Commonsense Morality and the Therapy/Enhancement Distinction

What follows is a series of examples designed to illustrate both that solid core and the fuzzy perimeter of the therapy/enhancement distinction.

The Normal Healthy Baby

Consider the desire of virtually all parents-to-be for a “normal, healthy baby.” They have in mind the following: (1) normal form, including the right number of limbs in the appropriate places and the absence of significant deformities; (2) normal organ function; and (3) the capacity for normal development. To the extent that infants fall short along one or more of these dimensions, we commonly say that they have birth “defects,” a term that would have no meaning absent some rough-and-ready concept of a nondefective condition. Similarly, I have yet to hear of an HIV-positive pregnant woman who wants her baby to be born with that condition. There are clear cases of disease, and we have no doubt that they are conditions to be avoided or cured if possible.

Activities of the World Health Organization

Similar considerations apply to groups such as the World Health Organization. We do not typically spend a great deal of time arguing about the normative valence of malaria or polio or river blindness. They are human bads, and the point is to resist and, if possible, eradicate them from the face of the earth. (Recall the global jubilation when smallpox was expunged from the human species and confined to laboratories.) To be sure, we can and do argue about the allocation of scarce resources among efforts to fight bad conditions. Often our judgments are shaped by contestable assessments of the social impact of different diseases or by the bang we can get for a limited number of bucks. But we are not arguing about whether these diseases are bad. Our moral vocabulary presupposes that they are.

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