From bench to bedside, to track and field : the context of enhancement and its ethical relevance

This thesis addresses enhancement technologies and their ethical permissibility through a contextual, bottom up approach based on case studies. The first chapter presents various definitions of 'enhancement', arguments for and against, and discusses the therapy/enhancement distinction. The second chapter discusses applying genetic technologies from bendh to bedside, analysing: the objections to reprogenetics grounded in 'eugenics'; and, how pre-implantation genetic diagnosis (PGD) and other embryonic genetic screening techniques, as well as genetic tests sold online directly-to-the-consumer (DTC) to measure children's athletic potential raise a conflict between parental reproductive freedom and children's rights to an open future and capacity for self-determination. Chapter 3 turns to how genetic technologies are translated directly from the molecular medicine laboratory to "track & field," analysing: the scientific and regulatory context of gene enhancement, and on which basis it is classified as doping; how the International Olympic Committee and the International Association for Athletics Federation incorrectly consider hyperandrogenism an unfair advantage; and, the World Anti­ Doping Agency Code and its current revisions. Chapter 4 discusses enhancements in a democratic society, and addresses the neglected issue of justifying enhancement research (ER). I propose: a model in which cognitive enhancements, currently prescribed under a 'disease' model, could instead be prescribed under an 'enhancement' model; and, a possible justification for ER that translates the ethical criteria justifying clinical research to the enhancement context. I then consider possible changes society would need to implement to accommodate ER. The last chapter attempts to advance the discussion of enhancement by shifting the debate from ethics to policymaking, arguing for a deliberative democracy approach. Throughout, I adopt a casuistic approach to ethics, deploying tools from consequentialist, principled and virtue ethics. I try to break the stalemate between enhancement's proponents and opponents, and discuss the ethical permissibility of technologies in ways that could inform policymaking.