The Ethics of Biological Modification of Human Beings

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The Ethics of Biological Modification of Human
Beings Julian Savulescu Uehiro Professor of
Practical Ethics University of Oxford
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Radical Alteration of Humans

• Current Possibilities
• Transgenesis
• Chimeras
• Human-Animal

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Transgenesis

• Current uses
• Medical research
• Disease resistant species
• Products useful to humans
• Xenotransplantation

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Chimeras

• Animal
• Human
• Human-Animal

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The Threat to Humanity

• Objection
• Threat to humanity
• Unnatural
• Affront to human dignity
• transgression of the unspeakably profound.
• Repugnance may be the only voice left that
  speaks up to defend the central core of humanity
  Leon Kass

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What is Humanity?

• Distinguishes us from other animals
• Candidate properties for our moral status
• capacity to reason
• capacity to act from normative reasons, including
  moral reasons
• capacity to act autonomously
• capacity to engage in complex social
  relationships
• capacity to display empathy and sympathy
• capacity to have faith (believe in a god)

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What Promotes or Erodes Our Humanity?

• Actions which express our humanity
• Express our practical rationality
• Modification to prevent disease vs creation of
  freaks for entertainment
• Actions which erode or promote the capacity to
  engage in practical reasoning
• Improved sensory capacity, longevity, empathy,
  rationality, memory vs ferociousness, violence

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Conclusion

• Radical genetic alteration of humans is not
  necessarily a threat to our humanity
• It may be
• But it may promote our humanity
• Another lesson
• Can does not imply will
• Against the empirical version of the slippery
  slope argument

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Vision

• Redefine the purpose of science and medical
  research
• 20th century medicine treat and prevent disease
• 21st century medicine should develop and use
  science and medical technology not just to
  prevent or treat disease, but to enhance peoples
  lives through biological modification
• We should we make happier, better people

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Making Better People Now

• Cosmetic surgery, botox, beauty industry,
  appetite suppressants, body art, piercing,
  tattooing
• Children bat ears, growth hormone
• Sport EPO, anabolic steroids, growth hormone
• Identification of athletes on the basis of
  genetic potential ACTN3
• Cognitive enhancement nicotine, ritalin,
  modavigil, caffeine
• Mood enhancement psychological self-help,
  prozac, recreational drugs, alcohol

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Making Better People Now

• Sexual performance/drive
• Hormonal castration of paedophiles
• Viagra
• 34 of all men 40-70 around 20 million in the
  US have some erectile dysfunction
• Only 1 in 5 seek help
• 20 million men world wide use viagra
• Largely treats effects of normal aging
• 12 decline in erectile function every decade
  normally.
• May prevent impotence - preventative

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Much more radical biological enhancement is
possible

• Longevity
• Cure disease 12 years
• Stem cell science
• Quality of life

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Radical Biological Enhancement

• Biology and how we live animal research
• Hard working monkey
• Monogamous prairie vole vs polygamous meadow vole
• Neuroscience to treat and prevent disease
• Environmental stimulation, prozac, nerve growth
  factors
• Prevents degeneration rats with the gene for
  Huntington Disease
• Enhance in normals?

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Behavioural Genetics

• genes which are associated with non-disease
  states, such as psychological types, personality
  traits, intelligence and behaviour in general.
• aggression and criminal behaviour
• alcoholism and addiction
• anxiety
• personality disorders
• psychiatric diseases
• homosexuality
• maternal behaviour
• memory and intelligence
• neuroticism and novelty seeking.
• ACTN3 and sprint/endurance performance

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Possibility of Enhancement

• Genetic selection
• By mating
• Prenatal diagnosis
• Preimplantation genetic diagnosis
• against diseases
• sex selection
• height
• Biological manipulation
• Pharmacology
• Genetic manipulation

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The ethical question - should we enhance?

• We should be happy people, not just healthy
  people.

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First Argument for Enhancement

• 1. Choosing not to enhance is harming
• Dietary neglect results in a child with a
  stunning intellect becoming normal
• Wrong
• Failure to institute some diet means a normal
  child fails to achieve a stunning intellect
• Equally wrong
• Substitute biological intervention for diet

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Moral Responsibility

• Ought implies can
• When we could not affect the biological nature of
  our children, we were not responsible for their
  deficiencies and disabilities
• Can (roughly) implies ought to decide
• When we can influence the biology of our
  children, we are morally responsible for the
  foreseeable consequences of failing to
  intervene/leaving it to nature
• We can be morally responsible for the foreseeable
  consequences of our omissions sins of omission

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Second Argument Consistency

• We accept environmental interventions
  education, diet
• Train children to be well behaved, co-operative
  and intelligent
• We accept drugs
• Ritalin, growth hormone
• But could increase production or number of
  receptors by genetic modification

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Consistency

• There is no difference between environmental and
  biological intervention
• Rats given stimulating environment vs prozac

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Consistency

• Environmental manipulations affect biology
• Maternal care and stress
• hippocampal development
• cognitive, psychological and immune deficits
  later in life
• Early experience can actually modify protein-DNA
  interactions that regulate gene expression,
  (changes in methylation id DNA) Michael Meaney

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Prozac

• Alters brain chemistry serotonin reuptake
  inhibitor
• Early in life acts as a nerve growth factor
• But may alter the brain early in life to make it
  more prone to stress and anxiety later in life,
  by altering receptor development (Science, 29
  October 2004)
• people with a polymorphism that reduced their
  serotonin activity were more likely than others
  to become depressed in response to stressful
  experiences (Science, 18 July 2003)

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Third Argument No difference to disease

• If we accept the treatment and prevention of
  disease, we should accept enhancement
• Goodness of health is what drives a moral
  obligation to treat or prevent disease
• Health is not what matters health enables us to
  live disease prevents us from doing what we want
  and what is good
• But how well our lives goes depends on our
  biology (in part)
• Drives a moral obligation to enhance

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Abortion as Enhancement

• Pregnancy is not a disease
• Abortion is not (generally) a medical treatment
• Abortion is provided because it makes womens
  lives go better

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Should we aim at perfection?

• It is a brute fact that we are different. Those
  differences are, in large part, biological. And
  not all differences are equal.

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What is the best life?

• Addressing the Value Skeptic
• Life with the most well-being
• Philosophers have exercised themselves for
  several thousand years on what constitutes
  well-being
• There are various theories of well-being
  hedonistic, desire-fulfilment, objective list
• Not just absence of disease.
• People trade length of life for non-health
  related well-being- smoking, alcohol, risk

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What is the best life?

• We do have some idea of the good life
• Social institutions and scientific research aimed
  at addressing this
• Services to enable people lead good lives
• Ask advice
• Self help
• Education of children

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Opportunity/Capability

• Determined by
• Genes
• Environment parenting, social institutions,
  material resources
• Increase capabilities/reduce disabilities
• Improve chances of a good life

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Disability

• X is a disability in circumstances c if
• 1. X reduces the goodness of a life and/or
• 2. X reduces the chances of a person realising a
  possible good life
• Disability is viewed as a bad thing
• That is why we try to cure it

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Examples of Character Traits Improving
Well-Being Self Control

• Disabilities are
• Pervasive
• Can be character traits flaws in character
• Can range from insignificant to profound
• Eg lack of self-control

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Self Control

• In the 1960s Walter Mischel conducted impulse
  control experiments where 4-year-old children
  were left in a room with one marshmallow, after
  being told that if they did not eat the
  marshmallow, they could later have two.
• Some children would eat it as soon as the
  researcher left.
• Others would use a variety of strategies to help
  control their behaviour and ignore the temptation
  of the single marshmallow.

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Self Control

• A decade later, they found that those who were
  better at delaying gratification had
• more friends
• better academic performance
• more motivation to succeed.
• Whether the child had grabbed for the marshmallow
  had a much stronger bearing on their SAT scores
  than did their IQ.
• Impulse control has also been linked to
  socioeconomic control and avoiding conflict with
  the law.
• Poor impulse control is a disability

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Other Categories

• All Purpose Goods
• Intelligence
• Memory
• Self- discipline
• Foresight
• Patience
• Sense of humour
• Optimism

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Other Categories

• Hearing can become deaf but the deaf cannot
  become hearing.
• Future opportunity-enhancing
• Hearing
• 4 limbs
• Open future
• Future opportunity-restricting
• Deafness
• Limb amputation (for apotemnophilia)

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Other Categories

• Autonomy enhancing
• Improving the psychological capacities necessary
  for autonomy
• concept of self
• ability to remember, understand and deliberate on
  relevant information
• strength of will
• foresight
• empathy, etc
• Our moral character
• empathy, imagination, sympathy, fairness,
  honesty, etc
• Monkeys and grape
• We try to instil these character traits, which
  are biological states, by education.

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Other Specific Examples

• Religiosity
• Criminality
• Dutch family criminality mutation in the MAO
  region of X chromosome
• Blushing, shyness, stuttering

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Should we make happier people?

• Genes, not men, may hold the key to female
  pleasure
• genes accounted for 31 per cent of the chance of
  having an orgasm during intercourse and 51 per
  cent during masturbation
• ability to gain sexual satisfaction is largely
  inherited
• The genes involved could be linked to physical
  differences is sex organs and hormone levels or
  factors such as mood and anxiety.
• The Age, June 8, 2005

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How do we decide?

• Nature or God
• Experts philosophers, bioethicists,
  psychologists, scientists
• Authorities government, doctors
• Decide for ourselves liberty and autonomy

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How do we decide?

• Principle of liberal state
• Neutrality to conceptions of the good life
• Personal Autonomy
• Sole ground for interference is harm to others
• Advice, persuasion, information, dialogue
  permissible
• Negative liberty coercion and infringement of
  liberty impermissible

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Limits of positive liberty

• What should be provided?
• Safety
• Harm to others
• Distributive justice

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Children

• Young children, embryos and fetuses
• Who decides?
• Nature or God
• Experts philosophers, bioethicists,
  psychologists, scientists
• Authorities government, doctors - eugenics
• Parents procreative liberty and autonomy

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Justifications for Procreative Liberty

• Privacy of reproduction
• Parents bear costs of child-rearing
• Parents know best what kind of family they can
  raise
• Experiments in living

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Limits to Procreative Liberty

• Safety
• Harm to others
• Distributive justice
• Plausible conception of well-being and a better
  life for the child
• Consistent with development of autonomy in child
  and a reasonable range of future life plans

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Summary Arguments

• What matters is human well-being, not only
  treatment and prevention of disease
• Our biology affects our opportunities to live
  well
• Our biology affects how we experience stimuli
• Essence of humanity is to choose to be better
• The biological route is no different to the
  environmental
• Biological manipulation to increase opportunity
  and reduce disability is right

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Objection 1 Playing God

• We are not omnipotent and omniscient
• Genes are pleiotropic- genes for manic depression
  may also promote creativity
• Responses
• We play God already life is nasty, brutish and
  short
• Caution but balance benefits against risks
• Selection preferable to enhancement

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Objection 2 Change Society, Not People

• We should alter social arrangements to promote
  well-being, not biologically alter people
• Related disability is socially constructed
• Response
• Biopsychosocial fit
• We should consider all modifications, and choose
  the modification, or combination, which is best
• Skin colour
• Social modification and discrimination
• Biological modification and environmental risk

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Social Not Biological Enhancement

• Good Reasons to Prefer Social Rather Than
  Biological Intervention
• If it is safer
• If it is more likely to be successful
• If justice requires it (based on the limitations
  of resources)
• If there are benefits to others or less harm
• If it is identity preserving
• BUT VICE VERSA

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Objection 3 Value of Diversity

• Enhancement would narrow the range of
  characteristics
• Diversity is a value
• Response
• Evolution has no design it is indifferent to
  how well our lives go
• Not all diversity is good psychopathy
• Engineer diversity

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Objection 4 Discriminination

• a two class society of the enhanced and the
  unenhanced, where the inferior unenhanced are
  discriminated against and disadvantaged all
  through life
• Gattaca

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Responses

• Nature alots advantage and disadvantage with no
  mind to fairness.
• Some are born horribly disadvantaged, destined to
  die after short and miserable lives.
• Some suffer great genetic disadvantage while
  others are born gifted, physically, musically or
  intellectually.
• nothing fair about the natural lottery
• allowing enhancement could be used to reduce
  natural inequality.

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Egalitarian social institutions

• how well the lives of those who are disadvantaged
  go depends not on whether enhancement is
  permitted, but on the social institutions we have
  in place to protect the least well off and
  provide everyone with a fair go.
• People have disease and disability egalitarian
  social institutions and laws against
  discrimination are designed to make sure
  everyone, regardless of natural inequality, has a
  decent chance of a decent life.

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Discrimination

• How the biologically modified and unmodified are
  treated is our choice
• Equal concern and respect is possible in a world
  of biological modification

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Objection 5 Enhancement Alters Identity

• Significant cognitive or other psychological
  enhancement may alter identity
• Complex
• Voluntary permissible
• Early in life like selection

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Objection 6 Value of Loss, Suffering, Limitation
and Mystery of Life

• Presidents Commissions Beyond Therapy
• Traumatic memories, shame, and guilt, are, it is
  true, psychic pains. In extreme doses, they can
  be crippling. Yet, short of the extreme, they can
  also be helpful and fitting. They are appropriate
  responses to horror, disgraceful conduct,
  injustice, and sin, and, as such, help teach us
  to avoid them or fight against them in the
  future.

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Beyond Therapy

• there appears to be a connection between the
  possibility of feeling deep unhappiness and the
  prospects for achieving genuine happiness. If one
  cannot grieve, one has not truly loved. To be
  capable of aspiration, one must know and feel
  lack. The world would be a sterile, monotonous
  place where everyone is the same, and the mystery
  and surprise of life is gone.
• Michael Sandel we must be open to the unbidden

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Shakespeare

• The web of our life is of mingled yarn, good and
  ill together our virtues would be proud if our
  faults whippd them not, and our crimes would
  despair if they were not cherishd by our
  virtues.
• Alls Well that Ends Well
• Thanks to Mike Parker for example

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Responses

• Introduce suffering, difficulty, light and dark
• Not all will enhance 10 choose not to abort
  Down syndrome
• There will be plenty of challenge and mystery
  left in an uncertain world
• Better children may be possible perfect children
  will not
• One can choose to go to a good play rather than
  a poor one, and still experience the mystery of
  events as they unfold.

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Objection 7 Self-defeating (or Unfair)

• If everyone stands on tiptoes, no one sees better
• But distinguish between
• positional goods height
• Non-positional goods - memory
• Question of justice not particular to
  biological modification
• If significant, make it free, like health care

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Public Interest

• Public interest is a legitimate ground for
  interfering in liberty in extreme cases
• Violence
• Health crisis - Cyprus
• We are responsible for the outcome would we harm
  some person for the sake of the public interest?
• Denying enhancement is a harm

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Conclusion

• 21st century medicine and medical research should
  be to develop interventions which not only
  prevent and treat disease, but make peoples
  lives better.
• Future
• Genetic engineering artificial chromosomes
• Internal technology nanotechnology, artificial
  intelligence
• Scientific and medical research is the way to
  realise this future

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• The reasonable man adapts himself to the world
  the unreasonable one persists in trying to adapt
  the world to himself. Therefore all progress
  depends on the unreasonable man.
• George Bernard Shaw, Man and Superman IV.

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Conclusion

• Shaw is wrong
• Sometimes it is rational to adapt biologically or
  psychologically to the world
• Sometimes it is rational to change the world
• Sometimes, we should accept things just as they
  are
• Which course of action or inaction we choose
  depends on the benefits and risks, the
  opportunity costs and the context

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Obligation to Consider Enhancement

• What we must do is consider all options and make
  an active choice which reason supports
• We good reason to be better
• We can no longer leave our lives thoughtlessly to
  chance

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• We should be here for a good time, not just a
  long time.
• Biology will provide one answer how...