Welfarist approaches to health and human enhancement: Why do treatments matter the most?

Abstract

Welfarist accounts of human enhancement claim that the treatment-enhancement distinction has no moral value. If treatments are understood as a subclass of enhancements, say these welfarists, nothing justifies denying people access to enhancements and offering only treatments to diseases. In defense of that, Julian Savulescu and Guy Kahane extend the concept of “disability” to include any state that can worsen someone’s life, classifying “disease” as a form of disability among others. In this paper, I intend to defend the value of the treatment-enhancement distinction and show how we can support human well-being without rejecting the distinction. However, in doing so, I intend to show how certain welfarist accounts of human enhancement hide an ambiguity in the use of “enhancement”. That is because someone may be “better” or “worse” relatively to a common standard and “better” or “worse” compared to others (or even to oneself). I intend to explore this difference in order to justify why treatments have a special value in distributive justice. The conclusion is that no one can be prevented, at least prima facie, from making use of enhancements in order to become better, but it does not follow from this that we can require from other people or the government that we become better than a standard (or than what is taken as adequate or sufficient). However, this is different in the case of health care needs. Living without health is living below a certain decent standard of well-being and this is what makes health care a special issue and a priority in public policy.

Keywords: treatment-enhancement distinction, human enhancement, rights to health care, welfarism, health, well-being.