Therapy or Enhancement?

“Being man is not tied to a certain shape and might thus also happen by various shapes which are not congruent with those we know.” Helmuth Plessner (1975, p. 293) The practice of medicine is a practice of judgement. When a patient presents himself to a doctor, the patient will first be subjected to anamnesis and physical examination. The outcome of this inspection constitutes the first judgment of the doctor: is the patient healthy or ill? Subsequently, a second judgement is made: does the patient have to be treated or not? Therefore, two central divides will be applied to patients when they enter the domain of medical healthcare: health versus disease and treatment versus no treatment. However, some patients present themselves with other intentions than being treated for a disease. Let us consider two medical fields in which these patients are encountered. The first field is sports medicine. Professional athletes strive to be the best in their discipline. Therefore, all of their efforts are focused on enhancing the capabilities which are involved in their performances. Commonly, when an athlete achieves these enhancements through physical training, adhering to a strict diet and taking adequate amounts of rest, such improvements are considered as being natural. However, some athletes use performance enhancing drugs or technologies – labelled as doping – which present an advantage over their competitors. The Spanish sports doctor Eufemiano Fuentes is a well-known example of a doctor aiding in these kinds of practices. In the past decade Fuentes was involved in the administration of blood transfusions to road racing cyclists with the aim to increase oxygen levels in the blood circulation of athletes (Verschuren, 2016). These kinds of enhancements are, however, considered unnatural, and each athlete being involved in these practices is judged a cheater with reference to the presupposed ‘normal‘ conditions of his sport. The second field is plastic surgery. In general, plastic surgery consists of two subfields: reconstructive surgery and cosmetic surgery. According to the American Society of Plastic Surgeons: "reconstructive surgery is performed to treat structures of the body affected aesthetically or functionally by congenital defects, developmental abnormalities, trauma, infection, tumors or disease. It is generally done to improve function and ability, but may also be performed to achieve a more typical appearance of the affected structure” (ASPS, n.d.-b). The procedures in reconstructive surgeries include, for example, skin grafting, skin cancer removal and cleft lip repair. Cosmetic surgery, however, includes “surgical and nonsurgical procedures that enhance and reshape structures of the body to improve appearance and confidence”, in which “healthy individuals with a positive outlook and realistic expectations are appropriate candidates” (ASPS, n.d.- a). This includes procedures as breast enhancements, facelifts and lower eyelid surgeries. It is evident from the objectives and procedures of these subfields that in the field of reconstructive surgery the intent is to restore health in patients, while treatments in the domain of cosmetic surgery are focused on the improvement of aesthetical bodily features, i.e. aesthetical enhancement.