Ethical issues in moral and social enhancement

5.4.
Ethical appraisal: the benefits of medicalization
Parens (2011) argues that discussions of medicalization often rely upon a tacit 
distinction between medicalization (which is good) and over-medicalization (which 
is bad). He suggests that the cases of PTSD and Alzheimer’s disease, which were 
once seen as non-medical problems but are now understood within a medical 
context, are examples of ‘good medicalization.’ Similarly, Carter and Hall (2012, 
p.231; also Burke, 2011) point out that some scholars use medicalization in a more 
positive sense to describe the increased use of effective medical treatments by those 
who were previously denied access, either for social reasons or because such 
treatments were not available. 
What are the potential benefits in the process of medicalization? The critical 
appraisal of arguments against medicalization already yielded some indication of 
such benefits. Medicalization may allow patients to forge collective identities 
around shared experiences, facilitating advocacy efforts and improving recognition 
(Browne et al. 2004). It may also shift social perceptions away from a moralistic, 
punitive approach to deviance, thereby creating space for increased support and 
tolerance (Burke, 2011). On an individual level, medicalization may also legitimize 
an individual’s struggles and lead to increased access to services and resources 
(Conrad and Potter, 2000; Conrad, 2007). Further, a medical diagnosis may afford 
access to social capital associated with ‘the sick role’ (Parsons, 1951).
To provide further counterweight to the critics’ claims I will use the example of 
medicalization of addiction to briefly outline some of the benefits that the process 
of medicalization may bring. Firstly, and rather obviously, taking a medical 

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perspective may lead to good outcomes following the development of a better 
solution to a pre-existing problem. I will not elaborate on this point in great detail, 
but medicalization may be desirable because all the potential and actual problems 
of medicalization may have less weight than the sometimes devastating results of 
addiction. 
Secondly, the construction of a problem as at least in part medical rather than 
entirely moral may pave the way to easier change, be it via medical or other means. 
For example, drug addiction can be regarded as a ‘chronic, relapsing brain disease’ 
(Leshner, 1997; see also Volcow and Li, 2005) or a matter of personal 
responsibility. The former view has been echoed in the attitude of US National 
Institutes (NIDA and NIAAA) while the latter is held by many drug users and 
families (Bell et al. 2012). That addiction has become medicalized is evident in the 
widespread position that addiction is a ‘chronic, relapsing brain disease’ (Leshner, 
1997), a claim informed by evidence of neurophysiological and neurochemical 
changes present in addiction (Volkow and Li, 2004). As the evidence of 
neurological changes that predispose drug users to subsequent use accumulates, the 
medical model has become prevalent, replacing the dominant perspective of the 20
th
century that individuals who use drugs were ‘autonomous, self-governing 
individuals who wilfully, knowingly, and voluntarily engaged in criminal and 
immoral behaviour’ (Carter and Hall, 2008, p. 81).
According to its proponents, the brain disease model of addiction leads to changes 
in social and public health policies, which will have the double benefit of providing 
more humane and ethical responses to addiction, as well as more effective solutions 
to addiction and related harms (Leshner, 1997; McLellan, et al., 2000; Volkow and 
Li, 2004; Dackis and O’Brien, 2005). Indeed, the rise of the medical model of 
addiction has already played a role in finding novel and beneficial approaches. A 
neurophysiological deficit-focus view of addiction led to the development of opioid 
substitution therapies, which have shown to be effective in reducing drug use. In 
fact, Bell et al. (2012) argue that the primary barrier to increasing the effectiveness 
of opioid substitution therapy is residual vestiges of a non-medical, moralizing 
approach to drug use evinced by healthcare practitioners working in inpatient 
treatment facilities. Furthermore, opioid substitution therapy has its analogue in 
approaches to tobacco smoking cessation such as nicotine replacement therapy, 

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which similarly depends on a medicalized, biological dependency perspective on 
cigarette smoking (Gartner and Partridge, 2012). Thus, the medical approach comes 
with an epistemic stance that facilitates the creation of certain kinds of solutions 
that have been shown to increase the chances of kicking the addiction or alleviating 
its harmful consequences.
Even where those approaches overemphasise the impact of physiological changes, 
such as changes in the reward circuitry in the brain, and unjustifiably 
underemphasise the impact of social factors or the strength of habit, the approach 
has generated previously unheard of solutions to addiction. Indeed, as the 
limitations of the ‘brain disease model’ start to come to the fore, the social, 
motivational and habitual influences on maintaining addiction enjoy greater 
attention and lead to an integration of pharmacological approaches with other 
remedies, such as counselling (National Institute on Drug Abuse, 2012).
Moreover, abandoning the view of addiction as a matter of moral strength or 
weakness may decrease blame and facilitate the search for solutions. Firstly, it is 
sometimes argued that addiction neuroscience encourages individuals to seek 
treatment or empowers them to make choices not to use drugs (Condit et al., 2006; 
Carter and Hall, 2012). Secondly, the existence of an authoritative scientific 
explanation of addicted individuals’ experiences might increase their willingness to 
engage in medical treatment (Hall et al., 2008). There is some empirical support for 
this view. Gartner and Partridge (2012) point out that ‘smokers who attribute a 
failure to quit to unchangeable intrinsic factors such as personal characteristics have 
lower personal quitting intentions and lower quitting self-efficacy’ (p.79). 
Similarly, many patients who received a mental health diagnosis describe the sense 
of relief coming with decreased self-blame associated with the attribution of 
responsibility shift, as well as with a hope for a solution. Paradoxically, although 
medicalization is often criticised as labelling and stigmatizing struggling 
individuals, it may also lead to de-stigmatisation. Thus, the change in attribution of 
responsibility coming with a medical model has the potential to be either 
pragmatically harmful or beneficial, depending on whether it increases or decreases 
effective coping.

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Additionally, models of dependency associated with medicalization give rise to a 
host of other approaches that recognize the biological basis of addiction. Those 
approaches tend not to focus upon abstinence, but upon reducing the risk of harms 
unnecessarily associated with drug use. These approaches include needle-exchange 
programs and medically-supervised injection sites, both of which are shown to 
reduce infections common amongst injection drug users forced to share needles or 
inject hurriedly to avoid detection. Those solutions, however, commonly face 
protests rooted in a view that the government should not allow drug users to act 
illegally and immorally – a perspective commonly associated with Brickman et al.’s 
(1982) moral model of addiction. Here, the medical model may facilitate adopting 
social policies that prevent a great amount of unnecessary harm.