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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 (unpublished) The framing of discussions of gene technology (GT) in bioethics Visions of fantastic achievements (VFA) • Debate: what could be bad with those?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