Hastings Center Report

In December 2008, a study group convened by Rockefeller University published a commentary in Nature recommending societal adoption of cognitive enhancing medications by healthy persons. The group included a prominent bioethicist, John Harris, who for two decades has recommended various enhancements—pharmacological, hormonal, chemical, genetic—as beneficial to human beings. Harris's most systematic defense of enhancements, including germ line and embryo enhancements, is presented in his very provocative book, Enhancing Evolution: The Ethical Case for Making Better People. The biotech revolution has brought us to a point where the human species, Harris contends, "will replace natural selection with deliberate selection, Darwinian evolution with 'enhancement evolution'" (p. 4).

Harris initiates his argument with a thought experiment: Given the lengths many parents will go to seek the best educational opportunities and social advantages for their children, why not instead achieve the desired qualities—such as enhanced intelligence, better health and fitness, and improved physical and mental capacities—through such means as genetic engineering, regenerative medicine, reproductive technology, or nanotechnology, particularly by selecting for traits in the human embryo? In either context, Harris suggests, our goals are the same. We have simply changed from social engineering to genetic or pharmacological means. Once we have willed the ends, we have necessarily willed the means to realize those ends.

This opening rhetorical reflection provides a compressed version of Harris's general argument on enhancements through medical interventions: Having embarked on the path of "making better people" through education, athletic camps, music lessons, and the like, it's not possible to claim these ends are off-limits to the medical enterprise; indeed, we are more likely to succeed through medical and biotechnological methods. Enhancements have already been incorporated within medicine. For instance, if one follows the trajectory from glasses to contact lenses to LASIK surgery, it seems arbitrary to draw a line against enhancements for night vision. Vaccinations against diseases like smallpox suggest we are morally committed to accept vaccinations that provide immunity against disease. And life-prolonging measures, such as organ transplants, usher us into a moral realm that endorses regenerative technologies to reverse aging or even to achieve a biological immortality, which Harris refers to as "the Holy Grail of enhancement" (p. 59).

Harris sees no conceptual difference between therapy and enhancement, nor any defensible criteria of normal human functioning or flourishing that traditionally have grounded objections to enhancements. He denigrates religious considerations as superstition and expressions of prejudice. The philosophical basis he offers for enhancements shows how much ground has been traversed in supplanting Darwinian with enhanced evolution: "Medicine can be described as 'the comprehensive attempt to frustrate the course of nature'" (p. 35). Remarkably, Harris offers no philosophical account or defense of this view of the vocation of medicine, or of medicine's relation to nature, even though this claim opens the way to a comprehensive medicalization of life, from pre-conceptual screening to end-of-life treatments.

According to Harris, the choice to use enhancement technologies is also protected by "the democratic presumption." This presumption amounts to a twenty-first century restating of Mill's "harm principle"—that the only ground for intervening with or restricting personal liberty is the prospect of harm to others. For Harris, such harms must be "real and present," not "speculative and future." There are at least two issues here that Harris needs to address—one focusing on the relationship of law and moral discourse (with the latter here in danger of being eclipsed by the former), and the other on how we should address uncertainty about outcomes in moral deliberation. While Harris rejects a mechanism like the "precautionary principle" in the face of uncertain outcomes, why we should presume enhancements are necessarily conducive to personal benefit and social betterment is not evident.

The philosophical and moral difficulties with Harris's proposal are revealed by his equivocal use of the language of "better" people in...