Nick Bostrom Rebecca Roache (2008) [Published in New Waves in Applied Ethics, eds. Jesper Ryberg, Thomas Petersen & Clark Wolf (Pelgrave Macmillan, 2008): pp. 120-152] www.nickbostrom.com
What is Human Enhancement?
Human enhancement has emerged in recent years as a blossoming topic in applied ethics. With continuing advances in science and technology, people are beginning to realize that some of the basic parameters of the human condition might be changed in the future. One important way in which the human condition could be changed is through the enhancement of basic human capacities. If this becomes feasible within the lifespan of many people alive today, then it is important now to consider the normative questions raised by such prospects. The answers to these questions might not only help us be better prepared when technology catches up with imagination, but they may be relevant to many decisions we make today, such as decisions about how much funding to give to various kinds of research. Enhancement is typically contraposed to therapy. In broad terms, therapy aims to fix something that has gone wrong, by curing specific diseases or injuries, while enhancement interventions aim to improve the state of an organism beyond its normal healthy state. However, the distinction between therapy and enhancement is problematic, for several reasons. First, we may note that the therapy-enhancement dichotomy does not map onto any corresponding dichotomy between standard-contemporary-medicine and medicineas-it-could-be-practised-in-the-future. Standard contemporary medicine includes many practices that do not aim to cure diseases or injuries. It includes, for example, preventive medicine, palliative care, obstetrics, sports medicine, plastic surgery, contraceptive devices, fertility treatments, cosmetic dental procedures, and much else. At the same time, many enhancement interventions occur outside of the medical framework. Office workers enhance their performance by drinking coffee. Make-up and grooming are used to enhance appearance. Exercise, meditation, fish oil, and St John’s Wort are used to enhance mood. Second, it is unclear how to classify interventions that reduce the probability of disease and death. Vaccination can be seen as an immune system enhancement or, alternatively, as a preventative therapeutic intervention. Similarly, an intervention to slow the aging process could be regarded either as an enhancement of healthspan or as a preventative therapeutic intervention that reduces the risk of illness and disability.
Third, there is the question of how to define a normal healthy state. Many human attributes have a normal (bell curve) distribution. Take cognitive capacity. To define abnormality as falling (say) two standard deviations below the population average is to introduce an arbitrary point that seems to lack any fundamental medical or normative significance. One person might have a recognizable neurological disease that reduces her cognitive capacity by one standard deviation (1σ), yet she would remain above average if she started off 2σ above the average. A therapeutic intervention that cured her of her disease might cause her intelligence to soar further above the average. We might say that for her, a normal healthy state is 2σ above the average, while for most humans the healthy state is much lower. In contrast, for somebody whose “natural” cognitive capacity is 2σ below the average, an intervention that increased it so that she reached a point merely 1σ below the average would be an enhancement. As a result, an enhanced person may end up with lower capacity than even an unenhanced person with subnormal cognitive functioning; and therapeutic treatment may turn a merely gifted person into a genius. In cases like these, it is hard to see what ethical significance attaches to the classification of an intervention as therapeutic or enhancing. Moreover, in many cases...