12. Bioethics and Human Enhancement

Genetic Engineering and CRISPR; Human Augmentations; Neuroethics and Brain-Computer Interfaces; Biotechnology; Cloning

From the earliest days of recorded history, humans have striven to overcome injury, disease, and the limitations imposed by nature. Ancient civilizations developed rudimentary forms of medicine, using herbal remedies, ritualistic healing, and early surgical techniques to treat wounds and illnesses. Over centuries, the figure of the healer evolved into the professional doctor, as societies formalized the study of anatomy, pharmacology, and hygiene. The establishment of medical institutions and the codification of ethical standards, such as the original Hippocratic Oath as well as the current versions as it has evolved over the years, marked significant milestones in the professionalization of medicine. These advancements, coupled with improvements in sanitation, nutrition, and public health, contributed to dramatic increases in birth rates and steadily rising life expectancies across much of the world.

In the modern era, the fusion of medicine and technology has ushered in a new age of diagnostics and treatment. Innovations such as magnetic resonance imaging (MRI), robotic-assisted surgery, gene sequencing, and targeted therapies have become accessible – and even commonplace – in many developed regions. These breakthroughs have enabled earlier detection of disease, more precise interventions, and improved outcomes for patients. Technologies like wearable health monitors, telemedicine platforms, and personalized medicine are reshaping the patient experience, making healthcare more efficient and, in some cases, more equitable. Yet, these advances are not uniformly distributed, and significant disparities in access to care persist both within and between nations.

Today, the frontier of technology and human biology is rapidly expanding beyond traditional treatment. Emerging capabilities in genetic engineering allow for the possibility of designing offspring with selected traits, raising profound ethical questions about autonomy, consent, and the very definition of humanity. Human augmentation – whether through biological enhancements, neural interfaces, or hybrid bio-robotic systems – challenges our understanding of ability, identity, and fairness. Cloning and advanced biotechnologies further blur the boundaries between natural and artificial life. These developments amplify longstanding issues of ethics and equity, as access to cutting-edge interventions often remains limited by socioeconomic status, geography, and policy. As we look to the future, society must grapple with how to ensure that the benefits of bioethical innovation are shared broadly, while safeguarding individual rights and addressing the risks of deepening inequality.

Genetic Engineering and CRISPR

For millennia, humans have shaped the natural world through selective breeding and cross-breeding, long before the discovery of DNA or the advent of modern biotechnology. Early agriculturalists learned to cultivate plants and animals with desirable traits – such as higher yields, resistance to disease, or improved taste – by intentionally mating individuals that exhibited these characteristics. Hybridization, the crossing of different species or varieties, produced vigorous new crops like hybrid grains and apples, while grafting and cloning techniques allowed for the propagation of seedless fruits such as bananas and larger, juicier varieties of produce. The transformation of wild teosinte (a Mexican grass) into modern maize (corn) is a striking example of how traditional breeding practices could fundamentally alter a species over generations. Similarly, the development of hybrid corn in the early 20th century revolutionized agriculture by increasing crop productivity.

As scientific understanding deepened, especially following the discovery of DNA’s structure, genetic manipulation became more precise. By the mid-20th century, plant breeders were using radiation and chemicals to induce random mutations, further expanding the genetic toolkit available for crop improvement. The real turning point came in the 1970s, when researchers developed techniques to directly modify DNA – splicing genes from one organism into another, regardless of species boundaries. Early successes included the creation of recombinant bacteria and the first genetically modified plants, such as tobacco engineered for antibiotic resistance. In animals, transgenic mice paved the way for more complex genetic research and applications.

The mapping of the human genome at the turn of the 21st century marked a watershed moment, providing a comprehensive blueprint of human genetic information. This achievement set the stage for the development of CRISPR, a revolutionary gene-editing technology that allows scientists to precisely "cut and paste" sections of DNA within living organisms. Today, CRISPR is being used in a wide range of applications – from developing disease-resistant crops and livestock to exploring potential cures for genetic disorders in humans. Researchers are even investigating the possibility of resurrecting extinct species by editing the genomes of living relatives.

As we have done previously, let’s consider some ethical questions surrounding the concepts of genetic engineering:

• Who should decide which genetic traits are considered "normal," "desirable," or "disorders" when it comes to genetic engineering in humans, plants, or animals?
• Is it ethical to use gene editing technologies like CRISPR for human enhancement (such as increasing intelligence or physical ability), rather than solely for treating diseases?
• How can society ensure fair and equitable access to genetic engineering technologies, so that benefits are not limited to the wealthy or privileged?
• What are the potential long-term and unintended consequences of editing the human genome, given that changes could be passed to future generations who cannot consent?
• Should it be permissible to patent genetically engineered organisms, genes, or gene-editing techniques, and what are the implications for intellectual property, innovation, and access?
• How might widespread use of gene editing affect societal acceptance of people with disabilities or differences, and could it lead to new forms of discrimination or eugenics?
• What responsibilities do scientists and companies have to ensure transparency, informed consent, and environmental stewardship when releasing genetically engineered organisms into the environment?
• Is it morally acceptable to genetically engineer animals for human benefit, such as for food production or medical research, and what are the welfare considerations for these animals?
• Where should the line be drawn between therapeutic uses of genetic engineering and non-therapeutic, elective, or cosmetic applications?
• How should regulatory frameworks evolve to address the rapid pace of genetic engineering technology, especially given current ambiguities in law and policy?

Legal and ethical frameworks have struggled to keep pace with these rapid advancements. In the United States, it was once legal to patent isolated human genes, a practice that sparked significant controversy over ownership and access to genetic information. However, a 2013 Supreme Court decision ruled that naturally occurring human genes could not be patented, though synthetic DNA (cDNA) remains patentable. The legal landscape for genetic engineering in plants, animals, and humans remains ambiguous, with regulations varying widely by country and often lagging behind technological capabilities. This uncertainty raises pressing questions about equity, access, and the responsible use of genetic technologies as society moves deeper into the era of bioengineering.

Human Augmentations

Throughout history, humans have sought ways to restore lost function and even enhance their bodies, as evidenced by archaeological discoveries of ancient prosthetics and artificial enhancements. Remains from ancient Egypt reveal prosthetic toes dating back nearly 3,000 years, crafted from wood and leather, suggesting both practical and possibly symbolic purposes. In China, a 2,200-year-old man of modest means was discovered having a prosthetic leg made from poplar wood, ox horn, and horse hoof. This limb was designed to help its owner – who suffered from a fused knee – walk more easily. Similarly, in medieval Europe, prosthetic hands and legs have been unearthed, some simple and functional, others more elaborate, reflecting both the medical ingenuity of the time and the social significance attached to bodily integrity and appearance.

These early prosthetics were primarily functional, aiming to restore lost mobility or utility. However, some may have also served as markers of status, identity, or resilience, particularly when crafted with care or adorned with valuable materials. Over centuries, the evolution of prosthetic technology has mirrored advances in materials science, medicine, and engineering – from wood and metal devices fastened with leather straps to today’s lightweight carbon fiber limbs and sophisticated bionic prosthetics that can be controlled by neural signals.

Modern human augmentation has moved beyond mere replacement of lost function. Today’s prosthetics can not only restore, but also enhance, physical abilities – sometimes surpassing what is considered “normal” human performance. Athletes with advanced running blades, for example, challenge conventional definitions of ability and fairness. Neural implants, exoskeletons, and sensory enhancements are pushing the boundaries of what it means to be human, raising profound questions about identity, equity, and the future of human evolution.

Consider these ethical questions surrounding the topic of human augmentation:

• Should there be limits on augmentations that enhance abilities beyond the typical human range, such as strength, speed, or cognition?
• Who should have access to advanced augmentations – should they be available to all, or only to those who can afford them?
• Could widespread augmentation create new forms of inequality or discrimination between “augmented” and “non-augmented” individuals?
• How should society regulate the use of neural implants or brain-computer interfaces that could alter thought, memory, or personality?
• If a person replaces most or all of their biological body with artificial parts, are they still the same person – philosophically or legally?
• Should children be allowed or required to receive certain augmentations to compete or participate in society?
• What responsibilities do designers and manufacturers have if an augmentation malfunctions or is hacked?
• How might human augmentation affect the value society places on natural abilities or disabilities?
• Should employers or governments be allowed to require or incentivize certain augmentations for work or public service?
• What rights and protections should individuals have regarding the data generated by their augmented bodies?

This last set of questions echoes the ancient philosophical thought experiment known as the Ship of Theseus: if every board of a ship is replaced over time, is it still the same ship? Applied to human augmentation, if all parts of a person are gradually replaced with artificial components, does their identity persist – or does something fundamentally change? This debate sits at the heart of the ethical, legal, and existential challenges posed by the future of human enhancement.

Neuroethics and Brain-Computer Interfaces

Neuroethics and brain-computer interfaces (BCIs) represent one of the most rapidly evolving frontiers in both neuroscience and technology. At the core of this field are neurological sensors, which can be broadly categorized as active or passive. Active sensors, such as deep brain stimulators and implanted electrodes, not only record neural activity but can also deliver electrical stimulation to targeted brain regions. Passive sensors, including electroencephalography (EEG) caps and functional MRI (fMRI), non-invasively monitor the brain’s electrical or metabolic activity for diagnostic and research purposes. These technologies have become invaluable in understanding neurological disorders, mapping brain function, and developing treatments for conditions such as epilepsy, Parkinson’s disease, and severe paralysis.

Figure 16: Exaggeration of brain-computer-interface

Brain-computer interfaces leverage these advances to create direct communication pathways between the brain and external devices. The most promising use cases include restoring movement or communication for individuals with paralysis, enabling control of prosthetic limbs, and providing new ways for people with severe disabilities to interact with the world. BCIs are also being explored for cognitive enhancement, mental health interventions, and even immersive gaming experiences. The ability to decode neural signals and translate them into digital commands holds transformative potential for medicine, rehabilitation, and human-computer interaction.

However, the scale and complexity of data collected by neurological sensors and BCIs present significant challenges. Current technology cannot isolate individual thoughts or intentions with precision; instead, it captures vast streams of brain activity, resulting in the collection of far more data about a person than is necessary for a specific research or clinical goal. This phenomenon mirrors broader concerns previously discussed in the chapter on Privacy, Surveillance, and Data Ethics. In that chapter we discussed how ‘big data’, the aggregation and analysis of massive datasets, can inadvertently expose sensitive personal information, create privacy risks, and lead to unintended uses of data. Just like with big data, the capture, storage, and analysis of neurological data repeats the same ethical concerns which include informed consent, data ownership, potential misuse of neural data, and the risk of surveillance or discrimination based on brain activity patterns.

Neuralink, a leading company in the BCI space, has recently achieved a major milestone by successfully implanting its “Telepathy” device in a human subject. This coin-sized implant uses ultra-fine threads equipped with thousands of electrodes to record neural activity at a high resolution. The device has demonstrated the ability to detect neuron spikes and correlate brain signals with intended motor actions, allowing users to control computers or external devices directly through thought. Neuralink’s approach combines advanced neurosurgical robotics for precise implantation with custom electronics that process and transmit neural data. Neuralink is currently engaged in human trials, offering hope for individuals with severe neurological conditions and opening new possibilities for human-computer integration.

Here, again, are several ethical questions surrounding neuroethics and BCIs:

• To what extent could brain-computer interfaces (BCIs) be used to read or decode private thoughts and memories, and what safeguards should be in place to protect mental privacy?
• If a BCI could send signals to the brain that override or contradict a person’s intended actions (such as controlling movement or behavior), who is responsible for the outcome, and how should consent be managed?
• What ethical concerns arise if technology advances to the point where data can be written to the brain – potentially altering memories, perceptions, or even personality traits – rather than just reading from it?
• How can individuals maintain autonomy and freedom of thought in a future where neurotechnology might make it possible for others to access or influence their mental states?
• Should there be limits on the collection and analysis of neural data, given that current BCIs capture far more information than is needed for specific tasks, raising big-data privacy and consent issues?
• In the event of a malfunction, hack, or unauthorized access to a BCI, what protections and recourse should users have if their thoughts or actions are affected without their consent?
• How should society address the possibility of BCIs being used for enhancement or manipulation, such as boosting cognitive abilities or influencing decisions, especially if access is unequal or coerced?

As BCI technology advances, the ethical landscape will require ongoing scrutiny, balancing the immense potential for benefit with the need to protect individual rights and societal values.

Biotechnology

Biotechnology is a broad field that encompasses the use of living organisms, cells, and biological systems to develop products and processes that benefit society. Many of the topics previously discussed – such as genetic engineering, CRISPR, brain-computer interfaces, and bioethics – are all integral parts of the biotechnology landscape. However, the reach of biotechnology extends even further, touching on a range of emerging technologies and applications that are reshaping medicine, agriculture, industry, and environmental management.

Beyond gene editing and medical diagnostics, biotechnology now includes advanced innovations like nanotechnology for direct cell repair and targeted cancer therapies. Nanotech-enabled particles can be engineered to seek out and destroy cancer cells without harming healthy tissue, offering more precise and less invasive treatments. In addition, biotechnology has enabled the development of bioengineered organisms – microbes or plants designed to clean up pollution through processes like bioremediation and phytoremediation. These organisms can break down toxic substances in soil and water, helping to restore contaminated environments and improve public health.

Another rapidly growing area is the production of bio-printed or lab-grown food. Using 3D printing technology and cell culture techniques, scientists can now create meat, organs, and other tissues in the lab, potentially reducing the environmental impact of traditional agriculture and providing new sources of nutrition. This technology is also being explored for medical applications, such as printing skin, bone, or even entire organs for transplantation.

While the benefits of biotechnology are substantial, significant risks and uncertainties remain. One major concern is the possibility of unintended release of engineered organisms or nanotech agents into the environment. Once released, these entities may not be easily converted from active to dormant or inert states, raising fears about long-term ecological impacts or the creation of new, hard-to-control forms of pollution. The microscopic or nanoscale nature of many biotech interventions also makes transparency and oversight difficult, complicating efforts to monitor their behavior and effects.

For example, bioengineered microbes used to clean up oil spills or toxic waste could themselves become hazardous if they mutate or interact with other organisms in unexpected ways. While the pros of such applications include cleaner water and soil, the cons may involve the organisms becoming toxic to humans or disrupting local ecosystems. Similarly, lab-grown foods promise sustainability and food security, but raise questions about safety, labeling, and the social and economic impacts on traditional farming communities.

Biotechnology is revolutionizing how we approach health, food, and environmental challenges, but it also demands careful consideration of the risks, especially regarding safety, transparency, and long-term sustainability. As these technologies become more integrated into daily life, ongoing ethical, legal, and societal debates will be essential to ensure they are used responsibly and equitably.

Cloning

Cloning, as a concept, has long fascinated humanity, appearing in ancient myths, literature, and modern entertainment as the idea of creating identical copies of organisms. The scientific journey toward cloning began in the late 19th century, when researchers like Hans Driesch demonstrated artificial embryo twinning in sea urchins, showing that separated embryonic cells could each develop into whole organisms. In the 20th century, landmark experiments included the cloning of frogs by nuclear transfer in the 1950s and the cloning of mammals from embryonic and adult cells in the 1980s and 1990s. The most famous breakthrough came in 1996 with the birth of Dolly the sheep, the first mammal cloned from an adult somatic cell, announced by Ian Wilmut and his team at the Roslin Institute in Scotland. Dolly’s creation proved that specialized adult cells could be reprogrammed to create an entire organism, igniting both scientific excitement and ethical debate. Other notable milestones include the cloning of cows, cats, and even monkeys, as well as the cloning of animals for agriculture, research, and pet reproduction.

Attempts at human cloning have been more controversial and less successful. In 2001, scientists at Advanced Cell Technology in Massachusetts cloned human embryos for the first time, aiming for therapeutic rather than reproductive purposes. In 2013, a team led by Shoukhrat Mitalipov achieved a breakthrough in human cloning by creating embryonic stem cells from cloned human embryos. While some fringe groups and individuals have claimed to have cloned humans, there is no verified scientific evidence of a live human clone. News of human cloning efforts has generally been met with skepticism and concern within the scientific and medical communities, and has sparked strong opposition from religious, ethical, and political groups around the world. Reactions have ranged from moral outrage and calls for bans to cautious support for therapeutic cloning aimed at treating disease.

Currently, human reproductive cloning is illegal or heavily restricted in the United States and many other countries. Therapeutic cloning – using cloned embryos to derive stem cells for research or medical treatment – remains a gray area, with regulations varying by state and ongoing debates about its ethical and legal status. The technology continues to raise profound questions about identity, individuality, and the boundaries of human intervention in nature.

Consider these ethical questions surrounding the concept of cloning:

• Is it ethical to create a human clone for reproductive purposes, knowing the potential risks and uncertainties involved?
• Should cloning be allowed for therapeutic purposes, such as generating tissues or organs for transplantation?
• What rights and status would a human clone have in society – would they be treated as individuals or property?
• Could the widespread use of cloning undermine the value of genetic diversity or lead to new forms of discrimination?
• How should society regulate or oversee cloning technology to prevent abuse or unintended consequences?
• Would the existence of human clones challenge traditional notions of family, parenthood, and identity?
• What are the long-term psychological and social impacts on clones and their families?

Textbook Definitions – Bioethics and Human Enhancement

• medicine – The science and practice of diagnosing, treating, and preventing disease and injury in humans.
• herbal remedies – Treatments derived from plants and plant extracts used for their medicinal properties.
• professional doctor – A person formally trained and licensed to practice medicine and provide healthcare.
• anatomy – The study of the structure of living organisms, especially their internal systems and organs.
• pharmacology – The branch of medicine concerned with the study of drugs and their effects on the body.
• hygiene – Practices and conditions that promote health and prevent disease, especially through cleanliness.
• Hippocratic Oath – An ancient ethical code historically taken by physicians, emphasizing medical ethics and patient care. The current accepted version of this oath (as of 2017) is:
  • AS A MEMBER OF THE MEDICAL PROFESSION:
    • I SOLEMNLY PLEDGE to dedicate my life to the service of humanity;
    • THE HEALTH AND WELL-BEING OF MY PATIENT will be my first consideration;
    • I WILL RESPECT the autonomy and dignity of my patient;
    • I WILL MAINTAIN the utmost respect for human life;
    • I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient;
    • I WILL RESPECT the secrets that are confided in me, even after the patient has died;
    • I WILL PRACTICE my profession with conscience and dignity and in accordance with good medical practice;
    • I WILL FOSTER the honor and noble traditions of the medical profession;
    • I WILL GIVE to my teachers, colleagues, and students the respect and gratitude that is their due;
    • I WILL SHARE my medical knowledge for the benefit of the patient and the advancement of healthcare;
    • I WILL ATTEND TO my own health, well-being, and abilities in order to provide care of the highest standard;
    • I WILL NOT USE my medical knowledge to violate human rights and civil liberties, even under threat;
    • I MAKE THESE PROMISES solemnly, freely, and upon my honor.
• sanitation – Measures and practices that maintain cleanliness and prevent the spread of disease, especially through waste management.
• nutrition – The process by which living organisms obtain and use food to support growth, health, and maintenance.
• public health – The science and practice of protecting and improving the health of communities through education, policy, and preventive measures.
• diagnostics – Techniques and tools used to identify diseases or medical conditions in individuals.
• treatment – Medical care or intervention given to manage or cure illness or injury.
• magnetic resonance imaging (MRI) – A non-invasive imaging technique that uses magnetic fields and radio waves to create detailed images of internal body structures.
• robotic-assisted surgery – Surgical procedures performed with the aid of robotic systems to enhance precision and control
• gene sequencing – The process of determining the exact order of nucleotides in a DNA molecule.
• wearable health monitors – Electronic devices worn on the body that track health metrics such as heart rate, activity, or sleep.
• telemedicine – The remote diagnosis and treatment of patients using telecommunications technology.
• personalized medicine – Medical care tailored to an individual’s genetic, environmental, and lifestyle factors.
• genetic engineering – The direct manipulation of an organism’s DNA to alter its characteristics or functions.
• autonomy – The right or condition of self-government, especially in making informed decisions about one’s own body and health.
• consent – Permission for something to happen or agreement to do something, especially after being informed of the risks and benefits.
• Human augmentation – The use of technology to enhance or extend human physical or cognitive abilities.
• neural interfaces – Devices or systems that enable direct communication between the brain and external devices.
• hybrid bio-robotic systems – Integrated systems combining biological and robotic components to enhance function or performance.
• Cloning – The process of producing genetically identical copies of an organism, cell, or DNA sequence.
• selective breeding – The intentional mating of organisms with desirable traits to produce offspring with those traits.
• cross-breeding – The process of mating individuals from different breeds or species to produce hybrid offspring.
• DNA – Deoxyribonucleic acid, the molecule that carries genetic information in living organisms.
• Hybridization – The process of combining different varieties or species to produce a hybrid with traits from both parents.
• random mutations – Unplanned changes in DNA that can result in new traits or variations in organisms.
• CRISPR – A gene-editing technology that allows precise modifications to DNA sequences in living organisms.
• eugenics – The controversial practice or belief in improving the genetic quality of a human population through selective breeding or genetic intervention.
• transparency – Openness and clarity about processes, decisions, and data, especially in science and ethics.
• informed consent – The process of providing individuals with sufficient information to make knowledgeable decisions about participation in medical or research activities.
• environmental stewardship – The responsible management and care of the environment and natural resources.
• therapeutic – Intended to heal or treat disease or medical conditions.
• elective – Chosen or optional, especially referring to medical procedures that are not medically necessary.
• cosmetic – Intended to improve appearance rather than health or function.
• prosthetics – Artificial devices that replace missing body parts to restore function or appearance.
• carbon fiber – A strong, lightweight material commonly used in advanced prosthetics and other high-performance applications.
• bionic prosthetics – Artificial limbs or devices enhanced with electronic or mechanical components to mimic or surpass natural function.
• neural signals – Electrical impulses generated by neurons that transmit information within the nervous system.
• running blades – Curved, spring-like prosthetic limbs designed to enable or enhance running performance.
• Neural implants – Devices surgically placed in the brain or nervous system to restore or enhance function.
• exoskeletons – Wearable robotic frameworks that support or augment human movement and strength.
• sensory enhancements – Technologies or interventions that improve or extend human sensory perception.
• thought – A mental process involving ideas, reasoning, or imagination.
• memory – The mental capacity to store, retain, and recall information or experiences.
• personality – The combination of characteristics or qualities that form an individual’s distinctive character.
• Neuroethics – The study of ethical, legal, and social issues arising from neuroscience and neurotechnology.
• brain-computer interfaces (BCIs) – Systems that enable direct communication between the brain and external devices, often for control or interaction.
• Active sensors – Devices that both detect and interact with biological signals, often by sending or receiving electrical impulses.
• implanted electrodes – Electrodes surgically placed in the body or brain to monitor or stimulate neural activity.
• Passive sensors – Devices that detect and record biological signals without actively interacting with the system.
• electroencephalography (EEG) – A non-invasive method for recording electrical activity of the brain using electrodes placed on the scalp.
• functional MRI (fMRI) – An imaging technique that measures brain activity by detecting changes in blood flow.
• cognitive enhancement – The use of technology or interventions to improve mental functions such as memory, attention, or intelligence.
• intended motor actions – Movements or actions that a person consciously plans or attempts to perform.
• neural data – Information collected from the nervous system, especially brain activity signals.
• Biotechnology – The use of living organisms, cells, or biological systems to develop products and technologies for human benefit.
• nanotechnology – The manipulation and application of materials at the molecular or atomic scale, often for medical or technological purposes.
• bioengineered organisms – Living organisms whose genetic material has been deliberately modified for specific purposes.
• bioremediation – The use of living organisms, such as microbes or plants, to clean up environmental pollutants.
• phytoremediation – The use of plants to absorb, remove, or neutralize contaminants from soil or water.
• bio-printed – Created using 3D printing techniques with biological materials, often for medical or food applications.
• unintended release – The accidental escape or spread of engineered organisms or substances into the environment.
• human reproductive cloning – The creation of a human being that is genetically identical to another individual through cloning techniques.
• Therapeutic cloning – The creation of cloned embryos for the purpose of generating stem cells for medical research or treatment.