Enhancement as a Basic Human Right

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Enhancement as a Basic Human Right
Professor Julian Savulescu
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Supermouse
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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.

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Modafinil

• Ninety percent of the prescriptions are for
  off-label usage
• Provigil's sales (Cephalon)
• 2007-- 1 billion
• 2005-- 500 million2004-- 289 million2003--
  200 million2002-- 150 million2001-- 75
  million
• If this growth were to continue, the market in
  2018 would be US70 billion!

Estimated 2018 Market US 7-10 billion
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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

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Survey

• Other drugs
• Adderall, a drug prescribed for ADHD containing a
  mixture of amphetamines.
• Centrophenoxine
• Piracetam
• dextroamphetamine sulfate
• ginkgo
• omega-3 fatty acids.

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Top 10 Enhancers
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!)
Anders Sandberg
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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.

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• 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 PPARd in their
  muscles- turn into slow twitch fibers that work
  well for long-distance running. More endurance
  and increased resistance to obesity.

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Biology, Psychology and Disability

• Welfarist Definition of Disability
• A stable physical or psychological property of
  subject S that tends to reduce Ss level of
  well-being in circumstances C,
• excluding the effect that this condition has on
  well-being that is due to prejudice against S by
  members of Ss society

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Improving well-being/Reduce Disability

• There are 4 ways to promote human well-being.
  Change
• Natural environment
• Social environment
• Psychology
• Biology

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Change Society, Not People

• We should alter social arrangements to promote
  well-being, 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

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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

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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.

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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 -25 Males in
jail -25 High school dropouts -28 Parentless
children -20 Welfare recipiency -18 Out-of-wed
lock births -15
Gottfredson 2002
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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

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Cartoon by Nicholson from "The Australian"
newspaper www.nicholsoncartoons.com.au
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Iodine

• 1 in 3 people in the world dont 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

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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

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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.

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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

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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

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Other Categories

• All Purpose Goods
• Intelligence
• Memory
• Self- discipline
• Foresight
• Patience
• Sense of humour
• Optimism

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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.

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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

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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.

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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

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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

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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.

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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

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Oxytocin and Trust

• Oxytocin shown to influence ability to infer
  anothers 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

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Lust
Hypothalamus, sex hormones
Corticolimbic, dopamine
Attraction
Oxytocin, vasopressin, CRH?
Attachment
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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

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Derivative Right

• Derived from Basic Human Rights

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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.

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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.

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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.

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Basic right

• Right to a sufficient level of well-being

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Biopsychosocial nature of well-being/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

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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

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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?

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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

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Second Argument Consistency

• We accept environmental interventions
• Education
• Computing and information technology

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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)

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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

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Parity

• Education
• Internal cognitive enhancement
• altering biology
• External cognitive enhancement
• computers, internet

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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

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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

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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

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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

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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