Carl Elliott, Enhancement Technology

• Definition of "enhancement tech"
• Medical interventions that can be used not just to cure or control illness (therapy), but to enhance human capacities/characteristics
  
• Example: Gene therapy versus genetic enhancement
• Gene therapy to cure genetic diseases
• E.g., cystic fibrosis: genetic disease affecting approximately 30,000 children and adults in the United States. A defective gene causes the body to produce an abnormally thick, sticky mucus that clogs the lungs and leads to life-threatening lung infections
• Would be good if could fix the gene
• Genetic enhancement: Manipulating a person's genetic constitution to improve them (make them smarter, better looking, change their personalities)
• Germ line genetic enhancement (could be passed on from generation to generation)
• Somatic cell manipulation could not
  
• Many think that therapy is permissible and enhancement is not
• Therapy (treatment) morally acceptable and insurance companies should pay
• Enhancement morally worrying and insurance companies should not pay
  
• DISTINCTION BETWEEN THERAPY AND ENHANCEMENT AND IDEA ONLY THERAPY IS PERMISSIBLE IS PROBLEMATIC
• One: Line between treatment and enhancement is very fluid
  • Most enhancements can be characterized as treatment for some kind of psychological problem
• Is antidepressant Paxil (or Zoloft) an enhancement making shy people more outgoing or a treatment for social anxiety disorder
• Doesn't this depend on the norm for humans?
• A person a little or even a lot shyer than normal does not have a disorder that could be treated, but a person who is very much more shy than ordinary people does have a disorder
• Is Ritalin an concentration enhancer or a treatment for attention deficit hyperactivity disorder
• Two: Not clear what is wrong with enhancement technologies
  • Some interventions that seem like enhancements seem ethically justifiable or desirable
• E.g: Immunizations enhance a person's immune system rather than cure or control an illness
• This is desirable and insurance companies should pay
• Is there a moral problem with wanting to be taller or better looking or happier or better able to concentrate?
• Many characteristics people want to enhance are positive
• Enhancing is not morally worrying if achieved via education or work or psychotherapy
• Why wrong to achieve with tools of medicine?
  
• Examples of possible therapies vs enhancement:


• Therapies
• Synthetic growth hormone for short children who lack it
  
• Enhancements
• Boosting your son's (already normal) height using growth hormone
• Breast augmentation surgery
• Immunizations (enhance a person's immune system rather than cure or control an illness)
• A clear case of morally acceptable enhancement? Or a preventative measure; block to disease?
• Desire of minorities to get rid of markers of their ethnicity (alter "Jewish nose" or "Asian eyes")
• Using anti-depressant Prozac to help with shyness or low self-esteem; using Ritalin (a concentration enhancer) to improve aspects of a person's mental life (rather than treating mental disorders)
  
• Cases that may not clearly fit in either therapy or enhancement category:
• Growth hormone for those "stigmatized by shortness"
• Rogaine for baldness (A restoration rather than enhancement)
• Beta blockers (for high blood pressure) work in a way that they will calm those with stage fright
• Transsexual surgery: I feel like a woman trapped in a man's body and the surgery lets me be who I really am (therapy?)
• Intersexed infants:
  • We see it as a medical problem to be treated by surgery and hormones to make sure physical appearance is as close as possible to a boy or girl;
  • Navaho thinks of them as blessed by the gods, revered and held in awe, made them heads of family-not an illness to be treated;
    • They would deny this is "therapy" and see it as a degradation of the person
• Is antidepressant Paxil (or Zoloft) an enhancement making shy people more outgoing or a treatment for social anxiety disorder?
• Ritalin an concentration enhancer or a treatment for attention deficit hyperactivity disorder


• ELLIOTT'S EIGHT ETHICAL WORRIES ABOUT ENHANCEMENT TECHNOLOGY
• Zero: Inequitable access
• If leave this to the market, the rich will be able to pay for these enhancement technologies and poor not (same problem as with good education today)
• One: Problem of cultural complicity
• Harmful social forces make people feel inadequate
• By giving into the pressure you reinforce it
• E.g., get rid of "Jewish nose" or "Asian eyes" or small breasts
• Two: Problem of relative ends (skip)
• Three: Role of the market (in creating "disorders")
• Psychiatrists/drug companies "discover /create"? whole new types of disorder; turn ordinary human variations (being shy, uptight, sad) into diagnosed psychological disorders
• Only when "treatment" became available was "problem" diagnosed
• Four: Problem of authenticity (being who you really are)
• A drug (e.g., Prozac) makes you feel like this is who you really are (even though never been that way before)
• Transsexual surgery example
• Five: Problem of relativism of illness
  • Whether or not something regarded as an illness depends on context; is there no fact of the matter here?
• Before ARTs infertility was a fact of nature, now that it can be treated it is a medical problem (same with poor vision before lenses)
• Intersexed infants example
• Six: Problem of competition
• If athletes use performance enhancing drugs then those who don't want to use them are forced to or they are at a serious competitive disadvantage
• Ritalin improving concentration for school kids who take it puts those who don't at a disadvantage
• Seven: Drive to mastery
• Enhancement techs represent an attitude that the world is something to be manipulated, mastered, and controlled
• Lack of humility in this attitude
• Arrogance of placing so much faith in human reason
• The playing god objection
• Imagine a world where
  • All athletes have safe performance enhancing drugs
  • We could choose sex of our children w/o getting gender imbalance
  • We eat factory farmed pigs/chickens GE not to feel pain
• We would resist such a world because of the extent to which it has been planned and engineered
• We resist the idea that the whole world is there to be manipulated for human ends.