The ethics of high-tech “conversion” therapy

An edited version of this article was printed in Humanism Ireland, September-October, Vol. 148 (2014)

In an earlier post I discussed the imminent prospect of biological manipulating our different love systems and some of the ethical implications that might follow from it. This topic originally appeared in an article published in 2008 by Oxford ethicists Julian Savulescu and Anders Sandberg, who argue that it might be possible, in the next number of decades or so, to biologically manipulate and enhance our quality of love. They propose that we could supplement our relationship counselling sessions with prescription ‘love drugs’—ones with the purpose of improving intimacy and commitment between partners. 

With emerging biotechnologies like this, which includes recent work in neuroscience, psychopharmacology and other related areas, it will also be possible to consider the prospect of using them to manipulate brain systems to diminish and alter the capacity from sexual feelings, intimacy and attachment. Would it be ethically acceptable, then, to use ‘anti-love’ drugs to try and fall out of love?

Before we consider this, you might ask: “What is the point, at this moment, discussing something that is speculative? We should focus on what is current and real over what might never actually arise.” However, it is at times sensible to speculate on possible future issues so we can somewhat prepare for them in case they do actually materialise. As the ethicist Rebecca Roache expressed it, “[w]e take some such speculative scenarios seriously, in that we deem it worth preparing for them, either by taking steps to avert them or by equipping ourselves to deal with them.” It’s important, for that reason, to examine these issues now and to reflect on what possible concerns they could bring; it might also be too late to grapple with the issues after the technology is present.    

Ensuing Savulescu and Sandberg’s enquiry of the neuroenhancement of love, further analysis on anti-love biotechnology has come from Brian Earp and his colleagues (which, incidentally, also include Savulescu and Sandberg). In a paper published in the American Journal of Bioethics last November, they argue that it might also be possible to block, reduce and even alter feelings using pharmacological strategies—perhaps with little side-effects and at an affordable cost. 

Without doubt there seems to be some good reasons for the development of anti-love biotechnology, especially when forms of love lead to bad and harmful outcomes (i.e., domestic abuse, adultery, violence, murder, paedophilia, or suicide). Needless to say, there’s a danger of coercion and abuse of administration for oppressive purposes is always possible. Earp et al. recognise this and propose some conditions to thwart the chances of this happening. For it to be permissible, they mark out, the love in question would clearly have to be harmful, the person herself would feasibly want to use it, where it would help her follow her “higher-order goals” instead of her “lower-order feelings,” and where she could not psychologically overcome the perilous feelings using non-bio-medical methods.

Arguably the most controversial issue that Earp et al. have touched on is the prospect of altering a person’s sexual orientation. In a separate article, published in the American Journal of Bioethics: Neuroscience in January this year, they say that “if scientists continue to unravel the various sub-personal, brain-level factors that govern sexual orientation, there is no good reason to think that such conversion may not be achievable.”  In other words, with our understanding of the neurochemical bases of love and of the genetic, epigenetic and hormonal factors that could shape one’s sexual preference, it’s possible to envisage a powerful ‘high-tech’ conversion therapy having the ability to enable gays and lesbians to become physically attracted to members of the opposite sex. By the same token, it would be feasible for it to work the other way around as well: a straight person could achieve same-sex attraction.

LGBT rights campaigners, not surprisingly, have concern about something like this materialising—as you might expect in light of the anti-gay prejudice and bigotry that has taken place for several centuries, and that still exists to some extent today.  Remarkably, certain Christian, Jewish and Muslim communities today still perform various forms of conversion therapy to ‘cure’ those who experience same-sex attraction. Most professional scientists and psychologists claim, almost unequivocally, that there’s not much (if any) evidence to say current methods are effective in the way intended. Conversely, there’s a lot of evidence, they affirm, to suggest these practices are dangerous; they can cause low self-esteem, guilt, mental breakdown and even suicide.

Though what if such conversion could be feasible with future technologies? The usual argument against the use of current ‘low-tech’ conversion treatment is that they are ineffective and unsafe. If sexuality-altering biotechnologies were proven to be effective, however, it would not be possible, then, to dismiss them on account of their viability. Still, you might say there should be legal prohibitions, not on account of their feasibility, but due to the psychological effects they would have. There are a number of cases, to be sure, where it would be harmful to use them, in spite of their actual feasibility. If they were used on children or young adolescences, it would certainly be wrong, and also with adults, where the conduct is involuntary—i.e., where someone is forced, pressured, or manipulated—it would also be morally impermissible. 

What about cases applied to adults where decisions appear voluntary? For instance, where someone declares his same-sex attraction is at odds with his religious values and future goals. If it was certain that the person in question was a mature adult, one that is capable of making decisions with regards to his own interest, could high-tech conversion technologies be allowable? This is a less straightforward case. An objection to this could be that we don’t need biotechnology to alter sexual orientation; in its place, we need to do something to alter social prejudice and homophobic attitudes. On top of that, it could be affirmed that there’s nothing unnatural, unhealthy or harmful about same-sex attraction—more education is what’s required to tackle everyday homophobia, and to loudly convey the message that same-sex attraction is not an illness or mental problem. Besides, this intervention fortifies the dangerous social norm that homosexuality is something that is unsavoury and unwelcome—it reinforces the idea that it’s something that can be got rid of.  As a result, sexuality-altering neurotechnologies, all things considered, must not be permitted.

These certainly are persuasive reasons to consider prohibiting love-altering drugs, particularly in the case of sexual orientation.  Despite being sympathetic towards these various factors, I don’t think it offers a prima facie argument in favour of banning sexuality-altering technologies.  Consider the case of somebody experiencing acute suffering, who wants to use them and where more ‘conventional’ methods lack success: it would seem exceptionally cruel to deny them access, even if the suffering was actually the result of discriminatory social or religious pressures. We might say, on the other hand, that the social and political fight against homophobia outweighs any concern we ought to give to particular individuals who are in distress. In the present situation, this sounds a little dubious though. Seeing that repressive norms within some religious and cultural communities are unlikely to undergo a significant change anytime soon, we would be hard-pressed, accordingly, to allow someone to continue suffering when we have the ability to enhance her well-being.

On the face of it, there are conflicting values present, and it doesn't seem obvious that the broader political concerns always prevail over individual ones. For this reason, Earp et al. say that the “safe, effective, and genuinely voluntary, pursuit of ‘high-tech’ conversion treatment—if such treatment could be shown to relieve suffering for an individual unable, or who did not want, to throw off the repressive norms or religious beliefs that were the ultimate source of his discomfort—could be considered morally permissible under certain circumstances.” Accepting this point, of course, doesn't mean we should abandon our focus on addressing unjust social norms. In fact, the two ends seem rather compatible. The professional administrating the treatment could be committed to campaigning against LGBT prejudice, yet fully support individuals who want to alter their sexual orientation. With high ethical standards and tight regulations, the use of advanced conversion treatment for certain individuals in certain circumstances could be morally acceptable.

In addition, if we assume someone is a rational agent and aware of all the relevant information, it actually seems difficult to deny treatment without restricting individual liberty. The concept of individual liberty is widely valued by almost all liberals and humanists today—something that can be traced back to John Stuart Mill in the nineteenth century. In his text On Liberty (1859), Mill states “that the only purpose for which power can be rightfully exercised over any member of a civilised community, against his will, is to prevent harm to others. His own good, either physical or moral, is not a sufficient warrant.” Each individual, in this way, is free to act in accordance with his own beliefs, and provided he doesn't interfere with others, the state or anyone else shouldn't get in his way.   

It could still be held that the person in question is not truly a rational agent. Given the many injustices gays and lesbians have experienced throughout history, we cannot really suppose that any individual decision to alter sexual orientation would be truly voluntary.  It seems reasonable to assume that someone who wants to use 'conversion' therapy, but who lives in a community that strongly adheres to traditional values, where homosexuality is considered wrong, is not truly making a free decision. Many, it seems to me, would be inclined to say her choice was influenced by her environment.

The problem with this line of reasoning, however, is that it could be difficult to falsify particular cases, not to mention it opening up the broader philosophical question of what actually determines a true independent choice, and whether or not we have free will. The same kind of argument, it seems, could be made against any choice one makes in her life (e.g. the goods she buys, the career path she pursues, or the values she follows). These instances might be analogous to the person who decides to alter his sexual orientation. We don’t normally say an individual’s choice was non-voluntary, even if we acknowledge external factors of influence. Consequently, it would seem problematic to use this line of reasoning to say that those who want to alter their sexual orientation are not truly making a free choice, while also assuming people are truly making voluntary choices in several other circumstances.     

From what we have examined, it looks like a case can be made, in some cases at least, for the moral permissibility of ‘high-tech’ sexually-altering neurotechnologies. At the same time, perhaps we should be a little bit watchful. Sometimes there can be a difference between our expectations of what new technology can attain and then its actual outcome. I consider this point in an earlier post on love enhancing drugs, so I’ll not say much about it here. In brief: Earp et al., largely examine the prospect of ‘high-tech’ drugs within the context of them being highly effective, having no major side effects, and occurring in a society where large commercial pharmaceutical companies wouldn't have excessive influence or bargaining power. In reality, though, it’s highly unlikely advanced biotechnologies would emerge—initially at least anyway—in such an ideal realm.      

Aside from this, I do think there are some other things we need to be concerned about. The arguments advanced by Earp and his colleagues, for the restricted permissibility of love-altering biotechnology, fits neatly into the fabric of modern liberal democracies, where there’s a general acceptance and tolerance towards gays and lesbians. That is to say, when we assume most people in society don’t have any vigorous hatred against homosexuality, then the emergence of new biotechnologies doesn't seem that problematic. 

Nevertheless, I do think their possible emergence has the potential to be misused in places where homosexuality isn't tolerated or considered acceptable. For instance, same-sex sexual activity is still illegal in almost 80 countries around the world (mostly in parts of Africa and Asia), and according to the International Lesbian and Gay Association (ILGA), about 2.7 billion people reside in countries where being gay is punishable by imprisonment, lashes or death. It’s not inconceivable, therefore, to envisage the grim scenario of state-enforced conversion therapy happening in countries where homosexuality isn't permitted. This would give rise to many individuals, in many parts of the world, being vulnerable to further suppression.

Having said that, this concern may not be enough to suggest a blanket-ban on ‘high-tech’ conversion therapy. To raise a concern, in itself, does not necessarily constitute an argument against something. The philosopher Allen Buchanan points out in his book, Better Than Human: The Promise and Perils of Enhancing Ourselves (2011), that we could easily identify concerns about democracy, but that might not be a sufficient reason to be against it.  At the same time, the concern here should certainly make us think about the wider ramifications of new advanced technologies being used in non-progressive ways. Yet we could also point out various risks associated with the advent of almost any new technology or invention.  In all, we must accept that new technologies like this carry with them new opportunities for the emergence of risk, but they also give us opportunities for improvement.

Moreover, even if we did want an outright ban, it’s not certain that it would be attainable. Advances in other areas of neuroscience might leave us with the same knowledge and technological capabilities, as if we directly pursued the love-altering neurotechnology path directly. Hence, it may not be possible to curtail knowledge, given that it probably would be indirectly revealed from other kinds of research in any case. If they are likely to emerge no matter what, it’s probably better that they are securely regulated than traded underground.       

It’s also possible to imagine some individuals from countries with anti-LGBT laws using love-altering drugs for the sake of their own well-being. They might not be willing to abstain from same-sex sexual activity, and if they risked imprisonment, or even death, they could use them as a means to protect themselves in an unsafe environment. Living in a country with anti-gay laws is far from desirable, but some might welcome this kind of recourse within the confines of dire circumstances. This, of course, would not be a desirable option for everyone, especially those who would be reluctant to change their sexual orientation, even when it lessened their chances of punishment. To alter something so central to one’s identity, someone might say, is to surrender too much. Some people living in countries with strong anti-gay laws and hostile attitudes towards homosexuals, as a possibility, might use them to their own advantage, but it’s unlikely to appeal to everyone.     
   

Finally, one other important issue raised by the prospect of ‘high-tech’ conversion technology is that it will negate some of the common arguments regularly invoked to thwart anti-gay prejudice and discrimination. If it was possible to actually alter one’s sexual orientation, the argument ‘being gay is not a choice’ becomes less viable. At the moment, this might be a sufficient defence, but if ‘high-tech’ conversion technology emerges, then gay rights campaigners will be left without a sound justification in opposition to opponents who say ‘homosexuality is a choice’. Since we would have the means to change sexual preferences, being gay would then be regarded as a choice—a choice to alter sexuality. As a result, it wouldn't be possible anymore to say that ‘being gay is not a lifestyle choice.’

This point of view, to be sure, reveals the fuzzy theoretical foundation—and hence weakness—of those who claim that being gay is not ‘unnatural’, ‘a choice’, or something that is alterable. As I deal with in an earlier post, some people don’t seem to be aware that our scientific knowledge can sometimes be tentative and, on occasion, subject to change. The reason why one’s sexual preference isn't a choice is due to the nature of our bio-technological limitations at present—something that could very well change in the near distant future.  One likely solution, in consequence, would be to ensure gay rights and equality rest upon stable, and not subject to change, ethical principles—ones that wouldn't be susceptible to advances in love-altering neurotechnologies.  Whether sexual orientation is alterable or not, as follows, would be largely irrelevant, morally speaking. It shouldn't really matter, in the end, what one’s sexual preference is, as long as it’s consensual and not damaging to others.