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Glover J. What Sort of People Should There Be? New York: Penguin Books, 1984.

      14 14 See note 7, McGee 1997.

      15 15 Resnik D. Debunking the slippery slope argument against human germ line gene therapy. Journal of Medicine and Philosophy 1993; 19: 23–40.

      16 16 Resnik D. Genetic engineering and social justice: a Rawlsian approach. Social Theory and Practice 1997; 23(3): 427–48.

      17 17 See note 3, Berger and Gert 1991.

      18 18 See note 4, Anderson 1985.

      19 19 See note 6, Anderson 1990.

      20 20 Rifkin J. Algeny. New York: Viking Press, 1983.

      21 21 Ramsey P. Fabricated Man: The Ethics of Genetic Control. New Haven: Yale University Press, 1970.

      22 22 It is not my aim in this essay to argue that there is no distinction between therapy and enhancement; I am only attempting to question the moral significance of the distinction. If it turns out that there is not a tenable distinction between therapy and enhancement, so much the worse for the moral significance of this distinction. For the purpose of this essay I will define “enhancement” as a medical intervention that has goals other than therapeutic ones. There may be many types of enhancement on this view. Some forms of enhancement, such as a circumcision, can have therapeutic aims as well, e.g., preventing urinary tract infections. Some forms of therapy, such as heart transplantation, could have enhancement effects, e.g., a person could acquire an above average heart. Some interventions, such as preventative medicine, could straddle the line between enhancement and therapy. For further discussion, see note 1, Juengst 1997.

      23 23 See note 4, Anderson 1985.

      24 24 Suzuki D and Knudtson P. Genethics. Cambridge, Mass: Harvard University Press, 1989.

      25 25 Resnik D, Langer P, and Steinkraus H. Human Germ‐line Gene Therapy: Scientific, Ethical, and Political Issues. Austin, Texas: RG Landes, 1999.

      26 26 See note 24, Suzuki and Knudtson 1989.

      27 27 See note 5, Anderson 1989.

      28 28 See note 6, Anderson 1990.

      29 29 Baird P. Altering human genes: social, ethical, and legal implications. Perspectives in Biology and Medicine 1994; 37: 566–75.

      30 30 In the current debate in bioethics, several writers have attempted to use the concepts of health and disease to distinguish between genetic therapy and genetic enhancement.

      31 31 See note 1, Juengst 1997.

      32 32 See note 3, Berger and Gert 1991.

      33 33 See note 5, Anderson 1989.

      34 34 See note 6, Anderson 1990: 24.

      35 35 Caplan A. The concepts of health, illness, and disease. In: Veatch R, ed. Medical Ethics, 2nd ed. Sudbury, Mass: Jones and Bartlett, 1997: 57–74.

      36 36 Khushf G. Expanding the horizon of reflection on health and disease. Journal of Medicine and Philosophy 1995; 1–4.

      37 37 Some writers distinguish between relativist and nonrelativist accounts; some others distinguish between biological and social accounts. But the basic insight is the same: the concepts of health and disease are normative or descriptive.

      38 38 Boorse C. Health as a theoretical concept. Philosophy of Science 1977; 44: 542–73.

      39 39 Daniels N. Just Health Care. Cambridge: Cambridge University Press, 1985.

      40 40 Sigerist H. Civilization and Disease. Chicago: University of Chicago Press, 1943.

      41 41 Pellegrino E.D., and Thomasma D.C. For the Patient’s Good. New York: Oxford University Press, 1988.

      42 42 For an overview of the normative approach, see Caplan A. Moral Matters. New York: John Wiley and Sons, 1995.

      43 43 Culver C. and Gert B. Philosophy in Medicine. New York: Oxford University Press, 1982.

      44 44 Lennox J. Health as an objective value. Journal of Medicine and Philosophy 1995; 20: 501–11.

      45 45 See note 44, Lennox 1995.

      46 46 Culver K. The current status of gene therapy research. The Genetic Resource 1993; 7: 5–10.

      47 47 See note 25, Resnik, Langer, and Steinkraus 1999.

      48 48 English J. Abortion and the concept of a person. Canadian Journal of Philosophy 1975; 5(2): 233–43.

      49 49 It is possible to define “human” in such a way that it is logically impossible to change our humanness. If we stipulate that possession of a single property is a necessary and sufficient condition for being human, then any changes we make in that property would result in people that are not human. For example, we can define “triangle” = “three‐sided object.” If we make an object that has four sides, it is not an altered triangle; it is not a triangle at all. For a definition of humanness that would seem to imply that it is difficult (though not impossible) to alter our humanness, see Anderson W. Genetic engineering and our humanness. Human Gene Therapy 1994; 5: 755–60.

      50 50 See note 25, Resnik, Langer, and Steinkraus 1999.

      51 51 For the purposes of this essay, I will not attribute this view to any particular author, since I think it deserves consideration on its own merit. For writers who come close to defending this view, see note 8, Vogel 1997, as well as Kass L. Toward a More Natural Science. New York: Free Press, 1985.

      52 52 See note 20, Rifkin 1983.

      53 53 These arguments do not address genetic enhancement per se, since they also apply to GLGT and they do not apply to

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