Reviewed by Robert Swan

The deep concern that parents show for the education of their children flows from love but has an unmistakable whiff of Darwinian struggle about it. In evolutionary terms, parents are in the business of making their children ready for business. The struggle for position in a world of limited resources makes a child’s abilities of more than merely academic interest. Additionally, we are mortal beings, concerned with living as long as possible and with improving the quality of our existence. If you were offered a magic pill that could enhance a given mental or physical capacity, giving you or your child an edge in terms of physical health, IQ, even emotional stability and mood, would you take it?

Medical science is in the process of providing a leg up on evolution, and Allen Buchanan’s new book is designed to explore the pros and cons of biomedical enhancement from a philosophical and practical point of view. It should be read by anyone interested in the public policy implications of, and ethical issues related to, the growing ability to apply scientific techniques to improve human capacities.

Some definitions are essential:

“An enhancement is an intervention — a human action of any kind — that improves some capacity (or characteristic) that normal human beings ordinarily have or … that produces new ones … A biomedical enhancement uses biotechnology to cause an improvement of an existing capacity by acting directly on the body, including the brain.”

Given the ghastly history of the 20th century, the idea of biomedical enhancement (BME) naturally gives many people the shivers. Buchanan, who is clearly a BME booster, is not suggesting that we proceed with BME without considering the very real and serious concerns of people of good will who find the prospect of BME disturbing. There are excellent reasons for being leery of moving too fast to embrace BME. What Buchanan argues is that there is no prima facie case for banning it altogether, or for prohibiting research into new opportunities for BME.

The hype which associates BME with Platonic eugenics, the Nazi lebensborn program, or marching columns of human “ready-mades” designed for conquest and produced to cookie- cutter specifications, flows from what Buchanan describes as “BME exceptionalism.” This is the idea that just because an enhancement has something to do with biology, it is “off the moral scale.” According to some critics, BME’s implications for who, and what, we are as human beings are so serious that research and development in a variety of BME contexts must simply be prohibited.

Buchanan points out that we already accept non-biomedical enhancements to human capacities in many contexts. For example, such historical developments as literacy, numeracy, science and the agricultural revolution constitute enormous long-term cognitive and social enhancements. Should these “historical” enhancements have been prohibited because of potential problems associated with resulting alterations in social or political systems, or the altered mental and physical capacities of those who benefitted from the changes?

Critics might counter that BME is fundamentally different. By directly tampering with our basic design, our biological structure, we are interfering with nature and, more importantly, human nature, God-given — if you are a believer — or otherwise. But BME does not create new beings from whole cloth. BME merely goes beyond therapy to “improve normal functioning.” Human beings have for years employed “back door” applications of BME, like mood-enhancing or mind-focusing drugs. These are “back door” applications because the BME was a by-product, an unintended consequence of treating a pre-existing disease or disorder. Buchanan suggests we seriously consider “front door” applications, intentionally designed BMEs.

Buchanan is clear about the types of improvements in performance to be expected, including “cognitive function; physical strength, speed and stamina; mood, temperament, and emotional functioning; and longevity.” No supermen spitting in the eye of God envisaged here. The criticism that we are somehow interfering with nature is misplaced. Consider the fact that human beings are already altered, naturally, over time, by random gene mutations, which may themselves have serious unintended consequences. Evolution, a perfectly natural process, does a pretty poor job given the randomness of the changes it engenders and the length of time required for those changes to manifest themselves. Our biology is thousands of years out of sync with our present environment. This causes a lot of trouble.

A simple illustration of the type of trouble engendered by evolutionary lag-time is evident all around us. How often have we been warned of late about the obesity epidemic, and the alarming global increase in levels of diabetes and heart disease? We love fatty, salty, sugary foods (I know I do). Why do we love them? We crave these foods because they were high-calorie energy providers tens of thousands of years ago, in a situation of severe scarcity. But the behavior flowing from these perfectly natural desires is actually inimical to our health today, when in many parts of the globe there is a superabundance of food. We’d all be better off if we weren’t drawn to Twinkies and blocks of cheddar cheese like steel filings to a magnet.

Well, shouldn’t we be able to control ourselves? That’s a character issue. Buchanan takes seriously the charge that we may become “morally flabby” by using BME to remove the need to strive against our own worst desires. But this amounts to arguing: life should be painful and difficult in order to make us … more adept at dealing with pain and difficulties, tougher in other words. Certainly there are character issues with any improvement in the human condition. This perspective has garnered support among a diverse set of thinkers and has a venerable pedigree. Among those expressing one or another version of this idea, religious ascetics from many traditions, as well as ancient Cynics, have advocated the moral and spiritual as well as practical benefits of a strong will and self-discipline. Heinrich von Treitschke, a 19th century German historian, advocated war as a tonic against self-indulgence and moral rot. It is a mainstay of fascist belief that struggle and self-denial counter the effects of soft living, bourgeois luxury and self-indulgence. But should any of us really desire life to be less pleasant or easier than it might be in the name of an abstract principle requiring us to turn our backs on medical progress so that we may remain in the fight to stay trim?

It’s a complex question. Most improvements to the human condition have made life a little physically easier, or more efficient, or more convenient, thereby engendering the same character concerns raised in relation to BME. Buchanan asks: Why not help nature along? If (and that’s a big if) gene manipulation would aid in reducing our intense desire for delicious but deadly comestibles, why should this option be rejected out of hand? Random mutations burdened us with the desire; intentional changes can perhaps remove it, with commensurate social benefits (increased health, lowering of insurance premiums, etc.).

Those who assert that something should not be done because it is “against nature” commit a very serious philosophical error: what it does not imply is a standard for what ought to be. An argument must be made for why a harmful human trait should not be eliminated if we have the power to do so. Ask yourself where the limits of “transgressing the bounds of nature” should fall. Technically, medical science interferes with nature all the time. Nature insists we die when we contract a terminal disease, but few would suggest that we should not provide treatment to ameliorate suffering or attempt to save someone’s life. Intuitively, we have the sense that the right thing to do is to intervene. What about other technologies that at one time might have implied that human beings are overstepping their bounds, playing God, or engaging in hubristic behavior? Think about it the next time you board an airplane and fly to your favorite vacation destination. The last time I checked, neither nature nor God gave us wings.

Small changes to the human organism do not necessarily mean that the entire structure of our being will alter, or that the enhancements will have a debilitating ripple effect. The human organism is not so densely interconnected and is designed to be flexible in relation to random mutations in genes. Undertaken correctly, humans can employ carefully limited and targeted techniques — Buchanan provides a thoughtful guide on how to approach BME carefully and responsibly — to engender improvements without bringing the sky down upon us.

What should be evident from all this is that BME does not promise a panacea for life’s ills; just because a given characteristic is improved does not mean that one’s life will be better overall. It does mean we may have an increased capacity to seek a better life, or be more effective in ameliorating negative aspects of our condition. Buchanan believes that the risks represented by using and continuing to study and develop BME are far outweighed by present and future potential benefits.

I cannot do justice to the richness of Buchanan’s analysis in the scope of this review. Buchanan is a first-class guide through the complex thicket of issues and arguments related to BME. He employs “epistemological excavation” (his term) to parse meanings, explore implications and deal with counterarguments, bringing clarity to a difficult, ongoing and often contentious debate. Convincing illustrative examples and thought experiments undergird his contentions. He consistently demonstrates the power of developing proper definitions in exploring policy implications. His book is the strongest possible illustration of the value of philosophical reasoning and reflection in the public arena.

Robert Swan teaches history and philosophy in the International Baccalaureate program at Richard Montgomery High School in Rockville, Md.