Bioethical Prescriptions collects F.M. Kamm's articles on bioethics -- revised for publication in book form -- which have appeared over the last 25 years and which have made her among the most widely-respected philosophers working in this field.

Biomedical innovations are making possible the enhancement of human capabilities. There are two philosophical stances on the role that medicine should play in this respect. On the one hand, naturalism rejects every medical intervention that goes beyond preventing and treating disease. On the other hand, welfarism advocates enhancements that foster subjective well-being. We will show that both positions have considerable shortcomings. Consequently, we will introduce a third characterization in which therapies and enhancements can be reconciled with the legitimate objectives of (...) medicine inasmuch as they improve the capabilities that enable the freedom to pursue personal well-being. (shrink)

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. (...) Building on prior research in moral philosophy and cognitive science, in this work, we ask why people draw a moral distinction between treatment and enhancement. In two experiments, we provide evidence that the accessibility of health-related interventions determines their perceived descriptive or statistical normality (Experiment 1), and that gains in descriptive normality for such interventions weaken the moral distinction between treatment and enhancement (Experiment 2). In short, our findings suggest that the tendency to draw a moral distinction between treatment and enhancement is driven, in part, by assumptions about descriptive abnormality; and raise the possibility that normalizing novel biomedical interventions by promoting access could undermine people’s selective opposition toward enhancement, rendering it morally comparable to treatment. (shrink)

While research to improve memory or counter decay caused by neurodegenerative diseases has a fairly long history, scientific attempts to erase memories are very recent. The use of non-invasive brain stimulation for memory modulation represents a new and promising application for the treatment of certain disorders [such as Post-Traumatic Stress Disorder ]. However, numerous ethical issues are related to memory intervention. In particular, the possibility of using forms of non-invasive brain stimulation requires to distinguish treatment interventions from the enhancement of (...) the healthy. Furthermore, a range of important societal and legal concerns arise when manipulating memories. In this short contribution, we address some of the most significant ethical, social, and legal implications surrounding the application of memory-modulation techniques and offer a series of reflections and considerations, which we hope can be of use to guide -and perhaps regulate- their potential, future implementation in society. (shrink)

Much of the excitement and concern with virtual reality (VR) has to do with the impact of virtual experiences on our moral conduct in the “real world”. VR technologies offer vivid simulations that may impact prosocial dispositions and abilities or emotions related to morality. Whereas some experiences could facilitate particular moral behaviors, VR could also inculcate bad moral habits or lead to the surreptitious development of nefarious moral traits. In this chapter, I offer an overview of the ethical debate about (...) using VR to improve morality. I start by clarifying the rationale of using VR for good, drawing on moral enhancement literature, branches of the science of morality, and the specific potentials of this technology. Then, I will briefly focus on three prominent domains of socio-moral improvement: the use of VR for enhancing empathy, reducing implicit biases, and improving pro-environmental behavior. After that, I shall consider three ethical objections to the enthusiasm for using VR in order to improve human morality. Finally, I will recapitulate the main points of the chapter and provide a few concluding thoughts on future avenues of discussion on how VR can make us act (morally) better. (shrink)

Biotechnology now makes it possible to enhance human traits as well as treat illnesses and disorders. What it has neglected to establish, however, is a clear line between these two functions, a distinction between what counts as treatment or therapy and what counts as enhancement. The bulk of the literature on enhancements focuses on the ethics of enhancements, not on the criteria that qualify a procedure as an enhancement . While the ethical questions regarding the desirability of enhancements are certainly (...) worthy of consideration, so is the issue of what constitutes an enhancement versus a form of treatment or therapy. Scholars have debated the issue of whether a distinction between therapy and enhancement exists, but the placement of that distinction has not yet been sufficiently addressed . Much like the field of bioethics itself, my study of this issue is a work in progress, so this paper will ask and explore questions relevant to this topic without providing answers to all of them. Nonetheless, they are important questions to ask with important implications for the future of bioethics. This paper will describe the line between enhancement and therapy, map the terrain and define the terms. It will also investigate where the line is at present, and where and how it has been set by legislation and private companies. It will then illustrate the issues, using two examples, to demonstrate the difficulties and complexities involved. Finally, it will explore the implications of the line for society’s financial as well as physical interests, and for healthcare access in the United States. It will conclude by considering the open question of how a company, a government, and a just society should go about setting the line. I hope that asking the questions and exploring their complexities will help draw attention to and prompt serious consideration of the placement of the line between therapy and enhancement. (shrink)

The genetic modification of children is becoming a more likely possibility given our rapid progress in medical technologies. I argue, from a broadly Kantian point of view, that at least one kind of such modification—modification by a parent for the sake of a child's comparative advantage—is not rationally justified. To argue this, I first characterize a necessary condition on reasons and rational justification: what is a reason for an agent to do an action in one set of circumstances must be (...) a reason for any in those circumstances to do the action. I then show that comparatively advantageous genetic modification violates this principle since a child's “getting ahead” through genetic modification cannot be rationally justified unless other children also could receive the modification, thus rendering the advantage useless. Finally, I consider the major objection to this conclusion: it seems to disallow all cases of a parent's helping a child get ahead, something that parents normally engage in with their children. I argue that typical practices of developing a comparative advantage in a child, as well as practices of societal competition in general, do not conflict because they involve circumstances that mitigate the universal character of reasons. Many ordinary cases of competitive advantage that we think of as unjust, in fact, can be explained by my argument. (shrink)

Seemingly ever improving medical technology and techniques portend the possibility of prenatally enhancing otherwise healthy, normal children—seamlessly enhancing or adding to a child’s natural abilities and characteristics. Though parents normally engage in enhancing children, i.e., child rearing, these technologies present radically new possibilities. This sort of enhancement, I argue, is morally problematic for the parent: the expectations of the enhancing parent necessarily conflict with attitudes of acceptance that moral parenting requires. Attitudes of acceptance necessitate that parents are open to the (...) essentially-individual choices of the child that will determine the kind of person he or she becomes. However, the intentional act of enhancing contradicts this openness by setting expectations on who the child becomes. Because of this, there is strong moral weight against parents’ prenatally enhancing their children. (shrink)

In this paper I give a short overview about the general implications of issues of human nature within the field of human enhancement. The first section of my contribution deals with a certain intertwining of human enhancement and the intrinsic claims of human nature, showing that a non-statistical concept of human nature can play a crucial role in the debate on human enhancement. After that, my aim is to validate that particular enhancements (e.g. neuro-enhancement) fall under the same normative criteria (...) as “normal enhancement”, only requiring a special contextual awareness to co-exist with it ethically. Methodically, my intention is to draw on quasi-naturalist approaches, which argue that our nature as humans is not a “mixed bag”, but seems to be wholly constituted by its species-related characteristics. As a result, we can state that our evaluations of living beings or life forms, which are also evaluations of our methods of medical treatments and of our ethical attitudes, depend on our picture of human nature. (shrink)