Moral Permissibility and Desert in the Therapy-Enhancement Distinction

In his widely anthologized article on the therapy-enhancement distinction, Resnik argues that, from a moral point of view, the claim that something is not health related cannot be a dispositive argument against the permissibility of enhancements. He further states how the permissibility of an intervention will depend on considerations like the intention for its use and the likely consequences that will ensue, and whether these violate any moral standards. Within this framework, in this paper I first argue that enhancements may be morally permissible on autonomy grounds (its political conception); and secondly, that this permissibility does not dissolve a moral distinction between therapies and enhancements, with the reason being that there is still a difference between something being generally permissible (i.e., therapies) and something being conditionally permissible (i.e., enhancements). But that is not all that is important for a moral therapy-enhancement distinction. I also argue that the distinction - apart from being about "permissibility" (at the level of regulation of individual use) - is also about regarding justice more broadly (at the level of what is owed to individuals). What captures the moral distinction more fully is that therapies are, generally speaking, not only morally permissible but also owed to persons (due to being enablers of social cooperation and competition), whereas, at this stage, enhancements can only be morally permissible. I demonstrate the appeal of this view by considering its stability and usefulness across specialized bioethical contexts and across various kinds of enhancements and show that its practical value for policy lies in its legitimizing / anticipatory and prioritizing functions.