Ethical issues in moral and social enhancement

5.3.5. Living well requires that we let some problems be.
Another ethical worry raised about medicalization is that the obsessive focus on 
averting small problems is self-defeating and we should accept some of the 

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problems as a part of human existence. For example, Barsky and Boros argue that 
empirical studies suggest that
‘people are increasingly bothered by, aware of and 
disabled by distress and discomforts that in the past were 
deemed less important and less worthy of attention’ (1995, 
p. 1932).
The authors note that social and cultural forces can lead individuals to amplify pre-
existing physical discomforts, misattribute them to disease and seek medical help.
Thus, they see somatization (defined as the propensity to experience and report 
somatic symptoms that have no pathophysiological explanation
[Woolfolk and 
Allen, 2007]) and medicalization are mutually reinforcing processes.
Medicalization of everyday and usual problems is on this account seen as troubling 
because it makes us attend to them more, and increases the suffering by making the 
problem more silent. In the same way that focusing on every single imperfection of 
one’s body makes one increasingly notice and assign weight to imperfections that 
would otherwise not be particularly troubling, medicalization may construct issues 
that previously were seen as usual (even if imperfect) features of life as problems to 
be fixed. In addition to increasing the weight of pre-existing problems, 
medicalization might lead one to make a previously unnoticed or unimportant 
feature or experience acquire a negative meaning, resulting in a proliferation of 
defects (Bordo, 1998). Susan Bordo describes how after a visit to dentist (motivated 
by a need to address an altogether different matter) her perception shifted: 
‘the gumminess of my own smile was of no concern 
to me until after I had seen the dentist; but under his 
care I began to wonder if it wasn’t in actuality 
something I’d better hide… or ‘correct.’ (…) If you 
are trained to see defect, you will.’ (Bordo, p.213).
The argument may go as follows: when previously acceptable traits and experiences 
become unacceptable we are faced with a situation in which, although more and 

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more imperfections are ameliorated and despite our increased capabilities, our 
subjective wellbeing falls. I think that the worry raised by Bordo (1998) is 
prima 
facie
plausible, insofar as medicalization involves construing something as a 
pathology, presumably at both an individual and social level. However, the issue 
raised by Bordo (1998) is also a matter of values and culture and not only 
medicalization. For example, Francis examined the stigma experienced by middle-
class parents of children with physical, psychological and behavioural problems and 
highlighted the importance of also considering ‘larger contexts of an anxious, 
intensive parenting culture’ (2012, p. 927). What is a reasonable response? The 
focus here, I think, should not be on the medical or biomedical toolkit, but rather on 
the cultural norms that may foster wellbeing or ignite stigma. The considerations 
raised by Bordo (1998) could also provide reasons to abandon the discourse of 
‘pathology’ and focus on the discourse of ‘improvement,’ as well as reevaluate the 
value of ends that the medical means might be used to achieve.
A related problem raised by Bordo (1998) has to do with the creation of new desires 
and the cultural norms and context medicine is embedded in. This problem is not a 
specific effect of medicalization but rather refers to the ‘creation of desires,’ which 
could equally be an effect of advertisers wanting to sell us their products, 
professionals wanting to sell us their services and more attention directed to the 
possibilities afforded by a new technology. Where the creation of new desires is 
unendorsed by the agent and happens without an easy ability for the agent to be 
able to engage with the influence, the issue merits our attention (For more 
discussion see: Arrington, 1982; Crisp, 1987; Phillips, 1994; Dow, 2013). Luckily, 
the fact that we could do something does not mean that we should do it, and that 
something is available does not mean that it is valuable.