After describing Heidegger's critique of metaphysics as ontotheology, I unpack the metaphysical assumptions of several transhumanist philosophers. I claim that they deploy an ontology of power and that they also deploy a kind of theology, as Heidegger meant it. I also describe the way in which this metaphysics begets its own politics and ethics. In order to transcend the human condition, they must transgress the human.

Important scientific, ethical and sociological debates are emerging over the trans-humanist goal to achieve therapeutic treatments to ‘cure’ the debilitation of age-related illness and extend the healthy life span of individuals through interventive biogerontological research. The scientific and moral discourses surrounding this contentious scientific field are mapped out, followed by a normative argument favouring ‘strong’ deliberative democratic control of human life extension research. This proposal incorporates insights from constructive and participatory technology assessment, upstream public engagement and back-casting analysis; to outline (...) a programme of participatory approaches to encourage two-way dialogue between scientific and citizen perspectives, and foster the long-term deliberative democratic governance of this developing field. (shrink)

Extreme human enhancement could result in “posthuman” modes of being. After offering some definitions and conceptual clarification, I argue for two theses. First, some posthuman modes of being would be very worthwhile. Second, it could be very good for human beings to become posthuman.

The therapy/enhancement distinction is a controversial one in the philosophy of medicine, yet the idea of enhancement is rarely if ever questioned as a proper goal of sports medicine. This opens up latitude to those who may seek to use elite sport as a vehicle of legitimation for their nature-transcending ideology. Given recent claims by transhumanists to develop our human nature and powers with the aid of biotechnology, I sketch out two interpretations of the myth of Prometheus, in Hesiod and (...) Aeschylus, which can help frame the moral limits of sports medicine. By way of conclusion I assemble some banal reminders: We are mortal beings; our vulnerability to disease, injury and the waning of our powers, far from something we can overcome or eliminate, represent natural limits both for morality and medicine generally and sports medicine in particular. (shrink)

In the philosophical debate on aging, it is common to raise the question of the theoretical definition of aging in terms of its possible characterization as a disease. Understanding aging as a disease seems to imply its medicalization, which has important practical consequences. In this paper, we analyze the question of whether aging is a disease by appealing to the concept of disease in the philosophy of medicine. As a result of this analysis, we argue that a pragmatist approach to (...) the conception of disease is the best alternative to highlight the relevance of the medicalization of aging. From this pragmatist perspective, it can be seen that the notion of aging is going through a conceptual change, and aging can today be understood as a not radically different process from any other condition that is usually considered a disease. (shrink)

This article provides a philosophical overview of different approaches to age and ageing. It is often assumed that our age is determined by the amount of time we have been alive. Here, I challenge this belief. I argue that there are at least three plausible, yet unsatisfactory, accounts to age and ageing: the chronological account, the biological account, and the experiential account. I show that all of them fall short of fully determining what it means to age. Addressing these problems, (...) I suggest the Two‐tier principle of age: whenever the three accounts of age contradict, combine the two accounts that differ the least, and reject the third. However, while this principle does solve some difficulties, it is itself vulnerable to problems; therefore I propose we should jettison it. I conclude that there are no accounts to ageing that are satisfactory; they all come with a bullet to bite. (shrink)

In her short story “Stable Strategies for Middle Management,” Eileen Gunn imagines a future in which Margaret, an office worker, seeks radical genetic enhancements intended to help her secure the middle-management job she wants. One source of the story’s tension and dark humor is dramatic irony: readers can see that the enhancements Margaret buys stand little chance of making her life go better for her; enhancing is, for Margaret, probably a prudential mistake. This paper argues that our positions in the (...) real world are sufficiently similar to Margaret’s position in Gunn’s fictional world that we should take this story seriously as grounding an argument from analogy for the conclusion that radical genetic enhancements are, for us, probably a prudential mistake. The paper then defends this method. When the question at hand is one of speculative ethics, there is no method better fit to the purpose than argument from analogy to speculative fiction. (shrink)

Transhumanism is a scientific and philosophical movement that proposes to overcome, through new technologies, the restrictions imposed on us by our biological condition. Some transhumanists assume that the struggle against natural limits could lead to a radical change in our body or even to its replacement. Other authors, such as Nicholas Agar, propose a moderate enhancement that does not exceed the framework of what we understand to be human. In this article, I will offer a plausible interpretation of the project (...) of human enhancement from a Thomistic perspective. To carry out my analysis, I will focus on three fundamental metaphysical and anthropological questions: How do advocates of radical enhancement understand the relationship between limits, imperfections and evils in human nature? How is this relationship understood from moderate positions? And Is any of these proposals compatible with Aquinas’ anthropology? I will conclude that the identification of limits with imperfections and evils assumed by radical positions is incompatible with Aquinas’ anthropology. Nevertheless, this does not entail that any bio-modification is unacceptable. Aquinas’ peculiar metaphysics, together with its anthropology in which the natural, the supernatural and the preternatural realms intertwine, can offer an interesting framework to assess the human enhancement project. (shrink)

Ethical debate surrounding human enhancement, especially by biotechnological means, has burgeoned since the turn of the century. Issues discussed include whether specific types of enhancement are permissible or even obligatory, whether they are likely to produce a net good for individuals and for society, and whether there is something intrinsically wrong in playing God with human nature. We characterize the main camps on the issue, identifying three main positions: permissive, restrictive and conservative positions. We present the major sub-debates and lines (...) of argument from each camp. The review also gives a flavor of the general approach of key writers in the literature such as Julian Savulescu, Nick Bostrom, Michael Sandel, and Leon Kass. (shrink)

Transhumanists exuberantly promise a posthuman future better than anything we can possibly imagine. But speculation about a perfect future is hardly new. It has longstanding mythological roots that betray a very human ambition—to free ourselves from what limits us. These connections shed light on how the transhumanist movement wins adherents and affects policy.

Wenn eine Person unter einer tödlichen Krankheit leidet und nicht über die Ressourcen für eine medizinische Behandlung verfügt, sind wir normalerweise dazu verpflichtet, ihr die notwendigen Ressourcen bereitzustellen. Wären wir aber in einem biotechnischen Zukunftsszenario, in dem die menschliche Lebensspanne durch Eingriffe in den Alterungsprozess erhöht werden kann, auch dazu verpflichtet, anderen Personen die notwendigen Ressourcen für solche Maßnahmen bereitzustellen? John Harris hat argumentiert, dass wir zu solch einer direkten biotechnischen Lebensverlängerung verpflichtet wären, da ein Leben zu verlängern das Gleiche (...) sei, wie ein Leben zu retten. Im vorliegenden Aufsatz wird gezeigt, dass Harris’ Argument nicht schlüssig ist, da entgegen seiner Prämisse ein begrifflicher Unterschied zwischen der Rettung und der Verlängerung eines Lebens besteht. Auf Grundlage von Harris’ zurückgewiesenem Argument werden dann aber zwei alternative Argumente für eine (prima facie) Pflicht zur direkten Lebensverlängerung konstruiert. Das erste Argument basiert auf der Überlegung, dass durch eine direkte biotechnische Lebensverlängerung trotz des begrifflichen Unterschieds mit einer substanziellen Wahrscheinlichkeit Leben gerettet werden würden. Das zweite Argument besagt, dass trotz deskriptiver Unterschiede eine moralische Äquivalenz zwischen der Rettung und der Verlängerung eines Lebens besteht, sofern durch die bloße Lebensverlängerung das Leben um die gleiche Dauer und Qualität verlängert wird wie durch die Lebensrettung. ---------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------- When a person suffers from a deadly disease and is lacking the resources for a medical treatment, we are normally obliged to provide the necessary resources. But would we also be morally obliged to provide the resources for an extension of someone’s lifespan through anti-aging treatments which might be developed due to biotechnological progress? John Harris has argued that there would be an obligation to such a direct biotechnical life extension because extending a life is the same as saving a life. In the present paper, it will be shown that Harris’ argument is not sound since, contrary to his premise, there is a conceptual difference between extending and saving a life. On the basis of Harris’ rejected argument, though, two alternative arguments for a (prima facie) obligation to direct biotechnical life extension will be developed. The first argument is based on the idea that, despite the conceptual difference, one saves someone’s life with a substantial probability when extending it by direct biotechnical means. In the second argument, it will be argued that there is a moral equivalence between extending and saving someone’s life despite the descriptive differences as far as the additional lifetime has the same duration and quality in both cases. (shrink)

Applied ethics is home to numerous productive subfields such as procreative ethics, intergenerational ethics and environmental ethics. By contrast, there is far less ethical work on ageing, and there is no boundary work that attempts to set the scope for ‘ageing ethics’ or the ‘ethics of ageing’. Yet ageing is a fundamental aspect of life; arguably even more fundamental and ubiquitous than procreation. To remedy this situation, I examine conceptions of what the ethics of ageing might mean and argue that (...) these conceptions fail to capture the requirements of the desired subfield. The key reasons for this are, first, that they view ageing as something that happens only when one is old, thereby ignoring the fact that ageing is a process to which we are all subject, and second that the ageing person is treated as an object in ethical discourse rather than as its subject. In response to these shortcomings I put forward a better conception, one which places the ageing person at the centre of ethical analysis, has relevance not just for the elderly and provides a rich yet workable scope. While clarifying and justifying the conceptual boundaries of the subfield, the proposed scope pleasingly broadens the ethics of ageing beyond common negative associations with ageing. (shrink)

After describing the disorder of psychopathy, I examine the theories and the evidence concerning the psychopaths’ deficient moral capacities. I first examine whether or not psychopaths can pass tests of moral knowledge. Most of the evidence suggests that they can. If there is a lack of moral understanding, then it has to be due to an incapacity that affects not their declarative knowledge of moral norms, but their deeper understanding of them. I then examine two suggestions: it is their deficient (...) practical reason or their stunted emotions that are at fault. The evidence supports both explanations. I conclude with an overview of the debate concerning whether they are morally or legally responsible for their actions. (shrink)

Debates about the ethical and social implications of research that aims to extend human longevity by intervening in the ageing process have paid little attention to the attitudes of members of the general public. In the absence of empirical evidence, conflicting assumptions have been made about likely public attitudes towards life-extension. In light of recent calls for greater public involvement in such discussions, this target article presents findings from focus groups and individual interviews which investigated whether members of the general (...) public identify ethical issues surrounding life-extension, and if so, what these ethical issues are? In this study, while some participants were concerned primarily with the likely personal consequences of life-extension, for others the question of whether or not to pursue interventions to extend longevity, and how they should be implemented, clearly raised important ethical issues, many of which have been prominent in debates among bioethicists. (shrink)

We have recently stated the reasons why we claim that biological ageing is undesirable. Räsänen has responded to our article by arguing that this process has certain desirable aspects and, therefore, our position is inconsistent. Räsänen develops two arguments to defend his position. We will call the first the argument from the totality of the ageing process and the second the argument from the reduced goods of the ageing process. In this reply, we will give reasons to show that both (...) arguments fail. The first, on the one hand, starts from a dubious conception of ageing and, on the other hand, even accepting this conception, its reformulation is morally empty. The second incurs in an absurd conclusion. (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)

El movimiento transhumanista tiene, entre sus propuestas principales, el proyecto de alargar la vida para poder alcanzar la inmortalidad en una vida indefinida o en una forma cibernética de existencia. En este artículo se presenta la propuesta del transhumanismo y se reflexiona sobre el deseo de ser inmortales y sobre las implicaciones antropológicas de la muerte. La crítica se hace desde la consideración de aspectos fundamentales del ser humano, como la finitud, la historicidad y la vulnerabilidad. Además, el proyecto transhumanista (...) de vencer la muerte supone una propuesta de salvación, que coincide en su formulación con la misma que hace el cristianismo. Ambos pretenden una victoria sobre la muerte. La crítica teológica se centra en la comprensión de la muerte y en la reflexión sobre los medios para vencerla. En este artículo la crítica al proyecto transhumanista se dirige, más que a lo que propone, a lo que queda sin plantear, provocando una reducción en la comprensión de la muerte y en la forma de vencerla. (shrink)

The multi-millennial philosophical discussion about life after death has received a recent boost in the prospect of immortality attained via technologies. In this newer version, humans generally are considered mortal but may develop means of making themselves immortal. If “immortal” means not mortal, thus existing for infinity, and if the proposed infinite-existing entity is material, it must inhabit an infinite material universe. If the proposed entity is not material, there must be means by which it can shed its material substance (...) and exist nonmaterially. The article examines arguments for how an infinite life would be possible given current physical understanding. The paper considers a Pascalian-style wager weighing the likelihood of adjusting to existence wholly within a finite universe versus betting on there being some way to construe the universe(s) as a viable medium for infinite beings. Conclusion: The case for a finite being to exist infinitely has little viable support. (shrink)

The article considers human enhancement from the perspective of liminality. It defines the concept of liminality, introduced by ethnologist van Gennep in an attempt to generalise the rites of passage. It shows how, thanks to Turner, this concept has spread beyond anthropology to characterise the many situations ‘betwixt and between’ associated with transitioning from the original social structure to the new one. The article points out that, by definition, liminal situations break down traditional structures; hence, polemical debates on whether to (...) allow human enhancement cannot be conducted from the position of existing normative standards. It argues, on the contrary, that these must be fundamentally expanded so as to reflect the current transitional phase from treatment to enhancement and that preparations must be made for the policies and institutions that will deal with the consequences. Otherwise, we will face threat of a new kind of totalitarianism. (shrink)

Blackballing the reaper is an old ambition, and considerable progress has been made. For the past 150 years, best-performance life-expectancy (i.e. life-expectancy in the country where it is highest) has increased at a very steady rate of 3 months per year.1 Lifeexpectancy for the ancient Romans was circa 23 years; today the average life-expectancy in the world is 64 years.2 Will this trend continue? What are the consequences if it does? And what ethical and political challenges does the prospect of (...) life-extension create for us today? This article comments on some views on the ethics, science, and politics of lifeextension from a recent edited volume, The Fountain of Youth. (shrink)

This essay shows that a sharp distinction between ethics and aesthetics is unfruitful for thinking about how to live well with technologies, and in particular for understanding and evaluating how we cope with human existential vulnerability, which is crucially mediated by the development and use of technologies such as electronic ICTs. It is argued that vulnerability coping is a matter of ethics and art: it requires developing a kind of art and techne in the sense that it always involves technologies (...) and specific styles of experiencing and dealing with vulnerability, which depend on social and cultural context. It is suggested that we try to find better, perhaps less modern styles of coping with our vulnerability, recognize limits to our attempts to “design” our new forms, and explore what kinds of technologies we need for this project. (shrink)

The technical possibilities of biomedicine open up the opportunity to intervene in ageing itself with the aim of mitigating, reducing or eliminating it. However, before undertaking these changes or rejecting them outright, it is necessary to ask ourselves if what would be lost by doing so really has much value. This article will analyse the desirability of ageing from an individual point of view, without circumscribing this question to the desirability or undesirability of death. First, we will present the three (...) most widely used arguments to reject biomedical interventions against ageing. We will argue that only the last of these arguments provides a consistent answer to the question of the desirability of ageing. Second, we will show that the third argument falls prey to a conceptual confusion that we will call the paradox of ageing: although ageing entails negative health effects, it leads to a life stage with valuable goods. Both valuations, one positive and the other negative, refer to two different dimensions of ageing: the chronological and the biological. We will defend that, by not adequately distinguishing these two types of ageing, it does not become apparent that all the valuable goods exclusive to ageing derive only from its chronological dimension. Third, we will argue that, if we just conceive ageing biologically, it is undesirable. We will elaborate on the two kinds of undesirable effects biological ageing has: direct and indirect. Finally, we will respond to potential objections by adducing that these are insufficient to weaken our argument. (shrink)

Technological dystopias incarnate transhumanist dreams of a this-worldly blissful immortality. Underlying these and others is a globalized technocratic paradigm, the loss of an overarching cosmic world view, rise in consumerism, a gnostic repudiation of the body, and a neo-pelagian aspiration to individualistic self-sufficiency. One response to these transhumanist dreams is to remind ourselves of how nature actually works, its origins, constrains, and future. Our relationship with nature spills over to how we feel standing face-to-face with pain and suffering. In this (...) article I reframe cancer as a journey of maintaining harmony with nature instead of a war against death that we are destined to lose. I argue that understanding the limits and constraints of the natural world help us come to peace with the reality of cancer, and perhaps find meaning in suffering. Instead of avoiding the inevitable at all costs, vulnerability and suffering have their own lessons. In contrast to trans humanist dreams, being human presents an opportunity to welcome the reality of imperfection, to be liberated from our addiction to control and excessive technological manipulation of nature, to draw together as a community, and to live the lessons of each stage of our finite life to its fullest. I hope this reflection, grounded in scientific literature and engaging with richly embodied medical humanities readings, can help us all change how we relate to cancer, from books to bench to biotech to bedside. (shrink)

While I agree in principle both with Banja's (2011) moral relativist claim that there are no absolute moral categories and with his anti-essentialist position (Hauskeller 2009b), it seems to me tha...

The purpose of this paper is to look into the question of whether considerable life extension should be seen as a form of human enhancement. Human enhancement, generally, refers to enhancing physical, psychological, and moral human capacities beyond the average or “normal” level. Much of the recent literature focusing on considerable life extension has been related to the human enhancement debate. I will examine whether considerable life extension and human enhancement are connected. I argue that they are not connected to (...) each other in the way that is presented by many philosophers such as John Harris, Nick Bostrom, and Nils Holtug, as well as Savulescu, Kahane, and Sandberg. Sometimes considerable life extension should be seen rather as a part of preventive care. Considerable life extension can result simply from preventive care. If we define considerable life extension as enhancement, it is interesting because it is related to many ethical questions. A quite common view, for example, is one that states that treatment should be supported financially by society, whereas enhancement should not. However, claiming that there is no strong conceptual link between considerable life extension and enhancement does not mean that the former should automatically be covered by public healthcare or insurance policies. The aim of this paper is not to present a strong view for or against the ethical desirability of considerable life extension. I argue that the importance of the human enhancement framework has been overstated in the case of considerable life extension. My point is simply that it is unclear why the possibility of radical extension in human life should be primarily discussed in the sphere of human enhancement. (shrink)

This essay shows that a sharp distinction between ethics and aesthetics is unfruitful for thinking about how to live well with technologies, and in particular for understanding and evaluating how we cope with human existential vulnerability, which is crucially mediated by the development and use of technologies such as electronic ICTs. It is argued that vulnerability coping is a matter of ethics and art: it requires developing a kind of art and techne in the sense that it always involves technologies (...) and specific styles of experiencing and dealing with vulnerability, which depend on social and cultural context. It is suggested that we try to find better, perhaps less modern styles of coping with our vulnerability, recognize limits to our attempts to “design” our new forms, and explore what kinds of technologies we need for this project. (shrink)

I argue that Heidegger’s account of technology as “enframing” is a helpful lens through which to understand the possible effects and dangers of transhumanism. Without resorting to nebulous concepts such as “dignity;” Heidegger’s analysis can help us understand how new technologies employed to modify the body; brain; and consciousness will enframe our own bodies and identities as something akin to “standing reserve.” Under transhumanism; the body is enframed as an external; technologically modifiable product. I indicate some of the problems that (...) might arise when our own bodies no longer appear as central to our identity as embodied beings. Further; I argue that; by treating aspects of our own consciousness as technologically modifiable; we will be driven into a commodified and inauthentic relation to our identities. By examining the work of prominent transhumanists – including Brad Allenby; Daniel Sarewitz; and Andy Clark – I show how the threat that technology poses can be hidden when the essence of technology is not uncovered in a primordial way. I argue that by threatening to obscure death as a foundational possibility for Dasein; transhumanism poses the danger of hiding the need to develop a free and authentic relation to technology; Truth; and ultimately to Dasein itself. (shrink)

Taking a cue from Teilhard de Chardin's Christologically inflected speculation, the key question in this issue is whether the project of transhumanism is compatible with Christianity and the Incarnation of Christ. Two articles focus on theological anthropology and the limits, if any, of human perfection in light of Christ's perfection. Another article examines the ontological claims about human nature in transhumanism and its incompatibility with a Christian ontology. The last two turn from more abstract concerns to consider how the use (...) of technology can inhibit or help human moral and spiritual development. (shrink)

Drawing on Ezekiel Emanuel’s controversial piece ‘Why I hope to die at 75,’ I distinguish two types of concern in ethical debates about extending the human lifespan. The first focusses on the value of living longer from prudential and social perspectives. The second type of concern, which has received less attention, focusses on the value of aiming for longer life. This distinction, which is overlooked in the ethical literature on life extension, is significant because there are features of human psychology (...) and the structure of a life that should give pause when considering how long one should aim to live, but which do not neatly coincide with considerations about how valuable additional life is likely to be. I argue that, while Emanuel’s case for hoping to die at 75 is unconvincing, he nonetheless provides weak pro tanto considerations in favour of taking a moderate life span as a prudential aim around which to base at least some significant life plans. (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)

Dementia is highly prevalent and up until now, still incurable. If we may believe the narrative that is currently dominant in dementia research, in the future we will not have to suffer from dementia anymore, as there will be a simple techno-fix solution. It is just a matter of time before we can solve the growing public health problem of dementia. In this paper we take a critical stance towards overly positive narratives of techno-fixes by placing our empirical analysis of (...) dementia research protocols and political statements in a framework of technology assessment. From this perspective, it becomes obvious that a techno-fix is just one of many ways to approach societal problems and more importantly that technologies are way less perfect than they are presented. We will argue that this narrow scope, which focusses on the usual suspects for solving illnesses, reduces dementia to organismic aspects, and may be counterproductive in finding a cure for dementia. We conclude with outlining how the narrow scope can be balanced with other narratives and why we should have a reasonable scepticism towards the usual suspects. (shrink)

Transhumanism at once embodies our most modern thinking and our biggest longstanding problems. Transhumanism aims to enhance human core capacities: health-span, lifespan, and cognition. The thesis answers the following ethical challenges arising from transhumanist aims. First, whether transhumanism can be an ethical endeavour if it relies on authoritarian intervention by governments and governing bodies to change, generate and enforce behaviour, or to influence and enforce the uptake of medical procedures. Second, the thesis answers the challenge that it is unethical deliberately (...) to encourage the uptake of and pursuit of medical transhumanism given the extent of accessibility and distributive issues that remain unresolved in existing medicine. Finally, the thesis addresses a particular mental health crisis that is often predicted for transhuman beings, namely loss of meaning from loss of death and vulnerability, resulting in widespread loss of social cohesion. The thesis argues that the right solution to the first two problems is a libertarian paternalist approach, viz. nudging, and that this approach will also neutralise the risk of widespread and inevitable boredom or alienation that might otherwise result from the widespread introduction of human enhancement if people are nudged to engage more and more reflectively in their enhancement choices. Additionally, lifestyle issues like obesity, heart disease, cancers, and inaccessibility of vaccines and birth control pose unresolved problems for existing general medicine, killing millions every year worldwide. As a result, another serious challenge for enhancement medicine, which I propose would be addressed by the nudge approach, is to justify its place in the professional domain of medicine. (shrink)