Normal Functioning and the Treatment/Enhancement Distinction: An Opportunity Based Assessment

As genome mapping technology uncovers the roots of pathologic and physiologic human functioning, important questions are brought to the fore concerning our conceptualization of ideas such as disease, treatment, and enhancement. In 1985, Norman Daniels proposed a normal-functioning model that expands John Rawls’ theory of justice to obligate the provision of health care based on the constraints disease places on individual opportunity, but also limits the commitment of the medical establishment by focusing on states that represent deviations from normal human function. While some argue that the boundaries of medical institutions’ commitment to provide services within a normal-functioning model are arbitrary, the degree to which these concerns truly threaten the framework is often exaggerated in special cases put forward in the literature. Furthermore, the normal-functioning model provides a comprehensive basis for agreement in discussions of medicine’s commitment to the demands of social justice where resources are limited and avoids the dangerous overextension of the healthcare system and medicalization to which more expansive models are exposed.