THE TREATMENT/ENHANCEMENT DISTINCTION

In the last chapter, we set out the objections that seem to underlie the presumption in favor of traditional means of changing minds (hereafter, “the presumption”). In this chapter we shall consider these objections in detail. Before we begin treating them, however, we need to consider another, more general, question, one that cuts across all the other objections and across a range of possible neurological interventions. Many people – laypeople, philosophers, bioethicists and neuroscientists – have importantly different responses to actual and potential neuroscientific (as well as medical) interventions, depending upon what they are being used for. Interventions to treat diseases and impairments are regarded as significantly more permissible (perhaps even obligatory) than interventions aimed at enhancing normal capacities. Treating disease is generally regarded as an intrinsically worthwhile activity, and we are therefore under a (possibly defeasible) obligation to engage in it, but enhancing already normal capacities is a luxury, which is at best permissible, and not obligatory, and at worst impermissible. Different thinkers make different uses of the treatment/enhancement distinction. For some, it marks the difference between the kinds of medical interventions which it is incumbent upon the state to provide, and the kinds of interventions which can permissibly be bought and sold, but need not be provided as a matter of justice; for others, it marks the difference between interventions which are permissible, and those which ought to be banned.