“Pulling up the bottom”

In his paper, “Normal Functioning and the Cog enhance cartoonTreatment-Enhancement Distinction,” (abstract) Norman Daniels renders a highly compelling and thought provoking argument against drawing rigid lines to demarcate medical interventions that are considered treatments, and those viewed as enhancements.  He focuses primarily on three basic objections: that it is difficult to clearly separate treatments from enhancements, that the distinction does not give us the boundary between what is obligatory and nonobligatory in medical interventions, and that it leaves us with hard cases that make the distinction seem subjective.

To reinforce his arguments, Daniels gives several examples in support of his objections. An example points to the insurance coverage for growth hormone treatment in children who are found deficient due to some underlying medical condition such as a tumor, while children diagnosed with idiopathic short stature are not covered for treatment. While one could fairly easily rationalize why growth hormone treatment for a “naturally” short child should be considered an enhancement, it becomes trickier when Daniels suggests that perhaps “bad genes” are to be blamed for both conditions. One child is “naturally” short because he has a set of genes that make his growth hormone receptors less responsive to secretion, while the other has a set of genes that causes him to grow a tumor, which then disrupts hormone secretion. Although both children are victims of “inferior” genes, an abnormal growth caused by bad genes is viewed by society as a disease, while a short stature also caused by bad genes is considered well…bad luck.

Daniels goes on to talk about society’s “social construct” of disease and presents more thought provoking arguments. Personally, I thought that his section on “permissible-impermissible boundary” posed an enduring question. Daniels asks of our obligation to justice as a society:

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