Читать книгу Bioethics - Группа авторов - Страница 126

A slightly different approach to these issues asserts that genetic therapy is on solid moral ground because it promotes the goals of medicine, while genetic enhancement promotes other, morally questionable goals. But what are the goals of medicine? This is not an easy question to answer, since medicine seems to serve a variety of purposes, such as the treatment of disease, the prevention of disease, the promotion of human health and well‐being, and the relief of suffering. Many of the so‐called goals of medicine, such as the prevention of disease and the promotion of human health, may also be promoted by procedures that we would classify as forms of enhancement.⁴⁵ For example, some writers have suggested that we might be able to perform genetic interventions that enhance the human immune system by making it better able to fight diseases, including cancer.⁴⁶ Most people would accept the idea that providing children with immunizations against the measles, mumps, and rubella promotes the goals of medicine. If we accept the notion that ordinary, nongenetic enhancement of the immune system promotes the goals of medicine, then shouldn’t we also agree that genetic enhancements of the immune system serve the same goals? And what about other forms of healthcare, such as rhinoplasty, liposuction, orthodontics, breast augmentation, hair removal, and hair transplants? If these cosmetic procedures serve medical goals, then cosmetic uses of genetic technology, such as somatic gene therapy for baldness, and germline gene therapy for straight teeth, would also seem to serve medical goals. Finally, consider the procedures that are designed to relieve suffering, such as pain control and anesthesia. If we can develop drugs to promote these goals, then why not develop genetic procedures to meet similar objectives? It is not beyond the realm of possibility that we could use genetic therapy to induce the body to produce endorphins. Many forms of enhancement may serve medical goals. Once again, the therapy–enhancement distinction appears not to set any firm moral boundaries in genetic medicine.

One might attempt to avoid this problem by narrowly construing the goals of medicine: the goals of medicine are to treat and prevent diseases in human beings. Other uses of medical technology do not serve the goals of medicine. There are two problems with this response. First, it assumes that we agree on the goals of medicine and the definitions of health and disease. Second, even if we could agree that medicine’s goals are to treat and prevent diseases and we can define “health” and “disease,” why would it be immoral to use medical technology and science for nonmedical purposes? If a medical procedure, such as mastectomy, is developed for therapeutic purposes, what is wrong with using that procedure for “nonmedical” purposes, such as breast reduction surgery in men with overdeveloped breasts? Admittedly, there are many morally troubling nonmedical uses of medical science and technology, such as the use of steroids by athletes and the use of laxatives by anorexics, but these morally troubling uses of medicine are morally troubling because they violate various moral principles or values, such as fairness and nonmaleficence, not because they are nonmedical uses of medicine.

One might argue that those who use medical science and technology for nonmedical purposes violate medicine’s professional norms, but this point only applies to those who consider themselves to be medical professionals. If a procedure violates medical norms, it is medically unethical, but this does not mean that the procedure is unethical outside of the context of medical care. For example, the American Medical Association holds that it is unethical for physicians to assist the state in executions, but this policy does not constitute an unconditional argument against capital punishment. To make the case against capital punishment, one must appeal to wider moral and political norms. Hence the goals of medicine also do not set a morally sharp dividing line between genetic therapy and enhancement.