The National Catholic Review
Distinguishing between therapy and enhancement
Image

Read part 1 of this discussion.

Dear Kristi,

Im afraid I dont know any more than you do about Sandels personal beliefs. At least I can say that if he professes any religious faith, or worships regularly, it is not something he wears on his sleeve. What we know from his other writings is that he has been a proponent of preserving a place for religious conviction in public debate, while also staunchly defending tolerance and diversity. He does not believe a Rawlsian liberal view is sufficient. For example, in Liberalism and the Limits of Justice, he wrote, Construing all religious convictions as products of choice may miss the role that religion plays in the lives of those for whom the observance of religious duties is a constitutive end, essential to their good and indispensable to their identity.

A few more thoughts: like nearly everyone else who has tried to define the distinction between therapy and enhancement, Sandel appears to have given up short of this elusive goal. Unlike Leon Kass, however, he does not deny that the question can be answered. He does a very good job of clearing the way for an adequate answer by explaining why he considers a whole list of answers inadequate. These include the unfair competition argument against enhancement in sports (wouldnt there still be something wrong with using steroids even if everyone did it?). In the end, however, all Sandel can say is that there appears to be some moral difference between perfecting what is given and distorting our natural endowments. Doesnt that strike you as merely a restatement of the question?

I was also a little disappointed with his treatment of disability. I imagine, given your work, that you were even more so. The only case he addresses is the case of genetically deaf persons who are now using pre-implantation genetic diagnosis to select hearing-impaired embryos so as to rear all their children as deaf members of a deaf family in a deaf community. This means, of course, discarding hearing embryos as unwanted members of another culture. Sandel does not come to a definitive judgment about this practice. But for me, this practice demonstrates how the rights-based approach of many members of the disability movement can go awry. At first, asserting rights seems like a good way to correct injustices, but it ends up looking like one group discriminating against another all over again. Isnt a dignity-based approach better? Wouldnt we be in a better position to defend the disabled against discrimination if we said that what commands respect for any and every human being--disabled or not, embryonic or elderly--is the fact that each has an intrinsic dignity that depends solely upon being members of the human family? Merely stipulating and demanding rights does not seem to be the best approach to defending the disabled against discrimination. Do you agree?

Best wishes,
Dan Sulmasy, OFM

Dear Dan,

I was also intrigued by Sandels attempts to distinguish between therapy and enhancement: he notes that like cosmetic surgery, genetic enhancement employs medical means for nonmedical ends--ends unrelated to curing or preventing disease, repairing injury or restoring health. I wonder whether part of his difficulty here is that hes trying to draw lines in areas where lines were erased and redrawn years ago. When reconstructive surgery expanded to include cosmetic surgery, werent the ends and goals of medicine also necessarily expanded to include libertarian notions of quality of life? He argues, persuasively I think, that altering ones body is different than enhancing the DNA of ones child, ultimately restricting rather than augmenting autonomy--i.e.,designer children are not fully free. But I found myself wanting a deeper critique of the multiple ways we currently use medical treatments for non-medical ends. We need to better understand the moral differences between perfecting what is given and distorting our natural endowments.

As for Sandels treatment of disability, I do think a deeper, more nuanced discussion would have been helpful. Though he wasnt specifically referencing disability in the following passage, there are echoes of a common debate in our field between the "social" and "medical" models (for more information, see Disability Rights and Wrongs): changing our nature to fit our world, rather than the other way around, is actually the deepest form of disempowerment. It distracts us from reflecting critically on the world, and deadens the impulse to social and political improvement. Sandels concern seems deeply rooted in the negative social implications of enhancement therapies. He worries they will have a dampening effect on such values as tolerance, respect for difference and accepting imperfection in ourselves and others. In other words, what happens when enhancement becomes not an individual vice but a habit of mind and way of being?

In closing, I answer your last question with a counter-question. Where is the evidence that we will be happier and more self-fulfilled, if we are prettier, more alike, stronger, smarter and more competitive? I look forward to your thoughts.

Regards,
Kristi

Read part 3 of this discussion.

Dr. Daniel Sulmasy, OFM, holds the Sisters of Charity Chair in Ethics at St. Vincent's Hospital-Manhattan and serves as professor of medicine and director of the Bioethics Institute of New York Medical College, Valhalla, NY. Dr. Kristi Kirschner is the Co