Ethical issues in moral and social enhancement

1.3.
 
Enhancement as improvement 
1.3.1. Treatment and enhancement 
This section aims to explore what can be referred to under the concept of 
enhancement, and proposes a wide understanding of enhancement as improvement. 
I will be discussing ‘enhancement’ in relation to concepts explicated in section 
1.2.2 and 1.2.3, that is both enhancement understood as an intervention that aids 
moral agency and an intervention in the moral sphere that is prudentially beneficial 
to an agent.
Enhancement is often assumed to refer to the improvement of functioning above 
normality, while treatments are aimed at maintaining and restoring normal 
functioning or good health (Juengst 1998). Some scholars argued for the normative 
significance of the distinction between treatment and enhancement. However, this 
basis for defining enhancement is problematic. Take, for example, the case of X-
linked severe combined immunodeficiency occurring in some boys (Häyry, 2010). 
In children with this syndrome, the immune system does not provide a defence 
against infections, so that what would otherwise be a minor infection becomes life-
threatening. If there was an intervention that could improve the functioning of the 
immune system in those boys, we would call it treatment rather than enhancement, 

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despite the fact that the function of the immune systems of those boys is a result of 
their genetic endowment (Häyry, 2010).
This limitation can be partly addressed if we take ‘normal functioning’ to refer to 
‘species-typical functioning.’ This approach was taken by scholars like Sabin and 
Daniels (1994; Daniels, 1996) who argued that in determining the natural functional 
organization of members of a species it is possible to create a model of normal or 
species-typical function. Disease would represent a statistical deviation from 
normal or typical functioning (Sabin and Daniels, 1994; Daniels, 1996). However, 
it seems reasonable to assume that disease refers to the state of impaired or indeed 
less than optimal function rather than simply a deviation from the average – it 
would be rather awkward to say that to be a genius is to have a disease (Pacholczyk 
and Harris, 2010).
If disease is a deviation from species-typical functioning, treatment is what restores 
it. However, that is only correct for those below the typical functioning level. An 
intervention that levels-down those who are above the range of typical function 
would be difficult to call an enhancement. Such intervention would be damaging 
and not beneficial. It would also not be ‘therapeutic’. Therefore, restoration of 
species-typical functioning can be called therapy only if it constitutes an overall 
improvement in function or, in other words, an enhancement relative to the state 
before the intervention (Harris, 2009).
Another problem with the species-typical functioning view is that species-typical 
traits can be reasonably thought to be disabling (Harris 2001; 2007). That could be 
the case, for example, when the environment changes in such a way that a given 
widespread trait becomes a maladaptation heightening the risk of serious harm, 
which in turn impairs the ability of those possessing this trait to lead full lives. 
Consider another example. Dying of the diseases of old age is species-typical and 
normal, but is not necessarily desirable. If we could systematically treat diseases of 
old age by stimulating the regeneration of tissue and simultaneously switching off 
the aging processes in the cells, the longevity of patients could substantially 
increase. This would appear to constitute both therapy and enhancement, and the 
fact that diseases of old age are species-typical seems not to be overly relevant 

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(Pacholczyk and Harris, 2010). As a result of the discussed problems of the species-
typical view, John Harris has proposed that enhancement may be understood widely 
as an improvement brought about by a change in a characteristic or function and an 
intervention that is overall beneficial (Harris, 2007; Pacholczyk and Harris, 2010).
In this work I will not attempt to fully consider arguments related to the 
treatment/enhancement distinction. The highlighted problems appear to me 
sufficient to question its normative force and to think about the reasons we want to 
resort to such a distinction in the ethical assessment of biomedicine. We could have 
a good reason if the distinction easily translated into moral appraisal of a given 
intervention, for example if it told us something about its permissibility or helped in 
decisions about allocation of resources. However, it is unclear that the distinction 
can serve this purpose. In their discussion of adult ADHD, Schermer and Bolt 
(2011; see also Schermer, 2007) argued that even if such a distinction could be 
made for a number of paradigmatic cases, it still leaves us with a large grey area in 
which such distinction would not be useful. In this work, I will not ground ethical 
argument in the distinction between treatment and enhancement.
Moreover, I will not attempt to clearly distinguish between the enhancing and 
therapeutic uses of potential social and moral enhancers. Wolpe points out that our 
understanding of ‘enhancement’ and ‘treatment’ is socially constructed: ‘concepts 
such as disease, normalcy, and health are significantly culturally and historically 
bound, and thus the result of negotiated values’ (Wolpe, 2002, p. 389). What 
conditions are included under the ‘therapy’ umbrella is socially negotiated and can 
be re-negotiated. Some scholars raised doubt about whether the expansion of 
diagnostic categories such as depression and ADHD is appropriate – perhaps we are 
labelling as diseases conditions that should not be treated as such (Conrad, 2007). I 
will address some of the ethical concerns related to medicalization in further 
chapters. In this introductory chapter it suffices to note that the presence of 
medicalization and de-medicalization, disease mongering and, expanding disease 
definitions (Schermer and Bolt, 2011) make the ‘enhancing’ and ‘therapeutic’ uses 
to be moving targets. It is not necessary for this work to hit those moving targets, 
and the discussion can be enriched by welcoming what Schermer and Bolt (2012) 
called the ‘grey area’.

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Thus, I will consider interventions of a similar kind (e.g. aimed at an increase in 
empathy, modulation of anger, etc.) regardless of whether they would attract a 
‘therapy’ label or not. What will be of a greater concern in this work is whether the 
intervention is a moral enhancement in the sense of making morally better agent 
(see s. 1.2.2) or an intervention in a moral sphere that is generally desirable (see s. 
1.2.3) as well as the factors that can influence the assessment of other factors that 
influence the assessment of overall moral permissibility of the modification.