Edited by Erik Parens, Washington DC, Georgetown University Press, 1998, 268 pages, £38.95 (hb), US$49.95.

This book on technologies aimed at enhancing human traits was written by people working in philosophy, ethics, theology, women's studies, literary analysis, medicine, law and public policy; the contributors had several meetings to discuss the book. The authors aim “to enable readers to begin to grapple with related conceptual and ethical issues”. The verb “enhance” begs the question that the activities concerned are desirable and beneficial, as the authors admit when they question which traits might be altered and how, and what benefits or disadvantages might follow. They conclude that the value of traits partly depends on their context. Some people like to be tall and others do not, some societies reward tall people, and medical growth treatments can reflect and reinforce these public values. The authors debate whether one future effect of “enhancements” through surgery, psychopharmacology and genetic modifications will be to increase differences between the rich elite, who engage in ultimately futile competitions to be, for example, ever taller, and everyone else.

The authors distinguish between enhancements and necessary medical treatment. One difference is that medicine tries to restore people or bring them up to a level of “normal” health, appearance or function, whereas enhancement tries to raise people to a higher “super” level. Yet the authors warn against over-sharp distinctions between treatment and enhancement, which insurance companies could use to refuse cover for much needed treatments by defining them as mere enhancements. While criticising dangerous or demeaning interventions, the authors are wary of denigrating people who are convinced that they need these treatments. There are useful discussions about combining respect for each individual and case, with working towards more just and equal access to treatment, partly through involving a wider range of concerned people in policy-making.

The book is academic North American in its views about insurance and favoured traits, such as high intelligence, though there is no evidence that very clever people live better or happier lives. Yet the book gains from being written in a society where science-fiction-style enhancements are becoming obvious and everyday realities. Each year, about two million people have cosmetic surgery in the US. Differences are drawn between adults who fairly willingly choose (subject to fashion and other pressures) to risk enhancement procedures, and parents who wish to enhance their children or future children. The adverse effects of involuntary enhancement for individuals and societies are well discussed, although the discussions would have benefited from involving more disabled speakers.

The book is packed with interesting discussions, including the following four examples.

1. Psychopharmacology can encourage attitudes which reduce all human feeling simply to pleasure or pain. These mechanistic approaches jeopardise our dignity as responsible people, who learn through our emotions (such as pity or fear), and struggle towards insights when we interpret and respond to our feelings. Medical enhancements are so popular partly because they fit neatly with ancient Western traditions of self improvement. Yet it is questionable whether the new scientific and passively acquired means, Prozac for instance, simply continue the older, harder and more active means, such as prayer. Any changes will be different in their nature and effects as well as in the ways they are gained.

2. We need to clarify what it means to be human, to separate being equal from being identical, and difference from disadvantage, and to be more respectful of differences. This involves being cautious about genetics, the study of difference, and its aims either to reduce differences, or to amplify those between a privileged few and the rest. Science can support unjust elitism because, when people have the opportunity to enhance themselves, this can turn into an oppressive duty to do so. John Rawls is quoted (page 100) as saying that people with permanent physical disabilities are not citizens or persons. So thinking about “being human” also involves thinking what is a good, or failed, or normal, or worthwhile life, before deciding how or whether to enhance a life. A sense of spiritual inner emptiness and pointlessness may be exacerbated by attempts to assuage it with happiness pills, which mistake complex spiritual and social problems for simpler medical ones.

3. Subliminal advertising messages express and also shape the desires of our own hearts, so that we create devices to achieve these desires—for freedom from fear and uncertainty, and for autonomy, comfort, control and conquest. Medical enhancements, like cars, cosmetics and pensions, appeal to these deep desires and are rationalised by them.

4. The magnifying lens gradually led on to the telescope and the microscope, through which Galileo, Darwin and others transformed our understanding of religion and society. Similarly, genetics is likely to have enormous unanticipated effects on future societies.

Mary Winkler ends this thought-provoking book with questions to ponder about each technology. Does it “enhance the whole person or offer only a palliative substitute for wholeness? Does it serve our desires for completeness and connection, or pander to our anxieties and our short-sighted demands for control? Finally, does the technology and its application help us to love and honour the body in all its fragility, imperfection and finitude”(page 249)?