Sandel’s location in the enhancement debate
It’s been almost a decade now since philosopher and Harvard professor Michael Sandel first published his critique of the genetic enhancement of human capabilities: The Case against Perfection: Ethics in the Age of Genetic Engineering. Another translation has again been published this year, which almost rounds out the one dozen foreign versions of this little book.
Sandel’s book presents many relevant moral cases located at the intersection of ethics, the economy, and the healthcare sector, such as increasing rates of Ritalin use or endocrinological methods of height enhancement.
In the days of CRISPR/Cas9, the epilogue of the book may almost seem a bit quaint in arguing for the use of embryonic stem cells for research purposes (a point which book reviews have often overlooked in labelling Sandel a conservative). The Obama administration relaxed the rules on this issue in 2009, and major breakthroughs have been made in creating stem cells out of regular somatic cells, iPS cells, rather than from embryos. The next big issue in bioethics seems to be the modification of the human germ line.
Nonetheless, there have been no such developments rendering the question of genetic enhancements out of date. On the contrary: genome editing has made huge strides on a technical level. As CRISPR has now been used for the first time to treat humans medically, discussions about genetic enhancement for non-therapeutic reasons seem less utopian (or dystopian, if you like). And we still require greater clarity about moral and immoral modifications of the human genome.
Among the issues under dispute, so-called genetic enhancements arouse great interest among philosophers – as well as among biotech venture capital firms . Even among those who agree that enhancing healthy humans is a good idea, there is little agreement about limits, with some urging us to keep humans human, while recommending a “liberal eugenics” (Nicholas Agar), while others are not worried about species boundaries, but argue strongly against an artificial enhancement of human morality (John Harris). Yet others argue for enhancement without exception (Julian Savulescu and Ingmar Persson). Since those arguing for far-reaching interventions into the human genome reveal such diversity, it is probably helpful to give another hearing to a fundamentally sceptical voice. Why is it, asks Michael Sandel, that we should resist the temptation to “enhance”?
Life as a gift
One point that makes Sandel wary of genetic enhancements beyond therapy is that it creates the temptation for parents to make their child in someone else’s image. He inveighs more generally against cloning:
“What exactly is wrong with creating a child who is a genetic twin of his or her parent, or of an older sibling who has tragically died, or, for that matter, of an admired scientist, sports star, or celebrity?” (6)
Along similar lines, by enhancing a child genetically, parents could make it be more, say, like the genius uncle with whom they have never been able to keep up. This would foreclose the “open future” to which every child has a right (7).
Sandel does not, however, understand this right of the child in the sense of a liberal rights conception. The first rule of morality is not, according to Sandel, that everyone is autonomous with respect to their own person. To some extent, autonomy is an illusion, Sandel submits, for nobody decides about their own genetic makeup and the circumstances of their birth. Further, if autonomy is the ethical yardstick, it would be fine for anyone to seek genetic enhancements for themselves later – and “our moral hesitation” suggests that this is not right either (8).
The right of the child, by contrast, as well as anyone’s right, emphatically includes the right to certain boundaries and limits, to an element of resistance in one’s life. It is a crucial, yet underappreciated aspect that, although I am free, life is not simply at my disposal.
This vision of life needs to be guarded, in Sandel’s view, against two extreme approaches to life. On the one hand, he wishes to protect the relative openness of life against the encroachment of human attempts at mastery. On the other, the intervention of human ingenuity has its legitimate place in health care. Medicine protects the relative openness of life against curtailment by disease.
The encroachment on life by disease is not a systemic, inherent feature of life. At the point where it seems to become so, in old age, indeed we reach the end of life. Life itself, by contrast, is the opportunity for flourishing. A condition of this is health, but to be healthy is not yet enough to flourish. For this reason, Sandel argues for a distinction between health care and enhancement. Health is “a bounded good”, involving only a limited activity. By contrast, to turn health into an open-ended, maximising pursuit with no particular goal in sight is itself a pathology: “No one aspires to be a virtuoso at health (except, perhaps, a hypochondriac)” (48).
The philosopher Tim Lewens, in a critical review article, overlooks this point when he reduces Sandel’s distinction between curing and enhancing merely to “a slippery distinction between interventions that ‘override’ natural capacities [i.e., enhancements] and those that permit natural capacities to ‘flourish’ [i.e., therapy]”.  Lewens then argues that therapy can also be said to “override” natural capacities, which, in the case of chronic illness, were stunted before. This distinction is indeed slippery, but it’s not all there is to Sandel’s distinction between health care and enhancement. In contrast to enhancement, therapy is not an “ever-escalating” effort (49).
While health care guards life against natural encroachment, life must also be protected from human encroachment. This is especially the case with genetic enhancement. But an encroachment is already taking place when parents micromanage their children. Venus and Serena Williams’ father planned their tennis career even before they were born. This is “hyperparenting” (52), or “procrustean parenting”, as Lewens calls it. Thus, the influence of parents on their children is no justification for genetic enhancement – as if we might achieve with genetic means what they achieve with parenting and educational methods. For education very easily blends into manipulation. Instead, life is a “gift”, and this comes to the fore most acutely in parenthood and birth. This “gift” involves a “mystery” that cannot and should not be mastered.
“The problem lies in the hubris of the designing parents, in their drive to master the mystery of birth. Even if this disposition does not make parents tyrants to their children, it disfigures the relation between parent and child, and deprives the parent of the humility and enlarged human sympathies that an openness to the unbidden can cultivate.” (46)
An openness to the unbidden, an appreciation for the mystery of life, and a refusal to compete with this elusive factor in an act of mastery: these are fundamental features in Sandel’s understanding of life that are at issue in the question of genetic enhancement. For Sandel, the notion of the gift and the boundaries it establishes is tied up with religious notions:
“To believe that our talents and powers are wholly our own doing is to misunderstand our place in creation, to confuse our role with God’s” (85).
Even non-religious people can and do acknowledge the free, unmerited nature of life as a gift, and Sandel does not consider his case against enhancement “inescapably religious” (93). In speaking of an athlete’s or a musician’s “gift”, we acknowledge that there is a fundamentally contingent factor in play. This factor influences not just this or that event but undergirds life fundamentally, especially in its most profound expressions.
A side-note: pre-normative foundations of human value
Sandel spends little time arguing why we should respect the gift-like nature of life. Why is it that this crucial description that should take centre stage? For Sandel, the gift-like character of life is only worth preserving if there is indeed something special about human excellence and human values. What is so special about human excellence is that a remarkable performance gives us a rare glimpse into the deeper reaches of that mystery precisely while preserving its character of mystery.
By contrast, it is possible that our common way of thinking of an athlete’s talent and a musician’s “gift”, with which Sandel illustrates his point, is merely a selection effect, an optical illusion due to unthinking habit. The particular capacities of athletes and musicians might be just coincidence, just as many other people have unusual qualities that seem unremarkable or non-sensical simply because our culture doesn’t highlight them in the way it does music and sports. If this were the case, then mystery and gift would seem much less plausible ways of thinking about life.
This is ultimately what Tim Lewens suggests when he misunderstands Sandel’s notion of gift. He supposes that the contingency to which Sandel attaches such importance consists in any feature of human life in general: “for Sandel, life is a gift in the philosopher’s sense of ‘the given’. Life is something that a person finds himself with”.  Lewens’ positivistic interpretation of Sandel’s “gift” pertains to the trivial and the adverse just as much as it does to the meaningful and the fortunate. For Lewens, the gift is, strangely enough, nothing gratifying or pleasant. For Sandel, by contrast, the gift-like character of human life comes to the fore especially in particular acts of human striving, excellence, and value.
But then why do we carve out value in this way, while we might do it in entirely different ways? Why should we assume that with the mystery of life in the arts and sports, and of course in parenting a child, something specific is disclosed to us, while we don’t assume that anything specific, meaningful is disclosed in the other mysteries involved in random natural constellations – as ancient civilizations did, for example, when they tried to divine the future from looking at an animal’s entrails? Why does Sandel draw attention to the gift-like character of human excellence, rather than remarking simply on the contingency of all aspects of life, even the contingency involved in irrelevant things, as when for example, on average someone is more likely to put on the left shoe before the right one on dates with an odd number? Why is human excellence and its gift-like nature remarkable at all?
In a slightly more technical passage, Sandel does argue that even philosophers in the liberal tradition – the tradition that highlights autonomy, among other things – have typically affirmed a state of affairs in which human life is simply embedded, whether we like it or not. They think of an ontology that undergirds human value. Human value fits a mould within a larger whole, rather than being just a quirk in a chaotic universe that has no rhyme or reason to it. This would make human value more ‘objective’.
“It is worth noting, however, that liberal thinkers from Locke to Kant to Habermas accept the idea that freedom depends on an origin or standpoint that exceeds our control. For Locke, our life and liberty, being inalienable rights, are not ours to give away (through suicide or selling ourselves into slavery). For Kant, though we are the authors of the moral law, we are not at liberty to exploit ourselves or to treat ourselves as objects any more than we may do so to other persons. And for Habermas … our freedom as equal moral beings depends on having an origin beyond human manipulation or control” (94).
What do we make of this? Is Sandel’s argument for the mystery of life just what is needed in an age of ever greater technical possibilities and a growing risk of overreaching technology? If so, is there not something ironic about the fact that a Harvard professor publishes an eloquent case against mastery? Further, is there perhaps a worrisome inegalitarian streak in Sandel’s thought, as when he contrasts artificially forced mastery – such as genetically enhanced athletic prowess – with natural talent?
“excellence consists at least partly in the display of natural talents and gifts that are no doing of the athlete who possesses them. This is an uncomfortable fact for democratic societies.” (28)
Should we perhaps explore the aspect of liberal autonomy further, with its high regard of equality? We will tackle such questions of evaluation in a later post.
For example, a report on ongoing research that explores the use of genome editing in the human germ line writes,
“The field of reproductive medicine has a well-established track record for pushing headlong into the clinic with technological innovations. Infertility is also big business. If [Kyle] Orwig [a stem cell expert at the University of Pittsburgh] were to demonstrate in animals that a simple genetic fix is possible, it would be a tempting procedure for the tens of thousands of men who cannot make their own sperm, for whom options are currently limited, as well as for the in vitro fertilization (IVF) industry, which did an estimated $2 billion in business last year in the U.S. (and perhaps 10 times that amount worldwide).”
Stephen S. Hall, “The Red Line“, Scientific American 315 (Sept. 2016), 54-61. doi:10.1038/scientificamerican0916-54
Tim Lewens, “Enhancement and human nature: the case of Sandel”, The Journal of Medical Ethics 35 (2009): 354-356, 355.