Matthew Westbrook

Bioethics and the Human Cyborg

11 May 2011

The boundaries which divide life from death

are at best shadowy and vague.
Who shall say where one ends,
and the other begins?
-

Edgar Allen Poe

In todays world of medicine and technology, we have the capability of not only successfully
treating diseases and conditions, but also going much beyond that by enhancing peoples traits. Most of
the discussion is focused on the ethical considerations of enhancement, as opposed to finding the
distinction between these two. I believe that Edgar Allen Poes question, when applied to the comparison
of treatment and enhancement, is critical to consider if we are to discuss enhancement at all. But where is
that distinction?
To start off, I would like to establish a few definitions. The Medical Dictionary of the Free
Dictionary states that treatment is management and care of a patient or the combating of disease or
disorder. Merriam Webster defines to treat as, to care for or deal with medically or surgically. The
use of deal with implies that there was an original condition that requires the treatment in order for the
patient to remain healthy. This can be applied, therefore, to many different procedures, from a
prescription for migraines to open-heart surgery. The important presupposition is that the patient is being
cared for because of a medical condition that is lowering his or her quality of life. Enhancement, on the
other hand, is defined as, the act of improving, heightening, or augmenting and to enhance is to
increase or improve in value, quality, desirability, or attractiveness. This definition does not presuppose
the initial condition of a disease or disorder. This critical distinction, I feel, allows us to have a clearer
picture of where the line is. Insurance companies also attempt to draw the line by covering only
procedures that are deemed medically necessary. Medicare, for example, defines medically necessary as:
Services or supplies that are needed for the diagnosis or treatment of your medical condition and meet
accepted standards of medical practice. According to Medicare, enhancement is unneeded services or

Matthew Westbrook
Bioethics and the Human Cyborg
11 May 2011

supplies. But what is needed? Who determines exactly which procedures are considered as treatment?
And how do they determine that? These are the kinds of questions we need to be asking in this time of
incredible biotechnical advancement.
One effective way to address these questions is by studying individual examples of medical
procedures that dont quite fall entirely in either category, according to most people. Recently, I
participated in a poster session where I discussed the same issue. To go along with my poster, I prepared
a short survey presenting nine of these examples and asked the attendees to rate on a scale of one to five
whether they believed that the case was treatment or enhancement with one being treatment and five
being enhancement. The first case is that of a man who takes anabolic steroids after an accident in order
to restore him to his previous level of strength. With one exception, everyone either gave it a one or two.
This goes along with the idea of motivation affecting the distinction of the procedure. Almost everyone
agreed that this procedure is a strong example of treatment. This is because the purpose of taking these
steroids was to treat his injuries. One of the most covered issues in the media about enhancement is
steroids and the MLB. Left and right we are finding out that some of the most successful players were
taking performance enhancing drugs. And while there are arguments for both sides, society at large holds
a very negative view of this practice. Our culture holds the view that taking steroids when a person is
hurt is perfectly acceptable, but when similar drugs are taken by a perfectly healthy person in order to
make them perform better than at their normal, healthy level, they have made a wrong decision. The
motivation of these drugs in this case, is not to heal, as was the drugs original intention, but is to
enhance, or make better, creating a level of power and athleticism when combines with rigorous exercise
will reach beyond the level achieved without the drugs.
Also along the lines of sports, the next case is of Oscar Pistorius, written without the inclusion of
his name. Pistorius uses prosthetics below his knee that are rather efficient when running. The average
score given to this case was around a three point seven. This shows a level of debate, with most leaning
on the side of enhancement. For our definitions of treatment and enhancement, though, his original

Matthew Westbrook
Bioethics and the Human Cyborg
11 May 2011

procedure would be treatment, since he received his prosthetic because of a condition that required the
removal of his lower legs. The motivation of his procedure was to allow him to walk, something healthy
human beings can normally do. The difference, though, is in the prosthetics themselves. For his original
procedure, he received a fairly normal set of legs that he can use to walk normally that he still uses in his
daily life. These legs function as a form of treatment for his condition. Later in his life, he had a separate
pair of legs produced solely for the purpose of running track. The Cheetah Flex-Foot, a J-shaped
carbon fiber foot is made so that when used for running, the elasticity of the prosthetic actually uses some
of the energy put into it by bending under the pressure exerted by his leg, and snapping back into shape,
propelling him forward. These legs are not meant to be used for walking, so these actually make him less
mobile for everyday use, unless he plans on sprinting every time he wants to move. So these new legs are
not meant to better treat his condition, they are meant to enhance his ability to run. This distinction is
fueling the controversy, since many argue that his Cheetahs are enhancing his ability to an unfair level.
Creating this distinction, however, allows the according rule-makers to decide whether Oscar Pistorius
should be allowed to complete, and with what kind of attachments.
Another way people distinguish treatment from enhancement is to see whether the end result of
the procedure is within the realm of human possibility. As long as a human being can achieve the end
result of a certain procedure without actually having it, then it is considered treatment. If a procedure is
done that results in abilities that no human being could do without such a procedure, then the procedure is
considered enhancement. This is a very popular belief among scholars as a logical, simple solution, and
following Occams razor, is very likely one of the best. One of the cases of the survey describes an
elderly man who has a failing knee. To correct this, he receives a titanium knee produced in such a way
that it has become virtually unbreakable. For instance, if he was replacing shingles on his roof and fell
off, landing on his replaced knee, he would not break his knee. A similar fall by a healthy strong-boned
man could cause severe skeletal injury to his knee. This shows that the replacement knee is, by this
definition, is an enhancement, since its strength is beyond the realm of human possibility. But the

Matthew Westbrook
Bioethics and the Human Cyborg
11 May 2011

average vote is almost exactly a two, leaning on the side of treatment. The reasoning was, learned by
speaking with the attendees about the survey and reading the comments written on the survey, that the
man was only being treated for his failing knee and the hardiness of the material was only a beneficial
side effect of his treatment. So the motivation of the procedure played a huge role in how people decided
whether the procedure was treatment or enhancement.
The rest of the cases portrayed similar results to the three presented, but in different forms. The
overriding conclusion is that in order to properly differentiate between treatment and enhancement, one
must understand the motivation for the procedure. Of course, the answer is not that simple, since the term
condition can have different meanings medically, showing just how difficult this distinction is.