Interview with Prof. József Kovács

During the reconnaissance phase, NERRI members met stakeholders to collect their visions about the issues raised by Neuro-Enhancement. Judit Sándor interviewed the Hungarian bioethicist József Kovács from Semmelweis University.

Judit Sándor: Have you ever encountered the issue of neuro-enhancement (NE) in your professional life? And, if yes, in what context?

József Kovács: Yes, I have, since I am a bioethicist, and neuro-enhancement is a key issue in bioethics. It is quite difficult to translate the term “neuro-enhancement” into Hungarian. The best term would be tökéletesítés (lit. “perfecting”). I think it is very important that we define neuro-enhancement so that when we speak about NE we refer only to the cases when a feature of an individual is improved anatomically or physiologically in comparison to what is considered as normal or species typical. We have to make a distinction between therapy and enhancement. Therapy is when one would like to cure an ill person, and healing it means that the given person will regain the normal characteristics or features of the species, her or his species-typical functioning. Enhancement means when such characteristics are improved above what is considered as normal or species-typical. To give an example: let’s consider that somebody has myopia and undergoes a surgery so that he or she will regain her or his normal vision, the one that a healthy person has. Enhancement is when the vision of a healthy person is improved to such an extent that he or she could see, for example, a mouse from 5 kilometers high – like an eagle. This is enhancement, since a normal human is just not able to see like this. In general, therapy is accepted, while enhancement is often seen as an intrusion into the course of nature.

The question is whether it is possible to draw such a sharp distinction between therapy and enhancement. Let’s take the example of vaccination: is this enhancement or prevention? Vaccination gives to the person a characteristic that he or she did not have before – namely, that his or her body will become resistant to the infections to which normally would not be resistant. Is this enhancement or prevention? It is difficult to draw the line between enhancement and prevention. It is important to draw this line because the consensus today is that therapy and prevention are acceptable while enhancement is not.

JS: The concept of “species-typical” is an important element in the definition. Another question is whether enhancement also depends on age. So let’s say that a certain ability or function is in the normal range during the years of young adulthood but later on this ability or function (for example memory) starts to diminish or decrease and the same person has memory problems. Would it be enhancement if we intervened here? Or if we consider a middle age person and we intervene in such a way that this person could have the intellectual ability corresponding to the ability in an earlier stage of his or her life. The point I would like to make is that the species-typical element is an important part of the definition but to a large extent age should be also taken into account. 

JK: Yes, this is right. What we mean by species-typical always implies age and sex. This is how this term is used in medicine – for example, the normal range of blood pressure for a male between 24–30 is so and so – this is the typical way of formulating a relationship in medicine, and this is considered as “species typical” or the normal range for a given age group. It is not considered “normal”, however, if an 80-year-old person has the same eyesight or strength that he or she had in his or her twenties. So the question is if we implant a hip prosthesis into a 90-year-old patient, then is it enhancement or only the restoration of normal physiological functioning? It would be the restoration of the normal function in the case of a 20-year-old person, but in the case of a 90-year-old it is not normal that his or her hip functions as efficiently and smoothly as it did at the age of twenty. So in this latter case we can speak about enhancement, basically. In many cases, medicine has already crossed the border between therapy and enhancement, but this phenomenon is accompanied by many contradictions.

For example, if a child with ADHD syndrome gets a medication to “treat” his or her attention deficit or concentration problems – this is an accepted treatment. However, if a healthy child gets such a drug to improve his or her abilities – it classifies as enhancement, a kind of doping that is forbidden in sport. It might also be possible that some of the cases that are nowadays treated with ability improving drugs are basically considered normal variants and not diseases. Currently, we do not accept giving drugs to healthy children to enhance some of their abilities, but we do accept treating diseased children with such medications to reach the normal range of the affected function.

So we can witness the medicalization of such conditions. What is in fact enhancement is made to look like the treatment of a disease, and not enhancement. The reason for this is the contemporary consensus, namely that an illness can be treated or prevented but enhancement is not permissible. Thus enhancement in many cases must be masked – and it is in fact masked – as therapy. This is possible because the distinction between the two (therapy and enhancement) is in fact not sharp. And we have to keep in mind that humans have always enhanced themselves. This is how they adapted to the environment in the course of their evolution. While animals have adapted with their bodies, and those who could not were selected out, the humans have adapted to the environment increasingly with their tools. They improved their tools while they themselves remained basically the same, from a biological point of view. This is where a moral issue is at stake: we may say that this or that technology is outdated but we do not say this for a person. But if we were to implant different technologies into our bodies we could say that this or that solution is outdated (his or her enhancement from 10 years ago is now outdated and needs an update).

The case of neuro-enhancement would be more problematic from an ethical point of view, because it touches upon issues of our personal identity. There are three areas that we could enhance: our intellectual abilities (for example, our intelligence), our affective abilities, and our moral sensitivity (to create persons like Albert Schweitzer or Mother Teresa). These are all elements that are central to our personalities.

It is also interesting how we define health. Normally, we regard those persons as healthy who are species-typical from a biological point of view, but if enhancement were possible we would consider healthy only those whose abilities or functions would be the best anatomically or physiologically possible and not those who would function in a species-typical way. For example, if we accept that xenophobia is species-typical in some sense and suppose that it could be totally eliminated by enhancement, then we could consider healthy only those people who would not have xenophobic feelings at all. Or if we consider the best possibility – the best possible vision, for example – the norm, then what falls short of this possibility would be regarded as disability.

It is quite strange that there is such an intense opposition against enhancement, since the whole human civilization is basically a series of experiments in enhancement. While, until now, enhancement has focused on our tools or devices, now this procedure entered into our bodies and genomes. But perhaps the difference between the two is not as significant as we tend to believe. The idea of not accepting the world as it is, according to Max Weber, is rooted in the spirit of capitalism. That was the force that motivated people to have more and to live better than their parents did.

The inequalities in the quality and quantity of objects one has given rise to significant status differences: one drives a cheap car while the other an expensive one. These differences have been tolerated, since these inequalities did not affect the body. The person in the cheap car had the same physical body as the other one with an expensive car. Now it becomes possible that those who have money to buy expensive cars have the money to enhance their bodies, too. Since the enhanced characteristics might be inherited from generation to generation this would produce such an enduring biological inequality that the notion of equality would be hardly sustainable. In my view this is the most important danger and this explains why there is such an opposition against human enhancement. 

JS: What real dangers or promises do you see in neuro-enhancement – let’s say, 20 years from now?

JK: I don’t think this could be guessed right now. When we anticipate certain developments as dangers, they prove to be very often less dangerous than those that we did not even think of as possible dangers. We cannot really foresee the risks and promises of a technology. So any such enhancement technology should be regarded as an experiment and should follow the course of any other experiment: first animal trials, then controlled human trials, then taking into account the social impacts, and so on. There is a danger, however, that this process might go out of control and will have a “natural” evolution of itself (like in the case of arms race when there is no way for any party to get out of the loop). For example, even if it were forbidden, some parents would enhance the IQ of their children, so that these children could have an advantage in the competitive societies of today. Then other parents would feel that they have to do the same, even if they knew it was forbidden, in order to keep their children competitive. This kind of competition between the parents could remain within the boundaries of a country, but it could develop across borders as well. One country might prohibit enhancement but it does not reduce the fear that other countries might allow it to have a competitive edge. 

JS: Do you think enhancement might alter identity? And what are the dangers related to this?

JK: I think yes, it would alter identity because, for example, an improved IQ would affect not only the cognitive functions, but the whole personality structure. But of course not only IQ could be enhanced but sensitivity or memory, or moral functions, as well. All these would of course significantly alter identity, and not necessarily in a positive way. And such enhancement would also give rise to unacceptable inequalities and would endanger the perspective of an open future. Another danger of enhancement would be that the person would be downgraded to the level of technique. We could say, for example, that a person is “outdated” – and this is why many of us feel that enhancement would endanger human dignity. The availability of such technologies might be not only an option, but it could have an obligatory, enforcing nature. Once the technology is available there might also be a social pressure to use it, like in the case of contemporary reproductive technologies. Thus, beyond a certain point there would not be any other choice but to apply it. 

JS: What can the legislator do if everything is so uncertain? Who should be protected? Children, for example? Or should the different technologies be assessed differently? Or should we adopt the precautionary principle? 

JK: The legislators always have to consider the balance between risks and benefits. However, there is a danger of adopting too strict regulations that would endanger the free development of technologies. There is certainly a need for many informed debates and adult people should be able to decide freely for themselves about using or not such technologies. In the case of children, however, this is different, since they can’t consciously consent to undertaking enhancement, so the outcome would be not their own decision but that of their parents.

What I would like to emphasize is that developments should follow the research paradigm: for a certain development to take place it would be necessary not only to obtain the consent of the research subject but also the approval of a research ethics committee. This might sound a bit paternalistic, but this is a procedure that is already well functioning. The research ethics committee should evaluate the risks and benefits of the given technology not only for the given research subject but for the society as a whole (I mean the societal impact of the application of a certain technology). 

JS: There are possible applications that are not related to health, but rather to social control. For example, the need to use some technology to detect potentially criminal, aggressive behavior might emerges with the aim of prevention. In a case like this we have to address the issue of voluntary or non-voluntary applications of such technologies.

JK: Yes, this is a real danger. Let’s consider the issue of privacy. As it is well known, today various neuro-imaging technologies make it possible to examine the brain. We are very close to the point when it will be possible to see what the content of one’s thought even if the person does not want to disclose his or her thoughts. This is a real danger for our privacy, and in such cases there will be necessary to create some kind of legal protection. On the other hand, this can be a very valuable tool in the hands of police or the legal system, but I am sure that it will be necessary to have special legislation for such issues in order to avoid any misuse of the technology (for example influencing someone without his or her will).

A further important issue, I think is the direction of enhancement, if it will be used. This is a difficult issue in today’s societies that are morally pluralistic. What is good? What are the desirable characteristics: to be as aggressive and competitive as possible or to be sensitive or highly emphatic?

JS: What should be the criteria based on which the ethics commissions could decide on the applicability of certain technologies or applications? Could certain medications or devices be used for enhancement (for example in case of some disabilities, or in case of elderly people)?

JK: An important criterion should be to see if the given application has reversible or irreversible effects. Taking a drug or a medication is usually reversible: one can stop taking it. Altering someone’s genome, however, is an irreversible intervention. In this latter case, in extreme cases, it can even be questionable, if we could speak about a human being in the sense that we are used to define a human being. Today, for example, people accept ageing because they think this is an inevitable process. However, if enhancement were possible, people might want to live their life in their 20-year-old bodies, even if they are already 80 or 90 years old. This would be a radical change for example.