Policy Implications

Clearly, all of the ways of understanding enhancement as a moral concept reviewed here have limitations. However, all these interpretations do seem to be alive and well and mixed together in the literature on the topic. It is not possible to cleanly assign the different interpretations of enhancement to different spheres of ethical analysis. But there do seem to be some rough correlations that might be made. Thus, the interpretations that contrast enhancement interventions with treatments seem most useful where it is the limits of medicine's expertise that are at issue. Whether medicine's boundary is defined in terms of concepts of disease, or in sociological terms as the scope of medical practice, or in terms of some theory of the human norm, this interpretation at least provides tools to draw that boundary. Moreover, all other considerations being equal, the line that it draws is the boundary of medical obligation, not the boundary of medical tolerance. Using this tool, enhancement interventions such as cosmetic surgery can still be permissable for physicians to perform, but it is also permissable to deny them to patients.

This has important implications for social policymaking about healthcare coverage, to the extent that society relies on medicine's sense of the medically necessary to define the limits of its obligations to underwrite care. Again, all other considerations being equal, this interpretation of the concept suggests that few enhancement interventions should be actively prohibited by society or foregone by individuals, even when they are not underwritten as a part of healthcare, since there is nothing intrinsically wrong with seeking self-improvements beyond good health.

In contrast, the interpretations of enhancement that focus on the misuse of biomedical tools in efforts at self-improvement seem the most relevant to issues of personal, rather than professional, ethics. Concerns about the authenticity of particular accomplishments are moral challenges to the individual, but find little purchase in the professional ethics of biomedicine, with its focus on the physical safety and efficacy of its tools. The primary policy implications of this interpretation are for the social institutions charged with fostering particular admirable practices, for enhancement interventions that offer biomedical shortcuts to achievement force reassessments of the values these institutions stand for, as well as the practices designed to foster them.

Finally, at the other end of the spectrum, enhancement interventions that seem to commit the moral mistake of trying to address social problems through the bodies of the potentially oppressed do seem to mark a stronger set of moral boundaries for all concerned. For biomedicine, this concept marks an epistemic limit beyond which medical approaches to problem solving are not only unnecessary, but conceptually wrong-headed. For individuals, parents, and society, these kinds of enhancement interventions risk either backfiring (by exacerbating the social problems they are intended to address) or being futile (if they merely result in a shift of the normal range for a given social trait).

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