Neuro-Enhancement Philosophical Issues – on the therapy/enhancement distinction

Many of the controversial issues approached in enhancement debates are (or are closely related to) philosophical questions. Some are moral problems, regarding what we should and shouldn't do, and some are metaphysical ones, concerning our most fundamental nature and that of the world around us – disentangling them isn't always easy. Some have been discussed since the days of Ancient Greece till today and some are completely new, arising with enhancement technologies. In this and the following texts, I shall focus on some of those problems, briefly exploring its nuances and showing the way they relate to the human/neuro-enhancement debates

Of the many philosophical issues surrounding enhancement debates, one that usually pops up is the conceptual questions about the therapy/enhancement distinction. Seemingly, it arks back to the questions we saw earlier about the characteristics or properties that make us humans and the degree to which one is normally or usually expected to have them. Normal and usual are indeed words to be stressed here: there is a very powerful pull to draw the line between therapy and enhancement based on those concepts. For many, one could separate normal and supra-normal degrees for the characteristics or properties in question and simply agree that whatever promotes or restores those to normal or usual levels is a therapeutic measure and whatever raises them beyond that threshold is to be viewed as an enhancement. So, to offer but one of many possible examples, using a smart drug to achieve normal or usual performance on a subject that is ADHD (Attention deficit hyperactivity disorder)-impaired could be viewed as a therapeutical intervention, using the exact same amount of the exact same substance on a non-impaired subject could be viewed as an enhancement.

But how exactly are we to specify or define the normality that is presupposed by this view? Is it the normal level of the individual herself that we’re talking about? Is normal here synonym for the natural level of that characteristic that the individual had before any intervention? This would render any inborn condition, from myopia to ADHD, impossible to be classified as anything else rather than enhancement. In defense of such a view, one can say that it brings new light to certain practices and objects we have been used to for so long that we never even think about it when we think of enhancement (e.g., prescription eyeglasses). Another form of thinking about the normal embedded in this distinction could be by simply looking at the expression of the characteristics or property under consideration within a given population and let statistics decide for us. Normal here would be a synonym for what is usual in a certain place and in a certain time. However, as has been show in close-cousin debates, such as the distinction between normal and pathological in medicine, quantification alone cannot solve it. To gesture at the population mean, as if it alone could decide for us, independently of political and social considerations, would be to forget how the labeling of diseases and conditions is influenced by cultural and ideological factors. Were the children of earlier generations also this prone to ADHD or have we undergone a massive process of medicalization? Was ADHD even a condition in the nineteenth century, for instance?

A more promising strategy to deal with the whole therapy/enhancement distinction may lie in a piecemeal approach, rather than trying to set in stone a conceptual distinction based on a dichotomy that has entertained philosophers and bioethicists for years, but with no clear result in sight. It seems at least prima facie possible to analyze controversial interventions on their own, assessing the risks and benefits on their own merits and demerits, without being forced to place them in either side of an opposition that, for all we know, may not even be a sharp one. Perhaps in what regards the therapy/enhancement distinction, as in many other instances of life in which (many) philosophers have tried to convince us of facing an unbreachable gulf, while all the time we were actually just facing another occurrence of life’s continuum. Perhaps it is the case that here, as in so many other situations, natura non facit saltum.

Rui Vieira da Cunha

Image credits: Anabela Nunes