Book Review

Enhancing Human Traits: Ethical and social implications

N Engl J Med 1999; 341:2101-2102December 30, 1999

Article

Enhancing Human Traits: Ethical and social implications
(Hastings Center Studies in Ethics.) Edited by Erik Parens. 258 pp. Washington, D.C., Georgetown University Press, 1998. $49.95. ISBN: 0-87840-703-0

Enhancing Human Traits consists of 12 articles derived from a series of discussions at the Hastings Center and an essay by the editor reviewing these 12 articles. Most of the contributors are philosophers, with a smattering of theologians and lawyers, and many are associated with university departments of biomedical ethics. As one would expect from such writers, the articles consist of thoughtful, albeit sometimes fanciful, explorations of physical and psychological enhancements, from cosmetic surgery to the use of methylphenidate (Ritalin) in children with attention-deficit disorder. Appropriately, the majority of the writers find no fault with enhancement for the purpose of providing relief from serious disability. They worry a great deal, however, about enhancement for conformity to the desires or pressures of society or parents. For example, the use of growth hormone in a child deficient in this hormone is generally lauded, whereas its use to increase stature in a short child without this deficiency so that he or she will grow closer to average height is generally frowned on. Like the rest of us, these eminent philosophers are not able to define the boundary between enhancement as a benefit and enhancement as a giving in to the somewhat vain desire to conform to current social norms. Many of the writers do try to establish principles by which these distinctions can be made, but in general, they do not succeed. An important problem, recognized by some of the authors, is the definition of “normal.” Since we now know that no two individuals (except identical twins or clones) are the same, it is my view that no one is “normal.” What enhancement seeks to achieve for a particular trait is a level that is either “average” (e.g., for height) or “above average” (e.g., for intelligence).

After reading this book, I was still unsatisfied with the solutions offered to this dilemma, although I now have a better understanding of why I am not satisfied. Like some of the authors, I am increasingly concerned about the burgeoning availability of surgical, pharmacologic, and genetic techniques that allow individuals to seek enhancements for themselves and families to seek them for their children. Some of these enhancements confound benefit with the vain desire to conform to a degree that is not acceptable either to the authors or, I suspect, to most physicians.

Enhancing Human Traits can be recommended to the increasing number of physicians who have a strong commitment to biomedical ethics. If one is not prepared to read so many complex philosophical treatises, I recommend reading the opening essay by the editor, which is a thoughtful summary of most of the arguments in the book.

Kurt Hirschhorn, M.D.
Mount Sinai School of Medicine, New York, NY 10029