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.