Drug-Centered Care and Enhancement
We might think that any action properly called medical treatment or healthcare should aim to mitigate or prevent a disease or symptom. Along these lines, Murphy and others have suggested that the concept of health qua persons is more a theory of well-being than a theory of health (Murphy 2015). On such a view, drug-centered decisions (starting, as they do, with the availability of a drug rather than a biological need) would be something other than medical treatment or healthcare. This would also cast doubt on Maslow’s claim that self-actualization is required for health rather than being something extra. Rather than focusing on well-being, I will consider whether drug-centered care might contribute to enhancement or quality of life, which corresponds more directly with how I carve up these concepts.
So let us suppose, contra my own view discussed above, that an intervention is only healthcare if it is biologically based. Enhancement will then be something like what moves us to better-than-health status on health-related measures. On this limited understanding of enhancement, not all enhancements will be pharmaceutical or even medical. They may, perhaps, even include simply learning. (Bostrom and Savulescu 2009: 3)
Enhancement is a bit like dessert: it is not necessary, but it can be nice; it is hard to pass up; and if we make it available to one person, we should probably make it available to all. Like dessert, we might be willing to share the cost of healthcare for other members of our community but unwilling to share the cost of enhancement.
Unlike with dessert, more enhancement is by definition always better—at least along some measure of better.
When it comes to healthcare in the biology-limited sense, we can distinguish the introduction of acceptable and useful drugs from inappropriate, manipulative moves to market drugs that are not actually beneficial. We can draw a similar distinction in the area of enhancement. Some drugs or nondrug interventions provide benefits that can move us beyond health by enhancing us in ways that we authentically find good or useful; others will be chosen for inauthentic reasons having to do with external influences, such as marketing rather than for reasons of self-actualization. Authenticity becomes a key concept here. Consider Charles Taylor’s idea that:
Being true to myself means being true to my own originality, and that is something only I can articulate and discover. In articulating it... I am realizing a potentiality that is properly my own. (Taylor 1992: 29)
In a strict sense, no desire that is the result of marketing would count as “properly my own” because it does not spring from “my own originality.” On the other hand, if I learn about a drug, consider the facts, and integrate a desire for that drug into my goals without being deceived or coerced, this could be an authentic choice.
I suggest, then, that a biology-only view of healthcare leaves open the possibility of legitimate drug-centered decisions that contribute to enhancement. This is supported by the fact that there are any number of functions that could be enhanced. Attention, memory, empathy, physical endurance, and eyesight are just a few. If there is more than one measure for which enhancement is permissible, the decision to pursue enhancement on one measure rather than another could very well be based on the availability of a drug—a drug-centered decision.
-  Eric Parens explores concepts of authenticity in the context of enhancement in Parens 2009,distinguishing authenticity as gratitude for the self as given from authenticity as creativity—as aninternal drive to change or grow. The question of whether a desire for some enhancement is authentic sits in the realm of authenticity as creativity (Cf Wargo 2011).