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