Download Enhancement as a Basic Human Right

Enhancement as
a Basic Human
Right
Professor Julian Savulescu
Tanner Lectures on Human Values 2009
Julian Savulescu
Tanner Lectures on Human Values 2009
Julian Savulescu
Tanner Lectures on Human Values 2009
Julian Savulescu
Tanner Lectures on Human Values 2009
Julian Savulescu
Supermouse
Tanner Lectures on Human Values 2009
Julian Savulescu
Tanner Lectures on Human Values 2009
Julian Savulescu
Tanner Lectures on Human Values 2009
Julian Savulescu
Modafinil
 Modafinil is a eugeroic
 stimulating without causing peripheral effects or
addiction/tolerance/abuse potential of the traditional stimulants
 prescribed to treat narcolepsy, obstructive sleep
apnea/hypopnea and shift work sleep disorder.
 "wakefulness promoting agent" sometimes used for
"excessive daytime sleepiness".
 off-label for ADD/ADHD, depression or fatigue.
Tanner Lectures on Human Values 2009
Julian Savulescu
Modafinil
 “Ninety percent of the prescriptions are for off-label usage”
 Provigil's sales (Cephalon)
2007-- $1 billion
2005-- $500 million
2004-- $289 million
2003-- $200 million
2002-- $150 million
2001-- $75 million
 If this growth were to continue, the market in 2018 would be
$US70 billion!
Estimated 2018 Market: $US 7-10 billion
Tanner Lectures on Human Values 2009
Julian Savulescu
Survey
• In April, 2008, an online survey of 1400
individuals who read the journal Nature
• 1/5 use prescription drugs to improve their
focus, concentration, or memory (Nature)
• methylphenidate (Ritalin) 62%
• modafinil (Provigil) 44%
• beta-blockers 15%
Tanner Lectures on Human Values 2009
Julian Savulescu
Survey
• Other drugs
– Adderall, a drug prescribed for ADHD
containing a mixture of amphetamines.
– Centrophenoxine
– Piracetam
– dextroamphetamine sulfate
– ginkgo
– omega-3 fatty acids.
Tanner Lectures on Human Values 2009
Julian Savulescu
Top 10 Enhancers
Drug
Effect
+
-
Sugar
Stimulates, memory improvement,
self-control improvement
Increased alertness, better
executive function
Legal, very cheap, safe,
well studied
Well studied, apparently
safe and non-addictive
Bad for teeth
Caffeine
Increased alertness
Quasi-addictive
Nicotine
(enhancing
cholinergic drugs)
Choline
Increased alertness, memory
enhancement
Legal, very cheap, safe,
well studied
Legal
Enhance memory in offspring
pregnant rats
Easily accessible, legal,
long-term effects
Amphetamine
Increased alertness, memory
enhancement, reorganisation
Well studied
Dopaminergic drugs
(e.g. Ritalin)
Attention, working memory
Recreational use
Beta blockers
Calming, reduce impact of anxiety
in traumatic memory
Memory enhancement, increased
alertness
Memory enhancement
Experimental, Seizure
risk?
Experimental
Modafinil
Ampakines
CREB-inhibitors
Risk of overexertion?
Biased studies?
Addictive, smoking
unhealthy
Unknown long-term side
effects
Not legal, addictive,
preservation
Bubblers: Piracetam, Ginkgo (improved blood supply?), Alcohol (creativity), hormones (memory enhancement), oxytocin (pair
bonding, trust, empathy), testosterone (spatial abilities?), odorants (mood?), chewing gum (working memory!)
Tanner Lectures on Human Values 2009
Julian Savulescu
Anders Sandberg
Table 1. Top 10 genetic enhancements
The Doogie Mouse. Better memory through overexpression of the
receptor subunit NR2B
Color Vision Mice. Adding human photopigment allows (at least
females) to see new colors.
Methuselah Mice. By reducing growth hormone levels long-lived dwarf
mice can be produced. The current record holder survived 4 years 11
months and 3 weeks, while normal mice have a two year lifespan.
Monogamous VolesNormally polygamous voles can be turned
monogamous (and more social) by changing the vassopressin V1a
receptor.
Regenerating MRL Mice. These mice regenerate holes punched in
their ears as well as some injuries to heart muscle.
Tanner Lectures on Human Values 2009
Julian Savulescu
Schwarzenegger Mice and Belgian Blue Cows. Increased
muscle mass through myostatin knockout. Occurs naturally in
cows and humans.
Hard Working Monkeys. Monkeys tend to slack off until they get
close to a reward they have to work for. If injected with a DNA
construct that blocks the D2 receptor they work at an even rate.
Anticancer Mice. Immune systems that kill cancer cells efficiently
and can even help other mice through blood transfusions.
Antiobesity Mice. Protected from obesity and diabetes by their
lack the enzyme DGAT1. Their fat tissue can even reduce
obesity and glucose buildup in other mice if transplanted.
Marathon Mice. Overexpress PPARδ in their muscles- turn into
slow twitch fibers that work well for long-distance running. More
endurance and increased resistance to obesity.
Tanner Lectures on Human Values 2009
Julian Savulescu
Biology, Psychology and
Disability
Welfarist Definition of Disability
A stable physical or psychological property of subject
S that tends to reduce S’s level of well-being in
circumstances C,
excluding the effect that this condition has on wellbeing that is due to prejudice against S by members
of S’s society
Tanner Lectures on Human Values 2009
Julian Savulescu
Improving well-being/Reduce
Disability
There are 4 ways to promote human wellbeing. Change:
1.Natural environment
2.Social environment
3.Psychology
4.Biology
Tanner Lectures on Human Values 2009
Julian Savulescu
Change Society, Not People
• We should alter social arrangements to promote wellbeing, not biologically alter people
– Improve society not enhance people to increase
well-being
• Related: “disability is socially constructed”
• Response:
– “Biopsychosocial fit”
– We should consider all modifications, and choose the
modification, or combination, which is best
• Skin colour
– Social modification and discrimination
– Biological modification and environmental risk
Tanner Lectures on Human Values 2009
Julian Savulescu
Social Not Biological Enhancement
• Good Reasons to Prefer Social Rather
Than Biological Intervention
– If it is safer
– If it is more likely to be successful
– If justice requires it (based on the limitations of
resources)
– If there are benefits to others or less harm
– If it is identity preserving
– BUT VICE VERSA
Tanner Lectures on Human Values 2009
Julian Savulescu
Social Construction of Disability
– disability is “socially constructed” when there are
good reasons to prefer social intervention than direct
biological or psychological intervention
– Biopsychosocial construction of disability:
• Must consider reasons for and against intervention
at all levels:
– Social
– Psychological
– Biological
» whether the modification will harm others or create or exacerbate
injustice.
Tanner Lectures on Human Values 2009
Julian Savulescu
Tanner Lectures on Human Values 2009
Julian Savulescu
Individual Effects
Cognition important for good life
Environmental toxin models - lead
+1 IQ point = +1.763% income (Schwartz),
+2.094/3.631% (Salkever, m/f)
Annual gain / IQ point US $55-65 billion
0.4-0.5% GDP
Effects on schooling, participation rate, social costs
Weiss 1998: 3 point IQ increase:
Poverty rate
Males in jail
High school dropouts
Parentless children
Welfare recipiency
Out-of-wedlock births
Gottfredson 2002
Tanner Lectures on Human Values 2009
Julian Savulescu
-25%
-25%
-28%
-20%
-18%
-15%
Individual Effects
 correlations between intelligence and income
having a low IQ
- increases the risks of a wide array of social and
economic misfortunes, as well as impairing many
everyday abilities
- makes people vulnerable and reduces the range
of jobs which they can select among, increasing
competition within the same level of IQ.
- require an IQ of about 90 to complete a tax
return; 120 to enter University
Tanner Lectures on Human Values 2009
Julian Savulescu
Cartoon by Nicholson from "The Australian" newspaper:
www.nicholsoncartoons.com.au
Tanner Lectures on Human Values 2009
Julian Savulescu
Tanner Lectures on Human Values 2009
Julian Savulescu
Iodine
• 1 in 3 people in the world don’t get enough
iodine
–
–
–
–
large goiters that swell their necks
dwarfism
cretinism
mental slowness (largest cause)
• Pregnancy
– loss of 10 to 15 IQ points
– loss of more than 1 billion I.Q. points around the world
Tanner Lectures on Human Values 2009
Julian Savulescu
Micronutrients
–
–
–
–
–
iodine
vitamin A
iron
zinc
folic acid
• Copenhagen Consensus (panel of top global
economists)
– micronutrients at the top of the list of foreign aid spending
priorities.
• “Probably no other technology offers as large an
opportunity to improve lives ... at such low cost and in
such a short time.” World Bank
– iodize salt costs only 2 cents to 3 cents per person per year
Tanner Lectures on Human Values 2009
Julian Savulescu
Biology as Disability
Self Control
In the 1960s Walter Mischel conducted impulse
control experiments where 4-year-old children
were left in a room with one marshmallow, after
being told that if they did not eat the marshmallow,
they could later have two.
• Some children would eat it as soon as the researcher left.
• Others would use a variety of strategies to help control their
behaviour and ignore the temptation of the single
marshmallow.
Tanner Lectures on Human Values 2009
Julian Savulescu
Self-Control
– A decade later, they found that those who were better at delaying
gratification had:
• more friends
• better academic performance
• more motivation to succeed.
– Whether the child had grabbed for the marshmallow had a much
stronger bearing on their SAT scores than did their IQ
– Impulse control has also been linked to socioeconomic control
and avoiding conflict with the law.
– Poor impulse control is a disability
Tanner Lectures on Human Values 2009
Julian Savulescu
Socioeconomic Disparities &
Prefrontal Function
•
Kishiyama et al, J Cog Neurosci 2009
– prefrontal-dependent electrophysiological measures of attention
were reduced in LSES compared to high SES (HSES) children in
a pattern similar to that observed in patients with lateral
prefrontal cortex (PFC) damage
– neurophysiological evidence that social inequalities are
associated with alterations in PFC function in LSES children
– number of factors associated with LSES rearing conditions that
may have contributed to these results such as greater levels of
stress and lack of access to cognitively stimulating materials and
experiences
– targeting specific prefrontal processes affected by
socioeconomic disparity could be helpful in developing
intervention programs for LSES children
Tanner Lectures on Human Values 2009
Julian Savulescu
Other Categories
“All Purpose Goods”:
•
•
•
•
•
•
•
Intelligence
Memory
Self- discipline
Foresight
Patience
Sense of humour
Optimism
Tanner Lectures on Human Values 2009
Julian Savulescu
Anti-Social Personality Disorder
• “Antisocial Personality Disorder is five times
more common among first-degree biological
relatives of males with the disorder than among
the general population
– The risk to first-degree biologic relatives of females
with the disorder is nearly ten times that of the
general population….
– Adoption studies show that both genetic and
environmental factors contribute to the risk of this
group of disorders, because parents with Antisocial
Personality Disorder increase the risk of Antisocial
Personality Disorder… in both their adopted and
biologic children.”
Tanner Lectures on Human Values 2009
Julian Savulescu
Empathy and Mirror Neurons
• People with an antisocial personality have a limited range of human
emotions and in particular, lack empathy for the suffering of others
• Empathy, or the capacity to understand and recognise and actions
and emotions of others may be provided by neurons located in the
inferior frontal cortex and the anterior part of the inferior parietal
lobule of the brain
• These nerve cells are active when specific action are such as
picking an object of food and eating are performed
– but what makes them remarkable is that they also fire when another
animal, the experimenter or even a robot perform the same action.
• mirror neuron fires as though the observer were itself performing the
action.
• Mal Horne
Tanner Lectures on Human Values 2009
Julian Savulescu
Empathy and Mirror Neurones
• Evidence is mounting that the region of the
brain known as the insula, provides the
substrate for our understanding of the
emotions of others
– activity of insula neurones underpins the
emotion of disgust.
Tanner Lectures on Human Values 2009
Julian Savulescu
Implications
– mirror system for hand actions and the mirror system
for emotions are more active in people who are
empathic as judged by questionnaires
– in children, the degree of activity of mirror neurons
induced by observations and imitation of facial
expression correlated with empathic concern and
interpersonal competence
– children with the autism spectrum disorders who are
social isolated and have difficulty demonstrating
warmth and interpersonal connectivity also have
disturbed activation of the mirror neurons
Tanner Lectures on Human Values 2009
Julian Savulescu
Criminality

The Genetics of Criminality/Aggression

Twin studies and adoption studies
» E.g. Cloninger & Grottesman (1987): correlation in
criminality 0.74 for MZ twins and 0.47 for DZ twins

MAOA gene polymorphisms

Brunner study in the Netherlands

Mutation on MAOA gene
Tanner Lectures on Human Values 2009
Julian Savulescu
The Neuroscience of
Criminality/ Aggression
 Caspi et al. (2002) investigated the relationship between the
presence of a change in the gene encoding for monoamine oxidase
A (MAOA), a neurotransmitter metabolising enzyme, and tendency
towards antisocial behaviour in a cohort of New Zealand males.
 They found that men who had been mistreated as children and were
positive for the polymorphism conferring low levels of MAOA were
significantly more likely to exhibit antisocial behaviour than those
who had mistreated but lacked the change.
 Both groups were more likely to exhibit antisocial behaviour than
those who were not mistreated.
 This suggests a possible interaction between mistreatment and
MAOA deficiency in causing antisocial behaviour and raises the
possibility that pharmacological manipulation of MAOA may
influence the development of such behaviour.
Tanner Lectures on Human Values 2009
Julian Savulescu
Tanner Lectures on Human Values 2009
Julian Savulescu
Serotonin
• lower than normal levels of CSF 5-HIAA (a serotonin
metabolite) in persons who behave aggressively
• inverse relationship between indicies of serotenergic
function and impulsive aggressive behaviour
• depleting serotonin leads to more aggressive behaviour
SSRI increase co-operation/reduced aggression
Tanner Lectures on Human Values 2009
Julian Savulescu
Oxytocin and Trust
• Oxytocin shown to influence ability to infer
another’s mental state
• Oxytocin increases willingness to trust, but this
does not extend to all risk taking, only social
risks
• decrease of trust after betrayal even after
several betrayals. Reduces fear of social
betrayal
Tanner Lectures on Human Values 2009
Julian Savulescu
Tanner Lectures on Human Values 2009
Julian Savulescu
Lust
Hypothalamus,
sex hormones
Attraction
Corticolimbic,
dopamine
Attachment
Oxytocin,
vasopressin,
CRH?
Tanner Lectures on Human Values 2009
Julian Savulescu
Right to Enhancement
• Significant enhancements for worst off to
bring about sufficient levels of well being
– Derivative right from existing rights
– Intrinsic right to a decent level of well-being:
right to a minimally decent life
Tanner Lectures on Human Values 2009
Julian Savulescu
Derivative Right
• Derived from Basic Human Rights
Tanner Lectures on Human Values 2009
Julian Savulescu
UN Universal Declaration of
Human Rights
Article 3.
Everyone has the right to life, liberty and security of person.
Article 18.
Everyone has the right to freedom of thought, conscience and
religion; this right includes freedom to change his religion or
belief …
Article 19.
Everyone has the right to freedom of opinion and expression; this right
includes freedom to hold opinions without interference and to seek,
receive and impart information and ideas through any media and
regardless of frontiers.
Tanner Lectures on Human Values 2009
Julian Savulescu
UN Declaration of Human Rights
Article 23.
(1) Everyone has the right to work, to free choice of employment, to just and
favourable conditions of work and to protection against unemployment.
Article 25.
(1) Everyone has the right to a standard of living adequate for the health and
well-being of himself and of his family, including food, clothing, housing and
medical care and necessary social services, and the right to security in the event
of unemployment, sickness, disability, widowhood, old age or other lack of
livelihood in circumstances beyond his control.
Article 26.
(1) Everyone has the right to education. Education shall be free, at least in the
elementary and fundamental stages. Elementary education shall be compulsory.
Technical and professional education shall be made generally available and
higher education shall be equally accessible to all on the basis of merit.
(2) Education shall be directed to the full development of the human personality
and to the strengthening of respect for human rights and fundamental freedoms.
It shall promote understanding, tolerance and friendship among all nations,
racial or religious groups, and shall further the activities of the United Nations for
the maintenance of peace.
Tanner Lectures on Human Values 2009
Julian Savulescu
International Covenant on Economic, Social and
Cultural Rights (ICESR)
Article 1
All peoples have the right of self-determination, including the right to determine
their political status and freely pursue their economic, social and cultural
development.
Article 11
Everyone has the right to an adequate standard of living for himself and his family,
including adequate food, clothing and housing...
Article 12
Everyone has the right to the enjoyment of the highest attainable standard of
physical and mental health.
Article 13
Everyone has the right to education. Primary education should be compulsory and
free to all.
Article 15
Everyone has the right to take part in cultural life; enjoy the benefits of scientific
progress.
Tanner Lectures on Human Values 2009
Julian Savulescu
Basic right
• Right to a sufficient level of well-being
Tanner Lectures on Human Values 2009
Julian Savulescu
Biopsychosocial nature of wellbeing/disability
• The basic argument
– Social impediments to a good life
– Biological and psychological impediments to a good
life
– Capabilities and disabilities are partly determined by
psychology and biology
– Capabilities and disabilities are unequally distributed
– Some “normal” people are so disabled by their
biology or psychology that they face significant or
insurmountable obstacles to achieving a good life
– These people have a right to have these obstacles
removed
Tanner Lectures on Human Values 2009
Julian Savulescu
Negative or Positive Right
• Is this a negative or positive right?
– In so far as we have positive rights to anything:
education
– Right to a sufficient level of well-being – right to
enhancements to achieve this
• Not a right any enhancement but a right to significant
enhancements
– Political as well as moral right
Tanner Lectures on Human Values 2009
Julian Savulescu
Positive Right
• Basic right, at least for the worst off
• Stronger claim:
– those above the level of sufficient well being
still have claim on significant enhancement
• “Modafenil for worst off”” or “Modafenil for
all”?
Tanner Lectures on Human Values 2009
Julian Savulescu
First Argument for Enhancement
• 1. Choosing not to enhance is wrong
– Dietary neglect results in a child with an IQ of 110
dropping to 85 (“normal”)
• Wrong
– Failure to institute some diet means a child with
an IQ of 85 fails to achieve an IQ of 110
• Equally wrong
– Substitute biological intervention for diet
Tanner Lectures on Human Values 2009
Julian Savulescu
Second Argument: Consistency
• We accept environmental interventions
– Education
– Computing and information technology
Tanner Lectures on Human Values 2009
Julian Savulescu
Consistency
• There is no difference between environmental and
biological intervention
– Rats given stimulating environment vs prozac
– Environmental manipulations affect biology – rats who
were mothered showed genetic changes (heritable
changes in methylation)
Tanner Lectures on Human Values 2009
Julian Savulescu
Consistency
– Environmental manipulations affect biology
• Maternal care and stress
– hippocampal development
– cognitive, psychological and immune deficits later in life
– “Early experience can actually modify protein-DNA
interactions that regulate gene expression,” (changes in
methylation id DNA) Michael Meaney
Tanner Lectures on Human Values 2009
Julian Savulescu
Parity
• Education
• Internal cognitive enhancement
– altering biology
• External cognitive enhancement
– computers, internet
Tanner Lectures on Human Values 2009
Julian Savulescu
Third Argument: No difference to
disease
• If we accept the right to treatment and
prevention of disease, we should accept
right to enhancement
• Goodness of health is what drives a moral
obligation to treat or prevent disease
Tanner Lectures on Human Values 2009
Julian Savulescu
No difference to disease
• Health is not what matters – health enables us to
live; disease prevents us from doing what we
want and what is good
– But how well our lives goes
– People trade health for well-being when engage in
risky activities
• Well-being drives a moral obligation to enhance
• Disability not disease matters
• Psychology and biology can be disability
Tanner Lectures on Human Values 2009
Julian Savulescu
Enforceable?
• Enhancement is not just a good thing but a
basic human right – pressure, provision
• Just like education
– Significant improvements to those falling
below the threshold should be treated like
basic education
• Raising IQ from 85 to 100
Tanner Lectures on Human Values 2009
Julian Savulescu
Too Expensive?
• US Military
"The world contains approximately 4.2 billion
people over the age of twenty. Even a small
enhancement of cognitive capacity in these
individuals would probably have an impact on the
world economy rivaling that of the internet."
• 3 IQ points:
– $150 billion per year to the US economy
– 1.5% increase in GDP
Tanner Lectures on Human Values 2009
Julian Savulescu
Basic Human Right to
Enhancement
• There is a basic and derivative right to human
enhancements which significantly increase well-being
– At least in those whose level of well-being falls below
a sufficient level
– This right is on a par with the right to education,
health care and life
– The most basic human interest is in a good life
• Our own biology and psychology may be an obstacle to a
minimally decent life
Tanner Lectures on Human Values 2009
Julian Savulescu