MORAL PROGRESS and MORAL Enhancementbioe 1965 285..290

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Bioethics ISSN 0269-9702 (print); 1467-8519 (online) doi:10.1111/j.1467-8519.2012.01965.x Volume 27 Number 5 2013 pp 285–290

COMMENTARY

MORAL PROGRESS AND MORAL ENHANCEMENTbioe_1965 285..290

JOHN HARRIS

It is a truth universally acknowledged that ‘because indeed easily do a lot of good, and yes, one can indeed humans now have at their disposal technology so power- easily do a lot of harm. However the issue only matters if ful that it could bring about the destruction of the whole there is some reason why we cannot both try to prevent planet if misused’1 it is a seriously important matter that harm and at the same time do good; so in a real sense this this misuse does not occur. On this, Ingmar Perrson, part of our disagreement is strictly ‘academic’. Julian Savulescu and I agree. I have been actively fighting this misuse since I joined the Campaign for Nuclear Dis- armament (CND) and took part in the Aldermarston TAKING ONE’S CHANCES Marches2 in the UK from 1960. This, almost lifelong, interest in the use and abuse of technology perhaps Before turning briefly to some of the issues that are still explains a certain obsessiveness in my theoretical interest live, it is worth noting an odd dissonance in P&S’s way of in these issues. taking about opportunities for good and evil. I would like briefly to correct some important misun- They start by noting that: derstandings that have occurred in the lively debate most readers of this paper probably have access to a car between Persson, Savulescu and myself over the uses and and live in densely populated areas. Whenever you drive, abuses of moral enhancement as one technique or strat- you could easily kill a number of people by ploughing egy for averting disaster and, more importantly, to point into a crowd. But, we dare say, very few of you have the consequences for our understanding of morality and opportunity every day to save an equal number of lives. moral progress. In their latest contribution to this debate3 Persson and They then go on to point out that: Savulescu (P&S) spend a great deal of energy trying to support their claim that doing harm is both easier than It might be thought that our claim is undermined by the preventing harm and easier than doing good to the same fact that we in affluent countries could save hundreds of degree. I had disagreed with them about this more out of lives, cheaply and easily, by donating money to the most a cussed belief that this claim was obviously wrong than cost-effective aid agencies. Most of us could save, rela- because it was particularly crucial to the issue of moral tively easily, 1350 lives over our lifetime. True, but, enhancement. However although I believe that doing again, this is because we happen to find ourselves in harm and preventing harm are not in principle necessarily special circumstances which are conducive to our provid- easier the one than the other, of course there are many ing great benefits, namely a huge global inequality, in particular cases where the balance will be skewed in a which we are vastly better off than many of those who particular direction. In their attempted rebuttal of my need our help. Also, we could accomplish these greatly claim that both these modalities, doing good and prevent- beneficial deeds only because there are already in place, ing harm, are both essential and equally effective ways of due to the work of many good-natured people, highly making the world a better and a safer place, they don’t cost-affective (sic) aid agencies. Therefore, we cannot seem to me to have done much but show that one can justifiably claim the whole credit for the lives saved by our donations.4 1 I. Persson & J. Savulescu. Getting Moral Enhancement Right: the I am entirely unclear why claiming the ‘whole credit’ Desirability of Moral Bioenhancement. Boethics doi:10.1111/j.1467- might be a crucial point, but in so far as it is, the cases are 8519.2011.01907.x In response to J. Harris. Moral Enhancement and isomorphic. First, chances or opportunities have to exist Freedom in Bioethics 2011; 25(2): 102–111. Published Online December 2010 doi: 10.1111/j.1467-8519.2010.01854.x. to be taken, and we are seldom entirely responsible for 2 And the less noticed ‘High Wycombe March’. 3 Persson & Savulescu, op. cit. note 1. 4 Ibid: 2.

Address for correspondence: Prof. John Harris, University of Manchester, School of Law, Institute of Medicine, Law and Bioethics, Oxford Road, Manchester M13 9PL. Email: [email protected] Conﬂict of interest statement: No conﬂicts declared

© 2012 John Wiley & Sons Ltd 286 John Harris creating the opportunities we take as well as for taking I use the term ‘easy’ because although it may be very them. Opportunities are often, as the name implies, difficult (possibly impossible) to develop a reliable drug ‘opportunistic’. So although the opportunity for doing based moral enhancer, once developed (like the motor car good by giving aid requires other things to be handily in in the P&S example above) it will be ‘easy peasy’ to do place, so do opportunities for evil. To take P&S’s own instantly an immense power of good. That is why P&S example, my ability to kill by driving my car into inno- have espoused moral enhancement so enthusiastically cent bystanders is contingent upon my happening to find and it is also why they cannot have their cake and eat myself in special circumstances which are conducive my it too. doing great harm, namely my living within driving dis- But there is another problem here. P&S believe that the tance of a suitable crowd of such bystanders. Also it is world is particularly threatened because just one maniac only possible because there are already in place, due to the or idiot might, given the immensely powerful and easily work of many good-natured people, highly cost-effective acquired destructive technologies that are increasingly motor cars for me to drive, gas stations for me to fill the readily accessible, destroy the world forever. For this cars in, roads kindly built to facilitate my murderous reason, drastic preventive measures, namely universal instincts etc etc. And of course I can only do all this moral enhancement are required.5 But the task of devel- because I have the good fortune to live in densely popu- oping, let alone universally distributing, these preventive lated areas, abounding with good natured and patient measures is, to say the least, somewhat ambitious. crowds just waiting for me to plough into them! I, for Remember their radical solution is premised on the pos- one, certainly can’t take the whole credit for all of this, sibility of just one outlier, one village idiot, destroying kind as it is of P&S to implausibly endow their readers everything. with this degree of power. As P&S have insisted: Before I seize murderous opportunities and take my Even if only a tiny fraction of humanity is immoral car out for a spin towards Oxford let us return to the issue enough to want to cause large scale harm by weapons of moral or rather theoretical symmetry between causing of mass destruction in their possession, there are bound death and saving lives. to be some such people in a huge human population, as on Earth, unless humanity is extensively morally enhanced...6 HOW MUCH IS ENOUGH The remedy therefore must be more than extensive to MORAL ENHANCEMENT? do the trick, it must be universal and exeptionless. Even if the eventual moral enhancement could be applied as I have to say I see no relevant differences between the easily as via, for example, the oral administration of two cases P&S present and I am also sure that we are all something on a sugar lump, we know from experience modest enough only to claim the appropriate degree of with the polio vaccine that it would be impossible to credit for what we do or for what the characters in our ensure anything like universal coverage. Moreover, examples are capable of. However P&S have another big unlike with vaccination, there will not be the benefits problem in maintaining, as they do, that there is a neces- of ‘herd immunity’ to help mask deficits in coverage. sary or structural and, more importantly, substantial The project seems doomed, not doomed to fail to effect asymmetry between our capacity to do harm and in par- notable moral enhancement, but doomed to fail to neu- ticular to kill, on the one hand, and our capacity to do tralize the threats upon which its urgency is predicated. good and in particular to save lives, on the other. This I must make clear that I have no objection to moral problem arises because P&S have nailed their colours to enhancement, or what P&S now call moral bioenhance- the mast of moral enhancement precisely because of this ment if, firstly it works, and secondly, if methods of moral alleged asymmetry and because they see moral enhance- bioenhancement do not counter-productively block alter- ment as required in order to prevent or indeed forestall native modalities of mitigating harm and doing good. My the sort of apocalyptic harms that the village monster or fear is that most of the evidence so far adduced for moral the village idiot might, through monstrosity or idiocy, bioenhancement seems to indicate that it will fail to perpetrate upon a gullible public. If moral enhancement enhance morality and do good ‘all things considered’.7 might be capable of this trick, or even if P&S think it might, then they must also think that both in principle and in fact that it is easy enough to save a large number 5 I. Perrson & J. Savulescu. The Perils of Cognitive Enhancement and of lives by this means. And if it wasn’t in principle as easy the Urgent Imperative to Enhance the Moral Character of Humanity. J Appl Philos 2008: 25(3). to do good as to do harm, then the P&S argument for 6 Ibid. moral enhancement would be proportionally reduced in 7 J. Harris. What it is to be Good. Cam Q Healthc Ethics. http:// power and attractiveness. onlinelibrary.wiley.com/doi/10.1111/j.1467-8519.2011.01946.x/full. See

I could be wrong about this, of course, but that is why we enhancement. Indeed, Elizabeth Fenton was equally must not use one strategy if there is a danger of it block- comprehensively deceived by the above claim, pointing ing another more promising one. out ‘it is difficult not to take [Perrson’s and Savulescu’s P&S seem to agree with this because they now say, as if pessimism] to imply that unless and until we further I had ever denied such an approach: understand moral enhancement, we should try to slow scientific progress’.11 I am glad to be reassured that P&S, But why should we bet on one against the other? like me, are in favour of pursuing research into all forms Why can’t we have both? Why can’t we have scientific if enhancement even though, in their view, these different research accelerated by cognitive enhacment, but methods may be mutually antagonistic. channel some of it towards finding means of moral bioenhancement?8 Oh why, oh why indeed can’t we? I, of course, think we UNENHANCED DICHOTOMIES12 can, but I have to admit having been grossly and per- 9 versely misled by P&S themselves. In their original paper P&S quote me correctly as saying: ‘The space between P&S specifically conclude: knowing the good and doing the good is a region entirely Even if only a tiny fraction of humanity is immoral inhabited by freedom.’ And then present this dichotomy: enough to want to cause large scale harm by weapons Suppose, first, that our freedom is compatible with it of mass destruction in their possession, there are bound being fully determined whether or not we shall do what we to be some such people in a huge human population, take to be good. Then a judicious use of moral bioen- as on Earth, unless humanity is extensively morally hancement techniques will not reduce our freedom; it will enhanced... simply make it the case that we are more often, perhaps A moral enhancement of the magnitude required to always, determined to do what we take to be good. We ensure that this will not happen is not sufficiently pos- would then act as a morally perfect person now would act. sible at present and is not likely to be possible in the near Suppose, on the other hand, that we are free only future. because, by nature, we are not fully determined to do Therefore, the progress of science is in one respect for what we take to be good. Then moral bioenhancement the worse by making likelier the misuse of ever more cannot be fully effective because its effectiveness is effective weapons of mass destruction, and this badness limited by our freedom in this indeterministic sense. So, is increased if scientific progress is speeded up by cog- irrespective of whether determinism or indeterminism in nitive enhancement, until effective means of moral the realm of human action is true, moral bioenhancement enhancement are found and applied. will not curtail our freedom. Admittedly they say ‘in one respect’ the progress of P&S seem to be suggesting that this dichotomy science is for the worse, but they discuss no other senses somehow demonstrates that the alternatives divide in which the progress of science is in any way for the without remainder in a way that demonstrates that I must better given the dangers that preoccupy them. I have be wrong. This horse won’t run! They are assuming in the argued elsewhere that science is our chief hope for the first paragraph that all methods by which actions might be future of humankind, and in particular for the discovery ‘fully determined’ are the same from the perspective of the of methods of blocking doomsday scenarios of the sort room left for the role of choice. I have expressed doubts 10 imagined by P&S. Given the significance of the apoca- about the extent to which some chemical and biological lyptic threats, and the whole direction of their paper ways of altering the emotions and other springs of actions being the need urgently to combat these threats, I took leave room for choice in the way that many believe the them to be recommending that we put on hold or even thesis that all events including mental events are caused attempt to reverse the progress of science and cogni- leaves room among those causes for choices. So it does not tive enhancement pending the development of moral follow from the fact that either some form of determinism is true or none is, (the dichotomy) and that determinism also: J. Harris & S. Chan. Moral Behaviour is Not What it Seems. Proc can be compatible with free will, that absolutely any form Natl Acad Sci Early Edition 2010 www.pnas.org/cgi/doi/10.1073/ of determinism must be so compatible; and hence if moral pnas.1015001107. S. Chan & J. Harris. Moral Enhancement and Pro- bioenhancement involves determinism it is necessarily not social Behaviour. J Med Ethics February 2011. J.Harris. Ethics is for antagonistic to freedom. P&S and I are discussing pre- Bad Guys: Putting the ‘Moral’ into Moral Enhancement. Bioethics, publication 2011. cisely whether or not there will be some forms of moral 8 Persson & Savulescu, op. cit. note 1, p. 5. 9 Persson & Savulescu, op. cit. note 5. 11 E. Fenton. The Perils of Failing to Enhance: a Response to Perrson 10 J. Harris. 2007. Enhancing Evolution Princeton and Oxford: and Savulescu. J Med Ethics 2010; 36(3): 149. Princeton University Press. 12 In less politically correct times these were called ‘false dichotomies’.

© 2012 John Wiley & Sons Ltd 288 John Harris bioenhancement that will leave room for freedom. I am ments – there are a lot of places out there, and use the sure there can be such, I have argued however that many word billions, and so on. And then I say it would be of the forms currently being canvassed as promising do astonishing to me if there weren’t extraterrestrial intel- not in fact augur well for the survival either of liberty or ligence, but of course there is as yet no compelling evi- indeed of rational strategies for seeing that good triumphs dence for it. And then I’m asked, ‘Yeah, but what do you ‘all things considered’. really think?’ I say, ‘I just told you what I really think.’ I think that the P&S choice of a combination of altru- ‘Yeah, but what’s your gut feeling?’ But I try not to think ism and a sense of justice are as good a choice as any with my gut.15 for core moral dispositions, although one must be clear Well, in a modest way I try not to do ethics with my gut that if so, ‘a sense of justice’ is an extremely theory laden either, and if at all possible I would like my successors not idea in a way that simple ‘do- gooding’ may not be. My to be determined by some well meaning philosophers to concern is first to avoid the elimination of deliberation have to do ethics that way, or to think that they needed from our understanding of what makes for a moral judge- no longer to ask themselves if what they were conditioned ment, to avoid methods which by-pass reflection and or determined to think right is indeed right? deliberation. Some philosophers, like Tom Douglas, have To believe that emotions can deliver answers to moral regarded the avoidance of deliberation as an advantage: dilemmas or generate moral judgements is like believ- The distinctive feature of emotional moral enhancement ing that the gut is an organ of thought, or one that can is that, once the enhancement has been initiated, there is answer complex, combined theoretical and empirical, no further need for cognition: emotions are modified questions. Ethical judgements involve, almost always, a directly.13 combination of evidence and argument and where this combination becomes disjoint, they, at the very least, It is unclear whether or not P&S also regard this as an involve judgement. By judgement is meant something advantage of moral bioenhancement, but whether or not involving reasoning and argument towards a conclusion, they do, it is likely that the currently foreseen methods of towards a ‘judgement’ properly so called. Ethical judge- moral bioenhancement will in fact operate in this way.14 ments cannot, literally cannot, be felt. There is no sense Secondly, current chemical and biological methods of organ for such a feeling. They can of course be stipulated intervention which have been taken to have implications rather than judged of, but stipulation butters no parsnips, for moral enhancement are targeted on so-called ‘pro and only well buttered parsnips cut the mustard in ethics. social’ emotions which tend to operate on what can be The reason for this is easily illustrated. Moral dilemmas immediately seen heard and felt, rather than on what we present a choice, a parting of the ways at a junction. The know might be happening beyond what we can immedi- resolution of a moral dilemma requires a moral reason to ately see, hear and feel. Such methods may distort the travel one road and not the other, not just any old reason, moral priorities which we would have if we considered not simply an arbitrary election or random choice between more and felt less. I do not think P&S and I are, all things one pathway and another, nor even a poetic or practical considered, so far apart; and contrary to what they obvi- reason. There may be many reasons to travel one road ously believe, I have no antipathy to moral enhancement. rather than another, but only some of them are moral reasons. And only the exercise of moral reason can lead to a moral judgement. The roads may both involve morally MORAL REASONING AND consequential journeys, journeys that make a moral dif- MORAL JUDGEMENT ference, to the traveller or to the world. But even morally consequential journeys can be embarked upon for frivo- Carl Sagan has reported that he is: lous or trivial or prejudiced or prejudicial reasons or for . . . often asked the question, ‘Do you think there is no reason at all. Moral judgement, and hence moral extraterrestrial intelligence?’ I give the standard argu- enhancement leads to better moral decision making, but not necessarily to better moral outcomes. 13 T. Douglas. Moral Enhancement via Emotion Modulation: A Reply Two roads diverged in a yellow wood, to Harris. Bioethics forthcoming. See also Harris, op. cit. note 7. 14 M.J. Crockett et al. Serotonin Selectively Influences Moral Judge- And sorry I could not travel both ment and Behaviour Through Effects on Harm Aversion. Proc Natl Acad And be one traveler, long I stood Sci USA 2010; 107: 17433–17438; M.J. Crockett et al. Reply to Harris And looked down one as far as I could and Chan: Moral Judgement is More than Rational Deliberation. Proc To where it bent in the undergrowth; Natl Acad Sci USA; Harris & Chan. 2011. op. cit. note 7; D. M Bartel & D.A. Pizarro. The Mismeasure of Morals: Antisocial Personality Traits Predict Utilitarian Responses to Moral Dilemmas. Cognition 2011 doi 15 Carl Sagan. The Burden of Skepticism. Skeptical Inquirer 1987:12. 10.1016/j.cognition.2011.05.010. In this paper moral judgements are Available at: http://www.positiveatheism.org/writ/saganbur.htm treated as if they were not deliberative in any important sense. [accessed 12 Oct 2011].

Then took the other, as just as fair, As I have argued elsewhere,19 exactly as not just any And having perhaps the better claim, judgment about things in which science is interested is Because it was grassy and wanted wear; ‘scientific’ so not just any judgement about things with Though as for that the passing there which morality is concerned are moral judgements. There Had worn them really about the same, may of course be argument about just what more is required in each case. I have, following Dworkin, sug- And both that morning equally lay gested some minimal standards for morality; these sever- In leaves no step had trodden black. ally, and perhaps even jointly, are certainly contestable. Oh, I kept the first for another day! But that some such standards are required is not, I Yet knowing how way leads on to way, suggest, open to doubt. Something must distinguish I doubted if I should ever come back. morality from other normative systems or systems of I shall be telling this with a sigh belief more generally. And just as not all rules about Somewhere ages and ages hence: things that interest the law are legal rules, so not all Two roads diverged in a wood, and I judgements about things that interest morality are moral I took the one less traveled by, judgements and not all normative systems are either legal And that has made all the difference16 or moral (dress codes in the workplace or the ‘laws’ of cricket). To be sure, the elements of any particular legal There are many reasons why this (and in principle any) system, or code of conduct, may be contested jurispru- choice between two roads, taken, as the text makes clear, dence; but uncertainty does not mean ‘anything goes’, for no decisive reason, moral or otherwise, might prove uncertainty almost always has parameters which are well hugely consequential and indeed ‘make all the difference’ understood just as some uncertainty about linguistic including all the moral difference, even ‘ages and ages meaning, ‘ambiguity’, is not total uncertainty, but uncer- hence’. But a decision which makes a moral difference is tainty within a range.20 not for that reason a moral decision, nor is a dilemma the Tom Douglas invites us to think about Chloe: resolution of which has moral consequences for that reason a moral dilemma.17 As Ronald Dworkin18 has con- Chloe is a student from a wealthy family. She believes vincingly shown, moral judgements command a special she ought to be more moved by the plight of the global respect, which is due to them partly because they are poor, and ought to do more to help them, both by taken to reflect the considered values of the individual donating money to charities, and by giving her own time. making them, and partly because moral judgements She could spend her summer vacations volunteering have to meet certain minimum standards of evidence and in Africa, but instead, she spends them travelling in argument which exclude a number of disqualifying fea- Europe. She does do something to help, for example, she tures. Such disqualifying features include gut reactions, often gives quite generously when directly approached and instinctive or automatic responses. Moreover moral by charities. But most of the time, the world’s most judgements are required to be distinguishable from preju- unfortunate are far from her thoughts, and when they do dices, arbitrary preferences, personal tastes, arguments or cross her mind, she has trouble drumming up the sort of conclusions based on manifest self interest or partiality, sympathy that might motivate greater sacrifices on her or arising from a personal emotional response ‘they make part. To remedy this, she sets up her television so that me sick!’, ‘it is disgusting!’ and the like. Finally someone it regularly displays disturbing and graphic images of claiming to act out of moral principle or on the basis of the effects of poverty, though for such brief periods that moral judgement must be able to explain just what is she does not consciously recognise them. Nevertheless, wrong with the conduct to which he objects or right through subliminal effects, the images do increase her about the decision she endorses. feelings of sympathy, and, as a result, she does indeed spend her next vacation volunteering in Africa. It seems to me that Douglas and indeed Savulescu and Persson who use this or similar examples are taking 16 Robert Frost. Road Not Taken. Available at http://www.poets.org/ an excessively (one might say ‘obsessively’) individualist viewmedia.php/prmMID/15717 [Accessed 10 Oct 2011]. Robert Frost sent this poem to his friend the poet Wilfred Owen and it seems to have view of the way to solve, not Chloe’s problem that is played an important role in convincing Owen to join the army, a deci- indeed a problem, but rather the way to solve or help sion that resulted in his death only a week from the end of the war on 4th solve global poverty. I have argued that ethics is for bad November 1918. 17 John Harris. 2001. Introduction: The Scope and Importance of Bio- ethics in Bioethics, John Harris, ed. Oxford Readings in Philosophy 19 Harris 2012, op. cit. note 7. Series, Oxford University Press. 20 William Empson. [1930] 1970. Seven Types of Ambiguity. 3rd edn. 18 Ronald Dworkin. 1977. Taking Rights Seriously. London: Duck- London: Chatto and Windus. (First edn 1930). The range in question worth: ch 9. may be indefinite but it is not infinite.

© 2012 John Wiley & Sons Ltd 290 John Harris guys,21 the good don’t need ethics and neither does Chloe. POWER TO THE PEOPLE What she needs is determination, not goodness. But more important than the needs of bad guys, who perhaps Neglected, as far as serious consideration in the literature we should disregard as beyond the pale of our moral is concerned, are the possibly beneficial effects of increas- concern, is addressing the problem of global poverty ing affluence, at least on the disposition to resort to politi- which it is, I suggest, insane to leave to personal altruism. cal use of weapons of mass destruction. Attention was We should not worry too much about Chloe’s weakness first drawn to one such effect by Bertrand Russell in 1930, of will! What we need in order to solve, or even help but so far it has not received the attention it deserves. mitigate, global poverty is a global solution and this must Russell, in an insightful essay entitled ‘Is Happiness be attempted at a minimum at state level, and probably Still possible’23 was bemoaning the apathy of the West in at an international or global level. It is clear we cannot the inter war years when contrasted with what he saw as provide health care ‘free at the point of need’22 by private the dynamism of the ‘young intelligentsia’ in India, China altruism. What we need is, at minimum, a national health and Japan: care system (like the NHS in the UK) delivered centrally using taxation (to which all contribute) to fund it. We Cynicism such as one finds very frequently among the need this, and other care and social welfare measures, most highly educated young men and women of the West precisely because we know that altruism so often fails results from the combination of comfort with powerless- (perhaps because of a combination of human weakness in ness. Powerlessness makes people feel that nothing is the form not least of weakness of will, but also because of worth doing, and comfort makes the painfulness of that the human weakness of not being able to drum up much feeling just endurable. sympathy for the ugly and unsavoury or for those out of There is an important sense in which we want to sight and out of mind). We cannot deliver healthcare ‘free encourage the sort of cynicism which makes people too at the point of need’ except at a national level, nor can we apathetic to resort to violent political action and it may provide social security, and other social services including be that the promotion of comfort and satisfaction with for example fire, police, ambulance and defence forces in life is a more reliable and even more morally respectable such a way either. way of achieving this than the sorts of moral enhance- In a real sense it is gross self indulgence, not to mention ment that might deprive us of free will. If we couple self-defeating, to try to address these big problems at the universal education with the eradication of poverty and level of individual morality. Let’s leave poor Chloe alone more, increasing affluence, we will I believe be doing the and think about addressing these important problems at most promising thing as far as moral enhancement goes. the level of policy and indeed of government or better, at That does not mean that we should forego other means, a combined governmental, truly international, level. This but it is self-defeating to use methods that undermine the is what P&S would have to do to implement moral bioen- very capacities required both for moral reflection and hancement, and if we all did more to ensure that govern- judgement and for moral progress. ments acted effectively on global poverty, climate change, education, population control, disease prevention, clean John Harris FMedSci, is Director of The Institute for Science, Ethics and Innovation and of the Wellcome Strategic Programme in The water and the like we might not even need to consider Human Body, its Scope Limits and Future, School of Law, University threats to liberty of the sort I believe that some forms of of Manchester, where is he is Lord Alliance Professor of Bioethics. moral enhancement would inevitably entail. We don’t Books include: On Cloning. 2004. London: Routledge. Enhancing need moral enhancement to see the force of this. What do Evolution was published by Princeton University Press in 2007. we need?

21 Harris 2011, op. cit. note 7. 22 A phrase used by successive UK governments to describe the aspira- 23 Bertrand Russel. [1930] 1964. The Conquest of Happiness. London: tions for care to be delivered by the NHS. Unwin Books.