Medicalisation and the Treatment-Enhancement Distinction in the Ethical Debate on Gene Editing

Abstract

"Since the advent of CRISPR/Cas9 gene editing technology, much bioethical effort has been devoted to prescribing the appropriate potential uses of gene editing in humans. Frequently in the literature, a normative distinction is drawn between “treatment” and “enhancement”. That is, gene editing may be morally acceptable or even morally required if used to cure a disease or genetic condition. For enhancement, however, it is morally unacceptable, having too weak a justification for the risks involved. In the context of this new technology, we all thus become vulnerable to a bias: medicalisation. There are clear non-medical benefits, as I show here, of using gene editing not for treatment, but for enhancement. Many individuals and governments will wish to pursue these benefits, but if we are ethically constrained by the current perceived force of the treatment-enhancement distinction, we may be prevented from legitimately doing so. We are faced with two options: firstly, to reject the distinction presented by many ethicists, and pursue gene editing for both treatment and enhancement purposes; secondly, to expand medical definitions and the scope of health care, to include the sort of benefits that we might wish were included under “treatment”. The first option, I argue, is to be preferred, but at least currently, faces much public resistance. Instead, we risk the second option becoming the norm, with the medicalisation of scores of non-medical characteristics drawing resources, causing anxiety, and burdening health care systems, because of stubborn adherence to an arbitrary distinction in the gene editing debate. "