Transcript PowerPoint-presentation - Moral Roots and Future Goals of

Therapy and Enhancement
meeting the need for a distinction without making it
Christian Munthe
Dept. of Philosophy,
Göteborgs University
Munthe C, The Morality of Precaution:
Interpreting, Justifying and Applying the
Precautionary Principle. (unpublished)

The framing of discussions of gene technology (GT) in bioethics

Visions of fantastic achievements (VFA)
• Debate: what could be bad with those?
– Enthusiasts (post/trans-humanists, futurists, followers of juche)
– Negativists (humanists, pessimists, natural law believers…)
– Sceptics (Can’t say before I know much more, especially if we want to be able to
address practical issues of policy and clinical practice) => Discussion needs to
be framed in termes of risks, chances and their evaluation, rather than whether
or not certain outcomes would or would not be acceptable ”in principle”). => Me!

Therapy - Enhancement (T-E)
• A negativist strategy for allowing some GT while excluding (alleged)
excesses
• Enthusist reducio strategy against negativists
• Debate: so, what’s so bad about enhancement, then?
– Enthusiasts: (VFA negativists: natural order, ethos of medicine, etc.)
– Negativists: (VFA enthusiasts: nature and ethoses don’t matter morally, all that
matters is magnitude of benefits and harms)
– Sceptics (Can’t say. The distinction is incomprehensible and to the extent that it
is not, it is doesn’t help with solving the practical problems of whether or not to
allow/fund/apply particular procedures).

I’m a sceptic on both counts => new framing in terms of the ethics of
risks

Reasons for a distinction



The (generic) distinction:




Absolute limit: different types of benefits
It is irresponsible (for health care) to engage in enhancement
Therapy should always be given priority
Criticism





Responsible procedures (risk-possible benefit)
Priorities (risk-possible benefit)
No clear/plausible typology of benefits
The importance of benefits only depends on magnitude
So go for the greatest arm-benefit ratio!
Risk-chance: repetition in terms of expected utility
Conflict


Equal benefits are morally on a par if the risks are similar
The original reasons defeated:



Mending a boken arm - transplanting a third functional arm.
Extending life expectancy to 160 years - preventing early death today
Transhumanism, Enhancement enthusiasm, etc.

My idea



Denying an absolute limit is compatible with a comparative (gradual and
option-sensitive) difference between the moral importance of equal riskchance ratios.
(0.5 x -1 / 0.5 x 1) vs. (0.5 x -10.000 / 0.5 x 10.000)
Some elements that may be employed:









Quality of evidence matters: poor quality is a cost (e.g., uncertainty)
Risks may be more important than chances even if they have equal magnitude.
Progressively increasing moral importance of risks (compared to chances)
Comparison with/relativisation to an idea about a decent risk-chance mix.
When are we ”OK”?
Also other ideas may do the job… a prioroty view in risk terms…
Abandoning the T-E distinction does not have to imply abandonment
of the original reasons for it.
If one wants, one may baptise permissible (in a certain context)
procedures as ”therapy” and impermissible ones as ”enhancement”
(but what’s the point?)
The distinction becomes relative to context (Global - National)
The distinction may not track ”intuitive” ideas very well