Ethical issues in moral and social enhancement

5.3.2. The’ proper goals of medicine’ and ‘the normal and usual traits’ 
objections 
This additional assumption supporting the essentialist view of ‘medical’ and ‘non-
medical’ problems is usually derived from intuitions about the proper goals of 
medicine. However, as Parens (2011) argues, it is difficult both to formulate and to 
justify such conception. Firstly, although a broad conception of health and the goals 
of medicine are available (such as the WHO’s), for the medicalization objection to 
be convincing, it needs to be sufficiently narrow. Moreover, Parens points out that a 
reader ‘attuned to how institutional goals change over time with the coming and 
going of more and less savory political interests, however, will be wary of an 
analysis that assumes knowledge of a given institution’s ‘proper’ or ‘essential’ or 
‘real’ goals.’ (2011, p. 3).
Conrad attempted to circumvent this problem by referring to whether or not 
diagnoses are viable, rather than whether they refer to ‘real’ medical problems: 
‘What constitutes a real medical problem may largely be in the eyes of the 
beholder, or in the realm of those who have the authority to define a problem as 
medical. It is the viability
 
of the designation rather than the validity
 
of the diagnosis 
that is grist for the sociological mill’ (2007, p.4). But it is unclear how the 

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distinction between viable and not viable and valid and invalid medical diagnoses 
would help the essentialism. Firstly, it is unclear what viability means according to 
Conrad (2007) and how it is different from validity. Perhaps it means 
‘reasonability’ or ‘usability’ or ‘usefulness’ in the given social context, since 
Conrad refers to the distinction understood in social constructivist terms; yet it is 
still unclear how that would impact the way sociological researchers go about 
choosing which diagnosis to investigate and how to investigate them. Parens (2011) 
suggests that in practice researchers tend to implicitly use the valid/invalid 
distinction, since sociologists do not investigate all viable diagnoses but rather pick 
and choose which diagnoses to investigate as cases of medicalization.
Another thread running through many objections to medicalization refers to the 
intuition that usual and normal human traits should not be understood as medical 
problems, even if they negatively impact wellbeing. The problem with the critics’ 
narrow conception of the goals of medicine that this usually entails – whether 
explicitly or inexplicitly – is some notion of 
normal 
or 
species-typical 
functioning 
(Boorse, 1977; Daniels, 1985; Sabin and Daniels, 1994), usually used normatively. 
However, the attempts to construe the notions of health and disease with reference 
to those concepts are riddled with problems (see: Agich, 1983; Engelhardt, 1986; 
Fulford, 1989; Harris 2007). Moreover, even if we could base our notions of health 
and disease on those distinctions, it is far from obvious that the protection of health 
is the only ‘proper’ goal of medicine – doctors typically perform organ 
transplantations, advise about contraception (which is plausibly understood as 
disrupting normal functioning of the organism for the benefit of preventing 
unwanted pregnancy), advise employers about their workers’ health, perform 
immunisations, etc. (Harris, 2007; Pacholczyk, 2011). Moreover, doctors perform 
amputations and brain lesions to ameliorate problems and avert danger to health or 
life (hardly, however, by restoring normal physiological function), prescribe aspirin 
that keeps blood clots from forming by interfering with the ‘normal’ production of 
thromboxine (keeping blood clotting below the average), prescribe bisphosphonate 
to prevent osteoporosis often occurring in older people by modifying the usual 
activity of bone cells, and prescribe hormone pills to reduce menstrual bleeding . 

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Thus, the generally accepted toolkit of medical professionals includes interventions 
which 1) do not attempt to restore health or prevent disease at all (e.g. providing 
birth control), 2) do not restore species typical-functioning yet are typically seen as 
treatment/prevention of a disease (e.g. dietary advice to ensure better health and 
longevity). This suggests that relying on a narrow concept of the proper goals of 
medicine is misguided and risks inconsistency, 
even if
we adopt a social 
constructivist approach.
Moreover, there is a problem with the normative assumptions behind the claim that 
medicalization going beyond the ‘proper goals’ of medicine is wrong. To say that 
the problem or cause of harm is commonplace provides little indication that we 
should not address it. It might have been commonplace for humans to get cold, yet 
we build houses and install heating systems; it might have been usual for people to 
die before 30, yet we welcome the chance to live longer if the quality of life is 
acceptable; it might have been usual for people to die of polio, yet we welcome the 
eradication of the disease and associated suffering (Harris, 2007) – the fact that an 
evil is usual, does not take away the permissibility of attempts to avert it, nor does 
the fact that a benefit is unusual make it morally impermissible to seek it. 
Even if
we accept that commonplace problems should not be medicalized, this says nothing 
about the permissibility of addressing them. But if we want to address them, why 
not do it via medical means when those means are available and effective? In this 
context, Harris (2007) proposed that we extend the notion of the proper goals of 
medicine to making people better, broadly conceived. This may include ‘making us 
better than well’ and giving us what we desire insofar as this is compatible with 
morality, is lawful, and so on.