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If Nanotechnology Were a Magic Wand What Obligations Would it Bring?
Or: The Right to Enhance Versus the Right to Morphological Freedom
Heather Bradshaw
Abstract
Sometimes nanotechnology is referred to as a 'magic wand' which will allow us to do almost anything we want with physical matter. What if it were? Then the medical institutions could not just offer 'therapy' but 'cures' for spinal cord injury, deafness, even nerve related deafness; macular degeneration, asthma, muscular dystrophies, cerebral palsy and so on. They could do that in the womb or for adults. There would be no question of 'curing' by denying life. Would there then be an obligation to 'cure' or 'fix' everything, at birth and later? Some adults might not want a cure, having adapted and formed a new identity. Some parents may not see a need for a cure for conditions not seen as negative.
But once that generation had passed, surely there would be an obligation on everyone to use this technology at every possible opportunity? But why? If we had such control over physical matter then the extra financial costs of accommodating those with unusual body morphology would also be dissolved.[1] In that environment and society what motivations could there be for choosing a particular morphology over others? How might diversity be regarded then? What differences would it be acceptable for society to impose on a few members for the education of all? This paper will consider possible obligations on reproducers and others in this imagined world and then ask whether these considerations have any relevance for the decisions we make today about nanotechnology applications.
Introduction
Nanotechnology as a "Magic Wand"
Molecular engineering the potential endpoint of nanotechnological development,[2] would greatly change our relationship with the material world (Drexler, 1990). Current limits on our medical and economic resources and powers would melt, changing our attitudes to our bodies and environments. We could make body parts to replace those damaged or missing. We could also create novel body additions or modifications or remove parts. By engineering from the atoms upwards we would also be able to shape the material world outside our bodies more easily.
Not Therapy but "Cure"
This kind of nanotechnology would enable us to alter the genetic makeup and physical characteristics of existing gametes, embryos and people (Drexler, 1990 p104-105) without replacing them.[3] We could rewrite the DNA in every cell in someone's body, (Drexler, 1990 p108) deleting the extra repeats in muscular dystrophy (Hoshiya, 2008), or adding the missing repeats in some forms of eczema (Brown & Irvine, 2008). A child with the extra chromosome associated with Down's syndrome or other trisomies could have some or all of the extra chromosome or chromosome parts removed early in gestation or even perhaps after birth. A blastocyst having one of the unusual chromosome layouts associated with deafness due to lack of connexin-26 protein (Nickel & Forge, 2008) could become a hearing child, rather than being replaced by a different, "hearing," blastocyst.[4] An adult deafened through years of exposure to high decibel levels or infections could have their ears re-engineered to retain the frequency sensitivity of a child's ears. The cochlea hair cells could be re-grown or recreated as required. "Hearing aid" would actually alter the inner design of the ear, not pummel it with ever larger pressure waves. There would be no need to deny life to particular embryos, or to limit reproduction, in order to increase conformity in a population. Morphological conformity would be available to anyone who wanted it.
Many people dearly want to be "cured" and to have abilities comparable to those of their peers. But not everyone does. For example, in a series of interviews with spinal cord injury patients Jonathan Cole asks one man, David, whether he would want to walk again. David has had a long struggle to adapt to his condition and has finally, after many decades, made an independent life he enjoys. He tells Cole he would not want to be cured even if someone could wave a "magic wand" and offer him a full recovery.
Even then I don't know. It's been a struggle to get to where I am now-all sorts of hurdles along the way which I have achieved or fallen over-but I'm pretty happy with who I am. I don't really feel the need to change, be it by magic or not. (David in Cole, p79)
This shows how human difference and variation can be important to an individual's social and psychological identity. Forcing cure or conformity on people against their will violates liberal ethical principles, for example that individuals should be autonomous, and that behaviour should be tolerated as long as it does not harm others, sometimes known as the Harm Principle (Mill 1974 p119-120). But under some circumstances we do expect individuals to do all they can to maximise their contribution to their society and that often appears to require morphological conformity (though not usually to the extent of suicide in our society). [5] Wounded soldiers in war time are expected to recover as fast as possible and return to battle. Malingering is morally opprobrious. Unruly teenagers are expected to cut their hair, wash more often and conform in dress and behaviour in order to take their place as productive, earning, members of their society. Will greater availability of "cures" increase pressure to conform, and when do individuals have an obligation to conform which should override their autonomous choices about their morphology?
Morphological freedom, or the right to freely choose your body form, is a key tenet of transhumanist thinking:[6]
As a negative right, morphological freedom implies that nobody may force us to change in a way we do not desire or prevent our change. This maximizes personal autonomy. (Sandberg 2001, p2)
Seeing morphological freedom as a basic right is one such safeguard. If it is widely accepted that we have the right to control how our bodies are changed both in the positive sense (using available tools for self-transformation) and in the negative sense of being free not to change, then it becomes harder to argue for a compulsory change. (Sandberg, 2001 p5)
From this perspective, an improvement to the human condition is a change that gives increased opportunity for individuals to shape themselves and their lives according to their informed wishes. Notice the word "informed". It is important that people be aware of what they choose between. Education, discussion, public debate, critical thinking, artistic exploration, and, potentially, cognitive enhancers are means that can help people make more informed choices. (Bostrom, 2003, p31)
But morphological freedom is often transmuted into a weaker "right to enhance":
According to transhumanists, the human condition has been improved if the conditions of individual humans have been improved. In practice, competent adults are usually the best judges of what is good for themselves. Therefore, transhumanists advocate individual freedom, especially the right for those who so wish to use technology to extend their mental and physical capacities and to improve their control over their own lives. (Bostrom, 2003, p31) (My italics.)
John Harris in his 2007 book Enhancing Evolution also develops this restricted conception of morphological freedom. Savulescu's Principle of Procreative Beneficence (Savulescu, 2001) leans in this direction, although in practice Savulescu qualifies his position in favour of a fuller morphological freedom and a nuanced obligation to enhance. (Savulescu, 2002). I wish to argue for a position slightly beyond even Sandberg's.[7] Morphological freedom needs to encompass enhancement, remaining the same, and, in some cases, the use of technologies to add limits where those limits do not harm others. Such a strong conception of morphological freedom requires careful thought about the concomitant responsibilities to contribute to society, and it is here that the possibilities of powerful nanotechnology play a significant role which I wish to explore in this paper.
But first a methodological note. The aim of this paper is not to explore futuristic possibilities (that is its method) but to stimulate thought about the ethical status of our reasons for accommodating or normalising unusual morphologies today, which I understand from "If and Then: a Critique of Speculative Nanoethics" Alfred Nordmann would have sympathy with:
In other words, there is nothing wrong with public debate of human enhancement technologies or molecular manufacturing where such visions provide a backdrop for society to reflect upon itself. However, if the point is to demonstrate foresight or to debate the ethics of technologies that converge at the nano scale, claims about human enhancement are misleading and serve only to distract us from comparatively mundane, yet no less important and far more pressing issues. (Nordmann 2007 p 43).
I make no claims to foresight about what will happen, only to acknowledge the breadth of imagined possibilities about what might happen. Readers sceptical of nanotechnology, and in particular the practicality of realising the theoretical possibility of molecular engineering, may wish to substitute the magic wand referred to in the title. For non-sceptics the paper may also have something to offer towards the evaluation of potential benefits from making certain choices today about science and technological research funding. In as far as such research funding decisions are not considered a mundane and pressing (ethical) issue to Nordmann, after his self-admittedly brief exposure to the use of imagination in philosophy about the future, Roache (2008) suggests how a possible confusion about the combination of probability and value might underlie the objections to comprehensively imagined possibilities in Nordmann's 2007 paper and also in work by Manson, Keiper, Weckert, Moor, Crow and Sarewitz. With this in mind let us move on to how nanotechnological "cures" might be used, were they available.
Section 1: Obligations to "Cure"
What might motivate an obligation to "cure"?
To begin, let us consider why society might want to wave a curative nanotechnological magic wand. It is important to explore the common assumption that any right thinking person would (a) want to "cure" impairments in others and (b) want to have any of their own impairments removed. Unpicking this is important because there are examples of intelligent, moral, otherwise rational people who do not want to have their own impairments removed. (For example the take-up of cochlear implant technology by the deaf community has been lower than the inventors expected (Blume 1999, Blume 2000)). The existence of people who have apparently freely made choices to remain "uncured" challenges the assumption.[8] What, if "curing" is not in accord with the wishes of those we expect it to benefit, might motivate our assumption?
The first and primary motivation is a wish to improve the well-being of those "cured". This is assigned great strength, and for many people "cure" does improve well-being.
But it can be objected from empirical work that some individuals, like David above and many members of the Deaf community, do not want to be "cured" not because of the limitations of current curative technologies but because they do not think this will improve their well-being. Others insist their well-being is not particularly low (Albrecht & Devliger 1999).
One reply to this is to say that such people are mistaken, they are not fully informed (see Bostrom, 2003, p31 , and Griffin's conception of well-being as the fulfilment of informed desired (Griffin, 1986)). These people have only experienced life with significant limits, and they find this satisfactory. What they do not know is that they are making do with far less than a non-limited life has to offer. The benefits of such a full life will outweigh the negatives of adapting to the change and even of developing a new identity.[9] Further, it is assumed to follow that those who experience the full life are thus in a better position to assess their situation than those whose experience has always been limited are.
Note that exactly the same point can be put to those who see no need for human enhancement: they do not know (and perhaps cannot imagine) how much better an enhanced life would be. Bostrom and Ord (2006) call this Status Quo Bias.
My response to this reply is to point out that there is equal ignorance on both sides. Life with limits may have some advantages which those of us who have not experienced it cannot immediately appreciate. Limitations in abilities or energy may have forced people to choose where they direct their resources more carefully (for example to more enduring sources of satisfaction than the accumulation of material possessions through economic competition), or shown them what it means to be without something we take for granted (human relationships, in the case of deafness), and hence what its true value is. Indeed, people who have lived with limits may have important things about values, ethics and living the good life to teach those who have not had these experiences. Different limits highlight different values and in this lies part of the benefit of diversity.
Those with unusual morphologies may feel it is easier to stay true to their values if they keep their limits, because these limits partially protect them from competitive and other pressures which threaten their values. Or they may value their place in their own communities. That is, they may be aware that their status would be lower in the wider world (even if their particular difference were entirely removed) and they may rationally (Layard, 2006) realise that status loss reduces well-being. In such cases "curing" them would genuinely not contribute to their well-being. Because of such complications we should treat the assumption that "cure" always contributes to well-being with great caution, even suspicion. (Of course, there are people who have already been "cured". Their judgements are of great value, but still likely to be biased by their wish to validate their own choices.) If improving others' well-being is our true motivation then pressing unwanted "cures" on people is too obviously an inappropriate act. What other motivations might be operating?
A second and less often mentioned motivation is the economic cost to society of diversity and difference.
Perhaps we are actually concerned to reduce the 'costs' to society of accommodating those with different morphology. A cochlear implant, and the therapy to maximise its usefulness, has been assessed as cheaper than providing the seven or nine years of sign language supported special education otherwise required (Cheng et al 2000).
Being physically different in a mass production economy imposes costs. A minor example: people with an unusual number of digits must have gloves made to order. They cannot avail themselves of the benefits in terms of price and, often, choice that mass production creates. Usually extra digits are removed. Cars, chairs, beds and gym equipment are all made for people with a limited range of heights and weights. Clothes, bathrooms, garden tools and the like all presuppose two arms and two legs and a minimum and maximum of height. Hotel rooms, aeroplanes, doctor's waiting rooms and other public spaces often assume a tolerance for soft furnishings, pot plants and even other people's animals that is not available to those with allergies or other immune system dysfunctions. Streets, stairs, lifts, signs, announcements and product labels are all unfriendly to certain body morphologies. Making all of these things suitable for all morphologies is complex and costly. Multiple mediums have to be provided, buildings must be modified, often using underdeveloped, low volume and therefore expensive technologies.
Widespread adoption of molecular manufacturing (Drexler 1990 p59 -60) would eliminate the drawbacks of single-item production. The limits would be the creator's imagination and design skills rather than the production process. Being different might still impose some costs: common designs might be available to download while more unusual designs would require more creator input, but this would be time and brainpower input rather than financial or physical. But still clothes, garden tools, bathrooms, and other goods could be created to exactly fit one's morphology.
Modification of public spaces also requires the solution of social coordination problems. Not only are there the inequities of cost-benefit reasoning to overcome but decision-making also requires public authority and/or consensus. From requesting having an icy pavement cleared through gaining permission to alter a listed building or move pavement furniture, to changing the law to require access modifications, social action is time consuming and requires considerable political and social resources, networking and effort. The social institutions available for such negotiation are currently not unbiased or themselves always accessible to those of unusual morphologies. The development of better methods of overcoming such coordination problems, and of increasing the political power of groups for whom current public space compromises are not suitable, is an extremely important and valuable activity which is likely to result in benefits for a wide range of disadvantaged groups in society including parents, those without cars, and the growing group of people involuntarily impaired by the extension of lifespan without concurrent extension of healthspan.[10] Social model thinking -- that the disability is due to the action or non-action of the wider society and not to the impairment-- has already been politically effective here and the development of campaigning models and new institutions also represents progress in a number of fields. However, it remains the case that the need to rely on social action to provide individual access makes those requiring such changes asymmetrically and unusually dependant on society for their personal mobility. Yet in many societies and situations people have been keen to separate their freedom of movement from the control or even influence of others.
Molecular manufacturing might be able to redress this asymmetric dependence on society for personal mobility. For example enabling individuals to temporarily modify the physical world. They might achieve a fit of morphology and environment comparable to that experienced by commoner morphologies, but by modifying the environment not the morphology. For example perhaps wheelchairs could carry inbuilt ramp producing nanofactories or be able to change the properties of the surfaces ahead of the wheels to increase grip. As users take more control of the design and manufacturing process perhaps there will be great progress in exoskeleton and other mobility technologies. Audio to sign language and sign to speech technologies are already easily conceivable. Availability may be currently restricted by market size and poor technological resource access for potential early adopters and developers. Similarly the effectiveness of Braille labels on lifts, bathrooms and consumer goods could be vastly improved with the use of radio tag technology.[11] Greater access to manufacturing technology might generate more creativity from those who fully understand what would be most helpful for their particular morphologies.
So molecular manufacturing might make single item production of goods as economically efficient as mass production, thus significantly reducing the economic costs to the individual and to society of diversity. At the same time the same technology might give individuals more power to temporarily modify unacceptably designed public spaces to accommodate their morphologies. Whilst this would be a negative if it reduced the drive to make public spaces acceptable to all members of the political community or public for which they are provided, it would perhaps provide individuals with significant benefits in before that goal is achieved, and possibly even assist them to assert their political rights more effectively. Together, this temporary ability to modify the environment plus improved institutions for agreeing public space compromises might significantly reduce the transaction costs and interaction frictions of diversity in political communities.
Therefore the economic and (practical) political motivations to change or "cure" the individual might become less important in a fully molecular engineered world as diversity costs reduce and environmental control returns to the individual. But are these costs ethically acceptable motivations for "curing" people today?
The third motivation for "cure" is a second sort of cost to society, the cost of lowered competitiveness of the social group. Consider two hunter-gatherer tribes. In one there is a high incidence of muscular dystrophy. In the other there is a low incidence. Which is going to be more successful at food finding, at fighting? Which tribe will survive, which will surrender?[12] Perhaps our well-being overriding desires for conformity and "cure" arise from our competitive, resource-starved evolutionary history. That is not to say that the same skills were important then as now, but only that our preferences might have been formed in an environment where the relative importance of skills was different. A preference for strength over intellectual skills, or verbal over written communication skills might have been rational then, when today it is not so, and becomes instead an unjustifiable prejudice. This prejudice in turn becomes ensconced in social traditions. For example, today, broadly speaking, service and commercial work dominates the economies of developed countries.[13] Although much of this does not depend on physical abilities for its performance, as say hunting does, or as traditional male employment did, neither does it place a premium on intellectual ability or educational achievement as a generally high (historically) level of literacy is assumed. Instead certain skills of social presentation, communication, appearance and posture conformity are crucial. Further, many of these jobs require location in customer facing environments or shared workplaces which are themselves designed to please common morphologies. The few exceptions are entrepreneurial ventures, academic research (but not, with exceptions, teaching), and small parts of commercial and professional operations where exceptional technical or intellectual skills are business critical, such as software development or mathematics in the finance sector. Yet these areas are highly competitive and often demand exceptional levels of mental and physical stamina. Are all these restrictions necessary or are some of them just the results of out of date prejudices?
And will they be more or less relevant in a nanotechnological world? Technology intercedes between dependant humans and their environment. This intercession redistributes the social burdens of dependency. Market economics contributes to this redistribution. For example, as a very simplified example, in a non-technological hunter gatherer society non-mobile individuals require two others to carry them (ignoring for a moment the use of an animal because of the difficulties of say, mounting, feeding and grooming a horse, though dogs have proved practical in some contexts). In a nomadic, predator vulnerable community this is a threat to the survival of all three. With basic wheelchair and asphalt road technology the dependency can be managed by one individual pushing a wheelchair. With the addition of the technology of electricity the direct dependency on another human, at least for basic mobility, is eliminated. The social burden of the dependency is thus removed from direct, human caring and redistributed into the manufacture of wheelchairs, laying of roads, the generation of electricity and the paying of taxes (or insurance) by the entire society. The social burden is less immediate, and less of a survival threat to any individual.
There is a second, related, effect of technology. When the technological level of a society is low there is a threshold of independence required of every individual in a social group. Only when that threshold has been reached can benefits of difference be traded off against higher dependency. But as the technological level of a society rises the threshold falls rapidly. For example, it matters not that a partially sighted person may, through different perception of body-language, be able to make a special contribution to the psychological well-being of his or her community if he or she is eaten by the first lion that attacks the camp. But in a more technologically advanced society where lions are less of a threat it may be possible to trade the psychological advantages for extra assistance crossing the road.[14]
Even a person with tetraplegia can trade their intellectual and personal skills in our society today, albeit not entirely fairly. There is no longer a threshold of ability below which survival is simply infeasible. Not even complete locked-in syndrome or a persistent vegetative state brings a person to a level where society is compelled to remove them, though consciousness is obviously required for social contribution at present. Anyone conscious and comfortable can participate, to some extent, in the trading of skills which takes place in today's societies. Greater technological assistance may reduce the human assistance they require, or increase their contribution, but in either case may act in their favour.
Thus nanotechnology is likely to increase the ability of people of all morphologies to contribute to society's resources because it will reduce the social burden of dependency further, and at the same time increase the effectiveness of their contributions, particularly where it is not used for "cure" but to modify the environment to better accommodate difference.
Lastly, competitiveness can be extrapolated to a species level. Today we face few serious external threats on a day to day basis (Bostrom, 2008). Predators, our environment and even the universe are either controlled, understood or work-in-progress. Threats of our own making-- starvation, plagues and environmental pollution-- are more significant to our survival. Nevertheless, we can conceive of having to compete against other intelligent beings, self derived or alien. Perhaps our concern for "cure" and conformity is motivated by a desire to ensure the species is best prepared to defend itself. In the past the aggregate effects of the uncoordinated actions of separate human groups served to reduce predator numbers, alter the environment in favour of human settlement and thus generally increase the survival chances of the whole species even where at a local level population numbers may have fallen due to temporary overpopulation. Today such uncoordinated action may, through the greenhouse effect, be making the world, as a whole, not locally, less hospitable for humans, however today we also have global institutions for coordinating our activities which can indeed explicitly consider the interests of the species as a whole.
But still, we do not know what form such external threats might take, nor the best morphology and skills for combating them. Diversity of morphology, genetic patterns, cultures and technologies will give multiple options. Generals are known for fighting the last war. Too fixed an idea of competitive requirements might leave us vulnerable to novel threats.
This leads to the fifth and final possible motivation I shall mention here: that our assumption that the right thing to do is always to "cure" those body forms seen as pathological is a result of a drive or desire to reach some kind of ideal, whether that be an ideal for the entire species, or just for an individual, or for a particular community or group.
The ancient Greeks had ideals of human flourishing, based on a universal human nature, which have been taken up by modern writers such as Foot (2001) and Hursthouse (1999). Yet technological possibilities such as nanotechnology, cognitive and affective enhancement and genetic engineering may alter the characteristics previously thought universal to humans. This would cast doubt on the appropriateness of fixed ideals of flourishing. Early eugenics, for example, was based on ideals of aesthetic beauty and health for humans specific to the cultures of the time. Today, though our ideals may be different, and perhaps better informed about human functioning, they may be not much less misguided and imperfect. Merely intuitively a variety of ideals in society also seems healthier than the widespread adoption of very similar ideals especially where the ideals themselves involve an element of conformity. So subgroup ideals may indeed be useful motivators for developments in particular areas. Ideals of deafhood (Ladd, 2003) are equally useful as transhumanist ideals, and the value of each is immeasurably increased by the presence of others as contrast. As a variety of ideals is hard to manage in a community or society methods of preserving tolerance and diversity may be more valuable to future survival than adherence to any particular set of morphological ideals.
We have discussed how cost, external ascriptions of well-being, competitiveness and ideals might motivate an obligation to cure. In no case was the motivation strengthened by nanotechnological progress towards molecular manufacturing. It is therefore not clearly the case that either individual well-being or the competitiveness of a society or group is increased by more "curative" applications of nanotechnology. The greater availability of "cures" does not, we can conclude, lead to a greater obligation to use them. This perhaps, to some, counterintuitive, conclusion is explained by the way that nanotechnological progress towards molecular manufacturing would, at the same time as it made "cure" easier, also remove many of the constraints which make "cure" attractive to some today. This technology would allow easier manipulation of the physical world, thus reducing the social burden of dependence still further, and increasing the social contributions which those of a greater variety of morphologies could make. Molecular manufacturing would reduce the social and personal costs of diversity, thereby making conformity less attractive.
Section 2: Nanotechnological Society Thought Experiment
Nano level engineering and increased medical knowledge might increase the available choice of morphologies. Few morphologies would be unalterable in the way they are now. So being unusual or different would be a free choice. Imagine that whatever one's birth morphology, at a certain age each member of society gains the rights to his, her or its own nanofactory. They may then modify their morphology as they choose.
Full morphological freedom would give equal respect to choices to both add and subtract abilities. When choosing whether to retain one's childhood morphology, augment it, or limit it, it may be helpful to think in terms of there being four levels of responsibility to consider. We are all responsible for our own well-being. We are responsible to our families or childhood environments. We may be responsible to a wider community. And we all have some responsibility to our species -- to continue it and ensure enough resources remain for this. Each of us has to balance these different, interacting obligations. For example, to state the obvious, personal well-being is often augmented by fulfilment of responsibilities to family and community. But these must be balanced against the individual's freedom to develop their particular talents, pleasures and autonomy. Individuals in every society have to demonstrate their responsibility in order to be fully accepted and respected by others (though we often assign rights on other criteria). This is the same for those with exceptional strength, intelligence or other abilities, who are easily seen as potential threats, as it is for those with low status morphologies and those with the commonest morphologies.
Morphological choice should similarly consider all four levels. But the best way of fulfilling these responsibilities may not always be to maximise one's abilities or continually develop new abilities. A family or community might value certain limits and the appreciation they bring. Fulfilling one's responsibility to them might require one to take on those limits. Just as some individuals today choose to return to a traditional way of life in their homeland after study abroad, or choose to turn down sporting or other opportunities to contribute to the family business, so in the future some might choose to retain or take on morphologies with particular limits to preserve the communities and values associated with that morphological pattern. They may believe that by living in support of these values they are also contributing to the diversity of the wider community and even the species. Others may see opportunities to contribute to resource generation or exploration of the physical world or mental realms which require them to take on new abilities, and leave the limits of their childhood. A few may see opportunities for novelty and learning in the systematic experiencing of limits, and choose to take on more limited morphologies than those of their childhood environments.
To consider and justify how one can best contribute to one's own well-being, that of one's family and community (however one may perceive one's community - geographically, religiously, culturally, morphologically or otherwise) and ultimately one's species are the obligations which must be considered when making morphological choices for oneself.
But we are not born fully mature and independent. What of people's lives before they are mature enough to decide on their own morphologies? Neither accommodating nor "curing" unusual morphologies would be particularly costly for an advanced nanotechnological society. What level of conformity should be imposed on children by their parents, families, communities or species before they reach the age of morphological freedom? In a liberal society, placing great value on autonomous and free morphological decisions, the answer must be the minimum for survival and education. Today we recognise that it is more costly economically for society to educate children with greatly differing morphologies. But with molecular engineering the costs of providing adaptive technology would be greatly reduced. There would be less need to standardise morphology in order to standardise received education. Medical care - the preservation of life and minimization of pain -- could also be applied minimally without unduly affecting subjective well-being. The preservation of individuality might come to be seen as more valuable than conforming genes, in childhood. Anyone unhappy with their situation can change it on reaching maturity. Special cases could be addressed earlier. But there would be no reason to impose hearing on signing children for the purposes of education, or even communication with hearing parents, nor to impose standard means of mobility unless the child itself felt strongly.
Morphological choices would have some similarities to career choices today, (Corwin, 2006b) and probably a similar level of flexibility. Leaving the child to decide at maturity rather than imposing ideals in childhood leaves them freest to select the morphologies most relevant to the world as they find it.[15]
Section 3: The Right to Enhance Versus the Right to Morphological Freedom
In short, full morphological freedom allows genuine 'experiments of living' as JS Mill proposed (Mill, 1074 p120). Through this people can authentically explore, develop and understand their values. Freedom to enhance, in contrast, imposes an external value set which distinguishes morphologies considered to be enhancing, and thus allowed, from those seen as harmful and thus not allowed. Whether this set is more rational, better for individuals, their families, communities, for species survival or in some other way preferable is a matter for individuals to decide for themselves, which they are unable to do if there is no legal alternative or if their freedom to do so is not recognised. Full morphological freedom allows those who wish to exemplify enhancement to explore the technologies and enhance themselves, and allows others to choose whether to join them or not. In this way choices to enhance will be genuine, free and authentic. But such choices can only have these valuable traits if the freedom not to enhance, and to retain or create a more traditional, or less capable body form, are genuinely available.
Conclusions
If the augmented states really are preferable, even in the less constrained circumstances that will obtain in the future, then over time, and without coercion to existing people, individuals will choose these for themselves. These choices should always be available. But before the experiments in living have been fully and freely performed we should not jump to judgements about lives and ways of experiencing that we may not know for ourselves; or even about the effects on others of states which we have experienced. Not everyone today lives, nor would want to live, in a competitive market economy, or academic environment, favouring particular morphologies. Those steeped in such competitive environments tend to assume all lives are as theirs and would be improved or ruined by the same things. But it is not so, as many individuals who have found satisfactions and happiness despite exclusion from the money economy can attest. Choices as free as possible will allow the deepest values to emerge.
Imagining the world with fewer limits imposed by the physical manipulation of matter draws to our attention how our attitudes to unusual morphologies may have been shaped. Limitations on our abilities to manipulate physical matter appear to have been an important factor in the formation of our attitudes in the past. Is this an ethically acceptable source of our current attitudes to people with unusual morphologies? Are the old limits still relevant? Further, this imagination exercise encourages us to question how our current, and potential future, abilities to manipulate matter should interact with our morphological diversity. I have argued from the assumption that significant progress in nanotechnology towards molecular engineering would be possible if human effort were directed to following through on the theoretical possibilities in this area. I have also tried to argue that increasing our abilities to manipulate the physical environment (through nanotechnology or otherwise) in ways that molecular engineering might be imagined to allow could greatly reduce the costs of diversity in morphology. And further, I have tried to argue that some of our prejudices against diverse morphologies are based on an already outdated understanding of the limits placed on us by our physical environment, and that realigning our attitudes with our powers would help to reduce prejudice against diversity. This would benefit individuals with an interest in retaining or exploring unusual morphologies, and benefit society by increasing the quantity of diversity that could be supported without loss of competitive advantage. If you accept the assumption about the possibility of developing the theoretical promise of molecular manufacturing it follows that we should direct our decisions about nanotechnology to creating a world in which choices about morphology can be freely made by as many people as possible, at a suitably mature age. If you do not accept the assumption it should still follow that increasing our ability to absorb diversity by technological means would be an ethically acceptable goal for technological or even social development programme, provided you agree with my conclusions about the role of past physical environment limitations in forming our prejudices against morphological diversity. Thus we should, I can conclude in general, try to bring about a world in which different morphologies, including some "cures" for morphologies currently regarded as undesirable, are widely available, but never coercively applied. In other language, we should consider reducing the pressure to "normalize" that is often exerted on those with unusual morphologies. The availability of these curative technologies should be balanced by commensurate efforts into developing technologies to intercede between individuals and their physical environments to bring out the benefits and reduce the inconveniences of different morphologies.
Perhaps following this path would lead to a need to develop new social institutions and interaction patterns to accommodate such diversity in the social and political world if the physical world no longer constrained it. Our tendency to organise social interaction tribally and by strict inclusion/exclusion boundaries regulated by similarity and difference (Jenkins 2008) may come under even greater pressure than in today's "multicultural" societies. Should efforts to change this through education, politics and other social means not prove adequate we may wish to investigate more technological avenues. For example, whether our new knowledge of how the interaction of genetics and environment affect characteristics such as aggression and altruism could be used to offer ways of overcoming fear of strangers, or unfounded stereotyping which interfere with the formation of positive social bonds. Positive social interaction triggers powerful reward circuits in human beings (Layard 2006) and many people might willingly use such technologies to improve their satisfaction with social interaction. Yet I wish to hold that even here, non-conformists should not be subjected to coercion, even when their unreformed sensibilities occasionally create considerable suffering for others or social friction. Freedom to be different is perhaps the only protection against our lack of omniscience.
Implications for Nanotechnological Development and Regulation
It is an implication of the above arguments, if they hold, that the imposition of "cures" or morphologies perceived by some as enhancing, on others who do not wish to alter their morphologies, whether through legislation, social pressure to conform, or economic exigency, should be prevented by all possible political, technological and social means. "Cures" imposed by force should be a crime accorded the same weight as we now accord actions which eliminate one or many individual identities or, if you prefer the terminology, destroy autonomy. [16] Without such protections morphological freedom will not be genuine, and we risk losing not only diversity in human experience, but a great opportunity to explore and develop our values and understanding of what makes lives valuable, both intrinsically to the liver of a life and instrumentally to the communities and wider groupings they feel allegiance to. Moreover, and more immediately, we risk the wholesale rejection of technologies which are potentially hugely beneficial for those who DO want to use them. As regards these potential benefits, business plans for companies developing nanotechnologies for "curative" applications should be scrutinised for the quality of their market research and sales predictions: these should be based not on the number of people who have a particular "pathological" morphology, but on a respectful and qualitatively rigorous assessment of the numbers who have expressed a clear wish to change their morphology when sensitively and ethically informed of the risks and possible benefits.
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Footnotes:
[1] By "body morphology" I include modifications to the brain, which, being a physical object I consider to be a part of one's body. Any event or intervention which has a long term effect on the shape or structure of the brain or body, including drugs and life experiences, can be included in the term.
[2] There is a dispute about the scope of the term "nanotechnology". As technologies around this scale have been developed and funding become available for nanotechnology many companies and researchers working at small scales have wanted to claim that they are nanotechnology companies, even when their technology does not move us towards the original vision articulated by Feynman and Drexler of manipulating the world atom by atom. Hence the term nanotechnology has changed from indicating single atom engineering or molecular engineering with the possibility of self-replicating systems, to engineering on a scale that is merely very small - hundreds or thousands of atoms at a time. There is a further, ethical, implication of this funding-driven terminological shift. Drexler considered at length the potential dangers inherent in the ability to manipulate the world at such a basic scale. But as commercial pressures have come to bear on the field there has been reason to play down these dangers. Thus some of those commercialising small scale technologies wish to distance themselves from what they see as the overly negative portrayal of the field publicised by Drexler and others. Drexler's vision is occasionally referred to as "true" nanotechnology by those aware of these differences of approach. (Bostrom, personal communication/s 2003/04, Mike Treder, personal communication 2008). This indicates both the more ambitious goal of his vision and the ambivalence about the balance of dangers and benefits. "Commercial" nanotechnology in contrast is less ambitious, and, perhaps consequently, less prepared to consider the low probability but potentially catastrophic risks.
[3] In this paper I ignore the deeper question of whether the psychological identity change would in some cases be great enough to prevent us speaking of the same person. I focus here on metaphysical and social identity and assume that none of these genetic changes would alter so much of the genome that we would be speaking of a different person. I assume memories will be continuous and the psychological change would be no more than currently experienced during serious illness or during education.
[4] Note the transhumanist position against such replacement outlined here:
Transhumanists hold that people are not disposable. Saving lives (of those who want to live) is ethically important. It would be wrong to unnecessarily let existing people die in order to replace them with some new "better" people. Healthspan-extension and cryonics are therefore high on the transhumanist list of priorities. The transhumanist goal is not to replace existing humans with a new breed of super-beings, but rather to give human beings (those existing today and those who will be born in the future) the option of developing into posthuman persons. (Bostrom 2003 p31)
See also Parfit 1984 on the non-identity principle and Gavaghan 2007a and 2007b for discussion of the ethics of replacement when cure is not an option.
[5] Sandberg says: "The right to life, the right to not have other people prevent oneself from surviving, is a central right, without which all other rights have no meaning. But to realize the right to life we need other rights." (p1) He includes morphological freedom in these supporting rights. In the case of prejudice against disability we would do well to give this greater prominence. Cases of suicide for the greater good seem to me to fall firmly into the category of supererogatory altruism.
[6] Transhumanism is "a belief that the human race can evolve beyond its current limitations, especially by the use of science and technology". (Oxford English Dictionary, 2009.) A focal point for such progressive and pro-technological thinking was provided during the last decades of the twentieth century by organizations like the Extropians (http://www.extropy.org/) and the World Transhumanist Association (www.transhumanism.org) where attempts were made to develop these beliefs into a consistent philosophical approach to science and technology, ethics, aesthetics and even political theory. These groups also defended progressive ideas and science and technology research against the then conservative and religious political atmosphere, especially during the first Bush administration in the USA.
[7] Wolbring (2008) criticises Sandberg's 2001 paper for its dependence on a negative conception of freedom. Wolbring claims this 'freedom from' imposes no moral obligation on society beyond altruism to protect morphological difference and that therefore Sandberg's conception of morphological freedom is too weak. A similar position was taken by Dale Carrico in 2006 in his blog "The Politics of Morphological Freedom". (Carrico 2006).He writes from a social democratic viewpoint in direct conflict with the libertarian stance of Max More, who stimulated discussion of these ideas in the early 1990s (More, 1993). Anne Corwin (Corwin, 2006, 2007a,b,c,d; 2008) has written extensively and far more incisively than I ever could, about the need to respect diversity and to protect full morphological freedom, and the interaction of transhumanist thought and disability rights issues. Nevertheless the concept and preferred conception of morphological freedom remains controversial in transhumanist circles.
[8] "Cures" available today are often not equivalent to the removal of an impairment. For example, the quality of hearing offered by even the best cochlear implants today is very different to that of a person with a healthy cochlear. Operations to change the shape of a malformed eyeball may leave the eye unable to change its focal distance. Cures can be partial then. Secondly many "cures" available today create new dependencies - cochlear implants and hearing aids require batteries, so, much more frighteningly, do artificial heart valves. Transplants create drug dependencies and so do treatments for mental health problems and asthma. But if the elimination of the impairment is the goal then, it is often reasoned, any improvement in that direction must also be desirable, providing that the sacrifice is not greater than the benefit. The patient's and doctor's relative evaluations of the sacrifice may be quite different however. And which is to be considered the more rational is itself a complex ethical issue. For the purposes of this paper I shall imagine that nanotechnological "cures" are neither incomplete nor create dependencies and that hence they are equivalent to the removal of impairment.
[9] Note that under the British Mental Capacity Act 2005 the irrationality of a particular decision is no reason to override the capacity and autonomy of an individual. Only if they prove themselves, through behaviour other than an irrational decision, to lack capacity for that type of decision can their decisions be overridden by others' opinions about their best interests.
[10] I thank one of the excellent and helpful reviewers for this important point.
[11] People could carry tags identifying them and their needs which would be picked up by aspects of their environment enabling, for example, signs to adjust their media accordingly.
[12] Consider two tribes where one is exceptionally strong and the other more conforming. The non-conforming tribe will pose a threat to non-members just as an under-performing tribe will pose a threat to members. Moreover the appearance of the extra-strong morphology within a tribe may result in the splitting of the tribe. In all cases, difference results in social upheaval.
[13] This is not the place for an extended review of the composition of western economies but as an example, for the UK in 2007, the percentage of the workforce employed by sector was: Agriculture, hunting & forestry; fishing, 1.4, Production industries, including energy: 10.7, Construction, 7.1, Wholesale & retail trade (including motor trade) 28.2; Financial intermediation; 20.9, Other service activities, 31.7 The figures are taken from p104 (Office for National Statistics' 2008). (NB These are pre-bust figures: the gross value added of the financial sector is more than double that of any other sector, yet this sector employs only 21% of the workforce, and that percentage includes many people other than those working in the banking industry and the City such as estate agents and accountants.) Of course, these figures do not give any indication of the relative percentage of physical, social and intellectual abilities required in each industry and presumably academic employment is subsumed into public services, but it is to be noted that retail and service account for approximately 80% of jobs, in comparison to just 8.5% in farming and construction, a radically different distribution of activity to a more traditional subsistence farming or hunter-gatherer society.
[14] I have, to my disappointment, not yet found much evidence of positive tradeoffs in subsistence communities, for example in the case of an elderly, visually challenged woman who is nevertheless carefully protected because of her wisdom, as suggested by one reviewer. Unfortunately cases such as those of Fatima and Halima at (Hampshire, 2002 p1031) seem to be more prominent. This may be due to researcher bias. See also (Sugiyama and Chacon, 2000) for estimations of rational behaviour (these assume even affection is regulated by rationality) in such societies. From these the (low) prevalence of long term disability versus acute illness can be estimated. For more discussion about treatment of chronically weak members, especially the elderly, particularly in nomadic societies, see (Brogden 2001; Chiu and Ames 1994; Silverman, 1987). Intuitively the extent to which younger, fitter individuals will care for dependents other than children seems to me to be largely dependent (given only mild scarcity) on the quality of relationship and affective bonds rather than pure or instinctive basically rational exchange calculations, but perhaps I am underestimating the evolutionary origin of human affective bonds, religion, traditions of respect for the elderly and other institutions which serve to encourage caring.
[15] See the definition of enhancement as improved environmental fit in Savulescu 2006.
[16] Murder, manslaughter, and at the extreme, genocide all eliminate individual identities or remove autonomy by destroying life. Rape, slavery and assault also, to a lesser extent, affect individual's abilities to form identities and direct their own lives with the autonomy that humans appear to need for health.
Contributor:
Heather Bradshaw
Centre for Ethics in Medicine
Bristol University
England
Email: Heather.Bradshaw@bristol.ac.uk
Author Biography:
Heather G. Bradshaw has a Philosophy, Politics and Economics degree from the University of Oxford.
She has been an intern at the Institute for Ethics of Emerging Technologies since 2004. After a period of ill health she worked for a small British manufacturing company before moving to British Trade International at Business Link Heart of England. She was awarded a British Trade International Best Practice Prize in 2000.
Heather has a Certificate in Health Care Ethics at the Centre for Medical Ethics at Bristol University, and is now working on a PhD on human enhancement and disability. She has published in a variety of places, including Nature magazine.
Acknowledgements:
I would like to thank for their encouragement and helpful comments about ideas presented here: Ms Donna Williams, the two reviewers from the International Journal of Disability, Community and Rehabilitation, Professor Julie Kent and Professor Ruud ter Meulen.
All mistakes, inaccuracies and faults in reasoning remain firmly my own.
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