Treatment vs Enhancement
To show that the problematic distinction between ‘treatment’ and ‘enhancement’ is an ethical problem we will first consider the moral issues raised when trying to define the distinction, and then consider the moral issues which could arise as a consequence of failing to successfully define the distinction between the two.
The difficulty in drawing a clear distinction between ‘treatment’ and ‘enhancement’ is an ethical problem for two reasons. One is that, in trying to define the distinction, we are led to consider questions of what qualifies as a normal (functioning) human as we question what must be ‘fixed’ in treatment. It also leads us to ask what the purpose of treatment is: is the goal equality, and if so, equality of what kind?
We can argue that the purpose of treatment is to improve equality of opportunity, to bring those from the bottom, lacking opportunity, towards the mean of the population. The question then arises, how far should we extend equal opportunity? To what extent is the state obligated to compensate the results of the natural lottery: only through supplementary social goods, or does it extend to ‘treating’ all the physical causes behind the inequalities? We can see here, that the question of the purpose of treatment is tied to the moral question of how far do the duties of the state lie towards its citizens.
To try and define the biological species-typical normal function is equally important as it also reveals what we should count as disease or impairment. The task is non-trivial however, and whilst biological sciences preoccupy themselves with distinguishing normal variation from disease, these ‘natural’ definitions may still contain elements of social construction.[1] For example, if child A has a tumour that inhibits his growth to 150cm compared to child B whose genes limit his growth, is it a social construction that has defined only child A as having a disease, and being worthy of treatment? It is important to try filter out, or at least identify, any valuations from our definition of disease.[2]
The other reason is that blurring the lines between enhancement and treatment could lead to several things: the socioeconomically blessed may have easier access to enhancements and so widen the class gap; it could devalue some lives or lead to increased discrimination; and it reduces plurality by both narrowing down and redefining what it means to be human. This debate is complex. For example: if we agree that that the definition of treatment lies within optimising the equality of opportunity, some may argue this endeavour does not necessarily lead to a narrow concept of diversity, because value pluralism in society will limit consensus of what qualifies as a disease. As a result, state action will be focused on impairments which are defined by the overlap of the population’s conception of disease[3] — like the intersection of a Venn diagram. But, how can we be so sure that this will be the case, that we needn’t worry about a slippery slope towards a dystopian, homogenised Brave New World?
In conclusion, the treatment/enhancement distinction is important both because of the ethical questions raised in defining them, and because their definitions determine the direction of society.
[1] Buchanan A. et al., From Chance to Choice – Genetics and Justice, Cambridge University Press, 9th Edition, 2009, p.151
[2] Ibid
[3] Buchanan A., p.101
Image by Dirk Wohlrabe
