Ethical issues in moral and social enhancement

bureaucratic gobbledegook
’, could be 
seen to be a bad development on Illich’s (1975) account. The position I just 
described is not, I presume, a position that Illich (1975) would endorse, yet it very 
well illustrates the problem with applying his and similar critiques. Finally, it is 
possible for all of those effects to be present simultaneously, making the evaluation 
of whether medicalization is a desirable or undesirable process a very murky 
evaluation.

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Moreover, according to Illich (1975), clinical iatrogenesis involves serious side-
effects which may be worse than the burden of the original condition. Clinical 
iatrogenesis include the harmful side effects of seemingly beneficial and advisable 
intervention, post-intervention complications, the negative effects of wrongly 
prescribed medication, bacterial resistance developed as a result of widespread use 
of antibiotics, hospital-acquired infections and harm resulting from negligent 
medical errors. Although some of the iatrogenic effects may be obvious, the burden 
of others may be difficult to calculate (e.g. the harmful effects of drug interactions 
that overlap with the progression of a disease or aging). One of the contributing 
reasons is the under-reporting of side-effects, as happened in the case of SSRIs, 
Rofecoxib (Avorn, 2012) and Lariam (Croft, 2007; Ritchie et al. 2013).
Finally, there may be a difficulty with detecting the full burden of side effects, 
including the causally related yet difficult to measure harms – such as the long-
lasting impact on the social interaction of moderately depressed people taking 
SSRIs and the impact of a Caesarean section on early formation of the mother-
infant attachment and its consequences. The cost-benefits analysis only makes 
sense on a case-by-case basis. Even when the cost-benefit analysis is performed, 
we have to be cognizant of the incompleteness of our view, the incompleteness that 
is reinforced and shaped by the ‘intangibility’ of some kinds of relevant side 
effects.
17
While indirect and intangible costs of a disease are often explicitly 
referred to, often the indirect and intangible costs of drug use are not mentioned.
It is important that direct, indirect and intangible costs of medical and non-medical 
solutions need to be compared, and accounted for to the extent possible. Intangible 
costs might sometimes give us a reason to choose a more expensive and perhaps 
non-medical solution to a problem, for example moral education over biomedical 
means of modifying empathetic ability. For example, if there was a cheap drug that 
would achieve an effect similar in this regard to a semester of moral education, we 
might see a drug as a cost effective solution. However, if it turned out that the drug 
affects adversely the ability to form and enjoy lasting relationships (as some reports 
17
‘Intangible costs’ usually refer to costs that cannot be directly expressed in monetary 
values, such as happiness or anxiety due to a disease. ‘Intangibility’ is perhaps an 
unfortunate term, since it implies that there is no way of measuring the impacts of those 
factors. I do not mean to suggest that those side effects are impossible to measure or 
estimate in any way, but I will follow the term used in the literature. See: Leukefeld et al. 
(2011). 

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on the side effects of SSRIs suggest), the balance of costs and benefits might 
change. In this case, more time and resources consuming moral education might be 
a better solution.
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