Enhancement Research Paper

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Abstract

Enhancements are about bettering human beings in some way and tend to be thought of as pursuits that aim to augment human beings in some way beyond what is normal. The very conception of enhancements is contested within the debate, and conceptual clarification arguments and normative arguments both against and for enhancements have been formulated within a vast literature. By examining such arguments, this research paper presents the state of the enhancement debate with a particular focus on global bioethical inquiry.

Introduction

The central question of the enhancement debate is “whether one should enhance?” The unity of the inquiry over enhancement splinters as one considers the conceptual assumptions and practical implications of answering such a question. The goal of this research paper is to represent the state of the debate of enhancements as a matter of examining the major arguments for enhancements and the major arguments against enhancements. The essay attempts to provide an examination of different answers and reasoning in support of why one ought to pursue enhancements or why one ought not to pursue enhancements, giving special attention to the implications of such arguments for global bioethical inquiry. The analysis of the essay unfolds in two sections. Section 1 examines the concept of enhancement and offers a brief historical orientation to the enhancement debate. Section 2 focuses on the ethical dimension of the enhancement debate by examining the arguments against enhancement and the arguments for enhancement.

The Concept Of Enhancement And A Brief Historical Orientation

For some defining “enhancement” is controversial in itself. For the sake of a brief orientation, it is worthwhile to adopt Ruth Chadwick’s framework of thinking of the concept of enhancement from the following four categories: (1) a “beyond therapy” framework, (2) a quantitative framework that aims to increase some numerically measured characteristic, (3) a qualitative framework that aims to improve or better some aspect of one’s life, and (4) a catch-all framework that accounts for certain effects and/or potential effects of medical improvement (Chadwick 2009). Inquiries into the morality of enhancement vary according to the defended definition, and such variety has arguably plagued the debate with diverse definition ranging from enhancement defined as opposed to treatment, as a species of treatment and in turn promoting well-being, as a relative concept determined by the social dynamics, as a perception concept determined by those effected by enhancement, or as a group of examples that have a resemblance. While reserving the conceptual difficulties, it is also worthwhile to historically situate the enhancement debate. Certainly the development of evolutionary theory in the nineteenth century and the rise of eugenic theory and subsequent nefarious pursuits in the twentieth century can be seen as a major impetus factor for the enhancement debate. There is some argument over whether enhancements are capable of escaping the long shadow of eugenics. This, coupled with contemporary advancements in genetics, neuroscience, and medical technology, has contributed to the intrigue, robustness, and perhaps sense of urgency surrounding the enhancement debate (Wiesing 2008). In some sense, it is necessary to limit the scope of “enhancement” by attempting to respond to the enhancement literature; however, embracing and tolerating the ambiguity of the concept “enhancement” may be necessary to some degree. The concept of enhancement sometimes imports other philosophical issues pertaining to dependent concepts that are integrated within the definition of enhancement, such as “health” and “normal,” for example. While not being completely uncontroversial, the prevalence of examining the concept of enhancement as distinct from therapy does give some reason for at least adopting the enhancement-therapy distinction for the sake of this inquiry.

Conceptually, it is sometimes useful to adopt an aim and avenue approach to sort out enhancements. Organizing enhancements according to an aim lens focuses inquiry on the specific something that is a matter of the enhancement pursuit (life span, immunity, improved cognitive function, etc.), while an avenue lens focuses inquiry on the means of pursuing such an aim (genetic manipulation, pharmaceutical, surgical, etc.). This is not to discount some arguments that use a nonspecific sense of enhancement, that is, that argue about enhancement in general and writ large. As a matter of scope, this research paper will focus more on biomedical enhancements as opposed to sports enhancement or cosmetic surgery issues. While the ethical assessment below is applicable to such discussions, brevity and the focus of the larger work require narrowing the scope. Also, not every argument below applies to each avenue and aim of enhancements equally. For example, some arguments are especially formulated and applicable for genetic enhancements. The generalized presentation is meant to provide an overview of the state of debate, and as such, in some cases, will eschew specific application to particular aims and avenues of enhancement for the sake of the inquiry. Finally, it is worth noting that enhancement inquiry as an abstract concept spans across several topics in global bioethics, ranging from nanotechnology and biotechnology to transhumanism and neuroethics to health justice and clinical ethics. While an exhaustive examination of such a vast range of topics is beyond the scope of this research paper, an awareness of the relation between the enhancement debate and such diverse areas helps to support the claim that enhancement inquiry is vast and integrated across global bioethics.

While a grouping strategy for defining enhancement has its limitations, it is helpful to get an overview of the type of pursuits that are associated with enhancements in the literature. The concept of enhancement has been associated with the following examples and themes: cheating, the meaning of sports, the use of hypoxic air machines for athlete conditions, cosmetic surgery, off-label usage of medications, Ritalin usage to improve cognitive focus, oxytocin to improve social coherence, cybernetics, cyborgs, deep brain stimulation for tremor reduction and mood stimulation, memory erasures as a manner of coping with war/trauma/rape, exoskeleton research for military and amputees, meditation, coffee, vaccinations, cloning, stem cell, regenerative medicine, human identity, disenhancement, animal human hybrids, etc. With such a diverse collection of examples in the literature, it is no wonder it can sometimes be difficult to pin down a precise definition of enhancement. This is still not to mention some operative distinctions that are used to categorize enhancement pursuits ranging from radical vs. non-radical, natural vs. artificial, and inner vs. external, for example.

The Ethical Dimension Of Enhancements

The arguments below start from those that are more abstract and concerned with logical, metaethical, and conceptual issues that, as a result of their universally applicable character as such, have direct import into global bioethical inquiry. While this is not a perfectly clean distinction, the later set of arguments offers a more practical set of concerns for why one should refrain from pursuing enhancements that is informed by more concrete concerns present in the global bioethics dialogue. This section is divided into two major subsections. The first examines the arguments against enhancement from playing God, bad character, contrary to human dignity/human rights, inauthenticity, harm to humanity, common heritage, human nature, social control, and inequality/ justice. The second examines the arguments for enhancement from enhancements as a not-sonovel concern, inevitability, autonomy, benefit to others, obligation to better our children, and concerns that humans are unfit for the future. It is worth noting that to some degree this framework is artificial; that is, the arguments over enhancements below tend to bleed into one another in the literature. The aim here is to provide a loose framework for identifying the major veins of inquiry and argument within the debate by highlighting the importance of such argument for global bioethics.

Arguments Against Enhancement

Playing God: There are at least two versions of the argument against enhancements from playing God. The first is the theistic version that stipulates that enhancements infringe upon the domain that is proper solely to God. That is, if there is something sacred about life, the course one’s life takes, and/or the given endowments one has, then interference in this scared domain constitutes a violation of God’s authority. As such, enhancement pursuers are “playing God” by manipulating and interfering in God’s domain. For example, attempts to selectively abort a fetus because of genetic abnormalities or attempts at designing children through genetic manipulation arguably illustrate enhancement pursuits that are subject to such a playing God objection because such pursuits infringe on God’s sovereign domain. The second version of the playing God argument is nontheistic. It, in some sense, imports the idea of a God-like being that is omnipotent and omnipresent without concern for whether such a being actually exists. As such, enhancement pursuits are morally problematic because such pursuits – characterized, for example, as designing another’s life or choosing who lives and who dies – are actions beyond any human being’s limited capacities and/or authority. Colloquially, proponents of such an objection seem to harbor the question: “who are you or we to make such decisions and pursue such activities?” In short, the nontheistic version of the playing God argument can be construed as an objection to enhancements from hubris (Coady 2009).

Bad Character: The argument from bad character formulates an objection to enhancement pursuits as a matter of such claims – that is pro-enhancement claims – being the expression of a bad character. That is, the very pursuit or minimally the desire and expression of such an enhancement claim is morally problematic. As such, the force of the argument is not so much a matter of the consequences of pursuing enhancements or a deontological claim about the status of the moral agent in relation to other moral agents, but it is rather an expressivist argument that takes pro-enhancement stances, utterances, and/or judgments as expressive of larger ethical problems.

One of the most prominent bio-conservative arguments from character is formulated by Michael Sandel when he argues that enhancement represents a will to mastery that in and of itself violates that inherent value of our given lives and that the very drive to mastery is contrary to the moral praiseworthy characteristic of giftedness (Sandel 2007). That is, for Sandel, there is a priority given to the being in a pre-enhanced state and the ethical response to such a being in a pre-enhanced state regardless of the particulars of that state ought to be a response of gratefulness. Enhancement pursuits from this perspective and as a sign of a desire/aim to control are signs of a lack of appreciation of the value of life. A virtue theory driven analysis of the argument from bad character might stress that one should avoid enhancements because implicit to enhancing is a drive to attain dominance and control that reeks of vice.

Contrary to Human Dignity/Human Rights: The argument from human dignity/human rights is an objection to enhancement from objectification that holds that one should avoid objectifying oneself and that enhancing requires this act or mindset of treating oneself – against one’s dignity – as an object. The argument, as opposed to the related argument from character, offers a deontological critique of enhancement pursuits. That is, there is something about enhancement pursuits that encourages such pursuers to commodify themselves and others such that human beings are reduced to mere objects suitable for manipulation. This commodification and/or reductive quality of enhancement manipulations is contrary and in conflict with the dignified status of being a human. The Kantian interpretation of such an argument might stress that enhancement pursuers are necessarily committed to treating human beings as a means to some further aim or end – the enhancement goal – and that this paradigm violates the inherent dignity of the person being enhanced. It is also worth considering the relation of such an argument and enhancement pursuits in general to the concept of objectification. There has also been some objection to enhancement and enhancement pursuits because they are viewed as a sign of an excessively individualistic or self-centered use of biomedical resources and medical practice that is inherently contrary to communal responsibility or solidarity (The President’s Council on Bioethics 2003; UNESCO 2005).

From Inauthenticity: The objection to enhancement from inauthenticity holds that one should avoid enhancements because its very use distorts the meaningfulness of the individual’s life and/or life projects. The specific activity that the enhanced person is participating in and the performance of the specific activity may lose their meaning because of the effect of the enhancement that is used. This sort of objection sometimes assumes a view of human nature or the natural that shuns artificial means of pursuing some objective or state of being. From an axiological point of view, it is what the person does as a matter of his or her own naturally given and naturally developed talents, for example, that truly determines the worth of the actions, character, decisions, sacrifices, etc. This sort of argument, if compelling, has implications for arguments about doping and sport enhancements in particular; in addition, there may also be implications for how one values creativity and achievement in general. The presence of an artificial means – a means judged to be an enhancement type intervention – is the cause, according to this argument, for questioning the authenticity of the activity, the action, or the person (Parens 2005).

Harm to Humanity: The argument against enhancements from harm to humanity can take several different formulations according to the following categorical framework: actual versus potential harm, quantitative versus qualitative senses of humanity, and consequential versus deontological interpretations of the argument as a whole. While an exhaustive analysis of this framework is beyond the scope of this work, below is a sampling of some of the major arguments from this sort of camp. George Annas is a major proponent of the argument that we should consider, in some cases, enhancement pursuits to be crimes against humanity (Annas 2010). There seems to be at least two ways to interpret such a concern. First, enhancements are capable of causing harm to the total population of humanity, and activities that are capable of causing harm to the total population of humanity are ethically problematic. Therefore, enhancements are ethical problematic and should not be pursued. This argument offers a quantitative and precautionary take on the concern over harm to humanity. There is also another interpretation of this type of concern that highlights the defeasible nature of our epistemological claim that enhancements are harmless and tries to establish a precautionary stance. The argument is as follows: enhancements are capable of causing harm to the total population of humanity, and activities that are capable of causing harm to the total population of humanity are ethically problematic. Therefore, enhancements are ethically problematic. Also, conceptually qualifying the effected population leads to versions of this argument that may highlight future generations as well as a current/actual population. The next version of the argument from harm has overtones of the argument from human dignity and presents a more deontological assessment of a reason not to pursue enhancements. Any action or pursuit that by its very nature is an overwhelmingly gross violation of the sanctity and/or dignity of an individual person is ethically impermissible as its magnitude represents a crime not just against the individual but against all of humanity. Enhancements are such a gross sort of violation, and therefore, enhancements ought to be impermissible. While the preceding arguments have a generalized scope as relates to enhancements pursuits, the scope of this argument is particularly relevant for genetic germ-line types of enhancement strategies, for example. That is, it is arguably less relevant, for example, when analyzing short-term pharmaceutical interventions that are limited in effect to just the individual in question. This same sort of limited scope quality carries forward into the two arguments that follow (the argument from common heritage and the argument from human nature). While the above examples focus on the abstract nature of the harm, concrete examples of potential harms generated by the use of enhancements include unforeseen effects of prolonged pharmacological enhancement and addiction.

Common Heritage: The argument against enhancements from common heritage is similar in style to several arguments above; however, the concept of “common heritage” and the prevalence of it in the global bioethics inquiry arguably justifies its categorization as a distinct argument. The argument unfolds as follows. First, the global human gene pool is a matter of the common heritage of humanity. A limit assessment of the concept of “common heritage” for the purposes of this argument could highlight the common or communal ownership of something like the human genome and cautions against it being privatized for commercial and/or scientific uses, for example. Second, activities that threaten the preservation of the global human gene pool are ethically problematic. Enhancements threaten the preservation if the global human gene pool; therefore, enhancements are ethically problematic and ought to be impermissible. Again, this argument can take varying interpretations depending on whether the preservation of common heritage is justified from consequential or deontological grounds. For example, and in its deontological form, justification of the premises could take the strategy of claiming that the human genome is not the type of thing that can be privately owned because it belongs to all of us collectively or is not capable of being owned. In its consequential form, justification for the premises could take the strategy of claiming that preservation is a matter of preserving the common genetic heritage from manipulation that may cause bad consequences for present and future persons (UNESCO 1997).

Human Nature: The argument against enhancement from human nature is similar in style to several arguments above, and like the argument from common heritage, it arguably is justified in being categorized as a distinct argument due to the concept of human nature’s prevalence in enhancement inquiry. The argument from human nature holds that human nature is not something that one ought to change. Enhancement pursuits that change human nature, therefore, ought not to be pursued. Again, this sort of argument is adaptable and can be molded into a variety of forms similar to those examined above. Some argue that human nature is something that has a sanctity or is due a certain protective status in and of itself, while others offer more consequentialist arguments that framed concerns over enhancement alterations and their effect on species designations and the consequences of such actions (Habermas 2003; Buchanan 2011).

Social Control: The argument from social control stresses the concern that enhancement technologies will become instruments through which people may be abused or exploited by their larger society, external power structures, or government sanctioned ideologies. These concerns come in a variety of ways and can be categorized as explicit and implied coercion. As explicit coercion, enhancement technologies become tools through which people are manipulated in order to satisfy some societal goal, for example, prenatal or genetic screening that attempts to eliminate certain characteristics of individuals or individuals themselves deemed unsuitable by society. As implicit coercion, enhancement technologies and more specifically their acceptance and use may create pressure on individuals to pursue or use such measures. For example, if cognitive enhancement drugs used by military personnel in order to heighten senses or allow them to remain awake and alert for longer periods of time become common practice, this may create an expectation or an obligation to use such enhancements. Allowing and promoting enhancements, as such, may place one’s career prospects, livelihood, and the safety of one’s team as motivating reasons for using enhancements. There is also a larger social-economic dynamic potentially at play here in terms of medical tourism issues that carry forward into the argument from inequality. As a matter of the argument from social control, the exploitation of a population can be analyzed according to the economic market that entices countries that are struggling to provide basic healthcare to their populations to invest in nonbasic healthcare or enhancement like technologies in order to draw foreign interest into the country. While the distribution concern is a matter for the next argument, the social dynamic that may harness members of a society to operate within such a dynamic is a matter akin to the argument from social control.

Inequality: The argument against enhancements from inequality holds that enhancement pursuits promote and magnify inequality.

Activities that promote or magnify inequality are ethically problematic; therefore, enhancement pursuits are ethically problematic. Different strains of the argument are formulated around different types of inequality. For example, the more prevalent of such arguments are formulated along distributive justice lines as a matter of economic inequality and along social or civil inequality lines. According to the first interpretation, healthcare is a good of society and goods of society – at least in a just society – are to be distributed equally within such a society. Here, those that are against enhancements tend to express several claims: that enhancements per the standard definition are beyond standard healthcare and therefore impermissible, that enhancements represent a cost and in some instances a tremendous cost relative to basic healthcare costs that make such enhancement pursuits unjustifiable, and that enhancement pursuits, if they are healthcare goods, will only be accessible by those already well off in society. These sorts of economic discrepancies are present within specific societies and are arguably more vivid when comparing societies across the globe. Comparing the tremendous wealth and infrastructure that it takes for one society to pursue enhancement-like research with the cost of providing basic antibiotics or vaccinations in another less wealthy country makes inequality objections very compelling to some proponents of this argument. Arguments concerned with social or civil issues of inequality tend to stress that enhancement use within a society may contribute to the stratification of society into the categories of the enhanced versus the unenhanced. The argument against enhancement from inequality stresses that pursuits that further stratify society ought not to be permitted and that this is precisely what allowing enhancements within a society will do. It will simply create another avenue for increasing the divide between the haves and the have nots in a particular society. Aside from both these distributive and civil-inspired concerns is the matter of regulation and enforcement of enhancement limiting principles or objections, a task that seems daunting if not impossible from a global perspective.

Arguments For Enhancement

Not-so-Novel: The argument for enhancements from their not-so-novel character is more of a defensive argument that attempts to shift the burden of the argument back on those that are against enhancements. The argument unfolds as follows: arguments against enhancements seem to imply that enhancement pursuits are so novel, strange, new, and/or cutting edge that one should be precautious, at least, and prohibit them, in the strongest sense of the argument, because of enhancements’ novel nature. However, proponents of this argument hold that enhancements are not novel; therefore, enhancements ought not to be opposed. This is a step away from endorsing enhancements, but the argument’s effort to switch the burden of proof toward the bio-conservatives makes it a pro-enhancement argument. Support for the claim that enhancements are not so novel sometimes comes in the form of arguments by analogy that attempt to compare enhancement pursuits with evolution, natural selection, or other “enhancement-like” practices that are not traditionally thought to be enhancements, like vaccinations, drinking coffee, or consuming traditional remedies like yohimbe and mulondo roots in some African countries like Gabon and Uganda or kola nuts for mental enhancers in parts of Nigeria. The persuasiveness of this argument tends to rest squarely on the force of the comparison, and if the comparison is compelling, then there may not be sufficient reason to be precautious or oppose enhancements. Such precaution, for example, would be comparable to being precautious about evolution or vaccinations, the former being logically or conceptually difficult to process and the latter being perhaps improbable at best (Buchanan 2011).

Inevitability: The argument from inevitability, like the argument from not so novel, is in some sense a defensive argument too. It does not hold that one ought to pursue enhancements per se, but rather that opposing enhancements is futile and therefore one should be more concerned with how to regulate enhancements, in its conservative form. In its more progressive form, the argument could imply that one should embrace such technological advances and the enhancement pursuits that such advancement will encourage. One such version of the argument holds that there is no way to stop the pursuit of technology and the development of medical practice that is informed by and molded by such technological advancements. Enhancement pursuits, as a subsection of such technological advancement, will be informed and encouraged by such advancement. Therefore, there is no way to stop enhancement pursuits; they are inevitable. One argumentative strategy for making the inevitability compelling has been to focus down on the idea that only one person, or one team of scientists, needs to cross that enhancement barrier for the inevitability claim to be established. Couple this with the power of scientific research, study and pursuits, and the inevitability that enhancing will happen, so the argument goes, becomes very compelling (Baylis and Robert 2004).

Autonomy: The argument from autonomy has several versions. One attempt is to form an argument in favor of enhancements from autonomy in terms of expectations of living in a liberal society. That is, if societies ought to be liberal in the sense that the citizens of a given society need to enjoy the most liberty possible in accordance with not harming others, then citizens of such societies ought to be able to pursue activities that do not harm others. So, enhancements that do not harm others ought to be ethically permissible; therefore, some enhancements are ethically permissible. If the default in the society is a liberal conception of freedom compatible with the freedom of others within that society, then once the issue of refraining from harm is satisfied, there is no reason, so the argument goes, for believing enhancements are ethically impermissible. A more individualized version of the argument holds that activities that contribute to the betterment of how one lives one’s life, especially if such activities do no harm to others, ought to be allowed. Enhancements are such an activity; therefore, enhancements ought to be allowed. There is a sense in which this second argument brings back into discussion the notion of authenticity if one can justify the use of enhancement as a tool that is necessary in establishing authenticity. More argument is necessary to make such a claim compelling, but it is worth considering that such an argument is an example of how the same concept can operate on either side of the enhancement debate (Agar 2008).

Benefit to Others: The argument for enhancements from benefit to others attempts to formulate a positive argument for enhancements as opposed to the negative formulations of the argument from autonomy from liberal society, for example. The conclusion of the argument from autonomy is that there is no reason to believe that enhancements ought to be considered ethically impermissible, and as such, in this formulation, it provides no affirmative reason for pursuing enhancements per se. The argument from enhancement from benefit to others makes, in this sense, a stronger sort of claim. A version of the argument is as follows: pursuits that can contribute to the well-being of the larger community ought to be allowed. Enhancements are such pursuits; therefore, enhancements ought to be allowed. The stronger formulation can be made by replacing “ought to be allowed” with “ought to be pursued.” The benefits that others can receive from enhancements may include what enhancements, like pharmaceutical avenues that can increase one’s creativity, contribute to the cultural life of a community. Also, if pharmaceutical cognitive enhancements can help military personnel stay awake longer and be more alert on military operations, then the safety (benefit of) their team and country might be arguably served by such enhancement pursuits. If the end goals of a certain practice are normative and enhancements can help to secure those end goals, then abstractly enhancements, or so the argument leads, must participate in or be normative themselves too. This argument can be extended to reformulate a conception of equality, such that if enhancements can help to level the playing field by mitigating intellectual or developmental disadvantages or allowing those with more difficulty in securing adequate economic opportunity to do so, then it might be worth considering enhancements as promoting equality rather than bolstering inequality.

Obligation to Better Our Children: While similar to the argument from benefit, this argument offers a stronger claim that implies that not only is enhancement ethically permissible; it is obligatory in some cases. While this is arguably a version or derivative of the argument for enhancement from benefit to others, the particular formulation of the argument deserves special consideration. The argument develops as follows: all parents and perhaps societies in general have an obligation to better their children and/or the children of their society. Enhancements are substantial tools for helping to better the lives of our children; therefore, enhancements ought to be permissible and possibly even ethically obligatory. Julian Savulescu and Guy Kahane offer a version of the argument aimed at promoting the well-being of children according to their formulation of the principle of procreative beneficence (Savulescu and Kahane 2009). That is, anyone having a child has a moral obligation to select the child with the best possible well-being given the available information. If such a principle is normative, then the implications for enhancements through genetic manipulation and/or pharmaceutical methods as tools to pursue and/or secure a child’s well-being are also normative. Briefly, it is worth noting potential germ-line and non-germ-line versions and implications of such an argument.

Unfit for the Future: The argument for enhancements from one’s unfitness for the future attempts to highlight the types of challenges that human beings will face in the future (and arguable do face currently) and to suggest that pursuing enhancements might be a way, or the only way in some strong formulations of the argument, for securing one’s fitness for the future. The argument can be constructed as follows. If the future will provide environmentally and technologically driven challenges to people’s health and survival, then one must adopt enhancements (especially moral enhancements) in order to meet those challenges. The future will provide such environmentally and technologically driven challenges to people’s health; therefore, one must adopt and promote enhancements (especially moral enhancements) in order to meet those challenges. While the argument has ramifications for different types of enhancements, its formulation by Ingmar Persson and Julian Savulescu stresses the importance of moral enhancements for future fitness. Moral enhancements are any biomedical avenue or means that is designed for augmenting a person’s moral sensitivity, with some forming such moral sensitivity as a matter of moral motivation, a robust sense of normative ethical belief, a minimalist increase in moral appreciation of one’s actions, or an increased capacity for sympathy and/or empathy. Whatever the outcome, the argument highlights the need for moral enhancement in the face of threats that are capable of global devastation (nuclear disaster, pandemics, etc.) on one hand and/or threats that are beneath our sensitivity to adequately respond to (subtle lethal changes in environmental pollution that accrue their cost over long stretches of time). So the argument goes, if these threats cannot be met as a matter of people’s fitness for such phenomena, then there is a moral obligation to pursue such enhancements (Persson and Savulescu 2012).

Conclusion

By examining the arguments against enhancement from playing God; bad character, contrary to human dignity/human rights; inauthenticity; harm to humanity; common heritage; human nature; social control; and inequality/justice and by examining the arguments for enhancement from enhancements as a not-so-novel concern, inevitability, autonomy, benefit to others, obligation to better our children, and concerns that humans are unfit for the future, this research paper aimed at providing an assessment of the state of the enhancement debate relevant for global bioethics.

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