Health and Happiness: A Bioethics Perspective

The philosopher Arthur Schopenhauer famously wrote that “nine-tenths of our happiness depends upon health alone.” For this reason, ready access to effective healthcare to cure (when possible) or effectively manage acute or chronic physical, mental, or emotional illnesses and conditions is one of our most pressing social imperatives. This comports with the bioethical principle of beneficence (the imperative to do the good and right thing). It also promotes the bioethical principle of autonomy, which recognizes each person’s right to govern themselves. The ability to exercise autonomy is limited when a person is struggling under the weight of an untreated illness, disease, or disorder.

From Healing to Refinement: The Bioethical Frontier

Science and technology have expanded our understanding of the human body and our ability to modify ourselves internally and externally. As a result, for many people, “health” has come to mean more than the absence of pathology (illness). Today, many people consider “health” to be a state of optimal physical, mental, and spiritual capacity and capability. Especially when we consider that millions of people still lack access to healthcare to address illness, this heightened standard for “health” presents an ethical dilemma: to what extent should society and healthcare systems support the use of the tools of medicine and healthcare to make internal and external refinements and changes in the name of “happiness”?

Some uses of medicine and healthcare tools represent a continuum that starts with remediation or repair on one end and progresses toward enhancement or exceptionalism on the other. Cosmetic surgery can reshape tissues affected by congenital or traumatic events to address both function and appearance, or it can change undamaged tissue to fulfill aesthetic aspirations. Medicines prescribed to support people with attention deficit disorders may be used by neurotypical students and professionals as cognitive performance enhancers to gain an intellectual edge. Advanced neuro-interventions used to replace misfiring or malfunctioning neurons are being studied for expanded use in people with brain function within customary parameters.

When studied and used for enhancement, the point and purpose of medical technological advancement arguably shifts from the pursuit of happiness in the form of healing and health to the pursuit of happiness in the form of perfectionism. Is this a problem? Proponents might argue that respect for autonomy means that every person should have the right to use medical tools to shape their body and mind in whatever way maximizes their personal happiness. If a cosmetic procedure or a performance-boosting medication improves a person’s self-image or quality of life, shouldn’t they be able to have it?

While this sounds entirely reasonable, it nevertheless presents ethical dilemmas:

• Authenticity vs. Convenience: Does relying on medical shortcuts to achieve emotional comfort or heightened performance bypass the valuable, necessary struggles that build true emotional growth?
• Equity and Distributive Justice: If we divert medical resources, including healthcare professional time and talent and research funds, to elective enhancements for the relatively fewer people who can afford them, does it widen the human health gap between those who “have” and those who “have not”?
• Redefining the “Normal” Human: As optional enhancements become more widely accepted and adopted, will they cease to be voluntary choices and instead become unwritten societal requirements?

Finding the Balance

True human well-being requires a thoughtful balance. In a just society, each person would have access to the medical care necessary to treat disease and alleviate suffering—providing a foundation for happiness.

However, we live in a time of stark contrasts: devastating shortages of basic medical care in many places, unprecedented technological endowment in others. We must recognize the difference between need and desire: medical care that restores health (need) and medical interventions designed to manufacture satisfaction (desire). At a time when so many are in need, it can be difficult to make a compelling case for society to actively subsidize and underwrite all or even many of the desires of those with more.

An old Arabian proverb reminds us, “He who has health has hope; and he who has hope, has everything.” By prioritizing the restoration and promotion of health, medicine gets us nine-tenths of the way to happiness, with hope for a brighter future for all.