Malmqvist Erik
*Department of Medical and Health Sciences, Division of Health and Society, Linköping University, Linköping SE-581 83, Sweden.
J Med Philos. 2014 Feb;39(1):41-54. doi: 10.1093/jmp/jht058. Epub 2013 Dec 13.
It is often argued that it does not matter morally whether biomedical interventions treat or prevent diseases or enhance nondisease traits; what matters is whether and how much they promote well-being. Therapy and enhancement both promote well-being, the argument goes, so they are not morally distinct but instead continuous. I provide three reasons why this argument should be rejected when it is applied to choices concerning the genetic makeup of future people. First, it rests on too simple a conception of the badness of disease. Second, it wrongly assumes that disease avoidance and enhancement can proceed with similar accuracy. Third, it overlooks that disease avoidance tends to be more urgent than enhancement from the point of view of distributive justice. Although none of these reasons establishes a firm therapy-enhancement distinction, they show that a continuum model is not an attractive alternative.
人们常常认为，生物医学干预措施治疗或预防疾病，抑或增强非疾病特征，在道德层面并无差异；关键在于它们是否以及在多大程度上促进了福祉。该观点认为，治疗和增强都能促进福祉，因此它们在道德上并非截然不同，而是连续统一的。我提出三个理由，说明当这一观点应用于涉及未来人类基因构成的选择时为何应被摒弃。其一，它基于对疾病危害的过于简单的概念。其二，它错误地假定避免疾病和增强可以同样精确地进行。其三，它忽视了从分配正义的角度来看，避免疾病往往比增强更为紧迫。尽管这些理由都没有确立治疗与增强之间的明确区分，但它们表明连续统一模型并非一个有吸引力的选择。
