PRE-PUBLICATION COPY: DO NOT CIRCULATE Enhancement and therapy: is it possible to draw a line? Alex McKeown Introduction In this chapter I analyse the therapy / enhancement distinction primarily as it relates to contemporary pharmaceutical methods of cognitive enhancement such as Modafinil, Adderall, and Ritalin, all of which have been argued to improve cognitive capacities such as concentration and short term memory retention. I will also briefly consider it in relation to potential genetic cognitive enhancements, should they become available in future. I will advance three interconnected arguments. Firstly, consistent with a view found both within the pro-enhancement literature (Savulescu, 2006; Bostrom & Roache, 2008; Sandberg & Savulescu, 2011); and amongst those who are more circumspect about its benefits (Shickle, 2000; Scully & Rehmann-Sutter, 2001; Kass, 2003) I argue that the distinction between therapy and enhancement is ambiguous and logically unstable. Secondly, that despite the potential threat that this instability appears to pose to identifying clear criteria for ensuring an ethical allocation of medical resources anchored by an account of ‘normal health’ (Buchanan et al, 2000; Pellegrino, 2004; Koch, 2010; Capps, 2011), there is a relatively simple theoretical solution. This solution could, if implemented, negotiate the difficulties raised concerning the separability of the two concepts, and thus continue to protect the just allocation of resources according to need. However, and thirdly, despite the simplicity of this solution contemporary medicine in the UK - is not institutionally ready to implement it because of its adherence to ‘normality’ as the boundary of appropriate medical practice. This assumption upholds the apparent nominal distinction between therapy and enhancement, despite the fact that no clear non-arbitrary line can be drawn between them. 1