Therapy and Enhancement
It is common, in classifying interventions, to sort them into those that are therapeutic, that is, directed at diminishing the harms suffered by a patient, and those that are enhancing, that is, directed at increasing the goods experienced by a patient. At least three independent but related questions can be raised about the therapy/enhancement distinction: (1) Can the two terms therapy and enhancement be defined clearly, reliably, and accurately? (2) Assuming they can be satisfactorily defined, under what circumstances is it morally justified for a physician to engage in either activity? (3) Assuming they can be satisfactorily defined, what implications does labeling an intervention as therapeutic or enhancing have on the issue of whether the cost of the intervention should be borne in part or in whole by third-party funding agencies?
Defining Therapy and Enhancement
The distinction between therapy and enhancement can be most clearly made by first having available a clear definition of a third term: malady. The following definition of a malady, adapted from Gert, Culver, and Clouser 1997 (p. 104) classifies all clear cases of maladies as maladies and does not classify as a malady any condition that is clearly not a malady.
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