In this article we argue that the principle of need, on some interpretations, could be used to justify the spending of publically funded health care resources on cognitive enhancement and that this also holds true for individuals whose cognitive capacities are considered normal.The increased, and to an extent, novel demands that the modern technology and information society places on the cognitive capacities of agents, e.g., regarding good and responsible decision-making, have blurred the line between treatment and enhancement. More specifically, it (...) has shifted upwards. As a consequence, principles of need on their most reasonable interpretations can be used to support publically funded cognitive enhancement. At least this is so, if broader aims than curing and ameliorating diseases are included in the goals of health care. We suggest that it would be plausible to see health care as accepting such broader goals already today. (shrink)

A key aspect of transhumanist thought involves the modification or augmentation of human physical and mental capabilities—a form of intervention often encapsulated under the term "enhancement." This article provides an overview of the concept of enhancement, focusing on six major areas in which usages of the term become slippery and controversial: normal or species-typical functioning, therapeutics or healing, natural functioning, human nature, authenticity, and the ambiguity between "more" and "better." I argue that we need to be aware of the tendency (...) to embed the concept of enhancement within stark binary oppositions that seem perfectly reasonable at first glance, but that in fact yield little more than conceptual muddles if they are not handled carefully. (shrink)

Human enhancement issues are not merely academic: the technologies and trends involved give rise to new needs and social demands, provide opportunities for individuals and society, and present new risks. They also challenge crucial cultural notions, social concepts and views of the human condition, and may cause new forms of social pressure and social exclusion. This chapter reports on a systematic attempt by the European Technology Assessment Group (ETAG), conducted on behalf of the Science and Technology Options Assessment (STOA) panel (...) of the European Parliament, to suggest policy options on the issue of human enhancement. It outlines and discusses a number of strategies for dealing with the issue in a European policy context, identifying a reasoned pro‐enhancement approach, a reasoned restrictive approach, and a systematic case‐by‐case approach as viable options. (shrink)

New emerging biotechnologies, such as gene editing, vastly extend our ability to alter the human being. This comes together with strong aspirations to improve humans not only physically, but also mentally, morally, and socially. These conjoined ambitions aggregate to what can be labelled “the gene editing of super-ego.” This article investigates a general way used to argue for new biotechnologies, such as gene-editing: if it is safe and efficacious to implement technology X for the purpose of a common good Y, (...) why should we not do so? This is a rhetorical question with a conditional, and may be dismissed as such. Moreover, investigating the question transformed into a formal argument reveals that the argument does not hold either. Nonetheless, the compelling force of the question calls for closer scrutiny, revealing that this way of arguing for biotechnology is based on five assumptions. Analysis of these assumptions shows their significant axiological, empirical, and philosophical challenges. This makes it reasonable to claim that these kinds of question based promotions of specific biotechnologies fail. Hence, the aspirations to make a super-man with a super-ego appear fundamentally flawed. As these types of moral bioenhancement arguments become more prevalent, a revealing hype test is suggested: What is special with this technology, compared to existing methods, that makes it successful in improving human social characteristics in order to make the world a better place for all? Valid answers to this question will provide good reasons to pursue such technologies. Hence, the aim is not to bar the development of modern biotechnology, but rather to ensure good developments and applications of highly potent technologies. So far, we still have a long way to go to make persons with goodness gene. (shrink)

This article draws attention to several common mistakes in thinking about biomedical enhancement, mistakes that are made even by some supporters of enhancement. We illustrate these mistakes by examining objections that John Harris has recently raised against the use of pharmacological interventions to directly modulate moral decision-making. We then apply these lessons to other influential figures in the debate about enhancement. One upshot of our argument is that many considerations presented as powerful objections to enhancement are really strong considerations in (...) favour of biomedical enhancement, just in a different direction. Another upshot is that it is unfortunate that much of the current debate focuses on interventions that will radically transform normal human capacities. Such interventions are unlikely to be available in the near future, and may not even be feasible. But our argument shows that the enhancement project can still have a radical impact on human life even if biomedical enhancement operated entirely within the normal human range. (shrink)

Does biomedical enhancement challenge justice in health care? This paper argues that health care justice based on the concept of normal functioning is inadequate if enhancements are widespread. Two different interpretations of normal functioning are distinguished: the “species typical” vs. the “normal cooperator” account, showing that each version of the theory fails to account for certain egalitarian intuitions about help and assistance owed to people with health needs, where enhancements are widespread.

According to the ‘fact-plus-value’ model of pathology propounded by K. W. M. Fulford, ‘disease’ is a value term that ought to reflect a ‘balance of values’ stemming from patients and doctors and other ‘stakeholders’ in medical nosology. In the present article I take issue with his linguistic-analytical arguments for why pathological status must be relative to such a kind of medico-ethical normativity. Fulford is right to point out that Boorse and other naturalists are compelled to utilize evaluative terminology when they (...) characterize the nature of diseases and biological dysfunctions. But the relevant ‘biofunctional judgements’ are no less factual and empirical for that. While it is indeed evaluative to say that biological dysfunctions involve failures to execute naturally selected functions, such judgments are not bound to entail anything about what is good or bad for us, and what should be treated or not. In the last part of the paper I ruminate briefly on the relationship between ‘biological evaluationism’, on my construal, and descriptions of ‘causal biology’. As I note in my conclusion, a strict bioevaluative concept of disease can be valid for every species on earth, and thus be of particular usefulness in general biological contexts. (shrink)

Examining the naturalist and normativist concepts of health and disease this article starts with analysing the view of C. Boorse. It rejects Boorse's account of health as species-typical functioning, giving a critique of his view based on evolutionary theory of contemporary biology. Then it gives a short overview of the normativist theories of health, which can be objectivist and subjectivist theories. Rejecting the objectivist theories as philosophically untenable, it turns to the subjectivist theories of Gert and Culver, and to the (...) view of Nordenfelt. These theories give quite a good subjectivist account of health and disease, but they do not pay enough attention to the notion of the environment, without which it is impossible to define health and disease. Starting with their definitions but introducing the notion of “reasonable social norms”, the article arrives at the following definition of health: The healthier a physical or mental characteristic, process, reaction is, the more it makes it possible for the individual to adapt to reasonable social norms without pain and suffering, and the longer, and happier a life it will be able to ensure him in that society. (shrink)

Examining the naturalist and normativist concepts of health and disease this article starts with analyzing the view of C. Boorse. It rejects Boorse's account of health as species-typical functioning, giving a critique of his view based on evolutionary theory of contemporary biology. Then it gives a short overview of the normativist theories of health, which can be objectivist and subjectivist theories. Rejecting the objectivist theories as philosophically untenable, it turns to the subjectivist theories of Gert and Culver, and to the (...) view of Nordenfelt. These theories give quite a good subjectivist account of health and disease, but they do not pay enough attention to the notion of the environment, without which it is impossible to define health and disease. Starting with their definitions but introducing the notion of "reasonable social norms", the article arrives at the following definition of health: The healthier a physical or mental characteristic, process, reaction is, the more it makes it possible for the individual to adapt to reasonable social norms without pain and suffering, and the longer, and happier a life it will be able to ensure him in that society. (shrink)

The literature on health and diseases is usually presented as an opposition between naturalism and normativism. This article argues that such a picture is too simplistic: there is not one opposition between naturalism and normativism, but many. I distinguish four different domains where naturalist and normativist claims can be contrasted: (1) ordinary usage, (2) conceptually clean versions of “health” and “disease,” (3) the operationalization of dysfunction, and (4) the justification for that operationalization. In the process I present new arguments in (...) response to Schwartz (2007) and Hausman (2012) and expose a link between the arguments made by Schwartz (2007) and Kingma (2010). Distinguishing naturalist claims at these four domains will allow us to make progress by (1) providing more nuanced, intermediate positions about a possible role for values in health and disease; and (2) assisting in the addressing of relativistic worries about the value-ladenness of health and disease. (shrink)

New technologies facilitate the enhancement of a wide range of human dispositions, capacities, or abilities. While it is argued that we need to set limits to human enhancement, it is unclear where we should find resources to set such limits. Traditional routes for setting limits, such as referring to nature, the therapy-enhancement distinction, and the health-disease distinction, turn out to have some shortcomings. However, upon closer scrutiny the concept of enhancement is based on vague conceptions of what is to be (...) enhanced. Explaining why it is better to become older, stronger, and more intelligent presupposes a clear conception of goodness, which is seldom provided. In particular, the qualitative better is frequently confused with the quantitative more. We may therefore not need “external” measures for setting its limits – they are available in the concept of enhancement itself. While there may be shortcomings in traditional sources of limit setting to human enhancement, such as nature, therapy, and disease, such approaches may not be necessary. The specification-of-betterment problem inherent in the conception of human enhancement itself provides means to restrict its unwarranted proliferation. We only need to demand clear, sustainable, obtainable goals for enhancement that are based on evidence, and not on lofty speculations, hypes, analogies, or weak associations. Human enhancements that specify what will become better, and provide adequate evidence, are good and should be pursued. Others should not be accepted. (shrink)

This paper examines the most influential naturalist theory of health, Christopher Boorse’s ‘biostatistical theory’ . I argue that the BST is an unsuitable candidate for the rôle that Boorse has cast it to play, namely, to underpin medicine with a theoretical, value-free science of health and disease. Following the literature, I distinguish between “real” changes and “mere Cambridge changes” in terms of the difference between an individual’s intrinsic and relational properties and argue that the framework of the BST essentially implies (...) a Cambridge-change criterion. The examination reveals that this implicit criterion commits the BST to the troubling view that an individual could go from being diseased to healthy, or vice versa, without any physiological change in that individual. Two problems follow: the current framework of the BST is ill-equipped to formally embrace Cambridge changes and it is theoretically dubious. The arguments advanced here are not limited to the BST; I suggest they extend to any naturalist claim to underpin medical practice with a value-free theory of health and disease defined in terms of an evolutionary view of biological fitness. (shrink)

The vagueness or imprecision of ‘the normal’ allows it to be exploited for various purposes and political ends. It is conspicuous in both medicine and athletics; I am going to try to say something about the normal in each of these areas. In medicine the idea of the normal is often deployed in understanding what constitutes disease and hence, as some see it, in determining the role of physicians, in determining what is or ought to be covered by insurance, and (...) in underwriting certain views on social justice. In athletics the use of performance enhancing substances raises different sorts of questions about the normal, especially when it comes to deciding what constitutes an enhancement and which enhancements, if any, are acceptable. (shrink)