In his Confessions St. Augustine, contemplating the excesses and indiscretions of his youth famously pronounced the verdict, O Lord, how crooked and sordid, bespotted and ulcerous was I. From Paul to the present, the Church has expressed especial hostility to the pleasures and meanings aroused in the free play of human bodies and brains in the world, and preached mortification of the flesh and faithful obedience as routes to the presumably deeper, more spiritual satisfactions the Church offers instead.
But the Churchs real and ongoing
commitment to the address and redress of
suffering on earth, to good works as an
incomparable path to redemption, constantly
and forcefully
re-embodies
this quest for spiritual fulfillment and
confronts the best, most righteous reformers
of the Church with quandaries with which
their worldview is finally deeply incapable
of dealing. It is a hard thing, after all,
to try to hold hope and hostility together
in a single vision.
A case in point is the
claim of Vatican officials last week to
decry what they called a religion of
health in affluent societies" and then "h[o]ld
out Pope John Paul's stoic suffering as an
antidote to the mentality that modern
medicine must cure all.
To the extent that the Pope is stoically
suffering rather than straightforwardly
dead a dozen times over by now only because
he has made repeated recourse to the most
technologically sophisticated medical
treatments in human history suggests that
the term health is functioning at any rate
ambivalently in this Vatican statement.
This becomes clearer still when Maurizio
Faggioni from the Vaticans Pontifical
Academy for Life makes the sensible point
that [w]hile millions of people in the
world struggle to survive hunger and
disease, lacking even minimal health care,
in rich countries the concept of health as
well-being figures in creating unrealistic
expectations about the possibility of
medicine to respond to all needs and
desires."
He goes on to expand his point, to say,
[t]he medicine of desires, egged on by the
health-care market, increases the request
for pharmaceutical and medical-surgical
services, soaks up public resources beyond
all reasonableness."
"Health" is used in two different registers
here, one demanded the other decried. On the
one hand there is a commitment to the
provision of health care to ameliorate
unnecessary suffering, but on the other hand
there is an almost hysterical hostility
directed at what the Vatican decries,
portentiously enough, as an unrealistic,
superficial, and endlessly distracting
religion of health.
The key move that distinguishes the two
registers is of course Faggionis
conjuration of a reasonableness that seems
to translate pretty much into a "moderation"
that is a mix of appealing intuitions about
fairness, and (to me) rather less appealing
intuitions to Puritanism and unquestionable
social conventions. Faggionis move will of
course be familiar to bioethicists who often
like to deploy the distinction between
therapy and enhancement to work their
way through these same quandaries.
The problem is that distinctions like the
one between "therapy" and "enhancement" are
ultimately moonshine.
At the heart of the distinction of therapy
and enhancement is always a fantasy of the
normatively healthy body -- or even the
normatively optimally healthy body -- a norm
which will inevitably be saturated with
parochial cultural and moralistic
assumptions mistaken for factual
descriptions. And consequently any effort to
provide health according to these
normative ideals will finally be as
prescriptive as it is remedial.
But more to the point, every effort to use
such a distinction to inform practice will
set in motion forces that inevitably
undermine the terms of the distinction
itself. It isnt possible to provide
health according to any normative ideal
without likewise empowering the provision of
capacities incompatible with those normative
assumptions and thereupon shifting what
constitutes the normative in the first
place.
Even the most conservatively therapeutic
understanding of the ultimate goals of
medical science and treatment, a Hayfleckian
utopia in which everybody on earth enjoys
the robust health and fulsome intellectual
capacity of the healthiest among us today as
we presently perceive them, as well as
lifespans prolonged for all to the extent of
the century or so available only to the
luckiest among us so far, this still would
set in motion a trajectory of scientific and
technological development that would provoke
unimaginable perplexities into the status of
profound biological experiences such as
pregnancy, sexual maturation, illness, aging
and death.
Already, today, the fresh susceptibility of
organisms to prosthetic and pharmacological
intervention has transformed the status of
"viability," "therapy," "normality," as
stable measures of just when lives can
properly be said to begin or to end, or as
benchmarks against which to leverage
intuitions about the proper scope of
healthcare practice. So too neuroceutical
interventions into memory, mood, and
motivation trouble our received intuitions
about what enables and constitutes proper
consent.
Even the most modest provision of basic and
decent health care, and ever more so
according to how universally it is provided,
will transform, quite possibly beyond
recognition, what will count as basic,
decent, and normal in the way of our
expectations about what bodies properly are
and what they are capable of.
The Vatican insists that all people should
have access to "basic health care" but that
there is a fantasy of perfect health in
the developed world that is driven by
unfulfillable desires and so is
unmanageable.
It is impossible not to see the force of
their point, but it is notoriously difficult
to mainstain any such distinction between
basic and perfect health that will hold
up for long to scrutiny. None of us is in
any kind of position to say definitively now
just what will be fulfillable or not
through the therapeutic address of medicine
over the course of our lifetimes.
And, frankly, it seems to me the Church is
one of the last places on earth one should
look for any kind of reasonableness in
working through quandaries of this kind.
What are we to make of the way the word
desire enters repeatedly into the Churchs
discussion of medical practices they
denigrate, for example? There seems to me,
as it happens, to be a conspicuous
continuity between queer practices and
prosthetic practices, among them the
epochal
feminist embrace of reproductive
technologies, a field of freedom and
emancipation on which the Church has been
perhaps the single most significant and
consistent opponent of any kind of progress
at all.
It is of course true that savage differences
in the level of health care available to
people in the world both expresses and
horribly exacerbates the deep and deepening
injustices in the contemporary distribution
of wealth both within so-called developed
societies, and incomparably more terribly,
forcefully demarcating the developed from
the developing world.
But at what point will what the Church means
by manageable healthcare goals nudge them
from a useful and progressive analysis of
the instabilities and calamities inhering in
this kind of injustice, instead into more
straightforward strategies to maintain their
own pernicious hold on authority in a
secularizing world? It seems very
interesting in this connection to notice
again that the Vatican describes
healthcare in the terms of a rival
religion of health when they want to
condemn particular healthcare practices and
goals as dangerous.
For me, emerging medical technologies enable
and demand the universal provision of basic
health care, at least the provision of
adequate nutrition and basic hygiene and the
therapeutic address of treatable diseases,
all as a foundational social recognition
that the unnecessary suffering of people
anywhere on earth diminishes us all while
securing basic capacities for everyone on
earth unleashes intelligence, creativity,
peace, and pleasure for which we are all of
us conspicuous beneficiaries.
But I also embrace the inevitable individual
recourse to these emerging genetic,
prosthetic, and cognitive technologies in
prosthetic practices of self-creation and
personal perfection.
These are in my view equally indispensable
registers of moral and ethical prosthetic
practice. They are, as it were, the public
and private faces of health care practice.
And far from being incompatible, they are to
my eyes absolutely interdependent.
Medicine becomes primarily a technique for
maintaining and consolidating the control of
established authorities whenever it is
embraced only to the extent that it provides
and imposes a normative standard of health
according to those established authorities,
all the while policing and repudiating the
occasion for deeply destabilizing,
subversive practices of personal
self-creation that inevitably arise with the
emergence of any new technological
capacities.
It is an obscenity that big Pharma devotes
millions to marketing competing treatments
for erectile dysfunction to the developed
world while millions die of cheaply
treatable diseases in the developing world.
But it would also be an obscenity for social
and religious bio-conservatives to deny
individuals the transformative recourse to
emerging consensual practices of genetic,
prosthetic, and cognitive medicine. Remember
that there is nothing in the least normal or
natural about the historically unprecedented
level of control human beings have come to
take for granted in the present day over
their sexual and reproductive capacities.
The emerging neuroceutical address of our
moods and memories provides the next
conspicuous terrain for such fraught
individual re-invention.
We can and in fact I insist we must value
both the public and private faces of health
care practice. Certainly we should not fall
for corporate propaganda that would
privilege the private over the public, or
pretend that only the denigration of public
healthcare provision enables desirable
prosthetic pursuits of private perfection.
But neither should we be bamboozled into a
denigration of prosthetic practices of
personal self-creation by cynically
sanctimonious arguments from social and
religious conservative authorities jealous
of their power and sensitive to the
precariousness of their position in a more
secular world.
When a doctor in the Church intones that it
is [p]recisely in the handicap, in the
disease, in the pain, in old age, in dying
and death one can... perceive the truth of
life in a clearer way, you can be sure this
is not so much the voice of wisdom and
modesty and fairness one is hearing, but yet
another echo of that immemorial priestly
hostility to the life that is lived in
bodies. We must hold instead in a single
vision an awareness of frailty and suffering
as an address that impels us to action, and
a grown-up celebration of the pleasures and
promises and dangers of new fleshly
humanities that have outgrown the old tired
and tyrannical crucifixations.
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