A principal challenge facing the progressive bioethics project is the crafting of a consistent message on biopolitical issues that divide progressives. -/- The regulation of enhancement technologies is one of the issues central to this emerging biopolitics, pitting progressive defenders of enhancement, “technoprogressives,” against progressive critics. This essay [PDF] will argue that technoprogressive biopolitics express the consistent application of the core progressive values of the Enlightenment: the right of individuals to control their own bodies, brains and reproduction according to their (...) own conscience, under democratic states that work for the public good. -/- Insofar as left bioconservatives want to ensure the safety of therapies and their equitable distribution, these concerns can be addressed by thorough and independent regulation and a universal health care system, and a progressive bioethics of enhancement can unite both enthusiasts and skeptics. Insofar as bioconservative concerns are motivated by deeper hostility to the Enlightenment project however, by assertion of pre-modern reverence for human uniqueness for instance, then a common program is unlikely. -/- imageAfter briefly reviewing the political history and contemporary landscape of biopolitical debates about enhancement, the essay outlines three meta-policy contexts that will impact future biopolicy: the pressure to establish a universal, cost-effective health insurance system, the aging of industrial societies, and globalization. Technoprogressive appeals are outlined that can appeal to key constituencies, and build a majority coalition in support of progressive change. Finally, some guiding principles for a technoprogressive approach to biopolicy are offered. (shrink)

A provocative work by medical ethicist James Hughes, Citizen Cyborg argues that technologies pushing the boundaries of humanness can radically improve our quality of life if they are controlled democratically. Hughes challenges both the technophobia of Leon Kass and Francis Fukuyama and the unchecked enthusiasm of others for limitless human enhancement. He argues instead for a third way, "democratic transhumanism," by asking the question destined to become a fundamental issue of the twenty-first century: How can we use new cybernetic and (...) biomedical technologies to make life better for everyone? These technologies hold great promise, but they also pose profound challenges to our health, our culture, and our liberal democratic political system. By allowing humans to become more than human - "posthuman" or "transhuman" - the new technologies will require new answers for the enduring issues of liberty and the common good. What limits should we place on the freedom of people to control their own bodies? Who should own genes and other living things? Which technologies should be mandatory, which voluntary, and which forbidden? For answers to these challenges, Citizen Cyborg proposes a radical return to a faith in the resilience of our democratic institutions. (shrink)

This paper considers the view that medicine is both “science” and “art.” It is argued that on this view certain clinical knowledge – of patients’ histories, values, and preferences, and how to integrate them in decision-making – cannot be scientific knowledge. However, by drawing on recent work in philosophy of science it is argued that progress in gaining such knowledge has been achieved by the accumulation of what should be understood as “scientific” knowledge. I claim there are varying degrees of (...) objectivity pertaining to various aspects of clinical medicine. Hence, what is often understood as constituting the “art” of medicine is amenable to objective methods of inquiry, and so, may be understood as “science”. As a result, I conclude that rather than endorse the popular philosophical distinction between the art and science of medicine, in the future a unified, multifaceted epistemology of medicine should be developed to replace it. (shrink)

This article argues against the relevance of the enhancement/treatment and biomedical/non-biomedical enhancement distinctions by analysing their validity in two ways: their clarity and whether they track our intuitions regarding what is permissible and impermissible. The treatment/enhancement distinction is found to be deficient in both respects. The biomedical/non-biomedical distinction, whilst clear, does not track our intuitions regarding what is permissible and impermissible. The article concludes that, in order to help the enhancement medicine debate, the distinctions should be abandoned due to the (...) fact they hinder clear ethical analysis. (shrink)

This article argues against the relevance of the enhancement/treatment and biomedical/non-biomedical enhancement distinctions by analysing their validity in two ways: their clarity and whether they track our intuitions regarding what is permissible and impermissible. The treatment/enhancement distinction is found to be deficient in both respects. The biomedical/non-biomedical distinction, whilst clear, does not track our intuitions regarding what is permissible and impermissible. The article concludes that, in order to help the enhancement medicine debate, the distinctions should be abandoned due to the (...) fact they hinder clear ethical analysis. (shrink)

A number of philosophers working in applied ethics and bioethics are now earnestly debating the ethics of what they term “moral bioenhancement.” I argue that the society-wide program of biological manipulations required to achieve the purported goals of moral bioenhancement would necessarily implicate the state in a controversial moral perfectionism. Moreover, the prospect of being able to reliably identify some people as, by biological constitution, significantly and consistently more moral than others would seem to pose a profound challenge to egalitarian (...) social and political ideals. Even if moral bioenhancement should ultimately prove to be impossible, there is a chance that a bogus science of bioenhancement would lead to arbitrary inequalities in access to political power or facilitate the unjust rule of authoritarians; in the meantime, the debate about the ethics of moral bioenhancement risks reinvigorating dangerous ideas about the extent of natural inequality in the possession of the moral faculties. (shrink)

Several authors have speculated that (1) the pharmaceutical, genetic or other technological enhancement of human mental capacities could result in the creation of beings with greater moral status than persons, and (2) the creation of such beings would harm ordinary, unenhanced humans, perhaps by reducing their immunity to permissible harm. These claims have been taken to ground moral objections to the unrestrained pursuit of human enhancement. In recent work, Allen Buchanan responds to these objections by questioning both (1) and (2). (...) I argue that Buchanan’s response fails. However, I then outline an alternative response. This response starts from the thought that, though moral status-increasing human enhancements might render ordinary, unenhanced humans less immune to permissible harm, they need not worsen the overall distribution of this immunity across beings. In the course of the argument I explore the relation between mental capacity and moral status and between moral status and immunity to permissible harm. (shrink)

Opponents of biomedical enhancement frequently adopt what Allen Buchanan has called the “Personal Goods Assumption.” On this assumption, the benefits of biomedical enhancement will accrue primarily to those individuals who undergo enhancements, not to wider society. Buchanan has argued that biomedical enhancements might in fact have substantial social benefits by increasing productivity. We outline another way in which enhancements might benefit wider society: by augmenting civic virtue and thus improving the functioning of our political communities. We thus directly confront critics (...) of biomedical enhancement who argue that it will lead to a loss of social cohesion and a breakdown in political life. (shrink)

What is illness? Is it a physiological dysfunction, a social label, or a way of experiencing the world? How do the physical, social and emotional worlds of a person change when they become ill? And can there be well-being within illness? In this remarkable and thought-provoking book, Havi Carel explores these questions by weaving together the personal story of her own serious illness with insights and reflections drawn from her work as a philosopher. Carel shows how the concepts and language (...) used to describe illness today are inappropriate and misleading. Too often illness is viewed as a localised biological dysfunction while ignoring the actual experience of the ill person, their fears, their hopes, the way they interact with others and, ultimately, experience life. By focusing on the impact of illness on the ill person's life and reflecting on the experience of illness as lived from within, Carel shows how illness is a life-changing process rather than a limited physiological problem. Carel's fresh approach to illness raises some uncomfortable questions about how we all - whether healthcare professionals or not - view the ill and challenges us to become more thoughtful. "Illness" unravels the tension between the universality of illness and its intensely private, often lonely, nature. It offers a new way of looking at a matter that affects every one of us. For those who are ill, it offers insights on our ability to remain happy within the constraints of illness. (shrink)

This paper argues for an inflationary and capacity-relative understanding of human enhancement technology. In doing so it echoes the approach followed by Buchanan. Particular emphasis is placed on the point that capacities themselves are relative to demands placed on the organism by its environment. In the case of human beings, this environment is to a very large extent institutionally structured. On the basis of the inflationary and capacity-relative concept of enhancement, I argue that the subject of enhancement must be understood (...) in terms of a bundle of capacities that is both extended and ecological. This consequence of the inflationary enhancement concept has some surprising upshots, namely that the subject itself must be considered as a technological enhancement and not a ‘platform’ or subjectum upon which the enhancement enterprise builds. This conclusion clashes, I argue, with some of the presuppositions of liberal philosophy, which starts by assuming a reflective subje.. (shrink)

The present work critically examines two assumptions frequently stated by supporters of cognitive neuroenhancement. The first, explicitly methodological, assumption is the supposition of effective and side effect-free neuroenhancers. However, there is an evidence-based concern that the most promising drugs currently used for cognitive enhancement can be addictive. Furthermore, this work describes why the neuronal correlates of key cognitive concepts, such as learning and memory, are so deeply connected with mechanisms implicated in the development and maintenance of addictive behaviour so that (...) modification of these systems may inevitably run the risk of addiction to the enhancing drugs. Such a potential risk of addiction could only be falsified by in-depth empirical research. The second, implicit, assumption is that research on neuroenhancement does not pose a serious moral problem. However, the potential for addiction, along with arguments related to research ethics and the potential social impact of neuroenhancement, could invalidate this assumption. It is suggested that ethical evaluation needs to consider the empirical data as well as the question of whether and how such empirical knowledge can be obtained. (shrink)