Special Supplement: Is Better Always Good? The Enhancement Project

Abstract

Worry about enhancement? not worry instead about apple pie? Enhancement, after all, is something we seek for ourselves and think others should too. We praise individuals who exercise so that they will live longer, be thinner, and if not richer, at least happier. We applaud individuals who seek excellent schools to enhance their intellectual development. We praise parents who do everything they can to enhance their children's moral development. So why would anyone worry about a new cosmetic surgery technique that promised to make us thinner? Why worry about a new psychopharmacological agent that promised to enhance concentration and performance in school? What about a new psychopharmacological or genetic technology that promised to make us kinder and gentler?[1] The following essay begins to say why and when it will sometimes make sense to worry about the prospect of aiming new biotechnologies at the enhancement of human capacities and traits. It grows out of a two-year, Hastings Center project, generously funded by the National Endowment for the Humanities.[2] When we began the project, we hoped to articulate for policymakers what we called "a continuum of uses of `enhancement technologies,' from those that promote shared values, to those that seem neither to promote nor threaten shared values, to those that threaten such values." That hope was misguided in a couple of ways. First, it faded to appreciate that the heterogeneity of the technologies and the number of problems surrounding their regulation make the idea of "a continuum" unrealistic. Second, the phrase "enhancement technologies" itself is potentially misleading. The phrase could be read to suggest that "enhancement technologies" are in a class different from, say, the class of "health technologies." But of course they are not. The same technology can be aimed at different purposes. A genetic technology that could increase muscle mass for the purpose of treating a patient with a degenerative muscle disease could also be used to enhance the ability of an athlete to compete at lifting weights. In a word, we quickly discovered that our project's primary aim should be to help clear some of the conceptual ground. This entailed not only trying to clarify the different ways in which the term enhancement is used, but trying to clarify some good reasons why anyone might worry about aiming some new biotechnologies at the enhancement of human capacities and traits. One of the things we learned is that to understand worries about enhancement, one needs to notice that the term enhancement is used in at least two different, albeit sometimes overlapping, sorts of conversations--and for different reasons. In the first sort of conversation, enhancement is one pole of the treatment/enhancement distinction. It is used in conversations by people attempting to say what doctors, as doctors, should and shouldn't do and/or by people attempting to say what a just system of health insurance should and shouldn't provide. This conversation is often conducted, explicitly or implicitly, in terms of the proper goals of medicine. In the second sort of conversation the concern is not primarily that doctors might provide an intervention that would undermine the proper goals of the profession. Rather, the concern is that anyone who provided the intervention would be undermining extra-medical, social goals or would be exacerbating already existing social problems. The first half of this essay is devoted to enhancement as it appears in conversations about the goals of medicine; the second half is devoted to enhancement as it appears in conversations about what might be called the goals of society. In the essay that follows I draw heavily on the work of the project participants, but do not claim that all would share my conclusions. In particular, some participants think the term enhancement so freighted with erroneous assumptions and so ripe for abuse that we ought not even to use it. …