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Highlights from this issue
  1. Imogen Goold, Associate Editor

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Genetic enhancement, post-persons and moral status

In the 21st century, the enhancement of human beings beyond their natural capacities is a growing reality. Enhancement could include enlarging physical capacities such as muscularity, cognitive ability in areas like memory and mental focus, and psychological capacities, including emotional stability. As our ability to change our physical and mental capabilities increases, we will face new and complex ethical challenges. One such challenge is the implications of enhancement for moral status. It has been suggested that enhancement of human cognitive or moral capacities might result in beings with dramatically greater mental capabilities than our own and that these beings might attain a moral status higher than that of unenhanced persons. A development of this kind could undermine the moral equality assumption that all with the characteristics sufficient for personhood enjoy the same moral status.

Allen Buchanan has recently explored this issue, tentatively arguing that the concept of a being with greater moral status than us is dubious, and that consequently the prospect of enhancement does not threaten the moral equality assumption in any serious way.1 In this issue's feature article, David DeGrazia responds to some of Buchanan's ideas in the context of genetic enhancement (see page 135). He begins by posing two fundamental questions. First, ‘could genetic enhancement in principle lead to the existence of beings so superior to contemporary human beings, in ways that matter to us, that we might aptly describe them as post-persons?’ and second, ‘if such post-persons emerged, how should we understand their moral status in relation to ours?’

DeGrazia suggests that we should take the notion of post-persons seriously. He introduces a case, A Future with Post-persons, to explore some of the qualities these genetically-enhanced beings might possess in the year 2145. Among other things, they possess exceptional memories and have far greater self-awareness than the unenhanced. They also posses extraordinary rationality and strength of will, and are enormously adept at envisioning the consequences of their choices. According to DeGrazia, the combination of these abilities renders them ‘much more intelligent, reasonable, and morally reliable than ordinary persons’. The distinctions between these post-persons and the unenhanced is so great that they regard themselves as different in kind, in a manner not dissimilar to the distinctions often drawn between persons and animals.

In DeGrazia's case, the question arises whether these post-persons have higher moral status than unenhanced persons. Although unsure of how to answer this, he stands by the comparative claim that ‘post-persons have about as much justification in believing that they have higher moral status than persons, as persons have in believing that they have higher moral status than animals’. This has potentially profound implications for understandings of moral status that hold persons to have greater moral status than non-persons, and it may affect how we justify some differences in our treatment of beings of different kinds. In a challenge to the widely accepted ‘respect model’ of moral status, DeGrazia concludes that a better approach may be to drop the idea of levels of moral status, and accept instead that all sentient beings have moral status, but that their different capacities and interests justify some differences in how we treat them (the ‘interests model’).

Four authors offer commentaries on DeGrazia's views, including Allen Buchanan, who responds that he remains sceptical about the notion of beings with higher moral status than us (see page 140), but tentatively so. Buchanan argues that there are good reasons for us to be hesitant about this idea because it has implications that go right to the heart of our thinking on morality. For Buchanan, persons derive their moral status from their capacity to be accountable for reasons, and this accountability is the vital distinction between those with moral status and those without it. This distinction is of a profoundly different kind to that between those with varying capacities for accountability. Any ability to be accountable above the threshold level does not alter moral status, but instead means only that the person is more virtuous or deserving of admiration. Therefore, Buchanan argues that if we accept moral status as a threshold concept, we should consider enhanced persons of the kind DeGrazia envisions as simply more admirable or virtuous, rather than as beings with a distinct, higher status. Buchanan also raises a more general concern about DeGrazia's approach, suggesting that it leaves him necessarily committed to holding that there are an indefinite number of moral statuses if he rejects an account that includes a threshold for moral status (or omits to explain what the threshold for post-person status is).

Thomas Douglas's commentary offers some reasons why we might not want enhanced persons to have higher moral status (see page 141). One concern, he suggests, is that we would not want them to be owed more, in the moral sense, where this would result in their having stronger claims to things like healthcare resources or political influence. DeGrazia's interests model would not address this concern, Douglas argues, because the enhanced would also possess more and stronger interests than the unenhanced. Douglas also questions whether concerns about the possible moral claims of enhanced beings imply anything about the true structure of moral status.

James Wilson defends the respect model in his commentary, and considers that DeGrazia has not successfully made a case against it (see page 143). On this basis, Wilson holds that if the respect model remains tenable, then there is no reason to think that the higher moral status of humans relative to animals entails the higher moral status of post-persons relative to persons. DeGrazia's view faces a dilemma, Wilson contends: either it is compatible with the respect model in the sense of privileging human interests (and hence merely shifts the locus of the debate about animal interests), or it is not compatible. If the latter, Wilson argues that this results in a framework in which ‘some of the deepest held views of many morally serious people cannot even be expressed’.

Finally, Nicholas Agar voices some suspicion about the connection between enhanced moral dispositions and moral status enhancement in his commentary (see page 144). He notes that the concept of personhood encompasses cognitive abilities beneath those of humans, and comments that it is then unclear why the category of personhood shouldn't extend beyond human cognitive norms to encompass DeGrazia's enhanced beings. He further argues that constructivist accounts of moral enhancement like DeGrazia's predictably fail to show why the enhancement of human capacities would affect moral status. If enhanced beings possess cognitive capacities that we lack, then it is to be expected that they will lie beyond our comprehension. Consequently, says Agar, these limits probably restrict us to indirect, non-constructive ways to demonstrate the possibility of enhancing status.

In reply, DeGrazia responds to Buchanan's claim that accountability for reasons is the only property that matters for the possession of moral status (see page 145). The many other criteria suggested by philosophers are no less plausible, he argues, and many are possessed in varying degrees and by many animals. Doubt then is cast on Buchanan's assertion that only differences in kind, not degree, can justify a threshold of moral status. DeGrazia notes Agar's point on the downwards pliability of our concept of a person, stretching to those with below average cognitive abilities, but replies that in his 2145 case, the distinction between persons and post-persons is such that it has become a difference of kind rather than degree, with important implications. DeGrazia then contends that Douglas and Wilson underestimate the significance of the interests model's requirement that all beings with moral status should receive equal moral consideration and hence that their comparable interests should be given equal moral weight.

DeGrazia uses his concluding sentences to lay down a challenge: either we accept the interests model and its radical implications for the treatment of animals, or we embrace the respect model while acknowledging that there can be beings with higher moral status than persons. We human persons, he ends, cannot have moral status that is both superior and unsurpassable.

Fair allocation of resources

Resource allocation decisions have significant, in many cases life or death, implications for individuals. Some diseases and conditions attract little interest in developing treatments, particularly where there is a lack of financial incentive to do so. Yvonne Denier and others propose an ethical framework to help health policymakers to most justly allocate resources for the prevention and treatment of rare diseases (see page 148).

Resource allocation decisions in the UK health system are made using an assessment based on Quality-Adjusted Life Years (QALYs). Healthcare funders utilise public opinion surveys about the value of various health states when making decisions about resource allocation. Such research shows that non-functionally impaired states are preferred to functionally impaired states. Sean Sinclair argues that as a result, patients who are disabled face a higher cost effectiveness hurdle than able bodied patients when the outcomes of healthcare interventions are valued (see page 158). As a means to redress this inequity, Sinclair argues that instead of researching the general public, we should instead research the population that is to be targeted with the intervention.

Testing challenges

Two papers this week examine some of the difficulties associated with genetic testing. Lillian Cohen looks at some of the ethical issues that arise when individual testing and treatment require information about family members (see page 163). Cohen comments that using interdisciplinary teams oriented to the integrated care of families, as well as the individual, help to meet some of these challenges. Chris Degeling explores the benefits of screening for type 2 diabetes mellitus using glycated haemoglobin (HbA1C)-based tests, which he argues will result in more just allocation of resources, as well as advances in tackling the social determinants of health (see page 180).

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