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Biographies for speakers Shook and Sabat

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Biographies for speakers Shook and Sabat

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Stream new movie releases and classic favorites on HBO.com or on your device with an HBO app. Check back often for new releases and additions.

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The Fastest Man On No Legs - Extraordinary People -  full documentary

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Oscar Pistorius - all copyrights of this doc are reserved to the owners

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PHLX101-02: Introduction to Bioethics | Course

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Sandel wrote an interesting point that "The meritocracy, less chastened by chance, would become harder, less forgiving." The question I have relates to the impact biotechnological research and enhancement would have on our democracy. Would our society become more or less just and equal?

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While Bailey makes a valid point when he says: "The highest expression of human nature and dignity is to strive to overcome the limitations imposed on us by our genes, our evolution and our environment," he did not address many issues humanity is dealing with today - poverty, wars, income disparity, etc. that need solutions. I would be happy if we solve these first before we deal with our genes. Or he assumes that these problems will be resolved if we first "overcome the limitations" of our genes?

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By the end of this century, the typical European may attend a family reunion in which five generations are playing together. Great-great-great grandma, at 150 years old, will be as vital, with muscle tone as firm and supple, skin as elastic and glowing, as her 30-year-old great-great-granddaughter with whom she's playing tennis.

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Case Against Perfection - Pre-reading article

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Case Against Perfection - Pre-reading article

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Breakthroughs in genetics present us with a promise and a predicament. The promise is that we may soon be able to treat and prevent a host of debilitating diseases. The predicament is that our newfound genetic knowledge may also enable us to manipulate our own nature-to enhance our muscles, memories, and moods; to choose the sex, height, and other genetic traits of our children; to make ourselves "better than well." When science moves faster than moral understanding, as it does today, men and women struggle to articulate their unease. In liberal societies they reach first for the language of autonomy, fairness, and individual rights. But this part of our moral vocabulary is ill equipped to address the hardest questions posed by genetic engineering. The genomic revolution has induced a kind of moral vertigo.

Consider cloning. The birth of Dolly the cloned sheep, in 1997, brought a torrent of concern about the prospect of cloned human beings. There are good medical reasons to worry. Most scientists agree that cloning is unsafe, likely to produce offspring with serious abnormalities. (Dolly recently died a premature death.) But suppose technology improved to the point where clones were at no greater risk than naturally conceived offspring. Would human cloning still be objectionable? Should our hesitation be moral as well as medical? What, exactly, is wrong with creating a child who is a genetic twin of one parent, or of an older sibling who has tragically died-or, for that matter, of an admired scientist, sports star, or celebrity?

Some say cloning is wrong because it violates the right to autonomy: by choosing a child's genetic makeup in advance, parents deny the child's right to an open future. A similar objection can be raised against any form of bioengineering that allows parents to select or reject genetic characteristics. According to this argument, genetic enhancements for musical talent, say, or athletic prowess, would point children toward particular choices, and so designer children would never be fully free.

At first glance the autonomy argument seems to capture what is troubling about human cloning and other forms of genetic engineering. It is not persuasive, for two reasons. First, it wrongly implies that absent a designing parent, children are free to choose their characteristics for themselves. But none of us chooses his genetic inheritance. The alternative to a cloned or genetically enhanced child is not one whose future is unbound by particular talents but one at the mercy of the genetic lottery.

Second, even if a concern for autonomy explains some of our worries about made-to-order children, it cannot explain our moral hesitation about people who seek genetic remedies or enhancements for themselves. Gene therapy on somatic (that is, nonreproductive) cells, such as muscle cells and brain cells, repairs or replaces defective genes. The moral quandary arises when people use such therapy not to cure a disease but to reach beyond health, to enhance their physical or cognitive capacities, to lift themselves above the norm.

Like cosmetic surgery, genetic enhancement employs medical means for nonmedical ends-ends unrelated to curing or preventing disease or repairing injury. But unlike cosmetic surgery, genetic enhancement is more than skin-deep. If we are ambivalent about surgery or Botox injections for sagging chins and furrowed brows, we are all the more troubled by genetic engineering for stronger bodies, sharper memories, greater intelligence, and happier moods. The question is whether we are right to be troubled, and if so, on what grounds.

In order to grapple with the ethics of enhancement, we need to confront questions largely lost from view-questions about the moral status of nature, and about the proper stance of human beings toward the given world. Since these questions verge on theology, modern philosophers and political theorists tend to shrink from them. But our new powers of biotechnology make them unavoidable. To see why this is so, consider four examples already on the horizon: muscle enhancement, memory enhancement, growth-hormone treatment, and reproductive technologies that enable parents to choose the sex and some genetic traits of their children. In each case what began as an attempt to treat a disease or prevent a genetic disorder now beckons as an instrument of improvement and consumer choice.

Muscles. Everyone would welcome a gene therapy to alleviate muscular dystrophy and to reverse the debilitating muscle loss that comes with old age. But what if the same therapy were used to improve athletic performance? Researchers have developed a synthetic gene that, when injected into the muscle cells of mice, prevents and even reverses natural muscle deterioration. The gene not only repairs wasted or injured muscles but also strengthens healthy ones. This success bodes well for human applications. H. Lee Sweeney, of the University of Pennsylvania, who leads the research, hopes his discovery will cure the immobility that afflicts the elderly. But Sweeney's bulked-up mice have already attracted the attention of athletes seeking a competitive edge. Although the therapy is not yet approved for human use, the prospect of genetically enhanced weight lifters, home-run sluggers, linebackers, and sprinters is easy to imagine. The widespread use of steroids and other performance-improving drugs in professional sports suggests that many athletes will be eager to avail themselves of genetic enhancement.

Suppose for the sake of argument that muscle-enhancing gene therapy, unlike steroids, turned out to be safe-or at least no riskier than a rigorous weight-training regimen. Would there be a reason to ban its use in sports? There is something unsettling about the image of genetically altered athletes lifting SUVs or hitting 650-foot home runs or running a three-minute mile. But what, exactly, is troubling about it? Is it simply that we find such superhuman spectacles too bizarre to contemplate? Or does our unease point to something of ethical significance?

It might be argued that a genetically enhanced athlete, like a drug-enhanced athlete, would have an unfair advantage over his unenhanced competitors. But the fairness argument against enhancement has a fatal flaw: it has always been the case that some athletes are better endowed genetically than others, and yet we do not consider this to undermine the fairness of competitive sports. From the standpoint of fairness, enhanced genetic differences would be no worse than natural ones, assuming they were safe and made available to all. If genetic enhancement in sports is morally objectionable, it must be for reasons other than fairness.

Memory. Genetic enhancement is possible for brains as well as brawn. In the mid-1990s scientists managed to manipulate a memory-linked gene in fruit flies, creating flies with photographic memories. More recently researchers have produced smart mice by inserting extra copies of a memory-related gene into mouse embryos. The altered mice learn more quickly and remember things longer than normal mice. The extra copies were programmed to remain active even in old age, and the improvement was passed on to offspring.

Human memory is more complicated, but biotech companies, including Memory Pharmaceuticals, are in hot pursuit of memory-enhancing drugs, or "cognition enhancers," for human beings. The obvious market for such drugs consists of those who suffer from Alzheimer's and other serious memory disorders. The companies also have their sights on a bigger market: the 81 million Americans over fifty, who are beginning to encounter the memory loss that comes naturally with age. A drug that reversed age-related memory loss would be a bonanza for the pharmaceutical industry: a Viagra for the brain. Such use would straddle the line between remedy and enhancement. Unlike a treatment for Alzheimer's, it would cure no disease; but insofar as it restored capacities a person once possessed, it would have a remedial aspect. It could also have purely nonmedical uses: for example, by a lawyer cramming to memorize facts for an upcoming trial, or by a business executive eager to learn Mandarin on the eve of his departure for Shanghai.

Some who worry about the ethics of cognitive enhancement point to the danger of creating two classes of human beings: those with access to enhancement technologies, and those who must make do with their natural capacities. And if the enhancements could be passed down the generations, the two classes might eventually become subspecies-the enhanced and the merely natural. But worry about access ignores the moral status of enhancement itself. Is the scenario troubling because the unenhanced poor would be denied the benefits of bioengineering, or because the enhanced affluent would somehow be dehumanized? As with muscles, so with memory: the fundamental question is not how to ensure equal access to enhancement but whether we should aspire to it in the first place.

Height. Pediatricians already struggle with the ethics of enhancement when confronted by parents who want to make their children taller. Since the 1980s human growth hormone has been approved for children with a hormone deficiency that makes them much shorter than average. But the treatment also increases the height of healthy children. Some parents of healthy children who are unhappy with their stature (typically boys) ask why it should make a difference whether a child is short because of a hormone deficiency or because his parents happen to be short. Whatever the cause, the social consequences are the same.

In the face of this argument some doctors began prescribing hormone treatments for children whose short stature was unrelated to any medical problem. By 1996 such "off-label" use accounted for 40 percent of human-growth-hormone prescriptions. Although it is legal to prescribe drugs for purposes not approved by the Food and Drug Administration, pharmaceutical companies cannot promote such use. Seeking to expand its market, Eli Lilly & Co. recently persuaded the FDA to approve its human growth hormone for healthy children whose projected adult height is in the bottom one percentile-under five feet three inches for boys and four feet eleven inches for girls. This concession raises a large question about the ethics of enhancement: If hormone treatments need not be limited to those with hormone deficiencies, why should they be available only to very short children? Why shouldn't all shorter-than-average children be able to seek treatment? And what about a child of average height who wants to be taller so that he can make the basketball team?

Some oppose height enhancement on the grounds that it is collectively self-defeating; as some become taller, others become shorter relative to the norm. Except in Lake Wobegon, not every child can be above average. As the unenhanced began to feel shorter, they, too, might seek treatment, leading to a hormonal arms race that left everyone worse off, especially those who couldn't afford to buy their way up from shortness.

But the arms-race objection is not decisive on its own. Like the fairness objection to bioengineered muscles and memory, it leaves unexamined the attitudes and dispositions that prompt the drive for enhancement. If we were bothered only by the injustice of adding shortness to the problems of the poor, we could remedy that unfairness by publicly subsidizing height enhancements. As for the relative height deprivation suffered by innocent bystanders, we could compensate them by taxing those who buy their way to greater height. The real question is whether we want to live in a society where parents feel compelled to spend a fortune to make perfectly healthy kids a few inches taller.

Sex selection. Perhaps the most inevitable nonmedical use of bioengineering is sex selection. For centuries parents have been trying to choose the sex of their children. Today biotech succeeds where folk remedies failed.

One technique for sex selection arose with prenatal tests using amniocentesis and ultrasound. These medical technologies were developed to detect genetic abnormalities such as spina bifida and Down syndrome. But they can also reveal the sex of the fetus-allowing for the abortion of a fetus of an undesired sex. Even among those who favor abortion rights, few advocate abortion simply because the parents do not want a girl. Nevertheless, in traditional societies with a powerful cultural preference for boys, this practice has become widespread.

Sex selection need not involve abortion, however. For couples undergoing in vitro fertilization (IVF), it is possible to choose the sex of the child before the fertilized egg is implanted in the womb. One method makes use of pre-implantation genetic diagnosis (PGD), a procedure developed to screen for genetic diseases. Several eggs are fertilized in a petri dish and grown to the eight-cell stage (about three days). At that point the embryos are tested to determine their sex. Those of the desired sex are implanted; the others are typically discarded. Although few couples are likely to undergo the difficulty and expense of IVF simply to choose the sex of their child, embryo screening is a highly reliable means of sex selection. And as our genetic knowledge increases, it may be possible to use PGD to cull embryos carrying undesired genes, such as those associated with obesity, height, and skin color. The science-fiction movie Gattaca depicts a future in which parents routinely screen embryos for sex, height, immunity to disease, and even IQ. There is something troubling about the Gattaca scenario, but it is not easy to identify what exactly is wrong with screening embryos to choose the sex of our children.

One line of objection draws on arguments familiar from the abortion debate. Those who believe that an embryo is a person reject embryo screening for the same reasons they reject abortion. If an eight-cell embryo growing in a petri dish is morally equivalent to a fully developed human being, then discarding it is no better than aborting a fetus, and both practices are equivalent to infanticide. Whatever its merits, however, this "pro-life" objection is not an argument against sex selection as such.

The latest technology poses the question of sex selection unclouded by the matter of an embryo's moral status. The Genetics & IVF Institute, a for-profit infertility clinic in Fairfax, Virginia, now offers a sperm-sorting technique that makes it possible to choose the sex of one's child before it is conceived. X-bearing sperm, which produce girls, carry more DNA than Y-bearing sperm, which produce boys; a device called a flow cytometer can separate them. The process, called MicroSort, has a high rate of success.

If sex selection by sperm sorting is objectionable, it must be for reasons that go beyond the debate about the moral status of the embryo. One such reason is that sex selection is an instrument of sex discrimination-typically against girls, as illustrated by the chilling sex ratios in India and China. Some speculate that societies with substantially more men than women will be less stable, more violent, and more prone to crime or war. These are legitimate worries-but the sperm-sorting company has a clever way of addressing them. It offers MicroSort only to couples who want to choose the sex of a child for purposes of "family balancing." Those with more sons than daughters may choose a girl, and vice versa. But customers may not use the technology to stock up on children of the same sex, or even to choose the sex of their firstborn child. (So far the majority of MicroSort clients have chosen girls.) Under restrictions of this kind, do any ethical issues remain that should give us pause?

The case of MicroSort helps us isolate the moral objections that would persist if muscle-enhancement, memory-enhancement, and height-enhancement technologies were safe and available to all.

It is commonly said that genetic enhancements undermine our humanity by threatening our capacity to act freely, to succeed by our own efforts, and to consider ourselves responsible-worthy of praise or blame-for the things we do and for the way we are. It is one thing to hit seventy home runs as the result of disciplined training and effort, and something else, something less, to hit them with the help of steroids or genetically enhanced muscles. Of course, the roles of effort and enhancement will be a matter of degree. But as the role of enhancement increases, our admiration for the achievement fades-or, rather, our admiration for the achievement shifts from the player to his pharmacist. This suggests that our moral response to enhancement is a response to the diminished agency of the person whose achievement is enhanced.

Though there is much to be said for this argument, I do not think the main problem with enhancement and genetic engineering is that they undermine effort and erode human agency. The deeper danger is that they represent a kind of hyperagency-a Promethean aspiration to remake nature, including human nature, to serve our purposes and satisfy our desires. The problem is not the drift to mechanism but the drive to mastery. And what the drive to mastery misses and may even destroy is an appreciation of the gifted character of human powers and achievements.

To acknowledge the giftedness of life is to recognize that our talents and powers are not wholly our own doing, despite the effort we expend to develop and to exercise them. It is also to recognize that not everything in the world is open to whatever use we may desire or devise. Appreciating the gifted quality of life constrains the Promethean project and conduces to a certain humility. It is in part a religious sensibility. But its resonance reaches beyond religion.

It is difficult to account for what we admire about human activity and achievement without drawing upon some version of this idea. Consider two types of athletic achievement. We appreciate players like Pete Rose, who are not blessed with great natural gifts but who manage, through striving, grit, and determination, to excel in their sport. But we also admire players like Joe DiMaggio, who display natural gifts with grace and effortlessness. Now, suppose we learned that both players took performance-enhancing drugs. Whose turn to drugs would we find more deeply disillusioning? Which aspect of the athletic ideal-effort or gift-would be more deeply offended?

Some might say effort: the problem with drugs is that they provide a shortcut, a way to win without striving. But striving is not the point of sports; excellence is. And excellence consists at least partly in the display of natural talents and gifts that are no doing of the athlete who possesses them. This is an uncomfortable fact for democratic societies. We want to believe that success, in sports and in life, is something we earn, not something we inherit. Natural gifts, and the admiration they inspire, embarrass the meritocratic faith; they cast doubt on the conviction that praise and rewards flow from effort alone. In the face of this embarrassment we inflate the moral significance of striving, and depreciate giftedness. This distortion can be seen, for example, in network-television coverage of the Olympics, which focuses less on the feats the athletes perform than on heartrending stories of the hardships they have overcome and the struggles they have waged to triumph over an injury or a difficult upbringing or political turmoil in their native land.

But effort isn't everything. No one believes that a mediocre basketball player who works and trains even harder than Michael Jordan deserves greater acclaim or a bigger contract. The real problem with genetically altered athletes is that they corrupt athletic competition as a human activity that honors the cultivation and display of natural talents. From this standpoint, enhancement can be seen as the ultimate expression of the ethic of effort and willfulness-a kind of high-tech striving. The ethic of willfulness and the biotechnological powers it now enlists are arrayed against the claims of giftedness.

The ethic of giftedness, under siege in sports, persists in the practice of parenting. But here, too, bioengineering and genetic enhancement threaten to dislodge it. To appreciate children as gifts is to accept them as they come, not as objects of our design or products of our will or instruments of our ambition. Parental love is not contingent on the talents and attributes a child happens to have. We choose our friends and spouses at least partly on the basis of qualities we find attractive. But we do not choose our children. Their qualities are unpredictable, and even the most conscientious parents cannot be held wholly responsible for the kind of children they have. That is why parenthood, more than other human relationships, teaches what the theologian William F. May calls an "openness to the unbidden."

May's resonant phrase helps us see that the deepest moral objection to enhancement lies less in the perfection it seeks than in the human disposition it expresses and promotes. The problem is not that parents usurp the autonomy of a child they design. The problem lies in the hubris of the designing parents, in their drive to master the mystery of birth. Even if this disposition did not make parents tyrants to their children, it would disfigure the relation between parent and child, and deprive the parent of the humility and enlarged human sympathies that an openness to the unbidden can cultivate.

To appreciate children as gifts or blessings is not, of course, to be passive in the face of illness or disease. Medical intervention to cure or prevent illness or restore the injured to health does not desecrate nature but honors it. Healing sickness or injury does not override a child's natural capacities but permits them to flourish.

Nor does the sense of life as a gift mean that parents must shrink from shaping and directing the development of their child. Just as athletes and artists have an obligation to cultivate their talents, so parents have an obligation to cultivate their children, to help them discover and develop their talents and gifts. As May points out, parents give their children two kinds of love: accepting love and transforming love. Accepting love affirms the being of the child, whereas transforming love seeks the well-being of the child. Each aspect corrects the excesses of the other, he writes: "Attachment becomes too quietistic if it slackens into mere acceptance of the child as he is." Parents have a duty to promote their children's excellence.

These days, however, overly ambitious parents are prone to get carried away with transforming love-promoting and demanding all manner of accomplishments from their children, seeking perfection. "Parents find it difficult to maintain an equilibrium between the two sides of love," May observes. "Accepting love, without transforming love, slides into indulgence and finally neglect. Transforming love, without accepting love, badgers and finally rejects." May finds in these competing impulses a parallel with modern science: it, too, engages us in beholding the given world, studying and savoring it, and also in molding the world, transforming and perfecting it.

The mandate to mold our children, to cultivate and improve them, complicates the case against enhancement. We usually admire parents who seek the best for their children, who spare no effort to help them achieve happiness and success. Some parents confer advantages on their children by enrolling them in expensive schools, hiring private tutors, sending them to tennis camp, providing them with piano lessons, ballet lessons, swimming lessons, SAT-prep courses, and so on. If it is permissible and even admirable for parents to help their children in these ways, why isn't it equally admirable for parents to use whatever genetic technologies may emerge (provided they are safe) to enhance their children's intelligence, musical ability, or athletic prowess?

The defenders of enhancement are right to this extent: improving children through genetic engineering is similar in spirit to the heavily managed, high-pressure child-rearing that is now common. But this similarity does not vindicate genetic enhancement. On the contrary, it highlights a problem with the trend toward hyperparenting. One conspicuous example of this trend is sports-crazed parents bent on making champions of their children. Another is the frenzied drive of overbearing parents to mold and manage their children's academic careers.

As the pressure for performance increases, so does the need to help distractible children concentrate on the task at hand. This may be why diagnoses of attention deficit and hyperactivity disorder have increased so sharply. Lawrence Diller, a pediatrician and the author of Running on Ritalin, estimates that five to six percent of American children under eighteen (a total of four to five million kids) are currently prescribed Ritalin, Adderall, and other stimulants, the treatment of choice for ADHD. (Stimulants counteract hyperactivity by making it easier to focus and sustain attention.) The number of Ritalin prescriptions for children and adolescents has tripled over the past decade, but not all users suffer from attention disorders or hyperactivity. High school and college students have learned that prescription stimulants improve concentration for those with normal attention spans, and some buy or borrow their classmates' drugs to enhance their performance on the SAT or other exams. Since stimulants work for both medical and nonmedical purposes, they raise the same moral questions posed by other technologies of enhancement.

However those questions are resolved, the debate reveals the cultural distance we have traveled since the debate over marijuana, LSD, and other drugs a generation ago. Unlike the drugs of the 1960s and 1970s, Ritalin and Adderall are not for checking out but for buckling down, not for beholding the world and taking it in but for molding the world and fitting in. We used to speak of nonmedical drug use as "recreational." That term no longer applies. The steroids and stimulants that figure in the enhancement debate are not a source of recreation but a bid for compliance-a way of answering a competitive society's demand to improve our performance and perfect our nature. This demand for performance and perfection animates the impulse to rail against the given. It is the deepest source of the moral trouble with enhancement.

Some see a clear line between genetic enhancement and other ways that people seek improvement in their children and themselves. Genetic manipulation seems somehow worse-more intrusive, more sinister-than other ways of enhancing performance and seeking success. But morally speaking, the difference is less significant than it seems. Bioengineering gives us reason to question the low-tech, high-pressure child-rearing practices we commonly accept. The hyperparenting familiar in our time represents an anxious excess of mastery and dominion that misses the sense of life as a gift. This draws it disturbingly close to eugenics.

The shadow of eugenics hangs over today's debates about genetic engineering and enhancement. Critics of genetic engineering argue that human cloning, enhancement, and the quest for designer children are nothing more than "privatized" or "free-market" eugenics. Defenders of enhancement reply that genetic choices freely made are not really eugenic-at least not in the pejorative sense. To remove the coercion, they argue, is to remove the very thing that makes eugenic policies repugnant.

Sorting out the lesson of eugenics is another way of wrestling with the ethics of enhancement. The Nazis gave eugenics a bad name. But what, precisely, was wrong with it? Was the old eugenics objectionable only insofar as it was coercive? Or is there something inherently wrong with the resolve to deliberately design our progeny's traits?

James Watson, the biologist who, with Francis Crick, discovered the structure of DNA, sees nothing wrong with genetic engineering and enhancement, provided they are freely chosen rather than state-imposed. And yet Watson's language contains more than a whiff of the old eugenic sensibility. "If you really are stupid, I would call that a disease," he recently told The Times of London. "The lower 10 percent who really have difficulty, even in elementary school, what's the cause of it? A lot of people would like to say, 'Well, poverty, things like that.' It probably isn't. So I'd like to get rid of that, to help the lower 10 percent." A few years ago Watson stirred controversy by saying that if a gene for homosexuality were discovered, a woman should be free to abort a fetus that carried it. When his remark provoked an uproar, he replied that he was not singling out gays but asserting a principle: women should be free to abort fetuses for any reason of genetic preference-for example, if the child would be dyslexic, or lacking musical talent, or too short to play basketball.

Watson's scenarios are clearly objectionable to those for whom all abortion is an unspeakable crime. But for those who do not subscribe to the pro-life position, these scenarios raise a hard question: If it is morally troubling to contemplate abortion to avoid a gay child or a dyslexic one, doesn't this suggest that something is wrong with acting on any eugenic preference, even when no state coercion is involved?

Consider the market in eggs and sperm. The advent of artificial insemination allows prospective parents to shop for gametes with the genetic traits they desire in their offspring. It is a less predictable way to design children than cloning or pre-implantation genetic screening, but it offers a good example of a procreative practice in which the old eugenics meets the new consumerism. A few years ago some Ivy League newspapers ran an ad seeking an egg from a woman who was at least five feet ten inches tall and athletic, had no major family medical problems, and had a combined SAT score of 1400 or above. The ad offered $50,000 for an egg from a donor with these traits. More recently a Web site was launched claiming to auction eggs from fashion models whose photos appeared on the site, at starting bids of $15,000 to $150,000.

On what grounds, if any, is the egg market morally objectionable? Since no one is forced to buy or sell, it cannot be wrong for reasons of coercion. Some might worry that hefty prices would exploit poor women by presenting them with an offer they couldn't refuse. But the designer eggs that fetch the highest prices are likely to be sought from the privileged, not the poor. If the market for premium eggs gives us moral qualms, this, too, shows that concerns about eugenics are not put to rest by freedom of choice.

A tale of two sperm banks helps explain why. The Repository for Germinal Choice, one of America's first sperm banks, was not a commercial enterprise. It was opened in 1980 by Robert Graham, a philanthropist dedicated to improving the world's "germ plasm" and counteracting the rise of "retrograde humans." His plan was to collect the sperm of Nobel Prize-winning scientists and make it available to women of high intelligence, in hopes of breeding supersmart babies. But Graham had trouble persuading Nobel laureates to donate their sperm for his bizarre scheme, and so settled for sperm from young scientists of high promise. His sperm bank closed in 1999.

In contrast, California Cryobank, one of the world's leading sperm banks, is a for-profit company with no overt eugenic mission. Cappy Rothman, M.D., a co-founder of the firm, has nothing but disdain for Graham's eugenics, although the standards Cryobank imposes on the sperm it recruits are exacting. Cryobank has offices in Cambridge, Massachusetts, between Harvard and MIT, and in Palo Alto, California, near Stanford. It advertises for donors in campus newspapers (compensation up to $900 a month), and accepts less than five percent of the men who apply. Cryobank's marketing materials play up the prestigious source of its sperm. Its catalogue provides detailed information about the physical characteristics of each donor, along with his ethnic origin and college major. For an extra fee prospective customers can buy the results of a test that assesses the donor's temperament and character type. Rothman reports that Cryobank's ideal sperm donor is six feet tall, with brown eyes, blond hair, and dimples, and has a college degree-not because the company wants to propagate those traits, but because those are the traits his customers want: "If our customers wanted high school dropouts, we would give them high school dropouts."

Not everyone objects to marketing sperm. But anyone who is troubled by the eugenic aspect of the Nobel Prize sperm bank should be equally troubled by Cryobank, consumer-driven though it be. What, after all, is the moral difference between designing children according to an explicit eugenic purpose and designing children according to the dictates of the market? Whether the aim is to improve humanity's "germ plasm" or to cater to consumer preferences, both practices are eugenic insofar as both make children into products of deliberate design.

A number of political philosophers call for a new "liberal eugenics." They argue that a moral distinction can be drawn between the old eugenic policies and genetic enhancements that do not restrict the autonomy of the child. "While old-fashioned authoritarian eugenicists sought to produce citizens out of a single centrally designed mould," writes Nicholas Agar, "the distinguishing mark of the new liberal eugenics is state neutrality." Government may not tell parents what sort of children to design, and parents may engineer in their children only those traits that improve their capacities without biasing their choice of life plans. A recent text on genetics and justice, written by the bioethicists Allen Buchanan, Dan W. Brock, Norman Daniels, and Daniel Wikler, offers a similar view. The "bad reputation of eugenics," they write, is due to practices that "might be avoidable in a future eugenic program." The problem with the old eugenics was that its burdens fell disproportionately on the weak and the poor, who were unjustly sterilized and segregated. But provided that the benefits and burdens of genetic improvement are fairly distributed, these bioethicists argue, eugenic measures are unobjectionable and may even be morally required.

The libertarian philosopher Robert Nozick proposed a "genetic supermarket" that would enable parents to order children by design without imposing a single design on the society as a whole: "This supermarket system has the great virtue that it involves no centralized decision fixing the future human type(s)."

Even the leading philosopher of American liberalism, John Rawls, in his classic A Theory of Justice (1971), offered a brief endorsement of noncoercive eugenics. Even in a society that agrees to share the benefits and burdens of the genetic lottery, it is "in the interest of each to have greater natural assets," Rawls wrote. "This enables him to pursue a preferred plan of life." The parties to the social contract "want to insure for their descendants the best genetic endowment (assuming their own to be fixed)." Eugenic policies are therefore not only permissible but required as a matter of justice. "Thus over time a society is to take steps at least to preserve the general level of natural abilities and to prevent the diffusion of serious defects."

But removing the coercion does not vindicate eugenics. The problem with eugenics and genetic engineering is that they represent the one-sided triumph of willfulness over giftedness, of dominion over reverence, of molding over beholding. Why, we may wonder, should we worry about this triumph? Why not shake off our unease about genetic enhancement as so much superstition? What would be lost if biotechnology dissolved our sense of giftedness?

From a religious standpoint the answer is clear: To believe that our talents and powers are wholly our own doing is to misunderstand our place in creation, to confuse our role with God's. Religion is not the only source of reasons to care about giftedness, however. The moral stakes can also be described in secular terms. If bioengineering made the myth of the "self-made man" come true, it would be difficult to view our talents as gifts for which we are indebted, rather than as achievements for which we are responsible. This would transform three key features of our moral landscape: humility, responsibility, and solidarity.

In a social world that prizes mastery and control, parenthood is a school for humility. That we care deeply about our children and yet cannot choose the kind we want teaches parents to be open to the unbidden. Such openness is a disposition worth affirming, not only within families but in the wider world as well. It invites us to abide the unexpected, to live with dissonance, to rein in the impulse to control. A Gattaca-like world in which parents became accustomed to specifying the sex and genetic traits of their children would be a world inhospitable to the unbidden, a gated community writ large. The awareness that our talents and abilities are not wholly our own doing restrains our tendency toward hubris.

Though some maintain that genetic enhancement erodes human agency by overriding effort, the real problem is the explosion, not the erosion, of responsibility. As humility gives way, responsibility expands to daunting proportions. We attribute less to chance and more to choice. Parents become responsible for choosing, or failing to choose, the right traits for their children. Athletes become responsible for acquiring, or failing to acquire, the talents that will help their teams win.

One of the blessings of seeing ourselves as creatures of nature, God, or fortune is that we are not wholly responsible for the way we are. The more we become masters of our genetic endowments, the greater the burden we bear for the talents we have and the way we perform. Today when a basketball player misses a rebound, his coach can blame him for being out of position. Tomorrow the coach may blame him for being too short. Even now the use of performance-enhancing drugs in professional sports is subtly transforming the expectations players have for one another; on some teams players who take the field free from amphetamines or other stimulants are criticized for "playing naked."

The more alive we are to the chanced nature of our lot, the more reason we have to share our fate with others. Consider insurance. Since people do not know whether or when various ills will befall them, they pool their risk by buying health insurance and life insurance. As life plays itself out, the healthy wind up subsidizing the unhealthy, and those who live to a ripe old age wind up subsidizing the families of those who die before their time. Even without a sense of mutual obligation, people pool their risks and resources and share one another's fate.

But insurance markets mimic solidarity only insofar as people do not know or control their own risk factors. Suppose genetic testing advanced to the point where it could reliably predict each person's medical future and life expectancy. Those confident of good health and long life would opt out of the pool, causing other people's premiums to skyrocket. The solidarity of insurance would disappear as those with good genes fled the actuarial company of those with bad ones.

The fear that insurance companies would use genetic data to assess risks and set premiums recently led the Senate to vote to prohibit genetic discrimination in health insurance. But the bigger danger, admittedly more speculative, is that genetic enhancement, if routinely practiced, would make it harder to foster the moral sentiments that social solidarity requires.

Why, after all, do the successful owe anything to the least-advantaged members of society? The best answer to this question leans heavily on the notion of giftedness. The natural talents that enable the successful to flourish are not their own doing but, rather, their good fortune-a result of the genetic lottery. If our genetic endowments are gifts, rather than achievements for which we can claim credit, it is a mistake and a conceit to assume that we are entitled to the full measure of the bounty they reap in a market economy. We therefore have an obligation to share this bounty with those who, through no fault of their own, lack comparable gifts.

A lively sense of the contingency of our gifts-a consciousness that none of us is wholly responsible for his or her success-saves a meritocratic society from sliding into the smug assumption that the rich are rich because they are more deserving than the poor. Without this, the successful would become even more likely than they are now to view themselves as self-made and self-sufficient, and hence wholly responsible for their success. Those at the bottom of society would be viewed not as disadvantaged, and thus worthy of a measure of compensation, but as simply unfit, and thus worthy of eugenic repair. The meritocracy, less chastened by chance, would become harder, less forgiving. As perfect genetic knowledge would end the simulacrum of solidarity in insurance markets, so perfect genetic control would erode the actual solidarity that arises when men and women reflect on the contingency of their talents and fortunes.

Thirty-five years ago Robert L. Sinsheimer, a molecular biologist at the California Institute of Technology, glimpsed the shape of things to come. In an article titled "The Prospect of Designed Genetic Change" he argued that freedom of choice would vindicate the new genetics, and set it apart from the discredited eugenics of old.

To implement the older eugenics ... would have required a massive social programme carried out over many generations. Such a programme could not have been initiated without the consent and co-operation of a major fraction of the population, and would have been continuously subject to social control. In contrast, the new eugenics could, at least in principle, be implemented on a quite individual basis, in one generation, and subject to no existing restrictions.

According to Sinsheimer, the new eugenics would be voluntary rather than coerced, and also more humane. Rather than segregating and eliminating the unfit, it would improve them. "The old eugenics would have required a continual selection for breeding of the fit, and a culling of the unfit," he wrote. "The new eugenics would permit in principle the conversion of all the unfit to the highest genetic level."

Sinsheimer's paean to genetic engineering caught the heady, Promethean self-image of the age. He wrote hopefully of rescuing "the losers in that chromosomal lottery that so firmly channels our human destinies," including not only those born with genetic defects but also "the 50,000,000 'normal' Americans with an IQ of less than 90." But he also saw that something bigger than improving on nature's "mindless, age-old throw of dice" was at stake. Implicit in technologies of genetic intervention was a more exalted place for human beings in the cosmos. "As we enlarge man's freedom, we diminish his constraints and that which he must accept as given," he wrote. Copernicus and Darwin had "demoted man from his bright glory at the focal point of the universe," but the new biology would restore his central role. In the mirror of our genetic knowledge we would see ourselves as more than a link in the chain of evolution: "We can be the agent of transition to a whole new pitch of evolution. This is a cosmic event."

There is something appealing, even intoxicating, about a vision of human freedom unfettered by the given. It may even be the case that the allure of that vision played a part in summoning the genomic age into being. It is often assumed that the powers of enhancement we now possess arose as an inadvertent by-product of biomedical progress-the genetic revolution came, so to speak, to cure disease, and stayed to tempt us with the prospect of enhancing our performance, designing our children, and perfecting our nature. That may have the story backwards. It is more plausible to view genetic engineering as the ultimate expression of our resolve to see ourselves astride the world, the masters of our nature. But that promise of mastery is flawed. It threatens to banish our appreciation of life as a gift, and to leave us with nothing to affirm or behold outside our own will.

We want to hear what you think about this article. Submit a letter to the editor or write to letters@theatlantic.com.

Michael J. Sandel teaches political philosophy at Harvard University.

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Breakthroughs in genetics present us with a promise and a predicament. The promise is that we may soon be able to treat and prevent a host of debilitating diseases. The predicament is that our newfound genetic knowledge may also enable us to manipulate our own nature-to enhance our muscles, memories, and moods; to choose the sex, height, and other genetic traits of our children; to make ourselves "better than well."

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Human enhancement is at least as old as human civilization. People have been trying to enhance their physical and mental capabilities for thousands of years, sometimes successfully - and sometimes with inconclusive, comic and even tragic results.

Up to this point in history, however, most biomedical interventions, whether successful or not, have attempted to restore something perceived to be deficient, such as vision, hearing or mobility. Even when these interventions have tried to improve on nature - say with anabolic steroids to stimulate muscle growth or drugs such as Ritalin to sharpen focus - the results have tended to be relatively modest and incremental.

But thanks to recent scientific developments in areas such as biotechnology, information technology and nanotechnology, humanity may be on the cusp of an enhancement revolution. In the next two or three decades, people may have the option to change themselves and their children in ways that, up to now, have existed largely in the minds of science fiction writers and creators of comic book superheroes.

Both advocates for and opponents of human enhancement spin a number of possible scenarios. Some talk about what might be called "humanity plus" - people who are still recognizably human, but much smarter, stronger and healthier. Others speak of "post-humanity," and predict that dramatic advances in genetic engineering and machine technology may ultimately allow people to become conscious machines - not recognizably human, at least on the outside.

This enhancement revolution, if and when it comes, may well be prompted by ongoing efforts to aid people with disabilities and heal the sick. Indeed, science is already making rapid progress in new restorative and therapeutic technologies that could, in theory, have implications for human enhancement.

It seems that each week or so, the headlines herald a new medical or scientific breakthrough. In the last few years, for instance, researchers have implanted artificial retinas to give blind patients partial sight. Other scientists successfully linked a paralyzed man's brain to a computer chip, which helped restore partial movement of previously non-responsive limbs. Still others have created synthetic blood substitutes, which could soon be used in human patients.

One of the most important developments in recent years involves a new gene-splicing technique called "clustered regularly interspaced short palindromic repeats." Known by its acronym, CRISPR, this new method greatly improves scientists' ability to accurately and efficiently "edit" the human genome, in both embryos and adults.

To those who support human enhancement, many of whom call themselves transhumanists, technological breakthroughs like these are springboards not only to healing people but to changing and improving humanity. Up to this point, they say, humans have largely worked to control and shape their exterior environments because they were powerless to do more. But transhumanists predict that a convergence of new technologies will soon allow people to control and fundamentally change their bodies and minds. Instead of leaving a person's physical well-being to the vagaries of nature, supporters of these technologies contend, science will allow us to take control of our species' development, making ourselves and future generations stronger, smarter, healthier and happier.

The science that underpins transhumanist hopes is impressive, but there is no guarantee that researchers will create the means to make super-smart or super-strong people. Questions remain about the feasibility of radically changing human physiology, in part because scientists do not yet completely understand our bodies and minds. For instance, researchers still do not fully comprehend how people age or fully understand the source of human consciousness.

There also is significant philosophical, ethical and religious opposition to transhumanism. Many thinkers from different disciplines and faith traditions worry that radical changes will lead to people who are no longer either physically or psychologically human.

Even minor enhancements, critics say, may end up doing more harm than good. For instance, they contend, those with enhancements may lack empathy and compassion for those who have not chosen or cannot afford these new technologies. Indeed, they say, transhumanism could very well create an even wider gap between the haves and have-nots and lead to new kinds of exploitation or even slavery.

Given that the science is still at a somewhat early stage, there has been little public discussion about the possible impacts of human enhancement on a practical level. But a new survey by Pew Research Center suggests wariness in the U.S. public about these emerging technologies. For example, 68% of Americans say they would be "very" or "somewhat" worried about using gene editing on healthy babies to reduce the infants' risk of serious diseases or medical conditions. And a majority of U.S. adults (66%) say they would "definitely" or "probably" not want to get a brain chip implant to improve their ability to process information.

And yet, perhaps ironically, enhancement continues to captivate the popular imagination. Many of the top-grossing films in recent years in the United States and around the world have centered on superheroes with extraordinary abilities, such as the X-Men, Captain America, Spiderman, the Incredible Hulk and Iron Man. Such films explore the promise and pitfalls of exceeding natural human limits.

HUMAN ENHANCEMENT IN POPULAR CULTURE

Not only is enhancement unquestionably part of today's cultural zeitgeist, questions about humanity's quest to move beyond natural limits go back to our earliest myths and stories. The ancient Greeks told of Prometheus, who stole fire from the gods, and Daedalus, the skilled craftsman, who made wings for himself and his son, Icarus. In the opening chapters of Genesis, the Hebrew Bible depicts a successful incident of human enhancement, when Adam and Eve ate the fruit from the tree of the knowledge of good and evil because the Serpent told them it would make them "like God."

Of course, while Adam and Eve gained a new awareness and self-understanding, their actions also led to their expulsion from paradise and entry into a much harder world full of pain, shame and toil. This theme - that hidden dangers may lurk in something ostensibly good - runs through many literary accounts of enhancement. In Mary Shelley's "Frankenstein" (1818), for instance, a scientist creates a new man, only to eventually die while trying to destroy his creation.

Whether these fears surrounding human enhancement are real or unfounded is a question already being debated by ethicists, scientists, theologians and others. This report looks at that debate, particularly in light of the diverse religious traditions represented in the United States. First, though, the report explains some of the scientific developments that might form the basis of an enhancement revolution.

Where does the science stand?

On Feb. 25, 2014, President Barack Obama met with Army officials and engineers at the Pentagon to discuss plans to create a new super armor that would make soldiers much more dangerous and harder to kill. The president joked that "we're building 'Iron Man,'" but Obama's jest contained more than a kernel of truth: The exoskeleton, called the Tactical Assault Light Operator Suit (TALOS), does look vaguely like the fictional Tony Stark's famous Iron Man suit. The first prototypes already are being built, and if all goes as planned, American soldiers may soon be much stronger and largely impervious to bullets.

A little more than a year later and an ocean away, scientists with the United Kingdom's National Health Service (NHS) announced that by 2017, they plan to begin giving human subjects synthetic or artificial blood. If the NHS moves ahead with its plans, it would be the first time people receive blood created in a lab. While the ultimate aim of the effort is to stem blood shortages, especially for rare blood types, the success of synthetic blood could lay the foundation for a blood substitute that could be engineered to carry more oxygen or better fight infections.

In April 2016, scientists from the Battelle Memorial Institute in Columbus, Ohio, revealed that they had implanted a chip in the brain of a quadriplegic man. The chip can send signals to a sleeve around the man's arm, allowing him to pick up a glass of water, swipe a credit card and even play the video game Guitar Hero.

Roughly around the same time, Chinese researchers announced they had attempted to genetically alter 213 embryos to make them HIV resistant. Only four of the embryos were successfully changed and all were ultimately destroyed. Moreover, the scientists from the Guangzhou Medical University who did the work said its purpose was solely to test the feasibility of embryo gene editing, rather than to regularly begin altering embryos. Still, Robert Sparrow of Australia's Monash University Centre for Human Bioethics said that while editing embryos to prevent HIV has an obvious therapeutic purpose, the experiment more broadly would lead to other things. "Its most plausible use, and most likely use, is the technology of human enhancement," he said, according to the South China Morning Post.

As these examples show, many of the fantastic technologies that until recently were confined to science fiction have already arrived, at least in their early forms. "We are no longer living in a time when we can say we either want to enhance or we don't," says Nicholas Agar, a professor of ethics at Victoria University in Wellington, New Zealand, and author of the book "Humanity's End: Why We Should Reject Radical Enhancement." "We are already living in an age of enhancement."

The road to TALOS, brain chips and synthetic blood has been a long one that has included many stops along the way. Many of these advances come from a convergence of more than one type of technology - from genetics and robotics to nanotechnology and information technology. These technologies are "intermingling and feeding on one another, and they are collectively creating a curve of change unlike anything we humans have ever seen," journalist Joel Garreau writes in his book " Radical Evolution: The Promise and Peril of Enhancing Our Minds, Our Bodies - and What It Means to Be Human."

The combination of information technology and nanotechnology offers the prospect of machines that are, to quote the title of Robert Bryce's recent book on innovation, "Smaller Faster Lighter Denser Cheaper." And as some futurists such as Ray Kurzweil argue, these developments will occur at an accelerated rate as technologies build on each other. "An analysis of the history of technology shows that technological change is exponential, contrary to the common-sense 'intuitive linear' view," writes Kurzweil, an American computer scientist and inventor whose work has led to the development of everything from checkout scanners at supermarkets to text-reading machines for the blind. "So we won't experience 100 years of progress in the 21st century - it will be more like 20,000 years of progress (at today's rate)."

GENETIC EDITING AND ENGINEERING

In the field of biotechnology, a big milestone occurred in 1953, when American biologist James Watson and British physicist Francis Crick discovered the molecular structure of DNA - the famed double helix - that is the genetic blueprint for life. Almost 50 years later, in 2003, two international teams of researchers led by American biologists Francis Collins and Craig Venter succeeded in decoding and reading that blueprint by identifying all of the chemical base pairs that make up human DNA.

Finding the blueprint for life, and successfully decoding and reading it, has given researchers an opportunity to alter human physiology at its most fundamental level. Manipulating this genetic code - a process known as genetic engineering - could allow scientists to produce people with stronger muscles, harder bones and faster brains. Theoretically, it also could create people with gills or webbed hands and feet or even wings - and, as Garreau points out in his book, could lead to "an even greater variety of breeds of humans than there is of dogs."

In recent years, the prospect of advanced genetic engineering has become much more real, largely due to two developments. First, inexpensive and sophisticated gene mapping technology has given scientists an increasingly more sophisticated understanding of the human genome.

The second important development involves the powerful new gene editing technology known as CRISPR. While gene editing itself is not new, CRISPR offers scientists a method that is much faster, cheaper and more accurate. "It's about 1,000 times cheaper [than existing methods]," says George Church, a geneticist at Harvard Medical School. "It could be a game changer." CRISPR is so much more efficient and accurate than older gene-editing technology because it uses each cell's immune system to target and splice out parts of its DNA and replace them with new genetic code.

CRISPR is already dramatically expanding the realm of what is possible in the field of genetic engineering. Indeed, on June 21, 2016, the U.S. government announced that it had approved the first human trials using CRISPR, in this case to strengthen the cancer-fighting properties of the immune systems of patients suffering from melanoma and other deadly cancers. "CRISPR's power and versatility have opened up new and wide-ranging possibilities across biology and medicine," says Jennifer Doudna, a researcher at the University of California at Berkeley and a co-inventor of CRISPR.

According to Doudna and others, CRISPR could provide new treatments or even cures to some of today's most feared diseases - not only cancer, but Alzheimer's disease, Parkinson's disease and others.

An even more intriguing possibility involves making genetic changes at the embryonic stage, also known as germline editing. The logic is simple: alter the gene lines in an embryo's eight or 16 cell stage (to, say, eliminate the gene for Tay-Sachs disease) and that change will occur in each of the resulting person's trillions of cells - not to mention in the cells of their descendants. When combined with researchers' growing understanding of the genetic links to various diseases, CRISPR could conceivably help eliminate a host of maladies in people before they are born.

But many of the same scientists who have hailed CRISPR's promise, including Doudna, also have warned of its potential dangers. At a National Academy of Sciences conference in Washington, D.C., in December 2015, she and about 500 researchers, ethicists and others urged the scientific community to hold off editing embryos for now, arguing that we do not yet know enough to safely make changes that can be passed down to future generations.

Those at the conference also raised another concern: the idea of using the new technologies to edit embryos for non-therapeutic purposes. Under this scenario, parents could choose a variety of options for their unborn children, including everything from cosmetic traits, such as hair or eye color, to endowing their offspring with greater intellectual or athletic ability. Some transhumanists see a huge upside to making changes at the embryonic level. "This may be the area where serious enhancement first becomes possible, because it's easier to do many things at the embryonic stage than in adults using traditional drugs or machine implants," says Nick Bostrom, director of the Future of Humanity Institute, a think tank at Oxford University that focuses on "big picture questions about humanity and its prospects."

But in the minds of many philosophers, theologians and others, the idea of "designer children" veers too close to eugenics - the 19th- and early 20th-century philosophical movement to breed better people. Eugenics ultimately inspired forced sterilization laws in a number of countries (including the U.S.) and then, most notoriously, helped provide some of the intellectual framework for Nazi Germany's murder of millions in the name of promoting racial purity.

There also may be practical obstacles. Some worry that there could be unintended consequences, in part because our understanding of the genome, while growing, is not even close to complete. Writing in Time magazine, Venter, who helped lead the first successful effort to sequence the human genome, warns that "we have little or no knowledge of how (with a few exceptions) changing the genetic code will effect development and the subtlety associated with the tremendous array of human traits." Venter adds: "Genes and proteins rarely have a single function in the genome and we know of many cases in experimental animals where changing a 'known function' of a gene results in developmental surprises."

A BETTER BRAIN?

For many transhumanists, expanding our capacities begins with the organ that most sets humans apart from other animals: the brain. Right now, cognitive enhancement largely involves drugs that were developed and are prescribed to treat certain brain-related conditions, such as Ritalin for attention deficit disorder or modafinil for narcolepsy. These and other medications have been shown in lab tests to help sharpen focus and improve memory.

But while modafinil and other drugs are now sometimes used (off label) to improve cognition, particularly among test-cramming students and overwhelmed office workers, the improvements in focus and memory are relatively modest. Moreover, many transhumanists and others predict that while new drugs (say, a specifically designed, IQ-boosting "smart pill") or genetic engineering could result in substantially enhanced brain function, the straightest and shortest line to dramatically augmenting cognition probably involves computers and information technology.

As with biotechnology, information technology's story is littered with important milestones and markers, such as the development of the transistor by three American scientists at Bell Labs in 1947. Transistors are the electronic signal switches that gave rise to modern computers. By shrinking the electronic components to microscopic size, researchers have been able to build ever smaller, more powerful and cheaper computers. As a result, today's iPhone has more than 250,000 times more data storage capacity than the guidance computer installed on the Apollo 11 spacecraft that took astronauts to the moon.

One of the reasons the iPhone is so powerful and capable is that it uses nanotechnology, which involves " the ability to see and to control individual atoms and molecules." Nanotechnology has been used to create substances and materials found in thousands of products, including items much less complex than an iPhone, such as clothing and cosmetics.

Advances in computing and nanotechnology have already resulted in the creation of tiny computers that can interface with our brains. This development is not as far-fetched as it may sound, since both the brain and computers use electricity to operate and communicate. These early and primitive brain-machine interfaces have been used for therapeutic purposes, to help restore some mobility to those with paralysis (as in the example involving the quadriplegic man) and to give partial sight to people with certain kinds of blindness. In the future, scientists say, brain-machine interfaces will do everything from helping stroke victims regain speech and mobility to successfully bringing people out of deep comas.

Right now, most scientists working in the brain-machine-interface field say they are solely focused on healing, rather than enhancing. "I've talked to hundreds of people doing this research, and right now everyone is wedded to the medical stuff and won't even talk about enhancement because they don't want to lose their research grants," says Daniel Faggella, a futurist who founded TechEmergence, a market research firm focusing on cognitive enhancement and the intersection of technology and psychology. But, Faggella says, the technology developed to ameliorate medical conditions will inevitably be put to other uses. "Once we have boots on the ground and the ameliorative stuff becomes more normal, people will then start to say: we can do more with this."

Doing more inevitably will involve augmenting brain function, which has already begun in a relatively simple way. For instance, scientists have been using electrodes placed on the head to run a mild electrical current through the brain, a procedure known as transcranial direct-current stimulation (tDCS). Research shows that tDCS, which is painless, may increase brain plasticity, making it easier for neurons to fire. This, in turn, improves cognition, making it easier for test subjects to learn and retain things, from new languages to mathematics. Already there is talk of implanting a tDCS pacemaker-like device in the brain so recipients do not need to wear electrodes. A device inside someone's head could also more accurately target the electrical current to those parts of the brain most responsive to tDCS.

According to many futurists, tDCS is akin to an early steam train or maybe even a horse-drawn carriage before the coming of jumbo jets and rockets. If, as some scientists predict, full brain-machine interface comes to pass, people may soon have chips implanted in their brains, giving them direct access to digital information. This would be like having a smartphone in one's head, with the ability to call up mountains of data instantly and without ever having to look at a computer screen.

The next step might be machines that augment various brain functions. Once scientists complete a detailed map of exactly what different parts of our brain do, they will theoretically be able to augment each function zone by placing tiny computers in these places. For example, machines may allow us to "process" information at exponentially faster speeds or to vividly remember everything or simply to see or hear better. Augments placed in our frontal lobe could, theoretically, make us more creative, give us more (or less) empathy or make us better at mathematics or languages. (For data on whether Americans say they would want to use potential technology that involved a brain-chip implant to improve cognitive abilities, see the accompanying survey, see U.S. Public Wary of Biomedical Technologies to 'Enhance' Human Abilities.)

Genetic engineering also offers promising possibilities, although there are possible obstacles as well. Scientists have already identified certain areas in human DNA that seem to control our cognitive functions. In theory, someone's "smart genes" could be manipulated to work better, an idea that almost certainly has become more feasible with the recent development of CRISPR. "The potential here is really very great," says Anders Sandberg, a neuroscientist and fellow at Oxford University's Future of Humanity Institute. "I mean scientists are already working on ... small biological robots made up of small particles of DNA that bind to certain things in the brain and change their chemical composition.

"This would allow us to do so many different things," Sandberg adds. "The sky's the limit."

In spite of this optimism, some scientists maintain that it will probably be a long time before we can bioengineer a substantially smarter person. For one thing, it is unlikely there are just a few genes or even a few dozen genes that regulate intelligence. Indeed, intelligence may be dependent on the subtle dance of thousands of genes, which makes bioengineering a genius much harder.

Even if scientists find the right genes and "turn them on," there is no guarantee that people will actually be smarter. In fact, some scientists speculate that trying to ramp up intelligence - whether by biology or machines - could overload the brain's carrying capacity. According to Martin Dresler, an assistant professor of cognitive neuroscience at Radboud University in the Netherlands, some researchers believe that "evolution forced brains to develop toward optimal ... functioning." In other words, he says, "if there still was potential to optimize brain functioning by adding certain chemicals, nature would already have done this." The same reasoning could also apply to machine enhancement, Dresler adds.

Even the optimistic Sandberg says that enhancing the brain could prove more difficult than some might imagine because changing biological systems can often have unforeseen impacts. "Biology is messy," he says. "When you push in one direction, biology usually pushes back."

THE FUTURE OF BLOOD

Given the brain's importance, cognitive enhancement might be the holy grail of transhumanism. But many futurists say enhancement technologies will likely be used to transform the whole body, not just one part of it.

This includes efforts to manufacture synthetic blood, which to this point have been focused on therapeutic goals. But as with CRISPR and gene editing, artificial blood could ultimately be used as part of a broader effort at human enhancement. It could be engineered to clot much faster than natural human blood, for instance, preventing people from bleeding to death. Or it could be designed to continuously monitor a person's arteries and keep them free of plaque, thus preventing a heart attack.

Synthetic white blood cells also could potentially be programmed. Indeed, like virtually any computer, these cells could receive "software updates" that would allow them to fight a variety of threats, such as a new infection or a specific kind of cancer.

Scientists already are developing and testing nanoparticles that could enter the bloodstream and deliver medicine to targeted areas. These microscopic particles are a far cry from synthetic blood, since they would be used once and for very specific tasks - such as delivering small doses of chemotherapy directly to cancer cells. However, nanoparticles could be precursors to microscopic machines that could potentially do a variety of tasks for a much longer period of time, ultimately replacing our blood.

It's also possible that enhanced blood will be genetically engineered rather than synthetically made. "One of the biggest advantages of this approach is that you would not have to worry about your body rejecting your new blood, because it will still come from you," says Oxford University's Sandberg.

Regardless of how it is made, one obvious role for enhanced or "smart" blood would be to increase the amount of oxygen our hemoglobin can carry. "In principle, the way our blood stores oxygen is very limited," Sandberg says. "So we could dramatically enhance our physical selves if we could increase the carrying capacity of hemoglobin."

According to Sandberg and others, substantially more oxygen in the blood could have many uses beyond the obvious benefits for athletes. For example, he says, "it might prevent you from having a heart attack, since the heart doesn't need to work as hard, or it might be that you wouldn't have to breathe for 45 minutes." In general, Sandberg says, this super blood "might give you a lot more energy, which would be a kind of cognitive enhancement."

(For data on whether Americans say they would want to use potential synthetic blood substitutes to improve their own physical abilities, see the accompanying survey, U.S. Public Wary of Biomedical Technologies to 'Enhance' Human Abilities.)

HYPE OR PARADIGM SHIFT?

So where is all of this new and powerful technology taking humanity? The answer depends on who you ask.

Having more energy or even more intelligence or stamina is not the end point of the enhancement project, many transhumanists say. Some futurists, such as Kurzweil, talk about the use of machines not only to dramatically increase physical and cognitive abilities but to fundamentally change the trajectory of human life and experience. For instance, Kurzweil predicts that by the 2040s, the first people will upload their brains into the cloud, "living in various virtual worlds and even avoiding aging and evading death."

Kurzweil - who has done more than anyone to popularize the idea that our conscious selves will soon be able to be "uploaded" - ">has been called everything from "freaky" to "a highly sophisticated crackpot." But in addition to being one of the world's most successful inventors, he has - if book sales and speaking engagements are any indication - built a sizable following for his ideas.

Kurzweil is not the only one who thinks we are on the cusp of an era when human beings will be able to direct their own evolution. "I believe that we're now seeing the beginning of a paradigm shift in engineering, the sciences and the humanities," says Natasha Vita-More, chairwoman of the board of directors of Humanity+, an organization that promotes "the ethical use of technology to expand human capacities."

Still, even some transhumanists who admire Kurzweil's work do not entirely share his belief that we will soon be living entirely virtual lives. "I don't share Ray's view that we will be disembodied," says Vita-More, who along with her husband, philosopher Max More, helped found the transhumanist movement in the United States. "We will always have a body, even though that body will change."

In the future, Vita-More predicts, our bodies will be radically changed by biological and machine-based enhancements, but our fundamental sensorial life - that part of us that touches, hears and sees the world - will remain intact. However, she also envisions something she calls a whole-body prosthetic, which, along with our uploaded consciousness, will act as a backup or copy of us in case we die. "This will be a way to ensure our personal survival if something happens to our bodies," she says.

Others, like Boston University bioethicist George Annas, believe Kurzweil is wrong about technological development and say talk of exotic enhancement is largely hype. "Based on our past experience, we know that most of these things are unlikely to happen in the next 30 or 40 years," Annas says.

He points to many confident predictions in the last 30 or 40 years that turned out to be unfounded. "In the 1970s, we thought that by now there would be millions of people with artificial hearts," he says. Currently, only a small number of patients have artificial hearts and the devices are used as a temporary bridge, to keep patients alive until a human heart can be found for transplant.

More recently, Annas says, "people thought the Human Genome Project would quickly lead to personalized medicine, but it hasn't."

Faggella, the futurist who founded TechEmergence, sees a dramatically different future and thinks the real push will be about, in essence, expanding our consciousness, both literally and figuratively. The desire to be stronger and smarter, Faggella says, will quickly give way to a quest for a new kind of happiness and fulfillment. "In the last 200 years, technology has made us like gods ... and yet people today are roughly as happy as they were before," he says. "So, I believe that becoming a super-Einstein isn't going to make us happier and ... that ultimately we'll use enhancement to fulfill our wants and desires rather than just make ourselves more powerful."

What exactly does that mean? Faggella can't say for sure, but he thinks that enhancement of the mind will ultimately allow people to have experiences that are quite simply impossible with our current brains. "We'll probably start by taking a human version of nirvana and creating it in some sort of virtual reality," he says, adding "eventually we'll transition to realms of bliss that we can't conceive of at this time because we're incapable of conceiving it. Enhancing our brains will be about making us capable."

Ethics and religion

A TALE OF TWO HUXLEYS

To some degree, the ideas and concepts behind human enhancement can be traced to biologist and author Julian Huxley. In addition to being one of the most important scientific thinkers of the mid-20th century, Julian also was the brother of Aldous Huxley, author of the famous scientific dystopian novel "Brave New World. "

The novel is set in a future where, thanks to science, virtually no one knows violence or want. But this brave new world also is a sterile place, where people rarely feel love, where children are "decanted" in laboratories and families no longer exist, and where happiness is chemically induced. Although there is an abundance of material comforts in this fictional world, the things that people traditionally believe best define our humanity and make life worth living - love, close relationships, joy - have largely been eliminated.

In contrast with his brother Aldous, Julian Huxley was a scientific optimist who believed that new technologies would offer people amazing opportunities for self-improvement and growth, including the ability to direct our evolution as a species. No longer, he said, would a person's physical and psychological attributes be subject to the capricious whims of nature.

In his 1957 essay "Transhumanism" (a term Julian Huxley coined), he laid out his ideas, writing that "the human species can, if it wishes, transcend itself - not just sporadically, an individual here in one way, an individual there in another way, but in its entirety, as humanity." Once man took hold of his biological destiny, he "would be on the threshold of a new kind of existence, as different from ours as ours is from that of Pekin[g] man," Julian Huxley wrote, referring to the name given to the 750,000-year-old fossils of one of our prehistoric ancestors.

A COST TO SOCIETY?

But like Julian's brother Aldous Huxley, those who oppose radical enhancement say the road to transcending humanity is paved with terrible risks and dangers, and that a society that embraces enhancement might lose much more in the bargain than it gains. "I think that the enhancement imperative, where we're going to overcome all limitations including death, seems to me to be a kind of utopianism that we'll have to break a lot of eggs to realize," says Christian Brugger, a professor of moral theology at St. John Vianney Theological Seminary in Denver.

According to Brugger and other opponents of radical enhancement, those "broken eggs" might include increased social tensions - or worse - as the rich and privileged gain access to expensive new enhancement treatments long before the middle class or poor and then use these advantages to widen an already wide gap between rich and poor. "The risks here of creating greater inequalities seem to be obvious," says Todd Daly, an associate professor of theology and ethics at Urbana Theological Seminary in Champaign, Ill. "And I'm not convinced that people who get these enhancements will want to make sure everyone else eventually gets them too, because people usually want to leverage the advantages they have."

For some thinkers, concerns about inequality go much further than merely widening the existing gap between rich and poor. They believe that radical enhancement will threaten the very social compact that underpins liberal democracies in the United States and elsewhere. "The political equality enshrined in the Declaration of Independence rests on the empirical fact of natural human equality," writes social philosopher Francis Fukuyama in his 2002 book "Our Posthuman Future." He adds: "We vary greatly as individuals and by culture, but we share a common humanity."

Brugger of St. John Vianney Theological Seminary agrees. "Right now, there is a common equality because we are all human," he says. "But all of this changes once we start giving some people significantly new powers."

Boston University's Annas shares these concerns. "I think at some point it will be inevitable that enhanced people will see the unenhanced as subhuman," he says. "[Enhanced] people would probably assume they had the right to rule us, and the rest of us might try to kill them, ending in a lot of dead and hurt people."

Supporters of human enhancement say the goal is not to create a race of superhumans but to use technological tools to improve humanity and the human condition. Indeed, they say, it is an extension of what humans have been doing for millennia: using technology to make life better. "I don't believe in utopias and I don't believe in perfection," says Vita-More, adding that: "For me, enhancement is a very practical way to give us new options to make our lives better. It's that simple."

A good example, Vita-More says, is cognitive enhancement. "By giving people increased memory and problem-solving skills, cognitive enhancement will help us be more creative by giving us the ability to put more things together in new ways," she says. "It will make us better problem solvers."

Those who support human enhancement also deny that these developments will make social inequalities dramatically worse. New technologies are often socially disruptive and can have a negative impact on certain vulnerable populations, they say. But the problem of inequality is essentially, and will remain, a political one.

"The core Luddite mistake is to point to a social problem and to say that if we add new technologies the problem will get worse," says James Hughes, executive director of the Institute for Ethics and Emerging Technologies, a pro-enhancement think tank. "But the way to cure the problem in this case is to make the world more equal, rather than banning the technology."

Human enhancement is just as likely, or even more likely, to mitigate social inequalities than to aggravate them, says Oxford University's Bostrom, a leader in the transhumanist movement. "The enhancement project could allow people who have natural inequalities to be brought up to everyone else's level," he says.

Hughes, Bostrom and others also dispute the idea put forth by Fukuyama and Brugger that enhancement could displace the sense of common humanity that has undergirded the democratic social contract for centuries. First, they point out that the history of the modern West has been one of an ever-expanding definition of full citizenship. "The set of individuals accorded full moral status by Western societies has actually increased, to include men without property or noble descent, women and non-white peoples," Bostrom writes. In addition, supporters of enhancement say, the notion that there will be a distinctive species of enhanced individuals who will try to enslave their unenhanced brothers and sisters might make for good science fiction, but it is not likely to happen. Instead, they say, there will be many different types of people, with different types of enhancements. "It seems much more likely that there would be a continuum of differently modified or enhanced individuals, which would overlap with the continuum of as-yet-unenhanced humans," Bostrom writes, adding that today there are very different types of people (very tall to very short, very intelligent to intellectually disabled, etc.) who manage to live side by side as moral and legal equals.

Finally, transhumanists and other supporters say, history shows that as people gain more control over their lives, they become more empathetic, not less. "Today we have more health, more intelligence and more lifespan than we did 100 years ago, and we're more compassionate and more empathetic today then we were then," Hughes says, pointing to a 2011 book by Harvard University psychology professor Steven Pinker, "The Better Angels of Our Nature: Why Violence Has Declined." The book makes the case that as human society has grown richer and more sophisticated, it also has become less violent. "The more ability we have as individuals, the better we become," Hughes adds.

A COST TO SELF?

Critics of enhancement question whether people really will be happier if enhancement projects are allowed to come to fruition. According to these critics, philosophers have long held that true happiness does not come from enhanced physical prowess or dramatically longer life, but from good character and virtuous living. "Happiness is found in marriages, in families, in neighborhoods ... in people who are willing to sacrifice and suffer for others," Brugger says. "None of these are promised by enhancement."

"Happiness also is found in limits, says Agar of Victoria University. "There are things that I value and am proud of in my life, like my recent book," he says. "But how can I value the writing of my book if I've been cognitively enhanced, and doing such a thing becomes much easier?"

But supporters contend that life still will be meaningful and challenging in a world where enhancement is widespread. "The things that have to do with human character and virtue and those things that make life meaningful will not change as a result of human enhancement, just like they haven't changed as our society has changed," says Ted Peters, a professor of systematic theology at Pacific Lutheran Theological Seminary in Berkeley, California. "As long as we are still human, these things will be important."

Furthermore, an enhanced life will still contain challenges and limits, just different ones, says Ronald Cole-Turner, a professor of theology and ethics at Pittsburgh Theological Seminary, which is associated with the Presbyterian Church (U.S.A.). "The challenges of life will still be there, they may just be different and harder," he says. "The goal posts will have moved further down the field, that's all."

TRANSHUMANISM AND FAITH TRADITIONS

Because human enhancement is still largely an issue for the future, it has not yet attracted a lot of attention in American religious communities. There is, for instance, no official teaching or statement on human enhancement or transhumanism that has come directly from any of the major churches or religious groups in the United States. However, some theologians, religious ethicists and religious leaders have started to think about the implications of human enhancement in light of their traditions' teachings, offering a sense of how their churches or religions might respond to radical human enhancement if it became possible.

All of the Abrahamic faiths - Judaism, Christianity and Islam - share the belief that men and women have been created, to some extent, in God's image. According to many theologians, the idea that human beings in certain ways mirror God make some, but not all, religious denominations within this broad set of connected traditions wary of using new technologies to enhance or change people, rather than heal or restore them.

The Roman Catholic Church, through its large network of educational and other institutions, already has begun formulating an argument against enhancement, based in part on the idea that God's plan for humanity includes limits and that life's limits are the very forces that create virtuous, wise and ultimately happy people. "Courage, fidelity, fortitude, generosity, hope, moderation, perseverance, are all cultivated in response to limitations of circumstance and nature," says John Haldane, a Catholic philosopher who teaches at the University of St. Andrews in Scotland.

Catholics actively support medical and technological advances that can restore someone to health, says Brugger. "But the dividing line for the church is the line between therapy and enhancement."

Concerns about crossing that line already have been expressed by Catholic-affiliated organizations. In 2013, for instance, the church-affiliated International Science and Life Congress met in Madrid and issued a declaration that warned that "new human species, artificially manipulated" would create "a real danger to human life as we know it."

Conservative evangelical Protestant churches also are likely to be wary of treatments or technologies that enhance, rather than heal, people, says Daly of Urbana Theological Seminary. "I think most [evangelical] churches will warn against this," he says. "I think a lot of evangelical leaders and pastors will see this as unwise and will call on people to avoid it." Indeed, Albert Mohler, one of the intellectual leaders of evangelical Christianity's largest U.S. denomination, the Southern Baptist Convention, already has, calling it " a new form of eugenic ideology."

According to Daly and others, evangelicals' opposition to enhancement would be based in part on the notion that man should not "play God." According to Daly, "when we attempt to be something more than human, are we running the risk of trying to become, in some ways, like God, as did Adam and Eve?" He adds, "This is an important issue for Christians that, I think, will help drive the debate for us."

Opposition also would be likely from the Church of Jesus Christ of Latter-day Saints, which teaches that the body is sacred and thus must not be altered. While small enhancements that do not overtly change the body might be acceptable to Mormon leaders, more significant enhancements would probably be "seen as a problem by the church," says Steven Peck, a bioethicist at Brigham Young University in Provo, Utah.

The Hindu tradition probably would approach human enhancement as a potentially dangerous development as well, although for different reasons than Christian churches, says Deepak Sarma, a professor of South Asian religions and philosophy at Case Western Reserve University in Cleveland. Enhancement is troubling, he says, because it could be used to alleviate suffering, which is necessary to work off bad karma (debt from bad deeds and intents committed during a person's past lives). Viewed in this light, Sarma says, Hindus could see enhancement as keeping someone from cleansing themselves of these misdeeds from their past lives.

In Islam, according to Sherine Hamdy, an associate professor of anthropology at Brown University, human enhancement would be viewed with concern by some scholars and leaders and embraced by others. Supporters might see new enhancements as a way to help the Muslim world catch up with the West or "at least not get left further behind," she says. Others would oppose enhancements out of a desire "not to change what God has created."

Other churches and religious traditions, however, probably would not be opposed or even divided on the issue, scholars say. For instance, mainline Protestant denominations, such as the Presbyterian, Episcopalian or Methodist churches, are unlikely to attempt to prevent their members from taking advantage of new enhancements, says Cole-Turner of Pittsburgh Theological Seminary, which serves a student body made up mostly of mainline Protestants. "I see no clear expression of opposition coming from any of the [mainline] denominations over this, because they will not view it as threatening," he says. "What you might see instead are efforts to assure fair distribution of these benefits, so that can we mitigate any injustices or inequalities that might be caused by this."

According to Lutheran theologian Peters, many mainline churches will view enhancement positively because they will see aspects of it as attempts to improve human well-being and alleviate suffering. "I think they will see much of this for what it is: an effort to take advantage of these new technologies to help improve human life," he says.

Similarly, Buddhists would largely accept and even embrace human enhancement because it could help them become better Buddhists, says Hughes, who is an advocate for transhumanism as well as a Buddhist and a former Buddhist monk. Enhancement that extends life and makes people more intelligent "would be seen as good because you'd have more time to work on enlightenment and ... you could be more effective in helping others," he says.

Jewish leaders and thinkers from all of the faith's major movements probably would favor developments that improve cognitive ability or physical strength. "Most Jewish bioethicists have no qualms about enhancement, and they see it as extension of the command [in Jewish law] to 'improve the world,'" says Hava Tirosh-Samuelson, the director of Jewish studies at Arizona State University. "So long as the improvement alleviates or prevents suffering, it is inherently good and ... they tend to endorse it."

In spite of intense disagreements about the utility and morality of trying to "improve" humanity, many thinkers on both sides of the debate share the belief that if just some of the dreams of today's transhumanists are realized, human society will change and change significantly. These changes, if they occur, will upend some social norms and possibly religious norms as well. And they will force churches and many other institutions (both religious and secular) to adjust to a new reality. For the first time in human history, the biggest material changes in our society may not be occurring outside of ourselves, in the fields, factories and universities that have shaped human civilization, but inside our bodies - in our brains and muscles and arteries, and even in our DNA.

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Human Enhancement: Scientific and Ethical Dimensions of Genetic Engineering, Brain Chips and Synthetic Blood

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Human enhancement is at least as old as human civilization. People have been trying to enhance their physical and mental capabilities for thousands of years, sometimes successfully - and sometimes with inconclusive, comic and even tragic results.