathogens such as smallpox, and this is not usually thought of as a violation of God's providential design. If we are prepared to act to prevent disability and disease caused by environmental pathogens then why baulk at measures, such as therapeutic abortion, which also aim to prevent disability and suffering caused, for example, by severe genetic disorders? One response is to claim that there is a crucial difference between the destruction of pathogens and the destruction of innocent human life. Even if the decision to terminate a human life is motivated by compassion, that does not, on a view widely endorsed by many religious authorities, alter the character of the act as an act of killing a creature whose unique character gives it a special place in God’s providential design. Abortion involves the destruction of a being with an immortal soul, and such an act presumes on the prerogatives of the deity. This objection to abortion may also be extended as an objection to prenatal genetic testing, since a major motivation for prenatal testing is to detect genetic defects with a view to therapeutic abortion if genetic mishap is detected. Making sense of the relationship between soul and body is notoriously problematic. But even if it is granted that fetuses have immortal souls it is hard to understand how the destruction of a fetus with genes, for example, for Tay-Sachs disease or Lesch-Nyhan syndrome is anything but an act of kindness. A physical life will be ended, but a truly immortal soul would continue, perhaps to be reunited with its maker. Indeed precisely this consolation is often provided to parents on the premature death of a child. It is sometimes suggested that suffering is good for the soul but this is, to put it no more strongly, an implausible way to defend the continuation of a life that will be wretched. It would constitute to an objection to virtually the whole institution of modern medical practice, which exists largely to alleviate suffering. Of course this is not a dominant view, and many religious authorities see little or no spiritual virtue in suffering and regard it, plausibly enough, as an affront to human dignity. It is important to distinguish religious objections to abortion from objections based on the claim that it is absolutely impermissible to terminate innocent human life because that involves the destruction of persons or potential persons. The present concern is only with explicitly religious objections to abortion. Objections based on secular considerations are considered elsewhere. The other major category of medical practice which attracts the charge of playing God in the termination of life is euthanasia. Sometimes it is alleged that it is contrary to the will of God to fail to treat the terminally ill; but, confusingly, it is also claimed that permitting the terminally ill to refuse heroic medical treatment, that is, to permit what is sometimes called "voluntary passive euthanasia", is precisely to decline to play the role of God. There is also a more controversial claim, supported by some progressive religious thinkers, that personal autonomy is a God-given right, and that a merciful and compassionate God would have no objection to a terminally ill patient choosing a quick, painless and dignified death. Once again confusion surrounds the charge of playing God, and rather than appealing to God's will or God's law it is essential to state explicitly what principle this claim alludes to so that it can be systematically examined. Taking innocent life, or allowing innocent life to come to an end, is always a morally serious matter which needs justification. The justification of end-of-life and ending-life decisions typically involves addressing important distinctions between acting and refraining to act, between killing and letting die, and consideration of the role of individual autonomy. However moral justification needs to be provided in each particular case; it cannot plausibly be delivered simply by an appeal to religious authority. V Applications in Genetics Molecular biologists have developed a variety of techniques of genetic engineering to manipulate and control the development, structure and hereditary characteristics of organisms. In particular manipulation of the genetic material itself (deoxyribonucleic acid or DNA) by gene splicing has led to the development of powerful tools for modifying life forms and creating new ones. The allegation of playing God has almost become a cliché in the field of genetics and is used, in particular, to describe proposals to modify the human genome. There are several important distinctions which need to be kept in mind when considering arguments about genetic engineering. First, there is the human/non-human distinction, and the question of whether there are special considerations which constrain the manipulation of human genetic material which do not apply in the case of other species. Secondly there is a distinction between somatic and germ cell genetic modification. Somatic changes affect only the subject organism; modifications to germ cells are passed on to an organism's descendants. Thirdly there is a distinction between therapeutic (also called negative or corrective) engineering which aims at rectifying some disease, defect or disability, and enhancement (also called positive or eugenic) engineering which might aim, for example, to produce a healthier, smarter, more capable, more robust and longer-lived individual or population. One way that misgivings about genetic engineering are expressed is in terms of the religious belief that the gene pool is God's sacred creation which should be preserved. Genetic engineering is sometimes characterized as a dangerous Promethean adventure which involves appropriating knowledge which is properly the province of the deity. In our post-Enlightenment state of knowledge this view does not survive inspection. Gene pools are more plausibly seen not as the product of divine providence, but as the piecemeal accretions of billions of years of accident, mishap and good fortune. Moreover even if we accepted God's providential design, that would presumably include the provision of creative and logical thought in humans—with the anticipated, if not intended, consequence that this unique cognitive information-processing intelligence would be used to acquire knowledge and to use it to manipulate and modulate matters; that is, to intercede in the scheme of things. There is no reason, then, why divine providence should not accommodate human manipulation of our own genetic material, and that of others—and not just to correct defects, but also to make enhancements. A more secular, and much more persuasive, argument for exercising caution when tinkering with genomes is that biological processes and products have evolved over billionyear geological time scales and have thereby proved their robustness. Natural life forms come with the quality assurance of exceptionally prolonged testing under the most searching conditions. There are also self-interested—as well as altruistic—considerations based on the desirability of maintaining biodiversity, which entail that we should take care to ensure that we not reduce biodiversity through genetic tinkering, or indeed in any other way. The first law of intelligent tinkering, after all, is to save all the pieces. The argument against the substantial genetic modification of any species which alludes to the alleged wisdom of the evolutionary process is summed up in the phrase "Nature knows best". This is a modern secular expression of an older religious belief in divine providence. The principle “Nature knows best” has been defended and endorsed by Barry Commoner, who dignified it as the Third Law of Ecology. However it is worth recalling J.S. Mill’s famous counsel of caution about taking nature as our guide: Our duty, according to Mill, “is the same in respect to his own nature as in respect to the nature of all other things, namely not to follow it but to amend it”. Not everyone is impressed by the result of several billion years of evolution and it is sometimes suggested that its products might well be improved. Why should we favor the slow fitful, chancy, piecemeal, small-scale, incremental processes of natural evolutionary change above the rapid and radical changes made possible by genetic technology? The alleged wisdom of the evolutionary process assumes that the blind process of evolutionary development, in which each improvement is conditional on the past and is locked into the prevailing fitness landscape, somehow provides the best ultimate biological solution or design—a view which there is no reason to accept. David Pearce provides a radical rejection of our evolutionary inheritance in his “Paradise Engineering” enhancement proposal, in which he argues in favor of rewriting the entire vertebrate (including human) genome “to escape from the poisoned legacy of our genetic past”. Pearce believes that we have the ethical imperative, and the technological capacity, to abolish suffering in all sentient life. Some powerful objections to Pearce’s claims will be noted below. At the other extreme, critics such as Howard and Rifkin suggest that it would be best if genetic engineering were completely prohibited. Howard and Rifkin argue that genetic engineering is inherently dangerous and threatens to transform organisms, including humans, into technologically designed products, and may lead to a new caste system in which social role is linked to genetic make-up. This alarmist assessment ignores or plays down the fact that genetic engineering of a kind has been practiced by selective breeding in animal husbandry, horticulture, and agriculture for thousands of years. Indeed all the principal plant and animal food sources in the human diet are products of selective breeding. It is certainly legitimate to be apprehensive about the possible dangers posed by recent genetic technologies, but rather than talk of playing God we need once again to examine what motivates these worries. There may be a serious basis for concern, such as a possible deliberate or accidental release of synthetic pathogens which might devastate a community or ecosystem. Risk should always be assessed prudently, bearing in mind that if there is a potentially hazardous solution to a problem it is always advisable to seek less hazardous alternatives. But the potential benefits of genetic engineering cannot be dismissed out of hand and objections to it need to be selectively directed to particular proposals. In the case of human genetic modification therapeutic engineering is generally thought to be ethically unproblematic, whilst enhancement engineering in general is not. A basic aim of therapeutic medicine is to eliminate serious disability and ceteris paribus, any measures which can help with this project, including genetic technologies, are to be welcomed. A proposal to use gene therapy for the topical treatment of the lung tissue of sufferers of cystic fibrosis, for example, seems unexceptionable. But the situation is not always straightforward and benefits must always be measured against risks. In general somatic genetic treatment amounts to treating DNA as a drug, and raises no more significant ethical issues, in principle, than the use of other powerful pharmaceutical drugs—which is not to suggest that the ethical issues are trivial or unproblematic. Some writers, such as Michael Ruse, accept therapeutic engineering in principle but argue against producing radical changes through enhancement genetic engineering, claiming that enhancement engineering could degrade much of what is distinctively human. There is however a problem defining the boundary between enhancement and therapeutic genetic manipulation which features centrally in the discussion by Ruse and others. Therapeutic engineering is corrective, and its aims are spelled out in terms of rectifying dysfunction, disease or abnormality. While these notions provide a rough guide, they are problematic in particular cases. Is correcting male pattern baldness, or the use of Viagra (sildenafil) to treat erectile dysfunction, therapeutic treatment or enhancement? Similar problems arise in the practice of cosmetic surgery and raise problems for decisions about categories of medical insurance. The boundary between therapy and enhancement is problematic. Nevertheless I will suggest that it may be prudent to restrict or even to proscribe radical enhancement proposals. There is no precise, universal, objective criterion which determines what constitutes either a dysfunction or an enhancement. In the case of therapeutic somatic treatment, it may be unexceptionable to allow individuals to make informed autonomous choices about selfregarding changes, though the case of genetic enhancement modification of somatic tissue is less clear. However if we allow people to change their appearance with breast implants or cosmetic surgery—and even to mutilate themselves up to a point, for example with bodypiercing and tattoos—perhaps we should allow them to genetically program themselves to grow green hair, or to make even more bizarre choices. Germ-line modifications are less straightforward because deciding the destiny of others without their consent seems to be precisely one of the objectionable features of an action censured by the charge of playing God. Germ-line engineering, including enhancements, involves making choices for others without their consent, though it is difficult to know exactly how much weight to put on this, since choosing to reproduce at all apparently involves that anyway. Moreover lack of consent provides no impediment to a wide range of guiding decisions which we paternalistically make for the benefit of our children. While a strong case can be developed for therapeutic germ-line engineering to eliminate such debilitating genetic disorders as cystic fibrosis, Tay-Sachs disease and Huntington's chorea, systematic attempts to improve or perfect a species presupposes that we know what constitutes an improvement or perfection. The value of a gene depends on the environmental situation in which it is expressed. Eliminating genetic traits may weaken a species, or make it unable to adapt to changing environmental circumstances which may arise from unforeseen contingencies. A powerful reason for exercising caution in any germline modification is that our knowledge of the effects of genetic modification of a single gene on its interaction with the rest of the genome is very limited. This is a powerful reason for rejecting Pearce’s paradise engineering, as well as other more modest proposals. It is worth also noting that the technical barriers to enhancement engineering are enormous. We need to significantly deepen our genetic understanding before we will be in a position to even consider what might be sensible choices about human evolution. The ethical and technical difficulties arising from therapeutic engineering are relatively minor in comparison. Whereas improving the shelf life of tomatoes does not generate any obviously serious hazards, tinkering with the complex system of the human genome—with an estimated complement of about 20 000 protein-coding genes, operating in a sequential and coordinated fashion with an unknown number of genes expressing regulatory RNAs—may have unforeseen serious or even catastrophic effects, some of which may not be expressed for several generations. This uncertainty argument applies of course to germ-line, but not somatic, genetic engineering. It is also worth noting that there are the about same number of protein-coding genes in all animals, from blue whales to microscopic nematode worms, and that most of these genes are orthologous—that is, produce similar proteins with similar, if not identical, functions. So there are very few human-specific genes. Moreover it is now clear that most of the differences between species, and individuals, lie in the regulatory sequences that control gene expression, not in the genes themselves. This is the real playground of evolution—or God—and perhaps for us in the future. There are, then, serious considerations which need to be addressed in deciding what forms of genetic engineering to allow; but we need to get behind the rhetoric of the phrase "playing God" and examine the underlying principles to evaluate how seriously these concerns are to be taken. The gaining of genetic knowledge proceeds with breathtaking speed—according to one estimate it is doubling every two years. We must be careful to ensure that this potent body of knowledge is accompanied by the gaining of genetic wisdom. VI Conclusion The phrase "playing God" is used to characterize actions or behaviour that are deemed to be morally blameworthy, and typically it is intimated, but not explicitly stated, that some absolute moral boundary has been crossed. It embodies the notion that there are possibilities which should not be realized; choices which should not be made. The accusation also often expresses concern about the hubris of tinkering with the sacred. The power and resonance of the phrase derives ultimately from a deep conviction that there is a providential divine or natural order. This conception of a hierarchically structured benign cosmic order reaches back to Plato, and its classic exposition can be found in Arthur Lovejoy’s The Great Chain of Being. It is a conception deeply entrenched in Western thought and is associated historically with what Lovejoy called the principle of plenitude, according to which every genuine possibility is realized. If inexhaustible divine productivity has left no gaps in nature then we should seek neither to add to nor subtract from the natural order. This is a potent conception which still has the power to exercise a subtle but substantial subterranean influence on our thinking. The danger presented by this seductive image is that it can come to dominate our thinking and provide a substitute for serious moral thought. "Playing God" is an expression which is unhelpful as an analytic tool, because it suffers from vagueness, multiple ambiguity, and in any case alludes to a dubiously secure foundation for moral principles. Apart from the unexceptionable metaphorical and rhetorical uses of the phrase, noted at the outset, the phrase does more to obfuscate than to clarify. ___________________________________________________________ Further Reading Commoner, B (1968). The Closing Circle. New York: Basic Books. Erde, EL (1989). Studies in the explanation of issues in biomedical ethics: (II) On "Playing God", etc. Journal of Medicine and Philosophy 14, 593–615. Grey, WL (1996). ‘The ethics of human genetic engineering’, Australian Biologist 9, 50– 56. Grey, WL (2005). ‘Design constraints for the post–human future’, Monash Bioethics Review 24, 10–19. Howard, T and Rifkin, J (1977). Who Should Play God? The Artificial Creation of Life and What it Means for the Future of the Human Race. New York: Delacorte Press. Kitcher, P (1996). The Lives to Come: The Genetic Revolution and Human Possibilities. Simon & Schuster, New York. Larue, GA (1996). Playing God: Fifty Religions' Views on Your Right to Die. West Wakefield, R.I.: Moyer Bell. Lovejoy, AO (1936). The Great Chain of Being. Harvard University Press, Cambridge, Mass. Mill, JS (1874). ‘On Nature’, in Nature, The Utility of Religion and Theism. London: Watts & Co, 1904. O'Donovan, O (1984). Begotten or Made? Oxford: Oxford University Press. Pearce, D The Hedonistic Imperative: http://www.hedweb.com/ Ruse, M (1984). 'Genesis revisited: can we do better than God?' Zygon 19, 297–316. Scully, T and Scully, C (1987). Playing God: The New World of Medical Choices. Simon & Schuster, New York. Cross-references Abortion; acting and refraining; enhancement/eugenic and therapeutic/corrective; eugenics; euthanasia; genethics; genetic engineering; genetic ethics; genetics; killing and letting die; religious ethics; reproductive technologies. Biography. William Grey is Associate Professor of Philosophy at the University of Queensland, Brisbane, Australia. He has a PhD in philosophy from Cambridge University. His research interests include Environmental Philosophy and Metaphysics.