Well-being and enhancement: reassessing the welfarist account.

There are an increasing number of ways to enhance human abilities, characteristics, and performance. In recent years, the ethical debate on enhancement has focused mainly on the ethical evaluation of new enhancement technologies. Yet, the search for an adequate and shared understanding of enhancement has always remained an important part of the debate. It was initially undertaken with the intention of defining the ethical boundaries of enhancement, often by attempting to distinguish enhancements from medical treatments. One of the more recent approaches comes from Julian Savulescu, Anders Sandberg, and Guy Kahane. With their welfarist account, they define enhancement in terms of its contribution to individual well-being: as any state of a person that increases the chances of living a good life in the given set of circumstances. The account aims to contribute both to a shared and clear understanding of enhancement and to answering the question of whether we should enhance in certain ways or not. I will argue that it cannot live up to either claim, in particular because of its inherent normativity and its failure to adequately define well-being. Nevertheless, it can make a valuable contribution to an ethics of enhancement. As I will show, the welfarist account refocuses the debate on a central value in health care: well-being, which can be a relevant aspect in assessing the permissibility of biomedical interventions - especially against the background of new bioethical challenges. To fulfil this function, however, a more differentiated understanding of well-being is needed.