Human beings are obsessive innovators. Homo sapiens (knower) is by nature Homo faber (fabricator). Life without what philosopher Michael Novak has called ‘the fire of invention’ doubtless would be nasty, bloody, and brutish. Since biomedicine and biotechnology are two spheres where innovation is especially rewarded, it is no surprise that we stand on the threshold of the development of human biological enhancements.
We have attempted enhancement in many different ways, especially for our children: diet, exercise, music lessons, tutoring, athletics, and even cosmetic surgery. But for many people, there is something deeply troubling about bioenhancement technologies, whether they are reproductive, genetic, neurological, or prosthetic technologies. By ‘bioenhancement’ I mean that these technologies magnify human biological function beyond species typical norms.
Ethical reflection about these technologies requires that we make some distinction between therapy and enhancement. Therapies would include medical interventions that restore human functioning to species typical norms. So, kidney dialysis, lasik surgery, and angioplasty are therapies; but adding twenty IQ points to someone who already has a normal IQ would be an enhancement.
Both proponents and critics of bioenhancements have argued, however, that the line between therapy and enhancement is vanishingly thin. But it may not be as faint as some imagine. I was once in a conversation with a prominent fertility specialist who used preimplantation genetic diagnosis (PGD) to help couples have children without genetically-linked diseases. He told of a couple who came to him requesting that he assist them to have a child who would have perfect musical pitch. Since they were both orchestral musicians and because there may be a gene associated with aural acuity, they wanted a child to follow in their footsteps. He steadfastly refused. He said he could not say exactly why, but his intuition was that it was unethical. Just because we cannot always make finely tuned distinctions does not mean distinctions are impossible. Just because a bright line may not be drawn does not mean no line can be drawn.
We should resist human bioenhancement technologies at least for a number of reasons, including their inconsistency with the goals of medicine, their violation of the principle of justice, and their complicity with cultural stereotypes.
Human bioenhancements should be resisted, first, because they are inconsistent with the goals of medicine. The first goal of medicine is healing for the “patient’s good.” The principle of medical beneficence assumes either that a patient is enjoying homeostasis, and the role of the physician is to assist him or her to maintain or optimize normal functioning, or that a patient is suffering diminished capacity due to illness or disease, and medicine’s role is to help restore as much normal function as possible. This aim of medicine is as old as the Hippocratic Oath. Whether we call it healing, wellness, or shalom, the goals of medicine are restorative and preventive.
Only recently have we begun to imagine medicine as a way to move beyond therapy. Medicine is seen less today as a profession and more as a commercial service. Physicians are not seen as professionals, they are merely body plumbers (no offense to plumbers). Consumerism thrives on giving the customer what he or she desires. While HBTs are not consistent with the traditional aims of medicine, they are very consistent with desire-satisfaction where, as ethicist Carl Elliot so elegantly puts it, “American medicine meets the American dream.” So now consumers employ doctors to make them “better than well.”
Another reason to reject bioenhancements is the principle of justice. Having recently witnessed the Olympic games in Beijing, and heard the hoopla over doping in the Tour de France, we should be sensitive to the ways even the hint of enhancements threaten the fairness of competition. By analogy, technologically enhanced IQ, speed, dexterity, hearing, musical ability, etc., would create injustices, at least in cultures where those qualities are valued. The enhanced individual potentially would have unfair advantage over others in employment or life, just as blood-doping and steroids created advantages over other athletes. Furthermore, enhancing already wealthy Westerners while so many individuals lack access to basic therapeutic medicine, seems patently unjust. In fact, most of the world’s people do not want enhancements, they want basic healthcare.
Georgetown philosopher Margaret Little has argued that enhancements contribute to cultural differences that lead to personal dissatisfaction and even stigmatization. For instance, Western culture’s valorization of the Barbie-doll figure leads to body dysmorphic disorder among American teenage girls. Some Asian girls are having cosmetic surgery to make their eyes rounder and less almond-shaped in order to fit the Western ideal. For a culture to legitimize enhancement is to be complicit in these pathologies. And this would seem especially heinous after spending untold social capital, tax-dollars, and educational resources trying to convince our culture that persons with disabilities should be respected equally as those without them.
Human bioenhancements seem to be a very dubious investment of time and other scarce resources. Only those already well-off can afford the luxury of enhancements. The sick need a physician.
Editor’s Note: This essay originally appeared in Ethics & Medicine: An International Journal of Bioethics 25, no. 3, (2009) and is used by permission.
