A NORMATIVE FRAMEWORK FOR ANALYZING HUMAN ENHANCEMENT TECHNOLOGIES by Michael Joseph Gentzel A dissertation submitted to John Hopkins University in conformity with the requirements for the degree of Doctor of Philosophy Baltimore, Maryland July, 2015 A NORMATIVE FRAMEWORK FOR ANALYZING HUMAN ENHANCEMENT TECHNOLOGIES Abstract of the Dissertation Due to the explosion of biotechnological advancements, there is a growing body of literature in philosophy concerning the moral and social issues surrounding biotechnical means of enhancing human capacities. A common trend has been to view enhancement as a homogenous category, and to either advocate for it or demonize it. This dissertation advances a moderate view, which suggests that human enhancement should not be normatively analyzed as a single and unified topic; rather, particular categories of enhancement ought to be normatively evaluated based on their own merits and demerits. In doing this, I suggest that concerns about harm to others have not received adequate attention. Addressing the diversity of human enhancements and their potential to create harm to others should play a more prominent role in evaluating specific forms of biotechnology used for human enhancement. This dissertation has two main divisions: a theoretical section and an applied section. In the first section, I develop an interpretation of Joel Feinberg’s conception of harm along with his version of the harm principle. According to this model of harm, A harms B when A unjustly damages B’s interests. The harm principle holds that the prevention of harm to others or the risk of harm to others is always reason in favor of legislation that limits individual liberty. In the second section (Chapters Four, Five and Six), I apply this harm principle and conception of harm to three categories of enhancement. Chapter Four deals with muscle enhancement technology; Chapter Five deals with cognitive enhancement technology; and Chapter Six deals with the ii genetic engineering of children. In each of these chapters, I consider several ways each category of enhancement could raise concerns about harm to others. I then critically analyze these concerns and propose tentative social policy recommendations based on my analysis of each category of enhancement using the harm principle. Dissertation Director: Hilary Bok Internal Readers: Dean Moyar and Richard Bett iii Acknowledgements This dissertation would not have been possible but for the support and help from many people. I would like to extend my thanks and gratitude to my dissertation committee. My dissertation director, Hilary Bok, provided important suggestions and advice on many drafts. Due to her guidance, I am no doubt a better philosopher and writer. My committee members, Dean Moyar and Richard Bett, provided essential feedback on drafts, and they were always available whenever I needed some assistance. Steven Gross has also provided insightful advice and suggestions on this project. I should also extend my gratitude to my fellow graduate students in the department of philosophy at Johns Hopkins. In particular, John Waterman, Bryan Miller, Michael Abramson, Victor De Fate, Jennifer Astin, John Brandau, and Jon Hricko all provided great philosophical conversation, encouragement, and friendship during my journey as a doctoral candidate. My undergraduate professors at Rutgers University-New Brunswick also deserve acknowledgments, especially Doug Husak, Peter Klein, and Martin Bunzl, for providing me with an outstanding philosophical foundation for my future studies. I must express how truly grateful I am to my family. My parents, Alfred and Pamela, taught me the difference between right and wrong. Their love and support have been infinite. They have always encouraged me to follow my dreams, and they were always there for me, no matter what. And lastly (but certainly NOT least), I must thank my wife Renee. Without her love and support, this dissertation would not be possible. She devoted her time and her patience in iv helping me succeed, especially during the home stretch of this work. She is truly my life partner. Thank you for being in my corner. v TABLE OF CONTENTS Abstract ii Acknowledgements iv Table of Contents vi Part I: Methodology and Theoretical Foundations 7 Chapter 1: Human Enhancement: A Question of Morality and of Policy 7 Chapter 2: The Theoretical Framework: The Harm Principle and a Conception of Harm 52 Chapter 3: The Harm Principle: Objections / Replies, Moral and Policy Implications, and a Guide for its Application to Categories of Enhancement 104 Part II: The Application of the Harm Principle to Specific Biotechnologies Body, Mind, and Birth: Physique Enhancement, Cognitive Enhancement, and Genetically Engineered Children 126 Chapter 4: Physique Enhancement: A Cultural Movement from Antiquity to Modernity 127 Chapter 5: Cognitive Enhancement: Smart Drugs and Mensa-Mice 163 Chapter 6: Choosing the Genotype of our Children: Designer Babies 189 Chapter 7: Conclusion 219 Bibliography 229 Curriculum Vitae 235 vi --‘Primum non nocere’ (First, do no harm).1-- Part I: Methodology and Theoretical Foundations Chapter 1 Human Enhancement: A Question of Morality and of Policy Introduction The Problem of enhancement The purpose of this work is to suggest a practically applicable and plausible theoretical framework of moral/ political philosophy that will provide preliminary moral and social policy solutions to the questions surrounding biomedically engineered human enhancement. During the past several years, the field of applied ethics has seen a proliferation of work concerning the moral use of biotechnology. Biomedical technology aimed at human enhancement has received a significant amount of attention, and not without good reason. Increasingly, science has allowed us to manipulate our own biology not only to cure and reverse disease, but also to improve the biological make-up of otherwise healthy individuals. Muscles can be made stronger and concentration can be improved by pharmaceutical and genetic alterations to the human body.2 In the near future, the lengths to which these types of enhancements can be carried by medical intervention will advance greatly, and what was previously considered science fiction is now being considered science fact. 1 This phrase is commonly thought to have derived its spirit from the Hippocratic Oath, which has been historically known to have set the ancient precepts of the ethical practice of medicine since antiquity. 2 Pharmaceutical and genetic means for enhancing both muscular strength and cognitive capacities are topics that I will consider in later chapters of this work. Steroid use, human growth hormone use, and gene therapy occupy the moral debate over physique enhancement. Drugs and genetic engineering techniques targeted to improve concentration, memory, and mood elicit ethical concern and political anxiety. Some of these means of enhancement are not yet possible (for instance, gene therapy treatment that will improve one’s intellect), but many are already currently available (consumption of the drug modafinil for improved concentration and IGF-I injected intramuscularly as a virus for muscular hypertrophy). 1 With these novel scientific abilities comes emerging moral concern. Michael Sandel has described this topic as inducing a sort of ‘moral vertigo’, for ‘…When science moves faster than moral understanding, as it does today, men and women struggle to articulate their unease.’ (Sandel 2004). It is clear that as bioengineering opens new doors and broadens horizons, serious moral questions arise that cannot be ignored. Is it morally permissible to make use of our knowledge and research in genetics and pharmaceuticals to enhance humans by altering human biology? What social and political considerations should we focus on to properly shape and prepare society for these potentially drastic changes in human functioning? If human enhancement is morally permissible, how should we regulate its use in society? These general questions give rise to more specific normative questions of philosophy and politics. Is it morally wrong for a set of parents to genetically modify their child to express certain characteristics, such as athletic prowess or musical talent? What sort of regulations and policies should govern the use of pharmaceutical and genetic enhancements aimed at achieving the ‘perfect physique’? These are just a couple of the many topic-specific questions that arise within the debate of human enhancement which have no easy answers. The focus of this work will be to shape a systematic way of handling these types of pressing questions. What is human enhancement? For the purposes of this work, we can define human enhancement as follows: Human enhancement is the non-therapeutic use of biomedical technology to improve biological functioning. 2 We should note that this definition stipulates several characteristics of human enhancement. Human enhancement refers to some intervention in the biological functioning of a person. Further, this intervention uses some form of biomedical technology. Accordingly, we would not consider special talents or capacities that have been inherited by the genes of the mother and father as human enhancement. Genetic inheritance is not intervention nor does it involve biomedical technology. Improving human capacity through mastering mindfulness meditation would be a form of intervention, but would not be accomplished by biotechnology. Since these ways of improving our capacities are not the