The position paper on cognitive enhancement by Henry Greely and colleagues starts out with the claim that “[s]ociety must respond to the growing demand for cognitive enhancement” (Greely et al. 2008, p. 702). The article by Beddington and colleagues on the mental wealth of nations begins with the conclusion that “[t]o prosper and flourish in a rapidly changing world, we must make the most of all our resources—both mental and material” (Beddington et al. 2008, p. 1057). Both statements are similar in that they frame recent developments in such a way that they necessitate a reaction: we “must” respond in a particular manner. Greely and colleagues call for a “responsible use of cognitive-enhancing drugs by the healthy” (Greely et al. 2008, p. 702), though the majority of readers responding to their paper understood them as exaggerating the benefits of drug use generally or as being financially influenced by drug companies (Greely 2010). Beddington and colleagues call for the maximisation of our resources. All these authors want to increase benefits and decrease harms. However, who defines what counts as a benefit, as wellbeing, or as a good life? This is an essential and fundamental question that will influence every benefit-risk-analysis on human enhancement (Nagel 2014; Schleim 2014b).
As mentioned in the previous section, several scholars discuss the potential of means for enhancement, particularly psychopharmacological drugs, with respect to studies employing clinical test designs—whether investigating healthy people, those with a mental disorder, or even animals. Such tests measure reaction times or error rates in tasks requiring, for example, attention, memory, or planning. That is, the experimental setting frequently originates from a pragmatic context guided by identifying, treating, and/or predicting the development of a certain mental disorder. The underlying mental disorder concept, which is in itself controversial and subject to recurrent modifications, essentially hinges on a subject’s clinically significant distress or functional impairment in the domain of cognition, emotion, and behaviour (American Psychiatric Association 2013; Stein et al. 2010). However, benefit, wellbeing, or a good life as discussed in the debate on human enhancement at large are not merely the opposites of clinically significant impairment; a five percent increase, say, in a task where a subject has to memorize as many digits as possible, and that may identify memory problems, does not reflect an increased performance in a real test, not even a maths exam at school or university. Much less is it a suitable indicator of a benefit for the quality of life, although such a finding may be sufficient for publication in a peer-reviewed pharmacological journal.
However, there are advanced, direct, and representative measures of the quality of life. One example is the United Nations World Happiness Report, which compares the situation in 156 countries. The variables GDP per capita, social support, healthy life expectancy at birth, freedom to make life choices, generosity, and perceptions of corruption together explain 75.5% of the international variance of world happiness in 2012 (Helliwell et al. 2013). A more recent development is based on the OECD Guidelines on Measuring Subjective Well-being (OECD 2013). These allow people to create their own Better Life Index, prioritising eleven pre-defined domains such as education, jobs, housing, or safety.
More than 60,000 citizens from OECD countries have so far submitted their preferences, yielding important regional differences.[1] For example, people from the USA valued housing (on average 7.8 on a scale up to 10 points) and income (10.0) the highest, but work–life balance comparatively low (5.3). By contrast, people from Denmark, which is number one in the World Happiness Report, prioritised work–life balance higher than all others (9.8), and also valued life satisfaction (9.4) and community (10.0) very highly, while considering income less important (4.0). One may raise the question, of course, whether such statements are biased by social stereotypes or social desirability, but what could be a better measure of what people find important for leading a happy life than asking them directly? This is particularly so when they participate in the survey entirely on their own account.
These results emphasise two essential points for the human enhancement debate: first, people differ individually as well as regionally on what they find important for their wellbeing. Second, many of these aspects are not directly based on bio-psychological factors, but on social factors. Indeed, the OECD construct of subjective wellbeing focuses on income, health status, social contact, employment status, personality type, and culture as determinants of life satisfaction, affect, and eudaimonic wellbeing. Unlike clinical measures of psycho-behavioural performance, they do not primarily rely on functional impairment.
Most importantly, the Better Life Index allows people to indicate themselves what they find important for their subjective wellbeing; and it turns out that many of these aspects, like housing or safety, are actual social factors that can only very indirectly be targeted by bio-psychological intervention. Therefore it becomes clear that a biased or narrowed concept of human enhancement carries the risk of missing the point of what determines or enables a better life. Further systematic analysis beyond the scope of this paper is required to show whether the factors identified are more amenable to individual psychobiological intervention, such as targeted by Savulescu and coleagues (Savulescu et al. 2011), or socio-political initiatives. Yet, while Greely and colleagues or Beddington and colleagues merely assume that increased cognitive performance will increase people’s quality of life (Beddington et al. 2008; Greely et al. 2008), an initiative like the OECD Better Life Index allows people to autonomously express their own views on the issue and thus provides robust empirical evidence. This strategy helps to avoid two normative fallacies: first, that a parentalistic decision is possible when it comes to what should be good for others and, second, the idea that just because some intervention leads to a higher test score it is therefore good.
This section has highlighted, again, the tension between individual freedom and social adaptation, between autonomy and heteronomy. While most scholars would emphasise that people should be free to choose for themselves, fundamental definitions as well as the framing of human enhancement can implicitly narrow freedom, for example by introducing a limited standard for quality of life or by constraining the target for intervention. That is, when people apparently have free choice, because they are asked to choose from a number of alternatives that choice may actually be quite limited, because the offered options neglect important alternatives.
As described in the previous section, people are well aware of the threat of coercion when discussing the prospects of enhancement. Coercion does not only exist at gunpoint, when acting under duress in a strong legal sense, but it can also come in a much less direct manner: For example, by telling people that they must choose from a limited set of options, because otherwise something bad is going to happen. Referring to what, putatively, many people are already doing or what globalisation requires increases the pressure on individuals. There are meaningful and evidence-based alternative views on human enhancement, beyond those focusing on functional impairment, as shown in this section. In the next section, I will focus on the epigenetic proactivism proposed by Kathinka Evers in more detail.