Ethical dimensions of enhancement technologies

Ethical dimensions of enhancement technologies

What a piece of work is a man! How noble in reason, how infinite in faculties! In form and moving how express and admirable! In action how like an angel, in apprehension how like a god! The beauty of the world. The paragon of animals...

Hamlet’s sentiments seemingly to the contrary notwithstanding, the theme of this issue, perfecting the human body, suggests that homo sapiens can be improved upon in a host of ways. What constitutes “improvement,” as well as if, when, and how it should be undertaken, is a target-rich environment for ethical controversy. The burgeoning bioethics literature on this topic has, perhaps unsurprisingly, spawned its own panoply of acronyms, including “robust human enhancement technologies” (R-HETs) and nano-, bio-, information technology and computer science (NBIC) neuroscience enhancements.

One of the ways in which bioethicists have attempted to analyze the ethical considerations of such efforts is to distinguish between those which are therapeutic and those which are purely enhancement of what falls within the range of species-normal function and appearance.

Therapeutic vs. enhanced

The supposition at work is that the genuinely therapeutic is entirely consistent with the widely recognized goals of medicine – the treatment of disease or malady, the prevention of premature death, and the relief of suffering associated with such conditions. Thus the President’s Council on Bioethics (PCB), which served during the G.W. Bush administration under the chairmanship of Dr. Leon Kass, published a report entitled Beyond Therapy – Biotechnology and the Pursuit of Happiness concerning the perils and pitfalls of pursuing “better children,” “superior performance,” “ageless bodies,” or “happy souls” through the use of R-HETs, NBIC neuroscience, and measures yet to be developed or even imagined.

A more mundane approach to distinguishing therapy from enhancement is what health insurance will customarily pay for – “yes” for plastic surgery following certain surgical treatments for cancer, “no” for plastic surgery to make you look years younger than your chronological age.

Those who seek a more expansive (and permissive) approach might invoke the World Health Organization’s definition of health: “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” Such a seemingly unachievable state of human flourishing potentially expands the range of “therapeutic” interventions almost without limitation. Proponents of R-HETs sometimes respond to those who would warn us of the “law of unintended consequences” by invoking a version of the “inevitability thesis” known as the “technological imperative (TI),” i.e., once a technology is introduced into a culture the development and deployment of it is inevitable. Of course, acknowledging the TI would not imply that reasonable regulation of new medical technologies as they move from bench to bedside is either unwarranted or impracticable.

Being human

The most profound and provocative concerns and implications, also raised by the PCB report, relate to the risk that at some point such “enhancements” might alter irretrievably what it means to be a living human being. Moreover, the report suggests, “the growing power to manage our mental lives … estranges us not only from the world but also from the sentiments, passions, and qualities of mind and character that enable us to live in it well.”

The extreme terminus of such a progression was proposed as a thought experiment by the late distinguished philosopher Robert Nozick, who challenged us to imagine an “experience machine,” an example of a very high-tech virtual reality device. It could be customized to a person’s preference with an extensive, elaborate menu of experiences. Once hooked up to the machine the user would have no awareness that the experiences would not be genuine. The “catch” to one version of this thought experiment, however, is significant: once you agree to be hooked up to the machine, you can never be unhooked.

Nozick believed that most people, after due consideration, would refuse to sign up for this because being alive as a person is much more than “how our lives feel from the inside.” We should, he suggests, view hooking up to the experience machine as a kind of suicide. Despite the custom tailoring of the program to our wishes, dreams, and fantasies, the machine would be living our lives for us. We would no longer exist in any way that matters; what remained of our life (or existence) would be devoid of authenticity.

Future humans

We have only scratched the surface of the benefits and risks posed by R-HETs. Despite our scientific and technological sophistication, we have not escaped the adverse sequelae of the moral and political limitations which have plagued us throughout history – human frailties with potentially ominous implications for R-HETs. At the dawn of the nuclear age, a philosopher with a more cynical view than the sentiments of Shakespeare with which this column opened observed in the Atlantic magazine: “collective modern man is a technical genius merged with a moral imbecile.”

With what degree of conviction can we declare that in the interim we have remedied that striking disparity of competencies?

Columnist Ben A. Rich, J.D., Ph.D., holds the UC Davis School of Medicine Alumni Association Endowed Chair in Bioethics