Soluble & Insoluble Challenges of Human Enhancement

Some objections to human enhancement just aren’t worth arguing about. Focus on the questions that are amenable to regulation.

Photo by CDC on Unsplash

by James J. Hughes

The debates over enhancement include fundamental issues of identity and even metaphysics, as well as more tractable issues about their proper regulation. In general it is far more productive to focus on the issues that can be operationalized with regulation, and leave the metaphysical questions to personal conscience.

The issues that are usually intractable because they involve incontestable beliefs include

• Is human enhancement against God’s will, a form of hubris, or a spiritual distraction?
• Are enhancements “unnatural?”
• Would the enhanced lose a sense of “authenticity” in their bodies, brains, or accomplishments?

Religious opposition to enhancement is not inevitable, and every religious tradition can be used to argue for both proscriptions against and tolerance of human enhancement. In the 20th century, most faiths adapted to eyeglasses, autopsies, cremation, organ transplants, fertility assistance, vaccination, and so on, and it is likely that religious opinion on many emerging enhancement technologies will shift from threatening forms of hubris to laudable medical therapies during the 21st century. As with the parsing of “the natural” from the “unnatural,” or the sense of what is or isn’t “authentic,” beliefs about how modern technologies fit into ancient faiths is completely subjective and quite malleable.

The topics that can be fruitfully debated about human enhancement are things like:

• How can we know they are safe and effective?
• How can we ensure that everyone has equal access to enhancement?
• Is there a meaningful distinction between therapy and enhancement?
• How can we reduce the risk of weaponization and hold those empowered by enhancement accountable?

Then there are some political questions that may be truly novel in an enhanced future, such as:

• Who are rights-bearing persons in an enhanced future?
• What comes after the autonomous liberal individual?

Clinical Trials for Enhancement Technologies

One central hurdle that enhancement technologies face is the therapy-enhancement distinction in clinical regulation. To begin the regulatory process in most countries a therapy must be targeted at a disease. Many enhancements, such as treatments for cognitive deficits or brain-computer interfaces, will start as therapies for severe diseases and disabilities, and then find broader use as they are proven safe and effective. Eventually, the technologies will surpass “species-typical performance,” at which point the healthy will want to use them, and we will need to research their safety and efficacy for the healthy.

In the case of age-retarding longevity therapies, this issue could be remedied by acknowledging aging itself as a disease process. If slowing aging was itself a clinical goal the challenge would be finding proximate outcomes, such as biomarkers of aging, to be used in clinical trials, since mortality as an outcome will generally take too long. The 21st Century Cures Act adopted in the United States in 2017, for instance, expanded the use of biomarkers in clinical trials by the Food and Drug Administration (FDA). The FDA also took a half-step towards longevist research in 2015 when it approved the Targeting Aging with Metformin (TAME) investigation of the drug metformin with multiple aging-related outcomes including cancer, stroke, dementia, and heart disease. As with other enhancements, developing age-retarding therapies that prophylactically prevent disease straddles the line between therapy and enhancement.

The therapy-enhancement distinction will also be critical in how we think about the social consequences of enhancement technologies. If a cognitive enhancement added 10 IQ points regardless of initial cognitive ability, a society could decide to sacrifice some of the benefits of allowing those already cognitively advantaged to be further advantaged, and achieve greater cognitive equality by only allowing those with cognitive deficits to use the therapy. On the other hand, a consequentialist metric like the “quality-adjusted life year” (QALY) would argue for allowing everyone to use the therapy, since making smart people smarter generates as many QALYs as bringing the disadvantaged to parity.

Innovations in clinical investigation from genetic engineering, machine learning, and Big Data, will likely speed up the testing of all therapies including enhancements. Chimeric animal models of human diseases for instance improve on the often faulty evidence from unmodified mice. In silico methods, computational models of the body and diseases, have already been speeding drug discovery and improving predictions of drug efficacy. Compared to smaller, more homogenous, randomized controlled trials, large, observational trials with diverse patient panels better identify side effects and ideal regimens.

Regulating Access to Enhancement

Many discussions of enhancement technologies imply that the regulatory options are laissez-faire access or banning. Once we get regulatory agencies to permit research on enhancements however they will face the same regulatory choices that all drugs and devices face. Some will be unsafe, ineffective, and banned. Some will be safe but ineffective, and those may be left to over-the-counter access. Some will be safe, effective, and included in the health care system with prescriptive control, as in needing a diagnosis of “mild cognitive decline” for a subsidized prescription of a cognitive enhancer. Some enhancements, like vaccination, may end up being so safe, effective, and inexpensive that societies make them mandatory.

A final speculative category of enhancements that many worry about are those that are expensive enough to only be available for the rich, and which provide some kind of superpower, such as strength or intelligence well above the human norm. We are already surrounded by such superpowers since vast wealth itself is a superpower. The wealthy already live longer than the poor, exercise more control over the world, and their children are more likely to flourish even without genetic tweaks or brain-machine interfaces. Before we start banning healthcare, education or yachts we should redistribute wealth, and strictly control the undemocratic influence that wealth exercises.

Without redistribution of wealth, some expensive enhancement technologies could become yet another advantage of wealth in the future. If the advantages that they provide are extreme — an IQ of a million, or immortality — we might decide to delay the adoption of these truly disruptive enhancements until they can be more widely accessible.

We can also imagine radical, disruptive enhancements that we would want to be restricted to only those licensed for their use, just as one needs training and a good reason to drive a tank. Fortunately, we have some time before human enhancements approach the superpower level; an extra decade of life expectancy or ten extra IQ points are not existential threats to social equality or public safety.

After religious objections, concerns about the impacts of enhancement on social equality are probably the most salient reasons people oppose them. This is one reason that those with university educations are more favorable towards enhancement than those without a university degree. But this concern can be addressed through social policy; if a therapy is safe, effective, and not too expensive, it can be made liberally available through subsidized universal healthcare. Those with a disease diagnosis could be given the therapy for free, while those without a diagnosis, for whom it would be an “enhancement,” could be asked to pay a premium.

Indirect Pressures on Non-Adopters

Another frequent concern about enhancement, after ensuring their safety and equitable use, is that their diffusion would create indirect pressures on the reluctant to adopt them. If some use effective performance enhancement in the classroom or the workplace, such as stimulant medications, others may feel obliged to use them as well. On the one hand, this is not a good reason to regulate their use since these kinds of pressures are ubiquitous. We all feel social pressures to become literate because the life opportunities of the illiterate are greatly curtailed, and they experience stigma. As with vaccination and masking under Covid, we may want non-adopters to feel social pressure to adopt a technology that is beneficial for the user and society.

On the other hand, some social pressures need to be resisted, such as the pressure to hide non-normative sexuality or to use performance-enhancing drugs in unsafe ways. The drug-testing regime in sports, for instance, is a way to curtail potentially harmful or unfair enhancements. Laws restricting the number of hours that truckers or doctors-in-training can work without sleep protect them from workplace pressure to use stimulants unsafely. Non-discrimination policies can protect the unenhanced just as they protect the disabled and minorities.

In the long run, as emerging technologies reduce the incidence of obesity, mental illness and disability social norms will change. But the case of disability suggests that an enhanced society will not necessarily become less supportive of difference, pressuring the disabled to get “fixed.” Due to the decline of military conflicts, industrial accidents and infectious diseases the incidence of disability declined in the last century, while the rights and visibility of people with disabilities increased. For example, while the use of cochlear implants has allowed many congenitally deaf people to work with the hearing, the deaf community is more empowered and visible than ever. Ubiquitous enhancement is as likely to encourage a broader tolerance of varieties of bodies and brains, as it is to encourage uniformity.

Rights-bearing Persons

Another old issue that enhancement will have to navigate is how we define rights-bearing persons. This issue is central to the debate over fetal rights, brain death, and rights for animals and robots. A core idea of the transhumanist movement, albeit not anything intrinsic to enhancement technologies themselves, is “non-anthropocentric personhood ethics,” the idea that the rights of a being are contingent on their level of consciousness and not on their “humanness” or their “substrate” (e.g. carbon vs silicon). As Bostrom notes, “Transhumanism advocates the well-being of all sentience, whether in artificial intellects, humans, and non-human animals (including extraterrestrial species, if there are any)” (Bostrom, 2005) while excluding fetuses and the brain dead since they lack sentience. For transhumanists being “human” is morally irrelevant, and enhancement technologies will become one more factor in this ongoing debate.

For instance we will have to address when enhancements threaten a human’s status as a rights-bearing person, and when enhanced animals gain rights. How much of one’s body or brain could be replaced before one loses full citizenship rights? If an ape is genetically modified to have human-level cognition would that grant them “human rights?” Will the full exercise of rights be contingent on demonstrating human social and emotional skills, such as a capacity for empathy or theory of mind? The future will need ways of determining which kinds of beings have different levels of rights.

Eroding Illusion of Self

In the longer term, as neurotechnologies begin to erode the illusory sovereignty of the individual self, it will become increasingly difficult to define personal identity, self-determined choices, and the boundaries of the self. The ability to record and share memories will blur the boundaries between individuals. The ability to make radical changes to one’s preferences, memory, and identity will blur the identity of the self over time. We already confront many of these questions, from the criminal culpability of the mentally ill to the status of advance directives made by people before they became demented. As neurotechnologies become more precise the idea of being a consistent liberal individual self over time — the concept at the base of liberal democratic politics — will need to be replaced with something more dynamic, a political framework that recognizes that the “selfing” process is embedded within myriad constraints.