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The Harms of Enhancement and the Conclusive Reasons View


Many critics of bioenhancement go to considerable lengths to establish the existence of reasons against pursuing bioenhancements but do little to establish the absence of reasons in favor. This suggests that they accept what Allen Buchanan has called the conclusive reasons view (CRV). According to this view, our reasons against bioenhancement are obviously decisive, so there is no need to balance them against countervailing reasons. Buchanan criticizes the CRV by showing that the reasons most commonly adduced against bioenhancement are not decisive, or, at least, not obviously so.

In this article, I suggest that both Buchanan and the authors to whom he is responding underestimate the strength of the case for the CRV. There are, I argue, harm-based reasons against bioenhancement that provide stronger support to the CRV than the reasons that have most often been adduced by critics of enhancement. However, I then argue that even these harm-based reasons are not obviously decisive. Thus, I ultimately agree with Buchanan about the falsity of the CRV, though I disagree with him about the reasons for its falsity.

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2. Buchanan, AE. Beyond Humanity? The Ethics of Biomedical Enhancement. Oxford: Oxford University Press; 2011.

3. Buchanan, AE. Better Than Human: The Promise and Perils of Enhancing Ourselves. New York: Oxford University Press; 2011.

4. See note 2, Buchanan 2011, at 16.

5. See, for example, Fukuyama, F. Our Posthuman Future: Consequences of the Biotechnology Revolution. New York: Profile Books; 2002.

6. Fukuyama, F. Transhumanism. Foreign Policy 2004;144:42–3.

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10. See note 9, Sandel 2007, at 92, 95.

11. See note 5, Fukuyama 2002, at 172.

12. See note 9, Sandel 2007, at 5–24.

13. See note 1, Buchanan 2008, and note 2, Buchanan 2011.

14. See note 1, Buchanan 2008, at 19–20.

15. See note 1, Buchanan 2008.

16. It is true that Michael Sandel, the chief exponent of the concern about expressing objectionable attitudes, connects this concern with a concern about the undermining of social solidarity, which might be thought to be ultimately a concern about harm to others (see note 9, Sandel 2007, at 89–92). However, I am inclined to think that he conflates two distinct arguments here. Taken at face value, the concern about expressing objectionable attitudes is not a consequence-based concern; it is a concern about motives. By contrast, the concern about undermining social solidarity plainly is a concern about the possible consequences of biomedical enhancement. It is, of course, possible that the motives to which Sandel objects would causally contribute to the undermining of social solidarity. In that case, the appeal to objectionable attitudes could be understood as a disguised appeal to a consequence-based concern. However, there is little reason to interpret Sandel’s objection in this way: he does not provide any argument for such a causal connection, and he is elsewhere at pains to emphasize that his appeal to objectionable attitudes is not a consequence-based concern (e.g., at 95–96). This leads me to conclude that Sandel’s appeal to the undermining of social solidarity is distinct from his main, attitudes-based critique of enhancement. I consider an argument similar to his solidarity-based critique later in this article.

17. Michael Sandel suggests that standard liberal principles are unable to capture the problematic nature of bioenhancement and takes this to count not in favor of bioenhancement but against liberalism. See note 9, Sandel 2007, at chap. 1.

18. Caldwell, JA, Caldwell, JL. Fatigue in military aviation: An overview of U.S. military-approved pharmacological countermeasures. Aviation, Space, and Environmental Medicine 2005;76(1 Suppl):C39C51.

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25. British Medical Association. Boosting Your Brain Power: Ethical Aspects of Cognitive Enhancements. London: British Medical Association; 2007, at 1923.

26. See note 9, Sandel 2007, at 18–19.

27. For example, the Elementary Education Act of 1870, which paved the way to compulsory primary education in England and Wales, was motivated largely by a concern for those countries to maintain their international economic competitiveness. See Ramirez, FO, Boli, J. The political construction of mass schooling: European origins and worldwide institutionalization. Sociology of Education 1987;60(1):217.

28. See note 9, Sandel 2007, at 89–91.

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36. This example is modified from Wikler 2009 (see note 29) and Buchanan 2009 (see note 31).

37. See note 1, Buchanan 2008, and note 2, Buchanan 2011, at 35–67.

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39. See also note 2, Buchanan 2011, at 38–49, though compare Persson, I, Savulescu, J. Unfit for the Future: The Need for Moral Enhancement. Oxford: Oxford University Press; 2012.

40. Sunstein, CR. Laws of Fear: Beyond the Precautionary Principle. Cambridge: Cambridge University Press; 2005, at 18.

41. United Nations Environment Programme. Rio Declaration on Environment and Development. Nairobi: United Nations Environment Programme; 1992, principle 15.

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46. See, for example, Nagel, T. Justice and nature. Oxford Journal of Legal Studies 1997;17(2):303–21, at 315.

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52. For discussion of various ways in which existing drugs may influence morally significant conduct, see Levy N, Douglas T, Kahane G, Terbeck S, Cowen P, Hewstone M, Savulescu J, Are you morally modified? The moral effects of widely used pharmaceuticals. Philosophy, Psychiatry and Psychology; Forthcoming.

53. Crockett, MJ, Apergis-Schoute, A, Herrmann, B, Lieberman, MD, Müller, U, Robbins, TW, et al. Serotonin modulates striatal responses to fairness and retaliation in humans. Journal of Neuroscience 2013;33(8):3505–13.

54. De Jongh, R, Bolt, I, Schermer, M, Olivier, B. Botox for the brain: Enhancement of cognition, mood and pro-social behavior and blunting of unwanted memories. Neuroscience & Biobehavioral Reviews 2008;32(4):760–76.

I would like to thank an audience at the University of Manchester and an anonymous reviewer for the Cambridge Quarterly of Healthcare Ethics for comments on an earlier draft of this article. I thank the Wellcome Trust (grant numbers 100705/Z/12/Z, WT087211 and GR077879AIA) for their funding.

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