In their introductory piece, “Well-Being and Enhancement”, to their edited collection Enhancing Human Capacities, Julian Savulescu, Ruud ter Meulen, and Guy Kahane attempt to define “enhancement” or “human enhancement”, settling on a conception related to well-being. Thus, they reject the idea that there is distinction between enhancement, on one hand, and therapy, healthcare, or medical treatment. All of the latter fall within enhancement.
The definition that they use, on page 7 of the book, is “Any change in the biology or psychology of a person which increases the chances of leading a good life in the relevant set of circumstances.” I hope it’s obvious that this is very broad: it could, for example, cover not only the entirety of good (whatever exactly that means) medical practice, but also much in the way of nutrition, sports training, academic study, moral teaching, and on and on. Perhaps this is, in fact, the ordinary meaning of “enhancement”, as applied to human capacities, as the authors suggest, but by itself it doesn’t tell us what the fuss is all about. There appears to be an idea abroad that some particular set of real or imagined interventions is especially morally problematic, and that the term “enhancement” tracks these. Why – where does that idea come from?
I doubt that we can, in fact, find a plausible set of interventions that: 1. is especially morally problematic AND 2. is well-labeled as “enhancement”, to the exclusion of the label being applied to other interventions (“ordinary” medicine, education, training, controlled nutrition, etc.). Accordingly, there is something going on that I agree with in the thinking of Savulescu and the others. They would have the same doubt. Still, their definition leaves it rather puzzling that there seems to be this widespread fear of something we can call “enhancement”, and which is distinguishable from other interventions. Perhaps later essays in the book will clarify this (perhaps needless to say, I have some ideas of my own).
An obvious problem that arises is what counts as “well-being” or “a good life” (for Savulescu and his colleagues these are tightly connected – a good life and a life of well-being seem to be the same thing). These terms have been contested over many hundreds of years – indeed one ancient conception of ethics is the search for an answer to the question, “What is the good life?” Furthermore, the debates appear intractable.
Savulescu and his colleagues are well aware of this problem, and they acknowledge that theories or conceptions of the good, or well-being, include hedonistic, desire-fulfilment, and objective list theories (page 10). There are doubtless others, such as the theory that well-being is rightness with God. Depending on which of these theories we adopt, we might classify a particular intervention as enhancing or detrimental.
Savulescu and colleagues would respond, first, that some interventions are enhancing (and some are detrimental) on any plausible conception of a good life. In practice, therefore, we can identify a very wide range of interventions as either enhancing or detrimental without much controversy. We might still think that certain enhancing interventions are morally wrong, all things considered, e.g. if they give the person who has been enhanced an unfair advantage over others. However, on this approach, the typical case will not be one where we have difficulty deciding whether the intervention was enhancing for the individual concerned.
This is attractive insofar as it allows us to distinguish between the question of whether an intervention is good for the person immediately affected and the question of whether or not the intervention was a morally good act, all things considered. That is, I think, a distinction that we want to be able to make. I suspect, however, that it is going to difficult to reach agreement in a wide range of cases, especially if we allow (and what’s the case against it?) people to make their own judgments and criticisms based on the full range of possible understandings of the good life, including understandings that involve some kind of otherworldly dimension to human life, as is typical of religious ideas of the good life.
Savulescu and his colleagues are political liberals, and they think that the state should defer to individuals’ conceptions of their own good, or well-being. Generally speaking, I agree. But it looks like there might be limits to this, and in any event decisions are often made by parents about children. It’s not so obvious that the state can be neutral, or anything like it, when these sorts of decisions are involved.
I’m sure that I’ll hear more about these problems as I come to later essays in the volume. Meanwhile, these are some of the problems I see looming.