American Voices on Ways Human Enhancement Could Shape Our Future

As far-reaching biomedical technologies emerge from research labs, Americans are beginning to grapple not only with how these breakthroughs might enhance people’s health and abilities, but also with the profound ethical and moral questions the discoveries raise.

How much change in the physical makeup of humans is possible and acceptable? When does enhancement of human abilities cross a line by giving some people unfair advantages over others? What oversight and regulation of body- and brain-changing procedures is necessary? And how should the government or insurance marketplaces respond to the availability of life-altering technologies?

Pew Research Center explored Americans�� attitudes toward these issues in a nationally representative survey of more than 4,000 respondents, supplemented with six focus groups across five regions of the country with a total of 47 participants. The focus groups were deliberately structured to include highly religious Christians as well as Americans who have no religious affiliation. The participants were racially and ethnically diverse, including whites, Latinos and blacks. And, since new biomedical developments are more likely to affect younger generations, the groups included a mix of Millennials and middle-aged adults.

This report describes the wide-ranging discussions that occurred in those focus groups, which, like the survey, centered around three potential kinds of human enhancements: gene-editing techniques that could give healthy babies a reduced risk of serious diseases over the course of their lives, computer chips implanted in the brains of healthy people that may help improve their concentration and ability to process information, and transfusions of synthetic blood designed to increase oxygen levels and give healthy people greater speed, strength and stamina.

While all these technologies are currently being developed in one form or another, none are widely available today to augment “healthy” people’s abilities. Accordingly, participants in the focus groups were asked to think about scientific advances that were, in many cases, unfamiliar to them and then to perform acts of moral imagination, anticipating societal reactions to possible biomedical interventions. The conversations were aimed at eliciting different viewpoints and understanding the participants’ moral reasoning. Though focus groups do not provide a representative portrait of the general public, they can yield insights into how individuals think about complex topics.

The three kinds of human enhancements – though far from an exhaustive list of biomedical technologies now under development – were chosen to cover a range of procedures (from blood transfusions to brain surgery) and goals (improved physical abilities, improved thinking abilities, improved offspring). To help distinguish between therapies aimed at healing the sick or correcting serious disabilities and human enhancements designed to give people greater capabilities and longer lives, the focus groups were asked to consider medical interventions on otherwise “healthy” people.

Within these limitations, the participants engaged in thoughtful and often passionate conversations. Their discussions revealed a number of clues about how and where Americans draw moral boundaries when considering scientific breakthroughs. And, to a considerable extent, the focus groups gave voice to concerns echoed in a representative survey of the general public. See “U.S. Public Wary of Biomedical Technologies to ‘Enhance’ Human Abilities.”

Often, the conversations reflected optimism about the march of science and technology, mixed with darker fatalism about social change. The focus groups were not pressed to reach agreement. But the general arc of the discussions, paraphrased broadly, might go something like this: Progress with technology and medical research is inevitable. It’s exciting to imagine what might happen, and there are plenty of reasons to hope these changes will make life better. Still, such developments are disquieting. Some people will be left behind as human enhancements become available, and someone or some part of the government will need to watch carefully to rein in potential abuses, because we are heading to a place where the boundary between human and nonhuman becomes quite blurry.

One participant summed it all up this way:

[when I hear these scenarios]

– 52-year-old black man in Atlanta

As they were asked to weigh pluses and minuses of these possibilities, many alternated between thinking about what they would do if their personal circumstances led them to consider an enhancement and thinking about how society would change if these enhancements were made available to everyone. It was telling that all the focus groups could easily construct substantial lists of advantages and disadvantages that might emerge if these new biomedical technologies become widely available to healthy people.

Participants in each focus group were selected to have some shared characteristics (such as race, ethnicity, age or religious background) to facilitate open discussion. The six groups (details in accompanying sidebar) were designed to elicit a variety of viewpoints.

Each group was convened with a moderator and seven or eight participants. All of the groups were recruited to include a balanced mix of men and women, and overall they were diverse in age (ranging between 18 and 64), household income and levels of educational attainment. Respondents were offered a small monetary incentive for their participation, with the exact amount varying by location. The focus groups were managed by Princeton Survey Research International and held at five sites around the country. For more details on how the discussions were facilitated, see the moderator guide in Appendix A.

Specific sets of broad principles about the subject matter were rarely embraced by everyone in every case. Still, some themes and tendencies stood out. The rest of this report explores these themes in greater detail.

Many felt that while no effort should be spared to help the sick, society should proceed with caution before allowing biomedical advancements to boost the capacities of the healthy, fearing a slippery slope toward the creation of “superhumans” or human “robots.”

Many focus group participants felt strongly that people with life-threatening diseases or significant disabilities deserve every chance to get whatever treatments might benefit them. However, they were equally insistent that brain-boosting or body-altering assistance for the wealthy, the vain or the excessively ambitious is a different matter. Most participants believed that healthy people should not gain immediate access to enhancements, especially if their main purpose is to gain advantages that “ordinary” people would not have.

[chip]

– 50-year-old Hispanic woman in Phoenix

While they often found reasons to support – or at least tolerate – gene editing, brain chip implants and synthetic blood transfusions, many participants expressed anxiety about how far the pursuit of human enhancement will go. Relatively few had clearly defined views of what is acceptable and what is not. Instead, they worried more generally about the social strife that might arise when some people can order up improvements that make them stronger and smarter, while others cannot.

[them]

He was not alone in feeling that recipients of these procedures may feel superior and act that way.

[trying to create]

– 59-year-old white woman in Atlanta

[synthetic blood]

– 31-year-old black man in the Boston area

“I hate to sound like a jerk, but I think … this comes with a certain amount of arrogance when you get this. Because now you go from being ‘normal Dave’ in the room to the smartest guy in the room. Being able to – can’t have a fight with your wife because you remember every single word that was said because now you have increased memory and everything else. “

– 40-year-old Hispanic man in Phoenix

“I think [synthetic blood] would sort of fundamentally change who we are. … You would have this culture of people just obsessed with being bigger, stronger, faster, and just outperforming everybody.”

– 35-year-old black man in Atlanta

Some participants worried that, in the pursuit of perfection through enhancement, humans could also lose their individuality and humanity, becoming more like robots than people. Many agreed that these issues should be confronted sooner rather than later because they affect essential notions about who humans are and what they can do.

[but there are]

– 59-year-old white woman in Atlanta

[synthetic blood]

– 35-year-old black man in Atlanta

In the eyes of these focus group participants, widespread use of human enhancements by healthy people has the potential to upend some of the most important aspects of human existence. These include family relations, workplace dynamics, dealings between socioeconomic classes and connections among racial, ethnic and religious groups.

For instance, the Boston group of religiously unaffiliated young adults discussed what would happen to families when more than three generations are alive at the same time.

[changes]

– 33-year-old white woman in the Boston area

Others envisioned changing workplaces, with enhancements being used as a means for career advancement.

“Who gets the promotion at work? Because you could afford to have an implant so you get it? I mean, what about everybody else? … It’s not fair to people who wouldn’t be able to afford that.”

– 50-year-old Hispanic woman in Phoenix

Some participants expressed concern that gene editing would lead to a less diverse human race. In general, people spoke out in favor of genetic diversity for its perceived health and species-survival benefits. As one woman thought about the impact on future generations, she speculated that if both she and her husband had nearly identical “perfect genes … and you have a kid, it’s probably going to be all messed up because you don’t have different gene pools to make a healthy child.”

Some also worried creativity would suffer if a process like gene editing homogenized the species. As one participant put it: “At what point do we only have three different types of people as opposed to having all of the great diversity that we have? That’s what makes us us.” Another focus group member said she was worried there would eventually be “one race of people” and that would make for a diminished human experience.

While each of these enhancements could be seen as humans “playing God,” some participants argued that these biomedical advances can be morally justified because God intended for humans to make the most of their abilities and to better humankind.

Every focus group had members who opposed at least one of these enhancements on moral grounds. Many expressed the expectation that all three kinds of enhancements would be opposed by people of faith because they affect the basic makeup and capacities of humans. Yet even some of the most highly religious people in these groups noted that the human condition has been vastly improved by a long line of technological and medical advancements. For participants who took this view, these procedures seemed more like “evolutionary” advances, rather than “revolutionary” departures:

[and it’s OK to take advantage of that]

– 52-year-old black evangelical Protestant man in Atlanta

“I think that’s one of those things where you don’t realize the religious effect it has on you personally until it affects you personally.”

– 40-year-old Hispanic Christian man in Phoenix

[order]

Another Christian woman, in Atlanta, expressed the belief that technology cannot actually change or evade God’s plans for each person. “I believe that we all have a certain time to live, to die,” she said.

One participant noted the tension between his personal religious beliefs about God’s plan and his generally accepting attitude toward technological change. He said that although he may feel that human enhancements are acceptable, in the abstract, if he had to personally receive them, he would be conflicted religiously.

“I think that’s one of those things where you don’t realize the religious effect it has on you personally until it affects you personally. It’s easy to say no, that’s OK, that’s OK, until it’s you and then you have to deal with it, you have to sleep at night.”

– 40-year-old Hispanic Christian man in Phoenix

An opposing line of thought embraced by some, including members of the religiously engaged groups, was that all preventive medicine could be interpreted as people honoring God’s wish for them to strive to make life better. This view emphasizes that God gave people the ability to take care of themselves and responsibility for each other. As one man in Atlanta put it, “… they’re already playing God now.”

[trying]

– 44-year-old white mainline Protestant man in Birmingham, Ala.

[or]

– 50-year-old Hispanic evangelical Protestant woman in Phoenix

[in]

An Atlanta participant sought to split the difference, in a sense. He said he would like to apply a standard so that those who want enhancements for “moral reasons” could get them and those seeking enhancements for “amoral reasons” would be weeded out.

Some noted, too, that their wariness about the societal impact of enhancements could change if they, or a loved one, personally faced some of the challenges that these procedures might alleviate. A man described his own change in thinking due to family circumstances:

[going to]

– 25-year-old Hispanic man in Phoenix

Potential risks and abuses of these enhancements highlight the need for oversight; the guideposts for regulation should be “do no harm” and “be fair.”

As a rule, focus group participants expressed the view that policies covering the availability of these procedures should hew to two broad principles. The first is the basic medical ethic: “Do no harm.” Many participants worried about the unforeseeable effects of editing the human genome and implanting foreign material into healthy people’s brains. What if these procedures actually made people sicker or affected people’s immune systems? Worse, what if a particular gene change spun out of control?

“Your whole personality would change. You’d be what the chip wants you to be.”

– 48-year-old white man in Atlanta

When focus group members talked about the impact of brain chips, they worried about possible brain damage during the chip implant process, side effects that might be hard to undo, the possible diminution of creativity, bad behavior that could not readily be explained but might be related to the chips, and brain manipulation that might make people less autonomous. A common refrain was that corporate makers of chips, criminals or hackers might gain access to people’s brains and even have the capacity to control them. A sampler of their concerns:

“Are we becoming robots, is that what the whole society’s going to become? And then pretty soon someone will hack the computer system that you hook up to and throw a little virus in your brain and then what? You lose your identity as a person.”

– 50-year-old Hispanic woman in Phoenix

“The thing just keeps going over in my brain is that you’re altering the brain. It’s such a high risk. …When you think about DNA, OK, but it’s your brain. It’s so complex and I just feel this is very, very high risk.”

– 27-year-old white woman in the Boston area

[have]

– 38-year-old black man in Baltimore

“Like all technology, it breaks down. And how long will it last? Is there no guarantee on how long it will last inside the brain?”

– 48-year-old black man in Atlanta

“Your whole personality would change. You’d be what the chip wants you to be.”

– 48-year-old white man in Atlanta

[of evaluation]

The second principle many participants said they would want applied is to “be fair” in making human enhancements obtainable. There was a consistent view that people in dire medical need should get first crack at the new techniques, while those whose needs were cosmetic or seemingly trivial (e.g., to cope with conditions that are the equivalent of a “runny nose” or people who “want to change their eye color”) should not be able to get enhancements like gene editing, many focus group members argued.

[if]

“I would [worry about creating a gap] in society between the haves and have nots.”

– 31-year-old black man in the Boston area

Focus group participants were particularly anxious about gene editing and the possibility that it would be available to the wealthy, but not fully available or affordable for others.

[that performs gene editing]

– 48-year-old black man in Atlanta

Inevitably, some felt those with enhancements would be in advantageous positions, which would go against the principle of fairness and prompt futuristic versions of inequality.

“If it’s there for everybody to get, then it’s a good thing. But if only a certain sector of society can get it, then that’s never good.”

– 52-year-old black man in Atlanta

[and don’t care about them]

– 40-year-old Hispanic man in Phoenix

Several took the argument to a broader level by arguing that the long-term impact of unequal access to human enhancements would be that the wealthy and their offspring would have better survival rates and be more productive than those from less-well-off families, because richer people would have the best immune systems. That could deepen class fissures and lead to dystopia.

[worry about creating a gap]

– 31-year-old black man in the Boston area

Really, what’s the difference between [a brain chip] and taking a bunch of vitamins that improve our memory?– 46-year-old white evangelical Christian woman in Atlanta

Some pushed back against these dystopian notions, however. The focus group made up of white Christians in Atlanta included people who were not convinced that social strife would ensue, and who compared future enhancements to existing technologies that have not worsened social divisions.

[It’s more like]

– 61-year-old white evangelical Protestant man in Atlanta

[a brain chip]

– 46-year-old white evangelical Christian woman in Atlanta

At the same time, some noted that social divisions have always existed and thought these potential enhancements would be in keeping with what we already experience in society.

[and]

– 23-year-old black man in Baltimore

[changing the]

– 25-year-old Hispanic man in Phoenix

“I think we may be overthinking this because some people are already generally faster and have more strength. … You’re just going to be stronger than me always; it’s not going to be a today or tomorrow; we’re already living in that world.”

– 31-year-old black woman in the Boston area

For some, the fairness concept also concerned the way enhancements would be applied. They said it would be permissible to use enhancements to help those with clear physical or mental deficits, but would be too much to make well-functioning people perform at an even higher level. For instance, a participant in Birmingham said he would approve of enhancements to “bring people up to normal” levels of performance, but would not back improvements that would give someone superhuman abilities.

[its]

But others thought a government agency like the federal Food and Drug Administration (FDA) would be the best candidate to make rules and enforce them. When pondering access to brain chip implants, focus group participants talked about age limits, screening committees of doctors and review boards composed of people with diverse interests to handle patient requests.

“I would think it would be sort of a board or committee with health officials, government officials, like different groups but together, so you don’t have to just have one group running it. “

– 35-year-old black man in Atlanta

“If you’re going to have only certain people get it, kind of like cosmetic surgery, then you do need a governing body pretty much handing out the licenses and having the powers to deactivate it if you do something stupid with it.”

– 25-year-old Hispanic man in Phoenix

[gene editing]

A number of participants made the case there should be screenings of candidates for enhancements. “I think there has to be a line that you say, ‘OK, how do we regulate this? How do we not let this get out of hand?’” said an Atlanta man. Another in his group said there should be close scrutiny of the creators of these enhancements: “What kind of group is inventing this technology? Are they doing it for the betterment of our society or are they doing it to make a great buck?”

A Hispanic man drew nods from others in the Phoenix-region group when he said, “I think there are certain processes that are going to be involved that just not everybody can have it. And maybe that’s financial, maybe that psychological, maybe – what have you. But I don’t think that it should be available just to everybody.” He argued that the process should block those with bad intentions and it should bar practitioners who were indiscriminate in providing enhancements.

There was broad consensus that no enhancement should ever be imposed on anyone against his or her will.

I shouldn’t have more control over somebody’s ability to figure out what’s going to work best for them.– 31-year-old black woman in the Boston area

This was the one principle that was largely unchallenged when it came up in the groups: that getting these procedures should be a decision left up to individuals.

Several of the groups turned the discussion at times into an exploration of whether societies might move toward a kind of preventative medicine model, but none of those who pondered these issues liked the idea of a public health mandate or incentive structure to push people into getting these enhancements. If enhancements were embraced by wide segments of the industry and government, people said, what’s to prevent them from becoming mandatory?

Some participants speculated that if there were no restraints on new biomedical procedures, companies might require employees to get enhancements in order to be more productive – or educational institutions might insist that their students get enhancements so that all students would be focused, productive and never absent. This troubled focus group members. A woman in Baltimore worried that enhancements might be implemented through communities to “control” them and make inhabitants “robots” and order them to “do this, and this and this.”

One young adult from the Boston area put it this way: “I wonder if we could ever get to the point where you could say then that it is required like vaccinations for schools. … Are we going to have kids that aren’t able to attend certain places because their DNA hasn’t been changed?” She did not think that would be a good outcome.

Most felt that a mandatory application of these enhancements would be disastrous to the social fabric of society. It should be “up to the person” whether to get an enhancement or not and should not be a policy dictate, said a Phoenix woman. “It would cross the line if you are making it a requirement and forcing people to do it,” argued a woman in Atlanta.

“I shouldn’t have more control over somebody’s ability to figure out what’s going to work best for them. I think if it causes harm to the collective and causes harm to general society, then yeah, we need to have it evaluated. But if it’s going to affect their individual life and they can take the superdrug and … that’s what they need to do, fine. For myself personally, I don’t think I would need those things.”

– 31-year-old black woman in the Boston area

The moral calculations and guideposts people use have a distinctive character depending on the type of enhancement.

While common themes emerged in the focus group discussions about all three kinds of enhancements, each of the individual scenarios elicited unique moral calculations.

Gene editing for healthy babies to reduce risk of serious diseases

As participants thought about this scenario, they often agreed that the promise of gene editing would be healthier, longer-living humans. Some found the idea of protecting their children from a lifetime of disease very appealing. At the same time, people expressed concerns about the long-term impact on society. Some were anxious about the impact on future generations, on the diversity of the human species, on people’s creativity, on core identity issues for recipients and on inter-generational relations. Further, people expressed concern about the use of gene-editing techniques on such things as parents ordering up “designer babies” or abusive tyrants trying to engineer their populations.

The prospect of using gene editing to prevent disease struck some as a profound alteration. “It seems like if you’re fooling around with gene editing and changing DNA, you are fundamentally changing something about the way a human being is originally created,” noted a white, evangelical Christian man who opposed the idea.

But some focus group participants were upbeat about the potential for gene editing to conquer diseases like cancer and Alzheimer’s, with a likely increase in human longevity. “If I’m going to live to be 120, I could start two other careers and have a lot of time for fulfillment and fitting a lot more into your life,” noted one woman in the Boston area.

[of living with a genetic disease or illness]

– 58-year-old white woman in Atlanta

[This is]

Brain chip implants for greater concentration and memory

Many focus groups members worried about the wisdom and ethics of tampering with people’s brains. This seemed to them a more perilous and less rewarding activity than gene editing because the process of implanting brain chips could affect people’s individuality, thinking abilities and emotions. Several Christians made references to the “mark of the beast” in the Bible’s book of Revelation, a symbol tied to the Antichrist and Armageddon, and argued that such implants could especially be susceptible to manipulation for evil purposes. “That’s talking about what they talked about in the Bible,” noted one evangelical Christian in Phoenix. “It’s scary.”

In separate groups that were made up of relatively active religious participants – including whites, Latinos and blacks – participants also made this connection.

[how]

– 23-year-old black man in Baltimore

“If you have studied the Bible or gone to church or whatever, could this be like the mark of the beast?”

– 34-year-old white evangelical Protestant woman in Birmingham

[worry about]

[or]

At the opposite end of the spectrum, others were concerned that people might rely too much on the chip for their thinking processes. As one Atlanta woman put it: “That chip might be your God.”

A cross section of participants, ranging from highly religious people in Atlanta to religiously unaffiliated Millennials in the Boston area, expressed related fears about how chip implants could lead to humans becoming robot-like – and to brains being hacked. “It would be like somebody would be married to a robot,” argued one participant from Atlanta.

Transfusion of synthetic blood substitutes for physical speed, strength and stamina

While there were some who seemed taken with the idea of synthetic blood, the overall tenor of the group discussions about this scenario was largely negative. Many participants referred to doping by athletes trying to cheat their way to a competitive advantage, saying it was hard to see how the use of synthetic blood could be anything but a corner-cutting boost to higher human performance.

[and]

Another participant suggested an outcome might be an akin to an arms race among individuals to best each other. The availability of synthetic blood might induce people to push past reasonable physical limits and hurt themselves, or it may prompt bosses to pressure workers into getting transfusions of synthetic blood to increase their capabilities.