Michael Sandel

“The Case Against Perfection” 2004



2.      Height

         a.      Since 1980s human growth hormone used for children with hormone deficiency makes them shorter than average

         b.      Increases height for healthy children too

         c.      Why make a difference whether child is short because of hormone deficiency or because parents happen to be short?

                   i.       Social consequences the same

         d.      1996 40% of growth hormone use was not related to a medical problem

         e.      FDA approved use and advertisement for shortest 1% of people (Boys under 5'3", girls under 4'11").

         f.       Why not allow its use for all under average height?

         g.      “Collective self-defeating” as lead to hormonal arms race where everyone uses it (and thus no one gets a benefit?)

3.      Sex selection

         a.      Involving possible destruction of human embryos: Amniocentesis, ultrasound, IVF (discards 8 cell, 3 day old embryos) uses pre-implanted genetic diagnosis (check for genes for obesity, height, skin color, disease)

         b.      MicroSort: Sperm sorting techniques (by a for profit fertility clinic in Virginia) to get desired sex with 80% accuracy

                   i.       Limits it to family balancing to avoid sex discrimination charge

                   ii.      Sexual discrimination?

4.      Market in eggs and sperm

         a.      Artificial insemination allows parents to shop for gametes with genetic traits they desire in offspring

         b.      Less predictable than cloning or pre-implantation genetic screening

         c.      Examples

                   i.       Ad in IVY league newspaper seeking egg from woman 5 feet ten and athletic no major family medical problems and combined SAT of 1400 or above ($50,000)

                   ii.      A sperm bank that opened in 1980 tired to improve world germ plasm and “counteract rise of retrograde humans”

                            (1)    Collect sperm of noble prize winning scientists and make it available to women of high intelligence to breed super-smart babies

                            (2)    Nobel laureates did not donate and they settled for sperm from young scientists of high promise, closed in 1999.

                   iii.     Calif Cryobank, one of worlds leading sperm banks (for profit)

                            (1)    $900 per month

                            (2)    Accepts only 5% of males that apply

                            (3)    Catalog detailing physical characteristics of each donor, ethic origin and college major

                            (4)    Extra fee get results of test assesses donor’s temperament and character type

5.      Attention improvement: Stimulants to enhance attention (for both those with attention disorders and those wanting better concentration)

         a.      6% kids on stimulants

6.      Muscles: Synthetic gene injected into mice prevents and reverses muscle deterioration and strengthens healthy muscles

         a.      Okay to fight muscular dystrophy

         b.      Okay to cure immobility that afflicts elderly?

         c.      Not okay to improve athletic performance?

                   i.       Gene altered athletes lifting SUVs or sub 3 minute miles

                   ii.      Same as use of performance enhancing drugs–steroids, epo?

7.      Better Memories: GE of memory related gene into mice and they learned more quickly and remembered better even into old age; advantage passed on to offspring

         a.      Good for Alzheimer’s disease

         b.      But also for 100 million American’s over 50 beginning to encounter natural memory loss due to age

                   i.       Viagra for the brain

         c.      Straddle line remedy/therapy and enhancement

                   i.       Cure no disease, but restore capacities person once had

                   ii.      Consider GE that restore a 60 year old’s cardio-vascular ability to what she had when 30

                            (1)    Enhancement? Therapy/remedy?

         d.      Pure non-medical use: Lawyer trying to remember facts for a trial (enhancement)

8.      Others possibilities

         a.      Musical talent

         b.      Greater intelligence

         c.      Mood enhancement

         d.      Moral enhancement!



10.    Many believe (including Sandel, it seems) and it seems intuitively plausible that

11.    Therapy/remedy/medical use is okay while enhancement/non-medical use is problematic

         a.      Curing a disease, trying to get healthy okay

         b.      Reaching beyond health, enhancing physical/cognitive capacities not

         c.      Lifting above the norm, not okay?

                   i.       What if the norm is unhealthy?

12.    Immunization example: Therapy or enhancement?

         a.      Immunization seems like a case of enhancement (of immune system) rather than therapy and yet we think this is permissible

         b.      Permissible to increase our bodies ability to avoid disease? (What about to avoid death?)

         c.      This is enhancement for “medical reasons”

13.    Sandel worried about usingmedical means” for non-medical ends

         a.      Medical ends: Curing or preventing disease or repairing injury

         b.      Genetic enhancement (GE) uses medical means for nonmedical ends

         c.      Examples to consider: Cosmetic surgery, Botox injections for sagging chins and furrowed brows, breast implants (after breast removal cancer treatment or simply for larger breasts, Liposuction)

         d.      Questions

                   i.       By “medical means” does he mean altering our physical/mental constitution by going inside?

                   ii.      How different from

                            (1)    Building muscles by training

                            (2)    Ingesting foods that make one stronger?”



15.    Unfairness: Gives a person unfair advantage over competitors

         a.      Especially for those who couldn’t buy their way up

         b.      “Fatal flaw”: Always been true some athletes are better endowed genetically, yet don’t consider this to undermine fairness of competition in sports

         c.      Avoids deeper issue

                   i.       We could just subsidize these enhancements so everyone had them

                            (1)    Insure equal access to GE available to all;

                            (2)    Avoid two classes of humans--genetically improved or those not

                   ii.      More basic question: Not equal access to enhancement that but should this be pursued at all?

16.    “Collective self-defeating” leading to GE arms race objection

         a.      True for enhancements aimed at getting competitive edge over others

         b.      Still thinks deeper issue is do we went to do this enhancement at all?

17.    Undermines autonomy: What is wrong with the cloning/enhancement is that it undermines person’s autonomy/open future

         a.      Replies:

                   i.       Even absent designing parent, children not free to choose genetic inheritance

                   ii.      At mercy of genetic lottery

                   iii.     Less free, if constrained by intentional design than by chance?

         b.      Also, autonomy worry can’t explain what is wrong about choosing one’s own genetic enhancements

18.    Threatens our capacity to determine our fate by own efforts and consider ourselves responsible (worthy of praise/blame) for what we do and how we are

         a.      Compare:

                   i.       Person who excels (70 home runs) due to hard training and effort

                   ii.      Person who excels due to steroids or genetically enhance muscles

         b.      As enhancement increases, our admiration for achievement fades

         c.      Moral response to enhancement is a response to the diminished agency of the person whose achievement is enhanced

                   i.       But much athletic and other achievement is not due to effort but to natural talent and we still admire this...

         d.      There is truth in this argument, but ...

19.    Deeper danger is too much responsibility

         a.      Hyperagency

         b.      Promethean aspiration to remake nature, including human nature

                   i.       Prometheus was a Greek god who stole fire from Zeus and gave it to humans

         c.      To serve our purposes and satisfy our desires

         d.      Problems is drive to mastery

         e.      Ignores or destroys the “gifted character of human powers and achievements

         f.       Same language as environmental ethicists have used to condemn the destruction of wild nature and remaking of world



21.    Crucial to acknowledge the giftedness of life

         a.      Recognize our talents/powers not wholly our own doing, though we do put forth effort to develop and exercise them

         b.      Not everything in world is open to whatever use we may desire or devise

         c.      Involves a certain humility

         d.      Partially religious, but goes beyond to morality

22.    GE athletes mainly problematic not because they get rid of the importance of effort in sport, but because they undermine our ability to admire/honor natural given talents

         a.      We admire both hard effort and native talent and in sports it is excellence (a combination of the two) that we celebrate.

         b.      GE athletes is they corrupt athletic competition as a human activity that honors the cultivation and display of natural talents

23.    Enhancement can be seen as ultimate expression of ethic of effort and willfulness–a high tech striving

         a.      Ethic of wilfulness (acting, doing. controlling) against claims of giftedness



25.    Ethic of giftedness is key to parenting (like Kass’ idea)

         a.      To appreciate children as gifts/blessings is accept them as they come, not as objects of our design or products of our will

         b.      Unlike friends and spouses we choose based on attractive qualities, don’t choose our children

         c.      Love for them not contingent on these qualities

         d.      Parenthood teaches “openness to the unbidden”

26.    Deepest objection to enhancement is not perfection it seeks but human disposition it expresses/promotes: Hubris (overbearing pride)

         a.      Problem lies in the hubris of designing parents

         b.      Their drive to master the mystery of birth

         c.      Deprives parent of humility and enlarged human sympathies that openness to unbidden involves

27.    Hyperparenting and genetic enhancement similar

         a.      Hyperparenting is the heavily managed, high-pressure child rearing now common

                   i.       Sports crazed parents bent on making champions of their children

                   ii.      Overbearing parents molding and managing children’s academic careers

         b.      Both hyperparenting and genetic enhancement of children are excesses of mastery and dominion that miss the sense of life as a gift



29.    Like eugenics, GE is triumph of willfulness over giftedness, of dominion over reverence, of molding over beholding

30.    Playing God “argument:”

         a.       To believe our talents and powers are wholly our own doing is to misunderstand our place in creation

         b.      To confuse our role with God’s

31.    Moral argument

         a.      If we become self-made men

         b.      Can’t regard out talents as gifts for which we are indebted (to whom?), rather than achievements for which we are responsible

                   i.       Unless they are self-chosen, the individual recipient of GE is not responsible, though humans in general, parents are

         c.      Affects on humility, responsibility, and solidarity

32.    Humility

         a.      Openness to the unbidden

         b.      Abide the unexpected, live with dissonance, rein in our impulse to control

         c.      A world where all people are GE and chosen is like a “gated community writ large”–we control who gets in

33.    GE explodes, not erodes, responsibility

         a.      Responsibility takes on daunting proportions

         b.      Less left to chance and more to choice

         c.      It is a blessing to see ourselves as creatures of nature/god, fortune, as then we are not totally responsible for way we are

         d.      More we engineer ourselves the more responsible we are for our talents and performance

34.    Solidarity is eroded

         a.      The more alive we are to chanced nature of our lot, more reason we have to share our fate with others

                   i.       Like health insurance

         b.      Genetic enhancements (routinely practiced) would make it harder to foster moral sentiments that social solidarity requires

35.    Why owe anything to least advantaged members of society?

         a.      Best answer depends on giftedness

         b.      If much of our talent and success is based on luck of genetic lottery

         c.      Then conceit to assume that we are entitled to full measure of bounty we reap in a market economy

                   i.       Controversial assumption one is entitled only to what one has earned by way of effort

         d.      Obligation to share this bounty with those who through no fault of their own lack comparable gifts.

36.    Contingency of our gifts, none wholly responsible for our success, saves meritocractic society from smug assumption rich are rich as more deserving than poor

         a.      Even more than now would view themselves as self-made, self sufficient and wholly responsible for success

         b.      Bottom of society would not be simply disadvantaged (thus owed some compensation) but simply unfit and worthy of eugenic repair.

37.    Promethean supporters of GE want to

         a.      Rescue the losers in the chromosomal lottery

         b.      Rescue the 50 million Americans with IQ of less 90

         c.      Desire more exalted place for humans in cosmos

         d.      Enlarge man’s freedom, diminish his constraints and what must accept as given

         e.      We can rescue ourselves from the Darwinian put down and see ourselves as taking control of evolution

38.    Intoxicating appeal of human freedom unfettered by the given

         a.      Want to see ourselves as astride (one leg on each side) the world

         b.      Masters of our own nature

39.    Promise of mastery is flawed

         a.      Banish our appreciation of life as a gift and leave us with nothing to affirm or behold outside our own will

         b.      A kind of species loneliness

Questions on Sandel’s The Case Against Perfection

1.      Describe some of the examples of genetic enhancements that are on the drawing board and beginning to be used.

2.      What are some examples of arguments against genetic enhancement that Sandel thinks are incomplete, weak, or fail? Do you agree with him about the weaknesses of these arguments?

3.      Explain the distinction between use of genetic engineering for therapy/remedy and its use for enhancement. Is it clear that the former is permissible and the latter not? Discuss which of these immunization for disease illustrates.

4.      What does Sandel mean by pursuing non-medical ends with medical means? Is he right in thinking this problematic? Explore with examples.

5.      Does Sandel think the main problem with genetic enhancement is that it lessens our responsibility? Explain how he think it increases our responsibility.

6.      What does Sandel mean when he characterizes enhancement as “Promethean?”

7.      What is Sandel’s reason for objecting to genetically enhancing athletes? Is it because this makes effort less important in sport?

8.      What does Sandel mean by acknowledging the given, the giftedness of the world? How does parenting encourage this virtue and how does genetic enhancement undermine it?

9.      What does Sandel mean by “openness to unbidden?”

10.    What is “hyperparenting” and how does Sandel relate it to genetic enhancement?

11.    Explain why Sandel thinks genetic enhancements undermine humility, proper responsibility and solidarity.

12.    Does Sandel value absolute human freedom?