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.

Conscience As It Relates To Natural Religion: An Analysis of John Henry Newman

In Fifteen Sermons Preached Before the University of Oxford Between A.D. 1826 and 1843 (15S) and An Essay in Aid of a Grammar of Assent (GA), John Henry Newman compares natural religion to that of revealed religion in an apologia of faith. I will provide an overview of his definition of natural religion including how it changes over the course of his writings. I will then argue that the faculty of conscience is the common thread that holds his definition of natural religion together between the two works. Lastly, I will explore whether conscience is sufficient to keep Newman’s definition of natural religion coherent within his argument for revealed religion.

In “Sermon II: The Influence of Natural and Revealed Religion Respectively” (15S), Newman attempts to show how Christianity as authenticated, revealed religion relates to natural religion. He starts by claiming that, “No people (to speak in general terms) has been denied revelation from God …” He says that only a portion of the world; however, enjoy authenticated revelation, which refers to the Christian God of the Gospels. He then introduces a definition of natural religion as an attainable creed that arises from this general revelation evidenced by the writings of pious men from what he calls the heathen world. This is still too general a definition for his purposes but he must get past some of the prima facie objections that the term “Natural Religion” carried with it in the eighteenth century. It is here that he introduces conscience as an obvious and essential principle of religion. Conscience allows an understanding of the difference in the nature of action and motivates one to act in one way over another. Happiness begins to be associated with acting in favor of conscience because we vaguely feel remorse when we act against it. The idea of evil is also associated with the feeling of acting against conscience and together with general revelation, a presentiment of life after death and judgment of our deeds begins to form. Happiness is then connected with right action, which then becomes the basis of an individual moral system. From here, a disciplined mind might develop a religious creed that points to the individual’s idea of moral truth. Keep in mind that the source of the religious creed arose out of conscience but even though it may be built from there on the principles of logic and observations of nature, it remains problematic.

Newman claims that this is how natural, religious creed is attained; however, is not truly attained because others reach different conclusions pointing in a different direction of moral “truth”. The mind may go in the direction of philosophy, which would make the religious creed too abstract, or it may go in the direction of rude natural feeling, which would make the religious creed unintelligible. What seems to be lacking in natural religion is an insight into God’s true personality and a doctrine for moral action that points in the direction genuine moral truth. Authenticated or revealed religion provides this deficiency. Natural religion allows for deep and true religious feeling but with an object to place affections and a standard by which all can gauge moral action. Revealed religion provides the unity of a “Judge and Governor” to keep any corruption of reasoning in check. A large portion of his work is how reason functions in relation to faith, which is beyond the scope of this essay, but it is important to note that natural religion relies more on obedience to moral principles by reasoning alone while teaching religious truth by investigation. Revealed religion enforces obedience more on faith and teaches religious truth historically. Revealed religion engages the faculty of faith, indeed all of our faculties more completely, and as such, it fulfills our nature in a way that natural religion is never able achieve. From Fifteen Sermons, the crucial point to remember is that natural religion prepares the mind for the moral truth and recommends doctrine that revealed religion brings.

It is interesting that the definition of natural religion depends, in a large part, on the definition of revealed religion. This works well in supporting his argument that there is a relationship between the two but I will now discuss how Newman’s definition for natural religion changed over the next 20-40 years as evidenced in A Grammar of Assent. In “Chapter Five: Apprehension and Assent in the Matter of Religion” (GA), Newman considers the dogmas of belief in one God, the Holy Trinity, and dogmatic theology in addition to their relation to notional and real assent. He claims that it is natural to associate empirical evidence of nature with an individual outside of our senses. He then claims that God indirectly gives us through our conscience an insight to His nature. This is the first departure from how he postulated conscience as a starting point for natural religion in Fifteen Sermons. Now he argues that revelation works through conscience rather than as a separate phenomenon. Further, he refers to a child’s response to conscience and states, “The child keenly understands that there is a difference between right and wrong; and when he has done what he believes to be wrong, he is conscious that he is offending the One to whom he is amenable, whom he does not see, who sees him. His mind reaches forward with a strong presentiment to the thought of a Moral Governor, sovereign over him, mindful, and just.” This is another departure from his argument in Fifteen Sermons because he is now claiming that conscience more directly leads to the truth of revealed religion versus a process that requires introduction to the doctrine and truth of the Holy Bible. Lastly, he implies in §1 “Belief in One God” of the same chapter that natural religion relates to notional assent. In his introductory comments, he distinguishes between real and notional assent by associating religious acts with real assent and theological acts with notional. This entails that natural religion is a theological or an intellectual endeavor and therefore more abstract. Here again, he generalizes natural religion into one category of the abstract versus into two categories of abstract or rude natural feeling that arise from the development of a religious creed as posited in Fifteen Sermons.

The differences between the definition of natural religion in Fifteen Sermons and Grammar of Assent may be subtle but I argue that it is significant enough to require a defense of its coherency. My claim is that there may be contextual differences that are explanatory to the differences. Fifteen Sermons fits within the context of a sermon while Grammar of Assent is a philosophical treatise defending Catholic faith. It is beyond the scope of this essay to more fully detail why there are differences in his definition but I argue instead that the faculty of conscience lends support to the coherency of his conceptualization. Since I developed the role of conscience in Fifteen Sermons, I will now focus on Newman’s concept of conscience in Grammar of Assent to support my claim.

In §1 of Chapter 5 (GA), Newman first addresses conscience as mentioned above. He then expands on his definition of conscience along the same lines from Fifteen Sermons in addition to claiming its legitimacy alongside memory, reasoning, and imagination. Further, he discusses the consequences of conscience, which are a moral sense and a sense of duty. This is in line with how he previously conceptualizes the essence of natural religion in Fifteen Sermons. Remember that conscience allows a moral system to develop or be a consequent from the vague apprehension of right and wrong. He asks us to consider conscience as, “ … not as a rule of conduct, but as a sanction of right conduct. This is its primary and most authoritative aspect.” He expands here on his original definition again by discerning conscience from taste and claiming that conscience concerns itself primarily with people and the actions of people or with the self and actions of the self. According to Newman, taste relates more to aesthetic preferences for beauty and ugliness rather than the rightness or wrongness of action. The important point is that his definition so far remains coherent concerning the faculty of conscience between the two works. Lastly, he adds to the definition of conscience by stating, “… when the conscience is good, as real though less forcible, self-approval, inward peace, lightness of heart … constitute a specific difference between conscience and other intellectual senses … indeed they would also constitute between conscience and moral sense…” The disconnect between the concept of natural religion in Fifteen Sermons contrasted with Grammar of Assent becomes less incoherent when attention is focused on the faculty of conscience. The idea of what natural religion is and how conscience relates to it must arguably be teased apart more in Grammar of Assent; however, the same structure of natural religion is apparent when evaluated as a consequent of conscience. The disconnect then may be attributed to contextual differences and sheer length of time between the two works. His conceptualization of conscience evolved over the course of years but the primary function, definition, and relationship to natural religion remains the same.

The question remains whether conscience is a sufficient explanation to maintain coherency and therefore validity of his argument distinguishing natural from revealed religion. Although I argue that conscience supports a claim of coherency between the two definitions, it is not sufficient to completely define natural religion because of his appeal to revealed religion. This is the inherent weakness of his argument in that he defines, in a large part, what natural religion by what is not. For Newman to provide a stronger argument for a relationship between natural and revealed religion he would have to better define natural religion on its own. Secondly, he minimizes religions that have similar agency and doctrine as the Judeo/Christian system. He does refer to Islamic faith as false against the argument that it is also a revealed religion in “Chapter 10: Inference and Assent in the Matter of Religion” (GA); however, it not sufficient to say that one religion is natural while another is revealed simply because the tenets are different. His argument for revealed religion as a logical consequent of natural religion, which is a logical consequent of conscience, rests upon structure. He must therefore focus on the differences in structure between different religious creeds to distinguish Judeo/Christian faith from all others. I argue that the phenomenon of conscience supports a theistic worldview in that it seems to point in the direction of moral truth without proof. This implies, as Newman would agree, that there is something intangible and objective outside of ourselves. It is only a small leap from here to entail theism. I also argue in conclusion that more work to Newman’s argument must be made before Christianity can truly claim itself to be authenticated, revealed religion. Conscience as the starting point may yet provide an argument to better support his claim.

Dichotomy and Interdependence: An Analysis of "The Matrix"

The release of the Wachowski brother’s film The Matrix in 1999 was a milestone in science fiction cinema and special effects. The film depicts a dystopian future where the reality perceived by humans is actually a simulated reality created by sentient machines in order to subdue humans and utilize their biological energy to power a machine civilization. The plot follows Neo, a messianic character in the film, as he is liberated from the bondage of the machines and attempts to unshackle, or unplug, the remaining members of the human race. Combining elements of cyberpunk, martial arts, and what has come to be known as “bullet time” special effects, The Matrix is both visually stunning and conceptually thought provoking. The film also utilizes imagery and a narrative structure to seemingly illustrate many philosophical and social dichotomies that may be familiar in our current cultural context. I will argue that these dichotomies are in fact complements in the film and are not only symmetrical and interdependent but inform and define each other. I will go through the film in chronological order and use the specific imagery and narrative context to describe and illustrate these complements. I will also discuss how the film is a warning against technology and provide a commentary on the sublime nature of reality.

The film opens with greenish, electrically shimmering film logos and ominous music to immediately convey to the viewer that something will be different in this film compared to others. The viewer is then presented with what seems to be computer code written in an unfamiliar, Asian-like language cascading down the screen, slowly disappearing and morphing into the title of the film. The purpose of these first 40 seconds is to set a tone of disengagement and confusion along with begging the viewer to ask the question, “What is the Matrix?” This is important because one of the themes of the film is the philosophical difficulty of reality. In other words, how does one know with certainty that what they perceive to be real is, in fact, true? The more disengaged and confused the viewer is at this stage of the film, the deeper they will be engaged into the film itself as the story develops. This is the first set of dichotomies established in the film – disengagement versus engagement and confusion versus clarity. These dichotomies serve to bring the viewer along for the ride and also reinforce the notion that belief is important to both character and viewer. In the case of Neo, belief is important in a new “reality” (Matrix) where anything is possible and in the case of the viewer, belief is important in accepting the possibility of such a future. Each dichotomy depends on its analogous parts to drive the intrigue forward, present in both character and viewer.

The next scene follows the character of Trinity, first as a voice discussing Neo and later as she performs some seemingly impossible kung fu and flees the agents on the rooftops. The menacing, corporate clad agents set up another dichotomy with the vinyl clad Trinity both in clothing and morality. The viewer is unsure who she is but it seems clear that she somehow represents good while the agents represent evil. We later learn that this is the case, although it is suggested that the roles were reversed at some point in history when humans unjustly treated the machines in their early stages of self-awareness. Clothing is important throughout the film. The agents in their brown suits, matching ties, and square sunglasses could arguably represent a corporate system of control while the vinyl or leather clothing worn by Morpheus and his crew could represent the bondage of the individual or non-conformist in a corporate state. Again, dichotomies of good versus evil and corporate versus individual are established early in the film before the viewer has comprehension of what is taking place. This scene ends with a phone booth and the disappearance of Trinity, the question of how she disappeared left as yet unanswered.

The next scene introduces the Mr. Anderson/Neo character played by Keanu Reeves by taking the viewer through what appears to be an electronic circuit, greenish patterned energy flowing past. This scene also introduces the dichotomies of waking versus sleep and machine versus human. Neo is first seen asleep with headphones on, a computer search running in the background for Morpheus. The search for Morpheus, named for the Greek god of dreams, is actually Neo’s search for an answer to the question of the Matrix. The answer to the question of the Matrix concerns the nature of reality. The mind relies on the senses to interpret the world by which reality is defined. Without the mind or the senses, neither could truly exist just as dying in the Matrix means death in the real world. This is yet another complementary dichotomy that the film illustrates. The imagery of the computer words on a black screen and not an actual voice waking Neo up speaks to the interdependence Neo has with machines along with the idea that reality can be like a dream state, further supporting the notion that reality may be ambiguous. Descartes’ Meditations on First Philosophy explores and develops methodological doubt along similar lines. This scene will also tie into the computer center of the Nebuchadnezzar in that Mr. Anderson’s room in Matrix looks remarkably like the computer network of Morpheus’ ship. The imagery and quiet narrative of Reeve’s character in this introductory scene are rich with opposites that will reverberate throughout the film – reality versus illusion, waking versus sleep, machine versus human, rationality versus experience - all interdependent and complementary because neither opposite could function or exist without the other.

The notion that “life is but a dream” recurs many times throughout the film along with references to Alice in Wonderland to exacerbate the idea that everything may not be as it seems. References to “follow the white rabbit” and the appearance of the character of Du Jour with a white rabbit tattoo on her shoulder are the most obvious examples of this link to Lewis Carrol. It is interesting that the character of Troy, a somewhat shady figure, reveals the future of Neo by saying, “Hallelujah. You’re my savior, man. My own personal Jesus Christ” and “Don’t worry, you don’t exist.” Finally, Troy says, “It just sounds like you need to unplug.” This is interesting because he seems serious about his use of mescaline, a mind-altering hallucinogen. This could be a commentary about drug use in that by “dropping out”, one may actually be more in touch with what may be actual reality. This notion is certainly supported further by the choice Neo has to make after meeting Morpheus between taking a drug, whether it be a red pill or the blue.
The scene that takes place between Neo meeting Trinity and his introduction to Morpheus further develops many of the dichotomies already established. Trinity confirms that Neo is searching for something other than Morpheus, the work discipline meeting with the boss that looks like an agent, and the attempted escape illustrate the dichotomy between corporate versus individual, reality versus illusion, and the interconnectedness of man and machine. Neo needs computers in the Matrix to find the answer of what the Matrix is, which proves to be part of the machine world. The lecture given to Neo by his boss is remarkably like the message of the what machine world is attempting to achieve with humans, which further adds to the notion of interconnectedness between the parts and the whole of both the machine world and the corporate world. The attempted escape from the agents not only sets up the inevitability that agent Smith refers to in his fight with Neo later in the film but also another dichotomy between ordinary and extraordinary. The humans that are plugged in need the comfort of the ordinary environment produced by the simulated reality of the Matrix, which is, in fact, an environment where the extraordinary feats may be achieved. The journey Neo takes is from the commonplace world that the Matrix provides, into the real world of Morpheus and Zion, and finally back into the commonplace world of the Matrix, is a journey that allows for his transformation into savior. Once again we see interdependence and complementary dichotomies that help define and inform each other woven throughout The Matrix.

The scene from Neo’s interrogation by the three agents to his birth out of the Matrix further develops the ambiguous nature of reality, Neo’s relationship with Agent Smith, and the dual nature of Neo himself. The viewer is once again transported through an electronic device, which seems to give the illusion of coming though a television monitor. This could be a commentary on the dual nature of television and media in general along with establishing yet another dichotomy. As much as we view television and are informed by it, maybe in a way, television views and is informed by us. The imagery of the “bug” transforming into a fleshy creature, disappearing through Mr. Anderson’s navel followed by Neo waking to Morpheus’s phone call further plays with the notions of disengagement, confusion, and reality both for the viewer and in a diegetic way. Agent Smith’s character is developed more in this scene as well, with many negative “human-like” qualities starting to surface such as pride and sadism in Neo’s disturbing loss of his mouth and subsequent invasion by the “bug”. It is interesting that Neo’s character is many times affectively flat, much like Agent Smith. This is not a coincidence as each character helps to define each other. They are in fact symmetrical and complementary just as good and evil or Jesus and the anti-Christ are symmetrical and complementary. Each is, in a way, without purpose and meaning without each other. We also see that Neo is a dichotomy within himself, living two separate lives with almost two different personalities. His choice of taking the red pill after he finally meets Morpheus does not erase the plugged in side of this dichotomy and indeed sets him up for failure before he succeeds by eventually saving Morpheus. The imagery of the mirror becoming unbroken for Neo, covering him, and eventually overwhelming him supports the notion that the two sides will become one in his future. It is only through finding the interdependence between the two-sides of his nature that he is able to master the Matrix. Besides entertaining and challenging the viewer, maybe this is the ultimate message of The Matrix – we all have two sides in our nature and knowledge of this fact and balance between these forces is what we should strive to achieve.

The scenes from Neo’s birth from the Matrix into the “desert of the real” through his visit with the Oracle to Morpheus’ rescue by Neo work together to develop the interdependence that the Matrix and the “real world” have on each other as well as the relationship between knowledge and belief. The imagery and music as Neo “awakens” from the Matrix in a reddish pod overlooking humanity/power generator towers is probably one of the most memorable in all of science fiction film. It is here that the diegetic reality world is revealed to Neo and the narrative reality to the viewer. The power of the mind over the body is clear as Neo is rehabilitated from an atrophied state into a functional member of this new reality. The interesting part of his rehabilitation, however, is that it requires plugging him into a computer construct for training and education. It is also in the construct that Neo learns of nature of the Matrix, which initially is overwhelming to the point of a psychosomatic break. The machines become the tools and life support systems in a new way or maybe just in a different way.

The harshness of the real world aboard the Nebuchadnezzar is also evident by the imagery of ragged clothes, worn out technology, and less than desirable food. In many ways and what will become Cipher’s argument, the Matrix may make for a better life than the real. The epistemic difficulty of certainty and knowledge is fully revealed in these scenes. How do we know with certainty what we know and how can we trust our eyes and other senses to support our sense of truth and actuality? Other questions that are begged are what makes for a good life or what is an acceptable price to pay for freedom? Cipher’s meeting with Agent Smith in the restaurant illustrate that freedom itself may be an illusion and defining a good life may have universal attributes. The classic kung fu scene between Neo and Morpheus also begin to reveal that maybe belief, not knowledge, is more important in both worlds because knowledge itself may be untrustworthy. The cryptic message from the Oracle to Neo allows him the power or freedom to believe in something not as big as saving the world, but in the saving of one man (Morpheus). Trinity and Morpheus’ belief in Neo is both challenged and confirmed while their knowledge is also tenuous. Ultimately, Neo finally believes that, “There is no spoon.” in the lobby gun and kung fu sequence to rescue Morpheus and Trinity later from the helicopter. Through belief, the student becomes the master, another interdependent dichotomy illustrated in the film. Lastly, these scenes begin to develop the dichotomy between fate and choice and its relationship between illusion and reality. As Morpheus says, “There is a difference between knowing the path and walking the path”. This makes the viewer question that notion that if a prophecy can come true, was there ever any choice along the way. The dichotomies in these scenes allow for Neo to become the power that that was prophesized by the Oracle, but challenge both his character and the viewer to wonder if he is simply a tool in a larger scheme, out of his control.
The scenes from Neo’s fight with Agent Smith to the end of the film bring the dichotomies I have discussed so far through imagery and narrative structure to illustrate the complementary and symmetrical nature of interdependent opposites. Neo’s disengagement, confusion, and struggle with the Mr. Anderson side of himself are somewhat maintained in his character but these qualities are brought together with their opposites, which allow him to reach his potential, stop the bullets, and bring about Agent Smith’s demise. Jumping into Agent Smith is symbolic in that there is a part of both characters that is fighting for control and freedom. It also begs the question of how much of Smith is now inside of Neo. If Neo is the ultimate human in the film and Agent Smith is the ultimate machine representation, then by the dichotomous structure that the film takes, both need each other as much they are in conflict. Neo and Agent Smith are visually and narratively the largest representation of Yin and Yang in the film - corporate versus individual, good versus evil, and machine versus human all come together through their interaction. This part of the story will be brought to the forefront more in the second and third Matrix films.

The other dichotomy that is developed in a significant way in these last scenes is between Neo and Trinity. This part of the film develops the love story between them and demonstrates its power over the two characters. Indeed, it was Trinity’s words and kiss, just as in a fairy tale, that was essential to Neo’s resurrection after Agent Smith killed him. This is where the message of hope is revealed – love may sometimes conquer all. Both Neo and Trinity are strong in complementary ways. Both are essential to the plot and storyline in complementary ways. Both find and rescue each other in complementary ways. Both need each other in symmetrical and complementary ways. The notion of male and female, whether that is in physical form or of character, make for the last dichotomy in the film, and not by chance. We cannot venture through this world alone because it can be ambiguous and filled with self-doubt. It is only through the connections we make with other that allows us the hope and ability to make it through each day. This is especially true with those that we consider to be our opposite, our match, or our soul mate because we give as much as we receive in an ultimate state of interdependence. The Matrix presents us with a dystopian future, but it ends on a message of hope, both in the context of the love of one and within the context of society as a whole. Maybe one day all of us, like Neo, we will strike that balance between our own inner dichotomies so that we may also fly.

The relationship that humans hold with machines could arguably be considered fragile. The bone that allowed our ancestors the ability to fend off starvation by killing animals for their meat also held the power for murder of other humans, as Stanley Kubrick illustrated in 2001: A Space Odyssey. The more advanced the tool, the greater potential for its misuse. Computers speed up processes that would be nearly impossible for any one mind alone, but its development also paved the way for new kinds of theft and depravity. Dynamite was invented for use in mining, but history clearly shows how much pain and suffering has come with its development through munitions and bombs. Along with that potential for misuse, the development of technology has increased our dependence on it. We have lost much of the body hair that our ancestors possessed because clothing and other forms of technology no longer made that trait a necessity. How long could we survive without the technology of shelter and electricity? Many of us would survive but it unquestionable that many would perish as a result. It is important to keep in mind, however, that our evolution into sentient creatures may not have been possible without our use of technology. John Harris, author of Enhancing Evolution, argues that human evolution stopped around the mid 1800’s. Technology took enough environmental pressure off of us as a species so that natural selection could no longer act. Instead, he argues that deliberative selection replaced the natural in setting the course for a human future. Therefore, if it is true that we are dependent on technology and have an evolutionary relationship with it (even though it may be misused), it follows that the misuse of technology holds with it the potential to harm us or lead us into our own de-evolution. Technology, like the machines in The Matrix, holds within it dichotomies then for good and evil along with happiness and despair.

The Matrix is, in a way, a commentary on the dichotomy of technology. As much as we depend on technology, the development of technology is dependent on us. Should we ever achieve sentience in the machines that we create, the interdependence between the two would change the way we define responsibility and look at ourselves. In the film, the humans in the “real world” suffer many creature comforts that many would call necessities, but they could not survive without the machines such as the Nebuchadnezzar that serve them. The machine world need humans for power and could not survive without us. We need them as much as they need us. Maybe the conflict between man and machine reached the level that it did because the humans of the future unwittingly built their psyches into the machines and ended up seeing themselves like the repetitive images of mirrors within The Matrix. Many times, we fight as much with our psyches as we do with each other so the future people in the film ended up doing what humans do best – fighting with each other. If we endow a machine with all of the qualities we characterize as human, would we not be fighting ourselves because we have put us into them? What else should we expect of a sentient technology that we make in our image? The message and warning of The Matrix is that technology will no doubt continue to be part of our shared future, but hubris and not remembering that technology has a dark side may become our undoing. Remember that the person that goes higher up a ladder will be able see farther than those below, but the higher one goes up, the harder and more lethal the fall.

To conclude, I will briefly discuss the sublime nature of reality surrounding the story of The Matrix. The epistemological difficulty of reality has been debated since the birth of philosophy. Rene Descartes took the argument to extremes to ultimately argue for the existence of God and provide a method for practicing science. He brought the idea down to one certainty with the cogito, ergo sum (I think, therefore I am). The idea of confusing reality due to being plugged into a machine or in a dream state is not original then to the Wachowski brothers. It is interesting that the development of technology allowed the concept of an ambiguous reality to be conveyed in such a sublime way. In other words, without powerful computers and other technology to generate expansive special effects, The Matrix could not be made, which would not provide us the warning against technology. The image of Neo overlooking the towers of humans dreaming away existence is simultaneously beautiful, terrible, and beyond comprehension – the very epitome of the sublime. Agent Smith also commented on the nature of the Matrix as he is torturing Morpheus, the view from the top offices overlooking the expanse of the Matrix to the artificial horizon. As much as the Matrix represents slavery, it is from a sensory point of view, indistinguishable for anyone except Neo. But what if it was true? What if you, the reader of this paper, did not exist in the way that you think you do? That would be sublime as well because there is just as much beauty, terror, and that which is beyond comprehension in this reality as any other imagined reality so even if you did not live in the desert of the real, I argue that it would not matter. Trinity says to Neo on their way to see the Oracle that the Matrix cannot tell you who you are. Meaning, purpose, and perspective ultimately lie within each of us, regardless of reality. The truth of what our senses tell us is not important in the grand scheme of things. Reality or more precisely the idea of reality provides us the challenges to find the balance within and what we do with the cards we are dealt. All of these ideas may have philosophical implications in regards to truth but at the end of the day, we must function within the world that we live. Maybe then truth, like reality, is also sublime.

Evolution, Technology, and the Sublime: An Analysis of Kubrick's "2001: A Space Odyssey"

Stanley Kubrick’s release of 2001: A Space Odyssey in the spring of 1968 marked a pivotal moment in filmmaking history. Whether referring to the stark realism of space travel in contrast to such films as Destination Moon (1950) or the deafening quiet and lack of dialogue reminiscent of the silent film era, 2001 was and remains to this day unique. Many argue, including co-screenwriter Arthur C. Clarke, that the story is an expansive 4 million year history of human evolution through intelligent, alien means. I will argue that through Kubrick’s use of music and imagery of the sublime, the film is indeed about human evolution, but more precisely, it concerns the evolution of the human relationship with technology. I will show how the film's depiction of technology makes a commentary that it is not simply a tool of human masters to achieve ends otherwise impossible to our physical selves, but that it actually informs and defines identity and the human condition. As such, human evolution and the human condition are dependent upon technology and the ensuing culture that technology allows, blurring the distinction between master and servant. I will describe the visual and musical aspects of the sublime from the pre-film overture through “Jupiter Mission: 18 Months Later” as support. Lastly, I will briefly discuss a possible implication and future of the human relationship with technology.

Kubrick begins to set the tone of 2001 before the MGM logo even appears by playing a three-minute musical overture of Ligeti’s “Atmospheres” against a blank screen. The eerie quality of the music puts the audience in an expectant mood, which, after the brief appearance of the movie logo and before the opening credits, is delivered by a stunning image of the sunrise over the planet Earth. The imagery immediately places the viewer and that of mankind within an intended perspective – humans as a small, almost insignificant entity in an immense, awe-inspiring universe. Richard Strauss’ grand “Also Sprach Zarathustra” is playing forcefully, further adding to the mood and affect of the sublime. The planetary alignment is representative of the sublime in its grandeur, beauty, and vastness but more importantly, it speaks to the meaning of this celestial configuration in human history. The religious importance of lunar and solar eclipses throughout the history of civilization is undeniable. The black screen of the overture coupled with the sunrise over Earth scene could be interpreted to be symbolic of the religious in that many creation stories start with absence of light and nothingness to a sudden birth of light and form. The creation of the ape-man in “The Dawn of Man” is left open to speculation but this opening sequence sets the stage for the birth of man within the universe, not just within a localized region of our planet.

“The Dawn of Man” opens with wide still-shots of what appears to be the African savannah. It is desolate, vast, and immensely quiet except for the sounds of crickets and wind. This imagery, lack of music, and minimal sounds are used by Kubrick to convey the state from which our ancestors lived – sublimely beautiful and terrible. It is clear from the first images of the ape-men that their nature is different from conventional thought of innate human aggressiveness. They are weak, non-threatening, and starving to death. They forage for plants in the dust alongside obviously plump tapirs and are preyed upon by a leopard from a position above the framing of the shot. The viewer sees sun-bleached humanoid bones strewn about also as an indication that even the basics of what we would deem civilization has not yet been established. The point of this prelude to the monolith is that the ape-men are on the brink of extinction and they do not have the intelligence or means to do anything about it. This is exacerbated by the nighttime scene of fright that seems to be evident on the strained faces of all of the ape-men.

Dawn, however, brings something different to both the ape-men and the audience. It begins with light upon their sleeping faces, the waking of one of their number, and the rising music of Ligeti’s “Requiem”. Before we see the monolith, Kubrick creates another expectant mood of the sublime or, arguably, the religious. When the audience finally sees the monolith, it is with the same curiosity and wonder as the ape-men exhibit, and this is deliberate. The monolith is itself an image of the sublime in its perfection and mystery. It further conveys the notion of the sublime and, again arguably, the “birth” of man when the alignment of the Sun and Moon rise over the rectangular form. Whether divine or alien, the monolith seems to give our ancestors the push they need to survive through the discovery of tools. Primitive in rock and bone, our evolution to sentience is dependent on what will later become technology. The ape-men no longer starve replacing the leopard on the top perch of the food chain. What is troublesome and poignant, however, is the immediate association with appears to be the first murder at the waterhole. A double-edged sword perhaps, but certainly an essential dependence on technology and factor in the evolution if our species has been born.

The image of a bone thrown into the air transposed into a satellite, a leap of 4 million years into the future, is at once memorable and purposeful signifying that maybe mankind has become more sophisticated with the use of tools but not with issues related to what is necessary to take another leap in evolution. Johann Strauss’ “Blue Danube” further conveys the idea of sophistication and evolution as well as once again setting a sublime mood associated with the beauty and vastness of space. It is beyond the scope of this essay to explore possible interpretations of Kubrick’s vision of what our next step in our evolution might look like in “Jupiter and Beyond the Infinite”, but I argue it must involve elimination or, at very least, a minimization of the double-edge nature or dark side of the interdependent relationship we hold with technology. In “TMA-1”, the double-edge nature of technology is evident in the fragility and dependence of not only the physical human self throughout Heywood Floyd’s journey to the Moon, but with the interaction with the Soviet scientists and deception imposed by the discovery of the second monolith as well. It is double-edged or a dark side because, just as our ape-men ancestors, we still rely on technology for life yet use it not to unify but to divide. Most notions of an evolutionary next step involve a move to a more ideal, peaceful, and unified humanity. It is possible that this step will only be achieved by a true mastery of technology coupled with a lack of dependence, which I will further explore next.

In “TMA 1”, we start to see a similarity between man and machine. First, the clothing and emotion are sterile just as the space technology of 4 million years of evolution is sterile. Secondly, there is a mundane quality to the action (or lack thereof) of the characters including Heywood Floyd and the flight personnel. The technology may not be mundane, even by today’s standards, but the acceptance of the technology seems to be associated with quiet boredom or the mundane. From eating liquid food from an enclosed tray to using a gravity-free toilet, the dependence on technology does not seem to be on a conscious level of awareness. When the shuttle lands on the Moon and is lowered into the docking bay, the shuttle itself looks like a human head. Further the bay itself is lit with red light, which gives the impression of womb, more symbolism Kubrick uses to bring together the idea of human evolution and technology. The act ends with the approach of Heywood Floyd and company to the second monolith. Again, there is the same reverence, curiosity, and awesome potential meaning associated with Kubrick’s filming of this scene in a similar way as the ape-men scene with the first monolith. Ligeti’s “Requiem” is again playing communicate both the similarity to our ancestors and the sublime nature of the spatio-temporal moment in history. As before, the imagery of the Earth, Moon, and Sun is highlighted with the monolith, which is abruptly disrupted by the radio interference generated presumably from within.

The acceptance of and dependence on technology sets the stage for next act, “Jupiter Mission: 18 Months Later”. Again, boredom and the mundane seem to be what Kubrick is trying to convey about the reality of space flight. The carousel and the introduction of HAL are a constant reminder for the audience of the dependence Bowman and Poole, indeed humanity, have with technology. The cryogenic chambers with seemingly dead bodies within bring this notion clearly into focus. The similarity between man and machine is also developed further through the seemingly robotic apathy of Bowman and Poole along with certain characteristics of HAL. He suffers from hubris and seemingly human emotion but it is interesting that his speech is maintained at a monotone level from the beginning of the scene through his destruction. It is the emphasis of similarity between man and technology that highlights the interdependence of the two. The tool cannot be without man while man cannot be without the tool. Mankind still wins out in this scene because Bowman is able to achieve what HAL could not - murder. It is also seems clear that since HAL is one of the first of his kind that this might not always be the case unless the construct is changed concerning the interaction and relationship between mankind and technology.

The construct Kubrick portrays through imagery and music of the Jupiter Mission along with the relationship between HAL and the crew of Discovery is at the heart of my thesis – the story of human evolution is inextricably linked with the evolution of technology. Further, technology informs us and defines certain aspects of identity through what is culturally possible with technology. In the case of 2001, the similarity between man and machine are almost necessary for the rigors of space travel. At the same time, it is doubtful that the encompassing technology of HAL and Discovery do not shape the identity of Bowman and Poole. The simulacra that HAL represents, is not only evidence of how far evolution has taken us but what we may become. The more we advance technologically, the more risk we take in changing the human condition that is itself shaped by the technology we create through the our advancement. This is not so hard to believe when we look at cell-phone technology and how it has transformed how we communicate and how we relate to each other. What is even more startling is the relatively short time these cultural changes have taken place. Text messaging has streamlined the number of words necessary to relay a message to someone we may never actually physically have contact with. How is this so different from the design of the cell-phone technology we created to allow us to do that in the first place? We have shaped the technology as much as technology has shaped us.

2001: A Space Odyssey, is both a sublimely beautiful and cautionary at the same time. Like the relationship humans have with technology, the tale carries with it throughout the film the thread of interdependence, danger, and identity in exploring one possible explanation for our evolution. The monolith with its coldly perfect form may be part of our past as well as our future in ways that Kubrick never intended. In other words, maybe technology gave birth to us so we could give birth to more technology, but maybe we are the monolith and our destiny is to merge with technology, to become cold and perfect. If we continually strive to advance and perfect technology and technology shapes who we are in relation to the universe, it is logical and inevitable that humans are headed down the same path to advancement and perfection. The question then is: will we reach that destination or, like the creation of HAL, will we create our own demise? One thing is for certain, our relationship with technology will remain tenuous until we can master ourselves and maybe that was the real message that Kubrick was trying to convey. Only with this mastery of ourselves can we shape advancing technology that will in turn shape an ultimate destination, not a demise.

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.