Ethical issues in moral and social enhancement

5.2.2. New approaches to medicalization – biomedicalization 
The social context of medicine, however, has changed. Critiques of the ways in 
which the medical profession has extended its jurisdiction have become part of 
everyday and professional debate, and the power of doctors is constrained by the 
law and threat of litigation, the critical eye of bioethics, the increasing imperative 
for evidence-based medicine, as well as by a strong focus on patient autonomy, 
patient’s rights to health and compensation of injuries. Perhaps there is room for 
improvement in the way the medical profession pays attention to those constraints 
in practice, but currently a host of new actors and problems have exerted increased 
influence over the process of medicalization.
In a recent paper, Clarke et al. argue that medicalization is intensifying and being 
transformed: around 1985 ‘dramatic changes in both the organization and practices 
of contemporary biomedicine, implemented largely through the integration of 

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technoscientific innovations’ (2003, p. 161) contributed to an expanded phenomena 
they call biomedicalization. They define biomedicalization as
‘the increasingly complex, multisited, multidirectional 
processes of medicalization that today are being 
reconstituted through the emergent social forms and 
practices of a highly and increasingly techno-scientific 
biomedicine’ (Clarke et al. 2003. p. 162).
The concept is very wide and includes a wide variety of phenomena: biotechnology, 
medical informatics and information technology, changes in health services and the 
production of technoscientific identities. This new conception was criticised by 
Conrad for losing the focus on the definitional issues, which have always been a 
key to medicalization studies. 
Whether we see the changes as a transformation into a qualitatively new 
phenomenon (Clarke et al. 2003) or as an extension of medicalization (understood 
as in Conrad, 2005), medicine has been and is changing. By the beginning of the 
1990s we began to see impacts of the changes in the organization of medicine. As 
the emphasis in health policy shifted from concerns about access to cost control and 
care management (Pescosolido, 2006; Scott et al. 2000), some scholars noted an 
erosion of medical authority (Starr, 1982). Sociologists focused on 
deprofessionalization, decline, and public distrust (Pescosolido, 2006). McKinlay 
and Marceau (2002) noted that the ‘golden age of doctoring’ has ended in an 
emerging, increasingly buyer-driven system, as the physicians – like all other 
workers in a capitalist society – were eventually stripped of control over their work 
through corporatization and bureaucratization (McKinlay, 1982). Patients began to 
act more like consumers, both in choosing health insurance policies and in seeking 
out medical services (Inlander, 1998), and although this trend was especially strong 
in the US, it can also by noticed in countries with publicly funded health care 
systems, such as the UK’s. In addition, new arenas of medical knowledge were 
becoming increasingly dominant, with the boom in scientific knowledge in 
neuroscience and genetics, as well as the increasing profitability of pharmacology 
and early applications of genetics and neuroscience. Conrad notes a change in the 
drivers of medicalization. He cites the three new forces contributing to 

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medicalization as biotechnology, consumers, and healthcare funding and 
emphasises that medicalization is currently driven by commercial and market 
interests, with doctors increasingly acting as gatekeepers of technology (Conrad, 
2005).