Prompt: Write an essay in which you argue for or against a distinction between therapeutic technological modification and technological enhancement. In your essay, also address the relationship between this distinction and the ethical acceptability of the modification.
I will be arguing that there is a distinction between therapeutic technological modification and technological enhancement. I am not arguing whether or not they are morally obligatory or entirely different in every way. Rather, I’m simply arguing that there is a necessary distinction between the two. Before moving forward, I will define the term “enhancement” that this essay will focus on. Enhancement “is to increase the worth or value of” (“EnhancementMurray.Pdf,” n.d., 496). Yet, this begs the question: what is being enhanced? Is there something intrinsically valuable in humans? If so, what is it? For example, let’s say that a particular enhancement allows human beings to live twice as long as their normal counterparts would. Would this enhancement create a hierarchy within the moral worth of particular human beings over others?
Despite our “inclusive” culture, it’s clear that we do value certain characteristics over others. Characteristics of desirable attributes that become (intentionally or unintentionally) a societal hierarchy. For example, Down syndrome is seen as an undesirable characteristic for a person to have. Denmark “became one of the first countries in the world to offer prenatal Down Syndrome screening to every pregnant women, regardless of age or other risk factors” (Sarah Zhang, “The Last Children of Down Syndrome,” The Atlantic, October 30, 2023, https://www.theatlantic.com/magazine/archive/2020/12/the-last-children-of-down-syndrome/616928/?gift=eIJLmzuJkH5uR7Iqhs9RLGZzK3mwG7Qsvmz3gn9i8Uo&utm_source=copy-link&utm_medium=social&utm_campaign=share, para. 2). Mothers who receive a Down syndrome diagnosis after the test almost always (more than 95% of the time) choose to abort their children, thus killing their child because of an undesirable characteristic (Sarah Zhang, “The Last Children of Down Syndrome,” The Atlantic, para. 2). My point in bringing this up is to illustrate the point that people already determine the worth of an individual based on their characteristics. In this case, Down syndrome was the determining factor as to whether or not the baby was worth keeping or not. It was not based on something intrinsic about a human being, but rather the quality of life they would experience. Parents even bestow their children with enhancements that are not biomedical, such as swimming lessons or math tutors (See “EnhancementMurray.Pdf,” 494).
Enhancements are not restricted to a philosophical discourse of what may or will be; after all, human beings already use enhancements. For example, the hearing aid that the professor uses provides an increase to his hearing capabilities. Something that is outside of himself is being applied to him to improve a natural biological function. To further exemplify this point, our bodies have the inherent ability to heal themselves, yet medicine is utilized to enhance this process. While the nature of the enhancements and their effect may differ, the point remains: we have become accustomed to using things that enhance our biological functions. Yet, the reader may notice that the two examples I provided either entail or presuppose a deficiency in our health.
Enhancements may be valued, some more highly than others, such as one that would eliminate the genetic defect that causes Down syndrome. It is also an example of an enhancement that is also therapeutic. Yet, labeling it as “therapeutic” presupposes that Down syndrome is something that infringes on one’s quality of life and ought to be corrected. The article I referenced supports that this perspective is present among the citizens of Denmark and most likely other countries as well. Despite this overlap, does it entail that there is not a distinction between therapy and enhancement? Certainly, there is an overlap between therapeutic technological modification and technological enhancement, but to say the two are virtually identical is incorrect.
Traditionally, enhancement and therapeutic technological modification have been contrasted with one another (“EnhancementMurray.Pdf,” 493). The mere fact that they are being contrasted reveals that there is something different about each of them, despite any other similarities. Unlike utilizing technology to remedy deficient medical conditions (therapeutic technological modification), enhancement extends beyond the “terrain of medicine into the larger world of goals, values, and social institutions” (“EnhancementMurray.Pdf,” 494). This point is evident in Julian Savulescu’s work, “New breeds of humans: the moral obligation to enhance,” which will be looked at shortly.
Thomas H. Murray points out that there are several difficulties in assuming that “for biomedical intervention the key distinction is between enhancement and therapy” (“EnhancementMurray.Pdf,” 494). First, the therapy itself “can be understood as enhancement” (“EnhancementMurray.Pdf,” 494). Many physicians perceive their ministrations as simply “building upon the intrinsic [emphasis added] healing processes of the body and mind” (“EnhancementMurray.Pdf,” 494). For example, antibiotics “can be understood as a means to enhance the body’s capacity to fight off infection” (“EnhancementMurray.Pdf,” 494). Next, certain biomedical interventions are targeted at improving the individual’s health yet are an enhancement of sorts, such as vaccines. They work by “enhancing the immune system’s capacity to mount a response against an infectious agent” (“EnhancementMurray.Pdf,” 495). The goal of the vaccine is to enhance the number of antibodies when it sees a foreign substance within the body, thus building upon the latent capability of the immune system (“EnhancementMurray.Pdf,” 495). While it is therapeutic in that it preserves our health and prevents diseases, it is also an enhancement that magnifies the body’s resistance “to infection” (“EnhancementMurray.Pdf,” 495). Lastly, Murray points out that some biomedical interventions, such as human growth hormone (hGH), “occupy a continuum between what appears to be a clearly ‘therapeutic’ application and an outright and unabashed pursuit of enhancement” (“EnhancementMurray.Pdf,” 495). Children who lack natural production of hGH may utilize this as a ‘therapeutic’ tool, whereas others may receive it simply because they will be a few inches below the average height (“EnhancementMurray.Pdf,” 495).
While these provide challenges to my argument, they fail to refute it. Concerning his first point, the mere presence of overlap between the two categories does not demonstrate that the conceptual distinction between them is invalid. It does not follow that because antibiotics are a therapeutic means and a biological enhancement, therefore the two are the same and the distinction is invalid. While medicine may be utilized to enhance a pre-existing biological function, it does not necessarily entail a deficiency in that function (as seen with hGH). Therefore, the distinction between a therapeutic use of medicine and one geared towards biological enhancement is valid. Again, I acknowledge that there is overlap between therapy and enhancement, but it does not eliminate the distinctions.
Second, vaccines do serve both purposes as an enhancement and a therapy. Murray makes a specific claim in that vaccines are a therapy in the same manner as they are an enhancement (“EnhancementMurray.Pdf,” 494). This portion of his argument is flawed from my perspective; I concede that his example demonstrates the vast overlap between the two, but vaccines are not given to remedy a pre-existing condition, such as Down syndrome. Rather, it is used to prevent one’s health from failing, akin to vitamins or exercise. While his example is valid, it does not account for the inherent differences between the aim of therapy and the aim of enhancement.
Lastly, hGH can be used in a way that is geared towards restoring a deficiency in our health or as an enhancement. In fact, his example acknowledges as much. One child may be receiving hGH as a means of therapeutic technological modification, whereas another may use it as an enhancement towards their height. Moreover, multiple uses of a particular thing do not entail that those uses are not themselves distinct. For example, testosterone can be used therapeutically for men who have a natural deficiency in creating it, whereas others may utilize it as an enhancement. Despite its multiple uses, it does not entail that there is not a distinction between a therapeutic use of testosterone, and one aimed at enhancing one’s natural supply, that is not deficient. While hGH may occupy a unique continuum, it is not being served for both purposes at the same time. Therefore, the distinction between therapy and enhancement still stands.
The distinction also provides a firmer framework for the moral ambiguity that enhancements can and will bring. If we eliminate the distinction between therapeutic use and biological enhancement, it follows that if we are morally obligated to provide therapy (whether biomedical or otherwise) to our children, it follows that the same applies to enhancements. Julian Savulescu, Uehiro Chair in Practical Ethics at the University of Oxford, argues that we do have a moral obligation to enhance human beings” (Savulescu, Julian, “New Breeds of Humans: The Moral Obligation to Enhance,” Reproductive Biomedicine Online 10 Suppl 1 (2005): 36–39, Accessed December 12, 2024, https://doi.org/10.1016/S1472-6483(10)62202-X, 36). It is because of our evolutionary history that we select mates “both rationally and instinctively, on the basis of their genetic fitness – their ability to survive and reproduce. Our goal is the success of our offspring” (Savulescu, Julian, “New Breeds of Humans: The Moral Obligation to Enhance,” 36). This is reflected in how women treat their unborn children and how parents treat their children outside of the womb. He points out that most people, despite what they say, implicitly reject the view that interfering with human nature is wrong. Things such as embryonic screenings, vaccines, pain relievers, and cancer treatments are examples of this (Savulescu, Julian, “New Breeds of Humans: The Moral Obligation to Enhance,” 37). Although I disagree with him, if one forgoes the distinction between therapy and enhancement, the grounds to reject his argument become less firm. If we permit enhancements of one kind, why not support the enhancements that have the potential to be far more efficient, cost-effective, and less painful—emotionally and physically? To illustrate my point, Savulescu argues that “no one would object to the treatment of disability in a child if it were possible. Why, then, not treat the embryo with genetic therapy if that intervention is safe?” (Savulescu, Julian, “New Breeds of Humans: The Moral Obligation to Enhance,” 37).
Using his example, let’s say the embryo was healthy but would be slightly shorter than average. Under Savulecu’s view, there is no reason to not give that child an enhancement, provided it is safe. To not do so would be “to harm them” (Savulescu, Julian, “New Breeds of Humans: The Moral Obligation to Enhance,” 38). In my view, I can recognize that all of his previous examples are targeted at a deficiency in one’s health and thereby distinguish one’s moral obligation to provide such treatment, as opposed to people being morally obligated to enhance children who have no underlying health condition. Savulescu acknowledges that the basis for determining a genetic enhancement is unclear, thus advocating for a moral obligation towards enhancement yet no firm criteria as to what those enhancements (on matters unrelated to disabilities, disease, etc.) should be (Savulescu, Julian, “New Breeds of Humans: The Moral Obligation to Enhance,” 38). As previously mentioned, enhancement steps into the world of “goals, values, and social institutions” (“EnhancementMurray.Pdf,” 494). But this begs the question, what is valuable? Most would value things such as intellect, strength, speed, and so forth; in other words, those traits that contribute to human flourishing. But, because Savulescu argues that there is a moral obligation to provide enhancements, in the same way that we provide treatment for children with diseases, the issue becomes pressing.
However, Savulescu believes that the destruction of embryos is not infanticide (Savulescu, Julian, “New Breeds of Humans: The Moral Obligation to Enhance,” 38). He believes that embryos are not people, as evidenced by the vast number of abortions and other matters concerning IVF and adoption (Savulescu, Julian, “New Breeds of Humans: The Moral Obligation to Enhance,” 37). In sum, according to Savulescu, embryos are not children, but rather potential children (Savulescu, Julian, “New Breeds of Humans: The Moral Obligation to Enhance,” 37). Yet, he goes on to argue that we are morally obligated to give enhancements to embryos in the same way that we give care to children (Savulescu, Julian, “New Breeds of Humans: The Moral Obligation to Enhance,” 37). But if embryos do not carry the same moral value as human beings, why should we be obliged to give them enhancements? I’m not arguing that under Savulescu’s view embryos are worthless, but that they are worth less than human beings, in a similar way that concerning people, animals have less value but value, nonetheless. The distinction I’m arguing for does not entail a moral obligation to give humans and embryos (using Savulescu’s language) any enhancement that is deemed to increase the opportunities for our children and their experience of life. Savulescu provides no basis as to why one should be morally obligated to give a person and a non-person the same kind of care. A view that does not account for the distinction between therapy and enhancement will lead to a similar (if not identical) conclusion as Savulescu.
Nevertheless, just because something is arbitrary does not mean that it cannot be defended (“EnhancementMurray.Pdf,” 499). If one can “offer good reasons for drawing a line in the first place, and also good reasons for drawing it at this particular place, calling the line ‘arbitrary’ makes no important philosophical or ethical point” (“EnhancementMurray.Pdf,” 499). However, my critique is not that a line was drawn, but rather the moral obligation attached to it. There is a stark contrast between the morality of therapy and enhancement. The mere contemplation as to whether or not individuals should enhance themselves and/or their children demonstrates that “we are approaching unsettled moral territory” (“EnhancementMurray.Pdf,” 494). On the other hand, most would not hesitate to “treat disease and promote health” in children (Savulescu, Julian, “New Breeds of Humans: The Moral Obligation to Enhance,” 37). Some may say it’s obligatory, but the concept of enhancement is far more difficult to ascertain than therapeutic technological modifications. Murray notes that medical professionals may find enhancements useful as a boundary marker of what they are not morally obliged to do (“EnhancementMurray.Pdf,” 493). Eliminating the distinction between therapy and enhancement gives credence to the obligations that Savulescu puts forth concerning enhancement. Hence, his argument is why I am advocating for a distinction between the two.
Despite the overlap between therapeutic technological modification and enhancement, there are distinguishable differences between the two. By considering those differences, we can more effectively guide ourselves into a realm of upright moral actions concerning the progressive technology surrounding us. Instilling obligations to treat the infirmities of our children and promote their well-being is important, but enhancements extend beyond such things. Attaching a moral obligation to both will cloud our judgment and conflate two different treatments. In conclusion, the distinction between therapeutic technological modification and enhancement is not merely conceptually correct, but a lived experience.
Bibliography
“EnhancementMurray.Pdf,” n.d. Accessed December 11, 2024. https://philtech2024.michaelreno.org/wp-content/uploads/2024/10/EnhancmentMurray.pdf.
Zhang, Sarah. “The Last Children of Down Syndrome.” The Atlantic, October 30, 2023. Accessed December 12, 2024. https://www.theatlantic.com/magazine/archive/2020/12/the-last-children-of-down-syndrome/616928/?gift=eIJLmzuJkH5uR7Iqhs9RLGZzK3mwG7Qsvmz3gn9i8Uo&utm_source=copy-link&utm_medium=social&utm_campaign=share.
Savulescu, Julian. “New Breeds of Humans: The Moral Obligation to Enhance.” Reproductive Biomedicine Online 10 Suppl 1 (2005): 36–39. Accessed December 12, 2024. https://doi.org/10.1016/S1472-6483(10)62202-X.