We Must Decide Who We Are to Determine Who We Become

1. Philosophical Pre-Requisites to Technological Self-Determination We Must Decide Who We AretoDetermine Who We Become Kevin T. Keith IHEU Conference, 12 May, 2007

2. Patient autonomy – pre-requisites Competence Full information Voluntariness Deciding Who We Are,Determining Who We Become Respect for autonomy comes wrapped in a paternalistic package: For their own good, patients must meet minimal criteria to qualify to have their wishes and desires respected. 2

3. Patient autonomy – deviation triggers challenge Competence Incomprehensible requests “Harmful” requests Indifference to: pain; appearance; normal species functioning Full information Unusual requests High risk acceptance Voluntariness Motivation other than presumed best interests (and religious belief) Deciding Who We Are,Determining Who We Become Deviation from expected desires for / requests for / interest in / uses for healthcare technology prompt suspicion of illegitimate motivation. Non-standard requests for technological intervention are presumptively non-autonomous. 3

4. Autonomy: Standard model is normative, not descriptive Accepted norms (mental, physical) define autonomous desires Non-standard desires are evidence of sub-standard thinking Deviant evaluative conclusions signify inadequate capacity / information Taking the wrong risks, wanting the wrong things, is not “authentic” Motivation (desires, values) signifies – not drives – decision-making Your desires are evidence of your mental health De gustibus est disputandum Deciding Who We Are,Determining Who We Become The standard model of autonomy presupposes a particular vision of human nature and human body norms. This model is built into our expectations not merely of what humans look like or do, but who they are and how they think. 4

5. To be autonomous, you must have decisional capacity To have “wrong” desires is to be mentally ill To be mentally ill is to lack decisional capacity Therefore: To be autonomous, you must not have “wrong” desires Deciding Who We Are,Determining Who We Become Socially expected desires / values / intentions / goals are psychologically normative, therefore morally normative. 5

6. Desires translate to moral standing Having “wrong” desires indicates disordered thinking Disordered thinking indicates lack of decisional capacity Lack of capacity equates to lack of autonomy Deciding Who We Are,Determining Who We Become • Your moral authority over your own life is in part defined by the content of your desires, not your process of evaluation of your desires. 6

7. Technological enhancement challenges a normative vision of human nature If we are “supposed to be” . . . something, it is wrong to be otherwise Enhancement violates perceived norms of human nature Endorsing enhancement implicitly rejects such norms, and vice versa Deciding Who We Are,Determining Who We Become Adopting, and investing in, a regime of technological enhancement requires repudiating normative constraints on what humans should be / can be / are allowed to be. 7

8. Challenging the normativity of human nature is . . . unsettling, to some . . . Deciding Who We Are,Determining Who We Become Anti-enhancement sentiment is often driven by a commitment to the normative vision of human nature. Embracing enhancement is a threat to moral standards. 8

9. “Immoderate desires and aspirations make us impatient with the frailties of human nature and the contingencies of social institutions, prompting us to try to overcome these imperfections by creating a new man, a new society and a new polity. Such enterprises, history remind us, are fraught with peril. . . . Contra naturam, the defiance of nature, used to be a sufficient argument for those who were not persuaded by contra deum, provoking the wrath of God. But what does it mean today, when we have defied, even violated, nature in so many ways, for good as well as bad? If cloning is against nature, is not also artificial insemination, or in vitro fertilization, or, for that matter, the pill?”  Gertrude Himmelfarb, “Two Cheers (or Maybe Just One) For Progress Deciding Who We Are,Determining Who We Become Difference itself – transcendence, enhancement, norm violation – is an argument against difference from the anti-enhancement position. 9

10. “[G]etting from here to post-humanity will exact a steep moral price. . . The technological breakthroughs necessary to create a true post-humanity will almost surely never come. But this doesn't mean that transhumanism is benign--far from it. Dismissing the intrinsic value of human life is always dangerous, and presuming to determine which human traits are desirable and which not leads to very dark places.”  Wesley J. Smith, “The Catman Cometh” Deciding Who We Are,Determining Who We Become Difference itself – transcendence, enhancement, norm violation – is an argument against difference from the anti-enhancement position. 10

11. “Libertarian advocates of genetic choice want the freedom to improve their children. But do we really know what it means to improve a child? It is hard to object to therapeutic aims, such as the elimination of genetic tendencies toward diseases. But would a child be ‘improved’ if parents were able to eliminate genetic propensity toward gayness? Would the child of an African-American couple be ‘improved’ if she could be born with white skin? Would boys be better human beings if they were born with less of a propensity for aggression? The possibilities for politically correct, or incorrect, parental choices are endless . . . .”  Frances Fukuyama, “The Fall of the Libertarians” Deciding Who We Are,Determining Who We Become Difference itself – transcendence, enhancement, norm violation – is an argument against difference from the anti-enhancement position. 11

12. “[G]enetic intervention to create a deaf child would constitute a form of child abuse that would in theory justify state action to protect the child. . . . So what to do about deaf parents who want deaf kids? . . . The best approach is probably an indirect one, such as some sort of liability for the doctors and others who perform prenatal genetic alterations. If the doctor who deliberately creates a deaf child has to pay for the youngster's special education, I don't think we'll see a lot of medically assisted child abuse. It would also help in the long run (though at the cost of considerable pain in the short run) to eliminate the many protections and privileges accorded disabled individuals. These may be less than perfect policies, but this is a less than perfect world. The alternatives are worse . . . .”  Virginia Postrel, response to Fukuyama Deciding Who We Are,Determining Who We Become Difference itself – transcendence, enhancement, norm violation – is an argument against difference from the anti-enhancement position. 12

13. “The Council’s experience of considering these disparate subjects under this one big idea— ‘beyond therapy, for the pursuit of happiness’—and our discovery of overlapping ethical implications would seem to vindicate the starting assumption that led us to undertake this project in the first place: biotechnology beyond therapy deserves to be examined not in fragments, butas a whole. . . . Taken one person at a time, with a properly prepared set of conditions and qualifications, it will be hard to say what is wrong with any biotechnical intervention that could improve our performances, give us (more) ageless bodies, or make it possible for us to have happier souls. . . . If there are essential reasons to be concerned about these activities and where they may lead us, we sense that it may have something to do with challenges to what is naturally human, what is humanly dignified, or to attitudes that show proper respect for what is naturally and dignifiedly human. As it happens, at least four such considerations have [been identified]: appreciation of and respect for ‘the naturally given,’ threatened by hubris; the dignity of human activity, threatened by ‘unnatural’ means; the preservation of identity, threatened by efforts at self-transformation; and full human flourishing, threatened by spurious or shallow substitutes.”  President’s Council on Bioethics, Beyond Therapy: Biotechnology and the Pursuit of Happiness Deciding Who We Are,Determining Who We Become Difference itself – transcendence, enhancement, norm violation – is an argument against difference from the anti-enhancement position. 13

14. It cannot simply be the pursuit of improvement that is making anti-meliorists nervous . . . They fear that in applying new biomedical knowledge to improve human beings, something essential about humanity will be lost. If biomedical tinkering is allowed, we will destroy the very thing that makes us human—our nature. Anti-meliorism rests, however, on a very shaky foundation. To support their position, the anti-meliorists must state what human nature is. They do not. They must also be very clear about why they see human nature as static. They are not. And they must advance an argument about why human nature, which has presumably evolved in response to an enormous array of random forces, tells us anything about what is good or desirable in terms of the traits humans should possess. They cannot. . . . Ultimately, anti-meliorism posits a static vision of human nature to which the anti-meliorists mandate we reconcile ourselves. If anything is clear about human nature, it is that this is not an accurate view of who we have been or what we are now, or a view that should determine what we become.  Art Caplan, “Nobody is Perfect – But Why Not Try to be Better?” Deciding Who We Are,Determining Who We Become The normative view of human nature is both ahistorical and morally ungrounded – an expression of preference rather than an invocation of principle. 14

15. However . . .The perception of a “natural” way of being is widespread, intuitive Not something most people will give up Fear of “other” or becoming “other” an important emotional driver “The preservation of identity” (President's Council) Many people want “more of the same”, not “more of something else” Promoting “the new you” will not win over those who liked the old thems. Deciding Who We Are,Determining Who We Become Forcing change in self-definition / self-understanding is as great an imposition as prohibiting it. 15

16. Biotechnology: “examined not in fragments, but as a whole”(President's Council) Broad/narrow perspective has moral implications “Harm” of enhancement: to the individual or to society/humanity? Modeling the conflict as individualist vs. communitarian tilts the playing field one way or the other Competing moral principles: Self-determination vs. Society/Species norm Self-identification vs. Human nature Deciding Who We Are,Determining Who We Become Rhetorically, setting the terms of debate is the winning strategy; morally, identifying the determinant perspective or decisive principle plays the same role. 16

17. Acceptability of enhancement depends upon the width of the normative space “Enhancing” means expanding the range of the normal This requires expanding the range of the normative space The question is whether any particular technology falls within the acceptable range The “width of the normative space” - the size of the acceptable range – determines what falls inside/outside Deciding Who We Are,Determining Who We Become The conflict is not between competing visions of human nature, but between competing norms for ways of being human. 17

18. Expanding the normative space: Possible stances There is no human nature Each person defines their own nature/identity; society defines acceptable behavior Human nature is malleable Has changed historically (lifespan, gender dichotomy) Individuals can change their own (personality development, therapy, catharsis) Human nature is fixed but minimal Sociobiology posits inherited behaviors – all are socially controllable Deciding Who We Are,Determining Who We Become Human nature is not normative, whatever else it may be. Enhancement is a question of autonomy, not biophysical normativity. 18

19. “Who we are”: Beings of varied and fluid natures “Experimenters in life” Diversity of communities, generational / gender relations Community-builders Form, define, change types / structures of communities Cyborgs Technology now an integral part of biophysical normative space Deciding Who We Are,Determining Who We Become The defining feature of human nature is the lack of fixed norms. Enhancement is a response to open possibilities, not a transgression of inherent limits. 19

20. “Who we are”: Self-makers and self-seekers Self-definitional Unconstrained by non-biophysical limits Exploratory Tending into new areas / avenues / modes (cf. body mod movement) Creative Attach value to newness / uniqueness / broadened possibilities Deciding Who We Are,Determining Who We Become Enhancement is properly seen as self-definitional, thus a question of self-determination. 20

21. “Who we may become”: Explorers of wider territories Wider normative range grants greater freedom for self-definition Moral grounds for limitation / prohibition of technology use must be articulated Expansivity is not moral anarchy “Plain old ethics” still holds sway Moral reasons may be given for / against technologies or policies; ungrounded norms are out of court Deciding Who We Are,Determining Who We Become Moral debates over enhancement must be undertaken on rational and factual grounds. 21

22. Notes: Caplan, Arthur, “Nobody is Perfect – But Why Not Try to be Better?”, in Caplan A, Elliott C (2004) Is It Ethical to Use Enhancement Technologies to Make Us Better than Well? PLoS Med 1(3): e52 doi:10.1371/journal.pmed.0010052 [accessed 5/11/2007] Fukuyama, Francis, “The Fall of the Libertarians”, WSJ Online, http://www.opinionjournal.com/editorial/feature.html?id=105002013 [accessed 5/11/2007] Himmelfarb, Gertrude, “Two Cheers (or Maybe Just One) for Progress”, Wall Street Journal, 5 May 1999 Postrel, Virginia, blog post: http://www.dynamist.com/weblog/archives/2002/apr29.html [accessed 5/11/2007] President’s Council on Bioethics, Beyond Therapy: Biotechnology and the Pursuit of Happiness Smith, Wesley J., “The Catman Cometh”, The Weekly Standard, 26 June, 2006 Deciding Who We Are,Determining Who We Become Presenter: Kevin T. Keith City College of New York – Center for Worker Education ktkeith@panix.com www.sufficientscruples.com 22