Clinical practice and human enhancement

Clinical practice (or therapy) is generally the restoration (or preservation) of a previous (or average) condition in the population. Enhancement is the improvement of a person's natural capacities by heterogeneous means for them to acquire more skills and, therefore, access more opportunities. The two are in principle very different processes, but the line between them can become blurred. With the rapid improvement of medical treatments and technological progress, it may seem neither feasible nor even necessary to try to separate clinical practice from enhancement. However, there are pressing ethical and social reasons why this distinction should be preserved as far as possible at the analytical level. In fact, according to certain values that appear to be shared in liberal-democratic societies, warnings and rules concerning so-called therapeutic enhancement are functional in order to avoid excesses or collateral negative effects that outweigh the direct benefits obtained through interventions that go “beyond therapy.” In this chapter, we will deal with genetic engineering in medicine, cognitively enhancing drugs, and devices, as well as research into improving longevity. In all these cases, dutiful attempts to restore a state of health, to maintain it over time or to increase an individual's well-being may also lead to situations that need ethical scrutiny and, in some cases, regulation.