Professional Domain Approaches

One approach to the enhancement/treatment distinction is to define it in terms of the accepted limits of professional medical practice. Under this view, treatments are any interventions that physicians and their patients agree are useful and proper, while enhancements are simply interventions that are considered to fall beyond a physician's professional purview. Thus, physician-prescribed physical therapy to improve muscle strength would be considered legitimate medical treatment, while weight lifting under a coach's supervision to achieve a particular physique would be considered an enhancement. This view resonates well with a number of contemporary social-scientific critiques of bio-medicine, which suggest that medicine has no natural domain of practice beyond that which it negotiates with society (Good). It also provides a simple normative lesson for professionals concerned about their obligations in specific cases. Given medicine's fundamentally patient-centered ethos, one takes one's cues from the patient's value system, and thus negotiates toward interventions that can help achieve the patient's vision of human flourishing (Engelhardt).

Unfortunately, these same features also deny this approach the ability to be of help to those attempting to use the treatment/enhancement distinction in order to regulate biomedical research. Some argue that medicine's lack of an essential domain of practice means that a coherent distinction between medical and nonmedical services can never be drawn in the first place (Davis). Others accept the distinction between treating and enhancing, but question traditional values of medicine by arguing that privileging treatment over enhancement is itself wrong (Silvers). Still others argue that, for psychological and economic reasons, a professional medical line between treatment and enhancement will be impossible to maintain in practice (Gardner). To the extent that useful "upper-boundary" concepts are required at the policy level—for societies making healthcare research allocation decisions, for example—this impotence is an important weakness.

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