This volume is a welcome addition to the literature at a propitious time. The debates about human medical enhancement have been more or less deadlocked between The Ethics of Human Enhancement have drawn together papers which attempt two ends: to advance the debate through the impasse and to explore ways to recast the debate in order to get on with it.

In the introductory paper, Giubilini and Sanyal the agreements and disagreements historically, across issues of instrumentality versus ‘substantive’ bioethical concerns, the worry about ‘playing God’, how important intuition should be seen in the debates, the concern with ‘human dignity’ and ‘human nature’, whether the ‘restrictive’ view contributes to the debates or detracts from them, and whether evidence from neuroscience and moral psychology is even relevant to the issue.

The book is divided into two broad sections. Both reason and emotions play a significant part in relevant neuroscientific research, that seriously considering both at the same time will help cut across debate in both philosophy and psychology that are hung up on this dichotomy. May’s paper grapples with a trend in the conservative literature to place a great deal of weight on ‘disgust’ or other sorts of psychological aversion. While it has been argued for some time that being disgusted by an act is morally irrelevant, May makes the case that being repelled by an act or state is psychologically irrelevant, in that being disgusted really doesn’t seem to make much difference as to whether we morally reject that of which we are disgusted. This line of questioning is continued by McConnell and Kennett in their paper. They take on the idea that our more or less instinctive or involuntary aversions to certain acts or states are somehow indicative of a ‘deep wisdom.’ They argue that intuitions have and should be coupled with reflection in order to come to ‘wise’ positions rather than taken as limits to what can legitimately accepted.

The rest of the first section deals with specifictherapy/enhancement distinction (Barclay) and the accusation that enhancement amounts to ‘playing God’ (Weckert). McMillan traces some of the history of conservative resistance to medical technologies noting that what was once opposed is now accepted, and Gynell and Selglied are concerned that there are too many conceptions of ‘enhancement’ being deployed around the literature, a bit less than thoughtfully.

In the last chapter of the first section, Robert Sparrow raises the question of exactly whose interests are at stake when considering enhancing future generations. He suggests that there are several troublesome issues regarding balancing the interests of ‘the parents’, ‘the child’ and ‘the world’, especially if the State becomes involved in regulating these choices. States tend to act in the interest of ‘the Nation’, which is a concern given the recent rise of Nationalism.

In the second section of the book, several authors make an effort to advance the debate by questioning the assumptions of the various camps and/or by re-characterising those camps that defeat the impasse.

The most interesting article in this section, by Roache and Savulescu, discusses whether conservatives have characterised their own position properly. Perhaps, they suggest, conservatives should reconsider whether enhancement itself is problematic or the negative consequences (as they see them) are problematic. If the latter, where conservatives defend certain values by rejecting enhancement, they fail to consider that those very values could themselves be furthered through enhancement, if the negative consequences could be avoided or minimized.

Bernadette Tobin, in her chapter, casts the entire project of human enhancement as a paradox. She argues that if we were to enhance our children in ways that fulfil the virtues to which we aspire for ourselves, our children would be the kind of people that would look back on the project that created them and be horror-struck. The sort of person which we would create would value the struggle to achieve those ends.

The rest of the second section consists of attempts to reconcile conservative values with medical enhancement (Pugh, Kahane, and Savulescu), reconsiderations of what human nature consist in (Agar; and Hauskellar), the relationship between our own human nature and our social and political structures perhaps giving reason to believe that moral enhancement justified (Clarke; Kaebnick; and Powell and Buchanan).

The Ethics of Human Enhancement contains work that is not only valuable to the student of medical ethics, but to those who are working at the frontiers of the field. The excellent surveys of the current state of play are one thing, but the arguments therein which attempt to recast and thus advance the debates are those of which every medical ethicist working today needs to take note and engage.

© 2017 Diane Gall

Diane Gall, PhD is Instructor in Philosophy at Medicine Hat College, Alberta, Canada.