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Encyclopedia of Ethical, Legal and Policy Issues in Biotechnology

Thomas H. Murray,
President, The Hastings Center 
Maxwell J. Mehlman,
Case Western Reserve's Law-Medicine Center

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Sample Article . . .
Human Enhancement Uses of Biotechnology
By Robert Wachbroit

2 volume set 
approximately 1,250 pages
112 articles
ISBN: 0-471-17612-5

Special introductory offer 
through December 31, 2000

There is little doubt that the most controversial issue regarding biotechnology is the prospect of employing it for the purpose of human enhancement. The following discussion is intended to serve as a roadmap to the various questions and topics raised by the prospect of enhancement, with special emphasis on the conceptual issues. A detailed examination of the ethical issues is the topic of another entry.

We will begin by examining the so-called demarcation problem: What is enhancement and what is it being contrasted with? We will then survey some of the types of modifications that lead to enhancement. Although the primary modification people have in mind is genetic, it is worth looking at non-genetic modifications - biotechnological and non-biotechnological - in order to place the concerns with genetic modification in a broader landscape. Finally, we will examine some general approaches for assessing genetic enhancement.

The Demarcation Problem
A therapeutic modification is one that brings a trait that was below a recognizable, species-wide norm up to that norm. (The term "traits" is meant in its broadest sense, including physical attributes, mental or physical abilities, dispositions, and capabilities.) As a first approximation, we can characterize an enhancement modification in contrast as one that is a non-therapeutic improvement. The norm referred to here is the one that separates conditions of health from those of disease. The distinction between enhancement and therapy is therefore linked to the distinction between health and disease.
Two important points should be raised about this linkage. First, while the various proposed theories of health and disease yield corresponding accounts of what enhancement and therapeutic modification means, controversies and obscurities in the former will translate into the latter. Problems with particular theories of health will have counterparts in problems with the corresponding account of enhancement modification. Indeed, skepticism about there being an objective contrast between health and disease will translate into a corresponding skepticism about the distinction between enhancement and therapy. Consequently, the health/disease distinction is of limited use in explaining the enhancement/therapy distinction. None of this, however, undermines the link. The first distinction will be as clear and useful as the second. Thus, while it is true to say that therapeutic modifications attempt to treat disease whereas enhancement modifications attempt to improve a trait that is not diseased, there can be considerable debate over whether a particular modification therefore constitutes an enhancement and why.

Perhaps the most debated issue regarding theories of health and disease is whether or not the distinction - what constitutes the norm - is normative or value-free: Is the judgment that someone is diseased - that someone's condition falls below a norm - an objective discernment of a biological state or a value judgment? Is a particular condition a disease independent of whether we think it is bad or undesirable? Can a condition be a disease in one culture and not in another? Although this dispute is not particularly salient in discussions over enhancement, these discussions have typically proceeded with the idea of the norm being fixed and not relative to individuals or cultures. If what constitutes enhancement varies with individual or culture - if enhancement is in the eye of the beholder - then it is not clear that we can sensibly articulate an (ethical) issue about enhancement as such. Non-relativistic conceptions of normality tend to favor objective theories of health and disease, though that still leaves considerable latitude over how to conceive of normality, from statistical conceptions (Boorse, 1997) to biological conceptions (Wachbroit, 1994). Nonetheless, objective conceptions are not the only kind of non-relativistic conception of normality. Norms that are recognized to be arbitrary and conventional can still frame the issue, as discussions over the problems of enhancements in sports demonstrates. Indeed, even a normative conception of norms could be invoked, as long as the relevant values are themselves understood to be non-relativistic.


Human Enhancement Uses of Biotechnology: Overview
By Robert Wachbroit

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