Human beings are almost obsessive innovators. Homo sapiens (knower) is by nature Homo faber (fabricator). Thank God He has made us so. Life without what Michael Novak has called “the fire of invention” would be nasty, bloody, and brutish. Medicine and biotechnology are two spheres where innovation is especially rewarded. So it is no surprise that we contemplate the possibility of human biological enhancements. After all, we attempt enhancement in many different ways, especially for our children: diet, exercise, music lessons, tutoring, athletics, and even cosmetic surgery. But for many people, there is something deeply troubling about enhancing human beings through biomedical technologies, whether through reproductive, genetic, neurological, or prosthetic technologies. For the sake of my argument, I will call this clutch of technologies, “Human Bioenhancement Technologies” (HBTs). By “bioenhancement” I mean that these technologies improve human biological function beyond species-typical norms.

Therapy versus enhancement

Ethical reflection about these technologies requires that we make some distinction between therapy and enhancement. Therapies would include medical interventions to restore human functioning to species-typical norms. So, kidney dialysis, lasik surgery, and angioplasty are therapies, but adding twenty IQ points to someone who already has a normal IQ would be an enhancement. Both proponents and critics of HBTs have argued, however, that the line between therapy and enhancement is vanishingly thin. But it may not be as faint as some imagine. I was once in a conversation with a prominent fertility specialist who used preimplantation genetic diagnosis (PGD) to help couples have children without genetically-linked diseases. He told of a couple who came to him requesting that he assist them using PGD to have a child who would have perfect musical pitch. Since they were both orchestral musicians, they wanted a child to follow in their footsteps. He refused. He said he could not say exactly why, but his intuition was that it was unethical. I think we have fairly reliable intuitions about most examples of enhancement. Let’s test our intuitions. Would you consider the following cases therapies or enhancements?

• A woman is told that the baby she is carrying has fetal hydrocephalus. She opts to have surgical intraventricular decompression for the fetus. Therapy or enhancement?
• The Pentagon pressures Congress to pass legislation requiring all children to be genetically altered to be able to tolerate a greater range of temperature exposure in order to survive future biological warfare. Therapy or enhancement?
• A pre-teen basketball player wants to alter herself genetically so she will continue to grow through her college years in order to improve her chances of playing in the pros. Therapy or enhancement?
• A medical student uses modafinil to help him stay alert longer so he can pass his medical board examinations. Therapy or enhancement?

Just because we cannot always make finely tuned distinctions does not mean distinctions are impossible. Just because a bright yellow line may not be able to be drawn does not mean no line can be drawn. We should resist human bioenhancement technologies for a number of reasons, including their inconsistency with the goals of medicine, their violation of the principle of justice, and their complicity with cultural stereotypes.

The goals of medicine

HBTs should be resisted, first, because they are inconsistent with the goals of medicine. Edmund Pellegrino, MD, has made much of the notion that the first goal of medicine is healing for the “patient’s good.” The principle of medical beneficence assumes either that a patient is enjoying homeostasis, and the role of the physician is to assist him or her to maintain or optimize normal functioning, or that a patient is suffering diminished capacity due to illness or disease, and medicine’s role it to help restore as much normal function as possible. This aim of medicine is as old as the Hippocratic Oath. Whether we call it healing, wellness, or shalom, the goals of medicine are restorative and preventive. Only recently have we begun to imagine medicine as a way to move beyond therapy. Medicine is seen less today as a profession and more as a commercial service. Physicians are not seen as professionals, they are merely body plumbers (no offense to plumbers). Consumerism thrives on giving the customer what he or she desires. While HBTs are not consistent with the traditional aims of medicine, they are very consistent with desire-satisfaction where, as ethicist Carl Elliot so elegantly puts it, “American medicine meets the American dream.” So now consumers employ doctors to make them “better than well.”

The principle of justice

Another reason to reject HBTs is the principle of justice. Having recently witnessed the Olympic games in Beijing, and heard the hoopla over doping in the Tour de France, we should be sensitive to the ways even the hint of enhancements threaten the fairness of competition. By analogy, technologically enhanced IQ, speed, dexterity, hearing, musical ability, etc., would create injustices, at least in cultures where those qualities are valued. The enhanced individual potentially would have unfair advantage over others in employment or life, just as blood-doping and steroids create advantages over other athletes. Furthermore, in a nation like the U.S. with such massive healthcare costs, and in a world with such massive healthcare needs, enhancing already wealthy Westerners while so many individuals lack access to basic therapeutic medicine, seems unjust. In fact, most of the world’s people do not want enhancements, they want basic healthcare.

The problem of cultural complicity

Georgetown philosopher Margaret Little has argued that enhancements contribute to cultural differences that lead to personal dissatisfaction and even stigmatization. For instance, Western culture’s valorization of the Barbie-doll figure leads to body dysmorphic disorder among American teenage girls. Some Asian girls are having cosmetic surgery to make their eyes rounder and less almond-shaped in order to fit the Western ideal. For a culture to legitimize enhancement is to be complicit in these pathologies. And this would seem especially heinous after spending untold social capital, tax-dollars, and educational resources trying to convince our culture that persons with disabilities should be respected equally as those without them. For these and other reasons, HBTs seem like a very dubious investment of time and scarce resources. Only those already well-off can afford the luxury of enhancements. The sick need a physician. For additional information: Carl Elliott, Better Than Well: American Medicine Meets the American Dream  (Norton, 2003). C. Ben Mitchell, Edmund D. Pellegrino, Jean Bethke Elshtain, John F. Kilner and Scott B. Rae, Biotechnology and the Human Good (Georgetown, 2006). Edmund D. Pellegrino, MD, The Philosophy of Medicine Reborn: A Edmund Pellegrino Reader (Notre Dame University Press, 2008). President’s Council on Bioethics, Beyond Therapy: Biotechnology and the Pursuit of Happiness (Dana Press, 2003).