Rawls' "A Theory of Justice"

The following is a brief treatment of the main ideas in John Rawls’ book A Theory of Justice. Rawls’ theory of justice has two parts. First, there are two principles of social justice, which he puts forward as the most acceptable principles of justice. Second, he argues for these principles by means of a hypothetical social contract argument. I will start by explaining the two principles and then discuss his social contract argument.

For Rawls, principles of justice have to do with the distribution among members of a society for desirable goods such as rights, freedoms, wealth, and opportunities. Such good he calls primary goods, which he defines as things people want regardless of whatever else they want. They are wanted in this way because they are general means essential for achieving most of our aims in life. Rawls’ first principle of justice focuses on one of these goods, liberty. It says that liberty should be distributed equally and that citizens should have an equal right to the most extensive liberty compatible with a like liberty for all. Rawls calls this the Equal Liberty Principle.

The second principle deals with social and economic goods and here inequality is allowed if two conditions are met:

• First, the inequalities must make everyone better off than they would be if such goods were distributed equally, and they must do this in a way that those who end up in the lowest positions are as well off as they can be.
• Second, everyone must have and equal opportunity of ending up in the best of positions and they have this when positions are allocated on the basis of qualifications, and everyone has an equal chance of developing whatever socially useful talents they innately, which Rawls calls Fair Equality of Opportunity.
  

The first part of the second principle is called the Difference Principle and the second part the Equal Opportunity Principle.

The Difference Principle states that any societal change may be considered just and depart from equality if and only if it benefits the least advantaged. Inequality, in Rawls’ view is acceptable if it makes everyone better for it, but it must not just maximize the overall utility by benefitting the most advantaged. It must maximize the benefit to the least advantaged or as it is called, maximizing the minimum or Maximin. The minimum is maximized when any attempts to raise it would be counter-productive and would make those on the bottom worse off than they would have been if such attempts had not been made. In this sense, Rawls defends a welfare state whose crucial concern about justice is for those worst off. Transferring money directly from the rich to the poor is not the only or best way to raise their condition. Funds for better education, better employment skills, guaranteed health care might be more appropriate to fit into the Difference Principle to Maximin.

I will now discuss Rawls' social contract argument in support of his two principles of justice. Rawls understands a society as a group of people who cooperate for the production of mutual benefits. Principles of justice are principles about the appropriate allocation of these benefits and of the burdens necessary for their production. Rawls' core idea is that the best principles of justice are those which would be chosen by people in a situation which is fair to all those doing the choosing. The best principles of justice, he argues, are those which people in a fair situation would choose. He calls this fair situation the original position. He argues that in this hypothetical situation, the choosers are self-interested, rational, and required to come to a unanimous agreement. The most important condition is that the choosers are under a veil of ignorance about their own social relations and talents. They do not know their social class, their abilities, or their conception of the good. Rawls argues that a position with such a veil represents fairness between free and equal persons and that persons in this original position would choose his two principles of justice.

Concerning De Vitoria's "De Jure Belli"

Just War Theory traces its roots to Cicero over 2000 years ago but is more popularly associated with St. Augustine in the 5th century C.E. Just War Theory is broken up into the jus ad bellum concerning the conditions that must be met for war to be justifiably initiated and the jus in bello concerning the tactics that may be justifiably employed during war. Catholic theologian and philosopher Francisco de Vitoria is considered one of the first modern theorists to formulate rules of war related to the jus ad bellum and jus in bello. He developed five jus ad bellum propositions in De Indis et de Jure Belli (c. 1532), a treatise related to the wars the Spanish Conquistadors waged against Indians in South America. Those propositions are as follows:

1. Difference of religion is not a just cause for war.
2. Extension of empire is not a just cause of war.
3. Neither the personal glory of the prince nor any other advantage to him is a just cause for war.
4. A wrong received is the only just cause for commencing a war.
5. Not every kind and degree of wrong can suffice for commencing a war.
   

I will detail de Vitoria’s argument including premises and appeals he used to develop his conclusions. I will then discuss a difficulty with his argument related to differing religious worldviews and interpretations of a “wrong received”. Lastly, I will argue that he provides a prima facie argument against the initiation of an unjust war but that it could be strengthened to fit the modern world to include a provision concerning just trade.

De Vitoria structures his treatise as responses to questions in the form of propositions and doubts in numerical order. The first question related to the jus ad bellum asks what is the reason and cause of a just war. His first proposition is that difference of religion is not sufficient to be a cause of a just war. He appeals to St. Thomas Aquinas on this point and adds, “… religion forms conscience and conscientious acts in ignorance of natural law are not guilty in justifying our penal interventions.” As a devout Catholic, he seemed to abhor the subjugation and slaughter of people in the name of religion as the Conquistadors were doing in Central and South America. The second proposition is that extension of empire is not sufficient for initiating a just war. He claims self-evidence on this point and sets up a reductio ad absurdum with an example of two belligerent states waging war against each other in the quest of empire. The contradiction is that since each state would be justified and therefore innocent, it would be unlawful to kill combatants on either side.

The third proposition is that neither the personal glory of the prince nor any other advantage to him is a just cause for war. He supports this claim with the premise that even though the prince is the only authority to initiate war, he should subordinate both peace and war to the people. The quest for glory and personal gain mark the difference between a lawful king and a tyrant in this respect. De Vitoria appeals to Aristotle to note that since the prince derives his authority from the state, he ought to use it for the good of the state. Lastly, he comments that the difference between freemen and slaves is that slaves are exploited for the good of the master while freemen exist in their own interest. De Vitoria makes this analogy to the jus ad bellum to show the difference between a prince initiating a just war on behalf and in support of the people to that of a tyrant conscripting subjects into an unjust war for glory and personal gain.

The last two propositions relate to the initiation of a just war based on wrongs done to the state by other states. The fourth proposition claims that the single and only cause for commencing a war is a wrong received. This would include war in self-defense and offensive war for avenging a wrong. De Vitoria appeals to Augustine and Aquinas for support in addition to the Bible relating to taking up the sword against an enemy. Specifically, he says, “ … a prince has no greater authority over foreigners than over his own subjects unless they have done something wrong.” From the Bible he quotes St. Paul from Romans, “He beareth not the sword in vain: for he is the minister of God, a revenger to execute wrath upon him that doeth evil.” The fifth and last proposition claims that not every kind and degree of wrong is sufficient for commencing a war and so he introduces the notion of proportionality into the Just War Theory. The premise for this claim is that fact that not every crime warrants death or atrocious punishment. De Vitoria also makes an appeal to the Bible by citing Deuteronomy that says, “… the degree of punishment ought to correspond to the measure of the offence.” These five propositions make up de Vitoria’s first canon of warfare. Besides the principles listed above, he argues that a prince should only reluctantly initiate war and live in peace as St. Paul urges in Romans. The prince should also remember that, “… others are his neighbors, whom we are bound to love as ourselves, and that we all have one common Lord, before whose tribunal we shall have to render our account.”

It is important to frame de Vitoria’s argument within history to understand the importance of his contribution to Just War Theory and its implications in a modern context. The Spanish conquest of the Aztecs led by Cortés took place between 1591 and 1521, 11 years before de Vitoria wrote his treatise in 1532. The battle of Tenochtitlan alone saw the deaths of 40,000 Aztecs in a single day in the name of conquest, glory, and religious justification. In 1517, Martin Luther posted his 95 theses on the door of the Castle Church in Wittenberg and began the Protestant Reformation that would lead to violence such as the Knights War of 1522 and the Peasants War of 1524 that left over 100,000 dead. Religious based violence and war was spreading throughout Europe and would continue to do so until the signing of the peace treaties of Westphalia in 1648. As such, de Vitoria was ahead of his time with his propositions that war based on religion, empire, and glory was not a just cause for war. This is even more striking considering he was a Roman Catholic at a time when corruption and politics within the Church was rampant and led not only to the Reformation but the imprisonment of Pope Clement VII and the end of the Italian Renaissance in 1527. His claims, however, are not without difficulties and as I will show, need to be reformulated to include just trade to fit in the modern world.

Although religion is not a just cause for war as de Vitoria claims in his first proposition, it is the source through which morality and therefore right and wrong are determined. As such, this leaves open his fourth and fifth proposition to religious interpretation as to what qualifies as a wrong received and a just cause for war. Religious worldview colors the determination of both proportionality and threshold of a wrong received therefore entailing that a wrong received in one culture with one type of religious worldview would justify the initiation of a war while the same wrong to another culture with a different religious worldview would not meet that same threshold. The controversy surrounding the 2005 Danish Jyllands-Posten Muhammad cartoons that resulted in a Fatwah issued by Mahmoud-al Zahar, the leader of Hamas, is an example of difference in belief of wrong received based on religious worldview. For most people in the U.S. and Europe, the issue was a matter of free speech and not considered the level of wrong that much of the Islamic world held it to be. To many Muslims, the cartoons were blasphemous to the point that many, including Mahmoud-al Zahar, believed that violence against Denmark and the cartoonist was justified. The argument for or against such an edict is beyond the scope of this essay; however, it is clear that religion, arguably in an indirect manner, continues to play a role for the justification of violence. A stronger formulation of de Vitoria’s jus ad bellum would have to include not only the proposition that religion is not a just cause of war but cultural and/or religious wrongs never meet the threshold to initiate a just war.

The modern world is certainly different from the world of de Vitoria with borders meaning less now than ever before. Trade is also different today than in his time with a global economy that has affected political dynamics, interdependency, and, in a sense, justice. Even though de Vitoria provides a prima facie argument against unjust war, his propositions must be reformulated to fit in this modern world. National self-sufficiency is desirable but mostly unattainable with global resource distribution scattered and uneven. Unjust trade practices, sanctions, and prime resource control create a potential for suffering that may justify a wrong that meets the threshold of a just cause for war. As such, a provision for just trade would have to be added to his jus ad bellum to insure against this. Skyrocketing food prices around the world has led to violence in Haiti and Africa while 15% of all gas in the United States comes from bio-fuels derived from food. 2 billion people are starving while 860 million cars are in use throughout the world, 62 million in the U.S. alone. It may be justifiable in the modern world to initiate a just war to demand this right to subsistence against the unfair advantage of trade. De Vitoria’s intent was the elimination of all war and the propagation of peace among all peoples of the earth. If he were alive today, trade would be a legitimate concern for him in the attainment of such peace. Further, his principle of justice, in a modern context, would have to more clearly define "wrong received" and account for war in the name of humanitarian intervention and preemptive war in the name of self-defense along with how his principles would be used under the current U.N. charter.

Concerning Shue's "Basic Rights"

In his book Basic Rights: Subsistence, Affluence, and U.S. Foreign Policy, Henry Shue argues that everyone has a right to subsistence and that this right is as important as the right to physical security. This argument runs counter to a common view that the right to physical security is more stringent than the right to the necessities of life. In addition, the common view could be argued to hold that the right to life is a right that is overridden or justly violated only in extreme conditions, while the right to an adequate diet or minimal health care are more easily overridden. I will provide a brief overview of Shue’s argument and what he means by a basic right, right to security, and right to subsistence. I will also explain why people, in his view, think it is easier to justify rights to security than rights to subsistence and why Shue rejects this reasoning. Lastly, I will evaluate and expand on Shue’s argument from a cost perspective that subsistence rights are basic and just as important as security rights.

Shue approaches his argument by first defining a moral right as providing, “… the rational basis for a justified demand that the actual enjoyment of a substance be socially guaranteed against standard threats.” The rational basis allows for insistence to the right without shame and resistance to the denial of the right. The actual enjoyment of a substance refers not precisely to enjoyment of the right but rather to enjoyment of what the right provides such as liberty, security, or food. For a right to be socially guaranteed against standard threats arrangements must be made, mostly by a government in the form of laws, for people to enjoy the right. “Standard” in this case means a reasonable level, not absolute level of guarantee. In other words, a guarantee against any murders would not be feasible but a system that provided strong deterrents, law enforcement, and a judiciary to as much as possible minimize the instances of murder would be considered reasonable and “standard”.

From this framework, Shue proceeds to define a basic right as right that is essential to the enjoyment of all other rights. When a right is basic, “… any attempt to enjoy any other right by sacrificing the basic right would be self-defeating, cutting the ground from beneath itself.” In other words, a basic right is the foundation from which other rights build upon and without which we literally could not live without. As such, non-basic rights such as free speech or assembly may be justifiably sacrificed, if necessary, to protect basic rights. The question then is what qualifies as a basic right. Shue answers by first arguing that security qualifies as a basic right because no other rights can be enjoyed if a right to physical security is not protected. The argument is more formally structured as follows:

1. Everyone is entitled to enjoy something as a right.
2. Everyone is entitled to the removal of the most serious and general condition that would prevent or severely interfere with the exercise of whatever rights the person has.
3. Therefore, anyone who is entitled to anything as a right must be entitled to physical security as a basic right so that threats to his or her physical security cannot be used to thwart the enjoyment of the other right.
   

Shue also claims that the basic right of security is universal because the argument applies to everyone.

The order of Shue’s reasoning within his argument is important because up until now, few would disagree that physical security is a basic right. This is important in his argument for subsistence as a basic right because of the similarity he will draw between security and subsistence. By subsistence or minimal economic security, he means access to unpolluted air, unpolluted water, adequate food, adequate shelter, and minimal preventative health care. He recognizes that his claim is a form of distributive justice but refrains from treating broader economic rights at this point. In addition, he limits the scope of the basic right of subsistence to at least those who cannot provide for themselves. As such, the same considerations that support physical security as a basic right support subsistence as a basic right because no one can fully, if at all, “… enjoy any right that is supposedly protected by society if he or she lacks the essentials for a reasonably healthy and active life.” The same reasoning applies to prevention of deficiency of essentials for survival and indeed may be more basic than physical security because a healthy individual may be able to fight off an attack where physical security is violated while a hungry or sick individual could not fight off such an attack. Both security and subsistence are equally essential to a normal, healthy life and before exercise of other rights are possible. This is not to say that a right to security and subsistence are means to the enjoyment of other rights but are instead inherent necessities. He concludes by referring back to the definition of a moral right to show that a social guarantee of protection against threats to both security and subsistence is necessary because giving less priority to a basic right rather than to non-basic or other moral rights is “literally impossible”.

Shue attempts to show that the common view of accepting security and not subsistence as a basic right lies within the view of negative and positive rights. A negative right is a right of noninterference or simply leaving people alone while a positive right is giving to others or redistributing wealth. The prima facie argument against a basic right to subsistence relies on the view that subsistence is a positive right and therefore secondary to the negative right of security. Shue rejects this argument and suggests that both security and subsistence impose positive as well as negative duties. These duties include not depriving the right-holder the object of the right, protection of the right-holder against such deprivation, and aid to those who have already been deprived. In the case of security, Shue claims that it is impossible to protect a right to physical security without taking or making payment for positive action such as salaries for police officers, judges, and maintenance of correctional facilities. In the case of subsistence, he shows that fulfillment of the right to subsistence may not involve a redistribution of wealth or grants of commodities but rather protection from individuals or institutions that would otherwise harm them and prevent them from providing for themselves. According to the opposing view, this is a negative right related to security. Further, he briefly discusses the misconception that negative duties cost less than positive ones and suggest that this argument rests upon “… empirical speculation of dubious generality.” Shue does not deny that reasonably guaranteeing a right to subsistence would involve some form of redistribution of wealth but only that denial of the right to subsistence based upon the premises that security only involves negative duties while subsistence involves only positive duties is fallacious. Shue briefly mentions the cost of security versus the cost of subsistence to further weaken the claim that it subsistence is not a basic right or at least secondary to the right of security. I will expand upon this concept and show that in many respects, the right to subsistence may actually be cheaper than the right to security. I will also show that the resources of security, like subsistence, favors the rich and therefore also involves a redistribution of wealth to socially guarantee security as a basic right for all.

Controversy has surrounded the concept of redistributing wealth for centuries and has been the subject of political philosophers from Immanuel Kant in the 18th century to modern philosophers such as Rawls, Pogge, and Singer. In regards to the costs associated with the
realization of subsistence rights in comparison to actual costs associated with maintaining security rights, the common view is that achieving the right to subsistence would be costly and therefore involve a substantial redistribution of wealth. Based on current spending in the United States alone, I argue that costs necessary to achieve subsistence rights domestically and make a significant increase to achieve international subsistence rights are obtainable without any additional cost to the American taxpayer. In 2007, the United States spent an estimated $693.3 billion for all military expenditures and domestic police protection, corrections, judicial, and legal activities. Based on these statistics alone, the annual per capita expense for security in the United States is, at minimum, $2,311. In contrast, the United States spent $49.9 billion in total foreign aid and its domestic food stamp program in 2007. Assuming all U.S. foreign aid went strictly to subsistence, this equates to an annual per capita expense of $161 or 7.1% of the per capita expense of security. As Shue has shown, security and subsistence rights both involve positive and negative duties thereby defeating the argument against subsistence rights on the grounds of redistribution of wealth. Further, as the numbers indicate above, a simple shift in expenditures would go far to achieve subsistence as a basic right without any further cost to the American taxpayer. For example, a 9.5% decrease in military spending could effectively double the current U.S. expenditures for both foreign aid and domestic food stamp program. One could argue that U.S. security expenditures are necessary and the funding required to achieve subsistence as a right, even domestically, would overburden the taxpayer and more specifically the wealthy. With over 700 military bases in 130 countries and an unpopular war in Iraq that costs approximately $5 billion a month, I find arguments either against subsistence as a basic right or as an unachievable ideal both weak and immoral especially since it is clear that shifts in expenditures could make a difference without any further taxpayer cost.

Concerning Hobbes' "Leviathan", Morality, and Human Nature

Thomas Hobbes may not have realized when he published Leviathan in 1651 that he would establish a base of Western political thought that would still be relevant over 350 years later. One of the most novel and controversial ideas to come out of Leviathan regarded the function of morality. Hobbes took a pessimistic view of human nature and believed that morality did not exist outside the constraints of the state or in our natural state without government. To fully understand Hobbes’ claim to our natural lack of morality and its function within society, I will first provide an overview of natural condition of mankind and the doctrine of egoism upon which his treatise is built. I will also briefly discuss the social contract, the origin of the state, and function of government. I will argue that Hobbes’ view of human nature and morality is problematic because egoism does not adequately explain human motivation and would not allow the initial creation of the state. Lastly, I will show that Hobbesian philosophy is still of value concerning international affairs within certain limitations.

Hobbes claims that nature endowed humans with a rough equality of ability. No one is born with an overly significant amount of strength or mental ability. He envisioned a state of nature for humans as a natural condition without laws, rules, or government inhabited by people with this inherent rough equality of ability. Further, everyone is of equal value and may act in any way necessary to protect or advance their interests. Most importantly, everyone would act out of self-interest at all times moved by short-term passion rather than long-term reason. The doctrine that individuals always act out of self-interest and self-interest alone is called psychological egoism and is key to Hobbes’ argument. He also believes that due to unchecked self-interest and this base, rough equality, “… ariseth, equality of hope in attaining of our ends” leading to competition for resources. Add to the equation the quest for prestige, respect and glory also inherent to human nature and a dangerous mixture is created. In fact, in a state with no laws and punishment where self-interest rules and competition for resources, justified paranoia, and quest for glory are ever present, enemies and violence are everywhere. This means that the state of nature is actually a state of war.

Life then in the state of nature then is, “solitary, poore, nasty brutish, and short.” For Hobbes, two Laws of Nature counter an unimaginable, uncivilized life without morality. The first Law of Nature is that humans should try to attain peace. If peace is not possible, one would have unlimited rights as in the state of nature. The second Law of Nature states that if everyone agrees to peace in mutual rather than individual defense then it is within reason to give up all rights inherent within the state of nature. These rights would be given to that entity that would enforce all agreements made within this social contract. That entity is the state or sovereign. In exchange for peace, rebellion, questioning authority, and breaking the social contract is expressly forbidden even if that sovereign abuses power to become a tyrant. The point is that even the worst state of government is better than the state of nature.

For Hobbes, morality does not exist in the state of nature nor is it part of human nature. The origin of government came about from the inherent desire of peace in a state of constant violence and passion for all that could not be possible in the state of nature. This includes culture, art, enterprise, and property that would be impossible without cooperation and a system that enforced certain rules of behavior. The function of government is simply to enforce the rules of cooperation necessary for society to function. Another way of stating the function of government is that it instills fear of punishment into its subjects. Morality functions then as promoting the rules of cooperation that restrain self-interested behavior. Since self-interest is natural, morality is unnatural and law is equivalent to coercion and lack of freedom. This is the price, however, we must pay for peace, progress and protection of our life, property, and enterprising interests. It is interesting that Hobbes believes that the very sovereign that allows our elevation out of the state of nature is, in fact, in a state of nature with other sovereigns. This makes sense because there are no sovereigns to govern sovereigns and therefore, no fear of punishment or reason to act out of anything other than self-interest. For Hobbes, morality from an international viewpoint does not exist.

Hobbes’ justification of authoritarian government is problematic and in many respects implausible. First, absolute psychological egoism would not allow our species to live more than a couple of generations at most. Life driven by passion without constraint would be too destructive to imagine. Mothers would not care for their babies who, more than likely, were fathered out of rape. If a baby were lucky (or unlucky) enough to make it to childhood, no one would take the time to teach her anything entailing no communication above a grunt or a club on the head. Without communication, the first social contract would be impossible. Hobbes’ first Law of Nature conflicts with the motivations within a state of nature. Only through reason is the social contract possible and as Hobbes stated, “A Law of Nature … is a Precept, or generall Rule, found out by reason …”. In the state of nature where reason is utilized to promote self-interest or protect oneself from the violence of others, reason would be overwhelmed and therefore, not allow cooperation necessary to begin to agree on even the simplest social contract. Some sense of morality and cooperation must have existed in humans before the first government originated. Ethical egoism is the doctrine that we should act according to self-interest while psychological egoism which is the doctrine that is part of our nature to always act according to self-interest. It is unclear whether Hobbes was an absolute ethical egoist or not but it is clear that absolute psychological egoism is not plausible. Lastly, it could be argued that altruism is a fantasy but there does seem to be evidence of genuine giving to others without personal gain of any sort. All of the major religions of the world promote altruism and abound with stories of self-stories of selfless giving in history and everyday life. The existence of communication, cooperation, and altruism seems to point to a more optimistic human nature than Hobbes claims thereby weakening his argument for the justification of authoritarian government. Lastly, it seems that Hobbes did not fully believe in a world completely without altruism thereby making his state of nature more of interesting thought experiment.

It is important to note that even though his argument is weakened, it does not entail that his political philosophy is not of value. As it concerns international affairs, Hobbesian philosophy is evident and sometimes necessary concerning relations between states. This is due to the difference between individual and populations along with the abuse of power that may develop within a regime. Imperialism that led to World War II and the U.S. invasion of Iraq could be argued to be an example of Hobbesian political thought in action since both are of questionable morality and seem to be driven by national self-interest. Political and military intervention by nations against other nations to stop genocide as in Darfur is also Hobbesian because of the questionable legality of interfering with another sovereign state. It could be argued that the United Nations makes such an intervention legal. Further, international morality and altruism also go against the Hobbesian idea of a state of nature between sovereigns, however, it is clear that disregard of a sovereign’s right to rule is both morally justified and Hobbesian. Much more could be said regarding Hobbesian political thought and international relations that is beyond the scope of this paper. Even though still somewhat controversial, it is likely that aspects of the philosophy of Hobbes will remain an important part of Western political thought.

Ethical Issues Surrounding Newborn Medical and Genetic Screening: Project Update

It has been some time since I have written here concerning the UROP project with Professor Tabery. Since I am presenting today at the capital, I thought I'd share this with everyone as well.

Currently, there are over 1,200 tests available to determine the genetic component of various medical disorders, predispositions, and traits. The state of Utah currently mandates that 46 screening tests be performed on all newborns to identify and treat certain disorders. The number of genetic tests will increase in the future, requiring policymakers to make decisions concerning what tests to require, allow, or prohibit. Guidelines for making such decisions require standardized, objective criteria; however, critical analysis of the criteria to justify these decisions is lacking in scientific and public policy literature.

In 1968, Wilson and Jungner were the first to develop criteria for making such decisions. In 2004, the American College of Medical Genetics developed more sophisticated criteria for newborn screening tests. Our analysis found that these criteria either consist of ambiguous language or are insufficient when applied to some current newborn screening tests and some tests for disorders currently being debated for possible mandate. Our research also found that significant variation exists between states related to newborn screening ranging from 17 to 53 mandated tests. Our goal is to provide policymakers with usable guidelines to make informed, ethical decisions for requiring, allowing, or prohibiting newborn screening tests. Our guidelines include two philosophical concepts necessary to make an informed, ethical decision concerning permissibility:

1. Understanding of the causal relationship between genes and disorders. The genetic component must be high in order for the state to consider a newborn screening test mandatory. In addition, the causal relationship between genes and disorders must be morally positive or neutral and free from scientific controversy. All tests within the impermissible category have a significant environmental component or are morally controversial related to causation and/or treatment.
2. Treatability. In order for a test to be mandatory, the treatment must be readily available, of reasonable cost to the parents, and benefit the least advantaged. A test may still be mandated by the state if it does not meet these criteria if and only if it is of significant public health concern and is currently under debate for possible public assistance related to treatment. We name the first category as mandatory-treatable (MT) and the latter as mandatory-informational (MI).
   

The following provides a brief outline of key concepts and arguments that we have developed to support this legislative formula.

The causal relationship between genes and phenotypic traits or disorders is important in the permissibility debate on newborn screening because it relates to a level of confidence medical professionals and patients may place in test results. In the traditional equation for phenotypic expression, P = G + E + (G x E), G must be high and E negligible for any test to be considered mandatory. This means that scientific consensus must conclude that a test have an insignificant environmental (E) component in order to justify mandatory testing and have a high correlation between specific genetic markers and expression of disorder near or at 100%. If there is a high genetic component but expression is not at or near 100%, then it may still be considered MI or permissible. In regards to justifying permissible or impermissible newborn tests, we argue that that the causal understanding of the genetic component may be high or low but are excluded from the mandatory category due treatability factors discussed below. The paradigmatic disorders for both ends of this spectrum include phenylketonuria (PKU) on the mandatory side and anti-social personality disorder (ASPD) on the impermissible side.

Newborn testing of PKU utilizes high-performance liquid chromatography (HPLC) as part of a tandem mass spectrometry (TMS) panel in most states. This tests for the genetic markers associated with the absence of an enzyme necessary to break down phenylalanine. Without this enzyme, the brain builds up toxic levels of phenylalanine resulting in mental retardation, brain damage, and eventually death. Early detection and a carefully controlled diet free of phenylalanine prevent morbidity and mortality in those individuals with this genetic disorder. The genetic component in this case is 100% with no environmental component in the expression of the disorder. The expression correlation of this disorder is also 100%. If a child is born with the defective gene, he or she will develop the disorder. PKU was the first newborn screening test used in the United States and is part of the mandatory testing program in each of the 50 states.

ASPD is a psychiatric condition symptomatic of behaviors associated with the term "evil" or "predator". The terms "sociopath" and "psychopath" are also sometimes used to describe a person with ASPD. Characteristics of the disorder include deception, violence, criminal acts, lack of empathy, and disregard for social norms. Many with ASPD simply do not seem able to emotionally differentiate or "morally" restrain their actions. Poverty, alcoholism, and drug abuse also are related to ASPD. It is estimated that in the U.S. general population as many as 5.8% of males and 1.2% of females meet the criteria for ASPD while the incidence in U.S. prison populations is anywhere from 50-80%. A genetic test for ASPD has been proposed that determines the markers associated with low levels of monoamine oxidase A (MAOA), correlated with ASPD in conjunction with severe childhood maltreatment. The association of ASPD with low levels of MAOA functions off an interactive predisposition model developed and is significantly impacted by the environmental component in expression of the disorder. No states currently require newborn testing of MAOA although its requirement was proposed by former British Prime Minister Tony Blair before the House of Commons in 2005. We argue that screening for this disorder should be impermissible because the high environmental component associated with its expression and the controversy surrounding genes and behavior. The causal component must be understood in consensus with the scientific community to have a genetic component of near 100% and be free from association related to behavior or other moral considerations that are still currently under debate. We believe that testing for ASPD in newborns represents a clear case of a test that should be made impermissible by the state.

Treatability is also important in any decision factoring for mandatory, permissible, or impermissible newborn testing. The American College of Medical Genetics (ACMG) developed criteria in 2004 that includes scores for availability, cost of treatment, efficacy, and benefits to both the individual and society. We argue that although this is a significant improvement from the ambiguous language used in the Wilson and Jungner criteria, it is still missing an important component related to inequality and social justice. This component derives from philosopher John Rawls’ Difference Principle from his work A Theory of Justice. The Difference Principle states that any system of justice must address the need and indeed benefit the least advantaged within the system. He also argues that even though the system will allow for inequality, it should be minimized at birth so everyone starts with an equal opportunity. This is important to any legislative decision regarding newborn screening because the state should not perpetuate or increase differences between classes of people. In other words, any test that is possible for mandate in the future must be treatable by means of availability, benefit, and cost across all classes of people including the least advantaged. Any newborn test for which treatment perpetuates or increases inequality between classes should be judged impermissible by legislators. Any test that is deemed permissible may involve treatment that is morally neutral or does not promote any type of inequality.

The role of the legislature as it relates to newborn screening must address the needs of public health and rights of the individual. Our formula includes the components of causal understanding of the underlying genetic mechanisms and a universal notion of treatability that follows a theory of justice. This will give legislators the tools to evaluate both current newborn screening tests for possible revision and more importantly, future tests that may not be as paradigmatic as PKU or ASPD. Our formula will also help standardize the number and type of newborn screening tests performed between states so that all American newborns may have a healthy start on life. We believe the newborn screening issue and our proposed solution is both conceptually important and practically necessary in the field of medical ethics.

Daniels' "Why Not The Best?"

Daniels, Norman (2000). “Why Not the Best" in Buchanan, Allen et al. eds, From Chance to Choice. Cambridge: Cambridge University Press, 156-203.

This chapter seeks to answer the question why parents should or should not seek the best – even through genetics - for their children. Parents are generally regarded as having permission and, some say, obligation to produce the “best" children possible. This includes development through nutrition, exercises, sports, and other investments to produce the best prudential or moral agents possible. The poor may struggle just to have their children survive and this may be the best they can do or expect of the child. We recognize that best as perceived by society may not constrain many religion’s pursuit of what they feel is best for their children. Neglect and abuse aside, interference is viewed as a fundamental interference to a parent’s conception of a good life. Environmental pursuits seem to be different from genetic because it is viewed as working within the natural capabilities of the child. This modifies the phenotype of the child and there is no agreed upon "best" as to what this should look like. Daniels rejects genetic determinism and claims that it is components of the phenotype that is central to our conception of self, not genotype. Because we leave so much room for environmental effects, this should undercut any idea of genetic determinism. Are there adequate or defensible standards as to what makes a child “best”? Who is allowed to make such decisions under what criteria?

Three positions supporting attempts to perfect children through genetic intervention:
1. Strongest – it is morally required of parents or others to seek to produce the best children possible.
2. Weaker – it is morally good for parents to use a variety of mean, including genetic interventions, to attempt to produce the best children possible, i.e., we attempt to benefit the child for the child’s sake.
3. Weakest – within the legitimate authority of parents in having and raising their children to use at least some forms of genetic interventions in seeking to improve their children.
Is the use of genetic intervention morally good or desirable, other things being equal, in the same way as environmental interventions? Even if some genetic intervention is on balance undesirable, is it morally permissible because of a parent’s legitimate authority over their children? The history of eugenics should give us caution when answering these questions but Daniels notes that prejudice and stereotyping is just as much of a problem for environmental interventions as it could be for genetic.

If we are to say that a parent tries to produce the best child possible, we must reasonably expect the child to share the value and criteria of best means. The problem is that childrearing shapes the values and evaluative standards that shape their outlook on their life and other standards so, in a sense, a child is tainted by the very practices in question. Daniels argues that any attempt to justify an endorsement of steps that produces the effects on the child must include the notion that the child later has the independent capacity to evaluate those steps. The problem here is that the notion of choosing your own character is incoherent when one considers that one must have character and values before one can evaluate character and values. In this respect, this criterion is insufficient to justify a child’s character. Disability is brought up again and he notes that different groups have advocated that their disability allows for a flourishing of other abilities so, with accommodations, this removes much of the disadvantages the disability confers. I think this is problematic in the same way a child's upbringing shapes the perspective of value as both a means and an end to that upbringing. Daniels further notes that there is not systematic contrast between harms and benefits that is objective, i.e., a harm to my life and child may be a benefit to yours. The idea of normal species functioning, Daniels argues, provides a prima facie case for elimination or benefit from genetic intervention in the treatment of disease. This is problematic, however, because it begs the question of who determines the medical boundary line. The authors seem to reject the idea of a parent’s neutrality in the use of genetic intervention and claim that it may lead only to particular or idiosyncratic conception of what the parent’s idea is of a good life.

Daniels then appeals to Feinberg (1980) to explore the case of a child’s right to an open future. I'll make only a few comments as I have studied this concept before in bioethics. He does feel that right to an open future is compatible to genetic intervention in the same way environmental intervention is compatible but he does question how much this has the possibility of limiting those options. If environmental interventions affect evaluative prospects of a future child and genetic interventions have the possibility of doing the same, is the idea of a right to an open future viable considering that autonomy is affected one way or the other? In other words, how much does a parent affect adaptive capacity? A child has moral and legal rights but we also know that even society limits the scope of these rights because they are not in a position, due to development, to make certain moral choices on their own. Daniels next goes into what role the state should play in genetic intervention, if any, of a child. He cautions that a society’s concern does rule out a perspective of what is best for the society, rather than for the individual. I think this disturbs them that eugenic history may repeat itself if society had too much power in this respect. He does think that it may be less problematic in a liberal democracy if it concerning all-purpose traits such as resistance to tooth decay. He argues that a society’s neutrality must be more stringent than a parent's concerning any type of intervention.

Daniels then appeals to Rawls’ notion that reasonable people, despite their own comprehensive moral views and conceptions of a good life, must incorporate within their views a view that others may reasonable disagree about such matters. As such, parents must aim to create children with the intellectual and emotional capacity to do the same, even if that means that child disagrees with the parent. This may be problematic for both environmental and genetic intervention because how can we know the future state or evaluative position of a child that we are responsible for developing?

Daniels' "Positive and Negative Genetic Interventions"

Daniels, Norman (2000). “Positive and Negative Genetic Interventions" in Buchanan, Allen et al. eds, From Chance to Choice. Cambridge: Cambridge University Press, 104-155.

Chapter 4 is primarily authored by Daniels but the preface also states that Allen Buchanan, Dan Brock, and Daniel Wilker should be credited as well. The chapter starts off with a brief history of eugenics including the distinction between positive and negative eugenics. The point is to show that there may be a moral distinction between practices that seek to achieve the same goal. The idea of normalcy is brought up to note that an idealized or perfectionist view of superior or normal traits may mean that we know to be normal today may be defective in the future. He concludes this section by pointing out that we are appalled by the bad science of the past. He is implicitly cautioning against science functioning out of control in the future.

The next section starts with a presumption that negative genetic interventions (abortion, screening, somatic/germline cell replacement) are mostly viewed as being permissible while positive genetic intervention (enhancement) is at least problematic and possibly morally impermissible. It is important to note that this chapter tends to focus on public policy as it relates to medical intervention by the state or insurance so it is unlike the focus Harris has on the individual. In fact, he does not even mention whether an individual has a right or the freedom to enhance certain traits. He does delve into social justice issues, which may actually indirectly state his position. He does make a distinction between the eugenics movement of the past and current interest in somatic or germline therapy by noting that we are less concerned about population gene pools and more about individual health. He also notes that the disability movement has increased awareness and led to more acceptance of diversity than in the past. Lastly, whereas negative eugenics was not generally viewed as a moral distinction, it very much is so today, especially when so many are sensitive and frightened that history may repeat itself.

The “brute luck view” or natural lottery that Scanlon coined drives the quest for the right moral approach to the notion of equal opportunity and its implications to health care. The treatment/enhancement distinction is closely related to the idea of medical necessity or a medical boundary line. From a public policy or insurance perspective, it has more to do with etiology than suffering because there are many cases of suffering (mostly psychological) that may not affect equal opportunity. Impairment seems to work better from the insurance view than unhappiness, preferences, or possibly even bad coping behavior. The treatment/enhancement line comes from the idea that it has a disease component that we are not responsible for and an objectively specifiable burden of harm. It must be typical of the human condition and not because someone has a bad attitude. This is problematic in certain cases that have different causal explanations but similar effects on impairment. He asks whether the Aristotelian idea of justice demands that we treat cases like this similarly. This too is problematic as he shows between the case of being dull and having a learning disability. We treat one and not the other (in a narrow sense) even though the starting position may have been the same. This raises the difficulty of making the treatment/enhancement line more arbitrary and of less value. There is also the possibility that the line may be value laden by social constructs, which therefore creates problems with postulating a moral boundary.

The treatment/enhancement line is not the same as the obligatory/nonobligatory line because resources may not be able to meet the needs of all impairments. It is also not the same because society recognizes that we may have certain moral and legal obligations to offer medical services without impairment. Daniels/Buchanan et al. claim that their primary justification for considering a health care service as obligatory by society is for the reasonable effective treatment of disease and impairment. They claim that the line between this and normal functioning is relatively objective and nonevaluative provided by biomedical science. I argue that objectivity is problematic because biomedical understanding/technology changes everyday along with societal values that struggle to keep up. They also claim that the normal functioning line also allows people to remain competitive in all aspects of social life, a point that they will relate to justice. This lead to an equality of opportunity that they argue is an obligation of society to protect. Some diseases/impairments will be more important than others to maintain this “normal range of opportunities”. It is here that they start to appeal to Rawls. They identify two other “pulls” as it relates to egalitarian concerns: to equalize of at least reduce the disadvantages that result from less than equal opportunities regardless of impairment/disease; and to remove the source of unhappiness from which we suffer through no fault of our own.

Daniels view of the normal functioning model rests on Rawlsian view of equality of opportunity. As it relates to health care, it keeps people as close as possible to normal function as possible as a way to create a just, egalitarian society. Liberty must come into the picture but may conflict with resources and efficiency of distributing health care. The equal capabilities model formulated by Sen argues that the object of our egalitarian concerns is equality in what can do or be. We achieve equality of opportunity when our capability sets are equal. Daniels thinks this might be problematic because a theory of justice requires integrating concerns for equality with that of liberty and efficiency, which the equality of opportunity model allows while maintaining equality of capabilities. Incommensurability is mentioned as a problem as well because different people may rank different sets based on different conceptions of a good life. Due to this, no baseline can be established, which may actually push for a more expansive model of medical intervention.

The equal opportunity welfare model says that we have a claim to others assistance whenever we are worse off than they are through no fault or choice of our own. Only if the same expected payoff in preference satisfaction can be achieved, can this model be obtained. Normal capacity for revising our goals, values, and preferences is more of an issue than explicit choice. They then continue to argue that the normal function model makes for better public policy. Further, they claim that support may wane for mental health interventions if reasonable efforts are not made to modify someone’s attitudes or behaviors through environmental means. The same goes for physical genetic enhancement as it relates to genetic enhancement. I do not see how public opinion or support should effect the question of justice and morality, especially as it relates to matters of freedom and health care. In addition, wouldn’t resources be different for enhancement technology than other types of technology? Even if the resources were the same, we would recognize utility of resources for need first, want second. The case that comes to mind is breast enhancement for a mastectomy victim versus the stripper. I think justice would dictate that the mastectomy victim has preference but if the resource was available, why shouldn’t the stripper be allowed to purchase the enhancement. Lack of resources creates a moral boundary on who gets the resource, not a boundary line on the procedure itself.

They conclude by claiming that the point behind appealing to a natural baseline is that it provides a good basis for public action, despite disagreements of value. They claim the natural baseline has not metaphysical importance but is a focal point of convergence to what we owe each other by way of medical assistance or health care. The treatment/enhancement line is useful but they do not expect a lot from it. Doesn’t that imply that maybe it is not the best line to use? They do note that it does not necessarily match up with the permissible/impermissible line. Many enhancements, they claim, would cause serious problems plus there may be other concerns so a moral flag should always be raised concerning questions of enhancement. Public goods and other coordination problems arise when all parents pursue a course intended to be best for the offspring. What parent doesn’t that is within the set of “good” parents? They also believe that enhancement would give a positional advantage and that the values of the child may be in conflict with the values of the offspring.

Harris' "Good and Bad Uses of Technology"

Harris, John (2007). “Good and Bad Uses of Technology" in Enhancing Evolution: The Ethical Case for Making Better People. Princeton: Princeton University Press, 123-142.

Harris argues against Leon Kass and Jurgen Habermas whom he believes express a strong opposition to enhancement. Kass argues that the following objections to enhancements fail:
• Safety is not any more a concern for enhancement technology than it does for nonenhancement technology. Harris agrees.
• The access to enhancement technology as it relates to justice and fairness does not stand; only the goodness or badness of the enhancement matters. Harris agrees.
• Parental control over the genotype would add to existing social instruments of parental control and of risks of despotic rule. Harris disagrees and argues that neither genotype nor parental wishes have significant impact on autonomy.
Parents want their children to experience a decent, civilized, and independent life but they will always also want willful control of the process because they think they know best. The claim that attempts to alter our nature through biotechnology is different than through medicine, environment, and education seems wholly implausible on this account. If it is a parents right to alter a child’s nature then the best, most reliable, efficient, and economical method of doing so should be a freedom afforded the parent.

In he next section, Harris addresses Kass’ concerns for cloning and notes that sexual reproduction is akin to roulette and that, if cloning technology was viable, there is less risk than to clone than through sex because the cloner is already a tried and tested product. Since experiences affect physical structures in the brain, there is little chance that a clonee would be exactly like a cloner just as one identical twin is not exactly like the other. Harris rejects pure genetic determinism in favor of free will, choice, and self-development in spite of enhancement. He notes that enhanced powers would not likely be expresses exactly the same way in all individual because on non-genetic factors so there will still be differences between people. We may raise the floor, but the ceiling would be raised as well viz. he rejects the idea that enhancement would create conformity.

Harris then attacks Kass’ critique of enhancement by first noting that it is not always the case that people feel repulsed by the idea of enhancement. Even if they do, it is not a morally relevant feature just as we do not always view it as a moral difficulty when both rich and poor live in the same world. It does not follow that if there is something good or dignified about a natural process that a synthetic modification or replacement is either bad or even of less value. Harris argues that it may actually be better than the natural process because of its relief of human suffering. He then backs to the idea that choice may still mean hard work but acknowledges that making the right choice may be more difficult in the future but that does not mean we should eliminate the choice. He attacks Kass again and comes back to the idea that enhancement, in many forms is already around us so to say that enhancement is somehow different and off-limits is puritanical. Harris obviously rejects the argument from design or God but only claims to want the freedom for individuals to choose for themselves and not have restrictions affect laws come from a religious convictions. In other words, do for your child what you think is best, I will do for mine what I think is best. I think this may have value in conjunction with Glover’s idea of the European model as government as a filter, not a stopper. He argues that Kass’ argument for limitation based on a puritanical and “stunted” view of life shackles the human spirit within the confines of his own imagination and desires. Lastly, he notes that enhancement will only be able to go so far and that experience will still have value viz. there will never be a pill that either induces or removes grief.

Harris then moves to Jurgen Habermas who wrote The Future of Human Nature (2003). Habermas argues against any type of eugenic control and calls enhancement on children human bondage. Further, he claims that it is inegalitarian and destroys future generation’s right to autonomy. Harris comes back with the idea that if we restricted this and restricted that for what a parent can and cannot do, few children would live to be adults. Our parents are instrumental in creating pathways in the brain and, hence, functioning of our minds. This is true with or without enhancement. This goes against the idea that we would be taking autonomy away from our children in some sort of despotic sense. As such, this does not create an unfair social justice of inegalitarianism. Harris concludes by arguing that enhancement would no more result in a loss of personal identity for a future child than a “natural” child born today would. If that child did claim such a loss of identity as the result of enhancement, Harris would remind them that the parents tried to give them best chance at a good life that was available and maybe they should pull themselves together and recognize that they are autonomous beings none the less. The responsibility for how children turn out will always be on the shoulders of parents in so far that they had a choice to do or not to do. To take away handicap or not take away, to enhance or not to enhance; they have to do their best.

Harris' "Perfection and the Blue Guitar"

Harris, John (2007). “Perfection and the Blue Guitar" in Enhancing Evolution: The Ethical Case for Making Better People. Princeton: Princeton University Press, 109-122.

Harris primarily takes up against Michael Sandel in this chapter. Sandel’s argument is along the same lines that others have argued, namely that enhancement is beyond us in a way that alters our essential nature and humanity. Harris calls this a conservative position and describes this as being a position the expresses suspicion to change, emphasize the virtue of things the way they are and acceptance of those things. He again points out that human history could be described by enhancement in all fields of human endeavor I mentioned in a previous post. He also notes that enhancement is part of the evolutionary process. I will not detail Sandel’s arguments that Harris quotes at length, only Harris responses as we will probably review Sandel’s work in greater depth later.

Harris does respond to Sandel first by claiming that it is not rational to think that effortful superiority is better than effortless. He uses the sports analogy to compare this idea. Was Pete Rose (the hard worker) better than Joe DiMaggio (the graceful, gifted player)? Harris argues that both had to train to develop what talents they were born with and that they were ultimately judged as baseball players by their achievements. Excellence is the result of doing, not just having. It requires authentic human agency with effort and non-effort. Even the steroid fueled behemoth must work at it and to think that it is easy, is missing the idea of what excellence is or should mean. Now Harris is not arguing for enhancement in this way, he is only arguing against Sandel that there is something inherently less to be valued in achievement from effortlessness compared to more effort.

Harris argues that it is true that an enhanced sense of human agency coupled with increased powers to influence the future and the world may transform our understanding of the moral landscape. A poignant point he makes is that with this technology, we become responsible for our inaction as well as for what actions we do take. Does a child a legitimate claim to harm if a parent fails to act on a disability when that choice was available? Harris would say yes. It is clear that Sandel is a theist so it is not surprising that Harris uses the word “destiny” in regards to the notion of human agency. Sandel also seems to appeal to Rawls in that we should not be entitles to a full measure of the bounty they reap on society compared to those with less gifts. Harris makes the interesting move of arguing that enhancement is actually a way of redistributing gifts before society has to redistribute resources to equalize for the sake of social justice. As Harris says, “enhancement provides more to redistribute and less need for redistribution” (p. 120). Ultimately, Harris wonders whether people who choose to enhance as true masters of their destinies or as the best judges for what they deem best for their children will be able to if arguments like Sandel’s are used to restrict freedom and liberty. This is a bigger question outside the scope of our project, but if God is the presupposition, where is the medical boundary line or is there one?

Harris' "What Enhancements Are and Why They Matter"

Harris, John (2007). “What Enhancements Are and Why They Matter" in Enhancing Evolution: The Ethical Case for Making Better People. Princeton: Princeton University Press, 36-58.

Harris attempts to argue that the overwhelming moral imperative for both therapy and enhancement is to prevent harm and confer benefit. He suggests that it is unimportant whether the protection of benefit conferred is classified as enhancement or improvement, protection or therapy. He rejects the notion that enhancements can be defined relative to normalcy or to normal species functioning. It is in this chapter that he addresses objections made in terms of motivation or objectives to be achieved along with tests that enhancements have to meet, primarily by Daniels and Buchanan et al. in From Chance to Choice. It is interesting that he finds the question surrounding the debate of change in human nature or evolution ethically uninteresting. Self-evolution, post-humanism, transhumanism, or the sciences of new breeds are not moral issues to Harris.

He starts by claiming that the abnormality of a characteristic relative to other humans does not affect its value unless the abnormality itself has other consequences such as the ostracizing that may take place because of green skin. If, however, the green skin turned into a benefit, then not even the ostracizing would decrease its value. He sees no problem with the creation of new species or a “different” human line if that meant a bettering of life because our current existence is due to a change that bettered us in the past creating our current form of human.

Harris points out that Daniels human subject research would rule out most enhancements while Buchanan et al. suggests that the lack equal opportunity related to enhancement technology would be the biggest moral drawback to enhancement technology. Harris seems to be attacking their idea of normalcy and the medical boundary line. I will be reviewing Daniels and Buchanan et al. later so I will not go into their arguments as much as his responses. Harris argues that the fact that we cannot cure everything has never been an argument for failing to cure something, especially when it is something that causes pain, misery, or premature death. Most of what passes for therapy is an enhancement for the individual relative to a state prior to therapy so the therapy-enhancement line is problematic. The moral imperative comes from the value of minimizing harm, not on conceptions or normality. He also argues that we should strive for equality of opportunity but that it is not the necessary moral condition for treatment or enhancement. Intervening on the natural lottery to simply promote equality of opportunity or ability to compete is not sufficient. Harris also does not think that the notion of normal species functioning or successful social cooperation are key ideas that license interference in the natural lottery as well because many things like aging and disease are part of normal species functioning. It would not be immoral to start vaccinating for HIV/AIDS or cancer even if was initially only available in scarcity. We save lives not to secure equal opportunity or secure access to “normal competition”. We save lives, postpone death, and enhance human functioning to better lives … no further moral justification is needed.

Harris argues against Daniels’ imperative not go above the medical boundary line viz. “normal claiming that his definition is too narrow and does not include benefit to society and population. He argues that we should take the viewpoint of possible functioning, not normal functioning because “normal” is problematic. For Harris, the moral imperative is safety and the duty to compare risks with benefits not on equality of opportunity, not on an ambiguous concept of normality, but rather on the probability of magnitude and probability that the proposed treatment or enhancement saves lives, postpones death, and decreases suffering. Save lives now with a perspective towards justice and equality along the way. The distinction between treatment and enhancement becomes more a matter of semantics, not morality. He concludes with a brief commentary on the nature of the human condition. He seems to think that to object to enhancement based on the grounds that it changes human nature or the human condition does not take into consideration where we have come as a species and how enhancement is everywhere. If we cured heart disease and cancer, we would change human nature and the human condition, which may not be a bad thing.

Harris' "Enhancement Is a Moral Duty"

Harris, John (2007). “Enhancement Is A Moral Duty" in Enhancing Evolution: The Ethical Case for Making Better People. Princeton: Princeton University Press, 19-35.

Harris attempts to introduce the ethical case for enhancement and the positive future of humankind. He uses five examples to give a sense of the debate and the different objections to the different modes of enhancement.

1. Mechanical versus Chemical Enhancement – he comments on the Boorse and Daniels definition of health to include illness as a departure form normal of species-typical functioning. He then makes the analogy of using glasses to binoculars. One raises sight up to a normal level while the other enhances beyond what is normally capable. He argues that to make an argument against enhancement, one would have to argue against the use of binoculars. He then makes some comparisons to give a sense of the moral debate. Buying a child the best education possible versus giving drugs to reach the same level of intelligence. Riding a bike versus using steroids. It seems the current debate says that the first choice is morally acceptable while the second choices are not. Harris seems to be a bit of a cautionary consequentialist in that if it is safe, then he sees no difference if the results are the same.
2. Disease and Vaccination – he notes that there has been very little resistance to this type of enhancement technology. If we alter human beings to affect their vulnerability to things, we are enhancing them. The issue then with new enhancement technology may be a matter of perception.
3. Genetic Enhancement – he notes David Baltimore's work at Caltech as HIV/AIDS and cancer vaccinations using genetic therapies as an example against "normal or species-typical functioning" against Boorse and Daniels. He further argues against Francis Fukuyama's claim that changes to human nature are absolutely unacceptable. Fukuyama's idea of Factor X, what is left when we strip away all of a person's contingent and accidental characteristics, as human nature is argued by Harris to include enhancement because if Factor X can be preserved or even enhanced then it must be a good thing by Fukuyama's own argument. He then notes that cloning is the only way to preserve the human genome and that universal cloning is the only way to prevent genocide. He notes that you could use Aquinas' Doctrine of Double Effect to argue for enhancement but that it would not be sufficient, again from a consequentialist viewpoint.
4. Chemical Enhancement – Harris favors enhancement as an absolute good and not as a positional good. This means that if we enhance for a longer life, it is good in and unto itself, not as an improvement to others even though other that do not have this good may not live as long. Making lives better rather making lives better than others must be the focus concerning enhancements, i.e., there may be inequality but is not necessarily a reason not to enhance. We already treat kidneys and hearts as scarce resources that some may get while others may not and we should work to get to a point that it may be available to all but that does not mean that no one gets a kidney until all can. Making a few better lives now may be unequal now but that does not mean we should abandon making those few lives better. It has to start somewhere and throughout history, new technology has started off on an unequal foot with many examples of that changing to be a common good. There is no moral case for delaying access to new technology or health saving device because it is not available to all.
5. Life Extension – life-saving is equivalent to death-postponing. Why do we look at certain methods of life-saving as morally necessary while talking about others as morally disdainful? If postponing death is a good, what about if we could postpone it indefinitely. Harris argues that regenerative medicine may not always be simply therapeutic but it may have an enhancing dimension. He ends this section with a word of caution by stating that we should not tamper with healthy human beings that will harm rather than benefit.

He concludes with a commentary on The Precautionary Principle and Playing God. He notes that UNESCO's International Bioethics Committee has maintained the idea that "...the human genome must be preserved as a common heritage of humanity." He responds with the following rebuttal of their assumptions:
1. The present point in evolution is unambiguously good and not susceptible to improvement.
2. The course of evolution will naturally make things better, not worse.
He views (1) and (2) as incompatible and argues that the common heritage of humanity is the result of evolutionary change. He then appeals to F.M. Cornford to note that if we reject any action on the present on the possibility of future harm, nothing would ever be done the first time to argue against the precautionary principle against enhancement. Lastly, he argues against the "Playing God" argument by noting that medicine can be described as a comprehensive attempt to frustrate the course of nature and therefore God. Artificially changing the nature of nature has led to a change of human nature.

Harris' "Introduction" and "Has Mankind a Future?"

Harris, John (2007). “Introduction” and "Has Humankind a Future?" in Enhancing Evolution: The Ethical Case for Making Better People. Princeton: Princeton University Press, 1-18.

Harris attempts to answer the question: if the goal of enhanced intelligence, increased capacities, and better health is something we might strive for though education, why should we not strive to produce these goals through other enhancement technologies, including genetic enhancement? He defines enhancement as good if they make us better people. His thesis defends enhancement and argues that not only are enhancement permissible, but that in some cases, there is a positive moral duty to enhance. He briefly appeals to Plato, Marx, Locke, Rousseau, and Bentham to argue that we, as moral agents, have a responsibility to make the world a better place. He notes that we have reached a time in human history at which further attempts to make the world a better place must include changes to the world and humanity. He does not seem to think this is a bad thing and he will show later in the first chapter. He does not think that it is a bad thing that our descendants will not be human in the sense that we now know, but that it is inevitable from an evolutionary point of view or a technological point of view. He thinks that natural selection will be replaced with deliberative selection and Darwinian evolution will be replaced by enhancement evolution. He believes that humans have a moral responsibility to make informed choices for our fate and the fate of the world in which we live along responsibility to make a world a better place. Done correctly, we can take the chance out of evolution and place it within our hands so that change leads to a better species altogether. He seeks to find an ethical way to enhance intelligence, happiness, strength, and life expectancy in ways that protect the safety of people and are consistent with justice, government, and regulation.

He will look at stem cell technology, gene manipulation, embryo selection, drugs, and mechanical enhancements. Harris will also argue against the health and disease models advanced by Boorse and Daniels, which we should review. He argues that the presumption is that citizens should be free to make their own choices in the light of their own values, whether or not these choices and values are acceptable by the majority. He will argue against Michael Sandel, Leon Kass, and Jurgen Habermas who have supported arguments against enhancement. He thinks that choice of phenotypical traits such as hair, eye, and skin color are morally neutral because it is it no worse to be black versus white or blond versus brunette, etc. Harris advocates for research and argues that the fetus is an irredeemably ambiguous entity and not sacred. Research should be regarded not only as desirable but as a positive moral obligation.

He opens up the first chapter by claiming that human enhancement is a good thing and that our genetic heritage is in need of improvement. He also quotes de Lampedusa, "If we want things to stay as they are, things will have to change." He takes this tact to argue against a conservative position and points out those conservatives who argue against enhancement actually engage in enhancement all the time. He notes that glasses and vaccinations are forms of enhancement – an improvement from what went on before. We enhance in these ways because we are decent, moral people who want to protect each other from harm and benefit ourselves and others. He argues that there is no inherent difference in types of enhancement. The opportunity to create healthier, longer-lived and therefore better lives is a moral responsibility and in the best interest of governments and society.

Harris then appeals to Bertrand Russell's Has Man a Future? to note that we must preserve and expand on what is good in humans, which entails that we should improve in humans over preserving the species in its current form. Harris does not believe that illness and poverty are likely to occur by chance over the thousands of generations evolution requires so any change for the better, based on where we are at as a species, must be up to us. Our potential is in our hands. In this sense, evolution does become something concerning progress and thus becomes teleological. Again, he goes back to the conservative question and argues that we must change at least to preserve, which may mean things cannot remain the same. Shelter, learning, teaching, toll using, farming, social living, and language lend to human enhancement. He argues that genetics will just be next in the list.

Harris does acknowledge that anything listed as historical proof of enhancement has been ill used but that does not discount the overall benefit to humans nor does it entail that we not attempt new technologies for enhancement. Just because something may be used improperly, does not mean that it should be abandoned altogether. Also, just because a new technology may not be available to all is not a good argument to abandon it until it can be. Take writing for example, at one time only a few were allowed to learn and slowly it became available to all. The same with certain antibiotics and electronic technologies. Sometimes technologies that advance are produced slowly. This does not mean that it is unjust or will not be available to all at some point later in the future. Just because it is elitist now does not mean that it always will. He then appeals to Richard Dawkins to warn against a "fetish" of sticking to any one evolutionary stage because any static period in our evolutionary past would entail that humans in our current form would not exist. This will be an argument he uses against Kass, Sandel, Annas, and Fukuyama. Evolution is change so why not embrace it instead of arguing that evolution exists but let's do everything possible to keep it static now. Lastly, he argues that we should take the dangers seriously but without knowledge of how probably or serious the dangers are against the probability and size of the benefits, we have to rational basis for either precaution or enthusiasm. Is ceasing to be human in the way we know now truly problematic?

Glover's “Human Values and Genetic Design”

Glover, Jonathan (2006). “Human Values and Genetic Design” in Choosing Children: Genes, Disability, and Design. Oxford: Clarendon Press, 73-104.

Glover explores philosophical issues surrounding liberty, the harm principle, and human nature as it relates to designing children. He starts with a quote by James Watson, “Most of us are in favor of autonomy … as long as we are not hurting someone else.” (p.73). He then launches into John Stuart Mill and reminds us that according to his political philosophy, “… the only purpose for which power can rightfully exercised over any member of a civilize community, against his will, is to prevent harm to other.” (p. 74). Glover again brings up Derek Parfit’s Non-Identity Problem, which states that different policies will shape the world in ways that will lead to different people but that does not mean that they would be worse off than an alternative set of descendents would have been. We may want to explore this idea further because I can imagine a future that is worse off than an alternative set based on bad policy. Would be actually be glad they were born if life is miserable? Maybe some would but others may not, especially if freedom and autonomy are compromised because of bad policy. Glover proposes the idea of ‘transpersonal harm’ to mean one course of action brings about a world where those people exist that are worse off than an alternative set of people, in a alternative future based on different policy so he does recognize that bad choices now can harm those in the future.

The idea of a medical boundary is a more conventional view that claims that intervention is acceptable if it seeks to eliminate disability below a medical standard of what defines disability. As genetic technology advances, this line could change providing an argument that we could have allowed enhancement now, which would be equivalent to treating disability in the future but the problem still remains of who is to decide. He comes back to the idea of human flourishing and advocates the notion that medically defined disability is morally acceptable and that in some cases, non-medical choices may be desirable to promote human flourishing. He also points out that those who advocate only to the medical boundary must specify why that boundary is so special. We should check out Robert Noziak and his idea of the ‘genetic supermarket’.

Glover argues that we should restrict liberty in making genetic choices only when something comparable important to human flourishing is at stake. He suggests that a regulated European model market may allow individual freedom with certain genetic features restricted in the name of public interest. The question then becomes, which choices should be excluded from the democratic debate. Some concerns include:
1. The dangers of uniformity.
2. Genetic inequalities.
3. The possible threat to central parts of human nature.
We recognize that sometimes the value of benefit to the minority justifies inequality. Again, Rawls comes into the picture. The problem here is that inequalities go deeper than economic concerns and are automatically replenished via future generations. The possibility of further class separation is not without merit. Then again, parental acquiensence may minimize inequalities in a reasonable free market. This might not have any effect in overall inequality because as he says, “… parents may all be standing on tiptoe without their children being able to see any better.” (p. 80). He also points out that enhancement for bad reasons may not necessarily entail a child’s harm or regret.

The next section explores definition of human nature. He does worry and argue against any type of state enhancement program as being eugenic. Francis Fukuyama comes up again with his central idea of human dignity and that consciousness, reason, feelings, and the capacity for oral choice must be preserved. Two possible starting points for the exploration of what we value in human nature:
1. The recognition that our nature includes both good and bad qualities.
2. The idea of a good life for human beings.
Glover argues that the first point acknowledging the dark side of human nature might not be subject to elimination through genetic enhancement but rather one of containment if we are to maintain autonomy. He suggests that the best account of a good life comes from an overlap between some version of human flourishing and some version of happiness. He calls this a liberalizing that tends toward convergence. The Darwinian and normal functioning account of human flourishing are too narrow. Humans do not want to do things passively but through experience so the Brave New World scenario must be avoided. The binocular analogy he makes adds depth to the genetic perspective as it relates to:
1. The fit between what you want/value and what your life is like.
2. How rich your life is human goods, what relationships you have with other people, your state of health, autonomy, and scope for creativity.
The hope for shared values then comes from resources of science and subjective experience so essentially an inner and outer view of human experience. As such, a plausible account of human flourishing is unlikely to have one blueprint.

Glover argues that there is a case for optimism in principle and caution in practice. This entails that public debate should continue about known and possible risks but that should not instill paralysis. Lastly, he appeals to the idea of open future to remind us that the future is open to us but that we must leave some of theta openness to the future as well.

Glover's “Parental Choice And What We Owe To Our Children”

Glover, Jonathan (2006). “Parental Choice And What We Owe To Our Children” in Choosing Children: Genes, Disability, and Design. Oxford: Clarendon Press, 37-72.

Glover starts by claiming that reproductive autonomy or whether or not to have a child is accepted throughout much of the world with exceptions as follows:
1. Religious objections to contraception.
2. Religious or moral objections to abortion.
3. Some would restrict autonomy where it requires access to techniques of assisted reproduction.
He seems to reject these reasons for infringement on parental autonomy including that for population control as in China. In this chapter, he explores the question of whether autonomy extends only to the question of having a child or if that extension should apply to what kind of child to have.

He argues in the second section of the chapter that the hope to have child without disability us unproblematic from the point of view of the child, procreative liberty, in this sense, is not in conflict with what we owe our children. As far as potential children not conceived, he claims that we do not owe them anything because they are even a potential third party viz. if I choose not to have a child because thallosemia, no rights have been infringed. Many argue that we should accept children into the world unconditionally regardless of disability. Glover does not think it is wrong to want a child without disability so he rejects the denial of prenatal intervention on those grounds.

The third sections opens up with the basic view ethics concerning positive and negative rights:
1. Sometimes we owe others not to act in certain ways.
2. Sometimes we owe others to act in certain ways.
One of the first appeals here is to Thomas Scanlon, “…we aspire to justify our decisions to others on grounds they could not reasonably reject. If they can reasonably reject our decisions then we are subject to their reproach. He then makes the distinction between doing harm when it could be avoided and not acting when you could reasonably protect someone from harm. By accepting that we are responsible, somewhat to the future children in creating policies or making individual choice we are saying that different people will be born than otherwise would be the case. Morality then is more than what we owe people. Is it a question of morality to bring one child into the world with less of a chance to a flourishing life than another with a greater chance even if both are happy to be alive? One of the issues of reproductive ethics is what our decisions do to the world (non-Identity principle) in addition to the individual. Glover seems to make a deontological move at the end when deciding correct action for a deaf child being born (p. 50). Selecting for a deaf embryo is, he argues, is more justified than a potentially hearing child made deaf.

The next section explores the following two questions concerning what we owe our children:
1. What we owe our children has to do with their having good lives.
2. What we owe our children has to do with respecting their autonomy.
His first claim is that no child being born with a life worth living has been harmed by being born. Glover then explores the ‘zero-line’ approach or the line just above ‘very terrible’ to answer the question of whether or not it is justified to have a child at this level. We should check out Julian Savulescu’s Principle of Procreative Beneficence, the idea that couples should select the child of all the possible children they could have that will have the best chance to a good life or at least as good a life as other based on available information. Glover suggests that medical, social, and economic factors may be components in determining the criteria for a good life. He then argues that passive exclusive is also a form of injustice and that equality of opportunity is seen as requiring action to reduce socially caused disadvantage. Previously, inborn differences were seen as independent of what justice society provides but genetic technology makes this less so. Genetic intervention against disability can increase a child’s chance for flourishing. Therefore, parental freedom should be constrained only by limits the potential flourishing of their child whether that is limited by poverty or by disability. Does this mean that poor people should not have children? He does call for a balance between parental freedom and flourishing of the child but it seems that by including some social factors, he is setting his argument up to serious objections. It will be good to explore the ‘zero-line’ philosophy he is arguing. Is this not just one-step above ‘very terrible’?

The section of the chapter focuses on identity and autonomy. He appeals to Kant to claim that to be treated merely as a means versus and end in and of themselves, there has to be some violation of autonomy or denial of some respect owed. He does state that the fetus and newborn do not have the capacity for choice so the issue of respecting the child’s autonomy does not arise at either stage. This may be problematic if we consider that future autonomy may be affected by choices made prior to the development of that capacity to choose. He rejects the idea of true independence and self-creation because of our ties to both genes and environment thereby limiting the right to an open future. I agree that certain choices away from disability may actually increase the openness of a potential future but that genetic intervention may be problematic in controlling how others control that future. I also agree with Habermas that genetic intervention will alter our self-understanding but that does entail a significant or negative effect compared to our current capacity for self-understanding. Glover does say that too much genetic intervention may make us feel like puppets to our parent but that some loss of independence may be a worthwhile price to pay.