- FROM BIOETHICS BRIEFINGS
Framing the Issue
When Guttenberg invented the printing press, making the written word accessible to the masses, he could have hardly envisioned today’s world where the entirety of human knowledge is available at the swipe of a finger in a device the size of your palm. We live in an era where the idea of a chess grandmaster losing to a computer seems quaint because machines can now beat humans at Go, a strategy competition where computational power alone was previously unable to outwit a living being. While chess and Go are fun and games, they illustrate the serious matter of how we now have the capacity to enhance intelligence that is not even human. In the eight years since we wrote the “Enhancing Humans” chapter for the first edition of The Hastings Center Bioethics Briefing Book, the rapid pace of science and technological advancement has caused us to reconsider the boundaries of what human enhancement is. How should we define it in a time driven by the exponential speed of innovation?
Wikipedia, in 2016, defines human enhancement as “any attempt to temporarily or permanently overcome the current limitations of the human body through natural or artificial means. It is the use of technological means to select or alter human characteristics and capacities, whether or not the alteration results in characteristics and capacities that lie beyond the existing human range.” We believe human enhancement moves an individual past the limits of her own mind or body.
Technologies That Enable Enhancement
In this chapter, we are not concerned with “natural” means for enhancement, which we consider to include such things as taking Advanced Placement classes, hiring a private tutor for music lessons, or eating healthier foods, things that people do often and without real controversy. We are concerned with the controversy surrounding the use of bodily interventions—internal or external–that, whether originally intended or not, are used to enhance a person’s physical or cognitive abilities beyond the existing range for that person or his cohort.
Genetic enhancement. Genome editing technology has existed for some time, but the latest iteration, CRISPR-Cas9, is a more precise and efficient tool that makes the possibility of “designing” a baby with specific traits much more conceivable. Even beyond CRISPR-Cas9, scientists are exploring the possibility of creating a human genome from scratch. The ethical and policy questions related to this abound. What traits should be selected for or defined as desirable? Who should make these determinations? Should taxpayer dollars fund such a project? Furthermore, the outcome may not be entirely as people expect, since genes alone are not deterministic. A complex relationship exists between our DNA, our behaviors, and our environment, and the interaction is often difficult to unravel.
When starting a family, every parent wants to have the healthiest child possible. Previously, the only way to confirm genetic abnormalities early in pregnancy was through amniocentesis, an invasive procedure that carries a risk, albeit small, of miscarriage. Today, noninvasive prenatal testing makes detecting these genetic traits even easier with a simple, risk-free blood draw from the mother. The test analyzes fetal DNA circulating in the mother’s blood. Currently, noninvasive prenatal testing is focused on detecting abnormalities, such as Down syndrome. This in and of itself has implications for the disability community. However, it is not inconceivable that in the future parents will ask to use the technology to screen for certain traits they wish to see in their children. Individuals may want their offspring to be enhanced with a certain intelligence level, height, or eye color. Some genetic testing companies today even go so far as to offer scientifically dubious assays they claim will allow you to assess if your child has inherited genes that could lead to, for example, superior athletic performance.
Wearable enhancement. The development of exoskeletons, essentially a wearable robot consisting of a motorized frame and computer to help paraplegics walk “on their own,” clearly serves a humanitarian purpose, and at least one version has been approved by the Food and Drug Administration. But those now under development and being tested can only be used by a specific range of people. There are height, weight, and age requirements that rule out children and most elderly, raising questions of fairness. The Defense Advanced Research Projects Agency, or DARPA, is funding research into exoskeletons for soldiers. These skeletons are attached to soldiers in order for them to hike long distances carrying up to 17 times more weight than normal, quickly and efficiently. This is only the tip of the iceberg. Further studies involve attaching an Iron Man-like device, called a tactical assault light operator suit, to these exoskeletons to extend mobility and increase protection. This melding of humans and technology also includes neurological devices implanted in the brain.
In the realm of athletics, what qualifies as a wearable enhancement is not always clear. A prime example is a line of swimsuits created by Speedo, the LZR Racer. It is a full-body suit designed to enhance a swimmer’s speed by compressing the body, increasing buoyancy, and reducing drag. The suit was worn by nearly all of the swimmers who won medals at the 2008 Summer Olympics, including 23 of the 25 swimmers who broke world records. Swimming’s governing body, Fédération Internationale de Natation (FINA), later determined that the LZR Racer conferred an unfair advantage and banned the LZR Racer from future competitions. FINA wanted to preserve the “core principle that swimming is a sport essentially based on the physical performance of the athlete.” FINA’s position is consistent with the notion that augmentation other than the athlete’s personal training is unacceptable in sport, whether ingested, implanted, or worn.
Cognitive enhancement. For years, students have been using Ritalin and Adderall, prescribed for attention deficit disorder, off-label to increase their focus for exams or writing papers, although the results are relatively modest and short-lasting. But the potential for cognitive enhancement extends beyond pills. Other technologies now used as therapies for people with mental and physical impairments might one day be used by people without disabilities to improve memory, intelligence, and reasoning. Neuroprosthetics are electronic devices that are inserted directly into the brain or nervous system. The initial purpose of this technology is to enable people with severe physical disabilities to control devices outside their bodies to achieve a degree of physical independence not otherwise possible. A privately-held company, BrainGate, is dedicated to “technology that will allow severely disabled individuals—including those with traumatic spinal cord injury and loss of limbs—to communicate and control common every-day functions literally through thought.” But the company also acknowledges a commitment to having its technology used in “both medical and non-medical applications.” Such brain-computer interface technologies have also caught the interest of the military, raising concerns about their nonmedical applications. Imagine, for example, if the thoughts of humans somewhere distant from the battlefield are used to control robot warriors to kill.
With massive efforts such President Obama’s BRAIN Initiative to further understand the biological underpinnings of neurological processes, these technologies are likely to move beyond therapeutic uses into the enhancement realm. The Presidential Commission for the Study of Bioethical Issues also recognized the importance of addressing the ethical issues that will inevitably arise from progress in neuroscience, including neurological enhancement-related topics, and published a report entitled, “Gray Matters” in March of 2015.
Artificial intelligence. In tandem with enhancing human cognitive abilities, we are also enhancing artificial intelligence. The question is not if AI will surpass human intellectual capacity, but when. For now, smart machines and humans work together. Military personnel have been using drones to drop bombs from thousands of miles away. But what if drones become intelligent enough to act without human control? The creation of thinking machines raises many ethical questions. For example, should they be permitted to make moral decisions, such as, whether to kill someone to save others? Similarly, today drivers can operate self-driving cars in autopilot mode, but what happens if and when completely autonomous cars become commonplace? should be responsible for their choices? In the case of an autonomous vehicle, who should be liable for an accident–the maker of the vehicle, the software developer, or the “driver” of the driverless car? We are moving toward an era of enhancement by proxy, when less effort is spent improving an individual’s capabilities, and more time is dedicated to improving the devices used to increase the ease with which tasks, from the mundane to the complex and from the benign to the lethal, are carried out. The human-machine policy issues already surfacing need to be addressed before the seemingly inevitable shift to autonomous intelligent machines occurs.
Safety, Coercion, and Fairness
In thinking about how enhancement should “work,” it is important to focus on three considerations: safety, coercion, and fairness. Safety is a paramount consideration, both when designing a new enhancement and deciding when to introduce it. Research has shown that improving one cognitive function can, in some cases, impair another. We do not want to expose people to new technologies, especially those that are invasive, without achieving an acceptable level of safety. Yet, calculating and weighing the benefits and risks associated with a new technology will change as current technologies improve and new ones are invented, and how one defines benefits and risks will, in most cases, depend on context–how it is used, on what population, authorized by whom, and whether the enhancement is expected to be (or may be) intergenerational.
Coercion is the opposite of having the freedom to decide how one will live her life. The danger in most societies is not that enhancement will be imposed on people, but that they will have little choice if people around them choose the enhancement option in order to gain advantage for themselves or their offspring over others. This is particularly worrisome in competitive environments, such as business, sports, and politics, as well as in other walks of life subject to social pressure. Abstaining from enhancement may not be a realistic option for some.
Fairness refers to equality of opportunity with regard to access to enhancement interventions as well as to the benefits that come from their use. One concern is that enhancement technologies are not likely, at least at the outset, to be financially within the reach of many in the population, possibly putting them at an even greater disadvantage than their wealthier counterparts. Another concern is that some will secretly avail themselves of enhancement to intentionally disadvantage others; for example, in athletic events or academic testing.
Enhancement, Human Rights, and Public Policy
Perhaps the most fundamental question one should ask about the enhancement trends mentioned above is whether they will make our lives, both collectively and individually, better—more peaceful, more satisfying, more productive, and so on. Core human rights are viewed as essential for fostering the dignity, equality, and liberty to which all human beings are entitled, and science and technology are perceived by many as advancing those rights. For example, both the Universal Declaration of Human Rights and the International Covenant on Economic, Social and Cultural Rights include a right to the benefits of scientific progress, and in 2011 the United Nations recognized access to the Internet as a basic human right, equal to more traditional rights such as marrying freely and having a family. What does this mean for governments tasked with the duty to safeguard and promote the human rights of their citizens? How does this duty apply in light of existing international human rights documents that prohibit certain types of enhancement, e.g., the Convention on Human Rights and Biomedicine states that interventions to modify the human genome “may only be undertaken . . . if its aim is not to introduce any modifications in the genome of any descendants.” How are policy makers expected to resolve such different approaches?
Policymakers also face other challenges. For example, what rigor should be required to test new enhancement technologies before they can be marketed to the public? In addition, who should have access to new enhancement interventions? If only the wealthy have access to them, the potential for creating an under-enhanced underclass exists.
Scientists and engineers also have responsibilities to consider the impact of their work on individuals and society. It is not enough to be concerned with how they apply their knowledge and skills, but also to consider the value of what they do for others. This means listening to what society states as its priorities and engaging in a genuine two-way dialogue about how science and technology can best contribute to these priorities in a manner that improves the lives of its citizens while also respecting human rights.
As enhancement pushes the limits of what are considered “human functions,” a framework for debate about the appropriateness of the technologies is needed. We must be proactive in our thinking and not limit our considerations of enhancement to those that impact the biological realm. As we make phones, televisions, and artificial intelligence smarter, we must ask ourselves if this is truly enhancing our lives.
Cristina J. Kapustij, MS, is chief of the Policy and Program Analysis Branch, National Human Genome Research Institute, National Institutes of Health. Mark S. Frankel, PhD, is the former director of the Program on Scientific Responsibility, Human Rights and Law at the American Association for the Advancement of Science (AAAS).
(The opinions expressed here are the authors’ and do not reflect the views of the National Institutes of Health, the National Human Genome Research Institute, or the American Association for the Advancement of Science.)