CAS PH 251 Lecture Notes - Lecture 20: Medical Necessity, Liberal Eugenics, John Rawls

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Human Enhancement:
Question: How far is too far when enhancing genes?
Terminology:
o Positive Enhancements enhancing one’s abilities/intelligence
o Negative Enhancements treating one’s disease
Old Eugenics negative eugenics were morally worse than positive eugenics (ex:
sterilization/genocide of inferior traits)
New Eugenics positive eugenics/enhancements are more morally concerning than
negative eugenics/enhancements
o There can be an uneven distribution for which individuals can use certain
technologies (violation of justice)
o There can be disparities as to what constitutes a positive trait
o Can be motivated by selfishness/ignorance/bias/differing perspective
o Essentially, the enhancement is what skews intuition rather than the medical
intervention being carried out
Treatment v. Enhancement Debate
Question: What is the moral significance in the difference between treatment and
enhancement?
o Treatment eliminates low end variation (imagine removing a tail end of a bell
curve)
o Enhancement skews overall structure (imagine flattening a bell curve)
There is a distinction between medical necessities and diseases and whether or not there
will be insurance coverage for certain things
o Essentially, ailments that are not classified as a disease will not be covered,
despite it having a similar impact on a person’s psyche and well-being
o ex: patient A’s coverage for breast removal due to either breast cancer is largely
different than patient B’s breast removal due to cosmetic intent
Question: So why is coverage not provided for both patients when they
would equally benefit psychologically from the procedure?
Answer #1: patient A would be getting something “restored” to
them while patient B would be getting something new “given” to
them
Answer #2: equal opportunity
o This goes back to the argument that healthcare should be
provided to people (comes from the Rawlsian Theory of
Equal Opportunity) and any variation in this affects equal
opportunity
o This makes treatment of disease disvaluable (affects life in
ways that reduce well-being or diminish ability)
Question: Why is only medical necessity tied to treating particular diseases and is this justified?
Often leads to misclassification of diseases (either intentionally or unintentionally) in
order to include certain diseases under certain rules
o But is there justification for the treatment v. enhancement distinction?
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