McKeown, AJ; (2014) Re-thinking the distinction between therapy and enhancement: a study in empirical ethics. Doctoral thesis , University of Bristol.

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Abstract

My aim in this thesis is twofold: to advance philosophical understanding of the contested therapy / enhancement distinction and its ethical implications; and to achieve this via the integration of empirical data into the philosophical and ethical debate. Despite its implications for justice in healthcare, and despite the abundance of theoretical literature, little is known about how human enhancement is understood within its own context. The division between therapy and enhancement is nominally defined by whatever is identified as ‘normal’ health. This seems unproblematic, however it is extremely difficult to offer a clear, non-relative account of normality that is not beset by logical and semantic difficulties, or modified by historical, socio-cultural, technological, economic, and geographical contingencies. This raises a challenge: if what is ‘normal’ cannot be clearly identified, how can we clearly identify the difference between therapy and enhancement? If we cannot clearly identify the difference between therapy and enhancement, how can we ensure that our medical policies are ethically appropriate in distinguishing between who may and may not receive assistance? The empirical data communicate relevant views held by medical professionals whose work involves a prominent ‘enhancement’ drug, recombinant human erythropoietin (EPO). I use the insights gained from analysing theory and data to develop a refined account of the therapy / enhancement distinction which integrates the two. I use this as the basis for developing normative conclusions and policy recommendations in response to the ethical challenges posed by any future proliferation of enhancement technologies. I use the philosophical approach of Critical Realism for integrating the theory and data and constructing the normative conclusions developed. This is the first time critical realism has been used in empirical bioethics, and this thesis therefore also makes an original methodological contribution to the field.

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