The distinction between treatment and enhancement may not be very clear. Indeed, as John Harris remarks:
[t]he overwhelming moral imperative for both therapy and enhancement is to prevent harm and confer benefit. Bathed in that moral light it is unimportant whether the protection or benefit conferred is classified as enhancement or improvement, protection or therapy. (John Harris, quoted in Bostrom and Savulescu 2009: 7)
Looked at in this way, we might decide to focus on quality of life rather than health or enhancement as the relevant measure or status in determining whether a drug or other treatment is beneficial.
10 Eric Parens explores concepts of authenticity in the context of enhancement in Parens 2009, distinguishing authenticity as gratitude for the self as given from authenticity as creativity—as an internal drive to change or grow. The question of whether a desire for some enhancement is authen- tic sits in the realm of authenticity as creativity (Cf Wargo 2011).
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Healthcare providers cannot be charged with preventing harms and conferring benefits in all aspects of life; their duties are limited to addressing health-related harms and benefits. Clearly, however, there are health-related interventions that can promote quality of life. Some of these would count as healthcare under any view;
others will be health-related only in the sense that they draw on skills characteristic of healthcare providers or affect functions that can also be affected in different ways by healthcare or by disease. Teeth whitening, removal of benign moles, and certain ways of enhancing cardiovascular fitness may be health-related quality of life inter- ventions. As with enhancement, the availability of a drug to improve quality of life in one area may reasonably drive a decision to take that drug.
Conclusion
Each of the four lines of reasoning pursued here has provided a way to describe drug-centered care that we could accept as unobjectionable or at least not obviously corrupt. This does not weaken the core of Brody’s critique of disease mongering. It does suggest that there might just be some babies that should not be thrown out with the Big Pharma bathwater. That is, there can be situations in which it is perfectly legitimate to make a decision prompted primarily by the availability of a drug.
References
Abel, D., and J.M. Guilfoil. 2007, June 1. Brookline OKs Trans Fat Ban. The Boston Globe. http://
www.boston.com/news/local/articles/2007/06/01/brookline_oks_trans_fat_ban/. Accessed 9 Apr 2015.
Boorse, C. 1977. Health as a Theoretical Concept. Philosophy of Science 44: 542–573.
Bostrom, N., and J. Savulescu. 2009. Human Enhancement Ethics: The State of the Debate. In Human Enhancement, ed. J. Savulescu and N. Bostrom, 1–22. New York: Oxford University Press.
Brody, H. 2017. Patient-centered Care or Drug-centered Care? The Influence of Pharmaceutical Marketing on Medical Science and Public Health. In Philosophical Issues in Pharmaceutics:
Development, Dispensing, and Usage, ed. D. Ho. Philadelphia: Springer.
Flanigan, J. 2012. Three Arguments Against Prescription Requirements. Journal of Medical Ethics. Published online July 26, 2012. http://jme.bmj.com/content/early/2012/07/25/
medethics- 2011- 100240.full.pdf+html. Accessed 9 Apr 2015.
Foucault, M. 1964. Madness and Civilization: A History of Insanity in the Age of Reason, 1st ed.
New York: Vintage Books.
Grynbaum, M. 2012, May 30. New York Plans to Ban Sale of Big Sizes of Sugary Drinks. The New York Times. http://www.nytimes.com/2012/05/31/nyregion/bloomberg-plans-a-ban-on- - large-sugared-drinks.html. Accessed 11 Aug 2016.
Ivtzan, I., H.E. Gardner, I. Bernard, M. Sekhon, and R. Hart. 2013. Wellbeing Through Self- Fulfilment: Examining Developmental Aspects of Self-Actualization. The Humanistic Psychologist 41: 119–132.
Maslow, A.H. 1954. Motivation and Personality. New York: Harper and Row.
Is There a Legitimate Concept of Drug-Centered Care?
Moynihan, R. 2006. Scientists Find New Disease: Motivational Deficiency Order. British Medical Journal 332(7544): 745.
Moynihan, R., I. Heath, and D. Henry. 2002. Selling Sickness: The Pharmaceutical Industry and Disease Mongering. British Medical Journal 324(7342): 886–891.
Murphy, D. 2015. Concepts of Disease and Health. In Stanford Encyclopedia of Philosophy. http://
plato.stanford.edu/archives/spr2015/entries/health-disease/. Accessed 9 Apr 2015.
Nordenfelt, L. 1995. On the Nature of Health: An Action-theoretic Approach, 2nd ed. Dordrecht:
Kluwer Academic Publishers.
Osgood, C. 1992, January 17. N.J. Runny Egg Law “Bad Yolk” on Diners. Sun Sentinel. http://
articles.sun-sentinel.com/1992-01-17/news/9201030706_1_soft-boiled-eggs-benedict-new- - jersey. Accessed 9 Apr 2015.
Parens, E. 2009. Toward a More Fruitful Debate About Enhancement. In Human Enhancement, ed.
J. Savulescu and N. Bostrom, 181–198. New York: Oxford University Press.
Richman, K.A. 2004. Ethics and the Metaphysics of Medicine: Reflections on Health and Beneficence. Cambridge, MA: MIT Press.
Richman, K.A., and A.E. Budson. 2000. Health of Organisms and Health of Persons: An Embedded Instrumentalist Approach. Theoretical Medicine and Bioethics 21(4): 339–352.
Skomorosky, A. 2015, March 30. Don’t Blame it on Depression. Slate.com. http://www.slate.com/
articles/health_and_science/medical_examiner/2015/03/germanwings_co_pilot_mental_ill- ness_suicide_is_linked_to_depression_but.html. Accessed 9 Apr 2015.
Supplemental Nutrition Assistance Program (SNAP). 2014. Eligible Food Items. http://www.fns.
usda.gov/snap/eligible-food-items. Accessed 9 Apr 2015.
Szasz, T. 1960. The Myth of Mental Illness. The American Psychologist 15: 113–118.
Taylor, C. 1992. The Ethics of Authenticity. Cambridge, MA: Harvard University Press.
Thompson, D.F. 1993. Understanding Financial Conflicts of Interest. The New England Journal of Medicine 329(8): 573–576.
U’Ren, R. 1997. Psychiatry and Capitalism. Journal of Mind and Behavior 18(1): 1–11.
Wargo M. 2011. Authenticity and Ethics in Human Augmentation. MA Thesis, Boston University Department of Philosophy, Boston.
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