induce the body to produce endorphins. Many forms of enhancement may serve medical goals. Once again, the therapy–enhancement distinction appears not to set any firm moral boundaries in genetic medicine.
One might attempt to avoid this problem by narrowly construing the goals of medicine: the goals of medicine are to treat and prevent diseases in human beings. Other uses of medical technology do not serve the goals of medicine. There are two problems with this response. First, it assumes that we agree on the goals of medicine and the definitions of health and disease. Second, even if we could agree that medicine’s goals are to treat and prevent diseases and we can define “health” and “disease,” why would it be immoral to use medical technology and science for nonmedical purposes? If a medical procedure, such as mastectomy, is developed for therapeutic purposes, what is wrong with using that procedure for “nonmedical” purposes, such as breast reduction surgery in men with overdeveloped breasts? Admittedly, there are many morally troubling nonmedical uses of medical science and technology, such as the use of steroids by athletes and the use of laxatives by anorexics, but these morally troubling uses of medicine are morally troubling because they violate various moral principles or values, such as fairness and nonmaleficence, not because they are nonmedical uses of medicine.
One might argue that those who use medical science and technology for nonmedical purposes violate medicine’s professional norms, but this point only applies to those who consider themselves to be medical professionals. If a procedure violates medical norms, it is medically unethical, but this does not mean that the procedure is unethical outside of the context of medical care. For example, the American Medical Association holds that it is unethical for physicians to assist the state in executions, but this policy does not constitute an unconditional argument against capital punishment. To make the case against capital punishment, one must appeal to wider moral and political norms. Hence the goals of medicine also do not set a morally sharp dividing line between genetic therapy and enhancement.
Our Humanness
One might try to draw moral boundaries between genetic therapy and genetic enhancement by arguing that genetic enhancement is inherently immoral because it changes the human form. Genetic therapy only attempts to restore or safeguard our humanness, while enhancement changes those very features that make us human. Although GLGE and GLGT can more profoundly change human traits than SGE and SGT, both technologies can alter our humanness (or our humanity). To explore these issues in depth, we need to answer two questions: (1) What traits or abilities make us human? and (2) Why would it be wrong to change those traits or abilities? Philosophers have proposed answers to the first question ever since Aristotle defined man as “the rational animal.” A thorough answer to the question of defining our humanness takes us way beyond the scope of this essay, but I will offer the reader a brief perspective.47
If we have learned anything from the abortion debate, we have learned that it is not at all easy to specify necessary and sufficient conditions for a thing to be human. Humanness is best understood as a cluster concept in that it can be equated with a list of characteristics but not with a set of necessary and sufficient conditions.48 Some of these characteristics include:
1 physical traits and abilities, such as an opposable thumb, bipedalism, etc.
2 psychosocial traits and abilities, such as cognition, language, emotional responses, sociality, etc.
3 phylogenetic traits, such as membership in the biological species Homo sapiens.
The beings that we call “human” possess many of these traits and abilities, even though some humans have more of these traits and abilities than others. For example, a newborn and an adult have many of the same physical and phylogenetic traits and abilities, even though the adult has more psychosocial traits and abilities. For my purposes, I do not need to say which of these traits and abilities are more “central” to the concept of humanness, since I am not defending a definition that provides necessary or sufficient conditions.
The question I would like to explore in more depth concerns the wrongness of changing those traits that make us human. Would it be inherently wrong to alter the human form? This question presupposes the pragmatically prior question, Can we alter the human form? The answer to this question depends on two factors: (1) the definition of our humanness; and (2) our scientific and technological abilities. According to the definition I assume in this essay, it is possible to alter the human form, since the human form consists of a collection of physiological, psychosocial, and phylogenetic traits and abilities, which can be changed in principle.49 Although we lacked the ability to change the traits that constitute our humanness at one time, advances in science and technology have given us the ability to change human traits. Since we have good reasons to believe that we can change our humanness, we can now ask whether we should do so.
Most moral theories, with the notable exception of the natural law approach, imply that there is nothing inherently wrong with changing the human form. For the purposes of this essay, I will not examine all of these moral theories here but will only briefly mention two very different perspectives on morality that reach similar conclusions. According to utilitarianism, an action or policy that alters our humanness could be morally right or it could be morally wrong, depending on the consequences of that action or policy. If genetic enhancement produces a greater balance of good/bad consequences, then enhancement would be morally acceptable. For example, genetic interventions that enhance the human immune system might be morally acceptable, but interventions that result in harmful mutations would be unacceptable. Kantians would object to attempts to alter our humanness if those attempts violate human dignity and autonomy. Some, but not all, genetic interventions could threaten our dignity and autonomy. For example, using SGT to promote hair growth should pose no threat to human dignity and autonomy (if informed consent is not violated), but using GLGE to create a race of “slaves” or “freaks” would pose a dire threat to dignity and autonomy. The main point here is that most moral theories would hold that there is nothing inherently wrong with changing our humanness; the moral rightness or wrongness of such attempts depends on their relation to other moral concerns, such as utility, autonomy, natural rights, virtue, etc.50
However, the natural law approach to morality could be interpreted as implying that tampering with the human form is inherently wrong. This argument assumes that the human form has inherent worth and that any changes to that form defile or destroy its worth. The human form is morally sacred and should not be altered.51 For example, one might hold that a great painting, such as the “Mona Lisa,” has inherent worth and it should therefore be left as it is; to change the “Mona Lisa” is to destroy it. Or perhaps one might argue that it would be wrong to change the formula for “Coke” or the plot of “Hamlet.” But what is inherently wrong with changing the human form?
One argument that changing the human form is inherently wrong is that natural selection has “designed” us to have specific traits, and that any attempt to change those traits would be a foolhardy and vain intervention in nature’s wisdom. It has taken thousands of years of adaptation for the human species to evolve into its present form. How can we possibly improve on nature’s perfection? We are more likely to make a major blunder or mistake with human genetic engineering than to make an important advance.52 Human genetic engineering is likely to produce harmful mutations, gross abnormalities, Frankenstein monsters, etc.53 There are two problems with this neo‐Darwinian view. First, it is Panglossian and naïve: natural selection is not perfect – nature makes mistakes all the time. We possess many traits, such as the appendix, that serve no useful function. There are some traits that we could add, such as enhancements to the immune