We Must Decide Who We Are to Determine Who We Become

1
We Must Decide Who We AretoDetermine Who We
Become

• Philosophical Pre-Requisites to Technological
  Self-Determination

Kevin T. Keith IHEU Conference, 12 May, 2007
2
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.
2
3
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.
3
4
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.
4
5
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.
5
6
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.
6
7
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.
7
8
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.
8
9
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.
9
10
Deciding Who We Are,Determining Who We Become

• Getting from here to post-humanity will exact
  a steep moral price. . .
• The technological breakthroughs necessary to
  create a true post-humanity 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.
10
11
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
  African-American 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.
11
12
Deciding Who We Are,Determining Who We Become

• Genetic 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.
12
13
Deciding Who We Are,Determining Who We Become

• The Councils experience of considering these
  disparate subjects under this one big idea
  beyond therapy, for the pursuit of
  happinessand 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.
• ? Presidents 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.
13
14
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 humanour 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 anti-meliorists
  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.
14
15
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.
15
16
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.
16
17
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.
17
18
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.
18
19
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.
19
20
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
self-determination.
20
21
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.
21
22
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
  doi10.1371/journal.pmed.0010052 accessed
  5/11/2007
• Fukuyama, Francis, The Fall of the
  Libertarians, WSJ Online, http//www.opinionjourn
  al.com/editorial/feature.html?id105002013
  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
• Presidents 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_at_panix.c
om www.sufficientscruples.com
22