Human enhancement is ontologically, epistemologically, and ethically challenging and has stirred a wide range of scholarly and public debates. This article focuses on some conceptual issues with HE that have important ethical implications. In particular it scrutinizes how the concept of human enhancement relates to and challenges the concept of health. In order to do so, it addresses three specific questions: Q1. What do conceptions of HE say about health? Q2. Does HE challenge traditional conceptions of health? Q3. Do concepts (...) of health set limits to or direct HE? Addressing Q1 reveals that HE tends to frame and form our conception of health. Thereby it challenges traditional conceptions of health. Accordingly, health does not provide strong sources for setting limits to HE. On the contrary HE seems to define and expand the concept of health. Common to the concepts of HE and health is that both depend on vague value concepts, such as happiness, well-being, or goodness. There seems to be a tendency in the HE literature to define the goal of human life in terms of what is bigger, stronger, faster, more intelligent, and more resilient. However, this is confusing “goodness” with “more” and quality with quantity. Until HE more appropriately defines happiness, HE will fail to provide a relevant compass for improving the life of human beings. On the contrary, if we let simplified conceptions of “enhancement” come to define goodness or health, we may do more harm than good. Until doing so, we may well learn from Tithonus, listen to Douglas Adams’ Wowbagger, and pay attention to Virginia Woolf’s Orlando. Enhanced life may not be better. The same goes for health. (shrink)

In this paper, I present an emerging explanatory framework about ageing and care. In particular, I focus on how, in contrast to most classical accounts of ageing, biomedicine today construes the ageing process as a modifiable trajectory. This framing turns ageing from a stage of inexorable decline into the focus of preventive strategies, harnessing the functional plasticity of the ageing organism. I illustrate this shift by focusing on studies of the demographic dynamics in human population, observations of ageing as an (...) intraspecifically heterogenous phenotype, and the experimental manipulation of longevity, in both model organisms and humans. I suggest that such an explanatory framework about ageing creates the epistemological conditions for the rise of a peculiar form of prevention that does not aim to address a specific condition. Rather it seeks to stall the age-related accumulation of molecular damage and functional deficits, boosting individual resilience against age-related decline. I call this preventive paradigm “ground-state prevention.” While new, ground-state prevention bears conceptual resemblance to forms of medical wisdom prominent in classic Galenic medicine, as well as in the Renaissance period. (shrink)

In this paper, I will argue that ageing can be construed as disease. First, the concept of disease is discussed, where the distinction is made between two lines of thought, an objectivist and a subjectivist one. After determining the disease conception to be used throughout the argument, it is proposed that senescence could be seen as disease. Three common counterarguments are discussed, none of which appears strong enough to effectively counter the advocated view. In the third section, two potential implications (...) of the view advocated here will be briefly touched upon. These are the quest for a cure or treatment for ageing and the general attitude towards the elderly. It is concluded that, utilizing an objective disease concept, ageing could be seen as a disease. None of the considered counterarguments packs enough of a punch to discard this. The implications are complex and intertwined, but need not be negative. (shrink)

There is a growing tendency for medicine to be used not to prevent or heal illnesses, but to fulfil individual personal wishes such as wishes for enhanced work performance, better social skills, children with specific characteristics, stress relief, a certain appearance or a better sex life. While recognizing that the subject of wish-fulfilling medicine may vary greatly and that it may employ very different techniques, this article argues that wish-fulfilling medicine can be described as a cohesive phenomenon with distinctive features. (...) Following a few examples of well established wish-fulfilling medical practices and a brief definition of the phenomenon, both theoretical aspects and ethical implications of such practices are discussed and the question is raised how wish-fulfilling medicine should be evaluated from an ethical point of view. It is concluded that modern medicine is currently ill equipped to provide reasons why wish-fulfilling medicine should be banned or discouraged. The phenomenon of wish-fulfilling medicine serves as a prime example of the vagueness of the descriptive and the lack of decisive orientation of the normative categories employed in modern medicine. (shrink)

Discussions about the merits and shortcomings of non-inferiority trials are becoming increasingly common in the medical community and among regulatory agencies. However, criticisms targeting the ethical standing of non-inferiority trials have often been mistargeted. In this article we review the ethical standing of trials of non-inferiority. In the first part of the article, we outline a consequentialist position according to which clinical trials are best conceived as epistemic tools aimed at fostering the proper ends of medicine. According to this view, (...) clinical trials are means to ends, and thus their moral status depends both on how well they perform as means to reach desired ends and on which ends they are meant to achieve. Building upon this normative framework in the next two sections we analyze the specific ethical issues raised by non-inferiority trials. By making it clear that clinical trials are just epistemic tools – i.e. means to certain ends – it is possible not only to clarify the conceptual debate over a fundamental issue in clinical research, but also to identify which ethically relevant considerations ought to be addressed in setting up a non-inferiority trial. (shrink)

Disease prioritarianism is a principle that is often implicitly or explicitly employed in the realm of healthcare prioritization. This principle states that the healthcare system ought to prioritize the treatment of disease before any other problem. This article argues that disease prioritarianism ought to be rejected. Instead, we should adopt ‘the problem-oriented heuristic’ when making prioritizations in the healthcare system. According to this idea, we ought to focus on specific problems and whether or not it is possible and efficient to (...) address them with medical means. This has radical implications for the extension of the healthcare system. First, getting rid of the binary disease/no-disease dichotomy implicit in disease prioritarianism would improve the ability of the healthcare system to address chronic conditions and disabilities that often defy easy classification. Second, the problem-oriented heuristic could empower medical practitioners to address social problems without the need to pathologize these conditions. Third, the problem-oriented heuristic clearly states that what we choose to treat is a normative consideration. Under this assumption, we can engage in a discussion on de-medicalization without distorting preconceptions. Fourth, this pragmatic and de-compartmentalizing approach should allow us to reconsider the term ‘efficiency’. (shrink)

This article presents a comparative analysis between Georges Canguilhem’sEssay on Some Problems Concerning the Normal and the Pathological, published in 1943 and the English language debate that started in the 1970s between the naturalists and the normativists. Seemingly, this comparison illustrates the opposition between the French historical epistemology and the Anglo-American philosophy of sciences. However, I put into perspective what is generally considered an opposition between the two traditions by analyzing certain conceptual similarities.

With a shift from genetics to genomics, the study of organisms in terms of their full DNA sequences, the resurgence of eugenics has taken on a new form. Following from this new form of eugenics, which I have termed "eugenomics", is a host of ethical and social dilemmas containing elements patterned from controversies over the eugenics movement throughout the 20th century. This paper identifies these ethical and social dilemmas, drawing upon an examination of why eugenics of the 20th century was (...) morally wrong. Though many eugenic programs of the early 20th century remain in the dark corners of our history and law books and scientific journals, not all of these programs have been, nor should be, forgotten. My aim is not to remind us of the social and ethical abuses from past eugenics programs, but to draw similarities and dissimilarities from what we commonly know of the past and identify areas where genomics may be eugenically beneficial and harmful to our global community. I show that our ethical and social concerns are not taken as seriously as they should be by the scientific community, political and legal communities, and by the international public; as eugenomics is quickly gaining control over our genetic futures, ethics, I argue, is lagging behind and going considerably unnoticed. In showing why ethics is lagging behind I propose a framework that can provide us with a better understanding of genomics with respect to our pluralistic, global values. (shrink)

With the recent advancements in scientific comprehension of genetics and the decipherment of complex techniques for editing human genomes, liberal eugenics—eugenic ideal premised on the liberal values of autonomy and pluralism that leaves reproductive choices to parents rather than anachronistic statist authoritarian interventions—has inevitably become a polarising conundrum in contemporary liberal societies as to its utility and destructiveness. Focusing on one species of liberal eugenics—namely, genome editing interventions—I contend that liberal eugenics could be harmful—harm herein construed as that which undermines (...) the salient liberal values of equality, autonomy, and pluralism—since it is itself antithetical to the bases of the liberal society. This contention is based upon three premises: first, that individuals are rather seldom rational decision-makers such that leaving all reproductive choices to the whims of individual parents would be immensely counterproductive to future offspring’s right to open future; second, that liberal eugenics—much like its authoritarian antecedent—could intersect with myriad identities, including race, class, sex, disability, and sexual orientation in ways that might exacerbate social divisions, marginalise different groups, and engender homogeneity; and third, that it undermines individual autonomy of the future person as a member of the liberal community, particularly if their capacities and abilities are tailored to fit parents’ specific life projects and putatively reasonable conceptions of the good. The underscored potential malaises of liberal eugenics should, I argue, be discursively negotiated between parents and the state via the development of robust general laws that regulate heritable genome editing interventions to ensure that the welfare of the future persons is prioritised and that the liberal commitment to autonomy is immune to antiliberal perversions. (shrink)

In the last quarter of 2024 four articles on survival after death were published online ahead of print in the International Review of Psychiatry. Two of these included gratuitous attempts to discredit the work of a well-known survival critic. After correcting these misrepresentations, in this response Keith Augustine lays out how those who appeal to survival research to support their beliefs bungle their purportedly scientific assessments of the evidence concerning whether or not individual human minds survive death in a discarnate (...) state (without a normal physical body). The response also lays out why the still-common arguments that the late eminent thanatologist Robert Kastenbaum offered in favor of a discarnate afterlife are fallacious. It canvasses erroneous tropes about discovering white crows and the supposed impossibility of proving negatives, how scientific facts are established as highly probable, how psychical research is grounded on fallacious arguments from ignorance, and when all else fails, how survival researchers resort to psychologizing their critics rather than address their critics' arguments. Their collective failure to engage their critics' actual arguments raises the issue of whether survival proponents are able to adequately answer them—and if not, why not. Augustine submits that they are unable to answer their critics because the scientific evidence against their afterlife beliefs is incredibly strong. 1. Introduction -- 2. Gregory Shushan -- 3. Andreas Sommer -- 3.1 The Irrelevance of My Work to Sommer’s Thesis -- 3.2 How My Use is Comparable to What Robert Kastenbaum Intended -- 3.3 Sommer’s Characterization of The Myth of an Afterlife -- 3.4 The Context of What Kastenbaum was Trying to Do -- 3.5 Where Kastenbaum Fell on the Survival Question—and Why -- 3.5.1 Fallacious White Crows -- 3.5.2 Proof, Certainty, and Proving Negatives -- 3.5.3 Causal Ignorance is not Causal Evidence -- 3.5.4 Psychologizing Opponents -- 4. Conclusion: A Belief in Search of Evidence, or Evidence-Driven Belief? (shrink)

Die wachsende Nachfrage nach Anti-Aging-Medizin wirft die Frage auf, welche medizinischen Leistungen ein solidarisches Gesundheitssystem tragen sollte. Die deutsche Entscheidungspraxis beruft sich auf den Begriff der Krankheit. Im Blick auf Anti-Aging wäre demnach 1) zu klären, was der Krankheitsbegriff bedeutet, 2) zu prüfen, ob das Altern sich unter diesen Begriff subsumieren lässt, um 3) abzuleiten, inwieweit Anti-Aging-Maßnahmen zur Verfügung zu stellen sind. Dieses Prozedere führt jedoch zu keinem brauchbaren Ergebnis. Unter Berufung auf den Krankheitsbegriff allein ist der Umfang solidarischer Gesundheitsversorgung (...) nicht zu bestimmen. Allerdings lässt sich durch Reflexion auftretender Probleme ein gangbarer Entscheidungsweg aufzeigen. Er sieht eine faire Verständigung über die Frage vor, wie wir alt werden wollen. (shrink)