Trudy Steuernagel
onsider the case of Maureen and Steven Kass. Before their 1993 divorce, the couple signed a contract stating both would have to agree before any of their five frozen embryos could be used to impregnate Maureen. Previously, Maureen had undergone nine in vitro fertilization attempts in an effort to conceive and bear a child. Twice she had become pregnant, but both ended in miscarriages. Since the time of their divorce, the couple has argued over what to do with the remaining five embryos, frozen and stored in a facility on Long Island. In May of 1998, the Appellate Division of the New York State Supreme Court ruled Maureen could not, without the consent of Steven, use the embryos to become pregnant.1
In January of 1998, scientist Richard Seed announced that within ninety days he would begin work on human cloning.2
In 1991, the United States Supreme Court rejected appeal of a California court decision ruling patients do not have property rights over tissues removed from their bodies. The decision involved the case of John Moore, a leukemia victim whose spleen had been removed in 1976 as part of his treatment. His doctor went on to use cells from that spleen to develop a drug with potential use to fight cancer. Moore wanted a share of profits, "just compensation," derived from any product that resulted from research on his spleen.3
What are we going to do about biotechnology? Current biotechnology policy is being made incrementally by courts, although some state legislatures have entered the arena. As of 1997, 26 states have laws protecting people from discrimination based on genetic testing.4 Nor has the executive branch been silent on issues of biotechnology. In 1995, for example, President Clinton created the National Bioethics Advisory Commission to "provide guidance to federal agencies on the ethical conduct of current and future human biological and behavioral research."5 Richard Seed's proclamation concerning his intention to begin work on human cloning set off what could best be described as a frenzy of responses from the President, the Congress, and relevant interest groups. President Clinton, following the successful Scottish effort to clone the sheep "Dolly," had directed both the public and private sectors not to conduct human cloning research. Following Seed's announcement, Clinton urged Congress to adopt a ban on human cloning, a position shared by House Majority Leader Dick Armey. The American Medical Association, in contrast, called for a five year voluntary moratorium on human cloning, arguing that an outright ban could stop valuable medical research.6
My interest in these issues is professional and personal. As a political theorist with a focus on women and public policy, I am attracted to the questions raised by advances in biotechnology. Should, for example, government require insurance companies to pay for fertility treatments such as in vitro fertilization? As a 49 year old woman with a 7 year old son, I experienced a number of medical procedures recommended for, as our obstetrician delicately phrased it "women of AMA." When I pressed, he confessed this meant women of "advanced maternal age." Despite good results from amniocentesis and a positive outlook predicted by genetic counseling, our son was born with a disability that may well have a genetic component. Should scientists develop some type of "gene therapy" for his condition, my husband and I will have to think long and hard about trying it with our son. Our hope is that he will be old enough when this happens and his communication skills will be improved enough that he will be an active participant in the decision-making process. Although people who do not have children with disabilities may think such a decision is a "no brainer," many of us who are engaged in this journey fear such treatments will mean the end of our children as we have known and loved them.
Since my interest in biotechnology policy is matched only by my ambivalence and confusion, I turn, as I have done at most points in my adult life, to the writings of Herbert Marcuse. Now granted this might seem a strange choice. Marcuse, after all, died before biotechnology as we know it began to raise ethical and legal dilemmas for our society. Nonetheless, his thoughts on technology in general and his vision of liberation can help us to clarify what is at stake in biotechnology policy and what we as a society might do to make certain we avoid its potential to dominate us.
Marcuse and (Bio) Technology
n his essay, "Marcuse and Ecology," Timothy Luke poses the question, "(W)hy return to Marcuse, especially now in the 1990s?"7 Luke, in response to his own query, suggests the crises of these times require help beyond what can be offered by poststructuralists and deconstructionists and Habermas' critical theory; and offers Marcuse and his critique of advanced industrial society as an alternative.8 Luke is particularly interested in Marcuse's framing of advanced industrial society's environmental crisis. Following a brief summary of Luke's reading of Marcuse on this point, I will offer a reading of Marcuse, informed by Luke, that, hopefully, helps to frame a discussion of biotechnology.
Luke directs our attention to Marcuse's contention that in a totalitarian society the individual human need for freedom gives way to acceptance of unfreedom. The society, in the interest of preserving itself, creates false needs which individuals accept as their own and credit the dominating societal apparatus for fulfilling them. The exploitation of nature produces short term material satisfaction and meets the false needs serving maintenance of the exploitative and oppressive order while simultaneously preventing the emergence of true needs for freedom and liberation. These false needs draw power from the Freudian notion of death instincts, a form of existence in which the absence of pain is equated with happiness and fulfillment. Marcuse, in contrast, looked to the life instincts or Eros to enhance our lives and recapture a positive relationship to nature. Marcuse himself believed environmentalism was a movement to replace the destructive force of the death instincts with the affirming power of Eros.9
To underscore his reading of Marcuse, Luke presents what he sees as Marcuse's position that science as we know it in advanced industrial society operates in a manner that reveals to us its instrumental character. Science as we know it brings with it a certain rationality that leads it to serve the interests of control and domination. Consequently, what could be the liberating potentialities of technology are subverted by its dominating potentialities.10
It is important to stress this aspect of Marcuse's views on technology. Marcuse, as I believe Luke rightly notes, is not saying that science and technology are neutral and can be put to good or bad use. He is saying that although science and technology have liberating possibilities, these cannot be utilized in the context of the current society. The liberation of technology demands the liberation of society. Marcuse was hopeful a new sensibility that brought together science and technology with Eros could be developed.11
How, then, can we use this to frame our discussion of biotechnology? To begin, Marcuse helps us to jettison the idea that biotechnology is neither good nor bad in and of itself. Instead, he forces us to look at the current system in which biotechnology is embedded and to see how the current development and implementation of biotechnology are used to serve the interests of an unfree society.
Reproductive technologies are a case in point. Why are so many resources being devoted to help infertile couples conceive when the world's problem is overpopulation? Why are any resources being devoted to allow women in their fifties and sixties to conceive and bear children? My point is not original, but it is important. Following Marcuse, I would argue that the development and implementation of reproductive technologies here and in countries such as Italy and England serve the interests of false needs and distract people from asking questions an oppressive society does not want raised. Why, for example, don't we spend more time questioning why so many women are postponing childbearing until a time when fertility treatments may be needed? Is it because we don't want to ask why society is unwilling to alter its workplace, community, and educational institutions in order to allow women to bear children during times when their bodies are better able to conceive? Why is it so important that postmenopausal women conceive? Is it because society needs to perpetuate the domination of women through the identification of self worth with reproduction?
Why has Richard Seed's proclamation been met with such bipartisan opposition? What is involved here that Dick Armey and Bill Clinton are singing the same song? Why is the creation of life met with such opposition, when each day so many lives are lost to poverty and the violence it brings? Why do our leaders get more agitated about a potential problem than the very real problems present in our schools? Aren't furnaces with gas leaks and pipes covered with exposed asbestos more of a threat to the future of the republic than the possibility, and it is certainly only that at this point, of human cloning? Cloning is a great issue for the power elite of a one-dimensional society. It doesn't cost anything to rail against what is easily framed as a threat to God, humanity, and nature. It also is a great distraction for a population that otherwise might be asking about the connections between pharmaceutical company campaign contributions and health policy.
No place is Marcuse's relevance to biotechnology policy more relevant than when it comes to discussing the role of the government. Fertility treatment is a case in point. It is first and foremost a big business. There are now over 300 fertility clinics in the United States, up from only 30 in 1985.12 Other than a 1992 law requiring uniform success rate statistics, there are no federal laws to regulate them; and desperate couples continue to turn to them despite what is on the average a one in four chance the treatment will result in the couple becoming parents.13
Although there are some state regulations, most of these clinics operate in a "free market" environment. Another issue is access to these procedures. Although infertility is more common among the poor, those who have access to it are in effect those who can pay for it out of pocket or those who have insurance coverage. Today 13 states mandate such coverage, but the type of coverage varies considerably. The effect of these current conditions is that only the wealthy or those with insurance coverage have access to infertility treatment.
Why is the federal government, no shrinking violet when it comes to regulation, so loath to enter the fertility treatment arena? One possibility suggested by issues Marcuse raises is that the current situation serves the interests of those in power. The middle and upper classes can access these treatments, and the poor, who have too many babies anyway, are excluded. The medical establishment, beset and irate about other areas of health care regulation, are freed from at least this one threat to their autonomy. Furthermore, the federal government can avoid responsibility for the abuses of these centers. No regulation, no harm, no foul.
The free market, as is so often the case, is not a solution that is neutral. Given the high costs of fertility treatments and the complexity of the procedures, it is naive to expect any but the rich or well-insured can avail themselves of treatment and that without regulation the industry will police itself.
Now What?
here are really two questions here. Can biotechnology itself be utilized in support of a humane and free society? If the first can be answered in the affirmative, the second can be considered. That is, what kind of world do we need to allow this to happen?
Again, I believe Marcuse useful in suggesting responses to both---which in itself is an obvious clue I think the first question can be answered positively.
As he suggests in One-Dimensional Man, it is not the benefits of biotechnology we want to jettison, but the false consciousness it embodies and in turn reproduces.14 Marcuse is right in this respect. We do have the attitude that the good must come with the bad, that if we are to conquer disease and improve the quality of life we will have to accept the "fallout," perhaps literally as well as figuratively. Any alternative speculation, that we could have the good without the bad, is Utopian. Furthermore, technology by definition "projects nature as potential instrumentality, stuff of control and organization."15 Marcuse rejects as inadequate the conceptualization of two separate realms, one of a basically neutral science and the other of the application of science in a social reality.16 As attractive as this might be, we could, for example, have no problems with biotechnology under socialism. Marcuse argues the relationship between science and its application is too intertwined to allow for this neat division and its tidy disposition. What science promises is the replacement of the vagaries of personal control and domination with the principles of reason. What we actually get, however, is a technological rationality of domination. The new master, technology, legitimates our unfreedom. As Marcuse writes, "(T)he liberating force of technology---the instrumentalization of things---turns into a fetter of liberation; the instrumentalization of man."17 The idea of science being able to control nature becomes distorted in the interests of a dominating social order. We accept the control of ourselves as we accept the control of nature.
If, however, the connection between science and domination can be broken, science can reconceptualize its relationship to nature and present us with what Marcuse refers to as "another rationality."18 In this other rationality, Logos and Eros would be reconciled and science would no longer serve to legitimate nor to participate in our domination. Technology, which for Marcuse is "the great vehicle of reification,"19 can be used in the interests of liberation.
What is to be done for this to happen? Again, Marcuse is useful in considering alternatives. He indicates, for example, the need for representative institutions in which "individuals work for themselves and speak for themselves."20 This is a particular problem when it comes to biotechnology policy. Perhaps in no other policy area is such deference given to the experts. Given the oftentimes ill informed and rushed judgments of political leaders, and Dick Armey's reactions to proposed human cloning research is one stellar example, "leaving it to the experts" is understandably attractive. How many citizens feel qualified to regulate biotechnology when few of us understand what it is?
I would argue that the direction best suggested by Marcuse's thoughts would be away from the current system of piecemeal judicial policymaking in the area of biotechnology and towards a more comprehensive legislative centered approach. Obviously, this suggestion is problematic. Our federal and state legislatures are far from being the representative institutions consistent with Marcuse's notion of a liberated, pacified existence. Nonetheless, the possibility of reforming into truly representative institutions is there. The judiciary as an institution is to be free from popular pressure. As illusory as this might be, it works against this institution as the agent of biotechnology policymaking. To make the judiciary representative would be to fundamentally alter it; to make legislatures representative would be to fulfill their promise.
Furthermore, consistent with Marcuse's emphasis on the need for individuals to become involved in decisions affecting their own lives, the tendency might be to suggest state legislatures should be the arena for biotechnology policy-making. This too is problematic. Historically, allowing the states to make policy has resulted in a patchwork quilt of oftentimes inconsistent and frequently unjust policies. Civil rights prior to 1964 and abortion prior to 1973 are dramatic reminders of what can happen when the national government is silent. Although debates in state legislatures concerning specific issues of biotechnology policy, such as mandated insurance coverage, do allow for some popular involvement and empowerment, the better alternative is to work toward a national dialogue on biotechnology resulting in Congressional action.
For our society to realize the liberating potential of biotechnology, we need to begin this national dialogue with the recognition and then rejection of the commodification of the individual. There are two aspects to this project. We must not treat users of biotechnology as things, nor can we continue to operate this country's health care delivery system in its current form.
As the case of John Moore illustrates, the potential commodification of the individual is taken to a new level by biotechnology. If a person does not "own" a part of themself, then the conclusion must follow that someone else can, unless, of course, the concept of ownership is rejected. In this case it was not. In fact, a bizarre version of the labor theory of value emerged. Without the "work" of the scientists, argued the court, the tissue would not have what could be called "exchange value."
Reproductive technology in particular has raised issues of commodification. Although many feminists support its use, there are those concerned with what is seen as patriarchal efforts to control women's bodies. Still, the disagreements among feminists are useful for exploring how the commodification problem of biotechnology can be framed and potentially overcome.
Janice Raymond, for example, contends the promotion of reproductive technology is not meant to help women but to enhance the technological capabilities of scientists. In order to convince women of the need for these technologies, according to Raymond, infertility has been defined as a "disease" and technological reproduction as its "cure,"21 despite the reality that such technological reproduction has a low rate of success. In contrast, Raymond sees technological reproduction as a false cure for a fake illness. She is joined by thinkers such as Robyn Rowland who, like Raymond, sees reproductive technology as threatening women's control over pregnancy, a traditional area of women's power, as well as their own bodies. As Rowland reminds us, the acceptance of reproductive technology is part of an ongoing trend towards greater acceptance of commodification disguised as the belief we can control all aspects of our lives.22 As she writes, "(T)he illusion of freedom is a powerful control mechanism."23
What can be offered in opposition to this compelling argument? Rosemarie Tong notes all feminists, and this would include Raymond and Rowland, are concerned with the risks to women's health of procedures such as in vitro fertilization.24 Feminists do, however, differ in their responses to these risks. Raymond and Rowland find the risks unacceptable, while advocates for reproductive technology argue it is up to the women themselves to decide what is best for them.25 In addition, the advocates argue that with safeguards in place women can use in vitro fertilization and similar techniques safely and free from exploitation.26
The key, then, to a feminist position supportive of reproductive technology is the consciousness of the women who would use them. If the women have all the relevant information, e.g. health risks, alternatives, success rates of clinics, and if they makes the decisions based on a legitimate desire for a child, not one pressed on them by individual males or by a society that devalues childless women, then they can utilize reproductive technology in a non oppressive fashion.
The question then turns to the circumstances under which women can make these kinds of decisions, and this brings us back to Marcuse. Under the current system, such decision making is difficult if not impossible. Due to the limited regulation of reproductive technology clinics, it is all but impossible for an individual woman to garner all the relevant information. Furthermore, given the prominent role the domination of women plays in support of this society, the ability of women to achieve true consciousness is dubious. Bringing the decisions concerning biotechnology closer to where people live their lives should empower them. In the case of reproductive technology, nationwide discussions of the circumstances under which fertility clinics, for example, may operate, might provide women with information and help them to ask the important questions.
Yet another aspect of biotechnology is access. It is one thing to argue that individuals can decide for themselves, and another to acknowledge their right to avail themselves of these options. The current system of health care financing in the United States serves to perpetuate uneven access to biotechnology. Since most health insurance is obtained through employment those who are unable to work or who work in part-time positions or in jobs not covered by insurance are excluded from the opportunity to even consider many if not all of the possibilities afforded by biotechnology. Discussions about access to fertility treatment, for example, are really moot for many poor people and people of color, those very individuals most likely to be affected by infertility. The same can be said of many other procedures, including genetic testing and gene therapy. I advocate movement toward some form of universal single payer health coverage. The national dialogue surrounding such a policy would include the discussion of whether coverage would be extended to, for example, fertility treatments. Admittedly, those with wealth will always be able to access procedures not covered by a universal plan; but the establishment of such would go a long way towards eliminating the current inequities.
There is one final movement we as a society can make to maximize the liberating potential of biotechnology. The hysteria surrounding Richard Seed's announcement he intended to pursue research on human cloning can be directed to legitimate discourse about where we as a society want to go with science. Profit should not dictate these decisions, but under the current system it does. With all the pain and suffering in the world, why have so many scientific resources been devoted to the development of Viagra? Certainly, profit is the obvious answer. Still, I cannot help but think there is more to it than that. Viagra is a symbol for our ability to triumph over the ravages of age and disease. It is, metaphorically, a manifestation of our belief that nature can be conquered, that political and economic impotence are illusory, and that Eros can dominate death. With science we can, crudely put, always "get it up."
A liberating vision of biotechnology, based on a liberating vision of science, would direct our energies to triumphing over pain and disease. If we are able to extend life, we need to take care that life is worth extending.
Notes
1 Raymond Hernandez, "Divorced Woman Can't Use Embryos, Court Rules," The Plain Dealer, May 8, 1998, 1-A, 18-A.
2 "Human Cloning Plans," National Public Radio, http://www.npr.org/news/health/980106.cloning.html.
3 Christopher Myers, "Supreme Court Won't Rule on Decision Denying Property Rights To Tissue," The Chronicle of Higher Education, http://chronicle/egi-bin/ SFgat....dir%2fissue29,dir%2f29a02702. htm.
4 "States Pass Laws on Insurance Use Genetic Testing Results," Planned Parenthood, http://www.igc.org/ppfa/ltr/ltr_1997_1024.html.
5 "Bioethics Commission to Focus on Human Subjects," The American Physiological Society, http://www.faseb.org/aps/nbac.htm.
6 See "Prohibition on Federal Funding for Cloning of Human Beings," The White House Office of the Press Secretary, March 14, 1997, http://www.nih.gov/grants/policy/cloning_directives.htm.
See also, "Armey Issues Sharp Rebuke to Human Cloning Physicist," http://freedom.house.gov/library/technology/pr980107.asp and "AMA Urges Cloning Moratorium", ABC News, http://www.abcnews.com/sections/science/Daily News/ama_cloning0212.html.
7 Timothy W. Luke, "Marcuse and Ecology," in Marcuse: From the New Left to the Next Left, John Bokina and Timothy J. Lukes, eds. Lawrence Kansas: University of Kansas Press, 1994, 189.
8 Luke, p. 189.
9 Luke, pp.192-195.
10 Luke, p.196.
11 Luke, pp.197-198.
12 Shannon Brownlee, "Regulation of Reproductive Technologies: An Overview," in Carol Wekesser, ed., Reproductive Technologies: Current Controversies. San Diego, CA: Greenhaven Press, Inc., 1996, 8.
13 Brownlee., pp.8-9.
14 Herbert Marcuse, One-Dimensional Man (Boston: Beacon Press, 1964), 145.
15 Marcuse, p.153.
16 Marcuse, p.54.
17 Marcuse, p.159.
18 Marcuse, p.167.
19 Marcuse, p.168.
20 Marcuse, p.206.
21 Raymond, p. 171.
22 Rowland, p. 38.
23 Rowland, p.39.
24 Tong, p.181.
25 Tong, p.182.
26 Tong, p. 186.