Following the death of 17-year-old Leelah Alcorn, a transgender teen who committed suicide after forced “conversion therapy,” President Barack Obama called for a nationwide ban on psychotherapy aimed at changing sexual orientation or gender identity. The administration argued that because conversion therapy causes substantial psychological harm to minors, it is neither medically nor ethically appropriate.
We fully agree with the President and believe that this is a step in the right direction. Of course, in addition to being unsafe as well as ethically unsound, current conversion therapy approaches aren’t actually effective at doing what they claim to do – changing sexual orientation.
But we also worry that this may be a short-term legislative solution to what is really a conceptual problem.
The question we ought to be asking is “what will happen if and when scientists do end up developing safe and effective technologies that can alter sexual orientation?”
Based on current scientific research, it is not unlikely that medical researchers – in the not-too-distant future – will know enough about the genetic, epigenetic, neurochemical and other brain-level factors that are involved in shaping sexual orientation that these variables could in fact be successfully modified.
And here is the important point. If such neuro-interventions are developed, they will have serious implications for a gay rights movement that is largely centered around a “born this way” response to discrimination – and the idea that sexual orientation isn’t something one can choose.
Where the science stands
With Oxford University colleagues Julian Savulescu and Anders Sandberg, one of us – Brian Earp – has proposed dividing potential neuro-interventions into sexual orientation into two categories.
On the one side, there are current and emerging technologies that could diminish (but not necessarily re-orient) same-sex love and desire. These would work by interfering with brain-level systems involved in lust, attraction and attachment that have evolved among mammals including humans. These could be called “anti-love biotechnologies.”
Today, most “anti-love” technologies work by regulating testosterone levels. Some target testosterone directly, such as anti-androgen drugs that are sometimes administered to sex offenders as a condition of parole, while others work more indirectly.
For example, a class of drugs known as selective serotonin reuptake inhibitors (SSRIs), typically used as anti-depressants, can have the “side effect” of a diminished libido. Disturbingly, there are reports out of Israel of ultra-religious Jewish groups prescribing SSRIs to yeshiva students – not to treat depression, but to harness the “side effect” of a reduction in sex drive. The point in these cases is to chemically blunt any same-sex desires or even the urge to masturbate.
However, the effects of these drugs are global. That is, they have a dampening effect on one’s entire libido – whether one has homoerotic desires or otherwise – rather than blocking attraction to a specific person or group of people based on their outward sex-based appearance.
On the other side, then, are what might be called “high-tech conversion therapies.” These are interventions that would change a person’s orientation from predominately same-sex attraction to predominately opposite-sex attraction – or, indeed, the other way around.
While these kinds of technologies are not currently available, based on the trajectory of scientific investigation, one of us has argued that “there is no good reason to think that such conversion may not one day be achievable.”
The upshot is this. All animal behavior — including human behavior — is at least in principle reducible to brain states. It then becomes a matter of figuring out which specific brain-based manipulations would work to alter the higher order drives and capacities that govern one’s sexual orientation.
We know that hormones and genetics play a large role in determining sexual desires. In 1991, Bailey and Pillard found that 52% of male identical twins compared to 22% of male non-identical twins had the same nonheterosexual orientations.
Hormonal studies have found that for many traits that differ between the sexes, gay men share similar characteristics with heterosexual women – including the index finger to ring finger length ratio and certain aspects of bone structure. These are characteristics that appear to be influenced by in utero exposure to androgens and other aspects of the amniotic environment.
Of course, it is no small step to get from learning about how genes and prenatal exposures affect the development of a fetus’s later sexual desires, to determining how we can manipulate those desires in adolescents or adults. But as the ethicists Decamp and Buchanan have pointed out, it is important to “explore a range of possible issues, some of which may not arise, than to be overtaken by events owing to the failure to think ahead.”
So what does thinking ahead about high-tech conversion therapy tell us?
Put simply, the more we learn about the biological processes that underlie sexual orientation, the more likely it is that someone will figure out how to influence those processes directly.
I can’t change, even if I tried?
The advent of high-tech conversion therapy would be disastrous for the “born this way” gay rights movement.
This movement uses a variety of evidence, such as the twin studies mentioned above, as well as the inefficacy of Christian conversion camps, to argue that being gay is biological and – hence – unchangeable. If one is born gay, this argument runs, then one cannot change this fact anymore than one can change one’s height or skin color. This is an idea that has been movingly expressed in the chorus of a recent pop song by Macklemore and Ryan Lewis. As the singer says, “I can’t change, even if I tried, even if I wanted to.”
This has become a lynchpin in the fight for gay rights. “Since I can’t change who I am,” many gay people have argued, “it isn’t fair to discriminate against me.” On this kind of view, sexual orientation is an immutable characteristic like race – a highly protected category. Yet if biotechnologies of the future do allow people to change their sexual orientations, then the gay rights movement would lose one of its central arguments.
So we think that better arguments are needed – and ones that are not dependent on the current state of technology. Surely, we don’t want to say that if sexual orientation could be changed, it would be therefore OK to discriminate against people who identify as gay!
There are two avenues of response worth considering. First, we can develop – and enforce – strict legal measures to prevent the (future) use of high-tech conversion therapies on children and other minors. As one of us has argued, “When it comes to protecting vulnerable children from the misuse of love- or sexuality-altering technologies, the strong arm of the law could go a long way” in reducing the potential for harm.
Second, we can take a closer look at our concepts about what it means to be gay in the first place, and ask whether being “born this way” is actually necessary to defend against discrimination.
Changeability and discrimination
In a notorious interview recorded earlier this year, Ben Carson, a Republican physician (and possible 2016 presidential candidate), was asked if he thought that being gay is a choice. He answered, “absolutely,” with the implication being that this could be a reason for failing to extend marriage rights to homosexual couples.
Progressive commentators were outraged. In a typical line of response, they took issue with Carson’s empirical claim: being gay isn’t a choice, they insisted, often pointing to studies that seem to show a biological basis for sexual orientation.
But there are at least two problems with this kind of reaction. First, it mixes up “being gay” (which is a question of how one self-identifies, and therefore something about which individuals do have some measure of choice) with “having a same-sex sexual orientation” (in other words, being predominately or exclusively attracted to members of the same sex), only the latter of which is – currently – largely outside of one’s control. But why should we think that a person’s sexuality has to be unchangeable in the first place in order to serve as a basis for equal rights? The activist and author Dan Savage has pointed out the flaws in this line of thinking:
“[R]eligious conservatives knock on doors,” he writes, “distribute pamphlets, proselytize, and evangelize all over the country in an effort to get people to do what? To change their religions. To choose a different faith.” In other words:
[F]aith – religious belief – is not an immutable characteristic. You can change your faith. And yet religious belief is covered by civil rights laws and anti-discrimination statutes…. The only time you hear that a trait has to be immutable in order to qualify for civil rights protections is when [conservatives] talk about [being] gay.
Choice and equality
Savage is right: if it’s unjust to discriminate against people because of their religious beliefs, which – while not necessarily immutable – are certainly central to many people’s sense of self as well as how they engage with the world, then it’s also unjust to discriminate against people because of their innermost sexual desires and orientation (whether these turn out to be immutable or not).
The lesson here is that “choice” is not the point. Whether you’re gay, straight, bisexual – or whether you reject such simplistic labels altogether – you should be free to form consensual relationships with whomsoever you please. And so long as the state is involved in regulating marriage, it should not be allowed to deny its citizens equal treatment before the law, whatever their orientation.