Introduction

Use of steroids by professional athletes; administration of human growth hormone to genetically “normal” children of short stature; preimplantation genetic diagnosis to select embryos with or without certain genes; cosmetic surgery for appearance; teeth whitening; genetic modification of plants and animals: The types and means of enhancing desirable characteristics, abilities, or looks are many, and opinions about the moral validity of their use are equally varied. When should use of a drug or a procedure be considered a treatment or an enhancement? Does the distinction matter? Why do some enhancements spark little or no controversy, while others incite public outrage and congressional investigations? The articles in this issue of the Kennedy Institute of Ethics Journal address a variety of ethical issues raised by enhancement technologies in a number of different contexts.

Ori Lev, Franklin Miller, and Ezekiel Emanuel explore the ethics of conducting research to assess the safety and efficacy of enhancement interventions prior their introduction into clinical practice. Some people contend that because the use of biomedical enhancements is unethical, research that enables their use would be unethical as well. Others suggest that research on enhancement interventions would expose research participants to risks with no potential compensating health benefits either to themselves or to society. By contrast, the authors argue that a uniform prohibition on enhancement research is unjustified. Rather, each proposed enhancement study should be individually reviewed to assess whether it fulfills the ethical requirements that make a clinical study permissible.

Robert Sparrow addresses the normative significance of the distinction between therapy and enhancement, which has come under sustained philosophical attack in recent discussions of the ethics of shaping future persons by means of preimplantation genetic diagnosis and other advanced genetic technologies. He creatively demonstrates that rejection of the distinction generates unrecognized and strongly counterintuitive implications when it comes to selecting what sort of children should be brought into the world.

Rob Goodman discusses the use of performance enhancing drugs, particularly in the area of cognitive function, with an eye to the different kinds of activities to be enhanced. Specifically, he concludes that (cognitive) enhancement should be most tolerated when the activities subject to enhancement are non-zero-sum and when excellence in outcome is of greater concern than excellence in process.

Gillian Crozier and Christopher Hajzler critically examine the significance of “market stimulus”—the idea that free markets can play a role in widening access to new technologies—to the debate regarding whether parents should be permitted to purchase germ-line enhancements. They conclude that market stimulus, even if it applies to human genomic interventions, does not provide sufficient reason to deregulate germ-line enhancements because: (1) doing so could widen the gap between the rich and the poor; (2) even if it does not widen the gap, it might not sufficiently benefit the poor; and (3) it could have harmful effects for future generations.

Finally, Russell Powell addresses use of the precautionary principle or approach, especially in national and international regulations, to contend with biological and environmental risk in the context of emerging technologies. Despite its popularity in the regulatory arena, the precautionary approach has been criticized in the philosophical literature for, variously, its inability to provide substantive guidance in decision making or its leading to irrationally restrictive or even contradictory prescriptions. Powell examines the precautionary principle’s prima facie preference, especially regarding the modification of organisms and ecosystems, for the regulation of activity that proposes to intervene in natural living systems. He argues that this preference would be justified “if it were the case that evolution tended to produce optimal, delicately balanced equilibria that generally coincided with what humans value” but concludes that such assumptions conflict with contemporary evolutionary theory. As such, the precautionary approach can lead to a misguided environmental ethic.