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  1. (1 other version)Can Enhancement Be Distinguished from Prevention in Genetic Medicine?Eric T. Juengst - 1997 - Journal of Medicine and Philosophy 22 (2):125-142.
    In discussions of the ethics of human gene therapy, it has become standard to draw a distinction between the use of human gene transfer techniques to treat health problems and their use to enhance or improve normal human traits. Some dispute the normative force of this distinction by arguing that it is undercut by the legitimate medical use of human gene transfer techniques to prevent disease - such as genetic engineering to bolster immune function, improve the efficiency of DNA repair, (...)
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  • Justice, health, and healthcare.Norman Daniels - 2001 - American Journal of Bioethics 1 (2):2 – 16.
    Healthcare (including public health) is special because it protects normal functioning, which in turn protects the range of opportunities open to individuals. I extend this account in two ways. First, since the distribution of goods other than healthcare affect population health and its distribution, I claim that Rawls's principles of justice describe a fair distribution of the social determinants of health, giving a partial account of when health inequalities are unjust. Second, I supplement a principled account of justice for health (...)
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  • Medical need and health need.Ben Davies - 2023 - Clinical Ethics 18 (3):287-291.
    I introduce a distinction between health need and medical need, and raise several questions about their interaction. Health needs are needs that relate directly to our health condition. Medical needs are needs which bear some relation to medical institutions or processes. I suggest that the question of whether medical insurance or public care should cover medical needs, health needs, or only needs which fit both categories is a political question that cannot be resolved definitionally. I also argue against an overly (...)
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  • Autism, Neurodiversity, and Equality Beyond the "Normal".Andrew Fenton & Tim Krahn - 2007 - Journal of Ethics in Mental Health 2 (2):2.
    “Neurodiversity” is associated with the struggle for the civil rights of all those diagnosed with neurological or neurodevelopmental disorders. Two basic approaches in the struggle for what might be described as “neuro-equality” are taken up in the literature: There is a challenge to current nosology that pathologizes all of the phenotypes associated with neurological or neurodevelopmental disorders ); there is a challenge to those extant social institutions that either expressly or inadvertently model a social hierarchy where the interests or needs (...)
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  • Recovery without normalisation: It's not necessary to be normal, not even in psychiatry.Zsuzsanna Chappell & Sofia M. I. Jeppsson - 2023 - Clinical Ethics 18 (3):298-305.
    In this paper, we argue that there are reasons to believe that an implicit bias for normalcy influences what are considered medically necessary treatments in psychiatry. First, we outline two prima facie reasons to suspect that this is the case. A bias for ‘the normal’ is already documented in disability studies; it is reasonable to suspect that it affects psychiatry too, since psychiatric patients, like disabled people, are often perceived as ‘weird’ by others. Secondly, psychiatry's explicitly endorsed values of well-being (...)
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  • The Better I Can Be: In Defence of Human Enhancement for a New Genetic Equality.Vera Lúcia Carapeto Raposo - 2022 - Canadian Journal of Bioethics / Revue canadienne de bioéthique 5 (2).
    The main objection to genetic enhancement is that it will create a “genetic apartheid,” deepening existing inequalities. This paper offers considerations that can weaken the inequality argument against genetic enhancement. First, I question the dichotomy of treatment versus enhancement since the differences between the two are unclear. Second, I argue that human enhancement is part of human nature and that there is no sound reason to accept it in other domains while rejecting it in genetics. The paper also demonstrates that (...)
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  • Limits to Health Care: Fair Procedures, Democratic Deliberation, and the Legitimacy Problem for Insurers.Norman Daniels & James Sabin - 1997 - Philosophy and Public Affairs 26 (4):303-350.
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  • Psychopharmacological enhancement: a conceptual framework.Dan J. Stein - 2012 - Philosophy, Ethics, and Humanities in Medicine 7:5.
    The availability of a range of new psychotropic agents raises the possibility that these will be used for enhancement purposes (smart pills, happy pills, and pep pills). The enhancement debate soon raises questions in philosophy of medicine and psychiatry (eg, what is a disorder?), and this debate in turn raises fundament questions in philosophy of language, science, and ethics. In this paper, a naturalistic conceptual framework is proposed for addressing these issues. This framework begins by contrasting classical and critical concepts (...)
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  • Pharmacological cognitive enhancement : how neuroscientific research could advance ethical debate.Hannah Maslen, Nadira Faulmüller & Julian Savulescu - unknown
    There are numerous ways people can improve their cognitive capacities: good nutrition and regular exercise can produce long-term improvements across many cognitive domains, whilst commonplace stimulants such as coffee temporarily boost levels of alertness and concentration. Effects like these have been well-documented in the medical literature and they raise few ethical issues. More recently, however, clinical research has shown that the off-label use of some pharmaceuticals can, under certain conditions, have modest cognition-improving effects. Substances such as methylphenidate and modafinil can (...)
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  • Will the "real boy" please behave: Dosing dilemmas for parents of boys with ADHD.Ilina Singh - 2005 - American Journal of Bioethics 5 (3):34 – 47.
    The use of Ritalin and other stimulant drug treatments for attention-deficit hyperactivity disorder (ADHD) raises distinctive moral dilemmas for parents; these moral dilemmas have not been adequately addressed in the bioethics literature. This paper draws upon data from a qualitative empirical study to investigate parents' use of the moral ideal of authenticity as part of their narrative justifications for dosing decisions and actions. I show that therapeutic decisions and actions are embedded in valued cultural ideals about masculinity, self-actualization and success, (...)
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  • The paradox of medical necessity.Samantha Godwin & Brian D. Earp - 2023 - Clinical Ethics 18 (3):281-284.
    The concept of medical necessity is often used to explain or justify certain decisions—for example, which treatments should be allowed under certain conditions—as though it had an obvious, agreed-upon meaning as well as an inherent normative force. In introducing this special issue of Clinical Ethics on medical necessity, we argue that the term, as used in various discourses, generally lacks a definition that is clear, non-circular, conceptually plausible, and fit for purpose. We propose that future work on this concept should (...)
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  • Normality and the Treatment-Enhancement Distinction.Daniel Martín, Jon Rueda, Brian D. Earp & Ivar R. Hannikainen - 2023 - Neuroethics 16 (2):1-14.
    There is little debate regarding the acceptability of providing medical care to restore physical or mental health that has deteriorated below what is considered typical due to disease or disorder (i.e., providing “treatment”—for example, administering psychostimulant medication to sustain attention in the case of attention deficit disorder). When asked whether a healthy individual may undergo the same intervention for the purpose of enhancing their capacities (i.e., “enhancement”—for example, use of a psychostimulant as a “study drug”), people often express greater hesitation. (...)
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  • Symposium on the Rationing of Health Care: 2 Rationing Medical Care — A Philosopher's Perspective on Outcomes and Process.Norman Daniels - 1998 - Economics and Philosophy 14 (1):27-50.
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  • (1 other version)Kognition à la carte?: Der Wunsch nach kognitionsverbessernden Psychopharmaka in der Medizin.Matthis Synofzik - 2006 - Ethik in der Medizin 18 (1):37-50.
    Die Fortschritte in der Psychopharmakologie führen zu einem immer breiteren Angebot an Substanzen zur Verbesserung der Stimmung, des Gedächtnisses oder der exekutiven Funktionen. Dieses Angebot trifft auf die Wünsche und Bedürfnisse vieler Menschen, ihre mentalen Leistungen und Zustände zu verbessern. Wie sollte die Medizin mit diesen Wünschen umgehen? An welchen Kriterien sollte sich insbesondere der ärztliche Entscheidungsprozess orientieren? Im Folgenden soll gezeigt werden, dass sich aus einer „Treatment-enhancement-Unterscheidung“, einem Krankheits- oder Normalitätsbegriff oder einem bestimmten Medizinkonzept keine zielführenden normativen Kriterien für (...)
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  • Policy Implications of the Biological Model of Mental Disorder.Douglas P. Olsen - 2000 - Nursing Ethics 7 (5):412-424.
    The current dominant paradigm of mental disorder is that psychopathology is a deviation from normal physiological functioning of the brain. This paradigm is closely allied to the identity theory of mind in philosophy, which holds that mental phenomena are identical with the physical state of the brain. The assumptions of the biological model have policy implications, regardless of the utility or ‘truth’ of the paradigm, which should be made explicit for the assessment of ethics in mental health policy formulation. The (...)
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  • Intervening in the brain: Changing psyche and society.Dirk Hartmann, Gerard Boer, Jörg Fegert, Thorsten Galert, Reinhard Merkel, Bart Nuttin & Steffen Rosahl - 2007 - Springer.
    In recent years, neuroscience has been a particularly prolific discipline stimulating many innovative treatment approaches in medicine. However, when it comes to the brain, new techniques of intervention do not always meet with a positive public response, in spite of promising therapeutic benefits. The reason for this caution clearly is the brain’s special importance as “organ of the mind”. As such it is widely held to be the origin of mankind’s unique position among living beings. Likewise, on the level of (...)
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  • When is diminishment a form of enhancement? : rethinking the enhancement debate in biomedical ethics.Brian D. Earp, Anders Sandberg, Guy Kahane & Julian Savulescu - unknown
    The enhancement debate in neuroscience and biomedical ethics tends to focus on the augmentation of certain capacities or functions: memory, learning, attention, and the like. Typically, the point of contention is whether these augmentative enhancements should be considered permissible for individuals with no particular “medical” disadvantage along any of the dimensions of interest. Less frequently addressed in the literature, however, is the fact that sometimes the _diminishment_ of a capacity or function, under the right set of circumstances, could plausibly contribute (...)
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  • The Americans With Disabilities Act and Its Application to Sport.Jack Bowen - 2002 - Journal of the Philosophy of Sport 29 (1):66-74.
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  • Medical necessity, mental health, and justice.Emma Prendergast - 2023 - Clinical Ethics 18 (3):292-297.
    This paper examines the concept of medical necessity as it relates to mental health care rationing, arguing that the normal functioning model of medical necessity is insufficient because it fails to cohere with an important aim and function of mental health care, which is to provide support for individuals in abusive or otherwise difficult personal relationships.
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  • (1 other version)Cognition on demand?—The wish for cognition-enhancing drugs in medicine.Matthis Synofzik - 2006 - Ethik in der Medizin 18 (1):37-50.
    Die Fortschritte in der Psychopharmakologie führen zu einem immer breiteren Angebot an Substanzen zur Verbesserung der Stimmung, des Gedächtnisses oder der exekutiven Funktionen. Dieses Angebot trifft auf die Wünsche und Bedürfnisse vieler Menschen, ihre mentalen Leistungen und Zustände zu verbessern. Wie sollte die Medizin mit diesen Wünschen umgehen? An welchen Kriterien sollte sich insbesondere der ärztliche Entscheidungsprozess orientieren? Im Folgenden soll gezeigt werden, dass sich aus einer „Treatment-enhancement-Unterscheidung“, einem Krankheits- oder Normalitätsbegriff oder einem bestimmten Medizinkonzept keine zielführenden normativen Kriterien für (...)
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  • Just choice: a Danielsian analysis of the aims and scope of prenatal screening for fetal abnormalities.Greg Stapleton, Wybo Dondorp, Peter Schröder-Bäck & Guido de Wert - 2019 - Medicine, Health Care and Philosophy 22 (4):545-555.
    Developments in Non-Invasive Prenatal Testing (NIPT) and cell-free fetal DNA analysis raise the possibility that antenatal services may soon be able to support couples in non-invasively testing for, and diagnosing, an unprecedented range of genetic disorders and traits coded within their unborn child’s genome. Inevitably, this has prompted debate within the bioethics literature about what screening options should be offered to couples for the purpose of reproductive choice. In relation to this problem, the European Society of Human Genetics (ESHG) and (...)
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  • Cognitive-Enhancing Drugs, Behavioral Training and the Mechanism of Cognitive Enhancement.Emma Peng Chien - 2013 - In Elisabeth Hildt & Andreas G. Franke (eds.), Cognitive Enhancement: An Interdisciplinary Perspective. Springer. pp. 139-144.
    In this chapter, I propose the mechanism of cognitive enhancement based on studies of cognitive-enhancing drugs and behavioral training. I argue that there are mechanistic differences between cognitive-enhancing drugs and behavioral training due to their different enhancing effects. I also suggest possible mechanisms for cognitive-enhancing drugs and behavioral training and for the synergistic effects of their simultaneous application.
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  • Addressing the Concerns Surrounding Continuous Deep Sedation in Singapore and Southeast Asia: A Palliative Care Approach.Lalit Kumar Radha Krishna - 2015 - Journal of Bioethical Inquiry 12 (3):461-475.
    The application of continuous deep sedation in the treatment of intractable suffering at the end of life continues to be tied to a number of concerns that have negated its use in palliative care. Part of the resistance towards use of this treatment option of last resort has been the continued association of CDS with physician-associated suicide and/or euthanasia, which is compounded by a lack clinical guidelines and a failure to cite this treatment under the aegis of a palliative care (...)
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  • Negative and Positive Genetic Interventions: Is There a Moral Boundary?Norman Daniels - 1998 - Science in Context 11 (3-4):439-453.
    The ArgumentSome have claimed that negative genetic interventions are morally permissible while positive ones are not, but the distinction cannot be used to draw this moral boundary. Underlying the negative/positive distinction is a distinction between treatment and enhancement. The treatment/enhancement distinction at best provides an imperfect guide to which health care services we are obliged to provide and which we are not. It offers only some “warning flags” to help us think about what is permissible or not.
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  • The concept of underinsurance: A general typology.Andrew Ward - 2006 - Journal of Medicine and Philosophy 31 (5):499 – 531.
    In a 2002 speech, Mark McClellan, a member of the Council of Economic Advisors at the White House, said that "[I]n the president's vision, all Americans should have access to high-quality and affordable healthcare." However, many healthcare researchers believe that a growing number of Americans are underinsured. Because any characterization of underinsurance will refer to the value judgments of people about what counts as "adequate" and "inadequate" healthcare, the goal of characterizing and measuring the underinsured is difficult to achieve. In (...)
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  • Ethically justified, clinically applicable criteria for physician decision-making in psychopharmacological enhancement.Matthis Synofzik - 2009 - Neuroethics 2 (2):89-102.
    Advances in psychopharmacology raise the prospects of enhancing neurocognitive functions of humans by improving attention, memory, or mood. While general ethical reflections on psychopharmacological enhancement have been increasingly published in the last years, ethical criteria characterizing physicians’ role in neurocognitive enhancement and guiding their decision-making still remain highly unclear. Here it will be argued that also in the medical domain the use of cognition-enhancing drugs is not intrinsically unethical and that, in fact, physicians should assume an important role in gating (...)
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  • Neuroenhancement in Young People: Proposal for Research, Policy, and Clinical Management.Ilina Singh & Kelly J. Kelleher - 2010 - American Journal of Bioethics Neuroscience 1 (1):3-16.
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  • Book Review: David Karp, Is It Me or My Meds? Living with Antidepressants. Cambridge, MA: Harvard University Press, 2006. ISBN 067402182–7. 263 pp. $25.95. [REVIEW]Giovanni Frazzetto - 2007 - History of the Human Sciences 20 (3):149-154.
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