8/13/2019 John Dupr -- The biopolitics of life

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Perspectives

708 www.thelancet.com Vol 372 August 30, 2008

It is hard to doubt that developments

in biotechnology in the past decades

have profoundly affected our lives,

but it is even harder to say exactly

what these effects have been. The

iconic marker of these changes was

perhaps the successful completion

of the Human Genome Project.

Although there have been expressions

of disappointment that this did not

immediately usher in an era of newcures for major diseases, and it is only

beginning to be widely understood

that this was the beginning rather

than the end of a scientific project, it

is surely an event of great ideological

importance. Perhaps paradoxically, at

least for those who have appreciated

the complexity of life processes

that contemporary biotechnology

has begun to disclose, the Human

Genome Project can also be seen as a

demystification of life. Whatever the

practical obstacles to understandingthe details of life processes, there is

nothing ultimately incomprehensible:

the inexorable march of molecular

biology has finally disposed of the

ghosts in machines and lans vitals

that might have kept these processes

forever beyond the reach of science.

This intelligibility implies a

possibility of control and suggests

unlimited possibilities for intervention

in life processes. And this, finally,

leads to the most intriguing general

thesis of Nikolas Roses The Politicsof Life Itself, that the medical goal of

normalisation has been replaced by a

goal of optimisation. In place of a sharp

boundary between health and disease,

a much more obscure and contestable

objective is provided of optimising

the quality of a life. Although it can

be argued that health and illness

were always normative notions, the

cases of illness that until recently

were reasonable targets of medical

intervention were not generally

especially controversial. Optimisation,

by contrast, is a clearly normative

concept from the start.

A major contributor to the move

from illness to optimisation is the

increasing emphasis on risk, and

especially on genetic susceptibility,

that itself blurs the distinction between

health and illness. As the spectrum

from fatal monogenomic diseases

with varying ages of onset, through

genetic flaws that provide high

probabilities of illness at some point

in life, to susceptibility genes that

increase relatively low risks of disease

is increasingly expanded at the low risk

end, the question of what constitutes

illness becomes more problematic.

The existence of such questions is

part of what underlies the epidemic ofbioethicists or, as Rose would prefer it,

the growing importance of biopolitics.

Bioethicists and biopoliticians

are not, however, in Roses vision

primarily involved in directing a

passive citizenry paternalistically

towards their objective best interests.

Rather, these developments must

be seen in the context of a certain

kind of contemporary western indivi-

dualism. Within this context, it is the

responsibility of the biological citizen

to create a life project that incorporatesresponses to the possibilities that

biomedicine offers or is expected soon

to offer. Plastic surgery, preimplantation

genetic diagnosis, and performance-

enhancing drugs, are among the

kinds of resources that citizens can

increasingly draw on in making their

particular life plans. And this perception

of a degree of autonomy among the

biological citizens to whom these

emerging technologies are giving rise,

is one reason why Rose is generally,

although not universally, optimistic

about the changes he describes. On

the spectrum between the deep fears

of dehumanisation expressed by, for

example Jurgen Habermas (The Future

of Human Nature) and the enthusiastic

embrace of biotechnology by writers

such as Nicholas Agar (Liberal Eugenics:

In Defence of Human Enhancement),

Rose is much closer to the latter end of

the spectrum.

A somewhat surprising source ofRoses optimism is the increasing con-

temporary focus on genetic suscep-

tibilities over simple monogenetic

disease. It is true, as Rose emphasises,

that this emphasis should contribute

to dispelling traditional worries about

genetic determinism, reductionism,

and so on. Susceptibilities, for Rose,

are a central part of the context

that generates the obligation to live

ones life as a project, generating a

range of ethical conundrums about

the ways one might conduct oneslife, formulate objectives, and plan

for the future in relation to genetic

risk. If this is a new phenomenon it

is because of the individualisation of

these risks.

This increasing emphasis on

susceptibilities can be seenrightly, I

thinkas reflecting a problem for the

philosophical argument for genetic

determinism, yet the connection is

subtle, and it is far from clear that

genetic determinism has declined in

the general public consciousness. In theend, no doubt only history will tell us

whether we are seeing a fundamental

change in our conception of what

it is to be human. My own hunch is

that this has changed continuously

throughout human history, and it

would be premature to suppose

that there was anything exceptional

about the changes happening at this

particular historical moment.

John DuprJ.A.Dupre@exeter.ac.uk

the medical goal ofnormalisation has been replaced

by a goal of optimisation

Book

The biopolitics of life

The Politics of Life Itself:

Biomedicine, Power, and

Subjectivity in the Twenty-First

Century

Nikolas Rose.

Princeton University Press, 2007.

Pp 350. US$2595.

ISBN 978-0-691-12191-8.