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WILEY BIOTECHNOLOGY ENCYCLOPEDIAS Encyclopedia of Ethical, Legal and Policy Issues in Biotechnology
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The second point to note is that acknowledging the link between health/disease and enhancement/therapy can suggest that the latter is a medical matter. Ethical issues regarding enhancement modification should then be seen in terms of the ethics of medicine and the professional duties and responsibilities of health professionals. As plausible as this suggestion may be, we need to distinguish at least theoretically between questions regarding the ethics of enhancement modifications and questions regarding the ethics of physicians performing enhancements modifications - e.g., whether a particular enhancement modification is ethically objectionable from whether it is unethical for a physicians to perform such a procedure. It may well be that the answer to the second determines the answer to the first - e.g., that the ethical questions regarding enhancements comes down to questions about the role morality and professional ethics of physicians, but a claim like that requires more of an argument than pointing to the connection between the enhancement/therapy distinction and the health/disease distinction (Cf. Parens, 1998).
An immediate challenge to any account of the enhancement/therapy distinction is the presence of apparent borderline cases or exceptions to the classification scheme. These fall into two classes.
A one class of cases are modifications that, strictly speaking are enhancements, but whose purpose is to respond to (the threat of) a disease. For example, a modification that improves people's resistance to particular diseases beyond the normal capacity would count as an enhancement but its purpose would be disease prevention and so arguably therapeutic.
A different class of borderline cases or exceptions arises from an ambiguity in the idea of "normal traits." It can mean a trait whose appearance and function is normal, but it could also mean a trait whose appearance, function, and development is normal. Moreover, normality itself often refers to a range within a trait rather than to a sharp line. Thus, imagine two people, both of whose height is five feet. While the first person has short parents, the second has tall parents but suffers from a growth disorder. Both people have a height that falls within the normal range, but the second person's height is the result of a disease. A modification that brought the second person's height from five to six feet would be a modification within the normal range and a response to a disease (Cf. Allen and Fost, 1990).
Both types of cases indicates that a classification scheme generated by outcomes and by purposes is a scheme driven by one too many criteria. Since there is no direct line between outcomes and purposes, we shouldn't be surprised if there are cases that fit each criteria differently. Which criteria we should use will depend upon what we are trying to classify. If we are trying to classify modifications, then outcomes would be the better choice; if we are instead trying to classify practices or aims, then purposes might be a better criterion. Using both criteria is inevitably confusing in that not only can the same procedure and outcome be associated with different purposes but the same event often is shaped by multiple purposes. Ambiguities in classifying particular cases will inevitably arise. (See Juengst's article in Parens (1998) for a discussion of various other alternatives and their problems.)
Human Enhancement Uses of Biotechnology: Overview
By Robert Wachbroit
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