Guest Post by Hazem Zohny
Some bodily and mental states are advantageous: a strong immune system, a sharp mind, strength. These are advantageous precisely because, in most contexts, they are likely to increase your chances of leading a good life. In contrast, disadvantageous states – e.g. the loss of a limb, a sense, or the ability to recall things – are likely to diminish those chances.
One way to think about enhancement and disability is in such welfarist terms. A disability is no more than a disadvantageous bodily or mental state, while to undergo an enhancement is to change that state into a more advantageous one – that is, one that is more conducive to your well-being. This would hugely expand the scope of what is considered disabling or enhancing. For instance, there may be all kinds of real and hypothetical things you could change about your body and mind that would (at least potentially) be advantageous: you could mend a broken arm or stop a tumour from spreading, but you could also vastly sharpen your senses, take a drug that makes you more likeable, stop your body from expiring before the age of 100, or even change the scent of your intestinal gases to a rosy fragrance.
Would all such changes be instances of enhancement?
According to this welfarist approach, yes – at least to the extent that such changes are likely to improve your well-being. The idea here is not to bog down the concepts of enhancement and disability with contestable boundaries tied to problematic concepts like normal and abnormal traits and functioning, along with unproductive attempts to distinguish treatment from enhancement. For instance, imagine one person is extremely short due to an otherwise benign brain tumour stunting their growth, while another is equally short due to genes inherited from short parents. Does one require treatment while the other can only hope for enhancement? The welfarist account asks us to skip these fruitless questions and focus on whether their stature is disadvantageous – i.e. whether it is reducing their wellbeing. If it is, the discussion can then move on to whether we ought to do something about it biomedically, or whether we should work to make society, for instance, more accommodating and non-judgemental towards the extremely short. That is what should occupy our deliberation, not whether a person is within some ‘normal’ range that is typical of the species or that is expected by society. The same holds for all other bodily and mental states, including intelligence, strength, life expectancy, appearance, and so on.
It’s an appealing approach to the extent that it reorients our attention to what most agree is of central value here: how bodily and mental states impact people’s well-being, and what we should do about states that are disadvantageous. But equally importantly, it divorces the concept of disability from the usual connotation that disabilities are unfortunate deficiencies that deviate from the norm and that require a medical fix – a connotation that is arguably at the root of much discrimination against people with various impairments.
On the other hand, by broadening the scope of these concepts, the welfarist account hits a different snag: if our sole criterion for what makes a state enhanced or disabled is merely whether that state is advantageous or disadvantageous to a person, we may find ourselves labelling people as disabled because of their race or sexual orientation. For instance, it can clearly be disadvantageous to be gay in a homophobic society. It can similarly be disadvantageous to be a certain skin colour in a racist society. Even being a woman can be disadvantageous in many societies. But are gays, blacks and women “disabled” in these contexts? This seems to be stretching the use of the term a little too far beyond how we ordinarily use it. There is also a degree of political incorrectness here, all the more so given that on this account, if, say, a black person in a racist society were to undergo an intervention to have paler skin, the welfarist account would deem them “enhanced” (presuming the intervention proved advantageous to them).
This seems troublesome. One way to avoid such seeming mislabels is to exclude things like social prejudice from what we consider advantageous or disadvantageous bodily or mental states. That is, since being gay, black or a woman is only disadvantageous because of unjust discrimination, then this is a separate matter from enhancement and disability – it is a social issue of prejudice and should be tackled as such.
And yet, this looks suspiciously arbitrary. If the whole point of this approach is that it gets us to focus on what is advantageous or disadvantageous to an individual in terms of their bodily and mental states (without getting side-tracked with morally irrelevant boundaries like what is “normal” or “abnormal”), then excluding social prejudice would seem like a distraction from that. Surely we can say that, for instance, in a homophobic society it can be disadvantageous to be gay, but that it shouldn’t be, or that it can be disadvantageous to be a women in a misogynistic society, but that it shouldn’t be. I argue that the controversy only arises if we use the label ‘disabled’ here with the kind of connotations this welfarist approach is aiming to undermine: connotations like “deficiency” or “misfortune” or the need for medical attention. None of those is implied by the welfarist account.
Follow this link for the full paper: Enhancement, Disability and the Riddle of the Relevant Circumstances.