Ethical issues in moral and social enhancement

5.3.4. The ‘full human life involves suffering’ argument
Regardless of the direct epistemic value of letting us know where we stand, 
unpleasant experiences can also be regarded as a necessary and valuable part of a 
full human life. As problems are medicalized, a critic might say, they are construed 
as pathological and in need of fixing, while some kinds of suffering should not be 
fixed.
In his critique of the process of medicalization, Illich (1975) argued that 
medicalization is associated with iatrogenesis, in which the problems created by 
medicine are worse than the solutions it offers to the original condition. Cultural or 
structural iatrogenesis may happen when the medical view of, for example, pain, 
birth and death changes the meaning that those experiences have to people. 
According to Illich (1975) the meaning and the experience of suffering goes beyond 
the mere occurrence of physiological pain, and the attitude and meaning we give it 
makes a difference to how we live our lives. He further argues that medicalization 
leads people to forget about accepting suffering as an inevitable part of their 
conscious coping with reality, and instead learn to interpret every ache as an 
indicator of the need for ‘padding or pampering.’ Meanwhile, the signs and 
experience of suffering were traditionally seen as signals with a function of eliciting 
a response from an agent. Thus, Illich sees medicalization as the process of 
detaching pain from its cultural context (and thus meaning) and aiming to annihilate 
it.
It is easy to agree with Illich 
(1975)
that the easier it is to make the pain just go 
away, the more temptation there is to alleviate the pain and ignore its cause, thus 
potentially bypassing the motivational and epistemic value of pain. On the other 
hand, there are many instances of unnecessary pain (in the sense of not serving any 
epistemic or motivational functions, or where the benefit brought by those functions 
is outweighed by harms) and alleviation of it would be appropriate. For example, it 
seems unnecessary to be dying in pain if one can die calmly and without pain; after 

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the function the a pain of a broken leg has been fulfilled, it seems unnecessary to 
continue to be in a strong pain. Illich’s argument holds only to the extent that we 
forget about the epistemic and motivational functions of pain.
An account inspired by existentialists may see anxiety as valuable because the 
experience of anxiety disrupts immersion in the usual projects and identity-creating 
roles, and is a part of the experience of oneself as a moral agent, responsible for 
one’s decisions (Moran, 2000). Klerman
(1972) made a more general point that 
Western culture developed under the influence of Ancient Greek and Christian 
traditions, which have assigned value to the suffering that comes with human 
problems. In a similar vein, Parens (2011) cites Shenk’s (2005) account of how 
Abraham Lincoln’s ‘melancholia’ was not just a huge burden, but also a crucial 
ingredient in his great life, this being but one recent example of that view. Thus, 
one may say that suffering may be seen as valuable and necessary for a full human 
existence and pharmacological interference with it as impairing our ability to 
flourish as people.
The critics of this approach sometimes call it ‘pharmacological Calvinism.’ The 
phrase was first used in the 1970s by Klerman, who thought that ‘[i]mplicit in the 
theory of therapeutic change is the philosophy of personal growth, basically a 
secular view of salvation through good works’. He describes ‘pharmacological 
Calvinists’ underlying intuition to be that
‘if a drug makes you feel good, it not only represents a 
secondary form of salvation but somehow it is morally wrong 
and the user is likely to suffer retribution with either 
dependence, liver damage … or some other form of medical-
theological damnation.’ (1972, p. 3)
Parens notes that ‘[i]nsofar as those traditions celebrated suffering for which there 
were no medical remedies, Klerman must be right that at least to some extent those 
traditions made a virtue of necessity’ (p. 5). Parens reformulates Klerman’s 
thought:

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‘If pharmacological and psychotherapeutic means can both 
achieve the same end – improving how one experiences 
herself and the world – then it is irrational and perhaps 
inhumane to prefer the more strenuous and expensive 
means. It’s irrational not to take a shortcut when 
improving human well-being is the destination. We should 
be slower to imagine that suffering leads to growth and 
understanding, and quicker to remember that sometimes it 
just crushes human souls.’ (Parens, 2011, p. 5)
One interpretation of Klerman’s may point to the value of a process (whether or not 
it involves suffering) rather than the outcome and the value we might ascribe to 
effort and struggle. Parens suggests that Kleman’s view ignores the moments in 
which we would think that suffering is a crucial element in a good human life and 
gives an example of grieving after a loss of a loved one. He suggests that such 
suffering should be endured rather than erased. This points to the fact that not all 
ways of improving wellbeing are good in the same way, and we may have reasons 
not to choose a ‘shortcut’ to wellbeing.
Although Parens’s example is an intuitively appealing counterexample to 
Klerman’s view, we should not let the intuitive appeal get the better of us. The 
appeal of the example stems from several sources, and I would propose that we 
question the intuitions to which Parens is appealing. The problem, I think, is not 
with the medical means of change but rather stems from the fact that we value a 
certain engagement with the world in which our feelings both express and reflect 
our situation and what we find valuable. The loss of a person we loved rightly 
evokes grief which we would be justified in not wanting to immediately remedy. 
However, the argument would equally apply if we decided to put ourselves though 
a two week course in psychotherapy, one that would alleviate our grief via 
attenuating the emotions, so that they would correspond to the emotions felt when 
losing a favourite umbrella. Parens would be justified in raising exactly the same 
objection and we may justifiably question whether immediate attenuation of grief 
amounts to ‘improving how one experiences herself and the world.’ (Parens, 2011, 

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p. 5) However, the problem has little to do with the exact means of medicalization, 
nor with medical solutions specifically.
Yet, there is another way in which Klerman's thought can be understood: he can be 
seen as criticising the view which focuses on the value of the effort, instead of the 
desired outcome. Several commentators emphasised the value of effort in the 
pursuit of excellence, and highlighted that medicalizing the problem means looking 
for a technological fix – which, even if pragmatically possible, would not be 
morally desirable (for discussion see: Cole-Turner, 1998; President’s Council on 
Bioethics, 2003, p. 289; Fox, 2005; Olsen, 2006; Schermer, 2008; Goodman, 2010). 
Since the scope for improvement and effort will remain, even if we find 
technological fixes for many problems and shortcuts to wellbeing, the objection is 
weak if it is trying to establish that biomedical enhancements are morally 
impermissible or inherently morally suspect because they take away the chance of 
morally valuable effort.
On the other hand, it correctly highlights the fact that we may not always have a 
reason to take shortcuts, since what we may value about something is the activity or 
the process. When solving brain-teasers we might prefer to ‘figure it out’ on our 
own, because we value the activity and process over finding an answer that we 
could easily find online. Similarly, there is a reason why we may prefer a bike tour 
over a flight, even if the end destination is the same. We might also endorse the 
suffering of grief, and find a certain degree of existential doubt and anxiety as 
reflecting the human condition. However, it appears that it is not ‘the effort’ or 
some other similar disconnected property undermined by biomedicine that we 
value, but rather the pleasure of the process, the importance of the journey, the 
character-shaping or skill-developing consequences of the effort. Similarly, 
experiencing pain may be valuable when it stimulates us to come to grips with our 
situation, or for its role in expressing and reflecting what we find important. The 
extent to which ‘effort’ or pain are necessary to achieve the things we find valuable, 
however, is contingent on circumstances and not valuable for its own sake.
Experiencing poverty, hunger, illness or loneliness may open to us an 
understanding of others who are in a similarly dire position, an understanding that 

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we would not otherwise have. It might also allow us to appreciate what we have got 
to a greater extent, and help us to learn ways of dealing with ourselves and the 
world that we otherwise would not learn. It might also stimulate social action. Yet, 
the importance of apparently undesirable states and experiences for a full and 
flourishing life should be scrutinised; since those experiences are considered to be 
necessary for fully experiencing life, they might be subject to the