The Normalcy Approach

Fortunately, another approach to interpreting the treatment/enhancement distinction is framed explicitly as a policy tool for separating legitimate healthcare needs from luxury services. The most developed exposition of this view is Sabin and Daniel's endorsement of what they call the "normal function" standard for determining the limits of "medically necessary" (and therefore socially underwritten) health services (p. 13). Sabin and Daniels argue that an appropriate boundary between medically necessary treatments and optional enhancements can be drawn by thinking about how to provide medical services fairly within a population. Following Daniels' earlier work, they construe healthcare as one of society's means for preserving equality of opportunity for its citizens, and they define "healthcare needs" as those services that allow individuals to enjoy the portion of the society's "normal opportunity range" to which their full array of skills and talents would give them access. This is done by restoring or improving the patient's abilities to the range of functional capacities typical for members of his or her reference class (e.g., age and gender) within the human species. Any interventions that would expand an individual's range of functional capacities beyond the range typical for his or her reference class would be deemed a medically unnecessary enhancement. Others have used similar understandings of human malady to help explicate a distinction between "negative" (e.g., therapeutic) and "positive" (e.g., enhancing) human genetic engineering (Berger and Gert).

The advantage of the normal-function approach is that it provides one relatively unified goal for healthcare, toward which the burdens and benefits of various interventions can be relatively objectively titrated (measured against one another), balanced, and integrated. The normal-function approach comes close to accurately reconstructing the rationale behind many actual "line drawing" judgments by healthcare coverage plans and professional societies (Brock et al.). Unfortunately, this approach also faces conceptual challenges in an important way. The first serious problem is that of prevention. While efforts at generic "health promotion" straddle the border of biomedicine, efforts to prevent the manifestation of specific maladies in individuals are always accepted as legitimate parts of biomedicine, and thus are automatically located on the treatment side of the enhancement boundary. On the other hand, one of the ways one can prevent a disease is to strengthen the body's ability to resist it long before any diagnosable problem appears. These forms of prevention attempt to elevate bodily functions above the normal range for the individual (and in some cases the species), and to that extent seem to slide into enhancement (Juengst). If human gene—transfer protocols like these are acceptable as forms of preventive medicine, how can it be claimed that healthcare practitioners should be "drawing the line" at enhancement?

Anxiety and Depression 101

Anxiety and Depression 101

Everything you ever wanted to know about. We have been discussing depression and anxiety and how different information that is out on the market only seems to target one particular cure for these two common conditions that seem to walk hand in hand.

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