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Bioenhancements and the telos of medicine

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Abstract

Staggering advances in biotechnology within the past decade have given rise to pharmacological, surgical and prosthetic techniques capable of enhancing human functioning rather than merely treating or preventing disease. Bioenhancement technologies range from nootropics capable of enhancing cognitive abilities to distraction osteogenesis, a surgical technique capable of increasing height through limb lengthening. This paper examines whether the use of bioenhancements falls inside or outside the proper boundaries of healthcare, and if so, whether clinicians have professional responsibilities to administer bioenhancements to patients. After explicating two theoretical approaches to the concept of health, one objectivist and the other constructivist, I contend that clinicians' corresponding professional responsibilities hinge on which philosophical account of health is endorsed, and illustrate how the lack of analytic clarity with respect to this concept can lead to defective positions on the place of bioenhancements in healthcare. With this conceptual framework in place, an account of health as a cluster concept that incorporates both constructivist and objectivist components is developed and defended.

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Notes

  1. See also the Oath of Maimonides and the Declaration of Geneva, a declaration of medicine’s goals adopted by the World Medical Association (1948) that submits “The health of my patient will be my first consideration.”

  2. See Freedman (1978) and Walzer (1973) for discussion of these issues.

  3. These claims are revisited in “The inadequacy of objectivism” section where it is argued that they are not in fact value-neutral.

  4. This requires Boorse to take the position that determining whether a given process contributes to survival or reproduction ought to be done prospectively rather than retrospectively. For at some point in our history, our ancestors did require wisdom teeth and other vestigal structures for survival (wisdom teeth enabled consumption of tough meat tissue). Hence, on this view, functions aren’t explanations of why a process is present (contra Wright 1973) or how a process is integrated in a system (contra Cummins 1975) but rather are contributions to goal-attainment.

  5. Objectivists debate the status of psychological conditions. Szasz (Murphy 1987, 2011) argues that “mental disease is a myth” since it doesn’t consist in demonstrable physiological dysfunctions. Others (e.g., Murphy 2012) explain that mental disease is reducible to physiological dysfunction.

  6. The reason why this is formulated as a necessary but not as a sufficient condition is that it is conceivable that a clinician might aim to ensure/restore someone’s biological normality but in doing so end up leaving that person worse off. Whether such acts would constitute acts of healthcare hinges on whether acts of healthcare are circumscribed by agents’ intentions or the outcomes of agents’ actions viz. restoring/ensuring health. This issue, while important, is beyond the scope of this paper.

  7. Cf., January 2003 report of the President’s Bioethics Council, Beyond Therapy.

  8. See Cummins (1975).

  9. See n. 4.

  10. The hybrid approach discussed here might be considered an informed-desire satisfaction theory (Cf. Alexandrova (2005), Murphy (2012)).

  11. The authorship of the Oath of Maimonides is contested; some claim that the Oath was penned not by Maimonides but by Marcus Hertz (1747–1802), pupil of Immanuel Kant and friend and physician of Moses Mendelssohn. For a detailed history, see Rosner (1998).

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Authors and Affiliations

  1. Harvard Medical School, 260 Longwood Avenue, TMEC 236, Boston, MA, USA

    Michael J. Young

  2. Department of Philosophy, Harvard University, Cambridge, MA, USA

    Michael J. Young

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Young, M.J. Bioenhancements and the telos of medicine. Med Health Care and Philos 18, 515–522 (2015). https://doi.org/10.1007/s11019-015-9634-9

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