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Very interesting! A few reactions/questions:

(1) In your definition of enhancement, you make a point of focusing on individual baselines rather than "societal averages," unless a recognized medical condition plays a role in the person's deviation from the norm. Maybe you can say more about your motivation. Doesn't the "medical condition" bring back societal averages to the extent that such averages play a role in determining what gets treated as a medical condition?

(2) In the bracketed language, you note that, under your definition, what gets classified as a medical condition can change and, thus, so can something's classification as a treatment/enhancement. But do you draw morally-relevant conclusions from your distinction of treatment/enhancement? If so, do those moral conclusions change as well along with social facts about medicalization? Or if you do not draw morally-relevant conclusions from the treatment/enhancement distinction, how is the distinction relevant to your project? At one point you refer to what is "considered enhancement," but do you mean "considered enhancement" under your definition of enhancement or under what people think of as enhancement (which may not track your definition)?

(3) When you say "less likely to run afoul of the Eighth Amendment" is that meant to be a moral claim or a legal claim? If it's a legal claim, are there sources of legal authority you have in mind for it? If it's a moral claim, is there any reason to think that law will track your moral views?

Again, thanks for sharing this thought-provoking post with us!

Thanks for the questions and comments!

1) I agree that "medical condition" brings back societal averages. We recognize that while our definition focuses on the individual's own capacities and the natural variation across a spectrum that exists in society, there may come a point in time where society determines that too significant a deviation from the "norm" constitutes a medical condition for which a person deserves treatment. So, while the person may have always experienced cognitive capacities at the level they are currently experiencing them (e.g., they may have always been far below average on impulse control), we realized that we could not simply reject a determination by the medical community that something is the product of a recognized "medical condition." The analogue for me is that someone may have been born with lesser lung capacity in one of their lungs, thus they've never experienced full capacity in that lung, but it does not mean that it is not the product of a recognized medical condition that simply pre-dates birth.

However, we wanted to focus on an individual's own capacities because there is a natural variation across a spectrum of cognitive capacities and some people will inherently have less than average (the very nature of an average demands it). So, we didn't want to encourage the idea that simply being below average in a capacity makes an intervention treatment.

2) We draw differing ethical conclusions based on whether something is treatment vs. enhancement, as far as whether the DOC should be expected to pay, whether individuals should receive "good time credit" for participating/receiving the intervention, and even whether the intervention should be offered if it will need to be continued post-release (e.g., if it's treatment it should be administered because it is more likely that some form of insurance, public assistance etc. might cover the cost post-release, while it is unlikely the cost of enhancement would be covered.)

3) We meant that as a moral claim. The cases tend to address the forcible medication of an individual or challenges to chemical castration laws (which seem to be largely unsuccessful). We believed that chemical castration was sufficiently different from the use of a drug like Valproate (that can enhance memory) that those cases didn't provide enough guidance as to how the law would react. As we note in the article, studies have shown that vitamin and mineral supplements can significantly increase cognitive functioning and reduce violence (see e.g., the work of Stephen Schoenthaler). It seems unlikely that addressing the problems with offenders' nutritional needs would run afoul of the Eighth Amendment.

I would like to think that the courts would track our moral views, but we've seen that they don't tend to track the moral views of many scholars regarding chemical castration. It seems that the determining factor could be not only what the intervention is, but what types of offenders it is being used on. The less sympathetic the class of offenders (e.g., sex offenders), the less likely it seems courts are to intervene and put a halt to the practice.

Thanks, Adam! Makes sense. So, if I understand your view, it means that whether the DOC morally ought to give good time credit can depend on facts about whether the medical community decides to classify something as a medical condition. That surprises me a little because it seems to make a moral ought depend on facts as assessed by a potentially faulty medical community. (I do, though, understand your reasoning as it applies to post-release treatment availability. In that case, the DOC's moral obligations may depend on plausible facts about what will happen to prisoners after release.)

Correct, in our view. Using our analogy, we felt it wouldn't make sense to give good time credit for treating a medical condition with cognitive interventions when the system seems highly unlikely to give the same good time credit to a diabetic for taking his/her metformin. Certainly, one "medical condition" would be more likely to have a direct link to the conduct that put the offender in prison, but something seemed morally wrong about giving credit for treating certain medical issues and not others.

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