This article explores some implications of the concept of transformative change for the debate about human enhancement. A transformative change is understood to be one that significantly alters the value an individual places on his or her experiences or achievements. The clearest examples of transformative change come from science fiction, but the concept can be illuminatingly applied to the enhancement debate. We argue that it helps to expose a threat from too much enhancement to many of the things that make human lives valuable. Among the things threated by enhancement are our relationships with other human beings. The potential to lose these relationships provides a compelling reason for almost all humans to reject too much enhancement.

It has been argued that moral bioenhancement is desirable even if it would make it impossible for us to do what is morally required. Others find this apparent loss of freedom deplorable. However, it is difficult to see how a world in which there is no moral evil can plausibly be regarded as worse than a world in which people are not only free to do evil, but also where they actually do it, which would commit us to the seemingly paradoxical view that, under certain circumstances, the bad can be better than the good. Notwithstanding, this view is defended here.

In this article, we consider contexts or domains in which (future) moral bioenhancement interventions possibly or most likely will be implemented. By looking closely at similar or related existing practices and their relevant ethical frameworks, we hope to identify ethical considerations that are relevant for evaluating potential moral bioenhancement interventions. We examine, first, debates on the proper scope of moral education; second, proposals for identifying early risk factors for antisocial behaviour; and third, the difficult balancing of individual freedom and third party concerns in (forensic) psychiatry. In imagining moral bioenhancement in practice, we observe that unlike other forms of enhancement, moral enhancement fundamentally asks how the interests and preferences of the individual and the interests of others should be weighed (in view of public safety and managing public risk). Highly diverse domains such as education, mental health, and the judicial domain might be involved, and moral bioenhancement might challenge existing institutional settings. Given these highly varied contexts and domains, it appears unlikely that there will be a distinct set of practices that will be referred to as “moral bioenhancement.”

There is frequently tension in medical education between teaching moments that provide skills and knowledge for medical trainees, and instrumentalizing patients for the purpose of teaching. In this commentary, I question the ethical acceptability of the practice of providing cardiopulmonary resuscitation (CPR) and advanced cardiac life support (ACLS) to dying patients who would be unlikely to survive resuscitation, as a teaching opportunity for medical trainees. This practice violates the principle of informed consent, as the patient agreed to resuscitation for the purpose of potentially prolonging life rather than to futile resuscitation as a teaching opportunity. Justifying futile resuscitation in order to practice normalizes deceptive and nonconsensual teaching cases in medical training. Condoning these behaviors as ethically acceptable trains physicians to believe that core ethical principles are relative and fluid to suit one’s purpose. I argue that these practices are antithetical to the principles espoused by both medical ethics and physician professionalism.

Within the literature surrounding nonhuman animals on the one hand and cognitively disabled humans on the other, there is much discussion of where beings that do not satisfy the criteria for personhood fit in our moral deliberations. In the future, we may face a different but related problem: that we might create (or cause the creation of) beings that not only satisfy but exceed these criteria. The question becomes whether these are minimal criteria, or hierarchical, such that those who fulfill them to greater degree should be afforded greater consideration. This article questions the validity and necessity of drawing divisions among beings that satisfy the minimum requirements for personhood; considering how future beings—intelligent androids, synthezoids, even alternate-substrate sentiences—might fit alongside the “baseline” human. I ask whether these alternate beings ought to be considered different to us, and why this may or may not matter in terms of a notion of “human community.” The film Blade Runner, concerned in large part with humanity and its key synthezoid antagonist Roy Batty, forms a framing touchstone for my discussion. Batty is stronger, faster, more resilient, and more intelligent than Homo sapiens. His exploits, far beyond the capability of normal humans, are contrasted with his frailty and transient lifespan, his aesthetic appreciation of the sights he has seen, and his burgeoning empathy. Not for nothing does his creator within the mythos term him “more human than human.”

There are manifold intriguing issues located within largely unexplored borderlands of bioethics, future studies (including global risk analysis), and astrobiology. Human enhancement has for quite some time been among the foci of bioethical debates, but the same cannot be said about its global, transgenerational, and even cosmological consequences. In recent years, discussions of posthuman and, in general terms, postbiological civilization(s) have slowly gained a measure of academic respect, in parallel with the renewed interest in the entire field of future studies and the great strides made in understanding of the origin and evolution of life and intelligence in their widest, cosmic context. These developments promise much deeper synergic answers to questions regarding the long-term future of enhancement: how far can it go? Is human enhancement a further step toward building a true postbiological civilization? Should we actively participate and help shape this process? Is the future of humanity “typical” in the same Copernican sense as our location in space and time is typical in the galaxy, and if so, can we derive important insights about the evolutionary pathways of postbiological evolution from astrobiological and Search for ExtraTerrestrial Intelligence (SETI) studies? These and similar questions could be understood as parts of a possible unifying research program attempting to connect cultural and moral evolution with what we know and understand about their cosmological and biological counterparts.

The term “moral bioenhancement” conceals a diverse plurality encompassing much potential, some elements of which are desirable, some of which are disturbing, and some of which are simply bland. This article invites readers to take a better differentiated approach to discriminating between elements of the debate rather than talking of moral bioenhancement “per se,” or coming to any global value judgments about the idea as an abstract whole (no such whole exists). Readers are then invited to consider the benefits and distortions that come from the usual dichotomies framing the various debates, concluding with an additional distinction for further clarifying this discourse qua explicit/implicit moral bioenhancement.

High-fidelity simulation (HFS) is a relatively new teaching modality, which is gaining widespread acceptance in medical education. To date, dozens of studies have proven the usefulness of HFS in improving student, resident, and attending physician performance, with similar results in the allied health fields. Although many studies have analyzed the utility of simulation, few have investigated why it works. A recent study illustrated that permissive failure, leading to simulated mortality, is one HFS method that can improve long-term performance. Critics maintain, however, that the use of simulated death is troubling and excessive. Given the controversy regarding simulated death, we consider the data about the educational value and the emotional harms associated with them, expecting that evidence could be useful in resolving the question. The goal of this narrative review is to explore the argument against simulated mortality and provide educators with an imperative as to why it can be safely utilized.

How individuals tend to evaluate the combination of their own and other’s payoffs—social value orientations—is likely to be a potential target of future moral enhancers. However, the stability of cooperation in human societies has been buttressed by evolved mildly prosocial orientations. If they could be changed, would this destabilize the cooperative structure of society? We simulate a model of moral enhancement in which agents play games with each other and can enhance their orientations based on maximizing personal satisfaction. We find that given the assumption that very low payoffs lead agents to be removed from the population, there is a broadly stable prosocial attractor state. However, the balance between prosociality and individual payoff-maximization is affected by different factors. Agents maximizing their own satisfaction can produce emergent shifts in society that reduce everybody’s satisfaction. Moral enhancement considerations should take the issues of social emergence into account.