Is it ever okay to conduct transhumanist medical trials on children? The answer to this ought surely to be obvious. But apparently it isn’t.
By “transhumanist”, I mean a medical intervention that departs from the age-old aim of medicine, namely restoring health. Transhumanist interventions, by contrast, interrupt or otherwise alter human physiology, in the name of individual identity or some other abstract goal.
On this definition, the recently announced King’s College puberty blocker trial, which will be carried out on under 16s, is straightforwardly transhumanist. Puberty is a normal part of human development: it comprises a complex set of naturally occurring changes intrinsic to the human genetic template, whose aggregate outcome is emotional, physical, sexual, and cognitive maturity. And the aim of the trial isn’t restoring healthy puberty. Rather, it’s interrupting this normal, healthy trajectory, in the name of that child’s unfalsifiable inner “gender identity”. The relevant King’s College web page doesn’t speak to whether this is wise or ethical. Nor, it seems, does Health Secretary Wes Streeting, who responded to the outcry by defending “compassionate care” for children experiencing “gender incongruence”.
The trial only asks: is it better to delay puberty blockers or administer them young? It thus accepts wholesale the transhumanist idea that there’s nothing special about normal health, which we are free to tinker with at will. So much so, that we can even do this to children too young to grasp the idea of side-effects, which in this case are poorly understood, though early indications suggest they may include an elevated risk of osteoporosis, cognitive impairment, and infertility. On this basis, the 2024 Cass report banned the use of puberty blockers — but only, per the report’s recommendations, pending better clinical data. This trial proposes to provide that data.
Most ordinary people feel instinctively that experimenting on children in this way is wrong. But advocates ask: why? Surely it’s more unethical to reject a treatment that could help some children feel happier in themselves? I’ll characterise these sides as the “noticers” and the “engineers”. The reason they usually just yell past one another is that they’re making irreconcilably different assumptions about reality, and hence also about what humans are, and what “healthcare” means. But this is hard to see, and explain, because the same sleight of mind gave us the scientific revolution — the engineers’ victory — a victory that, if we’re honest, most of us would mostly like to preserve.
Until the end of the Middle Ages, though, the noticers had the upper hand. Their received view of reality was a basically Aristotelian one: that as well as stuff and contingency, things have a nature — a form — and also a telos or end: that is, everything is directed to a purpose. Form and telos in turn shape normal patterns of behaviour, and affect what’s healthy or harmful. Rather than trying to control the world, most medieval noticers saw these patterns as part of a vast, sacred tapestry created by God and whose ultimate ground was God’s thoughts.
But in the 17th century, Francis Bacon’s Novum Organum took aim at these ideas. In the first exposition of what would become the modern scientific method, Bacon argued that form and ends are conjectural. We should focus on what we can see and analyse, he argued: the stuff of the physical world, and the forces that act on it. For Bacon, the purpose of this was to control nature, and make human life easier and more pleasant: in his words, “for the relief of man’s estate”. It worked: from Bacon’s vision was born a new way of looking at the world, which has yielded advances in technology and material comfort, plus a steady extension of our power over the universe. The price was that we agreed to act as though form and ends don’t exist, and the world is made up merely of stuff and contingent force, that we can manipulate as we please.
“Never mind consent, it’s an offence not just against that child, but against reality itself.”
Even with all the power it gives us, however, this is harder to maintain in the case of living creatures. The scientist and polymath J.B.S. Haldane memorably observed that teleology is like a mistress to a biologist: “He cannot live without her but he’s unwilling to be seen with her in public.” How can you explain (say) photosynthesis, without mentioning what it’s for? Even so, as time has gone on, we’ve come to accept, at least tacitly, that we can pretend otherwise, and use living creatures too “for the relief of man’s estate”, as if they were mere things. For example, we accept the suffering of laboratory animals and intensively farmed livestock, as a trade-off for the benefit that accrues to humans from effective drugs and cheap protein.
But all the way up to the 20th century, by common assent, the exception to this was always humans. The first break with this was the 19th-century “eugenic” movement, which set out to act on human nature, with the aim of “improving” our “breeding”, as if we were livestock. Various 19th-century progressives, such as George Bernard Shaw, advocated such measures, and eugenic arguments played a key role in the early birth control movement. But this instrumental view of humans suffered a setback after the defeat of the Nazis. Their nightmare regime leaned all the way into treating humans as things, from forced sterilisations and murder of so-called “defectives”, to the use of human experimental subjects in the laboratories of Josef Mengele. Discovery of these practices created such horror that great postwar efforts were made to avoid a repeat of such atrocities.
But these efforts tended to focus on avoiding the violence and coercion involved in the Nazi regime, for example via human rights laws and more stringent guidelines on consent in human medical trials. And while this is obviously good, it left unchallenged the core Baconian idea that we might treat humans, too, as having no form or ends. And since the war, biotech has leaned ever further into the question this left unanswered. Why shouldn’t we tinker with humans, provided everyone involved has consented?
For it turns out, once you accept a Baconian view of humans, it opens whole new realms of profitable engineering, grounded not in an idea of human nature or ends, but purely in “the relief of man’s estate”, defined however you like. The first technology to embrace and normalise this was the Pill: the inaugural mass-market application of the transhumanist approach to medicine, namely the belief that it’s fine to interrupt normal physiological functioning in the name of freedom, and call the interruption “healthcare”.
The whole puberty blocker debate is downstream of our having accepted this principle. Having embraced the engineers’ denatured, self-directed understanding of humans, it came to seem ever more normal, liberatory, and eventually just moral to reject the idea of human form or telos. So much so, in fact, that nowadays if you notice out loud that male and female human bodies are directed toward heterosexual reproduction, many will react as though you’ve said something blasphemous.
This is surely rooted in a well-intentioned fear that over-emphasising the telos of sex might be implicitly hostile to gay people, or risk suggesting that women should leave public life and spend our time barefoot and pregnant. Anyway, say the engineers, now that we have the tech, why shouldn’t everyone be free to become whatever they like?
But this doesn’t follow. History is full of women who understood that female bodies are directed to pregnancy and motherhood — and chose not to have children. Noticing a disposition isn’t the same as handing down an edict. But the engineers’ victory is now so complete that we aren’t even allowed to acknowledge this. Instead, we are obliged to act as though our nature doesn’t exist even when it obviously does. The default, morally acceptable position is now pretending that medicine and transhumanism are the same thing, and yelling at anyone who demurs.
We see this, for example, in a common argument in favour of puberty blockers: that parents of a child with cancer wouldn’t hesitate before consenting, on their child’s behalf, to the side-effects associated with chemotherapy. Puberty blocker advocates argue that since, they claim, so-called “gender incongruence” is associated with an elevated risk of suicide, it’s surely fine to accept a risk of side-effects given the “life-saving care” the drugs will provide. This is especially relevant because “puberty blockers” are themselves a cancer drug.
The usual riposte is that evidence for the supposed suicide risk is sketchy, while the evidence for claims that “gender-affirming care” reduces this purported risk is even sketchier. But these are secondary objections; the key point is that the use of these off-label cancer drugs in “gender-affirming care” is fundamentally different from its use in cancer treatment, because transgender-identified children don’t have cancer. There’s nothing physically wrong with them: they are in fact being given cancer drugs to “cure” them of developing normally, in the belief that the benefit of doing so outweighs any possible side-effects.
The nub of the King’s College debate, then, isn’t over trial design, or consent. It’s a metaphysical disagreement so deep as to be irreconcilable. Is there any difference between using a drug to restore normal health in a child with cancer or premature puberty, and using the same drug to induce abnormal puberty-less-ness in a child who simply believes themselves to be the opposite sex?
The engineers, advocating for “gender affirming care”, say it’s all just “healthcare”. But noticers of human nature respond: no, puberty is not an illness, it’s a sign of normally healthy physiology. It’s not an expressive option that can be altered to reflect inner feelings, like dyeing one’s hair. It’s an aspect of our form and telos.
We can argue all day about the boundary between nature and culture. But even a toddler can see that humans have a normal form, and that this comes in two sexes that are ordered toward one another and the creaturely telos of making more humans. It takes a carefully cultivated, self-imposed engineers’ blindness to insist that this isn’t so.
And yet the Baconian worldview pretends to do just this, insisting that humans can do without form and ends even as it tinkers with that form, to its own (often profit-driven) ends. There is a booming market in private providers offering “gender-affirming care”, one of whose most notorious proponents, Helen Webberley, has recently been on an aggressive self-promotional campaign despite being struck off the medical register.
From this perspective, no version of the human form is more or less natural than any other. Our ends consist only in what we choose for ourselves. There’s no reason why you shouldn’t interrupt naturally occurring puberty in the name of “gender incongruence”, and any side-effects are just further opportunities for engineering.
But as Haldane acknowledged, the engineer’s view was always more of a convention than a reality. Form and ends never really go away. Teleology is still the mistress we can’t do without, even when we pretend otherwise. This is even true of gender ideologues, who both insist that “gender” and “sex” are completely separable and (sometimes in the same breath) also that we must change the latter to align with the former.
Perhaps we can leave adults free to tinker with their own appearance, should they so desire. But when the subjects are children, and the proposal is to “cure” them of developing normally, we need to draw a line. Form and ends are still there. Puberty is intrinsic, and good, and its end is normal adult sexuality and perhaps having children. Deliberately inhibiting this maturation, to the extent of risking infertility, is monstrous. Never mind consent, it’s an offence not just against that child, but against reality itself: an atrocity only distinguishable from those of Dr Mengele in its having manipulated the victims into seeing it as “medicine”.
