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Is There a Problem With Enhancement? Frances M. Kamm a a Harvard University Published online: 20 Aug 2006.

To cite this article: Frances M. Kamm (2005) Is There a Problem With Enhancement?, The American Journal of Bioethics, 5:3, 5-14, DOI: 10.1080/15265160590945101

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Target Article

Is There a Problem With

Enhancement? Frances M. Kamm, Harvard University

This article examines arguments concerning enhancement of human persons recently pre- sented by Michael Sandel (2004). In the first section, I briefly describe some of his arguments. In section two, I consider whether, as Sandel claims, the desire for mastery motivates en- hancement and whether such a desire could be grounds for its impermissibility. Section three considers how Sandel draws the distinction between treatment and enhancement, and the relation to nature that he thinks each expresses. The fourth section examines Sandel’s views about parent/child relations and also how enhancement would affect distributive justice and the duty to aid. In conclusion, I briefly offer an alternative suggestion as to why enhancement may be troubling and consider what we could safely enhance.

Keywords

designer babies

distributive justice

duty to aid

enhancement

genetic engineering

intention

nature

parental love

responsibility

Open Peer

Commentaries

Franklin G. Miller and Howard Brody, p. 15

Peter H. Schwartz, p. 17

Richard E. Ashcroft and Karen P. Gui, p. 19

Marilyn E. Coors and Lawrence Hunter, p. 21

S. Matthew Liao, p. 23

Adrienne M. Martin and Jehanna Peerzada, p. 25

Jason Scott Robert, p. 27

Carson Strong, p. 29

Howard Trachtman, p. 31

Should we enhance human performance? There are at least two types of enhancement. In the first, we in- crease above the norm so that more people are above the norm in ways that many people are already quite naturally. For example, we might increase intelli- gence so that people who would otherwise be only normally intelligent function as well as those few who are geniuses. In the second form of enhance- ment, we introduce improvements that no human being has yet evidenced—for example, living to be two hundred years old and healthy. The question of whether we should engage in either type of en- hancement has arisen recently within the context of human genetics. Here one generation would prob- ably modify the next. However, enhancement can also occur by way of drugs or intensive training and be done by a person to himself or to another.

Michael Sandel has recently argued that there is a moral problem with both types of enhancement re- gardless of the way in which they would be brought about, even if there were agreement (which there often is not) that the changes would be improve- ments, that they were safe, and they were fairly distributed among socioeconomic groups (Sandel 2004). Sandel’s discussion is worth significant at- tention both because he is a member of the Presi- dent’s Council on Bioethics and because it expresses in compact form, readily available to the general public, some of the themes of the longer work on this subject produced by the President’s Council. In this essay, I will present what seem to me to be the important components of Sandel’s argument and then evaluate it.

I. SANDEL’S VIEWS

Sandel thinks that the deepest objection to enhance- ment is the desire for mastery that it expresses. He focuses especially (but not exclusively) on the at- tempt of parents to enhance their children, whether by genetic manipulation, drugs, or extensive train- ing. He says:

the deepest moral objection to enhancement lies less in the perfection it seeks than the human disposi- tion it expresses and promotes. The problem is not that parents usurp the autonomy of a child they de- sign. The problem is in the hubris of the design- ing parents, in their drive to master the mystery of birth . . . it would disfigure the relation between par- ent and child, and deprive the parent of the humility and enlarged human sympathies that an openness to the unbidden can cultivate. (Sandel 2004, 57)

And he thinks:

. . . the promise of mastery is flawed. It threatens to banish our appreciation of life as a gift, and to leave us with nothing to affirm or behold outside our own will. (62)

However, he believes this objection is consis- tent with the permissibility and even the obligation to treat illnesses by genetic modification, drugs, or training. He is, therefore, arguing for a moral dis- tinction between treatment and enhancement. He says, (Sandel 2004, 57): “Medical intervention to cure or prevent illness or restore the injured to health does not desecrate nature but honors it.”

The American Journal of Bioethics, 5(3): 5–14, 2005 ajob 5 Copyright c© Taylor & Francis, Inc. ISSN: 1526-5161 print / 1536-0075 online DOI: 10.1080/15265160590945101

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He also thinks parents must “shape and direct the development of their children . . . ,” but he thinks there must be an equilibrium between “accepting love” and “transforming love.”

Among the bad effects of mastery, he identifies the increasing responsibility that we must bear for the presence or absence of characteristics in ourselves and others and the effects this may have on human solidarity. The first point is concerned with the fact that we will no longer be able to say that our lacking a perfection is a matter of luck, something outside our control. We might be blamed for not improving ourselves or others. The second point is (supposedly) related to this. Sandel believes that the more our characteristics are a matter of chance rather than choice, “the more reason we have to share our fate with others” (Sandel 2004, 60). He goes on:

Consider insurance. Since people do not know whether or when various ills will befall them, they pool their risk . . . insurance markets mimic solidar- ity only insofar as people do not know or control their own risk factors. . . . Why, after all, do the successful owe anything to the least-advantaged members of society? The best answer to this leans heavily on the idea of giftedness. . . . A lively sense . . . that none of us is wholly responsible for his or her success makes us willing to share the fruits of our talents with the less successful. (Sandel 2004, 60)

II. DESIRE FOR MASTERY

Let us clarify the nature of Sandel’s objection to en- hancement based on the desire for mastery over life processes. First, note that it implies that if (both types of) enhancements were occurring quite nat- urally, without our intervention, Sandel’s objection to enhancement would not be pertinent. Indeed, in- terfering with the natural enhancing changes would itself require mastery over life processes, and so Sandel’s objection might pertain to this. It is also important to keep in mind several distinctions. Ac- tual mastery is different from the desire for it. We could achieve and exercise mastery over nature as a side effect of doing other things, without desiring it. This might be acceptable to Sandel. Suppose we did desire mastery, however. We could desire it as a means to some other end (e.g., achieving such good aims as health, beauty, virtue) or we could desire it as an end in itself. So long as we desire it as a means to other things considered good, it is clearly wrong for Sandel to conclude that desire for mas- tery will “leave us with nothing to affirm or behold outside our own will” (Sandel 2004, 62). Even if mastery were desired as an end in itself, this need

not mean that it is our only end, and so we could still continue to affirm other good aims (such as virtue, health, etc.) as ends. I shall assume that if we desire mastery, it is as a means to good ends, as this seems most reasonable.

Such a desire for mastery is not inconsistent with an openness to the unbidden that Sandel empha- sizes (Sandel 2004, 56), if the unbidden means just “those things that come without our deliberately calling for or causing them.”1 For if many good things were to come without our deliberately inter- vening to bring them about, presumably we would be happy to have them and not regret that they did not come about just because we deliberately brought them about. Such a form of openness to the unbidden does not, however, necessarily imply a willingness to accept whatever comes even if it is bad. Sometimes people are also unwilling to ac- cept things that merely differ from their preferences, though the things are not necessarily bad. One or both of the latter forms of being closed to the un- bidden may be what Sandel is concerned with, as he speaks of enlarged human sympathies resulting from an openness to the unbidden.

So far, I have been distinguishing various atti- tudes and states of mind that might be involved in a desire for mastery. Suppose some form of the de- sire for mastery and nonopenness to the unbidden is bad. The further question is whether there is any re- lation between having even a bad attitude and the impermissibility of enhancing conduct. As noted above, even Sandel supports the efforts to find cer- tain treatments for illnesses. But seeking treatments for illnesses by manipulating the genome typically involves desiring mastery as a means, not being open to all things unbidden, and attempting to master the mystery of birth. Hence, Sandel may think that while there is something bad per se about desir- ing mastery even as a means, not being open to the unbidden, and attempting to master the mystery of birth, these bad aims can be outweighed by the good of curing diseases (if not by the pursuit of enhancements). Alternatively, he may believe that

1. Notice that not deliberately causing something is not the same as not causing it. For example, a parent may cause his child’s IQ to move down from 160 to 140 by inadvertently eating improperly during pregnancy. This reduction is unbidden, though caused by the parent. It is in part because we might be causally responsible for making things worse than they could naturally be, that some may think that we have a duty to achieve at least the knowledge of life processes that prevents our interfering with naturally occurring goods.

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when the unbidden is very horrible—not a gift, even in disguise—not being open to the unbidden is not bad at all. If he believes these things, the question becomes why enhancements cannot out- weigh or transform what Sandel believes are bads in the same way he thinks that treatments outweigh or transform them.2

There is a further, deeper problem about the relation between having bad dispositions and the impermissibility of conduct. For suppose that de- siring mastery as one’s sole end in life is a bad desire to have. Suppose a scientist who works on finding a cure for congenital blindness is motivated only by such a bad desire for mastery. Does this make his conduct impermissible? Presumably not. The good of treating diseases still justifies the work of the scientist even when his primary aim is not that there be no disease, but rather to achieve mastery. This is a case where there may be a duty to do the work. However, even when the act we would do would produce a good it is not our duty to produce, I think the act can be permissible independent of our intentions or disposition in doing it. So sup- pose several people could be saved only if you do an act that has a high probability of killing you. It is not typically your duty to do such an act, though it could be morally outstanding to do it. If the only reason you do it is to make those who care about you worry, this alone will not make saving the people impermissible. More generally, it has been argued, the intentions and attitudes of an agent reflect on the agent’s character but not on the permissibility of his act (Scanlon 2002; Thomson 1990).3

Perhaps, however, this is not true. Sometimes we think an act is permissible only if it is satisfying a certain desire in an agent who does the act. For example, suppose we set aside scarce resources for a musical performance in order that those who desire pleasure from music shall have some. If someone’s only aim in going to a concert is to mingle with other people, this is an indication he has no desire for music per se. Hence, it is an indication that an end which justified the use of scarce resources for musical performances will not be achieved. Hence, this agent should not go to the concert not because of his intention per se, but only because it is an indication that some justifying effect will not come about. Now, suppose someone has a bad aim (e.g., to show off) in doing something otherwise permissible,

2. I shall return to this point below. 3. Judith Thomson (1990, 1999) has argued that inten- tion never matters to the permissibility of action. Thomas Scanlon (2000) makes a somewhat more limited claim.

such as chewing gum. It might be appropriate for him to, in a sense, be punished for the bad aim with which he would chew the gum, by making it impermissible for him to chew the gum. This, of course, is not just any punishment. It specifically makes it the case that his bad aim is not efficacious. But if the achievement of an important good for others or the performance of a dutiful act (e.g., not harming someone) is at stake and this can justify the act, it would not be appropriate to require someone to forgo an act as a way of making his bad aim inefficacious. That would be to punish others for the agent’s bad attitude.

It seems, then, that if Sandel is right and “the deepest moral problem with enhancement. . . ” is “the human disposition it expresses,” then the deep- est moral problem may provide no grounds at all for thinking that acts seeking enhancement are morally impermissible (Sandel 2004, 57). We will have to decide whether particular changes are permissible independently of the aims, attitudes, and disposi- tions of agents who act. Among the factors we might consider are the good ends to be brought about and the bad effects that might also occur. It is true that if the good outweighs the bad, then it is possible for a rational agent to have as his aim the pursuit of the good, rather than the (supposedly) bad aim of seek- ing mastery above all else. But it is the evaluation of objective goods and bads, rather than the agent’s aims or desires that play a role in accounting for the permissibility of acting. If the only possible aim of a rational agent in seeking a particular change were to seek mastery as an end in itself, then presumably the good ends achieved in the change would not them- selves be able to justify the act. But we need not be restricted to a consequentialist weighing of goods and bads in accounting for the permissibility of an act. Individual rights may be at stake. Furthermore, the causal role of bad effects (e.g., whether they are side effects or necessary means to good aims) can be crucial in a nonconsequentialist analysis of permis- sibility, even if agent’s intention and disposition are not.

In connection with the effects of enhancing, there is a further point that Sandel makes, for he is concerned not only with the disposition that en- hancement expresses but with “the human dispo- sition it . . . promotes.” Promoting that disposition to seek mastery could be an effect of seeking en- hancements, and we have said that the effects of acts can be relevant to their permissibility even if the attitudes of agents who perform the acts are not. Indeed, considering the disposition as an ef- fect helps us understand that when Sandel says that

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“the deepest moral problem with enhancement is the human disposition it expresses,” he is not so much giving an explanation of the wrongness of acts of enhancement, as simply focusing on the bad type of people we will be if we seek mastery.4 But should we condemn a disposition even if it never leads to any impermissible acts and the disposition always leads people to act for the sake of the very properties that make the acts permissible because they make it permissible? (This is unlike the dis- position of the scientist described above, yet it too is ruled out by Sandel’s view). Is it inappropriate to be the sort of people who will be disposed to master nature as a means because the goods to be achieved outweigh the bads and no further nonconsequen- tialist objections are relevant?

Perhaps such a disposition could still be bad to have, if it leads us to focus on these types of acts to the exclusion of other worthwhile activities. Con- sider an artist who is always seeking to improve her paintings. She never rests content with just appreci- ating her own and other people’s great works. Other people may have a better appreciation of great mas- ters that she lacks. But it is not clear to me that her way of responding to value—by trying to create more of it—is inferior to the admittedly good al- ternative way of responding to value. And in some people these two approaches to value may be com- bined to one degree or another. Similarly for the dispositions to enhance and to appreciate goods al- ready present.

III. TREATMENT VERSUS ENHANCEMENT

One conclusion so far is that we must look to such things as the properties of our acts and their effects, rights involved, and the required causal role of bad effects in producing the good, rather than to the dispositions of agents, to decide whether acts of en- hancement are wrong. Hence, the disposition that Sandel identifies as a primary moral problem with enhancement has nothing to do with whether pro- ducing enhancements is right or wrong. However, one might rephrase an objection bearing on the per- missibility of such acts. One might argue that the goods achievable by enhancement do not merit a causal role for the bads of people’s uncovering mys- teries of birth or mastering nature (whether they desire these or not), rather than letting nature give us whatever gifts it will.

There are two problems with rephrasing in this way. First, it may not be true that people’s mastering

4. As emphasized by Paul Litton and Larry Temkin.

nature, uncovering the secrets of life, and trying to improve what comes in life are bad in and of them- selves. If they are not bad in themselves—but even good in themselves—then we do not have to show that there are great goods at stake that outweigh us- ing the bads, in order to permissibly engage in these activities. Second, if they are bad, one would have to show not only that the good ends of enhance- ment are not as important as the goods of treatment but that they are not great enough to outweigh or transform the bads.

There are several possible routes to showing that the goods of enhancement are not as important as the goods of treatment. One is the idea of diminish- ing marginal utility, according to which the benefit someone gets out of a given improvement in his condition decreases the better off he is. Hence, we do more good if we help those who are worse off than if we help those who are already better off. A second route is the view that there is greater moral value in helping people the worse off they are in absolute terms, even if we produce a smaller benefit to them than we could to people who are better off. This is known as prioritarianism. A possible third route is to distinguish qualitatively between what some call harmed states and merely not being as well off as one might be but not badly off in abso- lute terms (Shiffrin 1999). None of these routes to comparing the good ends of enhancement and treat- ment, however, shows that enhancements are not in themselves great enough goods to justify mastery as a means. They also do not rule out that providing enhancements might itself permissibly be a means to achieving the treatments. That is, suppose it is only if we are much smarter than we currently are that we will find a cure for terrible illnesses quickly. Then the importance of finding treatments could be transmitted to the enhancement of intelligence. (Of course, not all means are permitted to even justified ends. So if enhancements were sufficiently intrinsi- cally objectionable, it might not be permissible to use the only available means to acquire treatments.)

At one point, Sandel tries to draw the distinc- tion between treatment and enhancement by claim- ing that “medical intervention to cure or prevent illness . . . does not desecrate nature but honors it. Healing sickness or injury does not override a child’s natural capacities but permits them to flourish” (Sandel 2004, 57). The assumption behind the first sentence is that nature is sacred and should be hon- ored. But why should we believe this? Cancer cells, AIDS, tornadoes, and poisons are all parts of nature. Are they sacred and to be honored? The natural and

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the good are distinct conceptual categories and the two can diverge: the natural can fail to be good and the good can be unnatural (e.g., art, dams, etc.).5

Suppose nature was sacred and to be honored. We would clearly be overriding its dictates by making people able to resist (by immunization) illnesses that they could not naturally resist. Is doing this imper- missible because it does not honor nature? Surely not.

Sandel’s view may better be expressed as the view that we may permissibly override and not honor nature when we get rid of the things in nature that interfere with the other parts of nature that are its gifts (i.e. good things). But if this is so, then Sandel’s position does not rule out dramatically lengthening the human life span and preventing the interference of the aging process with the exercise of natural gifts that we have had all our lives. Most people would consider this a radical enhancement.

When Sandel claims that curing and prevent- ing illness does not desecrate nature, he implies that enhancement is a problem because of the sort of re- lation we should have to nature. Emphasizing that healing allows a child’s capacities to flourish, may seem to suggest that enhancement (but not treat- ment) is a problem because of its effects on our rela- tions to other persons. But while Sandel does move on to the latter issue (and I will discuss his views on it below), he is here still focused on whether we are interfering with nature and the capacities (gifts) that nature has given someone when we enhance rather than cure. Hence, it is pertinent to ask, what if a child’s natural capacities are those of a Down’s Syndrome child and we seek to supplement these and provide greater gifts than nature provided by changing the child’s genome? This would change or add to natural capacities, not merely permit them to flourish. Yet, presumably, Sandel would want to classify this with allowable treatment rather than enhancement. This form of treatment, which in- volves supplementing nature’s gifts with new one’s raises the more general question of why appreciation of nature’s gifts requires limiting ourselves to them. We can appreciate what is given and yet supplement it with something new.

There are three primary conclusions of this sec- tion. First, Sandel’s attempt to draw a distinction between treatment and enhancement does not seem successful. Second, given the way he draws the

5. Similarly, the human and the good are distinct concep- tual categories. Human traits (such as arrogance) could be bad, and inhuman altruism could be good.

treatment/enhancement distinction. Sandel’s objec- tion to enhancement does not rule out maintaining natural gifts (that would otherwise wither) through- out a greatly extended human life span. Third, we would need much more argument to show that there is some duty owed to nature that we offend against when we change natural capacities, and that it is our relation to nature rather than to persons that should be a primary source of concern with enhancement.

IV. PARENTAL AND SOCIAL RELATIONS

In this section I will examine Sandel’s views on how enhancement may negatively affect our relations to persons, ourselves or others.

A. One’s Children

As noted above, Sandel paints with a broad brush in condemning enhancements due not only to ge- nomic changes but to drugs and training. However, he also realizes that much of ordinary good par- enting consists of what might ordinarily be called enhancement. Hence, he says the crucial point is to balance accepting love and transformative love. (Perhaps Sandel would want to apply this idea to changes adults seek to make to themselves as well.) He also seems to think of transformative love as concerned with helping natural gifts be fulfilled, framing and molding them so that they shine forth. (Similarly, in sport, he thinks that good running shoes help bring out a natural gift by comparison to drugs that would change a gift into something else.)

Let us first deal with the issue of balance. For all Sandel says, it remains possible that many more enhancements than he considers appropriate are ones that satisfy the balance between accepting and transformative love. This would most clearly be true if transformation were not merely a matter of mold- ing nature’s gifts, but of adding new ones. Further- more, it is not clear what falls under “balancing.” For example, suppose my child already has an IQ of 160. Might balancing the two types of love in her case imply that I may (if this will be good for her) increase her IQ another 10 but not 20 points, even though a parent whose child has an IQ of 80 should not change her child as much as to also give her a 170 IQ, for this would err on the side of too much transformation?

An alternative to such a balancing view might be called Sufficientarianism. It could imply that there is no need at all to increase the first child’s IQ and that in the second child’s case much more

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transformation (in the sense of adding to natural gifts) than acceptance is appropriate in order to reach a sufficient level. Sufficientarians are not in- terested in perfection, though they want enough mastery as a means to getting sufficient goods.

Let us now restrict ourselves to Sandel’s sense of transformation—bringing out natural gifts—and consider the ways in which this may be done. To the extent to which Sandel allows training and ap- pliances to be used to transform gifts, should he not also allow genetic manipulation that does exactly the same thing? So suppose that a certain amount of voice training is permitted to strengthen vocal chords. Would a drug or genetic manipulation that could strengthen vocal chords to the same degree also be permissible? If the argument Sandel gives does not rule out training, it alone will not rule out transformation by drugs or genetic means, be- cause a gift is transformed to the same degree by each method. (If appliances such as running shoes are allowed, why not genetically transformed feet that function in the same way?) A different type of argument, based on the possible moral difference in using different means would be necessary to rule out the genetic means, but Sandel does not provide it. Rather, as we have noted, he treats training, drugs, and genetic manipulation on a par.

Hence, while he rightly condemns excessive pressure to transform oneself and one’s children in a competitive, meritocratic society, especially if it is governed by shallow values, he does not condemn moderate training for worthwhile transformation.6

Unless he emphasizes a difference in means used, he should then permit moderate, worthwhile genetic transformations, even if not excessive ones driven by competitive pressures and/or governed by shallow values.

Now consider one way in which Sandel may be wrong not to distinguish different ways of trans- forming or bringing about more radical enhance- ment. Perhaps we should separate how we treat changes that are made before a child exists (what I will call ex ante changes) from those that are made once a child exists (what I will call ex post changes). The former are primarily genetic, while the latter will include drugs and training. Love, it has been said, is for a particular. Consider love for an adult. Before we love someone, we may be interested in meeting a person who has various properties, such as kindness, intelligence, artistic ability, a good sense of humor, etc. When we meet such a person we may

6. Hilary Bok emphasized this point.

be interested in him rather than someone else be- cause he has these properties. However, though it is through these properties that we may be led to love this particular person, it is the particular person that we wind up loving, not his set of properties. For if another person appears with the same set of properties, that does not mean that we could as eas- ily substitute him for the person we already love. Even if the person we love loses some of the prop- erties through which we were originally led to love him (e.g., his beauty) and another person has more of the good properties that originally interested us, we would not necessarily stop loving the particular person we love (Nozick 1977).

It seems then that when we love a particular per- son, this involves much of what Sandel calls accepting love. If we do seek transformation in the properties of the person we love, this may be because of moral requirements or because we want what is good for him. By contrast, before a particular person whom we love exists (just as before we find someone to love), it is permissible to think more broadly in terms of the characteristics we would like to have in a person and that we think it is best for a person to have, at least so long as these characteristics would not be bad for the person who will have them and are consistent with respect for persons. (The latter con- straint could conflict with merely doing what is best for someone. For example, suppose peace of mind and equanimity are goods for a person. Neverthe- less, insuring their presence by modifying someone so that she is self-deceived about awful truths would be inconsistent with taking seriously that one is cre- ating a person, an entity worthy of respect. Sandel says, “Not everything in the world is open to what- ever use we may desire or devise” (Sandel 2004, 54). This is certainly true of persons, even when we desire their good.)

Before the existence of a person, there is no per- son yet with certain characteristics that we have to accept if we love him and do not want to impose undue burdens necessary for changes. Hence, not ac- cepting whatever characteristics nature will bring but altering them ex ante does not show lack of love. Nor can it insult or psychologically pressure a per- son the way ex post changes might, as no conscious being yet exists. Importantly, it is (somewhat para- doxically) rational and acceptable to seek good char- acteristics in a new person, even though we know that when the child comes to be and we love him or her, many of these characteristics may come and go and we will continue to love the particular per- son. This is an instance of what I call the distinction

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between “caring to have” and “caring about.” That is, one can know that one will care about someone just as much whether or not she has certain traits and yet care to have someone that has, rather than lacks, these traits (Kamm 2004).7 Sandel says that ‘parental love is not contingent on talents and at- tributes a child happens to have” (Sandel 2004, 55). This is true. But I have tried to show this is consis- tent with seeking better attributes.

Applying what I have said to the issue of en- hancement suggests that even if transformative and enhancing projects should be based primarily on what is best for the child, this is consistent with trying to achieve ex ante a child with traits that will be desirable per se, so long as they will not be bad for the child and are not inconsistent with respect for persons. Ex ante enhancement will pri- marily be through genetic alteration. By contrast ex post enhancement may have to be more constrained for it could involve psychological pressure on the child and lead to fear of rejection. (Altering a fetus or early infant will be somewhere in between.)

Drawing a distinction between the methods of ex ante and ex post “designing” does not, however, put to rest different sorts of objections to even ex ante transformations. First, Sandel thinks that peo- ple are not products to be designed. I agree that people are not products in the sense that they are not commodities, but rather beings worthy of con- cern and respect in their own right. But I do not think this implies that it is morally wrong to design them. Consider first if it would be acceptable to re- design oneself. We are accustomed to people having replacement parts, such as knees, hips, and trans- plants. Suppose when our parts wore out, we were offered alternatives among the new ones. For exam- ple, teeth of various colors, joints that were more or less flexible, limbs that were longer or shorter. It might well make sense to make selections that involved redesigning our bodies. Similarly, if we could replace brain cells, it might make sense to choose ones that gave us new abilities. This would be redesigning ourselves.

Now consider creating new people. We already have much greater control over the timing of preg- nancy and, via artificial reproduction, over whether someone can conceive at all. Rather than humility,

7. I previously argued for this distinction when discussing the compatibility of (a) a disabled person caring about his life as much as non-disabled person cares about his life and (b) a disabled person caring to have a non-disabled life rather than a disabled one.

we have justifiable pride in these accomplishments. Now suppose we each had been designed in detail by other persons. Presumably, we would still be be- ings of worth and entitled to respect. In this sense, designing persons is not inconsistent with their per- sonhood. But might it be that although a being retains its high status despite such an origin, it is inconsistent with respect for persons to choose such an origin for them? (Analogously, a person retains his status as a rights bearer even when his rights are violated, but it is not, therefore, appropriate to violate his rights.) But suppose that the natural way of reproducing required that properties be selected for offspring, otherwise they would be mere lumps of flesh. Surely selecting properties would be per- missible. Would we be obligated, out of respect for persons, to search for a way to alter this (imagined) natural way for definite properties to come about when it is going well, so that they would happen by chance? I do not think so. Hence, I conclude, designing of persons is not per se inconsistent with respect for persons.8

A second objection asks, if someone wants to have a child, should they not focus only on the most basic goods, such as having a normal child to love? If so, then if they focus on achieving many superior qualities, does that not show they are interested in the wrong things in having a child? To answer this worry, consider an analogy. If the primary con- cern for a philosopher in getting a job should be that she be able to do philosophy, does that mean that it is wrong to choose between possible jobs equally satisfying that characteristic on the basis of other desirable properties such as higher salary or better location? If not, why is the search for prop- erties other than the basic ones in a child wrong, when the basic ones are not thereby put in jeop- ardy? (Of course, in the case of the child-to-be, un- like the job, the enhanced properties are usually to be for its benefit, not only for those doing the selecting.)

Furthermore, searching for more than the basics does not by itself imply that if one could not achieve those enhancements, one would not still happily have a child who had only the basics. (And even while someone who would refuse to have a child without enhancements might thereby show that he did not care very much about the core reasons for having a child, this does not show he is unfit to be

8. Notice also that designing the gene pool so that only enhanced options are available is compatible with chance determination of any given individual.

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a parent. For he could still come to love the child if he actually has it, through attachment to it as a particular, as described above.)

A third concern is that in the relation of parent to child, a parent will simply have greater control over the child’s nature, whether she seeks it or not. (This does not mean that the child has less control, for it is chance, not the child, that will determine things, if persons, such as parents, do not. Nor does it mean that the issues of “designing” children and parental control are not separable in principle. For if someone other than the parent designed the child, relative to the parent the child would still be part of the unbidden). But in numerous areas of life, persons now stand in relations of control over other people where once chance ruled. The important thing is that this be done justly, benevolently, and wisely. Furthermore, if we choose certain characteristics in offspring, the balance of control over the child’s life may shift to the child rather than the parent. What I have in mind is that if we could ensure that a child has such enhancing traits as self control and good judgment, the child would be less, not more, likely to be subject to parental control after birth. This is most important.

A fourth concern is that if each parent indi- vidually tries to do what is best for its child, all parents will end up making the situation worse for all their children. To avoid this prisoner’s dilemma situation, some rule that coordinates the choices of parents seems called for.9

B. Social Justice

Finally we come to Sandel’s views on the connection between enhancement and the twin issues of the burdens of responsibility and distributive justice. If people are able to enhance themselves or others, can they not be held responsible in the sense of being blamed for not giving themselves or others desir- able characteristics? Not necessarily, for one does not have a duty to do everything that could make oneself or someone else better, and if one has no duty, then one is not at fault in not enhancing and so not to be blamed. Even if one has certain duties, for example, to be the best doctor one can be, and taking certain drugs would help one to perform bet- ter, it is not necessarily one’s duty to take the drugs. Hence, one need not even be at fault if one does not do what will help one perform one’s duties better. But one could retain a right not to alter one’s body

9. Larry Temkin emphasized this point.

in order to better fulfill one’s duties as a physician, without making such alterations impermissible for anyone who wants them. Of course, if the charac- teristics one will have must be decided by others (for example, one’s parents), then one could not be held morally accountable for causing or not causing certain traits, as one could not direct one’s parents’ behavior.

What about cases in which one can be blamed for a choice not to enhance? Thomas Scanlon has emphasized that one can hold someone responsi- ble for an outcome in the sense of blaming him for it without thereby thinking that it is also his re- sponsibility to bear the costs of his choice (Scanlon unpublished). These are conceptually two separate issues. For example, suppose someone is at fault for acting carelessly in using his hairdryer. If he suffers severe damage and will die without medical treat- ment, his being at fault in a minor way does not mean that he forfeits a claim on others he otherwise had to free medical care.

Sandel thinks the issue of responsibility for choosing to have or to lack certain characteristics is intimately related to how much of a claim we have against others for aid. However, he is not al- ways clear in distinguishing the role of choice from the role of mere knowledge of one’s characteristics. For example, in discussing why we have insurance schemes, he seems to imply that even if we had no control over our traits but only knew what they were (for example, via genetic testing), we would lose a claim against others to share our fate. For if they knew they were not at risk, people would not enter into insurance schemes that mimic solidarity. This is an argument against knowledge as well as against control. But those who urge us to use a veil of igno- rance in deciding about what allocation of resources is just are, in effect, saying that even if we have knowledge of each other’s traits, there are moral rea- sons for behaving as though we lack the knowledge.

Let us put aside the issue of blameworthiness for, and the effect of mere knowledge of, one’s traits. How should the possibility of making choices that determine one’s traits affect responsibility for bear- ing costs for the outcome of choices. Sandel seems to share with some philosophers (known as luck egalitarians) the view (roughly) that if we have not chosen to have traits but have them as a matter of luck (or other people’s choices), the costs of hav- ing them should be shared. However, if we choose the traits (by act or by omitting to change them if we can), then even if we do not in any deep sense deserve to have made this choice, there is no reason

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Is There a Problem With Enhancement?

for the costs of having the traits to be shared. (We may, however, choose to buy insurance that will pro- tect us against bad choices.) Sandel says he cannot think of any better reason for the well-off to help those who are not well-off except that each is not fully responsible for his situation. (Many, however, do not find this a compelling reason for sharing with others. Robert Nozick, for example, argued that one could be entitled to what followed from the exercise of traits that one was not responsible for having10).

But it seems that often we want to give people new options without taking away from them help they would have gotten from others when they had no control over their fates. One example given above involved someone whose choice to use a hairdryer should not lead to his forfeiting aid to avert a major disaster. Similarly, if someone for reasons of con- science refuses to take advantage of the option to abort a difficult pregnancy, we do not think that she should forfeit medical care simply because she could have avoided the need for it. In many cases, arguments for the duty to aid others seem to have more to do with respect and concern for the value of other persons than with whether they have or have not gotten themselves into whatever situation they are in. Of course, in cases I have been consid- ering, someone chooses in a way that leads to a bad outcome he does not per se choose. But recall that Kant thought we had a duty to help people pursue even the ends they themselves had deliberately cho- sen because people matter in their own right, rather than because they could not be held responsible for their choices or because it was only the unwilled consequences of choices with which we were asked to help.

Finally, suppose it were true that to some de- gree as we increase the range of individual choice, we limit the claim of a person to the assistance of others. (For example, choosing to be paralyzed be- cause one preferred that sort of life might be con- sidered an “expensive taste,” and public assistance for it might be denied). It is still true that, if having the option to enhance leads many people to improve themselves or others, there will be fewer instances of people who are badly off (because they lack good traits) and, hence, fewer who require the assistance of others. For example, rather than redistributing wealth that only the talented can produce in a cer- tain environment, each person would have a talent and so have the opportunity to be more produc-

10. See his Anarchy, State, and Utopia.

tive in that environment. Furthermore, each person would not only have the material benefits that can be redistributed from some to others. Each person could have the abilities and talents whose intrinsic rewards (that come just from their exercise) cannot be redistributed.

The primary conclusions of this section are that Sandel does not successfully show that we should limit options to enhance ourselves or others as a way of ensuring a right to social assistance. He also does not show that seeking to enhance children, espe- cially ex ante, is inconsistent with a proper balance between accepting and transforming love.

V. CONCLUSION

Sandel focuses on the desire for mastery and the un- willingness to live with what we do not control as objections to enhancement. (He also focuses on the more contingent issue of the misuse of the ability to enhance ourselves and others that is likely to occur in a competitive environment, especially governed by shallow values.) I have argued that what is most troubling about enhancement is neither that there will be people who desire to have control over na- ture, offspring, and themselves, nor the unwilling- ness to accept what comes unbidden. However, I do think there are major problems with enhancement. Some are the ones Sandel puts to one side. Namely, could we really safely alter people, not making dis- astrous mistakes? And given our scarce resources, should enhancement be at the top of the list of things to which we should be attending?

A deeper issue, I think, is our lack of imagi- nation as designers. That is, most people’s concep- tion of the varieties of goods is very limited, and if they designed people their improvements would likely conform to limited, predictable types. But we should know that we are constantly surprised at the great range of good traits in people, and even more the incredible range of combinations of traits that turn out to produce “flavors” in people that are, to our surprise, good. For example, could we pre- dict that a very particular degree of irony combined with a certain degree of diffidence would constitute an interesting type of personality? In section IV A, I mentioned the view that potential parents should focus on having children with basic good properties rather than seek improvements beyond this. Oddly, the “lack of imagination” objection to enhancement I am now voicing is based on a concern that in seek- ing enhancements people will focus on too simple and basic a set of goods.

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How does the lack of imagination objection re- late to Sandel’s view that an openness to the un- bidden extends the range of our sympathies? One construal of his point is that if we have no control, we are forced to understand and care about people, as we should, even when they are difficult and non- ideal. (Even if we have some control but lack com- plete control, we would, I think, have to cultivate such a virtue). By contrast, the lack of imagination objection emphasizes that when creatures of limited imagination do not design themselves and others, they are likely to extend the range of their appreci- ation of goods because the range of goods is likely to be larger. A parent who might have designed his child to have the good trait of composing classical music, could not have conceived that it would be good to have a child who turns out to be one of the Beatles. (To have conceived it, would have involved creating the style before the Beatles did.) The lack of imagination objection is concerned that too much control will limit the number and combination of goods from what is possible. Hence, at least in those cases where enhancement—greater goods—is more likely to come about if chance rather than unimag- inative choice is in control, the desire for enhance- ment will militate against control.

Finally, if the controlled selection of enhanced properties is a morally acceptable means, at least sometimes, what are the good ends to which it could safely be used? Presumably, it would be a safe end to enhance our capacities to recognize and fulfill our moral duties (or recognize when these are

overridden). Recognizing and fulfilling moral du- ties (or recognizing when it is morally permissible for these to be overridden) is a side constraint on the exercise of any other capacities and the pursuit of any ends. There is no point in worrying about the risk that having such moral capacities will in- terfere with other unimagined goods. This is be- cause if such moral capacities interfere with other goods, this just means that those other goods are not morally permissible options for us. �

REFERENCES

Kamm, F. 2004. Deciding whom to help, health- adjusted life years, and disabilities. In Public health, ethics, and equity, ed. S. Anand, F. Peters, and A. Sen, 225–242. Oxford, UK: Oxford University Press.

Nozick, R. 1977. Anarchy, state and utopia. New York: Basic Books.

Sandel, M. 2004. The case against perfection. The Atlantic Monthly 293(3): 51-62.

Scanlon, T. 2000. Intention and permissibility I. Pro- ceedings of the Aristotelian Suppl. 74:301–317.

Scanlon, T. Blame. Unpublished article.

Shiffrin, S. 1999. Wrongful life, procreative responsi- bility, and the significance of harm. Legal Theory 5(2): 117–148.

Thomson, J. J. 1990. The realm of rights. Cambridge, MA: Harvard University Press.

Thomson, J. J. 1999. Physician-assisted suicide: Two moral arguments. Ethics 109(3): 497–518.

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Kukathas - The Case for Open Borders.pdf