The past 30 years also have witnessed growing concern about the ethics of med- ical interventions designed to enhance human traits. No clear definition of such enhancements exist, but the term is used to refer to techniques used to improve human traits beyond a level generally considered normal rather than to treat con- ditions considered deviant or defective. This is a necessarily subjective definition because individual judgments regarding what is normal vary greatly. Nevertheless, we would probably all acknowledge a qualitative difference between providing cosmetic surgery to a person with a severely burned face versus providing it to a professional model who desires more prominent cheekbones. Similarly, there is a qualitative difference between using psychotropic drugs to avoid schizophrenic hallucinations versus using them to improve one’s exam grades—a process psychi- atrist Peter Kramer refers to as “cosmetic psychopharmacology.”
Ethical questions regarding enhancements have increased as their use has in- creased. Is it ethically justifiable for individuals to improve their offspring through genetic preselection or fetal surgery? If so, will those who don’t use these technologies become a “genetic underclass”? Should health insurance cover drugs such as Viagra, which helps men achieve erections and can improve quality of life perhaps beyond the norm for a given age? Should health insurance cover cosmetic (as opposed to reconstructive) surgery, and should doctors promote surgeries (such as liposuction) whose benefits are purely cosmetic and whose potential risks include death? Should psychotropic drugs be prescribed to individuals who don’t have diagnosable mental illnesses but who want to be more sociable, alert, or assertive? And is it ethical to provide potentially harmful medical care to enhance some individuals while others still lack basic medical care? Finally, some professionals have questioned whether enhancements pro- vide unethical advantages. If Olympic athletes are forbidden from taking drugs to improve their performance, why are waitresses allowed to get breast implants to generate more tips and businesspeople allowed to take Ritalin to improve their concentration? Conversely, is it ethical to restrain the options of those who would provide or purchase such services?
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