The Ethics of Enhancement

We can make ourselves stronger, faster, smarter. Should we?

Dürer’s proportion of man

Articles about the possibility of “improving” mankind usually start with ethical chin-stroking and don’t get past it. Readers never actually get to hear about the particular fun and bizarre and scary possibilities. During this series, I’ve intentionally taken the opposite approach. I began the “Superman” project agnostic about enhancement and avoided thinking about ethics until I had finished reporting. Before I started fretting about the morality of it all, I wanted to know what exactly I was fretting about.

The reporting’s over. So, is enhancement a good idea? Is it right (and—a separate question—is it wise?) to give yourself infrared vision or a turbo-memory or MGF-pumped muscles? There is a range of ways to approach these questions.

Would-be enhancers—a category that includes scientists, gung-ho sci-fi fans, muscleheads, longevity nuts, etc.—use two strategies to dismiss ethical questions as irrelevant. First, they claim the coming enhancements are nothing new: We have always enhanced ourselves. As Carl Elliott—not an enhancement advocate, I should say in his defense—points out in his new book Better Than Well, yesterday’s enhancement is today’s necessity. When Elliott was a boy, such mundane activities as removing warts, medicating acne, and immunizing kids counted as enhancements: They allowed people to improve what had been the inevitable human condition. Glasses, contact lenses, and laser surgery all improve on nature’s work, but you don’t hear anyone agonizing over them. The supporters of enhancement suggest that tomorrow’s improvements are no different. In a generation, we will feel the same way about MGF-buffed pectorals as about nose jobs.

Man, brought to you by technology

This argument doesn’t persuade me. Today’s enhancers have extraordinarily grand ambitions, much greater than zapping warts or enlarging breasts. They crave powers that have been reserved for gods (superhuman strength) or beasts (infrared night vision). They also seek to change human beings permanently—something no previous enhancer could do. Doctors will soon be able swap genes in and out of embryos, protecting children from diseases or perhaps increasing intelligence or adding height. Such “germline engineering” will irrevocably alter the DNA of those kids and of the species. Clearasil, it ain’t.

The second argument for enhancement is its inevitability: Consumer demand drives enhancement, so it will happen if people want it, whatever the ethics might be. Just consider the history of cosmetic surgery: Who would honestly claim medical justification for breast implants and nose jobs? But consumers wanted ski-jump noses, and they got ski-jump noses. The same market ruthlessness applies to tomorrow’s enhancements.

Such shrugging is also unsatisfactory. Government legislation, moral suasion, journalistic haranguing, and medical self-policing still have huge influence on what kind of enhancements do and don’t succeed. The market may make it inevitable that athletes will use EPO, or that students will take Provigil, but that does not answer the question of whether they are right to do so.

Those who oppose enhancement have four major objections:

Should we mess with evolution?

Safety Every few weeks a story breaks about another gene therapy trial gone awry. A teenager dies in Pennsylvania. Two toddlers develop leukemia in France. These mishaps are tolerated because the subjects in question would have died without gene therapy in any case. In theory, medicine will tolerate terrible risks to save lives or repair disabilities but not to make patients feel better about themselves. This is the essence of the “therapy/enhancement” distinction favored by medical ethicists.

But the distinction between therapy and enhancement isn’t as clear as ethicists contend. Doctors practice enhancement all the time—even frivolous enhancement. Surgeons undoubtedly claim that there’s a therapeutic justification for breast enlargements, but they’re not kidding anyone.

What’s more, a recent revolution in patient expectations has further blurred the cultural value we place on this distinction. In the past generation, doctors have become less authoritarian, and patients better-informed about their condition and the risks and benefits they face. (The Internet and books such as Sherwin Nuland’s seminal How We Die have particularly galvanized patients.) The sanctity of doctor-knows-best has been diluted as doctors increasingly accept that a patient can make his own choices, including the choice to take physical risks for the sake of self-improvement.

There is also an obvious libertarian counterargument to the safety problem: We allow adults to take all kinds of risks for the sake of pleasure—from jumping cars on motorcycles to piercing their nipples to humiliating themselves on Joe Millionaire. Enhancement is no different, except it usually requires a doctor’s help. It’s my body, and I’ll pry if I want to.

But the libertarian argument fades when it comes to enhancing children. Currently, we permit parents to accept medical risks on behalf of their children but only for physical problems. The government should discourage, and perhaps even prevent, parents from exposing their children to terrible risks for the sake of ambition. It’s wrong for parents to risk a kid’s eyesight for supervision or dose their promising young linebacker with MGF so he can win a scholarship to Notre Dame.

A few weeks ago, I heard Leon Kass lecture on the perils of enhancement. After much eloquent agonizing, he concluded that enhancement is troubling because it’s a form of cheating. His was a Protestant ethic critique: Enhancement allows us to gain extraordinary powers without working for them, severing the “relationship between doing and accomplishment.” This cheating diminishes us by depriving us of the sense that we must work to make anything worthwhile.

But the logical conclusion of Kass’ argument against enhancement is that things were much better in the Bronze Age. After all, the last several thousand years have been an endless march toward diminishing the amount of drudge work we have to do. The automobile cheats us of the work of walking to our destination. Anesthetics deprive women of the healthy pain they should feel during childbirth. Computers weaken our brains by performing the computations that we should be doing in our heads. Yet we’ve embraced automobile and computers; why should his argument stand only when it comes to enhancement?

There is a fundamental weakness to the cheating argument: Enhancements do not eliminate work. They just change the nature of it. For example, football players train much harder today than they did a generation ago, even though many of them cheat with steroids. They play a game that is faster and more physical (and better) than it used to be. Why is the game better? The players are faster and stronger and better-conditioned—in part because they cheat with steroids. Similarly, computers have not abolished work: They have liberated people to explore new, different subjects, rather than waste their time adding columns of numbers or endlessly retyping documents.

Can DNA bear tweaking?

Hubris Evolution is a slow and fussy process. Human beings have taken shape over millions of years. There have been false starts, countless mutations, blind alleys. But the enhancers propose radically altering our genes in an evolutionary blink of an eye. They want to start adding DNA to embryos and manufacturing new genes to insert in our eyes and ears and muscles.

This is unsettling. Can the brain and body handle such extraordinary shake-ups? For the moment, we are very crude workmen with DNA. Genetic enhancement may be a wonderful future prospect, but we shouldn’t play with it casually. We may create genes that we can’t control, engineer children who don’t come out the way we expect.

The rich will be enhanced first. Only folks with cash to burn will be able to afford the fancy new memory drugs or fiendishly complicated new gene transfer technologies.

This is troubling for two reasons. First, frivolous enhancement siphons away resources from basic health care for billions. (Then again, so does Viagra, or research on balding, or liposuction.)

Second, is it right to let the enhanced group exploit their advantage to rule over the rest of us? The rich kid can score the Provigil that keeps him alert through the SAT, but the poor kid can’t. The job applicant who takes memory drugs will have the jump on one who doesn’t. The inequities could be glaring.

But people already gain all kinds of unfair advantages from being tall or white or good-looking or rich. Enhancement is, in some ways, a less troubling kind of inequity because it has something to do with actual ability. The person who takes the memory drug probably can do a better job at the law firm than the person who doesn’t: The enhancement really will help performance (unlike good looks, which wouldn’t make someone a better lawyer).

Moreover, we should be so lucky that our societal problems concern people who are overqualified and hypertalented. It may be, in some sense, unfair to create a class of enhanced people, but that does not mean that it is wrong to do so. If enhancements do work, perhaps they ought not be banned or restricted to prevent inequality but made more readily available. We ought to want more of them, not fewer.

My own views on the ethics of enhancement are situational. It depends on the kind of enhancement and the age of the person who wants it. I share the “Hubris” concern about all germline engineering. We don’t know what damage we may do when we permanently change the human genome. One day, germline engineering could be a miracle for mankind. But before we would know it is safe, many babies would be put at risk, and some would almost certainly suffer and die.

As for enhancements that don’t permanently amend DNA, I’m enough of a libertarian that I don’t see any reason to stop adults from altering their bodies to suit themselves. If they want to take pills or add weird implants or even temporarily change genes with somatic therapy, good luck to them. They have nothing to lose but their brains.

But I don’t feel the same way about enhancing kids. Parents always have unreasonable expectations for their children—you’ll never go to medical school with those grades, young man—but enhancements represent a new and particularly dangerous form of those expectations. Don’t tinker with your child to further your own ambitions. Tinker with yourself instead.