It is worth noting, however, a set of curious circumstances surrounding the paper itself.  Pursuant to a torture d reading of the relevant Department of Health and Human Services (DHHS) regulations, 45 C.F.R. 46.102(f),  the study qualified as being “not human subjects research.” This is because, per the DHHS definition, “research performed on anonymized data with no contact between investigators and participants does not constitute research on human subjects” (Eriksson et al., 16).  Thus, part of this bizarre conclusion rests on the fact that “participant names [were] anonymous with respect to the data seen by the investigators” (Gibson and Coperhaver 2010, 1).  On the issue of participant anonymity, the study further explains:

The Consent and Legal Agreement stated that participants’ genotype data and whatever phenotype data they entered would be used for internal research after being coded and stripped of individually identifying information (‘‘anonymized’’). Individually identifying information refers to personal information that is collected during purchase, such as name, credit card information, billing and shipping addresses, and contact information such as an email address or telephone number.  (Eriksson et al. 2010, 16)

Nothing more is provided on how participants’ information was “anonymized,” nor how such anonymity was preserved during the study.  Given the fact that 23andMe plans to “provid[e] participants with well-explained descriptions of their genetic data,” it follows that not all links between participants and their information were severed: otherwise, how would 23andMe report back their individual results?  That the participants’ data was not truly “anonymized” is no surprise, however, and hints at an underlying axiom of data analysis: “Data can either be useful or perfectly anonymous but never both” (Ohm 2009, 4).

In the last decade, increasingly-sophisticated data mining technology has essentially negated the traditional concept of information “anonymization.”  “At the very least,” one research concludes, “we must abandon the pervasively held idea that we can protect privacy by removing personally identifiable information” (Ohm 2009, 35).  Re-identification—the converse of anonymization—relies on “pockets of suprising uniqueness remaining in . . . data.  Just as human fingerprints can uniquely identify a single person and link that person with ‘anonymous’ information . . . so too do data generate ‘data fingerprints’—combinations of values of data shared by nobody else.”  (Ohm 2009, 21).

“It is noteworthy that several respondents who had particular experience with biobanks or social science research,” the author of a study on biobank security writes, “were concerned about datasets that permitted identification of individuals with special characteristics despite the coding [anonymization] and the absence of any name or directly identifying item” (Elger 2008, 181).  For example, according to a recent study 87% of the American population possess unique ZIP code, birth date, and gender combinations.  In other words, over 250 million Americans can be uniquely identified by the combination of the ZIP code, gender, and birth date.  (Ohm 2009, 4).  The point here is that three pieces of otherwise non-identifying data can intersect to re-identify a once-anonymized individual.  This begs the question: how could the 23andMe study participants give their informed consent if they were under the mistaken belief that their identities would be protected?

As the editors of PLoS Genetics acknowledge, further complicating this ethical quagmire is the fact that:

. . . the experience of 23andMe reflects an unfortunate loophole that applies to all research with human samples that is not, as above, formally designated to be ‘‘human subjects research.’’ For situations in which a study does not meet the aforementioned criteria but obtaining a consent form would still be desirable, there are no guidelines or policy with regard to how such a consent form should be developed and reviewed in an ethically responsible manner.  (Gibson and Gopenhaver 2010, 2)

Without informed consent guidelines, it is impossible to judge whether the 23andMe “Consent and Legal Agreement” properly advised study participants as to the risks associated with their participation.  That document only speaks to the matter to the extent that it states that information withheld from the study dataset “include[s] identifying information you provided when you purchased the Personal Genome Service(TM) or created an account (such as name, address, e-mail address, or credit card information)” (23andMe, Inc. 2010).   The study’s frivolous subject matter notwithstanding, at the very least its publication points up a glaring failure on the part of regulators to protect consumer privacy. 

Work Cited

23andMe, Inc. 2010. Consent and Legal Agreement. https://www.23andme.com/about/consent/.

Elger, Bernice et al. 2008. Ethical Issues in Governing Biobanks: Global Perspectives. Hampshire, UK: Ashgate Publishing, Ltd.

Eriksson, Nicholas, J., et al. 2010. Web-Based, Participant-Driven Studies Yield Novel Genetic Associations for Common Traits. PLoS Genet 6, no. 6 (June 24): e1000993.

Gibson, Greg, and Gregory P. Copenhaver. 2010. Consent and Internet-Enabled Human Genomics. PLoS Genet 6, no. 6 (June 24): e1000965.

Ohm, P. 2009. Broken Promises of Privacy: Responding to the Surprising Failure of Anonymization. University of Colorado Law Legal Studies Research Paper No. 09 12.

Connections from the periphery to the cortex are not intact before 24 weeks of gestation. Most pain neuroscientists believe that the cortex is necessary for pain perception; cortical activation correlates strongly with pain experience and an absence of cortical activity generally indicates an absence of pain experience. The lack of cortical connections before 24 weeks, therefore, implies that pain is not possible until after 24 weeks. Even after 24 weeks, there is continuing development and elaboration of intracortical networks. Furthermore, there is good evidence that the fetus is sedated by the physical environment of the womb and usually does not awaken before birth. (RCOG 2010, 11)

The report’s findings raise a host of issues stemming from the abortion debate. From a policy perspective, the report stands as an evidence-based ground for regulating when during pregnancy a woman may obtain an abortion. From an ethical perspective, the authors’ conclusions beg the perennial question: when does life begin? To speak of a being’s ability to feel pain presupposes the fact that that being is living.

Biologically speaking, this is unremarkable. Politically, the question “when does life begin?” has significant policy implications because much of the abortion debate in the United States has been framed by how one answers this question. This may very well be attributable to how the Supreme Court cast its holding in Roe v. Wade, 410 U.S. 113 (1973). There, the court divided pregnancy into trimesters, giving different legal significance to each. Id. at 164-65. This now-common formulation, however, is arbitrary. In a leading text on obstetrics dating to 1916 it is observed that while “most writers divide pregnancy into three periods of three months each, three trimesters, as they care often called . . . [this] serves only to complicate the situation.” “Pregnancy should not be divided according to months,” the text continues,” but according to its clinical characteristics” (Shears 1916, 27).

Since its ruling in 1973, the Court’s physiologically-clumsy notion of the trimester has accrued ethical dimensions. The idea of a dividing line during pregnancy—between lawful and unlawful abortion; between life and death—has permeated the abortion rights discourse. To this end, many pro-choice arguments are aimed at denying the status of “living” to the fetus at any point in time before the dividing line. Similarly, anti-choice advocates have couched their appeals in the idea the life begins at “conception”— effectively eliminating the distinction by pushing the dividing line completely to one side. While there are significant biological flaws with these anti-choice arguments, the ultimate thrust of their claim is sound (Singer 1994, 100-05).

Any claim that a fetus is not “living” at any point during pregnancy is factually incorrect, and in the interest of ethical clarity such claims should be avoided by pro-choice advocates. However unpalatable a proposition: all abortion is killing. The question must be whether such killing can be justified and, if so, how? Thankfully, philosopher Peter Singer provides just such an argument in his book Practical Ethics. In short, Singer divides human beings into two, partially-overlapping groups, persons and members of the species Homo sapiens, according different ethical weight to each (Singer 1993, 150). Two centuries ago, John Locke defined a person as “a thinking, intelligent being, that has reason and reflection, and can consider itself as itself, the same thinking thing in different times and places” (Locke 1803, 21). Singer similarly defines a person as “a rational and self-conscious being” (Singer 1993, 87). Moreover, Singer is quick to observe that “[t]he biological facts upon which the boundary of our species is drawn do not have moral significance.” “Whether a being is or is not a member of our species,” Singer adds, “is in itself no more relevant to the wrongness of killing it than whether it is or is not a member of our race” (Singer 1993, 150).

Singer uses two cases to illustrate the importance of his distinction: the brain-dead patient and the anencephalic baby. Both are undoubtedly human beings in the sense of being members of the species Homo sapiens, but neither has or ever will possess the attributes of rationality, autonomy, and self-consciousness that make a person. A brain-dead patient or an anencephalic baby, Singer concludes, ought not be considered the ethical equivalent of a healthy, adult human. Because the fetus also lacks these attributes, it follows that it is also neither a person nor the moral equivalent of an adult human being (Singer, 1994). But to say that a fetus is not the moral equivalent of a self-conscious adult is not to say that it has no ethical status. Looking to the fetus’s “clinical characteristics,” (Shears 1916, 21), Singer argues that it be accorded “no greater value than the life of a nonhuman animal at a similar level of rationality, self-consciousness, awareness, capacity to feel, etc.” (Singer 1993, 151). It is Singer’s last point that makes the RCOG paper particularly relevant on the question of when it is ethically permissible to permit abortion: if a fetus cannot feel pain prior to 24 weeks gestation, killing it prior to that time requires even less moral justification than thereafter.

The fetus prior to 24 weeks is thus—ethically—more like a literal vegetable than a human person. This analogy may seem odd or even objectionable to those used to thinking of our species as somehow ennobled or special among our fellow animals—a notion Singer terms “speciesism” and equates with racism and sexism. In justifying killing a fetus before 24 weeks thus requires only the same ethical consideration as one would give prior to killing a turnip. While this formulation surly rubs against the grain of our intuitions about ourselves, it has the benefit flawless moral reasoning. Rather than focus on some other, more arbitrary point in pregnancy at which to regulate abortion, the RCOG findings point to the 24-week mark as an ethically-important consideration for policymakers. Without reaching the question of how to regulate abortion after this point, in light of the above it is morally impermissible to regulate abortion prior to it.

Works Cited

Hui, Sylvia. 2010. “UK Report: Fetus Can’t Feel Pain Before 24 Weeks,” Associated Press, June 25.

Locke, John. 1803. An Essay Concerning Human Understanding. Boston: David Carlisle.

Royal College of Obstetricians and Gynaecologists. 2010. Fetal Awareness: Review of Research and Recommendations of Practice. London: RCOG Press.

Shears, George P. 1916. Obstetrics: Normal and Operative. Philadelphia: J.B. Lippencott Co.

Singer, Peter. 1993. Practical Ethics. 2d. ed. New York: Cambridge University Press.

———. 1994. Rethinking Life and Death: The Collapse of Our Traditional Ethics. New York: St. Martin’s Griffin.

Part I of this essay examines some of the social questions raised by human enhancement technologies. Employing John Rawls’s Theory of Justice, it explores the relationship between justice, healthcare, and enhancement. Ultimately, it concludes that there is a strong argument favoring the position that a just distribution of healthcare ought to include technologies aiming to augment Rawlsian primary goods. Turning from the social to the personal level of analysis, Part II utilizes Peter Singer’s principle of equal consideration of interests in considering the ethical questions faced by a person considering enhancement. In the final analysis, Singer’s ethical framework provides, at the very least, a strong argument against restricting the use of safe human enhancement technologies.

I. Social Justice and Human Enhancement

In A Theory of Justice, John Rawls identifies the subject of justice as “the basic structure of society,” by which he means “the major institutions [that] define men’s rights and duties and influence their life-prospects.”[4] In order to derive a just “set of principles for assigning basic rights and duties and for determining . . . the proper distribution of the benefits and burdens of social cooperation,” Rawls engages in a hypothetical exercise he calls “the original position.”[5] Unlike fellow contractarians such as Hobbes and Rousseau—who believed that their analogous “state of nature” actually existed—Rawls does not conceive of the original position as “an actual historical state of affairs, much less as a primitive condition of culture.”[6] Instead, it is “a purely hypothetical situation characterized so as to lead to a certain conception of justice,” to wit: Rawls’s theory of justice.[7]

Rawls’s original position is cloaked by a “veil of ignorance,” behind which no one knows his social class, personal wealth, or “fortune in the distribution of natural assets and abilities, his intelligence, strength, and the like.”[8] Because the original position deprives its occupant of this knowledge and thus the ability to choose principles that favor their particular circumstances, Rawls concludes that the principles selected from behind the veil of ignorance will be the product of fair agreement. In other words, the set of principles that men in the original position would chose to order their affairs would be “the principles which free and equal persons would assent to under circumstances that are fair.”[9] Rawls describes such principles as “justice as fairness.”[10]

Having postulated the original position, Rawls then sets to work out exactly what principles of justice persons so situated would chose for themselves. The two principles that Rawls derives, which he arranges in serial order—the first always taking precedence over the second—are as follows: (1) “each person is to have an equal right to the most extensive basic liberty compatible with a similar liberty for others,” and (2) “social and economic inequalities are to be arranged so that they are both (a) reasonably expected to be to everyone’s advantage, and (b) attached to positions and offices open for all.”[11]

The first principle of justice is unremarkable, stating in essence that one’s personal liberty should be extended as far as possible until it threatens to infringe upon the personal liberty of another. The second principle of justice, subject always to the precedence of the first, suggests an egalitarian social structure whereby difference among individuals is permissible only so long as that difference contributes to the welfare of the least well off. Contained here is the nexus of two second-order principles Rawls has labeled the principle of fair equality of opportunity and the difference principle.[12] Both the principle of fair equality of opportunity and the difference principle concern the distribution of “primary goods,” which is to say “things that every rational man is presumed to want.”[13] Primary goods are comprised of two subgroups, so-called “social primary goods” and “natural [primary] goods.”[14] The former consists of such things as “rights and liberties, powers and opportunities, [and] income and wealth,” whereas the latter is comprised of things such as “health and vigor, intelligence and imagination.”[15]

Guided by the difference principle, Rawls argues that a social order should function to redress what he calls “the bias of contingencies”—in other words, all of the things that the veil of ignorance is designed to obscure.[16] Because “inequalities of birth and natural endowment are undeserved,” Rawls reasons, “these inequalities are to be somehow compensated for.”[17] In accordance with his second principle of justice, Rawls regards these unmerited primary goods as common assets, inequalities among which can only be justified to the extent that they improve the lot of the least fortunate.[18]

Rawls’ principles of justice thus seek to order the basic structure of society so as to fairly distribute primary goods. Following in Rawls’s footsteps, several scholars have sought to apply these abstract principles to diverse questions of public policy. In particular, Norman Daniels has examined healthcare policy in light of Rawls’s principles of justice.[19] Daniels characterizes healthcare as a primary good that “extends life, reduces suffering, provides information and assurance, and in other ways improves the quality of life.”[20] His definition goes further, describing healthcare for the purpose of justice as “maintain[ing], restor[ing], or compensate[ing] for the loss of . . . functioning that is normal for a member of our species.”[21]

The concept of “normal functioning,” Daniels argues, determines the range of life-prospects that individuals can justifiably expect. Disease or disability—defined as “deviations from the natural functional organization of a typical member of a species”—thus deprives individuals of life-prospects they otherwise would have been justified in expecting.[22] “The normal opportunity range for a given society,” Daniels writes, “is the array of life plans reasonable persons in it are likely to construct for themselves.”[23] Because Rawls’s second principle of justice compels the protection of fair equality of opportunity, in conjunction with the concept of redress implicit in the difference principle, Daniels reasons that justice “requires that we design health care institutions . . . so that they protect opportunity as well as possible within reasonable limits on resources.”[24] Thus, using the normal opportunity range as “a fairly crude measure of the relative importance of health-care needs at the macro level,” Daniels concludes that “it will be more important to prevent, cure, or compensate for those disease conditions which involve a greater curtailment of an individual’s share of the normal opportunity range.”[25]

Alongside this conclusion about the just distribution of healthcare, Daniels’s “normal functions” model has further implications for the relationship between justice and healthcare. By defining the legitimate end of healthcare as a return to normal functioning, Daniels distinguishes between so-called “treatment” and “enhancement.”[26] According to Daniels, Rawls’s principles of justice demand a distribution of healthcare so that “treatment” is made available subject only to the limits of resources, whereas “enhancement” need not be made available at all. Daniels objects to the idea of healthcare institutions distributing “enhancements,” observing that “medicine has the role of making people normal competitors, not equal competitors.”[27]

The concept of normal functioning is keyed off the same principle as Rawls’s category of “natural primary goods”: the so-called natural or genetic lottery.[28] According to Rawls, the difference principle essentially states that natural primary goods are “common assets” in which all should share fairly. In other words, to the extent that some are more favored by the natural lottery in their talents and abilities, the resulting inequalities are just only to the extent that individuals possessing those talents and abilities contribute to improve the lot of the least so favored.[29] The range of life-prospects possible in the natural lottery is the same concept as the range of normal functioning, to which Daniel’s argues healthcare ought to seek to return the diseased and disabled. Provided the second principle of justice is observed, the domain of normal functioning may contain a wide and divergent range of life-prospects. Both Rawls and Daniels thus seem to agree that the principles of justice do not mandate that healthcare resources be arranged in such a way as to equalize the distribution of natural primary goods. Put differently, the principles of justice demand the fair distribution of “treatment,” whereas there is no such requirement for “enhancement.”[30]

Daniels admits that certain “hard cases” test the validity of the treatment/enhancement distinction.[31] As an example, he offers the hypothetical case of two 11-year-old boys: Johnny and Billy. Johnny suffers from a brain tumor that inhibits his production of human growth hormone, the result of which is a maximum predicted adult height of five feet and three inches. Billy, on the other hand, has two extremely short parents whose height-related genes he has inherited, the result of which is a maximum predicted adult height of five feet and three inches. In a society that puts a premium on height, both Johnny and Billy will be equally disadvantaged by their short stature.[32] How, then, can the principles of justice require “treatment” of Johnny’s tumor but not the “enhancement”—perhaps by way of artificial human grown hormone—of Billy’s equally disadvantageous predicted height?

Daniels offers no satisfactory response to the apparent arbitrariness of the treatment/enhancement distinction illustrated by the hard case. “[T]here is justification for adhering to a distinction that captures and sustains social agreements on important matters,” Daniels ambiguously argues, “even if that distinction seems arbitrary in isolated hard cases.”[33] But the “isolated hard case” that Daniels offers is deceiving. While height is certainly a variable in the normal functions model, it is not likely a “natural primary good.” Primary goods are, by definition, “things that every rational man is presumed to want.”[34] While there undoubtedly exists a societal prejudice favoring height, this is not to say that every rational person wants to be tall. There are a number of reasons that a more modest stature might be preferable to a taller one: convenient entry and egress though doorways, for example.[35] It would seem, then, that Rawls’s natural primary goods are a strict subset of Daniel’s range of normal functioning: natural primary goods are always within the range of normal functioning (by virtue of their being natural), but many characteristics that comprise the range of normal functioning are not natural primary goods (by virtue of the fact that reasonable persons can disagree as to whether or not they are desirable).

This discordant relationship between the range of normal functioning and natural primary goods complicates the treatment/enhancement distinction. Moreover, consideration of a “hard case” wherein the normal functioning characteristic in question is also a natural primary good undercuts Daniel’s conclusion that Rawls’s principles of justice do not warrant “enhancements.” Consider one case of overlap between the two concepts: health—more specifically: health in the shadow of aging. Despite the fact that “[p]athological or morbid changes are often the sole criteria by which age is assessed in the human body,” aging is not considered by medical science as a disease in itself. Aging is considered a normal or natural process of the human body: it falls within the range of species-typical functionality for humans.[36] The symptoms of aging however are indistinguishable in kind or degree from pathology, for example cancer or atherosclerosis: our bodies lose functionality in what is often a painful process.[37] Moreover, “[a]ging itself produces the same ultimate consequences as . . . diseases—death.”[38] Daniels’s normal function model nevertheless would not consider the wearing out of our bodies through the aging process as “departures from species-typical normal functional organization or functioning.”[39] Extreme efforts aimed at forestalling or ameliorating the aging process—by way of genetic engineering or cybernetic augmentation, for example—thus fall squarely on the enhancement side of the alleged divide. According to Daniels, considerations of justice do not compel that social resources be distributed so as to provide these procedures to the aging.[40]

Were the effects of aging produced by some societal factor—say pollution concentrated in an economically disadvantaged community—rather than a “natural,” biological one, Rawls’s principles of justice would compel a different conclusion. Rawls is explicit that the difference principle “holds that in order to treat all persons equally, to provide genuine equality of opportunity, society must give more attention to those . . . born into the less favorable social positions.”[41] Daniels would most certainly agree with this conclusion. But why does the source of the unhealthy condition determine whether or not the principles of justice compel distributing society’s resources in such a way as to alleviate it?

The distinction here does not appear to express a legitimate dictate of the principles of justice. Rather, it instead implies some other underlying assumption, namely: the fact that until recent times it has not been possible to radically extend the human lifespan. Because we have accepted aging and subsequent death as “natural,” there is an intuitive resistance to “interfering” with it, at least by the extreme measures contemplated here.[42] This same underlying assumption is reflected in the fact that Rawls saw fit to split primary goods into two categories. While his principles of justice presume that the “basic structure of society distributes certain primary goods,” Rawls recognizes the primary goods being distributed are social primary goods. Although the possession of natural primary goods “is influenced by the basic structure [of society],” he concludes, “they are not so directly under its control.”[43] While this assumption is historically factual, evolving human enhancement technologies increasingly allow more direct control over these natural primary goods.[44] Human enhancement technology thus represents the transformation of many natural resources into social ones.[45]

Put differently, where once there was only the genetic lottery, we now find a genetic supermarket. The question becomes: what do Rawls’s principles of justice have to say regarding the distribution of these newly-social resources? Daniels, as described above, would still interpose his concept of normal functioning between citizens and society’s institutions of healthcare, forbidding them access to “enhancement.” This argument falters, however, in the case of human enhancement technologies that directly or indirectly augment primary goods.[46]

Primary goods are those things that by definition every rational person would want, irrespective of their particular conception of good. Within Rawls’s framework, it would thus be irrational per se to refuse them. Rawls himself gives credence to this view when, in his revised edition of A Theory of Justice, he writes “in the original position . . . the parties want to insure for their descendants the best genetic endowment . . . [t]he pursuit of reasonable policies in this regard is something that earlier generations owe to latter ones.”[47] This implication is not novel to Rawls’s revised work; the difference principle has always contained the concept that “inequalities of birth and natural endowment are undeserved, [and thus] these inequalities are to be somehow compensated for.”[48]

This line of argument does not compel the conclusion that all human enhancement technologies that serve to alter the genetic endowments of latter generations are warranted. Instead, Rawls’ principles of justice demand only that healthcare resources be arrayed in such a way as to provide for the fair distribution of those technologies that can directly or indirectly (by aiding in their acquisition) augment primary goods.[49] There is still a distinction to be drawn, though it is unrelated to Daniels’s treatment/enhancement typology. On the one hand, there are technologies that enhance primary goods such as health, intelligence, and imagination. On the other hand, there are technologies that enhance non-primary goods—goods that are preferred by some, perhaps by way of culture or other bias, but would not be rationally preferred by all—such as skin color, eye color, or sex.[50] Following Rawls’s second principle of justice provides a strong argument that the social machinery of healthcare ought to fairly distribute the former (but not the latter) type of enactments among members of society.[51] Daniels and collogues concede as much in their later work From Chance to Choice: Genetics and Justice, concluding that “[i]nterpreted in this way, there is no reason to think that Rawls’s account or Daniel’s extension of it to health care would rule out sometimes being obliged to use genetic technologies to alter the distribution of talents and skills.” “The Rawlsian reconciliation between equality and efficiency, even if it captures the general case,” they reason, “will not justify treating the natural baseline as if it is an uncrossable boundary.”[52]

II. Personal Ethics and Human Enhancement

To respond to the question of how societies are to justly distribute their resources, Rawls’s principles of justice seem to provide a strong argument in favor of the distribution of human enhancement, subject only to the limits on resources that similarly constrain the distribution of treatment. At the individual level of analysis, however, Rawls’s notion of justice fails to capture the complexities that surround the question of human enhancement. This is not surprising, given that the confessed subject of A Theory of Justice is “the basic structure of society,” and not personal ethics.[53] Accordingly, a separate set of principles is needed to begin to answer the question whether it is permissible for an individual to subject themselves or their progeny to enhancement technologies.[54]

In Practical Ethics, Peter Singer articulates an ethical framework from which it is possible to address many of the individual—as opposed to the social—issues raised by human enhancement technologies.[55] Singer derives the central tenant of his system of ethics from the factual observation that “it is simply not true that all humans are equal.”[56] “Equality,” he argues, “is a basic ethical principle, not an assertion of fact.” Singer flatly denies Rawls’s efforts to “found[] equality on natural capacities.”[57] Rawls sees human equality as a fact—a sort of lowest common denominator shared equally by all humans. To illustrate this “range property” of human equality, Rawls uses the example of the set of points that inside a circle. Although the location of each point is different, they are all equally within the circle.[58] The specific “range property” that Rawls chooses as the factual basis for human equality is “the capacity for moral personality.”[59]

As with all purported universals, Rawls’s claim can be disproven by a single counterexample. The accident victim in a persistent vegetative state, for instance, is no less human—from the genetic or biological perspective—for his irreparable brain death. Nevertheless, he has no “capacity for moral personality” because he has no capacity for personality at all. Rawls would dismiss this and other counterexamples as outliers—a claim, though true, logically fails to rehabilitate his premise of factual equality.[60] As Singer keenly observes, “I doubt that there is any morally significant property that all humans possess equally.”[61] Without a substantive basis to ground a principal of equality, he approaches the question from a procedural perspective. Because “[t]here is no logically compelling reason for assuming that a difference in ability between two people justifies any difference in the amount of consideration we give to their interests,” Singer concludes that “the basic principle of equality [is] the principle of equal consideration of interests.”[62]

Singer’s utilitarian principle of equal consideration of interests holds that we ought to “give equal weight in our moral deliberations to the like interests of all those affected by our actions.”[63] All persons, though not equal in fact, all equally have interests—for example “the interest in avoiding pain, in developing one’s abilities, in satisfying basic needs for food and shelter, in enjoying friendly and loving relations with others, [or] in being free to pursue one’s projects without unnecessary interference from others.”[64] Unlike Rawls’s contractarian theory wherein the consent of the nonexistent or otherwise incapacitated person is assumed ex hypothesi, Singer is principally concerned with the actual interests of actual persons.

At first glance, it seems that Singer provides a ready means if disposing of questions relating to human enhancement: provided that the interests of everyone affected are considered equally, there is nothing ethically suspect about choosing enhancement over non-enhancement per se. This solution initially appears simplistic, given that “everyone affected” does not include any future children whose genetic endowment will be altered by the procedure. Because future children do not have present interests, the argument runs, there is nothing to weigh against the interests of the presently living. The principle of equal consideration of interests merely requires that we total up the effects of the proposed human enhancement and equally consider the interests of everyone affected. If the balance rests in favor of the interests of the person seeking enhancement, that enhancement is ethically permissible.

But this is not the end of the story. One implication of Singer’s principle of equal consideration of interest is the ascension of a “quality of life ethic”—as opposed to a “sanctity of life ethic.”[65] Put differently, because the interests of future children do not count in the strict sense described above, Singer’s ethical framework permits—in fact welcomes—qualitative judgments about the lives potential children are likely to lead.[66]

Consider a hypothetical, safe procedure by which an individual’s intelligence could be doubled at little or no cost, and that trait would be heritable to his progeny. The first step in Singer’s ethical enquiry is to consider the interest of persons likely affected by the proposed enhancement. Obviously the interests of the person seeking enhancement—let’s call him Tommy—are implicated. So too are the interests of anyone with whom Tommy may come into competition in the future. Because the procedure will produce a doubling of his intelligence, he will gain a comparative advantage over his peers. But this comparative advantage does not outweigh his strong interest in enhancement—anymore than the comparative advantage of the likely intellectually gifted child of two intellectually gifted parents would be a reason against their procreating. Moreover, the miniscule cost of this procedure suggests it is widely available, most importantly to Tommy’s peers. Taken together, the balance of interests seems to favor Tommy undergoing the enhancement procedure.

The second step of Singer’s analysis takes account of the effect of Tommy’s procedure upon his future children. Prior to undergoing the procedure, Tommy’s children would have had a likely range of intelligence owing to Tommy’s (and his mate’s) unaltered genetic heritage. Given that the effects of the procedure are heritable, children born to Tommy after his enhancement would be similarly enhanced: they would be much likely to have significantly higher intelligence. Looking at the likely interests of these two potential children—one of enhanced intelligence, the other of ordinary intellect—the balance of interests again rests with enhancement. All other things being equal, the potential child with greater intelligence will be more likely to live a happy, fulfilling life than the potential child of average intelligence.

Happiness and fulfillment are precisely the interests central to Singer’s principle of equal consideration of interests. As noted above, however, the interests of potential children do not count in the strict sense. This analysis therefore does not produce the ethical imperative that Tommy seek enhancement so as to improve the lot of his children. Instead, it demonstrates why considerations of future children do not in and of themselves provide a ground for opposing enhancement.

Singer’s principle of equal consideration of interests suggests at the very least a strong argument against restricting human enhancement technologies. Citing fellow utilitarian John Stuart Mill, Singer argues that “the state is justified in interfering with its citizens only to prevent harm to others.”[67] Assuming that research produces human enhancement technology similar to the kind suggested in the above hypothetical, it would not pose harm to anyone.[68] The state would therefore not be justified in acting to restrict access to such technology.[69]

In the final analysis, one thing is certain: humanity stands upon the threshold of a brave new world. Applying Singer’s principle of equal consideration of interests, a compelling argument emerges against state restrictions on safe enhancement procedures. Moreover, Rawls’s theory of justice provides a strong foundation for the conclusion that the demands of justice require that certain enhancements be distributed fairly among all members of society. Taken together, analysis of the personal and social implications of human enhancement technology suggests an important role for human enhancement if our posthuman future is to be a just one.

[1] K. Mark Smith, Saving Humanity?: Coutnter-arguing Posthuman Enhancement, 14 J. of Evolution and Tech. 43 (2005).

[2] Nicholas Agar, Whereto Transhumanism?: The Literature Reaches Critical Mass, Hastings Center Report, May-Jun. 2007, at 12, 12 (describing posthumans as “future beings whose basic capacities so radically exceed those of present humans as to no longer by unambiguously human by our current standards”) (internal quotations omitted).

[3] Françoise Baylis & Jason S. Robert, The Inevitability of Genetic Enhancement Technologies, 18 Bioethics 1 (2004). “[I]n our view, [the] development and use [of genetic enhancement technologies] is inevitable, not simply because of capitalist forces (though there are by no means inconsequential), or because of heedless liberalism (which surely plays a role), or because of a natural desire for knowledge (which is also a significant consideration), or because of a natural or fostered desire to outperform (which, too, is partly explanatory), but also because this is our destiny chose by those among us who are intent on achieving self-actualization by controlling the human evolutionary story.” Id. at 25.

[4] John Rawls, A Theory of Justice 7 (1971)

[5] Id. at 5.

[6] Id. at 12.

[7] Id.

[8] Id.

[9] Id. at 13.

[10] Id.

[11] Id. at 60.

[12] Id. at 83.

[13] Id. at 62.

[14] Id.

[15] Id.

[16] Id. at 100-101.

[17] Id. at 100 (citing Herbert Spiegelberg, A Defense of Human Equality, 53 Phil. Rev. 101, 113-123 (1944) and D.D. Raphael, Justice and Liberty, 51 Proc. Arist. Soc’y 167, 187 (1951)).

[18] Id. at 100-101.

[19] See, e.g., Norman Daniels, Just Health Care (1985); Norman Daniels, The Genome Project, Individual Differences, and Just Health Care, in Justice and the Human Genome Project 111 (Timothy Murphy and Marc A. Lappé eds., 1994); Allen Buchanan, Dan W. Brock, Norman Daniels, & Daniel Wikler, From Chance to Choice (2000).

[20] Daniels, The Genome Project, supra note 19, at 118.

[21] Id.

[22] Daniels, The Genome Project, supra note 19, at 118; Daniels, Just Health Care, supra note 19, at 27-28.

[23] Daniels, Just Health Care, supra note 19, at 33 (emphasis in original).

[24] Daniels, The Genome Project, supra note 19, at 118

[25] Daniels, Just Health Care, supra note 19, at 35(emphasis added).

[26] Daniels, The Genome Project, supra note 19, at 122.

[27] Id. (emphasis added).

[28] See David B. Resnick, Genetic Engineering and Social Justice: A Rawlsian Approach, 23 Soc. Theory & Prac. 427 (1997) (discussing role of “natural lottery” in Rawls’s theory).

[29] Rawls, supra note 4, at 100-101.

[30] Daniels, supra note 19, at 120-27.

[31] Id. at 122-23.

[32] Id.

[33] Id. at 126.

[34] Rawls, supra note 4, at 83.

[35] Fritz Allhoff, Germ-Line Genetic Enhancement and Rawlsian Primary Goods, 15 Kennedy Inst. of Ethics J. 39, 51 (2005) (observing that “[a]lthough height helps basketball players, it can be inconvenient with respect to entering doorways, physiological strains, and unwanted attention.”).

[36] Arthur L. Caplan, Death as an Unnatural Process, 6 Science & Soc. S72, S73 (2005) (asking “[w]hy is it wrong to seek a cure for aging?”).

[37] Id.

[38] Id.

[39] Daniels, supra note 19, at 122. Daniels argues that “[e]nhancement does not meet a medical need even where the service may correct for a competitive disadvantage that does not result from prior choices.” Id. Aging is a prime example of such “a competitive disadvantage that does not result from prior choices.” Id.

[40] Id. at 127.

[41] Rawls, supra note 4, at 100-101.

[42] See Nils Holtug, Does Justice Require Genetic Enhancements?, 25 J. of Med. Ethics 137, 141 (1999) (concluding that the treatment/enhancement distinction “is intended to capture some important moral intuitions . . . that treating is inherently more important [than enhancement].”).

[43] Rawls, supra note 4, at 83.

[44] Resnick, supra note 26.

[45] Id.

[46] Allhoff, supra note 33, at 50.

[47] Rawls, A Theory of Justice 92 (rev. ed. 1999).

[48] Rawls, supra note 4, at 100-101.

[49] Alhoff, supra note 33, at 50-51.

[50] Id. at 51.

[51] Holtug, surpa note 40, at 142 (explaining “that a plausible and influential line of reasoning that supports compensating people who have severe diseases because of their misfortune in the genetic lottery also speaks in favor of genetic enhancements.”).

[52] Daniels et al., supra note 19, at 129.

[53] Rawls, supra note 4, at 7.

[54] In the following argument, it is assumed there is no difference between subjecting oneself to enhancement and subjecting one’s progeny to enhancement. Although there are important distinctions to be drawn given the various kinds of human enhancement technology (cybernetic augmentation versus germ-line genetic enhancement), they are irrelevant for the purposes of the present theoretical argument.

[55] Peter Singer, Practical Ethics (2d ed.1993).

[56] Id. at 17.

[57] Rawls, supra note 4, at 508.

[58] Id.

[59] Id. at 505.

[60] Id. at 506.

[61] Singer, supra note 54 at 19 (emphasis added).

[62] Id. at 20-21.

[63] Id. at 21.

[64] Id. at 23.

[65] See, generally, Peter Singer, Rethinking Life and Death (1994) (arguing in favor of a quality of life ethic).

[66] See Peter Singer, Foreword: Shopping at the Genetic Supermarket, in The Ethics of Inheritable Genetic Modification: A Dividing Line? xxv (John E. J. Rasko, et al., eds., 2006).

[67] Id.

[68] Whether or not efforts to develop safe and inexpensive technology of this kind will bear fruit is an open question. The answer is however irrelevant to the foregoing theoretical argument.

[69] See Singer, supra note 58, at xxv (concluding “[t]here are strong argument against state interference in reproductive decisions, at least when those decisions are made by competent adults.”).

reveal to you your child’s Inborn Talent Genetic Test results you will have the unique DNA knowledge to make clear and correct decisions. You can use the results to know exactly what you need to do make the right decisions about your child’s future!

Is your child the next Einstein, Bill Gates, or Tiger Woods?  As the MyGeneProfile ramshackle website proclaims: “Knowledge is Power.”  Unfortunately, the knowledge in question is pure fiction, and the power is being exerted over the unsuspecting and ill-informed consumer.  Even in the fantasy worlds of science fiction the claims propounded by this company would be suspect.  Here and now, it is nothing more than molecular snake oil.  But it must be remembered that there was once a real market for snake oil.  The Genetic Absurd is thus the clash between the human search for meaning in our genome and our inability to find meaning there.  While this instance is so far removed from the reality of molecular biology that it would be a riotous joke—that is, if people weren’t spending their money on its illusory promises.

As more and more studies show, the gap between our individual genetic "code" and our health isn’t getting much smaller—certainly not at the rate you’d expect given the vast sums of money private enterprise has dumped into the so-called "new" personalized medicine.  I’d be surprised if this graph didn’t also approximate the profit forecasts for some of the country’s biggest pharmaceutical companies.  Having invested countless billions in recent years, it’s going to take more than an upside down trend in computing hardware and some fancy gene sequencers to make healthcare any more personal than it already is.

In every system of morality, which I have hitherto met with, I have always remark’d, that the author proceeds for some time in the ordinary ways of reasoning . . . when all of a sudden I am surpriz’d to find, that instead of the usual copulations of propositions, is, and is not, I meet with no proposition that is not connected with an ought, or an ought not. This change is imperceptible; but is however, of the last consequence.[1]

Rather, the Naturalistic FaPut differently, Hume keenly observes that a statement of fact about the way something is tells us nothing about the ethical question how it ought to be. It follows that any such ethical claim must be supported by independent reasons. In short: ought cannot follow from is. While this is generally described as the Is-Ought Problem, it is also referred to somewhat incorrectly as the Naturalistic Fallacy.

Rather, the Naturalistic Fallacy was express by G. E. Moore in his 1903 book Principia Ethica, in which he observes that “far too many philosophers have thought that when they named . . . other properties they were actually defining good; that these properties, in fact, were simply not ‘other,’ but absolutely and entirely the same with goodness.”[2] In other words, Moore stated that the Naturalistic Fallacy is committed whenever one attempts to prove a claim about ethics by appealing to a definition of the term “good” in terms of one or more natural properties (such as “pleasant,” “more evolved,” “desired,” &c.)—to wit: things that may well themselves be good, but cannot thus serve as a definition of good.

Despite the centuries that separate Moore and Hume from our world of rapidly-advancing biotechnology, their incisive observations bear heavily on at least one strand of argument that appears perennially in the bioethical discourse: the Argument from Nature. This argument proceeds as follows: X is immoral because X is unnatural and/or contrary to nature. This can be said to be a superficially vacuous argument for it merely begs the question what is natural; it requires a definition of nature.

This is not at all an easy proposition. In his discussion of the etymology of the term, Raymond Williams remarked that “[n]ature is perhaps the most complex word in the language.”[3] This is so in no small part because the term (and its antonym) has a multitude of meanings, the five principal usages being: (1) that which is natural is good; (2) the use of an organ or instrument in a manner consistent with its primary purpose or function is natural; (3) that which is common or normal is natural; (4) that which is not artificial is natural; and (5) that which is in accord with the descriptive laws of nature is natural.[4]

It takes no great effort to show why all of these definitions fail to lend substance to the Argument from Nature. Examining the first definition, it is easy to see that it is mere tautology. The last definition is equally unavailing for the opposite reason: by including everything that conforms to the descriptive laws of nature, it leaves nothing left that is unnatural.[5] One might point out that human understanding of the descriptive laws of nature have changed though time and thus something that was once prohibited by those laws is now permitted by them.[6] It is quite obvious that in such case it is our understanding of the descriptive laws of nature—not the laws themselves—whose revision permitted this hypothetical pseudo-transgression.

Looking to the second definition of the natural, one must immediately realize (1) that not all objects have a primary purpose or function, and (2) that to use those objects that do have such purposes or functions in some way contrary to them necessitates no ethical turpitude. One must ask questions like, “what is the primary function of the Moon?” or “what is the purpose of a tree?” Such things can be said to have many functions, but there is no principled means of distinguishing which among them are the primary ones—thus no basis for making the kinds of moral judgments the Argument from Nature demands. As regards the second kind of thing—those that assuredly do have primary purposes or functions—it does not follow that use contrary thereto is ethically suspect. The primary purpose of a hammer is to hammer nails. But were one to use that hammer to prop open a door on a breezy summer day, one would not say that this is an unnatural or immoral act.[7]

To assert that that which is natural is merely a normative claim—that the ordinary or normal is coextensive with the natural—invokes an unprincipled relativism that cannot stand as any ethical precept: for what is normal and ordinary in one place and time is abnormal and extraordinary in another.

To understand the fallacy at the heart of the artificial/natural distinction it must be kept in mind that our aim is to provide substance to the Argument from Nature. While that which is artificial is—more or less—readily distinguishable from that which is natural, that distinction nevertheless offers no definition of the natural that salvages the Argument from Nature. Hurricanes are certainly natural, but one could not say that they are good. Vaccines are certainly unnatural, but one could not say that they are bad. Ultimately, no concept of nature or the natural can save the Argument from Nature from succumbing to both Hume’s Is-Ought problem as well as Moore’s Naturalistic Fallacy. The facts of nature merely are, and have no bearing on how anything ought to be. To say that that which is natural is good under any of the above definitions completely abjures the precise ethical question at the heart of our inquiry: what is good and what is immoral and how do we know it is so?

Thus, any claim that seeks to equate morality with some state of affairs described as natural must be taken with the sharpest skepticism. In the final analysis, it seems the more prudent course to avoid the Argument from Nature entirely: to be against nature—within the context discussed here. As Hume further observed:

For as this ought, or ought not, expresses some new relation or affirmation, ’tis necessary that it shou’d be observ’d and explain’d; and at the same time that a reason should be given; for what seems altogether inconceivable, how this new relation can be a deduction from others, which are entirely different from it.[8]

In other words, to make an ethical claim whether or not some thing or action is proper or moral, one must supply independent reasons for that claim and not rely on the Naturalistic Fallacies.

[1] Philosophers Speak for Themselves: Berkley, Human, and Kant 247 (T.V. Smith & Marjorie Grene eds., 1957) (emphasis in original).

[2] G.E. Moore, Principia Ethica 10 (1st Ed. Reprinted 1959) (1903).

[3] Raymond Williams, Keywords: A Vocabulary of Culture and Society 219 (2d ed. 1985).

[4] Burton M. Leister, Is Homosexuality Unnatural?, in The Right Thing to Do: Basic Readings in Moral Philosophy 144, 145-151 (James Rachels ed., 2003); for a more extended discussion of Leister’s typology of nature, see Ch. 3, Dennis R. Cooley, Technology, Transgenic, and a Practical Moral Code (2010).

[5] This is of course excepting the supernatural—a topic no rational person need address.

[6] For example consider the incompatibility of Newtonian mechanics with Einsteinium special relativity. The former mandates the fixed passage of time whereas the latter mandated its variability with relative velocity. To say that an object traveling at relativistic velocities prior to Einstein’s discovery of special relativity violated the Newtonian laws of nature is logically absurd—predicated, as it is, on mere semantics rather than science or reasoning.

[7] Leister at 149.

[8] Philosophers Speak for Themselves at 247.

It is useful to attempt to draw a distinction between what it is that a term denotes and what it connotes. What it is that a word denotes is “a certain set of things in the world which it stands for and points to.” What it connotes, on the other hand, refers to “a set of feelings and associations which it arouses in the people who use it.” [2] For example, “home” denotes “the place where a person (or family) lives,” but also connotes “such things as warmth, intimacy, security, comfort, familiarity, and peace.” “In ordinary discourse,” it can be said, “connotative meanings are projections beyond denotative meanings.” [3]

The metaphor at the heart of this claim—the equation of meaning with physical space—hints at the deeper connection between these two types of meaning. One is liable to find both denotative and connotative senses of a term in a dictionary, though definitions of the former type will often outnumber those of the latter. But the example on point “suggests that connotations may have an effect on denotations, that what is more or less vaguely suggested by a word may in time affect the meaning of the word itself.”[4] Home has indeed come to signify a place of peace and warmth, not simply where someone lives. The progression from the concrete to the figurative, with the latter shifting from the connotative to the denotative over time, is a core process in the evolution of language. Linguistics teaches that words have a so-called “core meaning,” which in many cases is its oldest and most common meaning. As usage shifts through time, however, there are examples where the oldest, literal sense is less frequent than the figurative one.[5] This is true of the word synthesis.

The principal English sense of the word synthesis is “[t]he putting together of parts or elements so as to make up a complex whole.”[6] The primary usage of its adjectival form synthetic, however, is in the sense of “artificial” or “man-made.” Synthesis derives via Latin from the Greek σύνθεσις, meaning “a putting together, composition, [or] combination.”[7] The Greek σύνθεσις is a derivative of συντίθημι, from which also comes the closely-related cognate σύνθετος “put together, compounded of parts, composite.”[8] Moreover, σύνθεσις is itself a combination of σύν “with, along with, together,”[9] and θεσις, a derivative of τίθημι “to set, put, place,”[10] meaning “a setting, placing”[11] or “putting.”[12] Through a secondary definition σύν carries the implication of a “necessary connexion [sic],” and often applies to “things that belong, or are attached, to a person.”[13]

It is with these latter senses that the term entered Latin as synthĕsis, which means “a putting together of several things . . . which belong together,”[14] or “[a] set of matching articles,”[15] especially “a suit of clothes.”[16] Suetonius writes that Nero often wore “synthesinam indutus ligato circum collum sudario prodierit in publicum sine cinctu et discalciatus.”[17] In Liber Medicinalis, however, Serenus Sammonicus calls a compound of pennyroyal and anise an effective composite or synthesis.[18] He later employs the term a second with the same meaning:

Antidotos vero multis Mithridatia fertur
consociata modis; sed Magnus scrinia regis
cum raperet victor, vilem deprendit in illis
synthesin et vulgata satis medicamina risit,
Bis denum rutae folium, salis et breve granu
iuglandesque duas, tereti tot corpore ficus.[19]

When Mithridates VI, King of Pontus, fell to Pompey’s Army in 63 BCE, “the medicine found in his casket was worthless,”[20] Sammonicus relates, it was only “a cheap mixture” (synthesin et vulgata).[21] The term carried this second sense, especially in medical discourse, into Medieval Latin.[22]

At the turn of the 17^th Century when the term entered English in the context of philosophy, its meaning had shifted toward the figurative. In 1653, Thomas Hobbes wrote that synthesis is reasoning “from the first causes of [a] construction, continued through all the middle causes till we come to the thing itself which is constructed or generated.”[23] In other words, as noted, synthesis is a method of reasoning that runs from general principals to specific cases, from complex systems to their constituent parts. At first blush this may seem contrary to the Greek roots of the word, wherein individual parts are combined to become a σύνθεσις. This is not the case. In Plato’s Phædo, Socrates asks: “Ἆρ᾽ οὖν τῷ μὲν συντεθέντι τε καὶ συνθέτῳ ὄντι φύσει προσήκει τοῦτο πάσχειν, διαιρεθῆναι ταύτῃ ᾗπερ συνετέθη?”[24] Socrates’ question turns on the connection between συνθέτῳ, that which is put together, and διαιρεθῆναι, that which is taken apart. Here is Hobbes’s notion of reasoning by synthesis: the interrelation between a whole and its parts—one causally following from the other—permits one to reason from the former to the latter.[25]

Hobbes’s classical definition of synthesis—which accords with one of the two fundamental methods—is no longer the principal usage of the word, especially in its adjectival form synthetic. It was not until the 19^th century, with the explosion of the science of chemistry, that synthesis acquired its most common modern meaning. In the context of chemical synthesis, “[t]he formation of chemical compounds from more simple compounds” or elements, that meaning of synthesis shifted toward its Greek cognate σύνθετος, “compounded of parts.”[26] As chemists produced increasingly “new” compounds, the term synthetic came to describe the product of their efforts: that which was produced by man. Many of these “new” compounds were not to be found in nature. Their creation was, in this sense, unnatural—a term that had meant abnormal and monstrous since medieval times. Hence the modern usage and connotation of synthetic: the figurative “projection” of the concept of chemical synthesis onto the realm of all human artifice.

While the roots of unnatural’s monstrous meaning are beyond my scope, it is likely this association between the synthetic and the unnatural that lies at the root of the negative connotation synthetic presently carries. The West’s shared cultural iconography of unnatural life is literally dominated by a monster: the creature created by Dr. Frankenstein. This powerfully image brings to life the metaphoric linkage between synthetic (or man-made) and unnatural (or monstrous). But does one follow the other? Is the synthetic (read artificial) just another species of the unnatural (read ethically-suspect)? Or is it possible to rehabilitate the primary, methodological meaning of synthetic in the biological context?

[1] John Stuart Mill, Three Essays on Religion: Nature, the Utility of Religion, and Theism 4 (3d ed. 1885).

[2] John C. Sherwood, Discourse of Reason: A Brief Handbook of Semantics and Logic 4 (1964).

[3] Harold C. Martin & Richard M Ohmann, The Logic and Rhetoric of Exposition 24-25 (rev. ed. 1965).

[4] Id., at 26 (internal quotations omitted).

[5] Murray Knowles and Rosamund Moon, Introducing Metaphor 11-12 (2006).

[6] OED (online 2010?)

[7] Henry G. Liddell & Robert Scott, A Greek-English Lexicon 1492 (1897).

[8] Id., at 1493.

[9] Id., at 1470.

[10] Id., 1552. The Greek τίθημι is a descendent of Indo-European root *dhê- “to put, place, set,” with cognates including Latin faciō, Sanskrit दधाति (dádhāti), and Old English dōn (English do, deed, and doom). Semantically, the root means to establish something in its place: “the strict sense of *dhê- is to put, in a creative way, establish in existence, and not simply to leave an object on the ground.” Emile Benveniste, Indo-European Language and Society 381 (Elizabeth Palmer trans., 1971) (internal quotations omitted); Monier Monier-Williams, A Sanskrit-English Dictionary 513 (1964).

[11] Lidell & Scott, supra note 11, at 671.

[12] Id., at 671; Walter W. Skeat, An Etymological Dictionary of the English Language 620 (2898).

[13] Lidell & Scott , supra note 11, at 1470.

[14] A New and Copious Lexicon of the Latin Language 877 (F.P. Leverett ed., new ed. 1853).

[15] The Oxford Latin Dictionary (P.G.W. Glare, ed., 1982).

[16] D. P. Simpson, Cassel’s Latin Dictionary 591 (1968). For an extended discussion of synthesis as a garment worn in classical times, see Ethel Hampson Brewster, The Synthesis of the Romans, 49 Transacs. and Procs. of the Am. Philological Ass’n 131 (1918).

[17] Suetonius [Nero 51] 180 (J.C. Rolfe trans., 1920). Nero “generally appeared in public in a dining robe, with a handkerchief bound about his neck.” Id. at 181.

[18] Serenus Sammonicus, Liber Medicinalis, in Poetae Latini Minores 103, 133, [L. 572-73] (Aemilius Baehrens ed., 1881) (“Puleiumve potens et agreste iugatur anethum: / synthesis haec prodest unda mollita calenti.”)

[19] Sammonicus, supra note 22, at 156 [L. 1061-1066].

[20] Normal Moore, The History of the Study of Medicine in the British Isles 27-28 (1908).

[21] “Mithridatium, afterwards called Theriaca, contained opium. It began with thirty-eight ingredients, then had fifty-three, and later still seventy five, and continued to be made and prescribed long after the identify of many of its ingredients had been lost.” Id. at 28.

[22] Revised Medieval Latin Word-List from British and Irish Sources 473 (R.E. Latham ed., 1965).

[23] The English Works of Thomas Hobbs 312 (William Molesworth, ed., 1839).

[24] Plato 272 [78c] (Harold N. Fowler trans., 2005). “Now is not that which is compounded and composite naturally liable to be decomposed, in the same way in which it was compounded?”

[25] Describing Egyptian custom regarding swine, in Book II, Chapter 47 Herodotus observes that “ἐπεὰν θύσῃ, τὴν οὐρὴν ἄκρην καὶ τὸν σπλῆνα καὶ τὸν ἐπίπλοον συνθεὶς ὁμοῦ κατ᾽ ὦν ἐκάλυψε πάσῃ τοῦ κτήνεος τῇ πιμελῇ τῇ περὶ τὴν νηδὺν γινομένῃ, καὶ ἔπειτα καταγίζει πυρί” [“[T]he sacrificer lays the end of the tail and the spleen and the caul together and covers them up with all the fat that he finds around the belly, then consigns it all to the fire.”] Here, even in its most literal form, συντίθημι refers to parts of a constituent whole: the organs of the swine to be sacrificed. Herodotus 334-35 (A.D. Godley trans., 1975).

[26] A Dictionary of Chemistry; See note 12.

The finding that adding Alzheimer’s-risk genes to plain old age, sex, and apoE [another gene associated with AD] status does not improve the accuracy of disease prediction seems to defy everything the public is being told about the dawn of a new era of personalized medicine, in which knowing our genomes will tip us off about what diseases we are most at risk for.

Commenting on the same study, an editorial in the same issue of JAMA questioned

. . . the value of continued attempts to find genetic effects of diminishing importance remains uncertain.  Important questions are whether these small effect sizes have any value in understanding disease pathogenesis and what truly are the clinical implications of this line of study?

While many today tout the predictive ability of genome-wide analysis (so-called genomics), findings like those of Seshardi and collogues stand as a sobering reminder that, as geneticist David Altschuler of Harvard Medical School put it, such prognostications are “overhyped.”  It is important to remember that genes alone do not determine the course of our lives—that countless other factors, both biological and environmental, impact our chances for developing this or that disease.  Relying on oversimplified gene-disease associations as the basis for predictive models sets a dangerous president—especially in an age when genetic tests are marketed directly to consumers.

This situation raises the important issue of autonomy in patient decision making.  The facts of the present case are clear cut: it was a gross violation of the autonomy of the women in question, all other things being equal.  But what if they had been men rather than women; perhaps men for whom there was reasonable cause to believe had engaged in a knowing pattern of unsafe sex while HIV positive?  At what point does the often-unquestioned line of patient autonomy yield to larger, public health concerns?

There is no question that what the Namibian health services did to these woman was abominable.  But this is an easy case.  Had the fact been less clear-cut, would our ethical precepts lead us to the same result: the trumping of patient autonomy of all other concerns?

Also, check out my organization’s blog: the Council for Responsible Genetics Gene Watchdog!