What Is Enhancement and When Should We Enhance

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What Is Enhancement and When Should We Enhance? A
Welfarist Account Professor Julian
Savulescu Uehiro Chair in Practical Ethics Funded
by ENHANCE, European Union
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The Welfarist Account and Its Implications

• Stephen Hawking how can the human race survive
  the next 100 years?
• Asteroids
• Nuclear war
• Climate change
• Accidental or intentional release of genetically
  engineered viruses
• Theres a sick joke that the reason we havent
  been visited by aliens is that when a
  civilisation reaches our stage of development, it
  becomes unstable and destroys itselfThe
  long-term survival of the human race will be safe
  only if we spread out into space, and then to
  other stars.This wont happen for at least 100
  years so we have to be very careful. Perhaps, we
  must hoper that genetic engineering will make us
  wise and less aggressive. (The Guardian, Thurs
  Aug 3, 2006, News 3)
• That is, the future of humanity may lie in
  enhancing our genome

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1. The Sociologically Pragmatic Approach

• Paul Root Wolpe
• a slippery socially constructed concept
• Yet, ultimately, any exclusive enhancement
  definition must fail, in part because concepts
  such as disease, normalcy, and health are
  significantly culturally and historically bound,
  and thus the result of negotiated values.
• James Canton
• The future may hold different definitions of
  human enhancement that affect culture,
  intelligence, memory, physical performance, even
  longevity. Different cultures will define human
  performance based on their social and political
  values. It is for our nation to define these
  values and chart the future of human performance
• enhancement captures a certain a value-laded
  domain of discourse related to human performance
  rather than having a substantive transcultural
  meaning itself.

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2. The Ideological Approach

• Presidents Council on Bioethics defines
  enhancement in relation to
• human desires and goals.
• The human meaning and moral assessment must be
  tackled directly they are unlikely to be settled
  by the term enhancement, any more than they are
  by the nature of the technological intervention
  itself. Leon Kass
• Aims directly at deep values, invoking concepts
  of metaphysics or spirituality.
• ideological approach enhancement is the
  practical means to achieve ideological ends.

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3. The Not-Medicine Approach Treatment vs
Enhancement

• Another influential approach has been to define
  enhancement in terms of going beyond
  health-restoring treatment or health.
• The term enhancement is usually used in
  bioethics to characterize interventions designed
  to improve human form or functioning beyond what
  is necessary to sustain or restore good health.
  Eric T. Juengst
• Definition of disease
• Normative
• Non-normative naturalistic
• Boorse and BST
• Species-typical normal functioning

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4. The Functional Approach

• defined in terms of enhanced systems functions
• E.g. cognitive enhancement is defined in terms of
  improved general information processing
  abilities.

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Enhancement of What?

• Enhancement is a wide concept
• increase or improvement.
• doctor may enhance his patients chance of
  survival by giving the patient a drug.
• enhance the functioning of a persons immune
  system or memory (the functionalist account).
• Distinguish functional enhancement from human
  enhancement
• enhancing a permanently unconscious persons
  chance of surviving might not be good for the
  person. It might not constitute human
  enhancement. It might not enhance intrinsic good
  or good in a predicative sense.

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Example of Genetic Memory Enhancement

• Genetic memory enhancement has been demonstrated
  in rats and mice.
• In normal animals during maturation expression of
  the NR2B subunit of the NMDA receptor is
  gradually replaced with expression of the NR2A
  subunit, something that may be linked to less
  brain plasticity in adult animals.
• Tsien et al. modified mice to overexpress the
  NR2B.
• The NR2B Doogie mice demonstrated improved
  memory performance, both in terms of acquisition
  and retention.
• This included unlearning of fear conditioning,
  which is believed to be due to learning a
  secondary memory.
• The modification also made them more sensitive to
  certain forms of pain, showing a potentially
  non-trivial trade-off.
• It is possible that even though memory is
  improved, their lives go worse.

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What Is Human Enhancement?

• when we are considering human enhancement, we are
  considering improvement of the persons life.
• not mere functioning as a member of species homo
  sapiens
• The improvement is some change in state of the
  person biological or psychological- which is
  good.
• the value in question is the goodness of a
  persons life, that is, her well-being.

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5. A Welfarist Definition of Human Enhancement

• Welfarist Definition of Human Enhancement
• Any change in the biology or psychology of a
  person which increases the chances of leading a
  good life in circumstances C.
• On the Welfarist Definition of Enhancement, we
  can define an enhanced state as a capability.
• Capability
• Any state of a persons biology or psychology
  which increases the chance of leading a good life
  in circumstances C.
• Disability
• Any state of a persons biology or psychology
  which decreases the chance of leading a good life
  in circumstances C.

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Treatment vs Enhancement

• Disease vs disability
• Much debate about enhancement draws a mutually
  exclusive distinction between medical treatment
  and enhancement.
• Naturalistic Conception of Disease
• Any state of a persons biology or psychology
  which reduces species typical normal functioning
  below some statistically defined level.
• Narrow Definition of Enhancement
• Any change in the biology or psychology of a
  person which increases species typical normal
  functioning above some statistically defined
  level.
• For example, low intelligence is defined as
  intellectual disability and treated as a disease
  when IQ falls below 70.
• On the naturalistic conception of disease and the
  narrow definition of enhancement, raising
  someones IQ from 60 to 70 is treating a disease
  and raising someones IQ from 70 to 80 is
  enhancement.

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Folk Definitions

• Folk usage of the term enhancement supports this
  account.
• Enhancement
• The action or process of enhancement the fact of
  being enhanced
• Enhance
• to raise in degree, heighten, intensify
  (qualities, states, powers, etc)
• to raise (prices, value)
• to raise or increase in price, value,
  importance, attractiveness, etc
• (Formerly used simply, to increase in price
  or value esp. to raise the intrinsic value of
  (coin). Also (rarely) to increase in
  attractiveness, to beautify, improve.)
• The spirit of all these definitions is
• Enhance to increase value
• In the context of human enhancement, to enhance
  is to increase the value of a persons life.

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Subclasses of Enhancements

• Enhancements include a family of different kinds
  of improvements.
• Medical Treatment of Disease
• Increasing Natural Human Potential increasing a
  persons own natural endowments of capabilities
  within the range typical of the species homo
  sapiens, e.g raising a persons IQ from 100 to
  140.
• Superhuman Enhancements (sometimes called
  posthuman or transhuman) increasing a persons
  capabilities beyond the range typical for the
  species homo sapiens, e.g. giving humans bat
  sonar or the capacity fully read minds.
• By accepting the Welfarist Definition of
  Enhancement, the question of when should we
  enhance becomes when should we increase human
  well-being?

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Advantages of a Welfarist Conception of
Enhancement

• Sociologically Pragmatic
• Captures intercultural variability in concept of
  good life
• Ideological
• Can incorporate wide conceptions of human
  well-being
• Disagreements are about concept of well-being,
  not its maximisation (enhancement)
• Functional
• Facilitates normative evaluation of functional
  enhancements

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Advantages

• Treatment/Enhancement
• Disease is disability
• Gives an account of badness of disease -Colour
  blindness
• Gives more appropriate and justifiable value to
  treatment in terms of well-being
• Allows comparisons between treatments and other
  enhancements
• generally, disease has significant impact on our
  well-being gt medical treatment greater priority
• But it leaves open whether there might be
  non-medical enhancements that have a much greater
  influence on well-being than medical treatment
  and so have greater priority.
• Imagine we could raise the IQ of everyone who had
  an IQ of between 70-80 by 10points. This would be
  enhancement not medical treatment. However, this
  might (depending on which theory of justice you
  accepted) have greater priority than raising the
  IQ of a few people with an an IQ of 60 by 10
  points, even though the latter is medical
  treatment
• Removing a wart vs radically increasing memory

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The Nature of Enhancement

• Enhancement
• Capability
• Disability

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Expected to have a good life

• Expected does not mean will
• Those with the greatest gifts may squander them
• Those with significant disabilities may have very
  good lives

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Decision-theoretic Consequentialism

• One standard way of making decisions under
  uncertainty is to choose that option which
  maximizes expected value.
• the expected value of adopting any course of
  action can be given by
• Pr(good outcome given that course taken) X V(good
  outcome) Pr(other outcomes given that course
  taken) X V(other outcomes).

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Consequentialism

• Consequentialism instructs the agent to
• 1. List all the relevant possible courses of
  action.
• 2. List the possible outcomes of each action. 3.
  Estimate the probability that each outcome of
  each action will occur, given that the action in
  question is taken.
• 4. Assign values to each possible outcome.
• 5. Calculate the expected value of each possible
  outcome. This is the product of the value of
  that outcome and the probability of it
  eventuating, given that a particular action is
  taken.
• 6. Calculate the expected value of each action.
  This is the sum of expected values of each the
  possible outcomes (or consequences) of that
  action.
• 7. Choose the action with the greatest expected
  value.

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Example knee replacement

• Consider a person trying to decide whether to
  have a knee replacement for arthritis
• weigh the pros and cons
• how good/bad these are
• how likely they are
• how bad the pain and disability currently are
• how much they will be alleviated by the operation
• how likely the operation is to be successful
• what the risks of the operation are
• how bad the complications might be, how much the
  operation costs, in money and time, and the
  consequences of this
• what the costs or benefits of waiting are.
• Applies to hearing aid, laser surgery to achieve
  greater than 20/20 vision (hawk like vision),
  sonar

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What is the best life?

• 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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Disability, Capability and Well-Being

• Well-being
• how well a life goes (goodness)
• cannot distribute well-being
• Capability
• a state of the person which increases the
  probability of achieving a good life
• Disability
• a state of the person which decreases the
  probability of achieving a good life
• disease is disability
• Moral obligation to promote well-being through
  increasing capabilities and reducing disabilities

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What is a disability?

• In 2001, Sharon Duchesneau and Candy McCullough,
  a deaf lesbian couple had their second child
  Gauvin
• The women, who wanted to have a deaf child,
  conceived Gauvin through Artificial Insemination
  by Donor (AID), using sperm from a friend they
  knew to have five generations of inherited
  deafness in his family
• They argued that
• Deafness is an identity, not a medical affliction
  that needs to be fixed
• The desire to have a deaf child is a natural
  outcome of the pride and self-acceptance many
  people have of being deaf
• A hearing child would be a blessing, a deaf child
  would be a special blessing
• They would be able to be better parents to a deaf
  child than to one who was hearing
• The child would grow up to be a valued member of
  a real and supportive deaf community
• Deafness is not a disability

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Is Deafness a Disability?

• Yes
• A deaf person cannot hear music, the sound of
  wind, the crack of thunder or the seductive
  whisper of a lover.
• The human voice is a fundamental part of the
  human condition and verbal communication a
  characteristic part of human culture.
• Deafness also reduces the chances of realising a
  good life because it makes it harder to live, to
  achieve ones goals, to engage with others in a
  world which is based on the spoken word. It is
  harder to get a job, harder to move in the world,
  harder to respond to emergencies
• Signing may be a unique mode of communication but
  it is better to speak two languages than one

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An example

• On the night of 10th of April, 2003, a school for
  deaf and mute children in Makhachkala in Russia
  caught fire.
• Twenty-eight children aged 7 to 14 died and more
  than 100 were injured.
• Several children, some naked, jumped through
  windows to escape the inferno. Rescuing the
  children was hampered because each child had to
  be awakened individually and told in sign
  language what to do.

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Capability/Disability Is Context Dependent

• Deafness is not a disability in a very noisy
  world but it is in our world
• Atopic tendency
• Asthma in developed world
• Protection against worm infestation in developing
  world
• X is a disability in circumstances C if
• X reduces the chances of a person realising a
  possible good life in circumstances C.
• In order to decide whether a state is a
  disability or a capability we need to fix or
  predict the social and natural environment

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Biology/Psychology as Capability/Disability

• Biological or psychological states can be
  predicted to be capabilities or disabilities in
  likely future environments
• Our biology contributes not only to our health
  but to how well our life is likely to go

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Example 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

• Buchanan, Brock, Daniels and Wikler 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 experiment

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Other Specific Examples

• Religiosity capability or disability?
• Criminality
• Dutch family criminality mutation in the MAO
  region of X chromosome
• Aggression
• Hawking claims genetic modification to reduce
  aggression is an important strategy in preserving
  humanity over next 100 years (Guardian 3/8/06)

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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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Significance of a Welfarist Account of Enhancement

• 1 There is a reason to enhance
• 2. These reasons must be balanced against others
• 3. Medical treatment has the same normative basis
  as other enhancements
• 4. Disability is Ubiquitous All of Us Are
  Disabled and Fail to Lead the Best Life
• all of us are disabled in some ways which make it
  more difficult to lead a very good life.
• enhancement is an issue of vital concern to all
  of us.
• 5. There are strong moral reasons to enhance

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Choosing not to enhance is wrong

• 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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Change Society, Not People

• We should alter social arrangements to promote
  well-being, not biologically alter people
• Improve society not enhance people to increase
  well-being
• 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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Social Construction of Disability

• Disability is socially constructed when there are
  good reasons to prefer social intervention than
  direct biological or psychological intervention.
• Biopsychosocial construction of disability
• Must consider reasons for and against
  intervention at all levels
• Social
• Psychological
• Biological

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How do we decide?

• There are four possible ways in which our
  psychology and biology will be decided.
• Nature or God
• Experts philosophers, bioethicists,
  psychologists, scientists
• Authorities government, doctors
• By people themselves- liberty and autonomy
• It is a basic principle of liberal states
• State be neutral to different conceptions of
  the good life.
• This means that we allow individuals to lead the
  life that they believe is best for themselves
  respect for their personal autonomy or capacity
  for self-rule.
• The sole ground for interference is when that
  individual choice may harm others.

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Limits

• There are limits to what a liberal state should
  provide
• Harm to others
• the intervention (like some manipulation that
  increases uncontrollable aggressiveness) should
  not result in harm. Such harm should not be
  direct or indirect, for example, by causing some
  unfair competitive advantage
• Distributive justice
• interventions should be distributed according to
  principles of justice

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Mill and Well-Being

• Questions of enhancement are questions of
  well-being
• Forming and acting on our own conception of the
  good life
• John Stuart Mill argued that when our actions
  only affect ourselves, we should be free to
  construct and act on our own conception of what
  is the best life for us.
• experiments in living that people discover what
  works for them.
• Mill strongly praised originality and variety
  in choice as being essential to discovering which
  lives are best for human beings.
• distinguished between higher pleasures of
  feelings and imagination and lower pleasures
  of mere sensation. Mill criticized "ape-like
  imitation", subjugation of oneself to custom and
  fashion, indifference to individuality and lack
  of originality.

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Mill

• "I have said that it is important to give the
  freest scope possible to uncustomary things, in
  order that it may appear in time which of these
  are fit to be converted into customs. But
  independence of action, and disregard of custom,
  are not solely deserving of encouragement for the
  chance they afford that better modes of action,
  and customs more worthy of general adoption, may
  be struck out nor is it only persons of decided
  mental superiority who have a just claim to carry
  on their lives in their own way. There is no
  reason that all human existence should be
  constructed on some one or small number of
  patterns. If a person possesses any tolerable
  amount of common sense and experience, his own
  mode of laying out his existence is the best, not
  because it is the best in itself, but because it
  is his own mode."

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Conclusion

• Welfarist Definition of Human Enhancement
• Any change in the biology or psychology of a
  person which increases the chances of leading a
  good life in circumstances C.
• When should we bring about some modification of
  biological or psychological alteration of a
  person which is a putative enhancement?
• On a Welfarist Account, whether we should
  intervene depends on
• account of well-being we employ
• whether the modification is expected to increase
  the chances of the person in question leading a
  good life in the likely
• whether there are reasons to prefer modifications
  of the natural or social environment.
• whether the modification will harm others or
  create or exacerbate injustice.

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Comclusion

• Questions of enhancement are questions of value
  theory and the account of well-being we should
  employ.
• They are questions of science and what brings
  about well-being. And they are questions of the
  limits of the pursuit of self-interest or
  beneficence.
• When should we enhance biology or psychology?
• When there is most reason
• When this is the best way to improve a persons
  well-being, esp with respect to social or natural
  intervention
• When this does not result harm to others
• When there are no countervailing reasons of
  justice

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Procreative Beneficence

• Obligation to have children with the most
  capabilities and least disabilities

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Significance Scope for Enhancement

• Evidence that basic character traits, moral
  dispositions, and subjective well-being have a
  surprisingly high genetic basis
• We claim that we should change both
  genes/psychology and environment to promote
  peoples well-being.
• The basic (though not only) criteria for choosing
  between the two are factors such as efficiency,
  cost, etc.
• Other people think that there are moral reasons
  not to tamper with genes (or even psychology) and
  therefore promotion of well-being can be achieved
  only by changing the environment.
• If environment counts for little, and a person
  with an innate disposition for low subjective
  well-being couldnt be made very happy roughly in
  the same way that a mouse embryo couldnt develop
  to become an elephant, whatever the environment.
  This provides a strong empirical reason in favour
  of enhancement.
• Those who oppose it on various moral grounds must
  concede that the price is that many people will
  have less or even little well-being than is
  possible. This seems an unattractive view.

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Significance

• People complain that its hard to know what it
  the best life, or what traits could be expected
  to promote well-being.
• But if subjective well-being is mostly
  genetically based, then it may be a variable we
  can manipulate directly, through genetic
  manipulation. (Or, as people do at the moment, by
  altering psychology using psychoactive
  substances.) This largely answers these
  worries/objections.
• Not everyone would agree that what psychologists
  call subjective well-being is all of well-being,
  but few would deny it is an important part of it.