Thursday, April 21, 2005

The Beam in Your Eye - LASIK

Here is an news article about the use of laser-eye surgery on athletes, in this case the golfer Tiger Woods. The basic premise of this piece is that laser eye surgery is also a performance enhancement for athletes, but it is not banned. why not?

"A week ago, Tiger Woods was celebrated for winning golf's biggest tournament, the Masters, with the help of superior vision he acquired through laser surgery." (link)

Here is an extract from an article I have written on this theme, which will be published in a Dutch book on gene doping (edited by Bernike Pasveer and Ivo Van Hilvoorde):

"To articulate the differences between the various uses of medical technology for sport, one can draw three categories of human modification: therapy, non-therapy, and enhancement. To understand the conceptual differences between these categories, it is useful to consider an example of medical intervention where these boundaries appear to be blurred. Laser eye surgery is a medical intervention intended to relieve the deterioration of eyesight. If this technique is applied to someone who has severe or even mild eyesight problems, then it can be considered therapeutic, since it will rectify any imperfection that might inhibit vision. In this capacity, it is tempting (and usual) to describe this as a ‘therapeutic’ medical intervention. It also matters that the definition is underwritten by the existence of a physician’s authority here. Yet, what are the defining characteristics of this ‘therapeutic’ guise? Is it important that the individual’s eyesight is being restored to a previous level of vision? If this were true, then we might wonder about the relevance of this conclusion. How would we feel if the intervention were applied to a person who was born without eyesight? The surgery would not return the individual to any previous state and, in that sense, s(he) would not be restored. In this case, the person would be restored only in the sense that there exists some species-typical state of function, where the treatment is characterised as therapeutic based on some typical functionality that a given species should possess. It could be said that humans have evolved to utilise the capacity for vision. This could also account for an individual who is born with partial vision – for whom we might also argue that restoration to perfect human vision is justified on account of a species-typical level of functioning to which we are comparing the said capability.

Each of these methods of intervention is generally considered acceptable. While there is some disagreement about the legitimacy of interventions that appear to suggest certain ways of being human are preferable over others, let us assume for the moment that eliminating dysfunction, however troubling we might find its definition, is ideologically sound. So, the interest to ensure deafness is corrected is defended on account of it offering an ‘open future’ (Feinberg, 1980), where this entails maximising the possibilities any individual might encounter (for further elaboration see Savulescu, 2001 and Shakespeare, 2001). These examples can be contrasted with an intervention that would raise the level of capability beyond both an individual and species-typical level of normal or even perfect function. So, if laser eye surgery leads to better than perfect vision, we might have quite different concerns and feelings about it.

Yet, it is also possible to think of circumstances where there is not much resistance to such super-human capacities. For example, there do not seem to be particularly strong moral convictions about the use of binoculars, telescopes, magnifying glasses, or even satellites and cameras, which radically re-define our capacity to see beyond our physical constraints. Yet, how would we feel about super-human vision? What if laser eye surgery could enable humans to enjoy the vision of, say, birds of prey. Alternatively, what if it enabled some additional functionality, such as a zoom capability? What should be our moral stance to such modifications and would such modifications be accepted in competitive sporting cultures? (FN: while not specifically tied to a sporting example, ‘super vision’ has been discussed in the context of sport recently (Alderson, 2001))

In the world of sport, the ethical reaction to such innovations would be clearly expressed by a certain moral community, which argues that the ‘natural’ athlete must prevail in sports contests. Where a modification places an athlete over and above their natural level of functioning or some species-typical level of functioning, this constitutes doping and is considered to be unacceptable because it provides an enhancement of the natural. On one level, it is possible to understand why anti-doping exists and why some would seek to justify such rules on the basis of naturalness. In some sports, an athlete with the capacity to ‘zoom’ their vision would be at a considerable advantage to an athlete who does not have such capacity (though in others it might actually be an inconvenience and a skill to be able to modify one’s eyesight to optimise performance). In one very important sense, a contest between two athletes would not be of much interest where one of them has super-vision, since the enhanced athlete will be more successful. However, from another perspective, sport intends to reveal the most capable human. An athlete born with some ‘zoom’ capability is, in one very important sense, the most capable human. Why should an athlete not receive their gold medal, if they are the most capable? These matters raise questions about what is just in sport and the legitimacy of enhanced capabilities."

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