We Must Decide Who We Are
to
Determine Who We Become
Philosophical Pre-Requisites to Technological Self-Determination
Kevin T. Keith
IHEU Conference, 12 May, 2007
Deciding Who We Are,
Determining Who We Become
Patient autonomy – pre-requisites
• Competence
• Full information
• Voluntariness
Respect for autonomy comes wrapped in a paternalistic package: For their own
good, patients must meet minimal criteria to qualify to have their wishes and
desires respected.
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Deciding Who We Are,
Determining Who We Become
Patient autonomy – deviation triggers challenge
• Competence
• Incomprehensible requests
• “Harmful” requests
• Indifference to: pain; appearance; normal species functioning
• Full information
• Unusual requests
• High risk acceptance
• Voluntariness
• Motivation other than presumed best interests (and religious belief)
Deviation from expected desires for / requests for / interest in / uses for healthcare
technology prompt suspicion of illegitimate motivation. Non-standard requests for
technological intervention are presumptively non-autonomous.
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Deciding Who We Are,
Determining Who We Become
Autonomy: Standard model is normative, not descriptive
• Accepted norms (mental, physical) define autonomous desires
• Non-standard desires are evidence of sub-standard thinking
• Deviant evaluative conclusions signify inadequate capacity / information
• Taking the wrong risks, wanting the wrong things, is not “authentic”
• Motivation (desires, values) signifies – not drives – decision-making
• Your desires are evidence of your mental health
• De gustibus est disputandum
The standard model of autonomy presupposes a particular vision of human nature
and human body norms. This model is built into our expectations not merely of
what humans look like or do, but who they are and how they think.
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Deciding Who We Are,
Determining Who We Become
To be autonomous, you must have decisional capacity
To have “wrong” desires is to be mentally ill
To be mentally ill is to lack decisional capacity
Therefore:
To be autonomous, you must not have “wrong” desires
Socially expected desires / values / intentions / goals are psychologically
normative, therefore morally normative.
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Deciding Who We Are,
Determining Who We Become
Desires translate to moral standing
• Having “wrong” desires indicates disordered thinking
• Disordered thinking indicates lack of decisional capacity
• Lack of capacity equates to lack of autonomy
Your moral authority over your own life is in part defined by the content of your
desires, not your process of evaluation of your desires.
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Deciding Who We Are,
Determining Who We Become
Technological enhancement challenges a normative
vision of human nature
• If we are “supposed to be” . . . something, it is wrong to be
otherwise
• Enhancement violates perceived norms of human nature
• Endorsing enhancement implicitly rejects such norms,
and vice versa
Adopting, and investing in, a regime of technological enhancement requires
repudiating normative constraints on what humans should be / can be / are
allowed to be.
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Deciding Who We Are,
Determining Who We Become
Challenging the normativity of human nature
is . . . unsettling, to some . . .
Anti-enhancement sentiment is often driven by a commitment to the normative
vision of human nature. Embracing enhancement is a threat to moral standards.
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Deciding Who We Are,
Determining Who We Become
“Immoderate desires and aspirations make us impatient with the
frailties of human nature and the contingencies of social
institutions, prompting us to try to overcome these imperfections by
creating a new man, a new society and a new polity. Such
enterprises, history remind us, are fraught with peril. . . .
Contra naturam, the defiance of nature, used to be a sufficient
argument for those who were not persuaded by contra deum,
provoking the wrath of God. But what does it mean today, when we
have defied, even violated, nature in so many ways, for good as
well as bad? If cloning is against nature, is not also artificial
insemination, or in vitro fertilization, or, for that matter, the pill?”
 Gertrude Himmelfarb, “Two Cheers (or Maybe Just One) For Progress
Difference itself – transcendence, enhancement, norm violation – is an argument
against difference from the anti-enhancement position.
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Deciding Who We Are,
Determining Who We Become
“[G]etting from here to post-humanity will exact a steep moral price.
..
The technological breakthroughs necessary to create a true posthumanity will almost surely never come. But this doesn't mean that
transhumanism is benign--far from it. Dismissing the intrinsic value
of human life is always dangerous, and presuming to determine
which human traits are desirable and which not leads to very dark
places.”
 Wesley J. Smith, “The Catman Cometh”
Difference itself – transcendence, enhancement, norm violation – is an argument
against difference from the anti-enhancement position.
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Deciding Who We Are,
Determining Who We Become
“Libertarian advocates of genetic choice want the freedom to
improve their children. But do we really know what it means to
improve a child? It is hard to object to therapeutic aims, such as the
elimination of genetic tendencies toward diseases. But would a
child be ‘improved’ if parents were able to eliminate genetic
propensity toward gayness? Would the child of an AfricanAmerican couple be ‘improved’ if she could be born with white
skin? Would boys be better human beings if they were born with
less of a propensity for aggression? The possibilities for politically
correct, or incorrect, parental choices are endless . . . .”
 Frances Fukuyama, “The Fall of the Libertarians”
Difference itself – transcendence, enhancement, norm violation – is an argument
against difference from the anti-enhancement position.
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Deciding Who We Are,
Determining Who We Become
“[G]enetic intervention to create a deaf child would constitute a form of
child abuse that would in theory justify state action to protect the child. . . .
So what to do about deaf parents who want deaf kids? . . . The best
approach is probably an indirect one, such as some sort of liability for the
doctors and others who perform prenatal genetic alterations. If the doctor
who deliberately creates a deaf child has to pay for the youngster's special
education, I don't think we'll see a lot of medically assisted child abuse. It
would also help in the long run (though at the cost of considerable pain in
the short run) to eliminate the many protections and privileges accorded
disabled individuals. These may be less than perfect policies, but this is a
less than perfect world. The alternatives are worse . . . .”
 Virginia Postrel, response to Fukuyama
Difference itself – transcendence, enhancement, norm violation – is an argument
against difference from the anti-enhancement position.
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Deciding Who We Are,
Determining Who We Become
“The Council’s experience of considering these disparate subjects under this one big idea— ‘beyond
therapy, for the pursuit of happiness’—and our discovery of overlapping ethical implications would
seem to vindicate the starting assumption that led us to undertake this project in the first place:
biotechnology beyond therapy deserves to be examined not in fragments, but as a whole. . . .
Taken one person at a time, with a properly prepared set of conditions and qualifications, it will be
hard to say what is wrong with any biotechnical intervention that could improve our performances,
give us (more) ageless bodies, or make it possible for us to have happier souls. . . .
If there are essential reasons to be concerned about these activities and where they may lead us,
we sense that it may have something to do with challenges to what is naturally human, what is
humanly dignified, or to attitudes that show proper respect for what is naturally and dignifiedly
human. As it happens, at least four such considerations have [been identified]: appreciation of and
respect for ‘the naturally given,’ threatened by hubris; the dignity of human activity, threatened by
‘unnatural’ means; the preservation of identity, threatened by efforts at self-transformation; and full
human flourishing, threatened by spurious or shallow substitutes.”
 President’s Council on Bioethics, Beyond Therapy: Biotechnology and the Pursuit of Happiness
Difference itself – transcendence, enhancement, norm violation – is an argument
against difference from the anti-enhancement position.
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Deciding Who We Are,
Determining Who We Become
It cannot simply be the pursuit of improvement that is making anti-meliorists nervous . .
. They fear that in applying new biomedical knowledge to improve human beings,
something essential about humanity will be lost. If biomedical tinkering is allowed, we
will destroy the very thing that makes us human—our nature.
Anti-meliorism rests, however, on a very shaky foundation. To support their position, the
anti-meliorists must state what human nature is. They do not. They must also be very
clear about why they see human nature as static. They are not. And they must advance
an argument about why human nature, which has presumably evolved in response to
an enormous array of random forces, tells us anything about what is good or desirable
in terms of the traits humans should possess. They cannot. . . .
Ultimately, anti-meliorism posits a static vision of human nature to which the antimeliorists mandate we reconcile ourselves. If anything is clear about human nature, it is
that this is not an accurate view of who we have been or what we are now, or a view
that should determine what we become.
 Art Caplan, “Nobody is Perfect – But Why Not Try to be Better?”
The normative view of human nature is both ahistorical and morally ungrounded –
an expression of preference rather than an invocation of principle.
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Deciding Who We Are,
Determining Who We Become
However . . .
The perception of a “natural” way of being is widespread, intuitive
• Not something most people will give up
• Fear of “other” or becoming “other” an important emotional driver
• “The preservation of identity” (President's Council)
• Many people want “more of the same”, not “more of something else”
• Promoting “the new you” will not win over those who liked the old thems.
Forcing change in self-definition / self-understanding is as great an imposition as
prohibiting it.
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Deciding Who We Are,
Determining Who We Become
Biotechnology: “examined not in fragments, but as a whole”
(President's Council)
• Broad/narrow perspective has moral implications
• “Harm” of enhancement: to the individual or to society/humanity?
• Modeling the conflict as individualist vs. communitarian tilts the playing
field one way or the other
• Competing moral principles:
• Self-determination vs. Society/Species norm
• Self-identification vs. Human nature
Rhetorically, setting the terms of debate is the winning strategy; morally,
identifying the determinant perspective or decisive principle plays the same role.
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Deciding Who We Are,
Determining Who We Become
Acceptability of enhancement depends upon the width of
the normative space
• “Enhancing” means expanding the range of the normal
• This requires expanding the range of the normative space
• The question is whether any particular technology falls within the
acceptable range
• The “width of the normative space” - the size of the acceptable range –
determines what falls inside/outside
The conflict is not between competing visions of human nature, but between
competing norms for ways of being human.
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Deciding Who We Are,
Determining Who We Become
Expanding the normative space: Possible stances
• There is no human nature
• Each person defines their own nature/identity; society defines acceptable
behavior
• Human nature is malleable
• Has changed historically (lifespan, gender dichotomy)
• Individuals can change their own (personality development, therapy,
catharsis)
• Human nature is fixed but minimal
• Sociobiology posits inherited behaviors – all are socially controllable
Human nature is not normative, whatever else it may be. Enhancement is a
question of autonomy, not biophysical normativity.
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Deciding Who We Are,
Determining Who We Become
“Who we are”: Beings of varied and fluid natures
• “Experimenters in life”
• Diversity of communities, generational / gender relations
• Community-builders
• Form, define, change types / structures of communities
• Cyborgs
• Technology now an integral part of biophysical normative space
The defining feature of human nature is the lack of fixed norms. Enhancement is a
response to open possibilities, not a transgression of inherent limits.
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Deciding Who We Are,
Determining Who We Become
“Who we are”: Self-makers and self-seekers
• Self-definitional
• Unconstrained by non-biophysical limits
• Exploratory
• Tending into new areas / avenues / modes (cf. body mod movement)
• Creative
• Attach value to newness / uniqueness / broadened possibilities
Enhancement is properly seen as self-definitional, thus a question of selfdetermination.
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Deciding Who We Are,
Determining Who We Become
“Who we may become”: Explorers of wider territories
• Wider normative range grants greater freedom for self-definition
• Moral grounds for limitation / prohibition of technology use must be
articulated
• Expansivity is not moral anarchy
• “Plain old ethics” still holds sway
• Moral reasons may be given for / against technologies or policies;
ungrounded norms are out of court
Moral debates over enhancement must be undertaken on rational and factual
grounds.
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Deciding Who We Are,
Determining Who We Become
Notes:
• Caplan, Arthur, “Nobody is Perfect – But Why Not Try to be Better?”, in Caplan
A, Elliott C (2004) Is It Ethical to Use Enhancement Technologies to Make Us Better
than Well? PLoS Med 1(3): e52 doi:10.1371/journal.pmed.0010052 [accessed 5/11/2007]
• Fukuyama, Francis, “The Fall of the Libertarians”, WSJ Online,
http://www.opinionjournal.com/editorial/feature.html?id=105002013 [accessed
5/11/2007]
• Himmelfarb, Gertrude, “Two Cheers (or Maybe Just One) for Progress”, Wall Street
Journal, 5 May 1999
• Postrel, Virginia, blog post: http://www.dynamist.com/weblog/archives/2002/apr29.html
[accessed 5/11/2007]
• President’s Council on Bioethics, Beyond Therapy: Biotechnology and the Pursuit of
Happiness
• Smith, Wesley J., “The Catman Cometh”, The Weekly Standard, 26 June, 2006
Presenter:
Kevin T. Keith
City College of New York – Center for Worker Education
ktkeith@panix.com
www.sufficientscruples.com
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