Enhancing humans, controlling evolution.
Subject: Evolution (Evaluation)
Author: Campbell, Courtney S.
Pub Date: 07/01/2009
Publication: Name: The Hastings Center Report Publisher: Hastings Center Audience: Academic; Professional Format: Magazine/Journal Subject: Biological sciences; Health Copyright: COPYRIGHT 2009 Hastings Center ISSN: 0093-0334
Issue: Date: July-August, 2009 Source Volume: 39 Source Issue: 4
Topic: NamedWork: Enhancing Evolution: The Ethical Case for Making Better People (Nonfiction work)
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 220561136
Full Text: In December 2008, a study group convened by Rockefeller University published a commentary in Nature recommending societal adoption of cognitive-enhancing medications by healthy persons. The group included a prominent bioethicist, John Harris, who for two decades has recommended various enhancements--pharmacological, hormonal, chemical, genetic--as beneficial to human beings. Harris's most systematic defense of enhancements, including germ line and embryo enhancements, is presented in his very provocative book, Enhancing Evolution: The Ethical Case for Making Better People. The biotech revolution has brought us to a point where the human species, Harris contends, "will replace natural selection with deliberate selection, Darwinian evolution with 'enhancement evolution'" (p. 4).

Harris initiates his argument with a thought experiment: Given the lengths many parents will go to seek the best educational opportunities and social advantages for their children, why not instead achieve the desired qualities--such as enhanced intelligence, better health and fitness, and improved physical and mental capacities--through such means as genetic engineering, regenerative medicine, reproductive technology, or nanotechnology, particularly by selecting for traits in the human embryo? In either context, Harris suggests, our goals are the same. We have simply changed from social engineering to genetic or pharmacological means. Once we have willed the ends, we have necessarily willed the means to realize those ends.

This opening rhetorical reflection provides a compressed version of Harris's general argument on enhancements through medical interventions: Having embarked on the path of "making better people" through education, athletic camps, music lessons, and the like, it's not possible to claim these ends are offlimits to the medical enterprise; indeed, we are more likely to succeed through medical and biotechnological methods. Enhancements have already been incorporated within medicine. For instance, if one follows the trajectory from glasses to contact lenses to LASIK surgery, it seems arbitrary to draw a line against enhancements for night vision. Vaccinations against diseases like smallpox suggest we are morally committed to accept vaccinations that provide immunity against disease. And life-prolonging measures, such as organ transplants, usher us into a moral realm that endorses regenerative technologies to reverse aging or even to achieve a biological immortality, which Harris refers to as "the Holy Grail of enhancement" (p. 59).

Harris sees no conceptual difference between therapy and enhancement, nor any defensible criteria of normal human functioning or flourishing that traditionally have grounded objections to enhancements. He denigrates religious considerations as superstition and expressions of prejudice. The philosophical basis he offers for enhancements shows how much ground has been traversed in supplanting Darwinian with enhanced evolution: "Medicine can be described as 'the comprehensive attempt to frustrate the course of nature'" (p. 35). Remarkably, Harris offers no philosophical account or defense of this view of the vocation of medicine, or of medicine's relation to nature, even though this claim opens the way to a comprehensive medicalization of life, from preconceptual screening to end-of-life treatments.

According to Harris, the choice to use enhancement technologies is also protected by "the democratic presumption." This presumption amounts to a twenty-first century restating of Mill's "harm principle"--that the only ground for intervening with or restricting personal liberty is the prospect of harm to others. For Harris, such harms must be "real and present," not "speculative and future." There are at least two issues here that Harris needs to address--one focusing on the relationship of law and moral discourse (with the latter here in danger of being eclipsed by the former), and the other on how we should address uncertainty about outcomes in moral deliberation. While Harris rejects a mechanism like the "precautionary principle" in the face of uncertain outcomes, why we should presume enhancements are necessarily conducive to personal benefit and social betterment is not evident.

The philosophical and moral difficulties with Harris's proposal are revealed by his equivocal use of the language of "better" people in the subtitle and opening chapter of his book. "Better" seems to entail an expansion of various human capacities, including intelligence, memory, health, and longevity, but to have absolutely nothing to do with moral character, integrity, or virtue. Nor is it necessarily the case that becoming a "better" or enhanced person in Harris's understanding will fulfill aspirations for relationships, happiness, and well-being.

It is important to ask which people have the opportunity to become "better." Harris proposes that enhancements will somehow make us "fairer" persons even as he acknowledges that stratification will be present in the initial stages of an enhancement project. He then relies on an inchoate theory of the diffusion of new technology in claiming that "procedures which start expensive, rare (even elitist), and risky often become widely available, if not universal, cheap, ... and widely accessible" (p. 31). Perhaps this mode of diffusion is reasonable in a socialized health care system, but in a country like the United States, where 47 million people lack access to basic health care--that is, where health care itself is not "universal, cheap, ... and widely accessible"--a proposal to open enhancements to an elite while many citizens go without basic care seems an egregious misallocation of scarce resources and a violation of the principles of justice and equal opportunity.

Finally, it is puzzling just how Harris considers his advocacy of a moral (and, if necessary, legally enforceable) obligation to not only support but also participate in the biomedical research required to further enhancement as being at all compatible with the democratic presumption. The criteria for restricting my liberty on the model of the democratic presumption is that my acts pose a real and present harm to others, but the obligation to participate in enhancement research restricts my liberty on the grounds of a speculative benefit to unknown persons in future generations.

Less broad in imaginative scope (no pretensions to biological immortality), but more soundly argued philosophically is Ronald M. Green's Babies by Design: The Ethics of Genetic Choice. Harris and Green are actually reasonably close in their conclusions on most enhancement prospects, and there are echoes of Harris's title in Green's assertion that we are entering the "era of directed human evolution" (p. 2). And Green makes use of a similar casuistical method, continually citing instances of practices we currently accept as precedents that make drawing a line against most forms of enhancement difficult.

Still, Green's book is much more solidly grounded in ongoing scientific research; he devotes an entire chapter to "how we will do" enhancements scientifically, not just conceptually. He reflects thoughtfully on the dynamics of the parenting-child relationship and the impact on it of genetic choice, which is a marked contrast to the individualistic narcissism often characterizing Harris's arguments. Green takes objections to genetic design as "healthy warnings" rather than subjects for philosophical ridicule and devotes a chapter (albeit an unsatisfactory one) to religious considerations under the concept of "playing God," instead of dismissing such views as irrational superstition.

Green's assessment of what hinders societal support of enhancement technologies, especially in the realm of reprogenetics, is that we are prone to what he designates as "status quo bias." We have managed to delude ourselves into thinking that, medically speaking, we are in the best of possible worlds, so any projections of progress from genetic interventions seem fraught with moral peril and social catastrophe (p. 104). Yet, as Green rightly observes, had prior generations been afflicted with the same bias, many of the advances in biomedicine and health care that we now take for granted would not have occurred.

While Green and Harris agree that the traditional distinction between therapy and enhancement is no longer sustainable, Green does not believe medical research or society must be on the fasttrack quest for the biological "Holy Grail." He distinguishes between "preventive enhancements" such as vaccines, where the aim is related to maintaining health, and "pure enhancements," where the goal is "gratifying the wishes of normal and healthy people for improved performance or superior capabilities" (p. 61). Harris would surely challenge Green on this point, but Green, I believe, has made a compelling case that regarding enhancements (and moral choices in general), we are not solely concerned with outcomes but also with intentionality, design, and purpose; and, further, that a "wish" does not have the moral status of a "need."

Green also probes the implications of genetic design for the family as a moral community and social unit. He distinguishes parents' role as "guardians" of children's best interests from their role as "gardeners" who raise children not only for the child's sake but also for their own purposes. The morally responsible parent will balance these two roles, with the "guardian" restraining the "gardener."

While Green's insight that "parental love almost always prevails" (p. 114) may be generally valid, this doesn't quite explain why parents are willing to spend substantial financial resources, advance considerable emotional and relational investment, and undergo (for the female) a physiological ordeal to obtain a particular kind of child through genetic choice. Green's parenting models could be infused more with what theological ethicist William F. May refers to as "accepting" love as a constraint on the "transformative" love that motivates the parental quest for a specific kind of child. In general, Green's discussion of parental responsibility is a very thoughtful refutation of assertions that genetic modifications will "threaten" the family, but he is less successful in illustrating how having "babies by design" will, as he claims, "improve" on family life.

Both authors support parents' freedom to make responsible choices about genetic modification. Green has a narrower and Harris a broader notion of the meaning of responsibility in this context: Green's perspective is that parents can be responsible for harm when a child is born with a preventable impairment, while Harris would add that parents are also responsible if a child is deprived of a possible enhancement.

On either account, however, affirming procreative and parental autonomy for genetic design of children inevitably invites expanded medicalization of such choices, including increased use of technologies of reproduction, screening, selection, and manipulation. As parents assess their responsibilities to their unborn progeny, they are unlikely to be immune from pressures to conform and to control.

Babies by Design: The Ethics of Genetic Choice. By Ronald M. Green. Yale University Press, 2007. Hardcover. 288 pages. $26.00.

Enhancing Evolution: The Ethical Case for Making Better People. By John Harris. Princeton University Press, 2007. Hardcover. 260 pages. $27.95.
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