The Price of Perfection: Individualism and Society in the Era of Biomedical Enhancement

12. Access and Inequality

u Chapter 12 Access and Inequality As chapter 3 made clear, one of the most challenging problems created by biomedical enhancements is how they should be distributed . A main theme in my previous book, Wondergenes, was the unfairness that would result if access to highly effective biomedical enhancements were distributed as it is now, on the basis of ability to pay. Some enhancements, like caffeine and nicotine, are cheap enough to be available to virtually anyone. But more powerful and exotic enhancements are likely to be out of the reach of the average person, and some may be available only to the affluent. As I argued in Wondergenes, this could threaten the belief in equality of opportunity that sustains liberal democratic societies in the face of actual inequality, paving the way for social turmoil and the collapse of the liberal state. In Wondergenes, as here, I rejected the idea that we could simply prevent anyone from obtaining enhancements. Instead I described a number of steps that society might take to level the playing field when people with greater resources interact with their less fortunate brethren and suggested using them to prevent the enhanced from taking unfair advantage of the unenhanced. I proposed, for example, that people seeking to purchase an enhancement be required to get a license, which the government would issue on condition that they used their enhanced Access and Inequality 219 abilities only in socially acceptable ways. I also suggested that enhanced individuals be handicapped when they compete with persons who are not enhanced. It is relatively easy to see how this might be accomplished in the sports context, with enhanced athletes required to run farther or finish in less time. Outside of sports, we might handicap enhanced people by requiring them to disclose the fact that they are enhanced, by expecting them to subordinate their interests to those of weaker parties , and by undoing the deals they make if they seem in retrospect to be unfair. But there is a serious defect in all these approaches. For them to be effective, we will have to be able to identify persons who have been enhanced in order to know whom to handicap or whether enhanced individuals have misused their licenses or taken unfair advantage of other persons. In short, we would have to employ the same measures to detect the use of enhancement that would be needed to enforce an outright ban, measures that I concluded in chapter 8 were impractical as well as intolerably intrusive. The only difference between the remedial measures I proposed in Wondergenes and complete prohibition is that, under the former, society would be able to obtain some benefits from enhancement use, because people would be allowed to use them so long as they did so in the public interest. But the regime that we would have to create to produce this benefit would be so repressive that it would hardly be worth it. In Wondergenes I acknowledged that the surveillance and intrusion that would be needed to level the playing field would be harsh, but I defended it on the grounds that it would avoid a direr dystopia in which the enhanced and the unenhanced clashed for power in an increasingly unstable political environment. I pointed out that, when we deem it necessary, “we put up with the intrusion and the cost of leveling the playing field.” The example I gave was sports: “Athletes are forced to submit to physical examinations and to provide samples of body fluids for testing, often under conditions that deny them minimal privacy. If they don’t like it, we tell them, don’t play sports.” Similarly, I stated, “if you don’t like being leveled to promote competitive fairness, don’t become enhanced.” But sports is not an apt analogy. While we may have a choice about whether or not to play competitive sports, none of us can avoid the competitive scramble for scarce societal resources, and as Chapter 8 makes clear, the arbitrary rules that govern sports are not suitable for application elsewhere. If banning biomedical enhancements would be foolhardy and if re- 220 the price of perfection stricting their use to socially desirable ends would require a repressive police state, the only alternative is to make sure that enhancements are available, not only to the well-off but to everyone. In other words, access to enhancements should be subsidized for those who cannot...