When is diminishment a form of enhancement? Another twist to the “enhancement” debate in biomedical ethics

By Brian Earp, MSc

Photo by Rob Judges

Brian Earp is a Research Fellow at the Uehiro Centre for Practical Ethics at the University of Oxford. He is an interdisciplinary researcher with training in cognitive science, experimental (social) psychology, philosophy, and ethics. With Professor Julian Savulescu, Brian is writing a book on the neuroenhancement of love and marriage, to be completed this year.

There is a big debate going on about “enhancement.” For many years now, people have realized that new technologies, along with discoveries in neuroscience and pharmacology, could be used in ways that seem to go beyond mere “medicine” – the treating of deformity or disease. Instead, to use a phrase popularized by Carl Elliot, they could make us “better than well.” Faster, stronger, smarter, happier. Quicker to learn, slower to forget. It has even been suggested that we could use these new technologies to “enhance” our love and relationships, or make ourselves more moral. 



These kinds of prospects are exciting to some. To others, they are frightening, or at least a cause for concern. As a result, there has been a stream of academic papers—alongside more popular discussions—trying to get a handle on some of the ethics. Is it permissible to take “medicine” even if we aren't “sick”? Should we be worried about “Playing God”? Do some people have an obligation to enhance themselves? And so on.



At least one major problem has been lurking in the background. And that is that, quite simply, “enhancement” could mean almost anything. Definitions are often vague, if they’re attempted at all. Some authors resort to simply listing out various interventions, with the hope that the reader will somehow “intuit” how they all hang together. But there are some common themes. In a recent paper with my colleagues Anders Sandberg, Guy Kahane, and Julian Savulescu, I called attention to at least two major “approaches” to understanding the term enhancement that seem to crop up in the academic literature.



The first is the Functional-Augmentative Approach to Enhancement. According to this type of approach, “interventions are considered enhancements insofar as they improve some capacity or function (such as cognition, vision, hearing, alertness) by increasing the ability of the function to do what it normally does.” The debate then usually turns on whether it’s OK to “enhance” someone (in this sense) who doesn’t have a “medical” problem, at least not on that particular dimension. This then leads to a second way of understanding enhancement, which we called:



The Not-Medicine Approach to Enhancement. According to this type of approach, to quote the bioethicist Eric Juengst, “the term ‘enhancement’ [characterizes] interventions designed to improve human form or functioning beyond what is necessary to sustain or restore good health.” This is the sense of “better than well” that many people (seem to) have in mind when they are engaging in these kinds of debates.



Both of these definitions have flaws. For one thing, they focus almost exclusively on the “augmentation” of capacities or functions—on “going beyond” the ordinary limits of medicine, or even human nature. But what about interventions that work in the opposite direction? One common example of “enhancement”—found throughout the neuroethics literature—is the use of drugs or other technologies to “blunt” painful memories (for example, after a breakup). Although such an intervention is clearly relevant to these discussions, it seems a little bit more like a “diminishment” than an “enhancement.” How should we consider cases like this?



Here are some other examples. What about the use of “anti-love biotechnology” to help a victim of domestic abuse break ties with her abuser? Or voluntary “chemical castration” for pedophiles seeking to change? To pick something less disturbing, how about appetite suppressants to help someone with her dieting goals? Enhancements? Diminishments? Both?



There’s a simple solution to this puzzle. All of these interventions are “enhancements” in the sense that they are geared toward improving well-being. “That is, once we shift our focus from the particular capacity or function being modified, to the overall normative goal of the modification itself” we stumble upon a third approach to understanding enhancement, which we call:



The Welfarist Approach to Enhancement. On this approach, “enhancement” is defined as “any change in the biology of psychology of a person which increases the chances of leading a good life in a given set of circumstances.” As we explore in our paper—see below for the reference and a link—we think that this approach resolves a number of conceptual ambiguities in the bioethics literature, and offers a useful framework for thinking through the use of new technologies in terms of how they can promote human flourishing. We look forward to hearing what you think!







This post can also be viewed on the Psychiatric Ethics Blog. 



Highlighted paper [open access]



Earp, B. D., Sandberg, A., Kahane, G., and Savulescu, J. (2014). When is diminishment a form of enhancement? Rethinking the enhancement debate in biomedical ethics. Frontiers in Systems Neuroscience, Vol. 8, Article 12, 1-8.



Related reading [open access]



Earp, B. D., Sandberg, A., & Savulescu, J. (2014). Brave new love: The threat of high-tech “conversion” therapy and the bio-oppression of sexual minorities. American Journal of Bioethics: Neuroscience, Vol. 5, No. 1, 4-12.



Earp, B. D., Wudarczyk, O. A., Sandberg, A., & Savulescu. J. (2013). If I could just stop loving you: Anti-love biotechnology and the ethics of a chemical breakup. American Journal of Bioethics, Vol. 13, No. 11, 3–17.



Earp, B. D., Sandberg, A., & Savulescu, J. (2012). Natural selection, childrearing, and the ethics of marriage (and divorce): Building a case for the neuroenhancement of human relationships. Philosophy & Technology, Vol. 25, No. 4, 561-587.



Wudarczyk, O. A., Earp, B. D. , Guastella, A., & Savulescu, J. (2013): Could intranasal oxytocin be used to enhance relationships? Research imperatives, clinical policy, and ethical considerations. Current Opinion in Psychiatry, Vol. 26, No. 5, 474-484.





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Earp, B. (2014). When is diminishment a form of enhancement? Another twist to the “enhancement” debate in biomedical ethics? The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2014/05/when-is-diminishment-form-of.html