Enhancing the ill: The therapy-enhancement…

This post is in effect a gauntlet, a challenge for those who are significantly bothered by enhancements, such that they think that enhancing would be unethical or at least that there is a significant ethical difference between the two, largely because I can’t really work out what the fuss is and would like someone to try and explain to me what worries them about enhancements and whether it applies in this case.

Therapy is usually distinguished from enhancement in the following manner – therapy is about restoring normal functioning whereas enhancement is about going beyond normal functioning. So for example I’m an asthmatic and sometimes I am prescribed steroids to enable my lungs to regain normal functioning. However if an otherwise healthy athlete took the same medication it would function as an enhancement, boosting them above normal performance.

Objectors to enhancement typically argue that there is a morally relevant difference between therapy and enhancement in that there are medical justifications to provide therapies on the grounds of justice/rights/equality but not enhancements. Hence there is a moral distinction because the state is obliged to provide (some) therapies but not, or at least the argument goes, enhancements.*1

And some commentators further argue that enhancements are unethical because of an array of reasons such as justice, risks, meddling with human nature and so on.

I want to suggest there is at least one class of enhancements where there is a solid medical justification to provide these. This is when something acts as both a therapy and an enhancement for someone – I’ll call these therapy-enhancements. A case will make it clearer which I’ll refer to as the Pinky & the Brain case.

Suppose we have someone who we will call Pinky who has a profoundly low IQ – let’s say 40, so low that they require substantial levels of state support to be able to live their life. Suppose there is a new drug A on the market that will increase the IQ of those with profoundly low IQ’s (and only those with these IQ’s) however it will increase their IQ’s significantly above species normal IQ levels of 100 to let’s say 160, hence transforming Pinky into Brain.*2 This seems to me to be a drug which is both providing a therapy since it raises them to a normal IQ and enhancing them as well since it raises them substantially beyond a normal IQ as well. If this drug is relatively speaking affordable – more cost effective than any present treatment they are getting then it seems to me obligatory that the state provide this despite it being an enhancement.*3

So this raises worries about how strong objections to enhancement can be, since if they are strong one might think we ought to forgo therapies that also enhance, which would seem to me to be unjust. We can strengthen this concern by considering a further case which raises questions for the strength of any morally relevant difference between therapy and enhancement.

Suppose that the pharma company who developed A, recognising the concerns some have about enhancement have developed a new drug B which like A raises the IQ of those with profoundly low IQ’s but unlike A it only raises them to the species norm of 100 – unfortunately due to the additional development costs, smaller market etc the company decides to charge twenty times the price of A. What should the state do, should it switch to B to avoid enhancing? I think clearly it ought not, and for me at least that intuition holds true until B is cheaper than or perhaps equal to A in price (in which case I’m vaguely indifferent but probably lean towards the free additional 60 IQ points). What this seems to show is that any normative force the distinction has is at best quite weak, easily over ruled by a slight increase in efficiency.

This doesn’t of course show that there is no morally relevant difference, merely that if there is one it is quite, quite weak.

*1 Of course this might be challenged since some things that look like things health care systems ought to provide such as vaccines seem to function more like enhancements than therapies.

*2 I’ll leave it up to you whether this increase in intellect induces what this lovely book (Soon I’ll be Invincible) refers to as Malign Hyper-Cognition Syndrome…

*3 Are there actual cases like this? I suspect the answer is probably yes – for example if a disabled athlete runs faster with their blades than they did before losing their legs this would be a case of a therapy-enhancement.

  • Keith Tayler

    I suppose I better pick up your gauntlet. I have number objections to eugenics and one more for “enhancement”, a term I particularly dislike because it hides the fact we are talking about eugenics. Those that are apologists for enhancement, I have observed, seldom have any understanding or interest in the history of eugenics and the mathematics and (pseudo) science from which it immerged. Here is not the place to detail the history of eugenics, but if I did I would not like to be accused of making a ’fuss’.

    I do not think the distinction between therapy and enhancement is clear-cut. Nor am I a fan of thought experiments. It is quite reasonable to agree with your conclusions within the prejudices and limits of the thought experiment and still be opposed to eugenics in the real world. For sure the thought experiment contains many of the problems to be found in real world eugenics. However, within its context we might not want to make a fuss about the questionable use of IQs, the ideology of the normal, and the belief in the “technological fix”. In the real world we do want to make a fuss because therapies that alter mental states and intelligence are problematical and so-called enhancements are extremely problematical.

    Thought experiments are philosophically interesting, but, as with for example Rawl’s ‘original position’, they are usually constructed to promote an intuition, theory or policy. ‘Pinky and the Brain’ promotes your belief in enhancement and there is nothing wrong in that so long as you do not expect it to quell the fuss. Of course your thought experiment, changing the nice but dim Pinky into the megalomaniac Brain, could be used by those of us opposed to quick fix neurotechnological therapies and enhancement. I think I will stick with Pinky.

  • Thanks Keith – for the record I’m not pro-enhancement, certainly not in a strong sense, I’m just also not anti it – it is a debate where I think both sides (Transhumanist & Bioconservatives) have quite odd views.

    I’m certainly happy to agree that eugenics has had a bad history, but I think we ought to be careful of relying too much on history – medical practice for example has a pretty bad history (its telling that for trials in the UK where the death penalty was an option, butchers and doctors were not permitted to sit on the jury because they were inured to death…) but I don’t think we should therefore infer that medical practice shouldn’t be tolerated.

    I’m also not sure whether enhancement is inherently eugenic – but I’m happy to be convinced otherwise.

    I’ll admit to the ambivalence and short comings of the example, it was part of the charm for me, since as I said I’m not strongly pro either and think that those on the strongly pro-side tend towards wild unrealistic optimism in regards to the effects of technology and how they will be used…

  • Keith Tayler

    I agree that medical practice has a somewhat chequered past, not least because much of it was and still is closely linked with eugenics and so-called therapies that were and are “normalising” eugenics. Obviously eugenics has a terrible history but my interests in its past focuses more on the 19th and early 20th centuries. At that time its mathematical, scientific and philosophical credentials were impeccable and it was universally acclaimed by both left and right. It was ‘bad’, but why was it so respected among the scientific community and intellectuals of the day, and, as Galton urged, raised to the level of a religion in the minds of the populous? Scientific, technological, social and political change in the West was much faster at that time than it is now, so there are differences that make comparisons between eugenics and enhancement difficult. But what if that was to alter and we moved into a period of similar rapid change? Would enhancement follow a similar path to that of eugenics? (There are too many ‘what-ifs’ for here.)
    I am not anti-enhancement and could be said to support some eugenics (abortion in the case of some severe defects is reasonable). I just get tired and a little worried by the simplistic arguments of the pro-enhancement lobby. Surely they could spend a year or so doing some proper research into the history of eugenics, genetics, statistics, politics, etc. in order to get an understand of the shape of the world then and now. But all we get are thin analytical arguments that are located in poorly constructed thought experiments.
    I would not be at all surprised to discover that my concerns turn out to be unjustified (I will probably be dead by then so I will be beyond surprising. And no I do not want to be enhanced to live forever). Let us hope I am wrong and, as the crooks in the banks say, past performance is no guide to future performance.
    Sorry if I got confused about your beliefs on this matter but when I saw ‘fuss’ I thought ……. Best not say.