1) What is ‘enhancement’?

Enhancement refers to the ‘improvement’ of human performance, appearance or behaviour through genetic science, medicine, and technology.  A better term may be ‘augmentation’ as it does not so strongly imply that interventions are necessarily beneficial. 

2) The enhancement / therapy distinction

Bioethicists often attempt to distinguish between therapies that enhance, and therapies that merely treat medical disease. However this assumes that there is a discoverable boundary between health and illness.  This is not easy to establish, and some dispute that such a boundary exists at all.  The World Health Organisation, for example, defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”.  Critics argue that, by undermining any ‘enhancement’/therapy distinction, the WHO definition promotes the ‘medicalisation’ of many normal human conditions.  This means that non-medical problems, such as aging or shyness, come to be defined and treated as matters for medical intervention. A further difficulty with the enhancement / therapy distinction concerns disease prevention.  Innoculations, for example, improve immune response where there is no pre-existing disease or disability.  However as disease prevention aims to maintain health, and not to change normal bodily functioning, many agree that neither the concept of enhancement nor that of therapy is appropriate to it.

3) Types of ‘enhancement’

‘Enhancement’ can take many different forms including:

1. Technological: the use of physical technology to improve human abilities.  This ranges from the extreme (such as computer brain implants to improve intelligence), to the mundane (such as the telescope).  [For specific discussion of the ethics of AI, see the topic guide on AI and Robotics.]
2. Cosmetic surgery: the form of ‘enhancement’ with which we are most familiar; it includes breast ‘enhancement’s and face lifts.
3. Pharmaceutical: the use of drugs to improve performance.  Performance improving drugs are notorious in competitive sports, but may also be used to improve cognitive function (for example the drug Ritalin improves concentration).
4. Genetic: altering the DNA in human cells to change the behaviour of the cells.  Intervention may either be somatic or germline.  Somatic intervention affects only some body cells.  Germline alterations affect human eggs, sperm, or very early stage embryos; the children born from these modified cells and all their future offspring will be effected.

A third potential genre of genetic ‘enhancement’ has also been proposed by Gregory Stock; he proposes the development of an artificial chromosome which could be introduced to an embryo, and affect its whole body, but would be removable from the gametes or embryos that produce future generations.

4) The case for ‘enhancement’ 

Þ     Patient and parental autonomy

Patients are better placed than government or the wider community to decide what is in their own best interests.  Therefore they should be permitted any medical intervention which, as informed patient-consumers, they find desirable.  Similarly, it is argued, parents are best placed to choose what is in the best interests of their children.  Being closely involved in the child’s life they, more than anyone else, will have to bear the consequences and risks of choosing to enhance or not to enhance their offspring. These arguments, which are utilitarian in tone, are sometimes accompanied by the more explicitly libertarian conviction that government has no right to interfere in the personal and medical decisions of individual citizens.

It is also argued that human ‘enhancement’ is inevitable.  No government regulation, or social pressure will be able to prevent scientists and citizens from pursuing research and ‘enhancements’ which they desire.  Existing research into fertility and embryology will provide the scientific basis for ‘enhancement’ work.  Furthermore, if ‘enhancement’ is successfully banned in one jurisdiction, researchers and patients will simply move to another where they can evade regulation.  Therefore ‘enhancement’ should be accepted and developed legally and publicly, so that it is available to all and so that the risks and benefits can be known by all.

Þ     Transhumanism – ‘enhancement’ as goal

Transhumanists not only consider ‘enhancement’ acceptable, but positively desirable.  Two dominant strands of argument pervade this field of thought.  Firstly, human beings are the product of evolutionary development.  Change and improvement has been an integral and natural part of the emergence of human beings.  Evolutionary development causes the progressive improvement and specialisation of the species; ‘enhancement’ is simply the acceleration of this process and the means by which humans bring their species development under their own conscious control.  Secondly, ‘enhancement’ technologies are a means of realising normal human desires that exist widely across human societies and history.  Improved intelligence or strength, are goals which humans seek to pursue through education, diet and training.  Technological, cosmetic, pharmaceutical and genetic ‘enhancements’ are merely additional ways of pursuing normal, healthy human desires. 

5) The case against ‘enhancement’

 Þ     Safety

On a practical level there are substantial questions of safety to be addressed if non-essential medical intervention is to be researched or trialled.  However, many ‘enhancement’ technologies will emerge as side products of therapeutic research.  As a higher level of risk is acceptable when therapies are tested on the already sick, consideration of safety will probably not prevent the development of technologies conducive to human ‘enhancement’.  Nonetheless questions of safety will remain a pertinent ethical consideration whenever enhancement is considered, especially if the subjects of enhancement are embryos or children who are not able to offer informed consent. Even if initial questions of safety could be overcome, further safety problems could result from an ‘enhancement race’.  Many forms of ‘enhancement’ would only be beneficial relative to other people.  For example improved intelligence would offer no competitive advantage if it was widespread within a community.  Each individual’s attempt to enhance their personal interests would be annulled relative to similar ‘enhancements’ secured by other members of the population.  The result would be either no net gain, or worse, a situation in which all enhanced members of the population suffer side-effects from their ‘enhancement’.  For example, pharmaceutical treatment could realistically make a large proportion of the population stronger and faster.  However, as some athletes using illegal performance enhancing drugs have found, the side effects would only accumulate as the competitive pressure to be ‘more enhanced’ grew (stimulants used in athletics can cause among other things heart palpitations, heart rhythm abnormalities, hallucinations and convulsions).

Þ     Social justice and social control

No decision is made in a social vacuum.  ‘Enhancement’, if and when it occurred, would involve a range of actors (including the subject, medics, researchers, industry, family, and wider social networks).  The relations of power between these communities and individuals would both shape and be shaped by enhancement decisions.  Potentially, the ‘unenhanced’ could suffer relative to the ‘enhanced’, or the ‘enhanced’ could be victims of their ‘enhancers’.  The first of these possibilities, relating to inter-group social justice, is discussed in more detail on the 'Social Justice' page of this site. The problem of enhancement as a means of social control in personal relationships is discussed below. Particular controversy already exists around the drug Ritalin, prescribed for children suffering ADHD (Attention Deficit Hyper-activity Disorder).  Although the drug is licensed to improve the concentration and behaviour of these children, critics argue that it is also used to make ‘deviant’ children conform to the desires of parents and teachers for well behaved children who perform better academically.  The children however, without the freedom to choose not to be medicated, find themselves drugged into obedience to the expectations of a culturally contingent system of schooling and socialisation.   Widespread resistance to the idea of ‘designer babies’, so often referred to in debates about genetic ‘enhancement’, appeals to the common conviction that children should be valued unconditionally rather than fabricated as commodities.  If parents were able to choose or design ‘enhanced’ children, for example by genetically disposing them to intelligence, musicality or beauty, then the relationship between parent and child would be fundamentally changed.  Parents would, to an unprecedented degree be able to control the temperament, skills and life course of their offspring.  Naturally parents want to do all they possibly can for their children, but conventional sexual reproduction, with all its unpredictability, resists the commercialisation of children as products.  The psychological effect on engineered children who either lived up to, or fail to lived up to their ‘design’ is, at present, only a matter for speculation.      

Þ     “Human Nature”

The concept of ‘human nature’ is at the core of many arguments against ‘enhancement’.  Although critics argue that the idea is nebulous and elusive, it has been used by many prominent political and social theorists. Francis Fukuyama, the US political scientist, argues that human nature, “the sum of the behaviour and characteristics that are typical of the human species, arising from genetic rather than environmental factors”¹ is fundamental to human social and political relations.  Human rights, he argues, depend on assumptions such as that of the equality of human beings, which human ‘enhancement’ could subvert.  As a result the liberal democratic consensus could be undermined.   The German philosopher Jurgen Habermas argues that genetic intervention on children for the purpose of ‘‘enhancement’’ instrumentalises them for the benefit of others; this departs so far from the principle of moral autonomy that it would destabilize the human "species ethic"². An earlier but seminal account of human nature versus human ‘enhancement’ was developed by C S Lewis in The Abolition of Man.  Lewis argues that the purpose of science and medicine is to serve the human good. ‘Enhancement’, rather than serving the human good, changes what it is be human and thus undermines the purpose of the scientific enterprise itself.  Science ceases to serve human beings, but rather human beings become scientific products and are diminished in the process. 

Þ     Objections to Germline ‘enhancement’

See the page of this site committed to Germline ethics. 

6) Public Policy 

No public policy specifically addressing ‘enhancement’ exists in the UK regarding ‘enhancement’.  However human genetic engineering on human gametes or embryos (apart from research purposes when embryos will be destroyed by 14 days) is prohibited in legislation. Professional sports bodies have begun to pay attention to the possibility of ‘gene doping’.  For example, 2005, the World Assosciation of Anti-Doping Agencies, (in collaboration with the Karolinska Institute and the Swedish Sports Confederation) published the Stockholm declaration which opposed gene doping in sports.  Through the channel of sports policy, some national and international enhancement policies have emerged.  For example, the UNESCO international convention against doping in sport, 2005 prohibits non-therapeutic gene doping.  The UK ratified this in April 2006. In December 2006, The Office of National Drug Control Policy Reauthorization Act was passed in the USA.  Title VII of the act creates the US Anti-Doping Agency (USADA) which will guarantee that athletes involved in amateur athletic activities recognized by the United States Olympic Committee use neither performance-enhancing drugs nor performance-enhancing genetic modifications. Beyond the sports context, the most extensive analysis of human ‘enhancement’ yet conducted from an applied public policy perspective is the Beyond Therapy report, of the US President’s Council on Bioethics, 2003.