John Harris
email: john.harris@manchester.ac.uk

Prof John Harris

GOD ON MORAL ENHANCEMENT

Keywords: Moral Enhancement, Cognitive enhancement, Freedom, God Bioethics Bioethics Moral Enhancement, Cognitive Enhancement, Freedom, God

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God had important things to say on the subject of moral enhancement. If God's feelings on the subject have been reliably reported by John Milton, the verbatim account to be found in Paradise Lost 2 is important because it contains, in a most concise form, many of the most cogent reasons for suspicion as to the viability of moral enhancement as a coherent project, at least as it is being understood in the emerging literature.

Famously, in Book III of Paradise Lost Milton reports God saying to his "Only begotten Son" that if man is perverted by the "false guile" of Satan he has only himself to blame: ……………whose fault? Whose but his own? Ingrate, he had of me All he could have; I made him just and right, Sufficient to have stood, though free to fall. 3 These lines have inspired many writers about the human condition and about the precious nature of freedom and in particular of free will. William Golding echoed these famous lines and discussed their theme in his novel Free Fall. 4 I first read Free Fall as an undergraduate in the 1960s 5 (and it was Golding that pointed me to Milton) . Golding asks two crucial questions in that book: "when did I lose my freedom?", and "how did I lose my freedom?" Here is how they are posed on the first page of Free Fall: When did I lose my freedom? For once I was free. I had power to choose. The mechanics of cause and effect is statistical probability yet surely sometimes we operate below or beyond that threshold. Free will cannot be debated but only experienced, like a colour or the taste of potatoes. I remember one such experience. I was very small and I was sitting on the stone surround of the pool and fountain in the centre of the park. There was bright sunlight, banks of red and blue flowers, green lawn. There was no guilt but only the plash and splatter of the fountain at the centre. … The gravelled paths of the park radiated from me: all at once I was overcome by a new knowledge. I could take whichever I would of these paths. There was nothing to draw me down one more than the other. I danced down one for joy in the taste of potatoes. I was free I had chosen. 6 1 I wish to acknowledge the stimulus and support of the iSEI Wellcome Strategic Programme in The Human Body: Its' scope, limits and future. I thank John Coggon for reading earlier drafts and making many valuable suggestions and to Sarah Chan for some incisive suggestions. Thanks are also due to Saira Mian for helpful assistance and insights. 2 John Milton, Paradise Lost Penguin Books, London, 2000 Ed. John Leonard. Milton first published Paradise Lost in 1667. 3 Ibid Line 96ff. 4 William Golding, Free Fall Faber and Faber, London 1959. 5 While a graduate student in Oxford I had the good fortune to get to know Bill Golding through my friendship with his daughter Judy and with Terrel Carver (later to become Bill's son-in-law) and had the privilege of discussing freedom and many other issues with Golding on a number of occasions. 6 Golding op cit Penguin Books, Harmondsworth 1966 page 5. Leaving aside Golding's rather suspect views about statistical probability and the assertion that free will cannot be debated, which is demonstrably contradicted in the passage just quoted, Golding vividly illustrates a feeling that surely everyone has had, the feeling of what it is like to be free in an existential sense 7 . With the exhilaration of that feeling, I hope, coursing through our veins (and not, I hope, clouding our judgement) let's return to Milton.

When God says of man that "he had of me all he could have" he qualifies this in two ways. Firstly by the vainglorious claim "I made him just and right", and second by a wonderful analysis of freedom: "sufficient to have stood, though free to fall". Milton's God was certainly overestimating her role in making humankind just, right and all the rest, but nature, or more particularly, evolution, has done most of this for us. We have certainly evolved to have a vigorous sense of justice and right, that is, with a virtuous sense of morality. God was, of course, speaking of the fall from Grace, when congratulating herself on making man "sufficient to have stood though free to fall", she was underlining the sort of existential freedom Golding spoke of which allows us the exhilaration and joy of choosing (and changing at will) our own path through life. And while we are free to allow others to do this for us and to be tempted and to fall, or be bullied, persuaded or cajoled into falling, we have the wherewithal to stand if we choose. So that when Milton has God say mankind "had of me all he could have", he is pointing out that while his God could have made falling impossible for us, even God could not have done so and left us free. Autonomy surely requires not only the possibility of falling but the freedom to choose to fall, and that same autonomy gives us self-sufficiency; "sufficient to have stood though free to fall."

It would be tempting to conclude at this point that we humans, although we need many forms of enhancement and often desire much more enhancement than we need, do not need and are irrational to seek, specifically moral enhancement. This is because we already have not only an extensive moral endowment but because the ways being canvassed to enhance that endowment are unlikely to leave us sufficient to stand though free to fall. However that would not be quite right either. There are many very attractive and effective forms of moral development including enhancement, available; it is simply that they are not the ones so far being spoken of8 as either relevant to moral or to neuroenhancement.

These, tried and tested methods include the traditional ones of bringing children up to know the difference between right and wrong, to avoid inflicting pain or suffering, on or doing harm to, others and methods of instilling in them habits of respect for others. These modes of respect include altruism, sensitivity and consideration and perhaps above all of being able to put ourselves in others' shoes so that we not only understand, but imaginatively experience, what it might be like to be on the receiving end of the conduct F o r P e e r R e v i e w 4 of others. Equally, more general education, including self education, wide reading and engagement with the world and with ways in which the world is mediated, (including mass media, computers and the internet), are powerful tools of moral development and improvement or enhancement. These must include, of course, sophisticated understanding of cause and effect, in particular of the ways in which to allow things to occur is as effective a way of determining the state of the world as is making positive interventions. 9

Moral Enhancement. 10 In considering moral enhancement, first questions to ask are: what is moral enhancement and what does it have to do with ethical knowledge, if there is such a thing, or with ethical expertise; and what do all of these have to do with knowledge of ethics or morality?

One thing we can say is that ethical expertise is not "being better at being good", rather it is being better at knowing the good and understanding what is likely to conduce to the good. Those with the insight, sympathy, empathy understanding and knowledge to have formed clear ideas of what might conduce to the good are not necessarily better at doing good in any of the ways in which this is possible, including of course making the world a better place. There are many reasons for this and we have space only for a few. Some of these are to do with a problem, understood at least since classical Greece, the problem of "akrasia" or weakness of will, one form of which was brilliantly summarised by Oscar Wilde, when he defined virtue as "insufficient temptation". We know how lamentably bad we are at doing what we know we should. But equally problematic is the fact that this is not, or not wholly, due to lack of moral fibre or resolution or firmness of purpose. Rather, and again only very partially, it is because we have many purposes, many things to do and experience and many priorities, of which being good we hope is a part because we hope we do all of these things in a good, a moral way. But of course because we are doing these other things, hopefully with benevolence and good will and good intentions, it is the other purposes with which we also do them that are often, if not more important, at least more at the centre of our attention.

A very fundamental problem, which has not been much discussed in the literature on moral enhancement, is that the sorts of traits or dispositions that seem to lead to wickedness or immorality are also the very same ones required not only for virtue but for any sort of moral life at all. Tom Douglas, who has a good claim to be one of the grandfathers of moral enhancement, has defined the most promising form of moral enhancement as "an enhancement that will expectably leave the enhanced person with morally better motives than she had 9 11 Noting substantial difficulties in identifying "good motives" let alone thinking about how, other than through early education and imaginative engagement with others, or thinking about how to manipulate or improve them, Douglas adopts the interesting expedient of trying to identify what he calls "counter-moral emotions". He identifies at least two: "a strong aversion to certain racial groups" and "the impulse towards violent aggression". Douglas commits himself to the belief that "there are some emotions such that a reduction in the degree to which an agent experiences those emotions would, under some circumstances, constitute a moral enhancement". 12 There are two substantial problems with this, albeit highly creative, approach. The first is that it seems unlikely that, for example, an aversion to certain racial groups, or to one or more gender or sexual orientation is simply a "brute" reaction, a sort of visceral response, as perhaps is an aversion to spiders. Rather it is likely to be based on false beliefs about those racial or sexual groups and or an inability to see why it might be a problem to generalise recklessly from particular cases. In short prejudice, as well as rationality, usually has cognitive content and often makes factual claims. Beliefs with cognitive content are for example beliefs that X is true or Y is false, that A is a danger and B is not, that C is good and D is evil, they are explained by the people that have them in terms of beliefs and ideas, including beliefs about facts which may be, and therefore can often be shown to be, true or false.

The most obvious countermeasure to false beliefs and prejudices is a combination of rationality and education, possibly assisted by various other forms of cognitive enhancement, in addition to courses or sources of education and logic.

Ingmar Perrson and Julian Savulescu 13 have advanced some reasons for denying or at least circumventing the cognitive elements of certain "immoral beliefs". They refer to research which reports that "people encode the race of each individual they encounter, and do so via computational processes that appear to be both automatic and mandatory. Encoding by race is a by-product of cognitive machinery that evolved to detect coalitional alliances." 14 While this may be true and while this encoding might be susceptible to disruption, there are some problems with seeing this as a key to moral enhancement. Racism still remains widespread, but is almost everywhere deplored, and in many countries is also against the law. And of course it is racist behaviour, not racist beliefs that are the problem, or the main problem 15 . The most important thing about the prejudices that most, perhaps all of us, have in one form or another, is to recognise them and learn to be ashamed of them and above all not to act on them. The neutralization of the worst effects of racist beliefs, is thus probably enhanced by cognitive enhancement. Moreover, it seems likely that racism affects, in a virulent form, only a minority of the world's population and yet all of us have the encoding, so one might think that the encoding cannot be that powerful. Racism has been further reduced dramatically in the last hundred years by forms of moral enhancement including education, public disapproval, knowledge acquisition and legislation. We thus have a very effective blueprint for the sorts of ways in which we can reduce and hopefully eventually effectively eradicate racism. The blueprint provides a good measure of the effectiveness of these means and good reason to believe that racism can be defeated by such means without resorting to biological or genetic measures which might have unwanted effects. In the present case such an unwanted effect might be to weaken kinship ties more generally or one's that are unconnected with race for reasons similar to those we are about to discuss.

Moreover, Perrson and Savulescu suggest that having:

Suggested that the core moral dispositions …have a biological basis and, thus, in principle should be within the reach of biomedical and genetic treatment, the next question is to what extent such treatment is possible in practice. To this question the answer seems to be: only to a very small extent. 16 To return to Douglas, the second problem with his account is that we would need to be pretty sure that "the reduction in the degree to which the emotion was experienced" could be precisely targeted only on strong aversions to things it is bad to have strong aversions to and not things to which strong aversions are constitutive of sound morality. This problem was effectively articulated by Peter Strawson in a famous essay entitled "Freedom and Resentment". 17 Strawson was not of course concerned with moral enhancement, but rather with the problem of free will. And in the course of combating some absurd forms of determinism, he points out that certain strong emotions, including aversions, are an essential and even desirable part of valuable emotions, motives or attitudes to others. Could we in short have the sorts of feelings that are appropriate and indeed, it might be argued, necessary to morality, if we did not feel a strong aversion for example, to someone who deliberately and unjustifiably killed or tortured those we love? While Douglas is right when he claims "there are some emotions such that a reduction in the degree to which an agent experiences those emotions would, under some circumstances, constitute a moral enhancement" 18 this is a very modest claim indeed, and I for one am sceptical that we would ever have available an intervention capable of targeting aversions to the wicked rather than the good. Of course if ever we do have the prospect of such precise and unequivocally good producing interventions, I will welcome them. But I remain doubtful and remain worried about the prospect of weakening, possibly essential and essentially moral, responses. This is a "baby and bathwater" problem which may prove soluble, I hope it will, but fear it may be intractable. Moreover, as we have seen there are substantial issues of liberty which would also need to be resolved and which could conceivably be threatened by any measures that make the 16 Ibid. p172. 17 Peter Strawson, "Freedom and Resentment" Proceedings of the British Academy. Vol. 48. 1960. 18 Douglas "Moral Enhancement" op cit.

Perrson and Savulescu

Ingmar Perrson and Julian Savulescu have produced a characteristically bold and simultaneously an intriguing and a worrying manifesto for the urgency and importance of moral enhancement. In a paper whose title sums up the agenda, 19 they are pessimistic, to the point of paranoia, 20 about the merits of cognitive enhancement and seem to argue that efforts to improve cognitive powers and capacities should be put on hold until moral enhancement is perfected and infallible and made not only universally available, but comprehensively mandatory. One problem with such an approach is that there are good reasons (which we have reviewed and will return to in due course) to believe moral enhancement must, in large part consist of cognitive enhancement.

Persson and Savulescu summarise their argument in five main claims:

1. It is comparatively easy to cause great harm, much easier than to benefit to the same extent. 2. With the progress of science, which would be speeded up by cognitive enhancement it becomes increasingly possible for small groups of people, or even single individuals, to cause great harms to millions of people, e.g. by means of nuclear or biological weapons of mass destruction.

Even if only a tiny fraction of humanity is immoral enough to want to cause

large scale harm by weapons of mass destruction in their possession, there are bound to be some such people in a huge human population, as on Earth, unless humanity is extensively morally enhanced. (Or the human population is drastically reduced, or there is mass genetic screening and selection, though we take it that there is no morally acceptable way of achieving these sufficiently effectively.) 4. A moral enhancement of the magnitude required to ensure that this will not happen is not sufficiently possible at present and is not likely to be possible in the near future. 5. Therefore, the progress of science is in one respect for the worse by making likelier the misuse of ever more effective weapons of mass destruction, and this badness is increased if scientific progress is speeded up by cognitive enhancement , until effective means of moral enhancement are found and applied. If safe moral enhancements are ever developed, there are strong reasons to believe that their use should be obligatory…That is, safe, effective moral enhancement would be compulsory. Now of course the mischief is in the meaning…in this case of the words "safe and effective" but before seeing just how much mischief might be possible it is worth taking a moment to examine the plausibility of Perrson and Savulescu's five main claims.

First Claim 1. It is comparatively easy to cause great harm, much easier than to benefit to the same extent

This seems superficially true, so that when Perrson and Savulescu draw attention to the Virginia Tech killings in 2007 and say:

Seung-Hui Cho killed 32 people in the worst civil shooting in US history. Cho used two semiautomatic handguns. The actual killings took place in a couple of minutes. It is almost never possible to save 32 lives in the same period of time. 21 we are inclined to accept it at face value.

But when we stop nodding at the obvious, but limited, relevance of such an example and examine it, this claim shows itself to be totally implausible. Raising the alarm when a fire is noticed in a school so that the building can be successfully evacuated or overpowering hijackers or terrorists who would destroy a plane in flight, often saves as many and usually more lives in as many minutes. So that when Person and Savulescu say: "It is almost never possible to save 32 lives in the same period of time" I am sorry to have to say that this is manifestly absurd.

On Saturday 26 December 2009 Umar Abdul Mutallab tried to set off a bomb on flight 253 carrying 290 people while it was attempting to land in Detroit. Jasper Schuringa became an international hero for thwarting this attempt and probably saving every life on the plane. This is the report of the incident from The Observer, a London newspaper, of the following day: Schuringa and the cabin crew then dragged Mutallab, a 23-year-old Nigerian, to the front of the plane, where he was restrained until landing. Mutallab reportedly told intelligence agents who began interrogating him after he was taken to hospital strapped to a stretcher that he had an explosive powder strapped to his leg. He was trying to set off the device with a syringe filled with liquid. 22 We are obviously not going to quibble over the meaning of the words "same period of time". I am sure Mr Schuringa did not time the event, but the issue is the plausibility of the claim "It is comparatively easy to cause great harm, much easier than to benefit to the same extent". The example of Flight 253 23 shows that 9 times the number of people, as in the Perrson and Savulescu example, can be saved in a comparable period of time; and this is not an isolated example. The case of the infamous shoe bomber who was overpowered by crew and passengers while trying to set off a bomb and which anyone who has had to remove their shoes at airport security will remember with affection, 24 was similar, and there are many more.

When [it]
More obviously, the voting of huge sums of money for famine relief or aid work following a tsunami or earthquake, or to allocate vaccines (for example the provision of 35 million doses of the Tamiflu vaccine for the UK population against a pandemic) 25 is the work of a few minutes, but can save thousands, even millions of lives. In the event of course the influenza pandemic was much milder than feared and most of the anti-viral reserves remain for another day. Vaccine programmes, while not instantly implementable, are quick and dramatic ways to save millions of lives. Whatever the death toll of a disaster, once methods of preventing a recurrence are found, the implementation of those methods almost certainly saves as many if not more lives as might have been threatened by the disaster. This is because preventive measures probably forestall not only this year's disaster but next years' and the following years as well. For if the preventive measures are permanent, as is likely in the case of smallpox and polio for example, then arguably an indefinite time sensitive multiplication of the death toll relates plausibly and proportionately to the lives saved. Whether or not this is an acceptable basis for a precise calculation, it is surely unlikely that the lives saved will be less than those previously lost in a permanently prevented pandemic. Thus: And arguably the initiation of the WHO plan to eradicate smallpox saved at least as great a proportion of the world's population as that estimated to be threatened by it.

'
In 1967, when WHO launched an intensified plan to eradicate smallpox, the "ancient scourge" threatened 60% of the world's population, killed every fourth victim, scarred or blinded most survivors, and eluded any form of treatment. 27 As of the last century, as Perrson and Savulescu confirm, smallpox is regarded as entirely eradicated. So much for the claim that: "It is comparatively easy to cause great harm, much easier than to benefit to the same extent"! Perrson and Savulescu can certainly be forgiven for this error, it is all too easy to accept a dramatic cliché which seems to illustrate something one is tempted to believe, and I have done so many times myself. It is however useful to lay this particular "canard" to rest once and for all.

Perrson and Savulescu quite rightly make great play with the dangers of biological weapons and the possibilities of bioterrorism.

The polio virus has now been artificially constructed…More frighteningly scientists have modified mousepox to make it lethal in 100% of mice…Voltaire estimated that smallpox killed around 20% of the French population in his day. It was eradicated last century from the globe by vaccination…Genetic engineering of smallpox could create a new strain which would wipe out all or most of humanity.

So it could, and cognitively enhanced science might create a vaccine in time to prevent it. This seems a telling example; but what does it tell? The answer is that it tells rather against the Perrson/Savulescu thesis than for it. First it shows that just as a disease like smallpox is an effective killer, vaccines against it are equally successful ways of saving lives. How long did it take to kill 20% of the French population in Voltaire's day? How long did it take to save those same numbers with a vaccine? These are complex questions and because of ambiguities about when a lethal agent operates and when a protective measure actually does the protecting, they are probably not even answerable questions.

But if we compare the time taken by Seung-Hui Cho to kill 32 people and the time it would take to administer say thirty two doses of polio vaccine via sugar lump to a queue of children, the time difference would not be significant. Add to this the numbers killed by polio and the numbers vaccinated we can see that it is often comparatively easy and not time consuming to save great numbers of lives. Of course it might be claimed that the development of effective vaccines, for example against polio and smallpox, took a great deal of time, but so did the development of semiautomatic handguns. From the first use of firearms somewhere between China in the ninth century and medieval Europe in the thirteenth century to today is a very long time indeed. The fact that once developed, both vaccines and semiautomatic firearms, are fast acting emphasis the similarities rather than the differences.

What seems clear is that the time the killing or the saving takes is trivial compared with the effectiveness of each. No generalizations to the effect that damage is always or even often quicker than repair, or prevention slower in taking effect than what it prevents, are helpful in addressing the potency of dangers or the probability of defences against them being effective. We can be confident in our conclusion that claim one is false; not least because it depends on upholding a version of the acts/omissions distinction which I am sure that Savulescu at least, rejects. For if a mad or bad individual can destroy the world instantly by setting off a doomsday machine, then a good consequentialist can save the world as quickly by killing him (or morally enhancing him) the moment before he can do so or at any time before that! And this sort of prevention is a recurrent theme of Savulescu's work.

Claims 2 and 3 need to be considered together.

With the progress of science, which would be speeded up by cognitive enhancement it becomes increasingly possible for small groups of people, or even single individuals, to cause great harms to millions of people, e.g. by means of nuclear or biological weapons of mass destruction. 3. Even if only a tiny fraction of humanity is immoral enough to want to cause large scale harm by weapons of mass destruction in their possession, there are bound to be some such people in a huge human population, as on Earth, unless humanity is extensively morally enhanced…

Essentially this is the claim that it only takes one bad man to spoil things for the rest of us. This may well be true, in the sense that its possibility cannot be ruled out, but it is not just the wicked that present problems of this sort. Moreover, it is not clear either that speeding up the progress of science through cognitive enhancement exacerbates the process, nor that moral enhancement has much prospect of eradicating this possibility, indeed the reverse may be true. We need to remember that any tool or technology can be abused or misused and that accidents and negligence can already routinely cause or threaten, harms on a massive scale (Three Mile Island, Chernobyl).

If, and in so far as, it is true that scientific progress increases the power of individuals to do harm, it is not clear that moral enhancement if and when it might be possible to imagine it to have become "safe" and "effective", will much reduce this danger.

Although I am sure that Perrson and Savulescu would acknowledge that mad, as well as bad, individuals can cause harm, they talk throughout their paper almost exclusively as if 12 the danger was from wickedness, perhaps because they want to encourage the prioritization of moral enhancement as a field of study.

Remember the idiots.

Now add to this that the danger comes not simply from the malevolent, but from another important category of disastrous individuals. Perrson and Savulescu refer to the work of Martin Rees. Now Rees is famous for (among many other things) his elevation of the "village idiot" to global status. In his fascinating book Our Final Century 28 Rees catalogues the disasters which might, if the causes of them are not addressed, lead to the end of human life on this planet. Rees considers the role of malevolence or wickedness but also warns of the dangers posed by incompetence or stupidity.

We are entering an era when a single person can, by one clandestine act, cause millions of deaths or render a city uninhabitable for years, and when a malfunction in cyberspace can cause havoc worldwide to a significant segment of the economy: air transport, power generation, or the financial system. Indeed disaster could be caused by someone who is merely incompetent rather than malign. 29 Rees glossed these remarks at the Hay festival in 2006: "in a global village there will be global village idiots, just one could be too many" and he concluded "I think there is a real concern about whether our civilization can be safe-guarded without us having to sacrifice too much in terms of privacy, diversity and individualism". 30 I agree with Rees about this, and would add dangers to liberty and autonomy. But I run too far ahead, let's complete our discussion of Perrson and Savulescu.

Claims 4 and 5 need to be considered together.

4.

A moral enhancement of the magnitude required to ensure that this will not happen is not sufficiently possible at present and is not likely to be possible in the near future. 5. Therefore, the progress of science is in one respect for the worse by making likelier the misuse of ever more effective weapons of mass destruction, and this badness is increased if scientific progress is speeded up by cognitive enhancement, until effective means of moral enhancement are found and applied.

These final two claims are interesting. The first that moral enhancement by new and more radical means than education, knowledge acquisition and scientific progress is at best a long way off seems right to me; but the alleged sequitur is definitely of the "non" variety. One of the reasons for this is that claim 4 not only notes how far off moral enhancement of any new kind is likely to be, but refers to a "moral enhancement of the magnitude required to ensure that" disaster is avoided. There are many reasons to believe that such "ensurance" and the assurance that follows from it, are impossible, not least because failures in any human intervention are not only possible but are arguably inevitable.

There is no such thing as ensuring safety.

Even more significant are the costs of delay. While we wait patiently with Perrson and Savulescu for the mid to far future perfection of genetic or biological moral enhancement, and while we put on hold the cognitive enhancement that might accelerate scientific advance and the discovery and innovation it produces, "stuff" or even events happen! 31 That stuff will be the minute by minute, day by day accumulation of premature death and suffering from causes that cognitive enhancement and the resulting innovation might have prevented.

In my book Violence and Responsibility, 32 published thirty years ago now, I was concerned with our responsibility for harms which we might prevent or might have prevented. I insisted that, for example, the violence of political change must be evaluated against what the social historian Barrington Moore Jr called "the violence of normal times". "To dwell on the horrors of revolutionary violence while forgetting that of 'normal' times" he said is "merely partisan hypocrisy". [START_REF] Moore | The Social Origins of Dictatorship and Democracy[END_REF] Barrington Moore Jr warned that the death toll of, for example the revolutionary terror of the French Revolution, must be seen as a response to "the prevailing social order" which "always grinds out its toll of unnecessary death year after year". 34 We are attuned now to be sensitive to the costs of delay in instituting not only social reform that might prevent unnecessary death and suffering, but the delays that result from failures to turn discovery rapidly into innovation, and to ensure that innovation results in products in the clinic and the marketplace that will save and ameliorate lives. Perrson and Savulescu refer to the work of Jonathan Glover, although not in this regard, but they might also have referred to earlier work of Julian Savulescu. It is an irony that Savulescu is here advocating the sort of delays in adopting new technology and medical innovation which certainly will cost lives, delays of the sort that in the past he has been vigilant to oppose. [START_REF] Savulescu | Justice, Fairness and enhancement[END_REF] Of course if haste will cost more lives than delay we have good reasons for a precautionary approach. In the present case, as Perrson and Savulescu admit, there is not only no immediate prospect of moral enhancement but we have literally no idea how long (if ever) it will take to perfect.

On the other hand we have daily evidence of the record of science and technology in preventing and treating disease and premature death and in dramatic increases in life expectancy. Moreover if Martin Rees is right this cannot be ensured because it is unlikely that moral enhancement will affect the proverbial "village idiot", nor the sort of disaster that might result from negligence or miscalculation. Rees's book cites many examples of how much room there is for the disastrous miscalculation of the level of risk inherent in many apparently benign or "morally neutral" technologies. The question then becomes one of whether forgoing the benefits that might accrue from accelerating science via cognitive enhancement, including the rapid development of antidotes to engineered diseases and other bio-weapons and biohazards, better insights into how to combat the worst affects of climate change and reliable methods of predicting asteroid strikes and developing methods of diverting the asteroids, to identify just a few of the dangers that we may hope will prove amenable to a scientific or technological "fix". While we can be sure of none of these things it would not simply be a brave man, but surely a reckless one who would bet against the overall utility of scientific advance and cognitive enhancement.

Julian Savulescu is one of the smartest people I know. Until this moment I had no reason to think of him as, for this reason, also one of the most dangerous. Should I also begin to look on my most talented students with equal suspicion and do my best to sabotage their cognitive advancement? I hope I have found reasons in this paper both to continue to admire Julian, and continue to encourage my best students. Indeed as Elizabeth Fenton has pointed out "it is difficult not to take [Perrson's and Savulescu's pessimism] to imply that unless and until we further understand moral enhancement, we should try to slow scientific progress". 36 She might have gone further and pointed out that their extreme risk aversion would justify not only retarding scientific progress but retarding the cognitive powers of people as well.

Milton Revisited.

Although Perrson and Savulescu say: "True, there are also respects in which scientific progress accelerated by cognitive enhancement would be for the better, by protecting us against threats posed by asteroids, epidemics etc. We have not attempted to settle definitely the balance between these good and bad respects". This is disingenuous and is at odds with what they say elsewhere. In talking about the dangers from cognitive enhancement for example they say:

…it is enough if very few of us are malevolent or vicious enough to use this power for all of us to run an unacceptable increase of the risk of death and disaster. To eliminate this risk, cognitive enhancement would have to be accompanied by a moral enhancement which extends to all of us, since such moral enhancement could reduce malevolence. 37 Here they are explicit that cognitive enhancement "would have to be accompanied by a moral enhancement which extends to all of us" before the risks of cognitive enhancement would be other than "unacceptable". Notice also that they talk of the elimination of the risk in a context where moral enhancement which extends to all of us will only, at best, reduce malevolence. So even in the most ideal scenario in their terms, a risk which obtains if only one malevolent person escapes is still, for them, massively significant. So we have a strategy to eliminate a danger which has to be universally applied but only reduces (but not eliminates) the risk of the danger, the risk of which risk is defined in terms of the people who pose the danger (whose numbers are already admittedly very small) -"it is enough if very few of us are malevolent"! But of course cognitive enhancement is also well calculated to speed up the sorts of advances that can, do and will save lives. We would have to be very sure of the probability of its negative effects to be justified in ignoring the positive ones.

My own reading of the balance here is rather different. Science, innovation and knowledge production, particularly education, are I believe our chief hope of finding solutions to the most threatening sources of probable mass destruction and is moreover our only proven form of moral enhancement to date (and have proved very effective). Add to this the point, emphasised by Martin Rees, that evil is not the most probable source of catastrophe, and that threats not amenable to moral enhancement such as asteroids, new diseases climate change and idiocy, inadvertence and negligence of all sorts, are equally likely, perhaps more likely to produce disaster, and we have a different agenda. This agenda is to reject the idea of putting on hold cognitive enhancement until moral enhancement is in place to rein it in. Rather we must embrace reliable forms of cognitive enhancement in the hope and reasonable expectation that they are our best prospect of self-defence including whatever element of self-defence may eventually result from moral enhancement. Indeed cognitive enhancement might reasonably be expected to reduce idiocy, even of the common or village variety! Milton reminded us that we have been made with both freedom and a powerful sense of justice and the right, and I am sure that Darwinian evolution rather than God is the force responsible. Either way we have what we need, both to know the good and to try to do the good. This knowledge, like all knowledge, can be improved upon and I believe we should look to improve our capacity for knowledge as effectively and as fast as possible.

But the other part of Milton's insight is the crucial role of personal liberty and autonomy: that sufficiency to stand is worthless, literally morally bankrupt, without freedom to fall. Again my own view is that I, like so many others, would not wish to sacrifice freedom for survival. I might of course lack the courage to make that choice when and if the time comes. I hope however that I would, and I believe, on grounds that have more eloquently been so often stated by lovers of freedom throughout history, that freedom is certainly as precious, perhaps more precious than life.

Perrson and Savulescu end their paper with a truly chilling reference to C.S. Lewis's stories for children and the frightful "Deplorable Word". This is a 'magical curse which ends all life in the world except that of the one who speaks it'… If we all knew the Deplorable Word, the world would likely not last long. The Deplorable word may arrive soon, in the form of nanotechnology or biotechnology. Perhaps the only solution is to engineer ourselves so that we can never utter it, or never want to utter it. 38 Ironically and perhaps self-defeatingly it would have to be biotechnology, and possibly cognitively enhanced biotechnology, that would give us the power to engineer ourselves into losing our freedom to innovate in biotechnology in this truly deplorable way. I think we have to hope for something better and perhaps someone better than C.S. Lewis to analyse the dangers.

Perrson and Savulescu may well be right, but we will only know that once moral enhancement has been perfected and only if thereafter bad men, madmen and idiots have ceased to commit or attempt acts of mass destruction. The perfection of moral enhancement is admitted by person and Savulescu to be "not likely to be possible in the near future". I believe it will never be possible to the extent the Perrson/Savulescu thesis requires, or indeed that Tom Douglas believes,; both for reasons already given and because moral enhancement has little prospect of preventing idiocy -but of course I could be wrong! Even if Perrson and Savulescu have made the better bet, we will have to wait a long time to know which of us is right, a long time for non-traditional moral enhancement to be possible and then another, possibly even longer, period of time for it to become universal and then another even longer time than that to have any idea whether or not it is working. Meanwhile wickedness and idiocy not to mention human inadequacy will continue to grind out its daily death toll, a toll that might in all this time have been dramatically reduced by discoveries accelerated by cognitive enhancement. Moreover, these discoveries might save (might have saved) us from a very large class of mass destruction not attributable to malice, and therefore not susceptible to moral enhancement, such as disease, asteroid strikes and climate change. I don't believe it would be rational to bet on moral enhancement and against accelerating our ability to deal with…literally anything, an ability which is likely to stem, with immediate effect, from cognitive enhancement whether it takes the form of greater alertness or wakefulness in pilots and long distance drivers and emergency medical staff or better decision making from workers who have to function in all sorts of demanding situations. 39 A strategy that leaves us free to search for solutions to problems we cannot as yet even foresee, one that permits us to use techniques of cognitive enhancement to accelerate that process and one which leaves us free to find, and equipped to implement, those solutions as quickly as possible is a better bet. It is surely better to remain sufficient to stand and to hang on to our precious freedom to fall.

  immoral things impossible, rather than simply making the doing of them wrong and giving us moral, legal and prudential reasons to refrain.

  See John harris Violence and Responsibility, Routledge and Kegan Paul, London 1980. 10 In this section on moral enhancement I am influenced by the fact that I have just finished discussing them in a new introduction to the forthcoming paperback edition of my book first published as John Harris Enhancing Evolution Princeton University Press, Princeton and Oxford 2007

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  11 Thomas Douglas "Moral Enhancement" The Journal of Applied Philosophy Vol. 25, No. 3, 2008. See also http://www.ncbi.nlm.nih.gov/pubmed/19132548.

12

Ibid p. 231.

13

Ingmar Perrson and Julian Savulescu "The perils of Cognitive Enhancement and the Urgent Imperative to Enhance the Moral Character of Humanity" in Journal of Applied Philosophy, Vol. 25, No. 3, 2008. 14 Op Cit p 168. 15 I am grateful to Sarah Chan for reminding me of this important point.

Not "freedom from" but "freedom to". See Isaiah Berlin Two Concepts of Liberty in Isaiah Berlin Four Essays on Liberty Oxford, Oxford University Press 1969.

For example in two essays typical of , indeed exemplary of, recent work on moral enhancement, see below.

Bioethics

sites:http://www.infoplease.com/cig/dangerous-diseases-epidemics/smallpox-12000-years-terror.html

Perrson and Savulescu op cit. Page 175.

Henry Greely, Barbara Sahakian, John Harris, Ron Kessler, Michael Gazzaniga, Philip Campbell, Martha Farah: "Towards responsible use of cognitive enhancing drugs by the healthy" Nature, Vol 456, 18/25 December 2008

Bioethics Bioethics


Ruth Chadwick

Keywords: Human Genome Project, Personalisation, Genetic Determinism, Privacy

de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés.

about an individual's genome that is not only clearly health related but also advice on behavioural characteristics, the science of which is under developed. These facts have inspired a considerable amount of work on the sociology of promise and expectation. Technoscientific developments are accompanied by promises, to the public at large or to specific publics, to governments and to organisations. Related to promise is the concept of imaginary, an imagined future. Imaginaries are used by specific groups in the furtherance of other purposes, which can be political or economic. Imaginaries go beyond the thought experiment, a tool long used by philosophers to think through the possible implications and consequences of particular developments or courses of action, because they are used not just as an analytical tool but also to further particular purposes. An example might be the imaginaries that have been at work in the debates on genetically modified crops -e.g. 'feeding the world' is one imagined future; 'destroying biodiversity' is another. Clearly these imaginaries are likely not only to reflect particular commitments but also to have ethical implications, because the extent to which they are influential After ten years it is appropriate to take stock of the imaginaries that have been at work over the past period, and evaluate their success, or not, in an attempt to see the extent to which they are still at work at the present time. Ethicists, bioethicists in particular, are often accused, if not of attacking straw men, of considering possible consequences at too early a stage of development, or again, of coming in too late.

In the early days of the debates on genetics there was considerable anxiety about genetic discrimination, whether by insurance companies or employers. The relevant negative imaginary was 'creation of a genetic underclass', or 'a genetically segregated society'. On the other hand one positive (from some points of view) imagined future, contained for example in the 2003 report of the UK Department of Health, OurInheritance Our Future, involved that of health and At this point in time we find ourselves at a period when the science is once more rapidly developing, the prospect of relatively inexpensive and rapid whole genome sequencing of individuals on the horizon.

From the time and expense involved in producing the first human genome sequence, the science has come a long way. It is appropriate also to reflect on the extent to which there have also been developments in ethics over the last ten years, It is not necessary to subscribe to full-blown genetic exceptionalism to take the view that there have been developments in ethical thinking Willingness to share information and to participate in research is a praiseworthy contribution to society.

• Equity: To reduce health inequalities between different populations, and to work towards equal access to care is an important prerequisite for implementing genomic knowledge for the benefit of society."

The emphasis is thus on information sharing rather than on greater protection of individual rights.

In the light of the fast pace of development of the technologies ethical thinking is faced with the move towards greater 'personalisation', on In the case of pharmacogenomics, in practice it might mean no more than doing a genetic test to assign a person to one group or another -a poor or good responder to a drug, for example. If it is just allocation to a group, however, to use the term 'personalisation' is, to say the least, potentially misleading. The relevant difference is between this patient and the whole population, rather than between this patient and membership of any given group.

Personalisation can mean, secondly, particular action on the basis of genetic information -the choice between drug A and drug B; the selection of the appropriate dosage; the choice between drug A and no medication at all. In this sense, however, it could be argued that medicine has always been personalised in the sense of the application of professional judgment to the individual case. In this sense, again, to personalise and to individualise appear to be equivalent. In a third sense to 'personalise' might mean to treat the patient as a person, where a person is understood as a self-aware being with their own goals and life plans. It is in this sense that complementary therapies are sometimes said to be more concerned with the person that just with the symptoms of the individual case. This is where a difference between individualisation and personalisation may become apparent.

To treat a patient as a person, rather than just as one (individual) case, is to have regard to their goals as well as symptoms.

The sense in which personalisation is marketed as 'tailoring', however, seems not to be precisely equivalent to any of these meanings, although they are all significant from an ethical point of view. In order to have full tailoring to this one individual/person before you, arguably that person's whole genome needs to be looked at. While the prospect of whole genome sequencing is now on the agenda for debate the extent to which it is possible to make sense of all the information in a person's genome, however, is still a long way off.

A relevant sense in which this personalisation has ethical implications, however, is that such personal genomics is identifying If it becomes impossible to conceal one's identity (e.g against a totalitarian regume) and key facts about oneself, this raises issues about both genetic determinism and privacy.

Genetic determinism

In the immediate aftermath of the Human Genome Project, it was claimed that genetic determinism was dead. This was due to the discovery that there were far fewer genes in the human genome than had been expected, around 24.000 rather than 100,000. Surely, such a small number of genes could not account for the complexity of the beings that we are. This raises the question of the level at which the number becomes too small to do that. If there is determinism, it must lie elsewhere than in the genes per se.

Of course, there had been discussions of genetic determinism that predated this discovery. There had been debate about the difference between the ways in which a gene can influence rather than determine. Even in the case of a single gene disorder, there is variation in penetrance and severity. It is also important to remember that these discussions of determinism relate to the nuclear genome: disorders in the mitochondrial genome, inherited down the female line, produce very variable results. Since the Human Genome Project much more is also understood about such things as copy number variation and epigenetics.

With the advent of whole genome sequencing, however, genetic determinism is back on the agenda, and is heavily implicated in an imagined future in which it is possible to predict people's future talents and behavioural traits and use these predictions to inform training and educational needs. We might call this imaginary genetically informed education.

To return to the relevant conceptual question for Bioethics, is this reemerging genetic determinism, determinism in the same sense as the The genetic determinism that is emerging now is that the genome in all its complexity, is deterministic, taking into account the volume of data that can be made available on the precise sequence in an individual's genome, including all the myriad ways in which he or she differs from other individuals.

So we need to be clear about the form that genetic determinism is now taking, in addition to the ethical implications of its employment. It is still counteracted by other considerations. One of these recently discussed in the media is the 'ten thousand hours' hypothesis that anyone can develop a talent for x if he or she devotes ten thousand hours to x. It is not necessary for some genetically based predisposition to be present. Again, genetic determinisn is countered 13 by arguments about gene-environment interaction. Such interaction, however, has to take into account not only the environment external to the body, which can be both physical and social, but also the environment internal to the body, and in so far as that involves interaction between different genetic factors it arguably supports a view that the whole genome is deterministic rather than any given part of it.

Privacy

The new generation of sequencing technologies massively increases the density of analyses that can be performed in a single run, as compared with conventional sequencing. But what is meant by 'whole genome' here -all the coding exons in the genome or perhaps more usefully a subset of these we are interested in for diagnostic purposes?

  interests of individuals, groups and societies for good or ill.

  tailored to the individual'. Others, even those who regarded the future employment of genetic information for health care purposes as potentially positive, were cautious about what they saw here as a 'boutique model' of health care, and instead advocated an imagined future in which genetic information could be a mechanism for the reduction of inequities in access to health care between the developed and developing world.

  in genomics and in the social and political context in which these have taken place. In the early nineties the issues surrounding disclosure and rights to know and not to know tended to fall into two main types: conflicts of interest in the genetic counselling setting, where one person's reluctance to disclose information might have implications for another's right to know it; and situations where an individual had to deal with predictive information, concerning which they would prefer not to have knowledge. So discussion turned on the circumstances in which it could be right to disclose; and choice in relation to tests. The ethical considerations at stake included, primarily, individual autonomy, confidentiality, and beneficence. In 1997 for example, Jørgen Husted drew attention to two conceptions of autonomy, a 'thin' one which was typically used to support the benefits of genetic information; and a 'thick' one which supported a right not to know. The arguments of the time are still rehearsed in different contexts, but I want to draw attention to two trends since that time. The first is a towards more public health considerations: the other is towards a greater emphasis on principles of solidarity and equity. Thus the HUGO Statement (2007) on Pharmacogenomics, Solidarity and Equity states: "the Committee considers it urgent that the ethical principles of solidarity and equity be given increased attention • Solidarity: Because of shared vulnerabilities, people have common interests and moral responsibilities to each other.

  hand, and more global developments, on the other, in relation both to the facilitating of international biobanks (requiring thinking about harmonisation of standards and ethics) and to claims for sharing the benefits that genomics has to offer on a global scale. The discussion of rights to know and not to know has to be continually renegotiated in the light of these interests in tension.One of the principal tasks of the bioethical endeavour is to map the ways in which the boundaries of key concepts shift or become blurred over time. For example, in the context of reproductive ethics, this has been the case in relation to concepts such as 'parent'. I want to focus in this short editorial essay on three concepts : the concept of personalisation, genetic determinism, and privacy.PersonalWhat is meant by 'personal' in the personal genome? Let us first consider the related concept of 'personalisation'. Arguably the majority of discussion about pesonalisation has taken place in relation to pharmaceuticals, although nutrigenomics has not been far behind.

  was rejected at the turn of the century? I think not. It seems to me that what was being rejected in that debate was the 'gene for x' model that has also been implicated in various imaginaries, positive and negative.

  While for the near future targeted investigations are likely to remain necessary, the prospect of whole genome sequencing changes the scope of what is talked about in the right to know and right not to

  While there have always been issues concerning disclosure of incidental findings (e.g. non-paternity), the possibilities of whole genome sequencing open up the prospect of knowing everything in the genome. The very concept of 'incidental findings' becomes redundant. There is of course a question about the extent to which the volume of information will be meaningful, at least in the early stages of this development, but are there grounds for thinking that the privacy concerns are increased? If there is concern about access to knowledge about one's genome, does the volume of information that may be accessed give rise to a parallel increase in the concerns about privacy?These may be concerns influenced by a form of genetic determinism, that to know someone's genome is to know everything about the person. Again there are different imagined futures here. One is of a genetic surveillance society (encouraged by, for example, by developments such as the UK National DNA database). At the opposite extreme is of an open source genetic society, where and open with each other about their genomes, as instanced, for example, by the Personal Genome Project.It seems appropriate to engage in this particular discussion with reference to developments taking place in other contexts. There is evidence that in relation to the internet, for example, the increasing popularity of Facebook, Twitter and blogs provides evidence of changing attitudes towards privacy. It is, then, at least of interest to ask why in relation to genetics, in part6icular, has privacy been such a central concern. Different explanations are possible, and are not necessarily mutually exclusive.There may be generational differences; organisations and groups may be successful in deploying their imaginaries in different contexts.Different ways to counter anxieties are available. One is to try to allay concerns about privacy. The advent of 'celebrity genomes' are one instance of this: where key figures willingly publish their genomes to attitude towards privacy and disclosure, but such plans have not been met without some alarm.The second, not unrelated. trend is towards rethinking the concept and value of privacy. In the surveillance different context, it has been claimed that even if we could rely on public institutions to adhere completely to regulations on data protection, there is still a need to look at the issues in different ways.. In the genomics context, there has been a suggestion that emphasis on privacy cannot be guaranteed any longer and should be replaced by the concept of open consent.The concept of open consent is used in the context of the Personal Genome Project, which aims to build a framework for the development and evaluation of personal genome technologies.Towards this end, open consent implies that research participants accept that their data may be included in an open access database with no guarantees of privacy and confidentiality. deal of bioethical discussion has taken place in relation to genomics, arguably the most interesting phase is yet to come, and it is to be hoped that debate in this journal will play a significant part in the debates about genomic futures.