THE IDEA OF the perfect body may be the ultimate conceit of our age or the final victory of human will over the messy randomness of nature. Either way, this quest for perfection and its potential realisation go to the heart of who we are and what we might be.
The consequences are much more profound than most of us have begun to grasp; the slow dribble of science fiction off the page and into doctors' surgeries and onto chemists' shelves has only just begun. This promises, or threatens, to be followed over the next few decades by barely imaginable moral choices and new methods of political control, definitions of identity and social hierarchies that have the potential to challenge long-held ideas of equality and equity.
If the relentless pursuit of physical perfection continues at the rate at which it commenced at the beginning of the 21st century, the world may change so completely in a hundred years that it will be unrecognisable to those of us today struggling to keep our weight under control and diseases and ailments at bay.
There is a polarity in the quest for physical perfection – from the mind-boggling potential of genetic science to the macabre trivialisation of extreme body makeovers; from the scientific breakthroughs that promise to pull cloned humans off the movie screens and into research labs while millions of children die each year from preventable illnesses; from the possibility in some rich countries of an average three-figure life expectancy this century to the paradox that tens of millions of people are literally eating themselves to death.
There is an underlying assumption that it is within our power both to seek and attain physical perfection, of which beauty is one small part. Some see it as an act of extraordinary hubris, a "Promethean aspiration to remake nature to serve our purposes" to prove that we are truly masters of the universe. As political philosopher Michael J. Sandel wrote in The Atlantic in April 2004, "The genetic revolution came to cure disease and stayed to tempt us with the prospect of enhancing our performance, designing our children and perfecting our nature ... that promise of mastery threatens to banish our appreciation of life as a gift." Others see it in more pragmatic terms – the application of knowledge and technology to solve the unbearable problems of the frailty of human existence.
THIS HAS A personal dimension for all of us sooner or later. As I was preparing this volume, a dear friend, David McGrath, lay in a Canberra hospital desperately fighting the acute myeloid leukaemia that had invaded his body. The knowledge of a likely genetic predisposition to this aggressive cancer would not have altered his life choices. None of the treatments was able to turn off the disease, but as he bravely submitted to each new treatment the hope of a cure continued to beckon until his final days.
The capacity of doctors and medical science both to understand what ails us and to devise treatments that work is a relatively new phenomenon, as Robyn Williams, Sherwin B. Nuland, Charles Watson, John Carmody, Michael Wilding and Tracy Crisp show in Making Perfect Bodies. As knowledge about the essence of life and its effective management proliferates, the capacity to intervene will escalate. Michael F. Good draws on the current state of medical research to imagine a world four decades hence, one in which those with adequate means live much longer and healthier lives but those without continue to suffer and die of ailments long eliminated in the West. The geopolitical (and national) challenges of this could be dire, as Thomas Friedman has suggested, with fault lines running between frail, rich, old women and "super-empowered angry young men". It is certain the lure of discovery for scientists at the front line will not be dimmed by the fear of such potential consequences.
The promise of the genetic revolution may not be realised, as Robyn Williams writes, urging caution when considering medical breakthroughs and greater thought about what we want the future to hold. The hype of the most ambitious scientists and biotechnology companies – and the doom mongering of the Jeremiahs – may go the way of so much other self-serving promotion. The modification of human DNA is a much more complex process than the genetic modification of plants, which has galvanised protest movements around the world. There is a giant step from the identification of the sequence of the human genome to genetic engineering in humans to attain finely targeted outcomes. While there may be a continuum, such intervention is far removed from pre-implantation screening of an embryo to ensure the gender of a baby or the absence of a life-threatening disease. The knowledge such testing provides is powerful, the choices personal, but the issues go beyond any individual, as Sam Tormey writes. No one would wish the birth of a child knowingly destined to a short painful life. The knowledge that could prevent such suffering is an undoubted advance. But as knowledge increases the choices also multiply and take us in unexpected directions, leaving some philosophers concerned that, as a result, human nature may be undermined. If the mastery of will prevails it may deny what the theologian William May calls an "openness to the unbidden".
Eugenic outcomes are more likely to be the result of thousands of private decisions rather than of state-directed eugenic programs. Having a baby now goes well beyond the selection of a mate. Listen to a group of thirtysomething would-be mothers and the conversation is far removed from the old notion of "falling pregnant". These women don't fall anywhere, they make informed decisions: there are supplements to take, tests to be had, results to be analysed. For them pregnancy has been completely medicalised, but as Rose Michael writes in her short story, the promise of a baby remains a gift.
The contest between the act of will and an openness to the unbidden is particularly acute for those living with intellectual disability, as Natalie Corban writes in her heart-wrenching memoir of the struggles and joys of life with her child who has Asperger's syndrome/high-functioning autism. The strength of the human spirit to prevail over the unbidden should never be underestimated, as the photo essay from the Sydney Paralympics illustrates. Disability need not preclude acts of will, determination or achievement. Etched on the faces of the athletes in Duane Hart's photographs are the joy and pain of achievement well beyond expectation. Disabled athletes, as well as the most gifted able-bodied competitors, are achieving their potential thanks to the application of science – not yet the genetically enhanced athlete – but, as Matthew Ricketson writes, the science that calibrates performance can push people beyond giftedness or natural ability, even without the use of banned drugs.
MOST OF THE time these issues sit to the side of our consciousness. The ideas taunt us from the pages of popular fiction and films; occasional headlines thunder about the unimaginable – cloned babies and 150-year life expectancy – and heartbreaking choices as a result of embryonic research. Most of the time the reality of what the biotechnology revolution may really portend is too hard, too unknown and too threatening to conjure. But the precursors to a profoundly altered world are there in the science that enables genetic screening, produces mind– and mood-altering drugs and promises vastly extended lives.
It is artists who have engaged most actively with these possibilities. Their work, such as Patricia Piccinini's cover image, Protein Lattice Subset – Red Portrait 1997, is beginning to frame the way we think about the future. The compelling images in Making Perfect Bodies point to some of these complications and conundrums. Most of the time the debates have not made it into the mainstream – the ideas are captured in weighty reports, scientific studies and funding applications, or relegated to a religious response that falls short in such a determinedly secular age. Those closest to the issues – the scientists, ethicists and entrepreneurs who see the potential for enormous profit – acknowledge that there is a need for more debate but are wary of the overstatement and emotionalism they know will accompany it.
Meanwhile, scientists and privacy activists, among others, sit waiting for decisions that are repeatedly put into the "too hard" basket. Australian scientists conducting embryonic stem-cell research, which was permitted following a parliamentary decision in 2002, were still waiting for licences to start their research more than a year after they applied. Similarly, a year after the Australian Law Reform Commission produced its groundbreaking report on the protection of human genetic information, Essentially Yours, its core recommendation, the establishment of a Human Genetic Commission to deliberate and advise on these issues, was still in the hands of the Commonwealth Government. As Paul Chadwick points out, these policy questions are hard but they are essential – they will not go away by being pushed aside. As a result of newborn screening, a potential national genetic database is sitting untapped but awaiting exploitation in many states – an unresolved situation that is likely to fuel fears of new forms of control and surveillance.
It is in the criminal justice system that these issues have received greatest public attention. Studies have shown that juries are more likely to convict an accused person when DNA evidence is presented but, as Bernie Matthews writes, the view from inside jail is different – there the focus is on the use of DNA to establish innocence.
Arguments about biotechnology have been represented as ethical debates, which to a considerable degree they are, as Wendy Lipworth argues in her review of Essentially Yours, but the ethical choices are not necessarily about individuals. What is at stake is also political. Francis Fukuyama, who won international attention for his "end of history" thesis, recently wrote Our Posthuman Future (Profile, 2002) in which he argues that even the biotechnology we have today will have important and controversial consequences for the politics of this century. He foresees challenges to notions of human equality and the capacity for moral choice, new methods of social control and modification of personality and the potential for new class wars between those with access to the technology and those without. Fukuyama argues that the challenges are so great that there is a need for national and international regulation, a view shared by most scientists who have been at the forefront of arguing for bans on human cloning. He urges that the argument that the marketplace can decide, to which we have become accustomed in other spheres of economic activity, cannot be allowed to apply to this field. Fukuyama fears that the dystopian world of Aldus Huxley's Brave New Worldmay be closer to reality than even Huxley could have imagined; that we have entered a world in which the evil is less obvious because everyone gets what he or she wants, and "obvious benefits are mixed with subtle harms in one seamless package".
THE BODY HAS become our defence against the world, a retreat, a source of pleasure and pain and potentially the site of our greatest experimentation and insight. This statement is brought chillingly to life in David Sornig's haunting short story, while for Inez Baranay, the challenge lies in synthesising the body in writing and yoga. As Siri Hustvedt observed in her novel, What I Loved (Sceptre, 2003), "Our bodies are made of ideas as much as of flesh ... In an age that has absorbed the nuclear threat, biological warfare and AIDS the perfect body has become armour – hard, shiny and impenetrable."
Donald Horne is well placed to reflect on how ideas about the body have changed over his 82 years – although even the hard shiny bodies of Aussie lifesavers in his youth were slightly tainted by Leni Riefenstahl's fascist aesthetic. His memoir takes us beyond the physical body to a subconscious world of dreams and imagining, to insights sharpened by the experience of ageing. Creed O'Hanlon's short story also explores the process of ageing, but from the perspective of a young woman who fears her beauty – and with it her reason for living – may be lost before she turns 30.
While beauty has always been admired and desired, the notion that physical perfection could be crafted en masse is more contemporary. Beauty is no longer skin deep, the product of good fortune, cultural mores and fashion. It is now routinely aided by the surgeon's scalpel and chemical wizardry. Meera Atkinson, who comes from a long line of beautiful women, describes the painful pursuit of perfection she and her mother endured, while Loubna Haikal brings a satirist's eye to the voyeuristic manufacture of beautiful conformity. Making sense of competing and confusing ideas of beauty, health and belonging is particularly challenging for young women, as Elspeth Probyn writes in her personal exploration of the strengths and weaknesses of feminist rhetoric to touch the lived experience of being young and female.
DESPITE POPULAR CULTURE'S preoccupation with beauty and perfection, the reality is more mundane, much less touched by stardom, as Melissa Lucashenko observes in her essay on the competing images of Aboriginal bodies – the adored Cathy Freeman juxtaposed against a snotty youngster on a remote mission or a dead youth on a slab in a morgue.
But even these extremes are distant. It is the ailments of affluence that are most likely to curtail our lives. Overweight and obesity are looming as the greatest preventable health issues in the developed world. In Australia, more than 2.4 million adults are obese and almost double that number are overweight. Worldwide, the number of people whose extra weight is likely to cause serious health and medical problems exceeds 300 million. This is, as Stephanie Short writes, a health and fairness issue that will reverberate for decades, resisting simple solutions tied to food and fitness. The poor are disproportionately affected but, as Mark Peel observes in his study of the relations between charity workers and their clients in Melbourne in the 1930s, the bodies of the poor have often let them down. Yet when these people almost inevitably find their way to hospital, they are likely to encounter what John Menadue describes as a highly dysfunctional system in need of far-reaching reforms – some of which he proposes here.
It is a long journey from the promise of genetic science to the reality of obesity but our obsession with physical perfection has never been greater or likely to deliver such profound changes.