A Genetic “Fix” for Down’s Syndrome?

A couple of weeks ago I mentioned some of the thoughts presented at the July Summer Conference hosted by the Center for Bioethics and Human Dignity—thoughts I am still processing in the afterglow of an enjoyable and stimulating few days. Much has re-shaped my thinking on a host of issues, to which I alluded previously. But there was one nugget that remains with me, nagging at me, even as it was presented as a rather small bit of fresh information in a larger context of bioethical analysis of prenatal diagnosis. In a workshop session led by the estimable David Prentice, formerly a faculty member at Indiana State University and now a Senior Fellow with the Family Research Council, it was mentioned that American scientists have been successful in experiments to eliminate the “third gene” that is found in various “trisomy” disorders. This, of course, is most commonly seen in Trisomy 21, the genetic abnormality responsible for Down’s syndrome. The process, perhaps best described in an article in The Guardian, essentially inactivates the third chromosome, the one that makes a crowd out of an otherwise happy pair, in a process that is similar to what happens in normal meiosis, where the female gametes are formed and a non-functioning Barr body is produced. In typical British style, and in reality, the science is described as “elegant,” and is worth a look.

My first impulse on hearing this news was joyous relief. For as long as amniocentesis has been commonplace, the default position of genetic counselors when guiding those with a diagnosis of Down’s has been one of pregnancy termination, of abortion of the fetus that would suffer the mental and physical tolls of Down’s. Now that we can fix it, I thought, these babies can live. If we view genetic disorders as the fallout from a world where brokenness pervades all of creation as the result of sin, then a “fix” is a manifestation of God’s grace to make straight what has been made crooked by the Fall. It is a good thing, and I can view it as such. But what if we find a way to “eradicate” trisomy 21 and Down’s syndrome, even as the technology is still quite nascent and the fix quite tentative? Is that an altogether good thing, to see a future free of people who suffer Down’s?

I used the word “suffer” when describing someone with Down’s because it is a descriptor that is common, provocative, and almost entirely wrong. Certainly the medical issues associated with Down’s are real, the cardiac and gastrointestinal problems, the increased risks of cancer and dementia. Yes, Down’s syndrome is linked with numerous medical maladies—ones that made a thirty-year old adult with Down’s a rarity just a generation ago. Individuals certainly live longer today, blessed by improved medical technology. But do they flourish? I think of my prayers for my children when they were infants: protect them, of course, but most of all, keep them devoted to God through their lives, let their eternity be inextricably linked with their Savior. I would rather their earthly lives be significant than they be happy, to be completely honest. And I reflect on my experiences with those who have Down’s syndrome. I have yet to meet one who seems to typify “suffering.”

So we may someday, perhaps sooner than we can imagine, be able to eliminate trisomy 21 with a genetic “zap.” Will the child whose chromosome count has been normalized be a very different one from the one who has not had genetic intervention? I think of an 18-month old I met this week, who sat in his stroller as I examined the new puppy his parents just adopted. They looked like many parents of children with a mental disability, who have learned to accept the modification of their dreams for a child and who, so sadly, must somehow justify their decision to even bring this child into a judging world, given the options. But as I do the checkup on this bundle of puppy energy, they could see the same smile I could see, one that is more manifestly beautiful than that from a “normal” child in how it processes the unfolding scene. I can’t quite describe its wonder and delight. This smile was a mark of grace in a seemingly graceless world, one that God has supplied to a youngster created in His image and whom He has declared will someday judge the angels. I would have missed that if this little boy had been “fixed” by a genetic repair.

I think of my cousin, now in his mid-thirties, who has faced so many medical issues, and who has so challenged the lives of his parents. I have, sadly, struggled to connect with him over the years, because I cannot relate to his experiences and cognitive abilities easily. It is only in recent years that I see what I’ve missed. The middle of three brothers, he is the one who has been best able to find a true sense of pure worship toward God, one that has become clouded by cynicism (at least for now) in his high-functioning, articulate siblings. Would I wish an easier ride for my aunt and uncle, and for anyone with a special needs child in a society that values the capabilities of an individual above all else? Of course. But how serious have I been in my prayers that my children develop a deep spiritual devotion—would I exchange their future college and career and social success for it? If they were never to inculcate this devotion, would I sacrifice all the “normal” stuff and hope for a child with a lower IQ, a host of medical challenges, and a heart that embraces God?

None of us will ever know what would have happened spiritually, or in the degree of happiness and earthly success, if those with mental disabilities like Down’s had been rendered “normal.” I initially rejoiced at the happy thought that Down’s syndrome and similar issues would be cured someday. In the weeks that have passed, I have found new ways to grieve the potential loss of these individuals in our world, individuals who have made it a richer place for being here. Is it ethically wrong to wish an end to genetic aberrations? I think not. Is it ethically wrong to appreciate the diversity of God’s blessings that transcend a fallen world? Increasingly, I find it isn’t.

Privacy and Henrietta Lacks

News comes today that, in a settlement of a dispute, two descendants of Henrietta Lacks, whose cancer cells were used to establish the famous “HeLa” cancer cell line, will sit on a committee that will decide which scientists get access to the gene sequence from the cells.

The scientists want to sequence the cell’s genes so that they can understand them better and interpret experiments in light of what is known about genes and cancer.  Frequently, that information can be more relevant than more general information about the cells—for example, what sort of cancer they are supposed to represent.  In fact, the latter sort of judgment, which has been the order of the day until recently, is often wrong.  Cells believed to be, for example, breast cancer cells can turn out to be something else, like melanoma cells.  Cell lines are commonly shared among scientists, and somebody puts a label on them that serial recipients simply accept without checking, and before long, a cell has a reputation for being something that it in fact is not.

Ms. Lacks’ descendants are concerned that genetic information from the cells might be associated with members of the family, and create invasions of privacy, possibilities for discrimination, or health alarms, accurate or not.  These are understandable concerns, although one should note that the Genetic Information Nondiscrimination Act (GINA) prohibits discrimination for some things (hiring, for example) based on genetic information, and employers are not even permitted to ask questions about, or otherwise seek, genetic information about actual or prospective employees.

In a sense, though, the concerns seem a bit misplaced.  For one, immortalized cell lines change—often dramatically—over time.  I would guess that the current gene sequence of HeLa cells is not what it was when the cells were first obtained.  Even areas of accuracy would not necessarily apply to currently living descendants a couple of generations later.  For another, I would also guess that medical decisions for a living person would better be based on direct testing of that person.

In general, it appears that genetic information online is anonymous, except when it isn’t.  As I posted on this blog a while back, if someone posts genetic information with personally-identifying information, it is possible for hackers to infer that person’s representation in an otherwise anonymous, open-source gene database.  The most important first step is to keep one’s own genetic information separate from their personal information.  The most secure way to do that is probably physical sequestration under good old fashioned lock and key, with very limited access to the key.  People concerned with privacy and confidentiality in human subject research recognize that when it comes to data entered and stored online, subjects must be told that there can be no absolute protection against some breach, from hackers or elsewhere.  Modern data security methods certainly help, but are not considered entirely foolproof.

All the more so if, as will be the case for HeLa cells, the data will be freely shared in the scientific community.  Then again, the Lacks family has at least an online presence, although perhaps not including too much truly personal information.  Their concerns are reasonably placed, but perhaps the practical consequences are limited.

For the near future, I’m at least as troubled by news reports that there may be no meaningful protection of personal data in the upcoming Obamacare online exchange portals, and the assertion that the HHS has moved to exempt Obamacare from the provisions of the Privacy Act.  In a world where it also appears at least possible that government may disclose private information for political purposes (see, the IRS), this sort of privacy concern looks much more immediate, and ominous, to me.

Not that there is necessarily anything we can do about it…

On Myriad Genetics and Withholding Information

Mutations in the BRCA1 and BRCA2 genes confer an increased risk of many types of cancer. In 1995, Myriad Genetics patented the BRCA1 and BRCA2 genes which it had successfully sequenced and isolated, giving the company an effective monopoly on testing for mutations in these genes. However, Myriad’s achievement rested on many other shoulders: in 1990, US researchers first began to zero in on the BRCA1 gene, and in 1994 UK researchers first located the BRCA2 gene. Last year, Myriad made $500 million; most of its profits came from the BRCA test,which typically costs $3,000 to $4,000, putting it well out of the financial reach of many women. In June of this year, the US Supreme Court ruled that naturally-occurring genes cannot be patented; almost immediately, another company announced that it would offer the BRCA test for $995.

After the Supreme Court ruling, Myriad’s president and CEO stated that “we remain focused on saving and improving peoples’ lives and lowering overall health care costs.”

In the meantime, Myriad maintains a database of the information it gained from nearly two decades of testing millions of women. Until 2005, Myriad shared that data with the National Human Genomics Research Institute’s Breast Cancer Information Core, an open-access database of information that helps researchers understand breast cancer genetics. However, since 2006, Myriad has withheld its BRCA data — data that it generated by charging 250,000 women annually thousands of dollars a test.

Dr. Robert Cook-Deegan, a research professor at Duke University’s Institute for Genome Science and Policy, is cited in an article in this week’s JAMA arguing that the data Myriad is withholding might help improve cancer care of prevention. “The easy thing to do would be to behave like most other laboratories and share the information,” he said.

Not just the easy thing, but the ethical thing. In another article in the same issue of JAMA, Dr. Harlan Krumholz of Yale University School of Medicine is quoted as saying, “Science cannot be self-correcting if only some of the data are available to only some of the people.” Just as naturally-occurring genes cannot be considered proprietary per the Supreme Court, so population data that is potentially important for human health should not be considered proprietary. It is not clear why Myriad is withholding its information; some speculate that it hopes to leverage the data for profit. Maybe such a strategy makes good corporate business sense; it is not consonant with ethical scientific practice, and does not square with Myriad’s stated focus on “saving and improving peoples’ lives and lowering overall health care costs.” If Myriad is really interested in “saving and improving lives,” even if it doesn’t bring in lots of money for the company coffers, it should make available the data it has gathered from millions of patients. As Cook-Degan said, “Women paid for those tests — and paid premium dollars.”

 

The information for much of this post came from the article “Supreme Court Tules Agains Gene Patents,” published in the July 24/31 issue of JAMA, p 357 (Vol 310 No 4), available for free here.

On (Being) Better than Human, Part 3A

As I noted in Part 1 of this series (see my 03/25/13 post), in Better than Human Allen Buchanan considers four major lines of objection to the “enhancement enterprise.” As Buchanan summarizes them, each of these objections claims that biomedical enhancement is “different” in morally significant ways from other kinds of (nonbiomedical) enhancement. Specifically, these objections assert that:

(1) biomedical enhancements are different because they change our biology; (2) biomedical enhancements are different because (some of them) change the human gene pool; (3) biomedical enhancements are different because they could change or destroy human nature; [and] (4) biomedical enhancements are different because they amount to playing God (p. 12).

In Chapter 2, Buchanan takes on the second and third of these objections—that is, the “changing the human gene pool” and “changing human nature” objections, respectively.

The heart of Buchanan’s discussion in this chapter is a consideration of two competing analogies in terms of which one might understand evolutionary biology—or, alternatively, “nature” (p. 29)—and its processes: the “master engineer” and the “grim tinkerer” analogies, respectively. On the former analogy, “organisms are like engineering masterpieces: beautifully designed, harmonious, finished products that are stable and durable (if we leave them alone)” (p. 29). On the latter, evolution is “morally blind,” “fickle,” and “tightly shackled” (p. 49)—it produces “cobbled-together, unstable works in progress, and then discards them” (p. 28).

Evolution is disanalogous to a master engineer, Buchanan says, in two key respects. First, “natural selection never gets the job done” (p. 28). Environments are constantly changing, and organisms are constantly adapting both to their environments and to each other, in “a ceaseless round of adaptation and counteradaptation” (p. 28)—resulting in further changes both to organisms and their environment, in a process that never arrives at a terminus. So rather than being “the end points of a process whereby they climb a ladder to perfect adaptation to their environment,” organisms instead exist in a state of perpetual instability, one that belies the “finely balanced” nature implied by the master engineer analogy (pp. 28-29). Second,

unlike a master engineer, evolution doesn’t design what it produces according to a plan that it draws up in advance. Instead, it modifies organisms in response to short-term problems, with no thought of long-term effects. Evolution has no overall game plan for any species, and the results show it. What’s useful for solving today’s problems can cause new problems—and even extinction—down the line (p. 29).

In the final analysis, Buchanan contends, “evolution is more like a morally blind, fickle, tightly shackled tinkerer” than a master engineer. The burden of the rest of the chapter is to provide reasons why (on Buchanan’s view) we ought to accept this analogy over against the master engineer analogy.

In order to adjudicate between these two analogies, Buchanan says, we need to grasp certain key aspects of the mechanisms of evolution (p. 29). The first thing to notice in this regard is that nature is replete with instances of “suboptimal design” (pp. 30-31), which Buchanan takes to be prima facie evidence that the master engineer analogy is problematic at best. Examples of such “design flaws” include, inter alia, the fact that in male mammals the urinary tract “passes through (rather than being routed around) the prostate gland, which can swell and block urinary function,” and the “hasty shift from quadruped to biped, which resulted in back and knee problems and a birth canal that passes through the pelvis, resulting in greatly increased risks to both mother and child in the birthing process” (p. 30). Numerous additional examples could be cited (and Buchanan cites several other illustrative examples here).[1] “Design flaws” such as these led Darwin to develop his theory of natural selection, with which, Buchanan informs us, “Darwin debunked the argument from intelligent design, one of the traditional arguments for the existence of God, by cataloguing the ‘clumsy, blundering, wasteful’ works of nature” (p. 30).

To show more clearly why nature is not best thought of as a “master engineer,” Buchanan introduces at this point a distinction between what he terms “Unintentional Genetic Modification” (UGM) and “Intentional Genetic Modification” (IGM). UGM is “evolution as usual, what Darwin called ‘descent with modification,’ where a driving force of the modification is natural selection”—in other words, “evolution without intentional modification of human genes by human beings” (p. 31). IGM, then, in the context relevant to our discussion, is intentional modification of human genes by human beings.

Buchanan’s aim here is actually two-fold: first, he wants to provide reasons why we ought to reject the “master engineer” analogy in favor of the “grim tinkerer” analogy, and second, he wants to give us reasons for considering the possibility that it may be preferable, in at least some circumstances, to actively pursue IGM rather than simply leaving the development of the human species entirely to UGM. His subsequent discussion in the remainder of this chapter is designed to accomplish both of these aims simultaneously. To that end, he begins by enumerating some of the built-in limitations of UGM, and then goes on to describe some ways in which IGM might be employed to overcome those limitations.

In the next post in this series, we’ll finish up our explication of Buchanan’s argument, and then develop some critical observations regarding that argument. By way of preview, three major limitations of UGM to which Buchanan draws our attention are the facts that (1) UGM is “insensitive” to post-reproductive quality of life (pp. 32-37); (2) in UGM, beneficial mutations spread only by way of a “nasty, brutish, and long” process (37-45); and (3) UGM selects only for “reproductive fitness, not human good” (pp. 45-48). Critical remarks will focus, in turn, on several epistemological, ontological, and moral issues raised by the way Buchanan frames and develops his argument in this chapter.

 


[1] A bonus for the philosophy buffs out there: In the context of this discussion of “design flaws,” Buchanan offers an arresting image in answer to Nagel’s famous query regarding what it’s like to be a bat. As Buchanan explains, “bats spend a good deal of their time hanging upside down, closely packed together, with their feces pouring down over their bodies to their heads. (Imagine yourself holding a toothpaste tube upright and squeezing it until the contents cover your hands. That’s what it’s like to be a bat.)” (p. 31).

Emergent Dualism and the Sanctity of Human Life

My wife and I spent May 10-11 at the annual conference of Biola’s Center for Christian Thought (CCT), where the theme for 2012-2013 has been “Neuroscience and the Soul.”  The plenary talks are not all on the web, yet, although some are on Facebook, but a number of discussions on the general topic may be accessed here.  I encourage readers of this blog to spend some time knocking around the CCT website.

The weekend (though perhaps not the year, more broadly) didn’t have much neuroscience in it.  Most of the time was spent talking about philosophical and theological anthropology—in particular, what is the soul?  As I have previously written on this blog, I am most attracted to a “Thomistic substance dualism” (after Thomas Aquinas) of the sort advocated by J.P. Moreland of Biola, who argues that the “soul” is a simple (it doesn’t have parts) nonmaterial substantial entity that contains all the ultimate capacities of an organism and which is intimately involved in directing that organism’s development and expression of those capacities.  The word “ultimate” is critical here, because, as we all know, not all members of the human race realize all capacities at all times.  Moreland’s development shores up some shortcomings of Aquinas’s dualism (e.g., the notion that human embryos acquire souls at either 40 [males] or 80 [females] days of prenatal development), while attempting to retain its merits.  It, and other approaches that reject equating mind with brain function, appeal to certain Cartesian intuitions, like those of self-awareness, the sense of “what it is like” to have an inward experience, and others.  The philosophers call these “qualia” of mental events, which make them non-identical with physical/biologic events.  At the same time, Moreland and those of like mind reject the radical Cartesian distinction between mind and body in favor of a more wholistic, as it were, view of what the soul is and does.

Now, this fits nicely with the biblical notion of the image of God, even if one rejects Moreland’s view that the image is what man is, not just what man does (tend the earth), or the relationship between man and God, or the “status and standard” of man relative to God, creation, and the ultimate perfection man.  But I would argue that Moreland’s Thomistic substance dualism is not just faith-based, but also supported by formidable philosophic arguments and accessible on the terms of general revelation.   As such, I think it provides the strongest support available for the sanctity of individual and collective human life.  One sees this in arguments most commonly employed (perhaps not surprisingly) by Roman Catholic thinkers like Robert George; to wit, “humans are the kind or sort of being that….”

Two criticisms of Moreland’s view are:

  1. It amounts to vitalism, an otiose idea long-ago relegated to the biology’s scrap heap of history.   Moreland’s rejoinder to this is to claim that bad, old-fashioned vitalism was too crude, and that a more modern view, “organicism,” is more promising.  (I can’t carry on about that, yet.)
  2. Evolution is irreconcilable with the Thomist view of the soul, because the latter requires that genus and species not be degreed properties, but be in a real sense, immutable.  I agree that the Thomist view pushes one there, and I think that (along with Moreland, I believe), as these critics claim, the Thomist view requires one to accept that God is progressively active in creation.  But these points are said to be unacceptable because of the science of human evolution.

So, as an alternative, some philosophers who remain sympathetic to the idea that mental phenomena are not reducible to physical processes, and in fact are different in ways that cannot be fully explained by appealing to physical processes, nonetheless inescapably depend on those processes and “emerge” from them.  However, they would hold, what is emergent is not just mental properties but an actual, and in a meaningful sense, substantial self.  So they are dualists about human nature—even, in a sense, “substance dualists,” but they are less ready to allow that the human soul might exist independently of bodily life and processes—particularly those of the brain.

Now, there is more to be said about this than I can say, here or elsewhere, but it seems to me that the appeal to a “degreed” nature of life or consciousness disallows categorical distinctions of moral status between individual people, or people in general, and other beings.  (It seems to me that the emergent dualist also conceives “soul” as too readily identified with higher mental properties than the Thomist view would insist on.)  It risks making “personhood,” or “dignity” or moral status a degreed property.  Should we be more concerned about an anencephalic baby, or a fetus with Down syndrome, than a fully-endowed and functioning gorilla, and if so, why?  Should we be troubled about creating a human/non-human hybrid, and if so, why?  Would a super-intelligent robot, if there could be such a thing, potentially be a rival of “natural” humans in competing claims for concern?

I tried this out on a prominent Christian emergent dualist at the conference, and he quickly dismissed my objections.  To be fair, I hit him with a “drive by” on the coffee break, but as it happened, when I pushed, he responded, in effect, we can’t base all our moral appeals on rational argument.  Sometimes we have to just demonstrate the truth of the gospel, and show people the choice between worldviews and their consequences, and ask them what do they really prefer?  And, as unfairly as this brief post may be posing the issues, that kind of rejoinder worries me.

Ultimately, some appeal to a “givenness” of human nature is necessary to defend boundaries in bioethics.  We might indeed appeal to the naturalist by counseling caution—evolution has, over millions of years, presented us with ourselves, including our common intuitions—and we ought to have a “default” position of “no-go” on the most “out there” ideas.  We might indeed present a “two views” picture, and ask people to choose what kind of world they really want and what sort of people they ought to be.  We might argue, as I take the German philosopher Jürgen Habermas to argue, that the interplay of human autonomy, human language, and human social relationships lead us to conclude that some technological interventions would tend fundamentally to destroy who we are in community, and so ought to be avoided.  But I think it’s harder to identify, on emergent dualist grounds, what if any specific maneuvers ought to be proscribed with “thou shalt not,” or words to that effect.

The emergent dualists might be right.  (I tend to agree with Moreland that the position is unstable, tending toward either his dualism on the one hand or functionalism on the other.)  If so, we should, as the philosopher I challenged told me, follow the inquiry where it leads.  (One approach that could be called into question is Francis Schaeffer’s approach of asking whether one can live with the consequences of one’s philosophy.)  But my efforts, at least, are still awfully preliminary.

A Place Where We Ought to Fear to Tread

The current issue of World magazine includes a brief article about this work going on in the United Kingdom: attempting to circumvent certain inheritable diseases by replacing the mitochondrial DNA in a mother’s oocyte with mitochondria from an oocyte of another woman.  The re-engineered oocyte is then fertilized in vitro, with subsequent implantation of the embryo, etc, etc.  The article’s provocative title was, “Heather has two mommies.”

If one accepts IVF and is inclined to observe the “therapeutic boundary” as placing limits on what genetic manipulations we should be willing to undertake, then this project would seem to qualify as treatment, rather than enhancement, before a new individual person is conceived, and could qualify as an acceptable use of reproductive technology.  And one can argue that the risk/benefit analysis, in a case like this, is clearly positive (perhaps requiring that all embryos so created are implanted with the intent to carry them to term).

But I’m not so sure that a line has not been crossed here.  Still, to object on grounds of “repugnance”—as I would—would seem to succeed only if said repugnance reflects deep, universal moral sentiments and intuitions that are expressions of a natural moral law.  And a lot of people would not find the case here repugnant.  To object—as, again, I would—on the grounds that the undertaking here is part of the transformation of procreation (and receiving of new life as a gift) into manufacturing seems to require that there is an objective, given, human nature and order of human life that must not be tampered with.  If life is God-given and humans are in His image, then it is more natural to make that kind of assertion, but by so doing I think we (I) accept the task of saying what that human nature is.  The image, in that case, needs to be more than just a “status and standard,” or to say that it grounds the human nature we shouldn’t mess with seems tautological.  Alternatively, on more naturalistic grounds, one might argue that evolution “gave” us a core genetic nature (“in its wisdom??”) that “ought not be disposed with,” a tack the German philosopher Jürgen Habermas seems to take in opposing PGD.  Or, we could even invoke a form of the much-maligned “precautionary principle” and claim that, when we start mixing and matching pieces of genomes in newly-conceived people, we don’t know what difficulties we might be wandering into, so we can’t define a risk-benefit ratio in the first place.

Anyway, I think a line something like this—there is, in a meaningful sense, a “core human nature” that must not be altered, and a natural moral law that grounds at least the most basic, primary moral precepts setting that limit—is the line that is necessary if one wants to claim that our biotechnologic grasp must stop somewhere.  And so I want to hold.  None of it suggests that the march of biotech will be slowed—it seems that somebody will try anything that becomes feasible—but it is a basis for asking people to stop and think, and getting perhaps some to turn back.  It is a basis for articulating a “presumption to forbear.”

On (Being) “Better than Human” — Part 2

I ended my last post by identifying what I take to be an important methodological issue with Allen Buchanan’s pro-enhancement argument in his recent (2011) book entitled Better than Human: The Promise and Perils of Enhancing Ourselves. I want pick up on that point in this post, before moving on to other points of analysis in subsequent posts.

To recap briefly: for Buchanan, addressing ethical concerns regarding the “enhancement enterprise” requires, among other things, a consideration of what human nature is like. And the answer to that question, in turn, is to be found in the findings and pronouncements of evolutionary biology, as set forth in the “Darwinian worldview.” More to the point, for Buchanan, the only source of “evidence” relevant to answering the question of human nature is evolutionary biology. In other words, Buchanan’s approach here is significantly epistemically constrained—only certain sources of knowledge are considered legitimate for purposes of examining morally the enhancement enterprise. This methodological move is significant, for it has the effect of ruling out of court, from the outset, other potentially valuable sources of information regarding human nature, including, particularly, theological reflection.

The obvious question to ask here is: why accept this epistemic constraint in the first place? Presumably, a significant part of the reason for Buchanan’s insistence on this epistemic restriction is another major methodological commitment of his, to which I drew attention in my earlier posts—namely, his commitment to framing his argument in strictly secular, non-religious terms. As I have noted, Buchanan indicates (on one occasion) that he is adopting in this book a “non-religious” approach in order to advance arguments that can be “accepted” by non-religious as well as religious people. Given that methodological commitment, Buchanan presumably views the pronouncements of evolutionary biology—products of the “Darwinian worldview” to which contemporary science is (purportedly) committed, and in terms of which Buchanan seeks to couch his overall argument—as being beyond reproach, evidentially (and therefore epistemically) speaking.

What, then, does Buchanan think “modern evolutionary biology” actually tells us about human nature? In the book’s second chapter, entitled “Why Evolution Isn’t Good Enough,” Buchanan goes to great lengths to argue against what he terms a “pre-Darwinian” view of evolution, according to which “evolution is like a master engineer”— the idea that “organisms are like engineering masterpieces: beautifully designed, harmonious, finished products that are stable and durable (if we leave them alone)” (p. 27). If the “master engineer” analogy is correct, of course, it would seem to imply that we ought not to attempt to change what that “master engineer” has produced. As Buchanan acknowledges, “[i]f that’s what we are like, then biomedical enhancement is reckless indeed. Genetic enhancement—seen as an attempt to change the master design itself—seems especially ill-conceived. The master engineer analogy, if it is accurate, provides a strong augment against genetic enhancement and perhaps against biomedical enhancement generally” (pp. 27-28).

But this analogy, Buchanan says, is mistaken. Instead, he argues, “evolution is more like a morally blind, fickle, tightly shackled tinkerer” (p. 29). I will have more to say in a subsequent post regarding exactly what Buchanan means by this proposed alternative metaphor. For now, suffice it to say that the basic idea is that there’s no good reason to think that “natural selection” is currently doing a good job or that the results of evolution are “good”—either in the sense of being “beneficial” to us, or in terms of what we value as human beings—and therefore ought not to be interfered with. Evolution is, instead, more accurately thought of as being “morally blind”; the processes of natural selection are, more often than not, “nasty, brutish, and long”—displaying utter indifference to human suffering and quality of life. Moreover, rather than being a “master engineer,” evolution is more properly thought of as being a “fickle, tightly shackled tinkerer”–it operates inefficiently and frequently fails to achieve “optimal” design changes. Ultimately, Buchanan contends, “we have to steadfastly resist the common tendency to think that the latest product of the evolutionary process is the best, either biologically speaking or in terms of human values. We can’t say we are the best in either sense, and that’s why we should take the possibility of biomedical enhancement seriously” (pp. 47-48).

The bulk of Chapter 2 is devoted to defending and exploring the implications of accepting this metaphor for evolution over against the “master engineer” metaphor. A discussion of the specifics of Buchanan’s argument here will have to await another post. For now, what I want to emphasize is the conclusion Buchanan draws from this exploration—namely, that “[h]ow we think about evolution—or, if you prefer, nature—makes all the difference to how we should think about enhancement. Interfering with the work of a master engineer is one thing; selectively intervening in the work of a morally blind, fickle, tightly shackled tinkerer is quite another” (p. 29).

Or, as he puts it later in this chapter,

[t]he main point is that to come to grips with the challenges of biomedical enhancement, we need to consider it from the standpoint of evolutionary biology. Remaining stuck in the rosy old, pre-Darwinian view of nature stacks the deck against biomedical enhancement. As we’ll see in later chapters, there are a number of reasons to worry about biomedical enhancement, but the risk of damaging the work of the master engineer of evolution isn’t one of them (p. 51).

Now, to be clear: I don’t want to attempt here to litigate the creation-evolution debate—such a task would go well beyond what can be accomplished in a single blog post (or series, for that matter!). In particular, I do not intend in this post to delve into the disputes among adherents of non-theistic evolution, theistic evolution, and creationism (whether of the “old earth” or “young earth” variety). Rather, the key point I want to make here is that Buchanan’s claims about the evidentiary value of looking at (the products of) evolutionary biology actually cuts both ways, undermining his own argument as well as the position against which he argues. Buchanan wants to say that because the results of natural selection are best characterized as being, to borrow Tennyson’s famous phrase, “red in tooth and claw,” therefore we cannot say whether or not evolution is currently “doing a good job,” and therefore we cannot argue against the enhancement enterprise on the basis of an a priori assumption of a “pre-Darwinian,” “teleological” view of nature according to which our current biological condition is good and thus ought not to be (intentionally) altered. Fair enough. The problem for Buchanan now is, if the results of evolutionary biology are the only source for relevant data concerning “human nature,” this means that we also cannot appeal to evolutionary biology to argue in favor of the enhancement enterprise either. For simply looking at “the way we are” now biologically—whether that is understood as the product of unguided evolutionary processes, or the result of guided (“theistic”) evolutionary processes, or even the result of direct, special creation not involving evolutionary processes—will not be sufficient, by itself, to tell us how we ought to be biologically. After all, if our current biophysiological constitution is the result of “blind” evolutionary processes, then it is nothing more than a contingent historical accident—merely the result of unthinking, unknowing selective pressures, the consequences of which may or may not be “good” for us, and which certainly cannot be said to be the way things are “supposed to be,” in any meaningful sense of that phrase. If, on the other hand, our current biophysiological constitution is the result either of guided (“theistic”) evolutionary processes, or the result of direct, special creation—both of which would imply an intentional “design,” at least at the outset—we have no way of knowing, simply by observing our current state, whether and to what extent that state is in accordance with that original “design.” For all we know, simply through observation alone, our current condition may be very different than what was originally intended.

What these considerations highlight is the need for a broader normative framework within which to understand the significance of our current biophysiological condition and the implications, if any, that might flow from that state. We need some way of determining (a) whether or not our current biophysiological state is best understood as being a good, bad, or indifferent state of affairs; (b) whether or not attempting to “enhance” that state would be a good, bad, or indifferent course of action; and, accordingly, (c) how specific means of “enhancement” ought to be evaluated morally, in light of (a) and (b). Significantly, none of these questions can be answered simply by observing our current biophysiological condition.

To that end, theological reflection—and, specifically, Christian theological reflection—would seem to be, at the very least, a legitimate candidate for such a normative framework within which to think about and to evaluate the “enhancement enterprise.” Christian theology, in particular, proposes a coherent set of answers to such questions as who we are, how we got here, and where we are going—placing human beings in subordination to a God who designed, created, and sustains the universe and all that is in it, ordering it to His ends and for His purposes—thereby embedding human beings within the bounds of certain circumscribed limits that, arguably, are not rightly transgressed. Spelling out the details of this framework is beyond the scope of this post. The key point for present purposes is that this is the sort of framework that is needed to answer the relevant questions about the “enhancement enterprise”—crucial questions that a simple appeal to the “Darwinian worldview” cannot answer.

This is not to suggest that the Christian worldview is (necessarily) the only possible framework within which to think about these issues. Indeed, there may be numerous other possible such frameworks. The key point I want to emphasize here is that in limiting the legitimate sources for reflection on the enhancement enterprise to only that which can be said to fall within the purview of the “Darwinian worldview,” Buchanan is needlessly—indeed, one might argue, unfairly—excluding the sorts of resources that might be able to address the kinds of central questions about the enhancement enterprise that the Darwinian worldview is incapable of addressing in its own terms.

 

Works Cited:

Buchanan, A. (2011). Better than Human: The Promise and Perils of Enhancing Ourselves (Philosophy in Action Series). New York: Oxford University Press.

 

On (Being) “Better Than Human” — Part 1

Recent posts have called for reflection on the “ends” of medicine. Though not directly addressed to the specific questions raised in those posts, this series will touch on related themes and so will be relevant to that larger discussion. With that in mind, I invite my readers and fellow bloggers to add their comments and observations into the mix, with a view toward drawing connections between these reflections and the broader questions under discussion on this site.

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As I noted in my recent posts (2/11/13 and 03/04/13), Allen Buchanan’s Better than Human: The Promise and Perils of Enhancing Ourselves is an extended argument to the conclusion that “[t]here are powerful reasons in favor of a society like ours embarking on the enhancement enterprise, and there are no objections to enhancement that are sufficient to outweigh them, at least at the present time” (p. 181). In advancing his case for this conclusion, Buchanan explicitly eschews an appeal to what he terms “religious assumptions”—not, he emphasizes, because he is “antireligious,” but because he is “trying to discuss enhancement in ways that are accessible to most people, whether they are religious or not” (p. 145). Along the way, however, Buchanan ends up committing himself to some fairly robust assumptions that may or may not be “accessible” to “most people,” especially those who approach these issues from an explicitly religious or theological standpoint. In this post—the first of a multi-part series—I want to spend some time identifying and considering the ramifications of at least some of these assumptions. We will also consider two other recently published works—Jonathan Glover’s Choosing Children and Michael Sandel’s The Case Against Perfection, respectively—with a similar objective of examining (some of) their underlying assumptions, and with a view toward bringing these works into conversation with one another.

I begin, first, with a brief synopsis of Buchanan’s argument. This will, of course, omit or gloss over many details and nuances of his argument as presented throughout the book. Nevertheless, the following summary encapsulates key elements of his larger project, points that will serve as a launching pad for reflection in this and subsequent posts. Toward the end of this post, I will very briefly focus in on a specific methodological issue, one that recurs throughout the book and which, in my judgment, renders the larger argument problematic at best. A more detailed discussion of that issue, however, will be deferred until the next post.

 

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In the first chapter, entitled “Breathless Optimism, Hysterical Loathing,” Buchanan sets out his overall objective—namely, the task of steering between the two extremes (“breathless optimism” and “hysterical loathing,” respectively) to which analyses of biomedical enhancement are frequently prone. By contrast, he aims to advance a pro-enhancement argument that nevertheless acknowledges and grapples with the risks inherent in the enhancement enterprise. In service of this objective, the first chapter provides an overview of the argument to be developed throughout the rest of the book; subsequent chapters are devoted to developing each of the major lines of reasoning to which Buchanan appeals in support of his thesis.

Buchanan opens this first chapter with the provocative statement that “It’s too late to ‘just say no’ to biomedical enhancements: They’re already here and more are on the way” (p. 3). As Buchanan notes, people already employ a whole host of biomedical enhancements. For example, some college students (particularly at elite American universities) have been known to take Ritalin to boost their cognitive performance, even though they do not themselves have Attention Deficit Disorder (ADD), the condition for which Ritalin is normally prescribed. Using a fictitious scenario in which two students at an elite American university (“Michelle” and “Carlos”) debate the propriety of this sort of cognitive “enhancement”—to which scenario Buchanan will return, in various iterations, throughout the book—he identifies two key issues that are highlighted by the fictional case scenario.

First, there is the issue of what Buchanan refers to as back door versus front door enhancements. An example of an enhancement of the “front door” variety would be if a drug were developed, approved by the FDA, and marketed explicitly for purposes of improving “normal” memory capacities. By contrast, the use of Ritalin by persons who do not have ADD, for the purpose of improving cognitive performance, would be an example of a “back door” enhancement. “At present,” Buchanan observes, “biomedical enhancements don’t come through the front door. They come through the back door, as spin-offs of efforts to treat diseases or disorders” (p. 7). Examples include the use of SSRIs (such as Prozac) by individuals who are not clinically depressed, in order to feel better emotionally; and the use of Viagra by young men “so that they can perform like the Energizer Bunny, even when they’re drunk” (p. 7). (Such is the “brave new world” we’ve inherited!)

As Buchanan notes, enhancement can also come about as an unexpected or unanticipated side effect of treatment for some condition. Modern prosthetics can, for example, potentially enable a runner to achieve faster speeds than his or her “able-bodied” counterparts (consider the controversy over Oscar Pistorius’ status in Olympic athletic competition; I will resist the urge here to pontificate on the more recent controversy that he finds himself in, except to note the obvious: “enhancement” of one sort—physical, emotional, cognitive, etc.—certainly doesn’t entail “enhancement” in the moral domain, and vice versa). Similarly, while undergoing modern laser eye surgery to correct a variety of vision problems, one can also opt simultaneously to improve or “enhance” one’s vision to a better-than-20/20 level.

The upshot of all this is that “[b]iomedical enhancements will keep coming in through the back door as long as we continue to make progress in treating diseases and disorders. So, just saying no to biomedical enhancements isn’t really an option—unless we want to stop medical progress” (p. 8). But, Buchanan goes on to say, “…if biomedical enhancements continue to come in through the back door, we’ll have serious problems.” For example, those individuals who take Ritalin to improve cognitive function (rather than to treat ADD) are taking a drug for a purpose for which it was not intended, where the safety and efficacy of the drug for that purpose has not been evaluated through clinical trials or other objective measures. These and other such “back-door” enhancements could potentially pose serious health or other hazards to individuals and/or the public at large. But “[s]o long as biomedical enhancements come through the back door, we won’t be in a good position to evaluate their safety or even whether they really work for everybody who takes them” (p. 8).

The second issue to which the “Michelle-Carlos” scenario draws our attention is the question of the relative “novelty” of biomedical enhancements, and the ethical issues raised by them, in comparison with other types of enhancements (particularly of a cognitive variety). Consider, for example, the fact that millions of us use two commonly available “cognitive enhancement” drugs on a daily basis—namely, nicotine and caffeine. Or consider some of the other major “enhancements” that, historically, have had the effect (among other things) of improving human cognitive capacities, resulting in wealthier societies and higher standards of living—e.g., “nonbiomedical cognitive enhancements” such as literacy, numeracy, and modern science; and “institutional enhancements” such as the market.

The problem, Buchanan observes, is that “…in current discourse, the term ‘enhancement’ is usually attached only to interventions that involve biomedical technologies. This blinds us to how pervasive enhancements are in our lives and how central they have been to the origin and evolution of our species” (p. 10). The lesson to be learned here, according to Buchanan, is that we need to resist the temptation of what he terms biomedical enhancement exceptionalism—“the dogmatic assumption that because an enhancement involves biotechnologies (pills, computers, fiddling with embryos, etc.) it’s somehow off the moral scale, that our ordinary moral tool kit is useless for coping with it.” Buchanan’s point is not that biomedical enhancement poses no moral challenges; rather, it is simply to observe that “human history—or at least human progress—is in great part the story of enhancement” (p.10), of which distinctively biomedical enhancement is simply one further iteration.

Of course, these observations do not stop critics of biomedical enhancement from claiming that there is something unique, something distinctively problematic about that form of enhancement over against others. Why might someone think that biomedical enhancement is unique in this way? Here, Buchanan considers four candidate arguments to that conclusion—namely,

(1) biomedical enhancements are different because they change our biology; (2) biomedical enhancements are different because (some of them) change the human gene pool; (3) biomedical enhancements are different because they could change or destroy human nature; (4) biomedical enhancements are different because they amount to playing God (p. 12).

Each of the subsequent chapters of this book is devoted to investigating and responding in detail to one of these arguments. Here, I will simply set out the broad contours of Buchanan’s response to each of the arguments; in subsequent posts, I will go intro greater detail.

In response to the “playing God” objection (Ch. 4), Buchanan argues that this really amounts to a warning against hubris—being overly confident in our technological prowess and other capabilities. As an action-guiding principle, however, it is relatively uninformative and therefore unhelpful.

With respect to the “changing the human gene pool” objection (Chs. 2 & 5), Buchanan observes that the human gene pool is always changing, regardless of what we do. The real question, he says, is whether or not natural selection is “doing a good job of changing the gene pool.” We shouldn’t assume, from the outset, that changing the gene pool would always be a bad thing. Those who do assume this a priori, Buchanan suggests, are relying on an “unsupported dogma”—namely, a “pre-Darwinian understanding of nature as teleological” (p. 16), as a consequence of which they assume “that evolution is doing a good job and that our efforts are likely to make things worse” (p. 16).

Buchanan’s response to the “changing biology” objection (Chs. 2 & 3) runs along similar lines: since “our biology is a product of evolution” (p. 20), and is therefore always changing, the salient question is “whether we might have good reasons for deliberately changing our biology in some respects” (p. 20).

Finally, in responding to the “changing/destroying human nature” objection (Ch. 3), Buchanan notes, first, that on most accounts of human nature, including Christian and other theologically oriented accounts, human nature as we know it is, at best, “a pretty mixed bag,” one that includes both “awful as well as admirable features” (21). So, prima facie, it’s not immediately clear that “human nature” is necessarily something we should even want to preserve in its present form; perhaps, instead, we should try to improve human nature so as to get rid of, or at least to ameliorate, some of those “awful” features. Arguments to the contrary, Buchanan suggests, typically rely on what he terms the Extreme Connectedness Assumption (ECA), the notion that “…if we try to ameliorate the bad parts of human nature we will inadvertently destroy the good parts” (p. 22). But why, Buchanan asks, should we accept the ECA? In deciding whether or not to accept that assumption, he says, we should look at the “evidence” about what human nature is like. What sort of “evidence” would be relevant to this inquiry? For Buchanan, the answer to that question is obvious: we should look to “scientific evidence about what evolved organisms like us are like. In other words, we have to look to biology” (p. 22).

After having (in his view) dispensed with each of these objections, Buchanan then goes on to consider two additional types of arguments: (a) consequentialist arguments having to do with the potential for distributive injustice (Ch. 5, “Will the Rich Get Biologically Richer””); and (b) a virtue-oriented objection to the effect that the pursuit of enhancement is inherently morally corrupting (Ch. 6, “Is Enhancement Corrupting?”). Buchanan believes he has answers to these objections as well, and so arrives at the aforementioned conclusion that “[t]here are powerful reasons in favor of a society like ours embarking on the enhancement enterprise, and there are no objections to enhancement that are sufficient to outweigh them, at least at the present time” (p. 181).

 

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Detailed critical engagement with Buchanan’s argument will have to await the next and subsequent posts. By way of preview, I close this post with a crucial question regarding methodology. I noted above that, for Buchanan, the only source of relevant “evidence” is (evolutionary) biology. This trope—that the pronouncements of (evolutionary) biology are the only sources of data relevant to an inquiry concerning what human nature is like—recurs throughout Buchanan’s book. (It is, of course, a common theme found in much of the contemporary bioethics literature generally.) But, as a former professor of mine was fond of saying, “why think that?” Why think that evolutionary biology is the only relevant source for information concerning human nature? What about other possible sources, such as theology and philosophy? Surely these other domains of knowledge might have something to contribute to the discussion?

This question will be the subject of my next post.

 

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Works Cited in this Post

Buchanan, A. (2011). Better than Human: The Promise and Perils of Enhancing Ourselves (Philosophy in Action Series). New York: Oxford University Press.

Glover. J. (2008). Choosing Children: Genes, Disability, and Design (Uehiro Series in Practical Ethics). New York:

Sandel, M. (2007). The Case Against Perfection: Ethics in the Age of Genetic Engineering. Cambridge, MA: Harvard University Press.

Journeys of Transformation

In my last post, “A Preview of Coming Attractions” (02-11-13), I signaled the start of a multi-part series of review essays covering three recently published books addressing ethical issues surrounding enhancement technologies and practices. I had intended to launch that series with today’s post. Before starting that series, however, I want to go on a brief discursus, one that will, I believe, turn out to be relevant to the themes to be touched on in the forthcoming series.

Last week, I attended the annual “Christ and Culture” lecture at California Baptist University in Riverside, California. This year’s speaker was Ralph Winter, producer of the first three X-Men films and numerous other successful film projects. Using such recent films as Les Miserables, Toy Story, Avatar, and others as illustrative examples, Winter set out, in the broadest sense, to show “how the gospel is often displayed in… contemporary film.” The unifying theme in all these stories is what Winter referred to as a “journey of transformation.” In each of these stories, the main character/hero grows through experiencing some form of adversity, learns something important about him or herself, and is transformed positively in some way.

One of Winter’s central concerns in his lecture was to explore the general question of how Christians engage with the broader culture, and particularly with how they communicate their messages to that culture. Here, Winter contends that “Christian stories often fail because we’re afraid of the journey,” by which he means that “our stories often hide from pain”—they avoid addressing the painful, the difficult, the ugly, the uncomfortable aspects of life—and place an emphasis on propositional assent over against an embrace of the “transformational journey” that is the life of faith. That is to say, there is a tendency to focus on the destination (heaven) to the exclusion of the journey that we take along the way.

What does all of this have to do with bioethics? There are at least two central lessons to be learned here.

First, in the context of genetic enhancement technologies and practices, it is worth asking the question: to what extent is the “enhancement enterprise” (broadly speaking, the attempt to “improve” human capacities by way of genetic or other interventions and/or technologies, as well as the cultural push toward embracing that agenda) in fact driven by a deep-seated, underlying “fear of the journey”—that is, a fear of those aspects of the aging process that are ugly, uncomfortable, painful, and so forth? Put more simply, to what extent is the drive toward “enhancement” really a flight from the inevitable realities of our lives as embodied creatures? (I do not propose to answer this question here; I pose it, however, as an important background issue to be kept in mind when considering specific arguments regarding the enhancement enterprise.)

Second, and more generally, our bioethical reflections—whether on beginning of life issues, end of life issues, or whatever—must always be attentive to the lived reality of embodied human existence. In particular, we must be willing to face the sometimes harsh realities of pain, suffering, indignity, and so forth, that can accompany the experience of various medical and other conditions. This is especially pertinent at the end of life, where the dying process can (but does not necessarily) involve significant levels of pain, discomfort, and distress. In a word, our bioethical reflections must tell “stories” that are true to the lived realities of human existence. If we are not willing to face these sometimes difficult realities, our pronouncements on bioethical issues are likely to seem shallow, insensitive, or even irrelevant.

This is not to say, of course, that our arguments and other reflections on bioethical issues should be overly-negative or fatalistic. Indeed, a focus on truth mandates that we tell “the truth, the whole truth, and nothing but.” This means being attentive to the fact (for example) that while the aging and dying processes can be characterized by pain, discomfort, and suffering, they are not always so characterized (indeed, with the skillful use of pain management techniques, they rarely need to be—but that is a different post altogether). The aging and dying processes can also be characterized by peace, joy, personal growth and development, and a sense of fulfillment. In a phrase: these processes can themselves be “journeys of transformation.” From the perspective of Christian theology, of course, the entire human lifespan can be understood in this way as well. The key point for present purposes is simply this: our bioethical reflections and arguments must attend to the potentially transformational aspects of the experience of pain, suffering, and the like, in addition to other considerations having to do with rights, obligations, principles, and so on.

Human life, in other words, is as much about the journey as it is about the destination. And that fact can make all the difference when it comes to bioethics.

After the Super Bowl: Reflections on “Perfection” and Enhancement

By the time you are reading this, many of us—myself included—are (or soon will be) in full “withdrawal” mode from the “high” of yesterday’s Super Bowl. We were amazed by the awesome displays of athletic prowess on the field and caught up in the drama of watching this year’s AFC and NFC champions battle it out to the very end for the right to be called “Super Bowl champions”—the very best in the game of football, at least for a short while. Who could not have been impressed by the on-field exploits of Joe Flacco, Ray Rice, Jacoby Jones, and Colin Kaepernick? Who could not have been touched by the soaring notes of Jennifer Hudson singing “God Bess America,” or the soulful tones of Alicia Keyes singing the national anthem?

In similar fashion, we find ourselves fascinated by the accomplishment of Olympic athletes, musicians, artists, intellectuals, and others at the “top of their game,” or their art, or their craft.

Truly, these are specimens of excellence—indeed, one might say, of a certain kind of “perfection.”

Or are they?

Perhaps these NFL players, “great” as they already are, could in fact be more than what they are now—faster, stronger, more agile, more powerful. Wouldn’t that be good for the game? Wouldn’t that make the game even more exciting, more engaging, more thrilling?

Suppose, by way of a taking a pill or getting an injection—Human Growth Hormone (HGH), for example—football players could develop stronger muscles and greater physical stamina.  Would we want them to do so? Would we consider their resulting on-field performances as genuine reflections of their actual athletic abilities, or more akin to “cheating the system”?[1]

Suppose, more generally, that we “mere mortals”—those of us who are not Super Bowl champions, famous musicians, acclaimed scholars, or Nobel prize-winning scientists—could take a pill that would improve our memory, make us more intelligent, or help us feel more confident? Would this be a good thing?

And, finally, suppose we could alter the human genetic code permanently, through genetic engineering, either to eliminate unwanted conditions (diseases, genetic disorders, and so forth) or to enhance certain desired, genetically-linked traits (intelligence or sociability, for example). Should we avail ourselves of such opportunities?

In the wake of the Human Genome Project and other scientific breakthroughs, each of these scenarios is increasingly moving from the realm of “science fiction” to “reality,” a fact that should prompt us to ask—and reflect upon—a number of important philosophical and theological questions, among them the following:

  • What does it mean to be an “excellent” specimen of something (a book, a table, a human being)?
  • What does it mean to “flourish” as a human being?
  • Should we seek to “enhance” ourselves? If so, are there limits to how far we should go in pursuing enhancement?
  • What, if anything, is the value in human limitation? Are there limits that we should never seek to surpass?

In subsequent posts, we will explore some of the issues surrounding enhancement (genetic and otherwise). For the moment, as we bask in the afterglow of this year’s Super Bowl, it is worth taking a few moments to reflect on just what it is about “great” athletic, musical, intellectual and other human achievements that we find so appealing, and whether “enhancement” would render those accomplishments more or less so.


[1] The NFL is reportedly looking seriously at introducing HGH testing prior to the start of the 2013 season. See http://www.nfl.com/news/story/0ap1000000133761/article/goodell-confident-hgh-testing-in-place-by-next-season