Genetic Turning Points: The Ethics of Human Genetic Intervention

"A remarkably profound, insightful, sensitive, lucid, and helpful book." — Hessel Bouma III

"Highly recommended for anyone who wants to be well informed in this vital area of modern culture." — John Jefferson Davis

CHAPTER 2: What Technology Can Do for Us and to Us

About ten thousand people stood together in the dark. They were crowded around the courthouse in Wabash, Indiana, waiting expectantly. The courthouse bell began to ring. Suddenly the town square was as light as day. The gathered throng had expected it. Many had traveled miles to see it happen. But when it did, there was no roar of appreciation, no applause, just stunned silence. In the blinding light some people gasped, and others fell on their knees, overwhelmed. All their lives, if there was any outdoor light at night, it was the slight illumination of the moon and stars. All one could see was at best indistinct grey outlines in the darkness. Indoors there might be the faint flame of a candle, fire, or gas lamp that flickered and smoked. Here suddenly was intense light everywhere, as if the sun had been turned on at will. All was color and detail, steady, unblinking. At the throw of a switch, the town fathers had lit four three-thousand-candle arc lights on top of the courthouse, and the Wabash of 1880 would never again be seen in quite the same way. At least at night.

The dramatic lighting of the town square held the media's attention, but the transformation came elsewhere. Downtown lighting was spectacular, but that was not where electric lighting made the greatest difference. What most changed the way people lived was in the rapid but incremental steps of extending electricity to one house at a time. Wiring a house was not the stuff of headlines, but it was a transforming moment for each household it reached. Electric light was so valued that by 1934, 96 percent of the households in Muncie, Indiana, had electric lighting at the same time that more than half had no central heating, 34 percent had no running hot water, and 18 percent were still using outdoor privies. By 1945, half of Muncie's households were still without a telephone, but almost all used electric light. Electric lighting had many valuable uses, but it was in one home at a time that it most changed the way people lived, not only in bringing light but in opening the way for all the other electric machines that so shape our time, from television to the personal computer.

Much as the spotlights on top of the Wabash courthouse suddenly dazzled onlookers in the square, cloning now rivets public attention. Speculation about trying to duplicate people has dazzled and maybe to some degree blinded us in a brilliant flash of media focus. Actually, there are already more widely transforming events in genetics that have received less notice. For example, it is the rapid incremental steps of new genetic tests that are already changing what we see and how we live, one person at a time. In coming chapters we will examine the choices involved in the whole range of new genetic technologies. We will approach them in the order of their widespread implementation. But first in this chapter we will establish needed context by briefly looking at the nature and impact of technology more broadly.

Technology shapes us far more than most people realize. We often fear it as it first arrives and then come to take it for granted as necessary to our lives. What can technology actually do for us, and just as important, what will it not be able to do for us? If we can guide it toward particular ends, which ones should we prefer? The goal of this chapter is to avoid mindless boosterism of every new thing and just as much the stunned inaction of a deer caught in the glare of headlights. What should we see and do by this new genetic light, without letting it blind us? We need to start by better understanding the momentum of the tools we use to shape our world; the tools which also end up so deeply shaping us.

Technology Is Necessary

I have described science as a method of careful observation of the physical world. In contrast, technology is the sum of the tools that we use not just to understand our physical world, but to shape it. Our tools can be as simple and solid as a hammer or as intricate and conceptual as a hospital system. Ian Barbour refines the definition this way. Technology is "the application of organized knowledge to practical tasks by ordered systems of people and machines."In some ways the distinction between science and technology is quite artificial. The two drive each other. Copernicus's solar-system theory intrigued Galileo to study the planets with his new tool, the telescope. It was the telescope that enabled him to make observations of Jupiter's moons. Those observations were then substantial evidence for the solar-systemtheory of Copernicus. While science and technology are intertwined, it may be that "science is concerned more with what is, not what ought to be." In contrast, technology is all about changing the physical world to make it more what we want.

Adapting the physical world to our needs is necessary for most of us to survive. That does not refer only to those depending on respirators, kidney dialysis, or daily doses of blood thinner. Very few of us live where it is always near 20 degrees centigrade (72 degrees Fahrenheit), with ample food available that can be caught with bare hands and eaten raw. The simple fish hook is a tool, as is the fire and a pan for cooking, as are the clothes on our backs. The Amish, famous for maintaining older ways, depend on technology too. Horse-pulled reapers, hand pumps for obtaining water, and barn design are all technologies. They are just the continued technologies of an earlier era. Making and using tools is characteristic of human beings, who would otherwise be hard-pressed to live out the week. Philip Hefner has described human beings as "created co-creators" with God. The emphasis on the creative role that God has given us is welcome, yet even paired with "created," the noun "co-creator" might be misunderstood as claiming human beings as relative equals with God. Maybe the description "creative creatures" may better capture human beings and our mandate. According to the Christian tradition and others, this needed capacity to create tools is not contrary to God's provision. It is God's provision. We need technology to survive.

Technological Change Is Accelerating

While technology is necessary to our survival, it has developed far beyond that minimum. Its development is also accelerating. Certain inventions have increased the pace of technological development. The printing press made information about what others had discovered more widely available. Telecom-munications has dramatically quickened the spread of information, and the worldwide web has already compounded that. From one country to another different people receive credit for inventing the telephone. That is not just national chauvinism. Different people did invent the telephone independently of each other within a period of a few years. Without rapid communications they did not know what the others were doing. With modern communications new discoveries are quickly heralded, so that people are working on advancing the next step rather than duplicating what has already been worked out elsewhere. The pace of invention quickens.

Not only are the people who do research more efficient, but there are more of them. It has been suggested that most of the full-time scientists who have ever lived are working today. New information is discovered and quickly put to use discovering more. Product cycles are short and becoming shorter. From invention to widespread use takes less time. The television was invented in the 1930s and took thirty years to become ubiquitous in our homes. Personal computers took less than fifteen years from inception to widespread home use. Louise Brown, the first in-vitro baby, was born in 1978. Within ten years, thousands of babies had been born from the same method all over the world.

Technology Is Becoming More Intricate

Robert Pool describes how a Turkish Airlines DC-10 crashed shortly after takeoff from the Paris airport in 1974. A cargo door blew open when the plane reached twelve thousand feet. The sudden loss of pressure collapsed the passenger compartment floor, which severed the control lines to the tail control surfaces and brought the plane down. No one person designs the more than five million individual parts in a commercial airliner. Different teams of engineers had made design choices that interacted in a lethal way. The doors opened out rather than in. That made it easier to load the plane but also meant that air pressure at flying altitudes would be trying to open the doors rather than pushing them securely in place. The team that designed the door handles allowed the handles to close without fully engaging the pins that were to keep the door secure. The group that chose to route the control cables under the passenger floor had chosen a path that was well protected from outside injury but vulnerable to passenger-floor movement. The builders of the passenger floor chose lightweight materials that were more than adequate to carry foot traffic and airline seats, but not to stay rigid if there was a loss of cabin pressure below the deck. It was the interaction of all these choices that was lethal.

The science of ecology has helped us to realize how interrelated the natural world is. Lose one species here and the effects can be drastic at quite a distance. The ecology of modern technical systems is also vulnerable to seemingly irrelevant changes. When Hurricane Andrew knocked out power in Miami, cars started to run out of gas. Gasoline was abundant but stored in tanks only accessed by electric pumps. Changing one part has ripple effects far afield. It is like pulling on one thread in a tapestry and discovering that it is connected to many other threads. Such intricacy means both that it is increasingly difficult to foresee the results of new technology introduction and to withdraw damaging technology that has already been integrated. The complexity of modern technology means that we are more dependent on experts to maintain it and that whole systems depend on single parts. The experts are dependent on other experts to manage the subsystems fundamental to their systems. This makes it difficult to predict all eventual implications when introducing or removing a technology. Effects and the expertise needed to predict and manage them are dispersed. The discipline of technology assessment has been developed with particular emphasis on this problem of expecting the "unintended, indirect, and delayed" effects of present and new technology. Surprising results can be positive or negative. We need to choose, develop, and use our tools wisely, for much is at stake.

Technology Is Formative

Technology affects how we live and who we are. It has been suggested that if one has a hammer in hand, everything looks like a nail. Our tools do influence our perception and choices. Think of how deeply shaped we have been by the introduction of electricity described earlier. It does not just make certain tasks easier with dishwashers and vacuum cleaners, but it changes our environment with air conditioning, entertains us with music and images, and even extends the hours of "the day" available to us for work and play. It makes possible whole new tool systems such as the computer. It is so ubiquitous that it is its absence in a power outage that we notice, not its presence.

Think of another invention, the automobile. Contrast life in the rural/ suburban college town of Wingate, North Carolina, before and after the advent of the automobile system. Friends would be drawn from the few family groups within walking distance. With the automobile, one's socially closest friends may live tens of miles away. People are able to spend more time with others who share special interests. While there is only one family with twins in Wingate, one can drive a short distance to Charlotte and join the "Mothers of Twins Club" with hundreds of members. One can also associate with a particular religious group. Before the automobile, one's choice for worship within walking distance was First Baptist Church or the United Methodist Church. Now within a half-hour's drive are several hundred different congregations and tens of different religions.

Since the advent of the automobile one can associate with more specialized groups that are similar in some way, yet one is regularly exposed to more people with whom one might not have as much in common. To reach a particular place of worship one may have driven past tens of places gathering people with quite different commitments. Meeting a stranger used to be a noteworthy event, yet now one is exposed to countless strangers. On a trip to the grocery store, one sees hundreds of fellow shoppers, clerks, and cashiers. One might be surprised to recognize any of them. Exposure to more people can enrich one's life, but it also makes it easier to enrich one's life at the expense of another. Not only can one flee a crime scene in the get-away car, but one can use the stolen goods in relative anonymity a few minutes away by car from their original owner.

Even the flavors of our food and when we eat it have been affected by the automobile. It makes possible in suburban or rural housing the Arcadian dream of living in a quiet garden setting far from industry. This means that family members are often dispersed during the work day and gather again at its end. The main meal of the day used to be at noon, but now for most it is in the evening when family members have returned from work places that can be quite distant from where they live. The food at dinner has probably come from a giant supermarket accessible only by car or from a restaurant drive-up window. A major portion of the work force is involved in making possible the system of high personal mobility offered by the automobile. There are jobs involved in making basic materials such as glass and steel for cars, then design, transport, parts, assembly, sales, and finance to buy the machine. To operate it, there are insurers, appraisers, traffic police, courts, driving instructors, and maintenance and repair mechanics. Further, the automobile depends on an intricate and pervasive system of road construction and maintenance, parking lots, garages, parking decks, petroleum discovery, refining, transport, service stations, toll booths, map making.that absorbs a substantial part of our personal and national economy.

Time is affected as well. The average American drives about twelve thousand miles a year. If one includes stop lights, drive-up windows, finding parking places, traffic tie-ups, and other limitations on speed, an average of thirty miles an hour for these twelve thousand miles would be generous. That places most Americans in their steel boxes for at least four hundred hours a year. That is the equivalent of a full-time job fromJanuary first to mid March. The automobile is just one technology system that affects one's friends, religion, crime, food, education, land use, personal and social economy, place of work, and for many their very livelihood. Technology shapes our lives.

When the automobile was first introduced, it was available only to the wealthy. With mass production and the government's commitment to build roads, it became an option to more people. Today much of the United States is structured so that one cannot work, obtain food, or worship in a community without it. Residential neighborhoods are deliberately zoned away from industrial areas. Grocery stores have abundant variety in centralized locations. What begins as optional, if widely adopted, tends to become necessary to participate at all. In some parts of the world a shiny new car would be useless, except to polish the finish and listen to the radio until the first tank of gas ran out and the battery died. Technology often comes in complex and integrated systems that need and then enforce widespread adoption.

This integrated nature means that it is difficult to remove one part of the system without affecting others. Technology becomes entrenched over time and often builds its own momentum. In part II we will examine in detail the impact of new genetic diagnostic tests. Here, it might simply be noted as an example of technological momentum that when such tests exist there are substantial pressures to use them. The conscientious physician would want an available aid to patient care. Also would any physician wish to be placed on the witness stand and admit that there was an inexpensive accurate test for the patient's condition that was not used? The existence of the technology is often pushed forward into use by multiple societal dynamics.

One of these dynamics is the widespread assumption that new is better. Products can receive a noticeable bump-up in sales simply by adding to the packaging the word new. There is an optimism that technology will always produce a better way, as if human beings could resolve any question with enough technological insight and application. Further, innovation is craved. Last year's product or method is not good enough. Surely there is more power, more space, more speed, more something to add to the experience. People who lived quite well a few years ago without any internet access at all feel the need for more and more download speed. Ironically, while innovation is desired, the media has become so adept at projecting future developments to sell magazines, newspapers, and science-fiction films, that when new technologies become available people often feel that the capability has already been around for some time. Expectations are high and often fulfilled that new capabilities and the refinement of already present ones will occur frequently.

There is some resistance to this trend of constant innovation. England was traumatized by the "mad cow disease" disaster. English beef producers fed ground-up beef by-products such as cow brain to their cattle to speed growth. This practice made possible the spread of a brain disease lethal to cattle and apparently deadly for some humans who ate their meat. This understandably sensitized people to possible danger from the agricultural industry that provides their food. With the advent of genetically modified (GM) plants, the reaction has been not so much any specific objection but rather a horror that changes are again being made in the food system. Virtually all our food is genetically modified and has been for centuries. Standard plant cross-breeding that has produced our seed for millennia is a clumsy and slow type of genetic modification but GM nonetheless. Domestic sheep have been intentionally bred, genetically modified, to grow high-quality wool and docilely accept human handling to regularly shave it off. For the most part GM is just a more precise and quick way of cross-breeding, though admittedly genes can be introduced that have not been in plants before. The main impetus for concern may be that after the mad cow disease fiasco, people have reason not to trust the food industry. In practice the public debates have been more over whether civil disobedience or private property should prevail when a group masses to trample a farmer's crop, than concerning the actual effects of the technology.

Can we thoughtfully resist or direct the new technologies that so deeply shape us, or are they unstoppable juggernauts? Are we so quickly dependent on their accelerating and interlocked development that there really is no time or leverage for choice? Is technology like the Star Trek aliens, the Borg, who always announce their presence with "We will assimilate you. Resistance is futile"?

Technology Is Malleable

Refrigerators are ubiquitous, and almost every one of themhums. The hum is the sound of the electric compressor. In contrast, gas refrigerators are utterly silent. With no moving parts they do not wear out. They are also more energy efficient and no more expensive to mass produce. Why do we not all have gas refrigerators? It is the more efficient technology and was invented first. The commercial triumph of the electric refrigerator is an example that the most efficient technology is not always the one that is adopted. In this case the key reason electricity prevailed was the timely and concerted effort of a relatively small group, the leaders of an electric power generating corporation. What could be more beneficial to the sale of their product, in this case electricity, than an appliance in each person's home that uses their product twenty-four hours a day and could only be turned off at substantial financial loss to the owner? The corporation was willing to invest great sums of financial resources to mass produce the electric refrigerator so that they could drive the per unit cost down to competitive levels with gas ones. They then opened stores across the land to make their refrigerators more accessible and sustained a massive marketing campaign to introduce people to their product. The resulting economics of scale and development of widely available electric power not only gave electric refrigerators the lead but also provided the structural supports for their dominance to become complete. Electric power lines became more accessible than gas ones. Gas refrigerators still exist, but usually in commercial buildings that have the size and independence to have a custom system. Electric refrigerators own the domestic market.

This story does not reveal that economics determines all. That is not the case. It is an example that the most efficient technology is not always the one widely adopted. The disc operating system that currently dominates computer software is often cited as a similar case, as is the triumph of VHS video tape over another type of video tape called Beta. Generally, "Americans have traded away the neighborhood, local businesses, the walking city, and mass transit, for the detached suburban house, the shopping mall, and the freeway." Most American cities are "designed less to be lived in than to be moved through." Whether decisions are conscious, conscientious, or not, individuals and communities make formative choices about what technology we will use.

Jacques Ellul suggests that technology has taken on an independent life of its own. "It is artificial, autonomous, self determining, and independent of all human intervention." Langdon Winner sees much the same momentum but has more hope that technology can be shaped to human needs. "Human 'somnambulism,' rather than any inherent technological imperative, has allowed large technical systems to legislate the conditions of human existence."We have the capability to destroy human life on the planet with nuclear missiles but have so far resisted carrying out that capability. What can be done has not always been done. Possibility is not necessity. We do have a choice.

That choice is usually greater when a new technology is just beginning. Once a technology is formed and adopted, it tends to preclude other options. A choice for is often a choice against as well. That is not always a negative. Offering a choice socially legitimizes the offered options. We no longer allow the choice of dueling. That prohibition eliminates a method of conflict resolution but also frees people from being challenged to a duel. On the other hand, commitments to particular technologies can shape us in ways we later regret. Such problems are often hard to detect or predict at the beginning when they are still relatively easy to change. By the time adverse results are evident to all, the technology is often entrenched and difficult to disentangle. In the late 1990s billions of dollars were spent to rewrite computer software that was not designed to accommodate dates in the 2000s. The original shortfall in design came from an economy measure to save a computer's expensive memory space. Few considered the future confusion and expense that was being embedded in the system.

It is difficult to control the development of new capabilities, but one can try to guide applications thoughtfully. Technology shapes all of us. Its already pervasive presence and influence is increasing at an accelerating pace. We can choose where we want it to take us. So where do we want to go? Who do we want to be? That is the fundamental question for technology. It is certainly a key question for the developing technology of human genetic intervention.

We are back to the stunning lights that first night in Wabash, Indiana. It is essential that we let our eyes adjust to what is going on. We need to discern what to do with this new light, as well as whether to turn it up or off, or in an entirely new direction.

Chapter Summary