Hofmann BMC Medical Ethics (2017) 18:56 DOI 10.1186/s12910-017-0215-8 DEBATE Open Access Limits to human enhancement: nature, disease, therapy or betterment? Bjørn Hofmann1,2 Abstract Background: New technologies facilitate the enhancement of a wide range of human dispositions, capacities, or abilities. While it is argued that we need to set limits to human enhancement, it is unclear where we should find resources to set such limits. Discussion: Traditional routes for setting limits, such as referring to nature, the therapy-enhancement distinction, and the health-disease distinction, turn out to have some shortcomings. However, upon closer scrutiny the concept of enhancement is based on vague conceptions of what is to be enhanced. Explaining why it is better to become older, stronger, and more intelligent presupposes a clear conception of goodness, which is seldom provided. In particular, the qualitative better is frequently confused with the quantitative more. We may therefore not need “external” measures for setting its limits – they are available in the concept of enhancement itself. Summary: While there may be shortcomings in traditional sources of limit setting to human enhancement, such as nature, therapy, and disease, such approaches may not be necessary. The specification-of-betterment problem inherent in the conception of human enhancement itself provides means to restrict its unwarranted proliferation. We only need to demand clear, sustainable, obtainable goals for enhancement that are based on evidence, and not on lofty speculations, hypes, analogies, or weak associations. Human enhancements that specify what will become better, and provide adequate evidence, are good and should be pursued. Others should not be accepted. Keywords: Enhancement, Disease, Therapy, Naturalness, Nature, Limits “Don't know what I want / But I know how to get (religious and nonreligious) conceptions of sanctity, dig- it.”Johnny Rotten nity, and on the notion of “playing God.” In addition, there is a restrictive camp [1], not being in principle against enhancement, but which argues for limits from Background concerns for justice and safety. However, there are few Human enhancement (HE) is defined as “any kind of specifications of how to limit HE in detail. genetic, biomedical, or pharmaceutical intervention In this article I will investigate four specific routes to aimed at improving human dispositions, capacities, or limiting HE: Naturalness, disease, therapy, and better- well-being, even if there is not pathology to be treated” ment. The corresponding research questions are: [1]. The topic has stirred vast and vivid debates, espe- cially in the bioethics literature [2–6]. 1. Do conceptions of naturalness provide resources to There seem to be two predominant camps in the de- set limits to HE? bate on HE: a permissive and a prohibitive [1]. While the 2. Does the therapy-enhancement distinction provide first camp sees few limitations to HE, the latter sees resources for setting such limits? many. While the permissive position provides arguments 3. Does the concept of disease offer sources to limit from potential benefits, the prohibitive position refers to HE? 4. Does the concept of HE itself contain means for Correspondence: [email protected]; [email protected] setting limits? 1Norwegian University of Science and Technology (NTNU), Gjøvik, Norway 2Centre for Medical Ethics, University of Oslo, Blindern, PO Box 1130, N-0318 Oslo, Norway © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Hofmann BMC Medical Ethics (2017) 18:56 Page 2 of 11 While I will show that the first three questions do not normal process of growth. It is intrinsic, inheritable, provide convincing answers, the latter may. However, fixed in the germ plasm through the action of all of before I address these questions successively, I must ad- the forces of the Universe.” (Quoted from [11]). Most dress the following question. cultures employ a distinction between “nature” and “culture”; “man-made” and “nature-made” [12]. Ac- Why should there be limits to human enhancement? cordingly, a common understanding of medicine is There appear to be many motivations and arguments for that it works according to the norms of nature, as it why we should try to limit human enhancement. Allow restores a given harmony. me to mention a few of these: Hence, nature may provide a prima facie norm for set- ting limits to human enhancement. Let me briefly recap- Resources: HE has significant opportunity cost and itulate some of these arguments. would drain resources from more pressing needs. This of course relates to: Arguments from naturalness for limiting human Justice: There are not enough resources available for enhancement human enhancement for all, and to focus on human One argument why society should not permanently en- enhancement under such conditions can enhance hance humans is that this would alter our common un- disparity and injustice. derstanding of human excellence and flourishing in ways Humanity: Enhancement will change not only the that would undermine our social practices [13]. For ex- human condition, but humanity as such. One may lose ample, human enhancement would make us lose sight something charitable without knowing what will follow. “of why excellence is worth seeking at all, and hence Uncertainty about benefits and harms: HE may have what excellence really is, and how we pursue it as hu- unknown and potentially devastating consequences. man beings, not as artifacts” [4]. In particular, it would alter the meaning of sports, as we would come In this work I take it as a premise that HE needs to be to honor technological innovation and not talent and limited for some valid reason. At the end of the article, I athletic achievement [14]. will return to this premise. Although the traditional ap- Another argument to limit enhancement is that human proaches to set limits to enhancement may not be con- nature is a complex reality and that enhancing one aspect vincing, they may not have to do such heavy work. The of it could undermine the excellence of the whole [13]. limits to enhancement may be found in the conception Accordingly, enhancing separate abilities would “disrupt of enhancement itself. Investigating the weakness of the either the unity or the continuity of human nature” [15] arguments from naturalness, the therapy-enhancement and compromise humanity [4], e.g., by diminishing our distinction, and the concept of disease, may provide as- humanity by decreasing our appreciation for beauty, ben- sets for exploring the self-limiting potential of human evolence, and vulnerability [16]. A related concern is that enhancement. human enhancement would disturb a delicate balance in nature resulting in unintended and potentially disastrous Discussion consequences [17]. Alternatively, we obtain our enhance- Naturalness: limits in nature ment goal, but it appears to be counterproductive or Several objections to HE and arguments for its limita- undermining something cherished [18, 19]. tion are made with reference to human nature as a norm Yet another concern is that human enhancement [7]. The natural world has frequently been associated would make individuals stand outside the human spe- with order and design (Harmonia Mundi), either teleo- cies, as “post-humans” [13]. Or that human enhance- logical, mechanical, or cybernetic [8–10]. Correspond- ment would violate some special feature of human ingly, nature has been normative in many ways, e.g., nature, such as basic dignity. As expressed by Eric Co- epistemically, aesthetically, and morally. For example, hen: “All members of the human family – all living bod- our knowledge of how to heal a broken leg, how to re- ies – have a human life, and therefore deserve the store its appearance, and the impetus to do so is drawn respect that such membership commands” [20]. from the norm of a well-functioning leg of a being in its Further references to nature is made in claims “that natural habitat. handicap and limitations are inherent to human condi- An explicit expression of the norm of nature can be tion, and should be endured as given by our own indi- found in an editorial in JAMA from 1928: “The state- vidual fates” [7]. Such arguments sometimes are related ments that old age can be deferred have no more scien- to human responsibility, i.e., that altering human nature tific truth in them than the widely advertised promises would give us a responsibility that we are not suited to of rejuvenation. Senescence is a normal process of invo- handle, and sometimes related to the (religious or non- lution as necessary to the progress of life as is the religious) metaphor of “playing God” [1, 6]. Hofmann BMC Medical Ethics (2017) 18:56 Page 3 of 11 The point here is not to review all arguments from hu- what is good. Due to mutations, there is no stable man nature, but only to give a brief overview and a species-typical genome to refer to as natural [31]. backdrop for the counterarguments.