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Reframing Human Enhancement: A Population Health Perspective

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Abstract

The dominant understandings on human enhancement, such as those based on the therapy–enhancement distinction or transhumanist views, have been focused on high technological interventions directly changing biological and physical features of individuals. The individual-based orientation and reductionist approach that dominant views of human enhancement take have undermined the exploration of more inclusive ways to think about human enhancement. In this perspective, I argue that we need to expand our understanding of human enhancement and open a more serious discussion on the type of enhancement interventions that can foster practical improvements for populations. In doing so, lessons from a population health perspective can be incorporated. Under such a perspective, human enhancement focus shifts from changing the biological reality of individuals, to addressing environmental factors that undermine the optimal performance of individuals or that can foster wellness. Such a human enhancement perspective would be consistent with a population health approach, as it pursues more equitable and accessible interventions, on the path to addressing social inequality. Human enhancement does not need to be only about high-technological interventions for a selected group of individuals; rather, it should be a continuous project aiming to include everyone and maximize the public benefit.

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... … a person's well-being is shaped by a complex net of intersecting social determinants, and the weighing of outcomes is at the population level rather than at the individual one (Cabrera, 2017). ...
... Such a human enhancement perspective would be consistent with a population health approach, as it pursues more equitable and accessible interventions, on the path to addressing social inequality. Human enhancement does not need to be only about hightechnological interventions for a selected group of individuals; rather, it should be a continuous project aiming to include everyone and maximize the public benefit (Cabrera, 2017). ...
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Positive assessments of moral enhancement too often isolate intuitive notions about its benefits apart from the relevance of surrounding society or civic institutions. If moral bioenhancement should benefit both oneself and others, it cannot be conducted apart from the enhancement of local social conditions, or the preparedness of civic institutions. Neither of those considerations has been adequately incorporated into typical neuroethical assessments of ambitious plans for moral bioenhancement. Enhancing a person to be far less aggressive and violent than an average person, what we label as “civil enhancement,” seems to be quite moral, yet its real-world social consequences are hardly predictable. A hypothetical case about how the criminal justice system would treat an offender who already received civil enhancement serves to illustrate how civic institutions are unprepared for moral enhancement.
... While there is no commonly agreed-on definition of CE, existing definitions typically refer to practices aiming to improve brain functioning (including better working memory, concentration, and cognitive control) without a medical need (e.g., Bostrom and Sandberg 2009;Cabrera 2017;Farah 2015;Hildt 2013;Sattler 2020;Smith and Farah 2011). The definition implies that individuals act on the basis of subjectively believing that certain substances will help them improve their cognitive performance. ...
... Several definitions of augmentation have been proposed in recent years [5,6,9,[11][12][13][14][15][16]. This paper adopts the robust definition by Moore [14] who defines human augmentation as: ...
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Despite long-standing practices in human augmentation, the field of Augmented Cognition still lacks a generalized ‘theory of augmentation’ which guides the selection of such augmentations. We do not yet have a taxonomy that could help understand which augmentation to use to address which type of cognitive problem. By reviewing past applications of cognitive augmentation, this paper provides a framework that helps navigating the growing knowledge and guides the selection of cognitive-enhancing augmentations. Like a compass, the proposed taxonomy can be used to map previous steps in the field, to navigate the current state of the art, and to orient future research directions.
... Под улучшением человека следует понимать пространство деятельности, которое связано и направлено на изменение физических, биологических, психосоциальных и когнитивных качеств человека [15]. Значительная часть литературы оперирует категориями медицинских и психологических наук; в сфере социальных наук наиболее близким можно считать социологию медицины [16], общественного здоровья [17] или образования [18]. Популярным примером анализа принципа «человеческих улучшений» является работа Л. Кабреры [17], в которой делается достаточно комплексный анализ как самого термина, так и подходов, которые в том числе соприкасаются с социетальной природой и задачами человеческих улучшений. ...
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This book proposes a review on social capital, including trends, measurement and effects of social capital
... Finally, it is essential to note that 'enhancement' does not automatically equate to 'more': in some occasions, diminishing a particular trait can be a form of enhancement in itself, such as reducing traumatic memories of war or ill-directed lust (Earp et al. 2014). The more recent 'humane' framework (Cabrera 2017) positions enhancement in a social context, arguing that research efforts in enhancement technology should prioritise the benefit of society as a whole. Other definitions of human enhancement leverage on the distinction between natural and unnatural improvements (Ida 2004), the abolition of suffering for humans and nonhuman animals (Pearce 2004), boundless expansion and self-transformation (More 2003) and transcendence (Huxley 1927). ...
Chapter
The purpose—A critical analysis of the main literature contributions dealing with the digital transformation of social subsystems in Covid-19, focusing on digital government system innovations. According to the current research, the following research questions have been prepared: What state-of-the-art approaches and solutions emerged in the Covid-19 period (or increased digitalisation) and will be a key socio-technological factor in future development digitalisation of urban (smart) ecosystems?Design/methodology/approach—The automated content analysis was provided with the software Leximancer 5.0. The authors prepared a topic analysis function to determine the most frequent topics and contents and use the automated content analysis's extraction of statistically manipulative information about the presence, intensity, and/or frequency of thematic and/or stylistic features of texts.Findings—It is expected that the emergence of a cyber-physical ecosystem will arrive soon, with smart communities having an important impact on changing the existing approaches, for example, learning, medical treatment, and smart governance.Originality/value—The chapter presents the possible changes in the post-Covid-19 world, which will accelerate processes for the emergence of the technological advanced urban environment and will be based on the outgoing digitalisation of processes. Furthermore, the chapter aims to present new knowledge based on the current findings of the future possible interaction between the citizens and governance (from communication to decision making and self-governance tools). The issue of citizens' trust in sharing their data with public infrastructure is also addressed.Research/ Practical/ Social/ Environment implications—The Covid-19 outbreak caused massive disruption to the industry and urban social ecosystems. The pandemic impacted drivers of a nation's economy and caused changes, such as the emergence of remote working, a bike-riding spike, different smart city projects were postponed or re-aligned, and technological projects aimed at protecting against Covid-19 have been given priority. Attention must also be paid to smart technologies, such as contact tracing and surveillance tools, raising concerns about privacy and human rights.Research limitations—The particular research limitation of the chapter is that the authors used a mixed-method for literature content research.KeywordsData-driven solutionsE-governmentE-healthCovid-19Cyber-physical ecosystemSmart governance
... While this paper had the more modest, yet worthwhile, goal of highlighting the persistence of this genetic essentialist framing in CRISPR-Cas9 discussions, there are some indications of an emerging alternative (sociologically informed) framework taking formation. Some examples of this promising work can be seen in[38][39][40][41][42]. ...
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The revolutionary potential of the CRISPR-Cas9 gene editing technique has created a resurgence in enthusiasm and concern in genetic research perhaps not seen since the mapping of the human genome at the turn of the century. Some such concerns and anxieties revolve around crossing lines between somatic and germline interventions as well as treatment and enhancement applications. Underpinning these concerns, there are familiar concepts of safety, unintended consequences and damage to genetic identity and the creation of designer children through pursuing human enhancement and eugenics. In the policy realm, these morally laden distinctions and anxieties are emerging as the basis for making important and applied measures to respond to the fast-evolving scientific developments. This paper argues that the dominant normative framing for such responses is insufficient for this task. This paper illustrates this insufficiency as arising from a continued reliance on misleading genetic essentialist assumptions that generate groundless speculation and over-reactionary normative responses. This phenomenon is explicit with regard to prospective human (germ line) genetic enhancements. While many normative theorists and state-of-the-art reports continue to gesture toward the influence of environmental and social influences on a person and their traits and capacities, this recognition does not extend to the substance of the arguments themselves which tend to revert to the debunked genetic determinist framework. Given the above, this paper argues that there is a pressing need for a more central role for sociological input into particular aspects of this “enhancement myth” in order to give added weight, detail and substance to these environmental influences and influence from social structures.
... And how far can it be modified? (Bostrom and Sandberg, 2009;Greenbaum, 2013;Macpherson and Segarra, 2017), and what are the long-term psychological and social consequences on individuals and populations (GüellPelayo, 2014;Cabrera, 2017;Ishii, 2017b)? In fact, all these issues frame the ethical challenges of "genetic enhancement" and, specifically, the genetic enhancement applied to the individual's germline, aimed to improve the capabilities of the human subject. ...
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The new reproductive technologies have opened the door to different processes of germline genetic enhancement by which the characteristics of an individual according to the interests of the agents involved could be selected during its gestation. Although the initiative is apparently oriented towards developing individuals that would excel in society, critical voices raise the concerns about that this approach would generate and need for a reflection on the ethical, social and legal implications of these techniques and their implementation in society. We reviewed the literature about these issues throughout their historical records to date, focusing on the moral arguments and non-clinical aspects that affect the legal and social environment. We have observed various trends of thought with divergent positions (proactive, preventive, and regulatory) as well as a large number of articles that try to reconcile the different approaches. This review illustrates a series of concepts from the ethics and philosophy fields which are frequently used in studies that evaluate the ethical implications of germline genetic enhancement, such as dignity, benefit, autonomy, and identity. In addition, amongst the many unresolved controversies surrounding genetic enhancement, we identify procreative beneficence, genetic disassociation, gender selection, the value of disability, embryo chimerization, and the psychosocial inequality of potentially enhanced individuals as crucial. We also develop possible scenarios for future debate. We consider especially important the definition and specification of three aspects which are essential for the deployment of new reproductive technologies: the moral status of the embryo undergoing enhancement, the legal status of the enhanced individual, and the responsibility of the agents executing the enhancement. Finally, we propose the precautionary principle as a means to navigate ethical uncertainties.
... For two decades many alternative definitions of human enhancement have been proposed and discussed (Parens, 1998;Bostrom, 2005;Agar, 2008;Bostrom and Roache, 2008;Moore, 2008;Savulescu and Bostrom, 2009;Cabrera, 2017), a particular bone of contention being the question of whether an intervention that simply attempts to restore function lost due to illness, injury, or disability could still be identified as enhancement. ...
Article
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Recent advances in neuroscience have paved the way to innovative applications that cognitively augment and enhance humans in a variety of contexts. This paper aims at providing a snapshot of the current state of the art and a motivated forecast of the most likely developments in the next two decades. Firstly, we survey the main neuroscience technologies for both observing and influencing brain activity, which are necessary ingredients for human cognitive augmentation. We also compare and contrast such technologies, as their individual characteristics (e.g., spatio-temporal resolution, invasiveness, portability, energy requirements, and cost) influence their current and future role in human cognitive augmentation. Secondly, we chart the state of the art on neurotechnologies for human cognitive augmentation, keeping an eye both on the applications that already exist and those that are emerging or are likely to emerge in the next two decades. Particularly, we consider applications in the areas of communication, cognitive enhancement, memory, attention monitoring/enhancement, situation awareness and complex problem solving, and we look at what fraction of the population might benefit from such technologies and at the demands they impose in terms of user training. Thirdly, we briefly review the ethical issues associated with current neuroscience technologies. These are important because they may differentially influence both present and future research on (and adoption of) neurotechnologies for human cognitive augmentation: an inferior technology with no significant ethical issues may thrive while a superior technology causing widespread ethical concerns may end up being outlawed. Finally, based on the lessons learned in our analysis, using past trends and considering other related forecasts, we attempt to forecast the most likely future developments of neuroscience technology for human cognitive augmentation and provide informed recommendations for promising future research and exploitation avenues.
... If the driving force of human enhancement is individual interest (or individualism) it will begin to degrade and may end up perverting such initiative, due to lack holistic understanding of the relational dynamics. As Cabrera (2017) points out, human enhancement seems to be "very much about values, ideology, and political will." We think that until that effort, including the purpose of the actions, is made the ELSI initiative is at risk of becoming a chimera. ...
Article
Human genetic enhancement, examined from the standpoint of the new field of political bioethics, displaces the age-old question of truth: What is human nature? This book displaces that question with another: What kind of human nature should humans want to create for themselves? To answer that question, this book answers two others: What constraints should limit the applications of rapidly developing biotechnologies? What could possibly form the basis for corresponding public policy in a democratic society? Benjamin Gregg focuses on the distinctly political dimensions of human nature, where politics refers to competition among competing values on which to base public policy, legislation, and political culture. This book offers citizens of democratic communities a broad perspective on how they together might best approach urgent questions of how to deal with the socially and morally challenging potential for human genetic engineering.
Chapter
The purpose—This research aims to situate enhancement technologies within a second-order cybernetic framework. Enhancement is here characterised as the process of developing sensing systems to expand an agent’s internal variety in response to hidden affordances available inside the environment in which they are embedded and interacting. This article, in particular, suggests the Law of Requisite Variety (1956) as a valuable perspective for decoupling the subject matter from some of the ethical and practical challenges surrounding enhancement technologies, such as defining species-typicality and the notion of ‘better’. Requisite variety provides a fruitful framework for approaching enhancement technologies as it outlines a systems perspective on the matter that focuses on communication rather than specific technologies. Based on this new operational framework, this study offers guidelines for approaching the design of enhancing technologies.Design/methodology/approach—Ashby’s Law of Requisite Variety (1956) offers the basis for this chapter’s core thesis, which contextualises the theory within an agent’s interactions with its surroundings. The environment involves a range of sensory affordances (Gibson 1977, 1979). However, the agent’s body—whether human or nonhuman—often is not equipped with the sensory systems required to engage with all of the affordances available. Therefore, this study proposes redefining enhancement in a cybernetic context as the practice of revealing the environment’s hidden affordances. To this end, the agent’s body must integrate with novel sensing systems that reveal these hidden affordances via embodied sensory feedback loops relying on the agent’s previously existing sensory systems.Findings—As an alternative way to tackle the enhancement debate, this chapter proposes focusing on increasing agents’ internal variety regarding its environment. By focusing on the agent’s body and its distinct sensorimotor properties, enhancement is reframed as the intentional layering of new capacities onto pre-existing ones.Originality/value—This work proposes an epistemological shift that integrates cybernetics into the debate on enhancement technology. The argument presented here provides a pragmatic foundation for academics and practitioners designing novel enhancement technologies to address the subject matter. Further, this research offers an alternative to established approaches to enhancement technologies, such as Savulescu et al. (2011) and Cabrera (2017).Research/Practical/Social/Environment implications—This research’s perspective will aid in the development of cybernetic approaches to the unresolved issue of enhancement technology. Furthermore, by focusing on the body of the agents and their individual sensory systems, as proposed in this work, much of the debate surrounding enhancement technologies can be avoided.Research limitations—The arguments presented stem from the notion that cognition is embodied, embedded, enacted and extended. As a result, they might be challenged by alternative epistemological positions.KeywordsCyberneticsEnhancement technologiesRequisite varietyAffordance theoryEmbodiment
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Neuroenhancement concerns the improvement of a person’s mental properties, abilities, and performance. The various techniques of neuroenhancement offer new opportunities of such improvement, but also come with substantive perils. Neuroenhancement thus involves significant normative challenges for individual persons as well as for society as a whole. This expert report provides a concise overview of the contemporary debate on neuroenhancement. It discusses the definition, techniques and targets of neuroenhancement and examines arguments for and against it at the level of individual persons, social interaction, and social policy.
Book
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Neuroenhancement concerns the improvement of a person’s mental properties, abilities, and performance. The various techniques of neuroenhancement offer new opportunities of such improvement, but also come with substantive perils. Neuroenhancement thus involves significant normative challenges for individual persons as well as for society as a whole. This expert report provides a concise overview of the contemporary debate on neuroenhancement. It discusses the definition, techniques and targets of neuroenhancement and examines arguments for and against it at the level of individual persons, social interaction, and social policy.
Book
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The thirteen case studies contained in this publication were commissioned by the research node of the Knowledge Network on Priority Public Health Conditions (PPHC-KN), a WHO-based interdepartmental working group associated with the WHO Commission on Social Determinants of Health. The publication is a joint product of the Department of Ethics, Equity, Trade and Human Rights (ETH), Special Programme for Research and Training in Tropical Diseases (TDR), Special Programme of Research, Development and Research Training in Human Reproduction (HRP), and Alliance for Health Policy and Systems Research (AHPSR). The case studies describe a wealth of experiences with implementing public health programmes that intend to address social determinants and to have a great impact on health equity. They also document the real-life challenges in implementing such programmes, including those in scaling up, managing policy changes, managing intersectoral processes, adjusting design and ensuring sustainability.
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Ubiquitous cognitive biases hinder optimal decision making. Recent calls to assist decision makers in mitigating these biases-via interventions commonly called "nudges"-have been criticized as infringing upon individual autonomy. We tested the hypothesis that such "decisional enhancement" programs that target overt decision making-i.e., conscious, higher-order cognitive processes-would be more acceptable than similar programs that affect covert decision making- i.e., subconscious, lower-order processes. We presented respondents with vignettes in which they chose between an option that included a decisional enhancement program and a neutral option. In order to assess preferences for overt or covert decisional enhancement, we used the contrastive vignette technique in which different groups of respondents were presented with one of a pair of vignettes that targeted either conscious or subconscious processes. Other than the nature of the decisional enhancement, the vignettes were identical, allowing us to isolate the influence of the type of decisional enhancement on preferences. Overall, we found support for the hypothesis that people prefer conscious decisional enhancement. Further, respondents who perceived the influence of the program as more conscious than subconscious reported that their decisions under the program would be more "authentic". However, this relative favorability was somewhat contingent upon context. We discuss our results with respect to the implementation and ethics of decisional enhancement. © 2013. The authors license this article under the terms of the Creative Commons Attribution 3.0 License.
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This article draws attention to several common mistakes in thinking about biomedical enhancement, mistakes that are made even by some supporters of enhancement. We illustrate these mistakes by examining objections that John Harris has recently raised against the use of pharmacological interventions to directly modulate moral decision-making. We then apply these lessons to other influential figures in the debate about enhancement. One upshot of our argument is that many considerations presented as powerful objections to enhancement are really strong considerations in favour of biomedical enhancement, just in a different direction. Another upshot is that it is unfortunate that much of the current debate focuses on interventions that will radically transform normal human capacities. Such interventions are unlikely to be available in the near future, and may not even be feasible. But our argument shows that the enhancement project can still have a radical impact on human life even if biomedical enhancement operated entirely within the normal human range.
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This paper argues that transhumanism lacks persuasiveness because its futurological underpinnings are met with skepticism, not due to a lack of applicability, but for the lack of clarity about how transhumanity can become manifest within a cautious technological society. It is considered that the integration of transhuman ideals within social praxis is problematic in a variety of social contexts, but that sport offers an example where transhumanism can be applied and where posthumanity is already realised. Sports perpetuate a sufficiently ambiguous concept of humanness so that value within sports is afforded by the transhuman qualities of athletes and their ability to transcend known boundaries of human capability. Sports tend towards, endorse and depend upon the physical transcendence of humanness. In this respect, sport offers a unique environment where transhumanism can gain social credibility and where its ideals become manifest and normalised.
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Public health faces a new kind of drug problem with the growing prevalence of so–called ‘enhancement drugs’ that have the potential to improve human attributes and abilities. The widespread availability of such drugs has generated a new and growing audience of users. People are seeking out enhancement drugs in a quest to improve their bodies and minds—to look younger and more beautiful, to be stronger, happier and more intelligent. These types of drugs share a few similarities with recreational or addictive drugs—such as heroin, cocaine, ecstasy and ‘legal highs’— but also attract people who do not necessarily perceive themselves as ‘drug users’ and are vulnerable to cultural pressures to optimise their bodies. Manufacturers and retailers around the world are tapping into the demand for such drugs by harnessing innovations in science and medicine, as well as improvements in transport and communication networks. Significantly, in the case of illicit markets, retailers are able to circumvent national laws and regulation with creative and persuasive marketing strategies via the Internet. Often their customers are duped or remain unaware of the considerable harms associated with usage of these drugs, a situation that presents a threat to public health and throws up challenges for healthcare systems around the world
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The use of psychopharmaceuticals to enhance human mental functioning such as cognition and mood has raised a debate on questions regarding identity and authenticity. While some hold that psychopharmaceutical substances can help users to ‘become who they really are’ and thus strengthen their identity and authenticity, others believe that the substances will lead to inauthenticity, normalization, and socially-enforced adaptation of behaviour and personality. In light of this debate, we studied how persons who actually have experience with the use of psychopharmaceutical medication would view their ‘self’ or their authentic personal identity in relation to the use of medication. We have interviewed a number of adults diagnosed with ADHD and discussed their experiences with medication use in relation to their conceptions of self and identity. In the first part of this paper we illustrate that the concepts of identity and authenticity play an important and sometimes problematic role in experiences of ADHD adults. This shows that the question about identity and psychopharmacology is not merely an ‘academic’ issue, but one that influences everyday lives of real people. In order to answer the question whether psychopharmaceuticals threaten personal identity and authenticity, more than empirical research is needed. We also need to analyse the concepts of personal identity, authenticity and self: what do we mean when we are using statements as ‘a way of living that is uniquely our own’, ‘our true self’, or ‘who we really are’? In the second part of this paper we discuss two important philosophical views on personal identity, authenticity and self: the self-control view as elaborated by Frankfurt, and the self-expression view as proposed by Schechtman. We compare these with the experiences of our respondents to see which view can help us to understand the diverse and often conflicting experiences that people have with medication for ADHD. This will contribute to a better understanding of whether and in which cases personal identity and authenticity are threatened by psychopharmacology.
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Responding to several leading ideas from a paper by Allen Buchanan, the present essay explores the implications of genetic enhancement for moral status. Contrary to doubts expressed by Buchanan, I argue that genetic enhancement could lead to the existence of beings so superior to contemporary human beings that we might aptly describe them as post-persons. If such post-persons emerged, how should we understand their moral status in relation to ours? The answer depends in part on which of two general models of moral status--one based on respect and one based on interests--is more adequate. Buchanan tentatively argues that a respect-based model is preferable. I challenge Buchanan's view, along these lines: If we embrace a respect-based model of moral status featuring a threshold that divides persons, who are thought to have full and equal moral status, from sentient nonpersons, thought to have less moral status, then we should acknowledge a second threshold and a level of moral status higher than ours. A better option, I tentatively suggest, is to drop the idea of levels of moral status, accept that all sentient beings have moral status, and allow that some differences in interests and capacities justify some significant differences in how we should treat beings of different kinds.
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Opponents of biomedical enhancement often claim that, even if such enhancement would benefit the enhanced, it would harm others. But this objection looks unpersuasive when the enhancement in question is a moral enhancement - an enhancement that will expectably leave the enhanced person with morally better motives than she had previously. In this article I (1) describe one type of psychological alteration that would plausibly qualify as a moral enhancement, (2) argue that we will, in the medium-term future, probably be able to induce such alterations via biomedical intervention, and (3) defend future engagement in such moral enhancements against possible objections. My aim is to present this kind of moral enhancement as a counter-example to the view that biomedical enhancement is always morally impermissible.
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In discussions of the ethics of human gene therapy, it has become standard to draw a distinction between the use of human gene transfer techniques to treat health problems and their use to enhance or improve normal human traits. Some dispute the normative force of this distinction by arguing that it is undercut by the legitimate medical use of human gene transfer techniques to prevent disease-such as genetic engineering to bolster immune function, improve the efficiency of DNA repair, or add cellular receptors to capture and process cholesterol. If disease prevention is a proper goal of medicine, these critics argue, and the use of gene transfer techniques to enhance human health maintenance capacities will help achieve that goal, then the "treatment/enhancement" distinction cannot define the limits of legitimate gene therapy. In this paper, I argue that a line can be drawn between prevention and enhancement for gene therapy (and thus between properly medical and nonmedical uses of gene therapy), but only if one is willing to accept two rather old-fashioned claims: 1) Some health problems are best understood as if they were entities in their own right, reifiable as processes or parts in a biological system, with at least as much ontological objectivity and theoretical significance as the functions that they inhibit. 2) Legitimate preventive genetic health care should be limited to efforts to defend people from attack by these more robust pathological entities, rather than changing their bodies to evade social injustices.
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Population health is a relatively new term that has not yet been precisely defined. Is it a concept of health or a field of study of health determinants? We propose that the definition be “the health outcomes of a group of individuals, including the distribution of such outcomes within the group,” and we argue that the field of population health includes health outcomes, patterns of health determinants, and policies and interventions that link these two. We present a rationale for this definition and note its differentiation from public health, health promotion, and social epidemiology. We invite critiques and discussion that may lead to some consensus on this emerging concept.
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To what extent should we use technology to try to make better human beings? Because of the remarkable advances in biomedical science, we must now find an answer to this question. Human enhancement aims to increase human capacities above normal levels. Many forms of human enhancement are already in use. Many students and academics take cognition enhancing drugs to get a competitive edge. Some top athletes boost their performance with legal and illegal substances. Many an office worker begins each day with a dose of caffeine. This is only the beginning. As science and technology advance further, it will become increasingly possible to enhance basic human capacities to increase or modulate cognition, mood, personality, and physical performance, and to control the biological processes underlying normal aging. Some have suggested that such advances would take us beyond the bounds of human nature. These trends, and these dramatic prospects, raise profound ethical questions. They have generated intense public debate and have become a central topic of discussion within practical ethics. Should we side with bioconservatives, and forgo the use of any biomedical interventions aimed at enhancing human capacities? Should we side with transhumanists and embrace the new opportunities? Or should we perhaps plot some middle course? Human Enhancement presents the latest moves in this crucial debate: original contributions from many of the world’s leading ethicists and moral thinkers, representing a wide range of perspectives, advocates and sceptics, enthusiasts and moderates. These are the arguments that will determine how humanity develops in the near future.
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History's judgment on the success of bioethics will not depend solely on the conceptual creativity and innovation in the field at the level of ethical and political theory, but this intellectual work is not insignificant. One important new development is what I shall refer to as the relational turn in bioethics. This development represents a renewed emphasis on the ideographic approach, which interprets the meaning of right and wrong in human actions as they are inscribed in social and cultural practices and in structures of lived meaning and interdependence; in an ideographic approach, the task of bioethics is to bring practice into theory, not the other way around. The relational turn in bioethics may profoundly affect the critical questions that the field asks and the ethical guidance it offers society, politics, and policy. The relational turn provides a way of correcting the excessive atomism of many individualistic perspectives that have been, and continue to be, influential in bioethics. Nonetheless, I would argue that most of the work reflecting the relational turn remains distinctively liberal in its respect for the ethical significance of the human individual. It moves away from individualism, but not from the value of individuality.In this review essay, I shall focus on how the relational turn has manifested itself in work on core concepts in bioethics, especially liberty and autonomy. Following a general review, I conclude with a brief consideration of two important recent books in this area: Jennifer Nedelsky's Law's Relations and Rachel Haliburton's Autonomy and the Situated Self.
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The ethics of care sees a disposition to care appropriately for others as the chief characteristic of a morally desirable psychology. Such a disposition can be viewed as a virtue. This article, however, rejects the idea that the ethics of care is a kind of virtue theory on the grounds that its focus is on caring relations between people rather than on caring dispositions. The ethics of care clearly is not a virtue theory in the classical tradition, for it rejects the idea that the proper exercise of practical reason is needed to enable one to determine how to act. It holds that the moral emotions, such as empathy and sensitivity, guide us to act properly. Beyond this, the ethics of care stresses the moral importance of meeting people's needs.
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Media outlets are reporting that cognitive enhancement is reaching epidemic levels, but evidence is lacking and ethical questions remain. The US Presidential Commission for the Study of Bioethical Issues (Bioethics Commission) has examined the issue, and we lay out the commission's findings andtheir relevance for the scientific community.
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The developing human brain is shaped by environmental exposures - for better or worse. Many exposures relevant to mental health are genuinely social in nature or believed to have social subcomponents, even those related to more complex societal or area-level influences. The nature of how these social experiences are embedded into the environment may be crucial. Here we review select neuroscience evidence on the neural correlates of adverse and protective social exposures in their environmental context, focusing on human neuroimaging data and supporting cellular and molecular studies in laboratory animals. We also propose the inclusion of innovative methods in social neuroscience research that may provide new and ecologically more valid insight into the social-environmental risk architecture of the human brain.
Book
This book provides an overview of the new and emergent technologies that are and will continue to play a central role in the future of human enhancement. These technologies - including nanotechnology, neurotechnology, information technology, robotics and artificial intelligence - not only have unique capabilities, but have also instantiated separate ethical domains. This book discusses three possible human enhancement paradigms - the biomedical, the transhumanist and the social - and explores how each paradigm involves different values and different uses of technology. It also investigates the different degrees and kinds of ethical issues instantiated by each of these human enhancement paradigms. A framework to prioritise these human enhancement paradigms is advanced, a framework that promotes technological innovation that serves the improvement of the human condition in a respectful and sustainable way. More importantly, this is a framework that ensures that not only certain groups of individuals enjoy the benefits of technological innovation. Includes a foreword from Professor Steve Fuller, Auguste Comte Professor of Social Epistemology, University of Warwick, UK.
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This paper looks at some of the different practical cyborgs that are realistically possible now. It firstly describes the technical basis for such cyborgs then discusses the results from experiments in terms of their meaning, possible applications and ethical implications. An attempt has been made to cover a wide variety of possibilities. Human implantation and the merger of biology and technology are important factors here. The article is not intended to be seen as the final word on these issues, but rather to give an initial overview. Most of the experiments described are drawn from the author’s personal experience over the last 15 years.
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The ambiguity regarding whether a given intervention is perceived as enhancement or as therapy might contribute to the angst that the public expresses with respect to endorsement of enhancement. We set out to develop empirical data that explored this. We used Amazon Mechanical Turk to recruit participants (N = 2776) from Canada and the United States. Each individual was randomly assigned to read one (and only one) vignette describing the use of a pill to enhance one of 12 cognitive, affective or social (CAS) domains. The vignettes described a situation in which an individual was using a pill to enhance the relevant domain under one of two possible enhancement conditions, one perceived as enhancing above the norm (EAN), what most people recognize as a clear case of enhancement, whereas the other perceived as enhancing towards the norm (ETN), with the individual using the enhancement having a modest, but subclinical deficit. Participants were asked how comfortable they were with the individual using the enhancement and about the impact the enhancement might have had in the individuals’ success in life. We found that irrespective of the domain to be enhanced, participants felt significantly more comfortable with ETN than with EAN, and they regarded the enhancement intervention as contributing to greater success in life with ETN rather than EAN. These data demonstrate that the therapy enhancement distinction is morally salient to the public, and that this distinction contributes to the angst that people feel when considering the propriety of CAS enhancement.
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Optimizing the health of populations, whether defined as persons receiving care from a health care delivery system or more broadly as persons in a region, is emerging as a core focus in the era of health care reform. To achieve this goal requires an approach in which preventive care is valued and "nonmedical" determinants of patients' health are engaged. For large, multimission systems such as academic medical centers, navigating the evolution to a population-oriented paradigm across the domains of patient care, education, and research poses real challenges but also offers tremendous opportunities, as important objectives across each mission begin to align with external trends and incentives. In clinical care, opportunities exist to improve capacity for assuming risk, optimize community benefit, and make innovative use of advances in health information technology. Education must equip the next generation of leaders to understand and address population-level goals in addition to patient-level needs. And the prospects for research to define strategies for measuring and optimizing the health of populations have never been stronger. A remarkable convergence of trends has created compelling opportunities for academic medical centers to advance their core goals by endorsing and committing to advancing the health of populations.
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This paper traces the cultural and philosophical roots of transhumanist thought and describes some of the influences and contributions that led to the development of contemporary transhumanism.
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Human beings are subject to a range of cognitive and affective limitations which interfere with our ability to pursue our individual and social goals. I argue that shaping our environment to avoid triggering these limitations or to constrain the harms they cause is likely to be more effective than genetic or pharmaceutical modifications of our capacities because our limitations are often the flip side of beneficial dispositions and because available enhancements seem to impose significant costs. I argue that carefully selected environmental interventions respect agents' autonomy and are consistent with democratic decision making.
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A Special Supplement to the Hastings Center Report January-February 1998
Article
Human enhancement – our ability to use technology to enhance our bodies and minds, as opposed to its application for therapeutic purposes – is a critical issue facing nanotechnology. It will be involved in some of the near-term applications of nanotechnology, with such research labs as MIT’s Institute for Soldier Technologies working on exoskeletons and other innovations that increase human strength and capabilities. It is also a core issue related to far-term predictions in nanotechnology, such as longevity, nanomedicine, artificial intelligence and other issues.
Article
Human enhancement, in which nanotechnology is expected to play a major role, continues to be a highly contentious ethical debate, with experts on both sides calling it the single most important issue facing science and society in this brave, new century. This paper is a broad introduction to the symposium herein that explores a range of perspectives related to that debate. We will discuss what human enhancement is and its apparent contrast to therapy; and we will begin to tease apart the myriad intertwined issues that arise in the debate: (1) freedom & autonomy, (2) health & safety, (3) fairness & equity, (4) societal disruption, and (5) human dignity.
Article
Strictly speaking, “human enhancement” includes any activity by which we improve our bodies, minds, or abilities—things we do to enhance our well-being (Lin and Allhoff 2008). But it is tempting to think that “human enhancement” is about boosting our capabilities beyond the species-typical level or statistically-normal range of functioning for an individual (Daniels 2000). Consider the following illustrative examples. As it concerns the mind, taking Ritalin to treat attention-deficit hyperactivity disorder (ADHD) is aimed at correcting the deficit; but taken by otherwise-normal students to enable them to focus better in studying for exams is a form of human enhancement. And where reading a book may indeed make you more knowledgeable, it does not make you so much smarter than most everyone else or push your intellect past natural limits; on the other hand, a computer chip implanted into your brain that gives you direct access to Google or spreadsheets would provide mental capabilities beyond the species-typical level. Since, strictly speaking, human enhancements seem to include such activities as reading a book and eating vegetables it might appear that these “natural” enhancements are ethically unproblematic. It would be tempting to draw a line here in the human enhancement debate such that “artificial” or “unnatural” enhancements require moral evaluation. However, this approach is problematic. First, there appears to be vagueness as to what should count as “natural.” In addition, the distinction between natural and artificial might objectionably rest on dubious theological or teleological premises (e.g., that we have God-given goals or limits in life such that living to 300 would be profanely unnatural or in violation of God’s will). One might be tempted by the thought that the internal-external distinction is morally significant insofar as one might think that human enhancements that are internal are morally questionable, whereas those that are external are not. In other words, the use of tools is perfectly moral, but incorporating tools as part of our bodies is morally questionable. However, it could also be maintained that a neural implant that gives access to Google and the rest of the online world does not seem to be different in kind to using a laptop computer or Pocket PC to access the same. So why should it matter that we are imbedding computing power into our heads rather than carrying the same capabilities with us by way of external devices?
Article
We outline a number of ethical objections to genetic technologies aimed at enhancing human capacities and traits. We then argue that, despite the persuasiveness of some of these objections, they are insufficient to stop the development and use of genetic enhancement technologies. We contend that the inevitability of the technologies results from a particular guiding worldview of humans as masters of the human evolutionary future, and conclude that recognising this worldview points to new directions for ethical thinking about genetic enhancement technologies.
Article
This article begins by considering four traditional definitions of enhancement, then proposes a fifth, the Welfarist definition. It then considers fairness-based objections to enhancement, using the example of performance enhancement in sport. In so doing it defines sport and the values proper to it, surveys alternative theories of justice, considers the natural distribution of capabilities and disabilities, and draws a distinction between social, psychological, and biological enhancement. The article advances a new argument that justice requires enhancement.
Article
Cognitive enhancement, the amplification or extension of core capacities of the mind, has become a major topic in bioethics. But cognitive enhancement is a prime example of a converging technology where individual disciplines merge and issues transcend particular local discourses. This article reviews currently available methods of cognitive enhancement and their likely near-term prospects for convergence.
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It has long been suspected that the relative abundance of specific nutrients can affect cognitive processes and emotions. Newly described influences of dietary factors on neuronal function and synaptic plasticity have revealed some of the vital mechanisms that are responsible for the action of diet on brain health and mental function. Several gut hormones that can enter the brain, or that are produced in the brain itself, influence cognitive ability. In addition, well-established regulators of synaptic plasticity, such as brain-derived neurotrophic factor, can function as metabolic modulators, responding to peripheral signals such as food intake. Understanding the molecular basis of the effects of food on cognition will help us to determine how best to manipulate diet in order to increase the resistance of neurons to insults and promote mental fitness.
Epistemological and moral problems with human enhancement
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“Smart drugs”: do they work? Are they ethical? Will they be legal?
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