Posthuman dignity

Bostrom (Reference Bostrom2005) is one thinker who has argued that enhancements can be compatible with human dignity. He uses the concept of “posthuman dignity” to make the point. As other transhumanists have also maintained, we can change our biology and natures in accordance with human values, and these changes can and should be interpreted as expressions of valuable human interests; overcoming unnecessary suffering and enhancing certain abilities, for example, are ways people can realize their human interests and equal status (Bostrom, Reference Bostrom2005; Porter, Reference Porter2017). Bostrom challenges us to consider how our current phenotypes and ways of living are already almost completely different than the first humans; it seems apparent that these first humans would view us in the present day as “posthumans.” Yet, he contends that the changes we have gone through have not dehumanized us (Bostrom, Reference Bostrom2005).

Perhaps those who will be dehumanized are not the ones who have had SERTS used on them but rather those whose parents chose not to or could not afford to (leading to something like “unequal rights”) (Buchanan, Reference Buchanan2009). But if being dehumanized will mean different things to different people, how will we know whether SERTS violate human dignity, and that they, therefore, ought to be prohibited? I argue that SERTS may only violate the dignity of humans if they necessarily unjustifiably harm or demean other individuals. The moral principle of equality captures this point nicely and shows us a way forward. The basic moral principle of equality (moral equality) holds that all moral patients (e.g., all sentient beings) ought to have their interests considered equally; “each to count for one and none for more than one,” as expressed in Bentham’s famous dictum. The way we action this principle and respect persons’ moral equality is by considering their interests in our decisions as a constraint on what decisions we permit ourselves to reach.Footnote ⁸ From the point of view of the state, the process of considering interests entails that different reasonable conceptions of human dignity are balanced against each other. Moral equality, as a normative ideal prescribing how people should be treated, does not inherently favor a genetic essentialist view. However, it respects the perspectives of those who adhere to that view, ensuring they are not harmed or demeaned by the differing views of others. In the remainder of this paper, I will argue that the dignity of humans/moral equality need not be violated by the use of SERTS because there may be social measures that could be employed to protect the dignity of persons, meaning that SERTS cannot be prohibited on the basis that they necessarily violate the moral worth of humans.

Reproductive autonomy and impairments

The International Bioethics Committee raises several important points about the impact that genetic technologies may have on societal values and persons’ equal status (2015, p. 9). One such point is the concern that genetic enhancements, along with existing technologies like preimplantation genetic testing and polygenic scoring used in reproduction “weaken the idea that the differences among humans, regardless of the measure of their endowment, are exactly what the recognition of their equality presupposes and therefore protects” (2015, p. 27). For example, Hrouda (Reference Hrouda2016) points out that, according to critics, it is difficult to see how a technology that comes with the possibility of creating new forms of discrimination and stigmatization could ever be shown to respect the dignity of humans. The IBC expresses concern about a societal shift towards a form of eugenics, driven by individual reproductive choices that, when considered collectively, may have serious impacts on persons with disabilities (2015). They state, “the adding up of a lot of individual choices in non-invasive prenatal testing to the ‘acceptability’ of aborting or selecting certain kinds of embryos or foetuses brings forward a societal phenomenon, which resembles a kind of eugenics in the search for a ‘perfect child’” (2015, p. 23). Moreover, the IBC says that if genetic screening for the prevention of disability is primarily motivated by cost reduction for care and accommodation, it sends the message that such persons are not welcome in society (2015, p. 22). An example of this phenomenon is observed in the medicalization of deafness, where members of Deaf culture generally feel as though their lives are incorrectly perceived as undesirable by the rest of society (Chadwick & Levitt, Reference Chadwick and Levitt1998; Sparrow, Reference Sparrow2011; Wallis, Reference Wallis2019).

It may be criticized at this point that the IBC makes a logical mistake in equating parental intentions to ensure the health of their offspring with an unethical search for the perfect child. At first glance, we can see a distinction between “seeking health” and “seeking perfection.” Seeking health in the context of genetic technologies generally refers to the absence/treatment of known genetic disorders, and “seeking perfection” entails going beyond health by, for example, introducing novel traits or enhancing those traits that are typically considered unrelated to health such as height or super-intelligence. However, it is also true that as society and genetic technologies continue to change, the values of different “traits” may similarly change, blurring the boundary between health and perfection. For example, in a society where intensity and competition dominate, being lazy may be seen as a problem with the individual.Footnote ⁹ The IBC is likely being cautious regarding these possibilities as socially mediated traits have been interpreted very badly in the past (e.g., state eugenics). So, even though it may not make sense to equate health and perfection on paper, it is the case that, in the context of reality, politics and human biases can lead to what logic would not lead to.Footnote ¹⁰ And these outcomes may include harms that justify being more cautious in the present. In other words, the IBC’s role cannot assume the full rationality of humans and understand that what non-ideal (real) society sees as normal, however illogical it may be, can negatively influence the world. I take this possibility seriously as well, but I will not argue that the only or the best way to prevent such harm from arising is always through prohibiting SERTS. There may be a range of possibilities, for example, where the reproductive choice ought to be respected, and where the potential harm or the expression of a demeaning message is prevented by improving general social protections.

MacKellar (Reference MacKellar2021) is one thinker who has strongly objected to the general societal attitudes toward disabilities and the negative expressions arising from trait selection. He says that “choosing between possible future persons is an outward expression (revelation) of a discriminatory value system of a person or a whole society already in the real existing world” (MacKellar, Reference MacKellar2021, Reference MacKellarp. 24). Such a value system is said to accept an inequality of worth (dignity), implying that already living persons with disabilities should not have existed (MacKellar, Reference MacKellar2021). So, just like the IBC, MacKellar also believes that reprogenetic trait selection would be incompatible with the belief that all humans, despite their differences, are of equal worth and value, which is the “very basis of a civilized and genuinely inclusive society…” (2021, p. 25). He argues that society should uphold the belief that individuals with heritable biological impairments or differences are inherently equal to others by prohibiting trait selection and that the focus of the state ought to be on the provision of social resources to prospective parents so they do not come to view the process of caring for a “different” child as a burden (MacKellar, Reference MacKellar2021).

Still, in recognition of the importance of reproductive liberties, the IBC holds that it is important to develop “a framework that on the one hand acknowledges the right of an individual to make autonomous choices, and on the other hand ensures what is enshrined in articles 6 and 2 of the UDHGHR: that no one shall be subjected to discrimination based on genetic characteristics and that individuals should be respected in their uniqueness and diversity” (2015, p. 23). But if MacKellar is right that a civilized, pro-equality, inclusive society would not provide ability-selective reproductive procedures,Footnote ¹¹ does this mean that parental choices arising from their values or preferences have no weight here? A revision of MacKellar’s position is warranted to account for this gap.

John Harris (Reference Harris2001) accepts that all persons are equal to one another; that no disability implies lesser moral or political status; that persons with disabilities must be free from discrimination of any kind; and that individuals and societies must take all steps that are necessary to ensure that this free and equal status can be enjoyed with equal facility by all persons. Yet, he contends that “choosing to repair damage or dysfunction or to enhance function does not imply that the previous state is intolerable or that the person in that state is of lesser value or indicates that the individual in that state has a life that is not worthwhile or not thoroughly worth living” (Harris, Reference Harris2001, Reference Harrisp. 383). So, Harris and MacKellar (as well as bioliberals and disability rights advocates, in general) are using the same premises, 20 years apart, to reach opposing conclusions.

Harris is convincing in one particular regard. He states, “If I say … that I would prefer not to lose … a hand, that it would be better for me if I did not lose one of my hands, that I would be better off with both hands and so on, I am not committing myself to the view that if I did in fact lose a hand that I would therefore, automatically become less morally important, less valuable in what I call the “existential sense,” more dispensable or disposable than you.” (2001, p. 386). This seems right. His weaker point, however, is regarding the view that an impairment is necessarily a harm. To Harris, that very point is actually the strength of his position as he believes that defining disability as a “harmed condition” relative to alternative possibilities is better than defining it in relation to what is typical or normal for such beings (Harris, Reference Harris2001, Reference Harris2007). He holds this view because he thinks that one can be harmed by a trait even if that trait is species-typical: “The deaf are unable to hear whatever their social environment and are therefore disabled relative to those who can hear (whether or not hearing is species typical) and not relative to their environment.” (Harris, Reference Harris2001, Reference Harrisp. 383). It is ethical, Harris says, “…to prevent the births of people with disabilities because it is right to prevent needless harm” (2001, p. 387).

But an important question arises: if individuals with an impairment do not view this impairment as a harm (and perhaps identify with that way of being) and have a community of people like them, is it not wrong to publicly view (and perhaps enforce on them genetic selection policies that imply that) their impairment is a harm? Yet, the opposite may also be true. It can be said that perhaps the prospective parents do not view the impairment as a harm, but the potential, future person may. Is it not similarly paternalistic/wrong for parents to impose this impairment on a to-be individual (or to bring about a state of affairs where one starts off with a disadvantage when another could have started off without such a disadvantage)?

An objective account of unjustified harm is necessary to advance the debate on ability selection. If Harris can show that an impairment would still be a harm no matter what kind of reasonable changes are made in society, then the stronger argument would be on the side of prohibiting the selection of a child with an impairment, who would by definition start off with an unnecessary disadvantage. But if MacKellar can show that an impairment is only a harm in an ableist society, then it remains open to what parents should do. But when it comes to public policy, can you imagine the state prohibiting a socially disadvantaged group from making children, citing as their reason that being a part of this group in this society would harm the child due to the unjustified discrimination present in that society? Similarly, it would be equally wrong to have a policy that says only children who can be a part of that group can be brought to life, citing as the reason that otherwise the choice would express a negative message about members of that group, or that this is what is needed as a matter of justice. So, I argue that laws on ability selection should be on the side of allowing each to make their own reproductive choice regarding abilities that do not involve a shortened lifespan or pain. The decision to select a hearing child over a deaf child is not inherently wrong, even if it might be perceived by some as ableist (implying a demeaning message). This stance is not predicated on the belief that the ability to hear is the only “natural” way to be, but rather accepts that deafness can also be conceived as being natural. Instead, the justification lies in the principle of (reproductive) autonomy, which allows individuals to have personal preferences in reproduction (Lemoine & Ravitsky, Reference Lemoine, Ravitsky, Cohen, Shachar, Silvers and Stein2020). I argue that these preferences should be acceptable as long as they are not rooted in demeaning beliefs about others and do not result in harm such as a reduced lifespan or pain.

What constitutes a “demeaning” message is contested, so it is crucial to define what I mean. A choice or preference is demeaning if it is based on the belief that the alternative choice is intrinsically inferior or otherwise “bad” (e.g., racism, sexism). However, it becomes important to recognize that not all decisions that lead to the same outcome are driven by the same intent. A preference may simply stem from a personal liking for something without implying that the alternative option is negative or undesirable. Certainly, people ought to be wary of what their actions may mean within a historical context (Dean, Reference Dean, Hill and Cureton2018; Hellman, Reference Hellman2003; Kaposy, Reference Kaposy2023; Narayan, Reference Narayan1988). But, if the choice need not be demeaning; and it is not the individual’s intent to demean; and the individual is not publicly advocating that the choice is what everyone ought to do, it would be incorrect to say that there is a wrong present.

Consider the following. Scully says, “I may want to use PGD [pre-implantation genetic diagnosis] to have an audiologically deaf child, but not want it enough to undergo medical intervention … It would be quite possible for a Deaf couple to hold a very strong preference for a deaf child but at the same time feel it would be wrong to do anything about it, if they believe that their preference is outweighed by their parental obligation to accept a child unconditionally.” (Scully, Reference Scully, Reynolds and Wieseler2022, Reference Scully, Reynolds and Wieselerp. 119). Or, she says, one may have a preference for a particular trait, yet decide not to engage in selecting for it (or against the opposite) because they perceive it to be necessarily unjustifiably discriminatory (racist, sexist, etc.) (Scully, Reference Scully, Reynolds and Wieseler2022). Yet, others may still believe they could love the resulting child all the same and not consider it wrong, thereby both meeting a preference and fulfilling their parental obligations.

Hellman’s account of wrongful discrimination is relevant here. She argues that an action within an unjust context is wrong if it amplifies the effects of prior wrongdoing; and takes the prior injustice or merely its effect as a reason for action (Hellman, Reference Hellman, Collins and Khaitan2018, Reference Hellman, Collins and Khaitanp. 113). Hence, it seems to Hellman that it is not enough for an agent to not intend a wrong; they must also consider how their action may objectively contribute to an existing wrong in society. This means that the individual must perceive their planned action as though it were any other person conducting it. Could this action be done by a person who intends to discriminate? If yes, Hellman would say, they ought to avoid it. But this expectation ignores the importance of the individual, and their intent. As Buchanan has put it in another context: “To attribute to a person’s moral account everything that he or she does not prevent but could prevent seems incompatible with recognizing and respecting the fact that we each have one life to live, that we are each separate persons who are entitled to give our own projects a certain preference, and who accordingly require a substantial moral space within which to pursue our own conceptions of the good” (1995, p. 113).

So, expecting individuals to avoid actions that could be interpreted as demeaning by others or by society as a whole can be overly restrictive and tyrannical. What can be reasonably expected, however, is for parents to not intend an injustice, which, in this case, is measured via their reason for action. If the intent is merely to meet a reasonable preference in itself (i.e., a preference that would not be problematic in a just world), it should be an acceptable choice at first glance. While it can be criticized that the influence of an unjust society on the seeming “preference” of prospective parents is a valid concern (Scully, Reference Scully, Reynolds and Wieseler2022), this would not justify the claim that the person’s choice is invalid as a matter of sacrificed autonomy or that we ought to compel or otherwise direct them to choose or avoid choosing. Rather, what it does justify is that this societal bias against disability, for example, ought to be corrected. One way to do this is for genetic counselors to remain unbiased; counselors should avoid conveying the notion that deafness is inherently undesirable so that prospective parents can make an informed decision.

What is vital to emphasize here is that while choosing a hearing child is an acceptable choice, it does not mean that this is the only acceptable choice available to parents. The argument allows for the possibility of multiple acceptable choices in reproductive decisions. So, using genetic technology such as PGD to select a deaf embryo, in scenarios offering a choice between a deaf or hearing embryo, can also be considered a respectable decision, despite potential perceptions of the choice as being harmful.Footnote ¹² As mentioned above, these reproductive preferences are acceptable as long as they are not based on demeaning beliefs about others and do not lead to real-life harms such as a reduced lifespan or pain. This time, the main concern is that of “harm” since deafness is generally viewed as a harmed condition (Harris, Reference Harris2007) or an atypical functioning, implying there is a problem with the biology of the individual (Buchanan et al., Reference Buchanan, Brock, Daniels and Wikler2000). The concept of “unjustified harm” often includes societal conditions that could adversely impact a child’s life. For example, a child, due to the inability to hear, may face serious barriers when looking for a job (Chadwick & Levitt, Reference Chadwick and Levitt1998; Ha’am, Reference Ha’am2017). However, parents should have the discretion to assess and interpret potential negative aspects of the real world, especially in contexts where societal accommodations for disabilities are expected (i.e., accommodations that would exist in a just world) (Ha’am, Reference Ha’am2017; Robinson, Reference Robinson2023). It is problematic to assume atypical functioning as an unjustified harm simply based on what is “natural” or “normal,” for if societal changes can mitigate the impact of an impairment, and the impairment does not inherently involve a reduced lifespan or the infliction of pain upon the child, it should not be categorized as an unjustified harm warranting prohibition. Ha’am (Reference Ha’am2017) argues that

On Martha’s Vineyard (island in Dukes County, Massachusetts) in the 18th and 19th centuries, a high incidence of inherited deafness led to a community where both deaf and hearing residents used sign language, effectively eliminating communication barriers and integrating deaf individuals into social and economic life.

Or consider what Dean says about how society can accommodate some neurodiverse individuals as a way to address the problems they may face in daily life:

The state, rather than limiting the reproductive choice (or more generally, trying to change “differences”) should aim to improve social conditions for all, including those with disabilities. Here, too, genetic counselors have a responsibility; this time, to inform parents about the realities and challenges their child may face. Yet, it is ultimately the parents who should have the final say. Such a position acknowledges the plurality of acceptable choices within the scope of reproductive liberty, affirming the autonomy of persons to make decisions that align with their reasonable values and beliefs.

A further point of clarification is warranted on harm and autonomy. It may be said that there is a connection between being able to hear and an autonomy that may be greater than in the case of someone not able to hear. Even though that may end up being true, I argue that this does not follow from mere inability to hear. Primarily, there are many cases where Deaf persons have developed/gained other skills or benefits because of their deafness (e.g., enhanced visual and vibrational qualia experiences) and who lead fulfilling lives within culturally and linguistically Deaf communities and within broader society with or without accommodations (Wallis, Reference Wallis2019). Still, even if we were to deem their autonomy as lesser, I argue that it is generally above the lower limit we should accept (which is pain or a shortened life). The correct stance—as from the point of view of the state—must be to ensure sufficient autonomy, rather than to try to maximize it. Here, “sufficient autonomy” could be defined as having the capability to make decisions, pursue plans, and interact with the world in meaningful ways. This can exist in both deaf and hearing individuals.

It appears counterintuitive to say that selecting/creating a deaf embryo could be an acceptable decision when there is an option to select a hearing embryo, as it seems that this would be a harm—deliberately confining their life experiences and opportunities compared to a hearing individual—that can be avoided. Even though the autonomy linked with hearing might lead to easier navigation (lesser harm) in a world designed for hearing individuals, what I am primarily challenging is the idea that society should not also design a world that is also for deaf individuals. To decline to consider the option of making social changes, deafness must necessarily be a harm, and I do not think it is. This perspective recognizes deafness not as a harm but as a difference, with its own attributes, underlining the idea that “harm” can be subjective and culturally constructed; thus, what might be perceived as harm in one context (e.g., hearing society) might not be seen the same way in another (e.g., Deaf culture). In other words, “the desire of the hearing to impinge their own image is no justification for negating the essence and choice of others.” (Ha’am, Reference Ha’am2017, Reference Ha’amp. 84). So, when it comes to public policy, it is essential to distinguish between necessary harms (such as a life-threatening condition) and cultural/identity-based choices that do not impede an individual’s ability to lead a fulfilling life. Yet, none of this entails that one cannot argue that in “this” world (or in “this particular case”), deafness would be a harm. This argument is stronger. If we are not yet at such a world where an individual with this difference can lead a sufficiently autonomous life (for example, because the necessary social structures are not in place), this would be a strong moral reason for why we can prohibit the choice. That the world should be inclusive (ideal) does not, after all, mean that anything that would be justified in that ideal world is automatically justified in the here and now; sometimes there will be moral costs that are relevant and important to balance against what would ideally be justified. But even when the harms are too great, and so the action is prohibited, the prohibition ought to be accompanied by other actions that are meant to bring us closer to the realization of this inclusive world. Otherwise, the genuineness of the prohibition might be questioned.

In summarizing the analyses above, we can distill them into two main principles: respect for diversity and respect for choice. The principle of respect for diversity says we should not restrict parental choices unless those choices are intended by the parents to undermine diversity itself. Moreover, choices motivated by a positive view of diversity—and not by negative intentions such as a desire for a child to suffer— should be accepted by society. This acceptance should be extended as far as possible, provided that the choices do not lead to a reduced lifespan or pain. Thus, respecting and facilitating the autonomy of the decision-maker is paramount within the boundaries of (i) prohibiting the infliction of a shortened lifespan or pain upon the child; (ii) prohibiting the actualization of demeaning beliefs or intentions such as viewing certain groups as inferior; and (iii) prohibiting the choice resulting from an expression of unwillingness to love and care for the child. With these limits, choices cannot be said to undermine dignity/moral equality by creating unjustified harm or expressing demeaning ideas.

Notably, this emphasis on “respect for reproductive autonomy” does not mean that the range of options for parents ought to be maximized. Instead, it simply means that permitting different reasonable choices is in alignment with and/or arises from respect for autonomy. As observed above, having a preference need not equate to ableism or to being an unloving parent who intends something negative upon their child. In the case of deafness and hearing, for example, since neither choice inherently involves a harm or a demeaning message, neither side can justifiably demand a restriction on the other’s choice, even if individuals can ultimately be restricted from that choice (if it unjustifiably harms or demeans). Therefore, the role of the state should be to allow both choices at the level of policy while focusing its efforts on improving social structures and conditions to support all individuals. This approach fosters a society that is inclusive and respects the diversity of its members.Footnote ¹³

Why are “natural” and present genetic inequalities okay?

If the “mere difference,” disability position presented above is a reasonable position and has substantive argumentative weight, I argue that it would thereby also allow enhancement of certain abilities. It seems the transhumanist and disability position may have more in common than it appears; both give due weight to respect for diversity and autonomy, and place emphasis on making changes to society to accommodate or otherwise include different individuals. Among the first of these social accommodations is to guarantee the dignity of all despite the reality that people possess many different traits and abilities, and at varying degrees. The major difference between a disability and an enhancement is that one is a “natural” difference, and the other “human-made.” But why should diversity be more valuable when it is natural? If I landed on an unknown island and saw hundreds of different people, would I need to find out that the differences are natural before I decide whether to respect them as my equal?

In addition, what is so special about precisely the current genetic inequalities between people that they are judged as the (only) ones that ought to be preserved?Footnote ¹⁴ Why is it that these existing genetic inequalities, if and when they become problematic, can be adequately addressed via social means, but not the newly created ones? If there are no adequate answers to these questions, as I suspect, then the argument for allowing somatic enhancements is as strong as the argument for allowing current genetic differences, including disabilities.

Consider the basketball player. The way we address the potential dangers of inequality in height of the basketball player and the person of typical height, such as earning a better income and having better access to health care, is not by redistributing genes to achieve an “acceptable” level of genetic variance. Rather, it is done by ensuring that those who are not as tall are not denied their equal status in society, and perhaps redistributing some other social resources and income (Buchanan, Reference Buchanan1995). In fact, the UDHGHR does not promote the idea of genetic equality either. Instead, it promotes “genetic non-discrimination”; “everyone has a right to respect for their dignity and for their rights regardless of their genetic characteristics” (UNESCO, 1997, article 2a). In other words, the declaration accepts that the presence of natural inequalities need not imply inequality in dignity or treatment. Similarly, I argue that “new” genetic inequalities should not be assumed to be problematic either. Of course, certain variations will be problematic because they will necessarily lead to consequences that violate certain moral standards,Footnote ¹⁵ but this is different from assuming a problem from the start (Resnik, Reference Resnik2000). This insight on genetic variance is important because it suggests that we ought to consider whether social changes can be implemented to nullify any negative consequences, and whether these social changes would be reasonable. If so, the focus of our efforts should be on developing social safeguards for the protection of everyone’s equal status, rather than on enforcing an “acceptable” level of genetic variance. Otherwise, there seems to exist a eugenic aim that is magnified by this social inclination towards limiting autonomy to enforce a set level of genetic variance. Let us now take a closer look at the role of society.

Social changes to address the worries over the violation of dignity/moral equality

The IBC says that somatic enhancements and non-medical genetic selection introduce the risk of new forms of discrimination and stigmatization for those who cannot afford such technologies or simply do not want to use them (2015, p. 27). The worry that enhancements may create a social divide and exploitative relationships between those who have enhanced capacities and those who have not is a legitimate worry, but one that can be addressed through social means. Bostrom (Reference Bostrom2005), for example, explains how the promotion of acceptance towards those who are different from us, and the creation of inclusive social structures, policies, and accommodations can ensure that the advent of enhancements do not yield a social divide between those who are enhanced and un-enhanced. Afterall, dignity is something that is socially protected, meaning that the following are all possible social responses that can address the potential for unjustified discrimination, stigmatization, social division, and exploitation:

1. 1. Level of social protections for all are made more extensive.

2. 2. Bans are put in place for enhancements that will necessarily unjustifiably harm others such as an enhancement that will create a permanent undesirable gap between initial users and those who would only have access at a later time.

3. 3. Universally desired enhancements are subsidized.

In fact, the UDHGHR is itself an example of how a social measure can be used to address issues related to potential violations of dignity. The Declaration states, “No one shall be subjected to discrimination based on genetic characteristics that is intended to infringe or has the effect of infringing human rights, fundamental freedoms and human dignity” (UNESCO, 1997, article 6).

The IBC applies this principle to the present-day use of genetic tests and says that “high sensitivity and attention as well as effective measures to prevent and promptly fight … [discrimination and stigmatization] are necessary” (2015, p. 9). One particular worry about the use of genetic tests in society is regarding the formation of social expectations from individuals to “live healthy” once they come to learn about their genetic predispositions from genetic tests (IBC, 2015; Resnik, Reference Resnik2014). Blameworthiness, denial of care or insurance, social pressure, and incentives in the form of discounts and rebates can all be used to encourage health-promoting behaviour, and this, according to the IBC, could result in discrimination and stigmatization of those who do not live a health-promoting lifestyle (2015, p. 9). The worry is heightened given that genetic information is known to be erroneously perceived as overly deterministic (IBC, 2015, p. 9). Yet, despite these justified worries, the IBC does not deny the value of persons having access to their genetic information to help them make lifestyle decisions. Instead, they encourage “…the international community, governments and researchers to address the very complex issue of the looming conflict between the right to have access to scientific knowledge [e.g., one’s genetic information] and other relevant principles” (2015, p. 9).

Some reasonable social responses that would address the problem of undue social expectations are the creation of oversight bodies to minimize the possibility that service providers treat individuals’ genetic information erroneously; to work towards improving health literacy within the general public; and to provide basic universal health and life insurance to all citizens. Moreover, if insurance incentives are actually effective in reducing chronic, lifestyle diseases, then the state could also make it a priority to ensure that the incentives are available to all who meet the criteria; that the criteria themselves are not unjustified, and that none are unjustifiably withheld from being able to do what is needed to meet the criteria to be eligible for the incentive. Do people have access to healthy foods and other resources to be healthy, for example? Regardless, basic insurance premiums, without any such incentives, should already be affordable to all, whether through the state ensuring that the cost on the market is reasonably priced (through laws or subsidies), or through the direct public provision of something like universal basic insurance (O’Neill, Reference O’Neill2006). In this context, willing individuals could still benefit from incentives on the private market, and this would not amount to a kind of “individual genetic responsibility policy” that holds persons politically/socially responsible for their genetic risk factors (Resnik, Reference Resnik2014). Afterall, if health is so important that respect for autonomy still allows one to be unhealthy (and rightfully so), then respect for autonomy should also permit one to be more than healthy (i.e., benefit of insurance of health plus the benefit of the incentive). With social measures in place, there is no reason why unjustified discrimination, stigma, and infringement of dignity should ensue from the use of genetic tests or incentives.

In the context of SERTS, there can also be negative social expectations and discriminatory attitudes that manifest. As in the case of genetic tests, however, social measures can similarly address worries over discrimination and stigma. For example, there should not be something like a “right to enhance” unless it can be ensured that it is only for an enhancement that is universally desired; unproblematic in itself; and that this is the only way to guarantee that people who want to make use of it can access it. There would be no need to establish a positive right if those who want to make use of a desirable, unproblematic enhancement can already do so. In this way, we avoid creating a pressure to enhance, which would make people worse off even if they end up deciding what is best for them given the choice. Admittedly, avoiding the establishment of a positive right to enhance would not completely eliminate a potential social pressure to enhance, but these would be less powerful and easier to counteract via social mechanisms.

The societal decision to permit certain genetic enhancements would also come with the possibility of changing common social standards over time (e.g., public services requiring the ability to use a certain kind of information technology; public spaces designed for the average citizen who may now be one who has a particular enhancement; expectation of taking fewer sick days, etc.; Buchanan et al., Reference Buchanan, Brock, Daniels and Wikler2000). The state ought to monitor such trends and ensure that individuals are not excluded from the dominant cooperative scheme. As the UDHGHR itself states, making the benefits from research concerning the human genome available to all can contribute to respect for the dignity of all (UNESCO, 1997, article 12a). The development of biomedical technologies is a case in point. Buchanan et al. say that “if technology is designed with reference to “normal” abilities, then it may restrict rather than widen opportunities for some, and this is true regardless of whether those who do not have “normal” abilities suffer from genetic or other impairments or are simply too poor to afford the interventions that set a new level of “normality” with reference to which new technologies are designed” (2000, p. 298). Many others have emphasized the importance of including persons with disabilities in the design of biomedical technologies (Goering & Klein, Reference Goering, Klein, Wasserman and Cureton2020; Hansson, Reference Hansson and Hansson2017; Stramondo, Reference Stramondo, Reynolds and Wieseler2022).

Notably, Michael Wee (Reference Wee and Sands2022) opines that it will initially be those with enhanced capacities who are likely to be negatively affected by economic, cultural, and physical structures, which are designed for those with typical human range. He gives the following examples: “If… a small number of people were able to extend their lifespan by 50 years, would they find adequate family and social structures able to support and accompany them in their extended longevity … Would someone with greatly enhanced cognitive abilities be able to function well in a regular work environment, for instance, or would they instead be disabled by the speed at which things progressed relative to their own mental powers?” (Wee, Reference Wee and Sands2022, Reference Wee and Sandsp. 20). Accommodations that would be needed for people in such scenarios ought to be checked for whether they are reasonable. If unreasonable (e.g., undue hardship), an accommodation request could be denied, but this would not mean that the person ought to be prohibited from making the choice to enhance that capacity in the first place.Footnote ¹⁶ Instead, such information should be disseminated to individuals.

Future bioethics guidelines should more directly and centrally discuss how social changes can be used to counteract the potential for unjustified discrimination, pressure, indifference, or disrespect arising from the use of SERTS. For example, below are some of the points that something like the UDHGHR can include as an addendum:

• • Those with genetic enhancements for a particular ability and those without are equals.

• • States shall ensure that all can be participants in society. They shall implement and enforce anti-discrimination laws that specifically address potential biases against those who have (or have not) made use of genetic technologies, in employment, education, insurance, and other parts of social and political life.

• • States shall enact laws that protect individuals from being coerced into using enhancements, whether by employers, educational institutions, or through more general societal pressure.

• • States shall consider providing subsidies for, and only for, enhancements that are universally desired to ensure they are accessible to all who would like to make use of them.

• • States shall ensure that individuals are not excluded from opportunities due to changing societal demands for goods, services and required skills, by appropriately meeting the basic needs of all.