This paper looks at the future from the perspective of the way in which present thinking can influence what the future might be. It assumes that history shapes the future and that the present generation is in a position to shape it. It looks at the future of medicine as a science and a professional discipline, of health care as policy and politics, of culture and ideology as forces shaping medicine and health care, and of biomedical ethics as an influential (...) source of wisdom and perspective. The paper argues that a strong future for bioethics requires a broad rather than a reductionistic vision of its proper work. (shrink)

This article begins with some preliminary remarks about the general features and basic varieties of reflective equilibrium in moral reflection. It then considers a couple of preliminary doubts about this method. One of these doubts claims that the most plausible interpretation of RE is so comprehensive that it risks paralyzing our thinking, while the other claims that this same version of RE is insufficiently determinate in practical contexts and will thus fail to be sufficiently action-guiding. The article then explicates the (...) sense in which RE qualifies as a coherence theory of justification, and considers several objections to RE that flow from its reliance on the putative connection between coherence and moral justification. (shrink)

There must be few philosophical projects more serious than Jürgen Habermas’s lifelong effort to realize the lofty universalist ambitions of the Enlightenment in his communicative theory of rational discourse and deliberative democracy.

There must be few philosophical projects more serious than Jürgen Habermas’s lifelong effort to realize the lofty universalist ambitions of the Enlightenment in his communicative theory of rational discourse and deliberative democracy.

The possibility of enhancing human abilities often raises public concern about equality and social impact. This chapter aims at one particular group of technologies, cognitive enhancement, and one particular fear, that enhancement will create social divisions and possibly expanding inequalities. The chapter argues that cognitive enhancements could offer significant social and economic benefits. The basic forms of internal cognitive enhancement technologies foreseen today are pharmacological modifications, genetic interventions, transcranial magnetic stimulation, and neural implants. Cognitive enhancements can influence the economy through (...) reduction of losses, individual economic benefits, and society‐wide benefits. The strongest objection to the introduction of any enhancement technology is that it will create inequality, injustice, and unfairness. While there are clear economic and social benefits to cognitive enhancement, there exist anumber of obstacles to its development and use. One obstacle is the present system for licensing drugs and medical treatments. (shrink)

Most known technology serves to ingeniously adapt the world to the physical and mental limitations of human beings. Humankind has acquired awesome power with its rather limited means. Nanotechnological capabilities further this power. On some accounts, however, nanotechnological research will contribute to a rather different kind of technological development, namely one that changes human beings so as to remove or reduce their physical and mental limitations. The prospect of this technological development has inspired a fair amount of ethical debate. Here, (...) proponents and opponents of such visions of human enhancement are criticized alike for engaging in speculative ethics. This critique exposes a general pattern that extends to other nano-, bio-, or neuroethical debates. While it does not apply to all discussions of “enhancement technologies” it does apply to all ethical discourse that constructs and validates an incredible future which it only then proceeds to endorse or critique. This discourse violates conditions of intelligibility, squanders the scarce and valuable resource of ethical concern, and misleads by casting remote possibilities or philosophical thought-experiments as foresight about likely technical developments. In effect, it deflects consideration from the transformative technologies of the present. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Human Genome Project and BioethicsEric T. Juengst, Ph.D. (bio)The fifteen-year "human genome project" at the National Institutes of Health and the Department of Energy officially began on October 1, 1990. With it began a new dimension in federally supported scientific research: concurrent funding for work to anticipate the social consequences of the project's research and to develop policies to guide the use of the knowledge it produces. As (...) a result, the National Center for Human Genome Research (NCHGR) at NIH will support the largest public investment in bioethical analysis to date.NCHGR was established to work with other federal, private, and international organizations on the scientific effort to characterize the form and content of the human genome. The research will yield information—high-resolution genetic linkage and physical maps of all the human chromosomes as well as human DNA sequence data—that will be a resource for studies of gene structure and function. It will greatly increase our understanding of the genetic aspects of human health and disease. That increased understanding will eventually provide insights into the prevention and treatment of the 3,000 known inherited disorders, and of conditions caused by our (gene-governed) physiological reactions to pathogens, toxins, and mutagens of external origin.It has been clear since the conception of the human genome project, however, that professional and public deliberations concerning the responsible use of genetic information must be a part of the process. The most immediate consequence of genome research will be the development of new diagnostic and predictive tests, well in advance of corresponding therapeutic or curative advances. The implications of acquiring and using that knowledge about individuals raise policy questions at many levels within society. The primary purpose of the Ethical, Legal and Social Implications Program at the NCHGR is to anticipate and address these questions early in the life of the scientific project, to help optimize the [End Page 71] benefits to human welfare and opportunity from the new knowledge, and to guard against its misuses.The program has identified three sets of questions as particularly important to pursue as the genome initiative proceeds:1.Issues involved in the integration of new genetic tests into medical practice. Human genome research is expected to increase greatly the number of gene-based diagnostic and prognostic tests available to health professionals. The bioethical policy problems involved in integrating those tests effectively into medical practice include developing standards for:— accuracy and quality control of genetic tests;— medical indications for testing and design of testing protocols;— professional responsibilities of clinicians who perform tests;— confidentiality of information obtained from testing;— access to and use of test results by third parties, such as health insurers; and— reimbursement for testing and test-related counseling.These are problems for both those charged with regulating the use of new genetic tests and for those establishing the standards of practice within the health professions. Thus, in addition to soliciting and funding scholarly research proposals on both the factual and normative questions raised by these problems, the program is commissioning a major new study by the National Academy of Sciences/Institute of Medicine aimed at providing professional guidelines for the integration of genetic services into mainstream medical practice.2. Issues involved in educating and counseling individuals about genetic test results. The primary risk that health professionals will face in using genetic tests is the misinterpretation of their findings and the resulting potential for psychological trauma, stigmatization, and discrimination. Sometimes, out of ignorance, patients, families, and social institutions already stigmatize genetic disorders and treat those with them unfairly. This risk broadens as the genetic elements of more health problems are uncovered and gene-based tests for susceptibilities and carrier states are developed.To protect against these risks, NCHGR is soliciting and supporting projects aimed at improving professional and public understanding of these tests and their implications. For example, a philosopher is leading a team of geneticists and physicians in a scholarly effort to clarify [End Page 72] concepts of genetic susceptibility and draw out the social meaning of their different interpretations. Other projects involve social scientific studies of genetic risk perceptions, stigmatization, and discrimination. The conclusions of these studies, and... (shrink)

(No abstract is available for this citation).

Researchers in artificial intelligence and robotics often include a timeline stretching into the future in which they predict the convergence between human and artificial intelligence. Ray Kurzweil, for example, predicts that in a mere 100 years humans and intelligent machines will become indistinguishable from one another, both ceasing to have permanent corporeal forms. This article argues that the one thing we can know for sure about the future is that when it arrives, it will be different from what we imagined. (...) The cultural work that predictions like Kurzweil’s perform is less to prognosticate the future than to shape our understanding of what it means to be human in the present. Working from the ‘sense-think-act’ paradigm foundational to work in artificial intelligence and robotics, this article argues that predictions in all three areas feed back to affect how the human is envisioned in the present. The reconfigurations these predictions bring about are to downplay consciousness, embodied cognition, and evolutionary inertia. The article concludes by critically evaluating contemporary resistances to the posthuman, especially in the writings of Rodney Brooks and Francis Fukuyama. (shrink)

Too much contemporary bioethical discourse is weak on science, lazily citing and adopting science fiction scenarios rather than science facts in the framing of analyses and policies. We challenge bioethicists to take more seriously the role of providing informed insight into and oversight over contemporary science and its implications and applications. Bioethicists must work harder to understand the fast-changing truths and limits of basic science, and they must incorporate only appropriate and authentic science into their discourse, just as they did (...) in the past when addressing the quandaries of clinical medicine. The field of bioethics is not so old and entrenched that its future is assured. Bioethicists must make themselves useful to society in order to deserve and retain the public's trust. They can best do this by ensuring that decision making and public policy are grounded in facts, not fictions and fantasies. (shrink)

This article focuses on the follow question: Are human enhancement technologies likely to be justice impairing or justice promoting? We argue that human enhancement technologies may not be inherently just or unjust, but when situated within obtaining social contexts they are likely to exacerbate rather than alleviate social injustices.

In the newly emerging debates about genetics and justice three distinct principles have begun to emerge concerning what the distributive aim of genetic interventions should be. These principles are: genetic equality, a genetic decent minimum, and the genetic difference principle. In this paper, I examine the rationale of each of these principles and argue that genetic equality and a genetic decent minimum are ill-equipped to tackle what I call the currency problem and the problem of weight. The genetic difference principle (...) is the most promising of the three principles and I develop this principle so that it takes seriously the concerns of just health care and distributive justice in general. Given the strains on public funds for other important social programmes, the costs of pursuing genetic interventions and the nature of genetic interventions, I conclude that a more lax interpretation of the genetic difference principle is appropriate. This interpretation stipulates that genetic inequalities should be arranged so that they are to the greatest reasonable benefit of the least advantaged. Such a proposal is consistent with prioritarianism and provides some practical guidance for non-ideal societies–that is, societies that do not have the endless amount of resources needed to satisfy every requirement of justice. (shrink)

Pharmaceuticals or other emerging technologies could be used to enhance (or diminish) feelings of lust, attraction, and attachment in adult romantic partnerships. While such interventions could conceivably be used to promote individual (and couple) well-being, their widespread development and/or adoption might lead to “medicalization” of human love and heartache—for some, a source of serious concern. In this essay, we argue that the “medicalization of love” need not necessarily be problematic, on balance, but could plausibly be expected to have either good (...) or bad consequences depending upon how it unfolds. By anticipating some of the specific ways in which these technologies could yield unwanted outcomes, bioethicists and others can help direct the course of love’s “medicalization”—should it happen to occur—more toward the “good” side than the “bad.”. (shrink)

Proposals to make us smarter than the greatest geniuses or to add thousands of years to our life spans seem fit only for the spam folder or trash can. And yet this is what contemporary advocates of radical enhancement offer in all seriousness. They present a variety of technologies and therapies that will expand our capacities far beyond what is currently possible for human beings. In _Humanity's End,_ Nicholas Agar argues against radical enhancement, describing its destructive consequences. Agar examines the (...) proposals of four prominent radical enhancers: Ray Kurzweil, who argues that technology will enable our escape from human biology; Aubrey de Grey, who calls for anti-aging therapies that will achieve "longevity escape velocity"; Nick Bostrom, who defends the morality and rationality of enhancement; and James Hughes, who envisions a harmonious democracy of the enhanced and the unenhanced. Agar argues that the outcomes of radical enhancement could be darker than the rosy futures described by these thinkers. The most dramatic means of enhancing our cognitive powers could in fact kill us; the radical extension of our life span could eliminate experiences of great value from our lives; and a situation in which some humans are radically enhanced and others are not could lead to tyranny of posthumans over humans. (shrink)

In this provocative book, philosopher Nicholas Agar defends the idea that parents should be allowed to enhance their children’s characteristics. Gets away from fears of a Huxleyan ‘Brave New World’ or a return to the fascist eugenics of the past Written from a philosophically and scientifically informed point of view Considers real contemporary cases of parents choosing what kind of child to have Uses ‘moral images’ as a way to get readers with no background in philosophy to think about moral (...) dilemmas Provides an authoritative account of the science involved, making the book suitable for readers with no knowledge of genetics Creates a moral framework for assessing all new technologies. (shrink)

“Because those who come after us may not be like us, or because those like us may not come after us, or because after a time there may be none to come after us, mankind must now set to work to insure that those who come after us will be more unlike us. In this there is at work the modern intellect’s penchant for species suicide.” With these words Paul Ramsey brings to a conclusion his provocative and surprising study of (...) the problems we are encountering – and will encounter – as scientific advances make the genetic control of man a real possibility. Now, increased knowledge of chromosome structure has taken the alteration of the human race out of the realm of science fiction and placed it in the hands of laboratory scientists. Ramsey sees this advance in science and technology as a mixed blessing. He examines the ramifications of genetic control, not only the now common measures of birth control and artificial insemination, but also the effect on the genetic pool of the increasing numbers of genetically poor individuals. His concern for humanistic values informs each argument as he tackles such issues as asexual reproduction of men, frozen semen banks, and the breeding of human beings for special purposes. No less than the future of man as we know him hangs on these issues. One must pay particular attention to this book. (shrink)

As our scientific and technical abilities expand at breathtaking speeds, concern that modern genetics and bioengineering are leading us to a posthuman future is growing. Is Human Nature Obsolete? poses the overarching question of what it is to be human against the background of these current advances in biotechnology. Its perspective is philosophical and interdisciplinary rather than technical; the focus is on questions of fundamental ontological importance rather than the specifics of medical or scientific practice.The authors -- all distinguished scholars (...) in their fields -- take on questions about technology's goals and values that are often ignored or sidelined in the face of rapid scientific advances and the highly specialized nature of technical knowledge. The essays included represent a rich variety of thought, ranging from finely nuanced philosophical and theological arguments to historical studies and cultural commentaries. Several explore the historical background of today's biotechnology: Timothy Casey traces such developments as the emergence of cybernetic humanity from Cartesian dualism, and Diane Paul presents the history of "positive" versus coerced eugenics. Jean Bethke Elshtain discusses cloning as a "messianic project" to perfect the body and exclude natural diversity -- giving as an example the elimination of Down Syndrome as an acceptable human type -- while Harold Baillie calls for an examination of the metaphysical roots of personhood. Robert Proctor finds no evidence in paleontology for any "essence of humanity," and Tom Shannon argues against materialist reductionism. Addressing social concerns, Lisa Sowle Cahill finds the possibility of a political solution to the problems raised by genetic engineering in Catholic teachings on social justice, and Langdon Winner looks critically at the "scientific enthusiasts of a posthuman future." Taken as a whole, the book provides a humanistic overview of a subject too often considered only in its technological aspect. (shrink)

In Beyond Humanity a leading philosopher offers a powerful and controversial exploration of urgent ethical issues concerning human enhancement.

Recent developments in biotechnology and genetic research are raising complex ethical questions concerning the legitimate scope and limits of genetic intervention. As we begin to contemplate the possibility of intervening in the human genome to prevent diseases, we cannot help but feel that the human species might soon be able to take its biological evolution in its own hands. 'Playing God' is the metaphor commonly used for this self-transformation of the species, which, it seems, might soon be within our grasp. (...) In this important new book, Jurgen Habermas - the most influential philosopher and social thinker in Germany today - takes up the question of genetic engineering and its ethical implications and subjects it to careful philosophical scrutiny. His analysis is guided by the view that genetic manipulation is bound up with the identity and self-understanding of the species. We cannot rule out the possibility that knowledge of one's own hereditary factors may prove to be restrictive for the choice of an individual's way of life and may undermine the symmetrical relations between free and equal human beings. In the concluding chapter - which was delivered as a lecture on receiving the Peace Prize of the German Book Trade for 2001 - Habermas broadens the discussion to examine the tension between science and religion in the modern world, a tension which exploded, with such tragic violence, on September 11th. (shrink)

Current discourse on human enhancement is strongly influenced by far-reaching, radical visions concerning the future of human corporeality and civilisation. These visions are most forcefully brought into the discussions by proponents of transhumanism, which constitutes both a worldview and a sociocultural movement that is increasingly influential in academia, industry and other sectors of society. Aiming to shed new light on our societies’ current fascination with human enhancement discourse, three narratives concerning the genesis of transhumanism and the attractiveness of this worldview (...) are presented. Such a historically interpretative approach may give rise to a new reflexive stance on current enhancement discourse. (shrink)