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Under the influence of scientific and technological developments, the theme of ‘engineering peo-
ple’ is receiving increasing attention. The health care system also, to an increasing degree, has
to deal with the possibilities provided by the biomedical sciences for perfecting healthy people
in accordance with their own preferences. In medical ethics, this theme is known as ‘enhance-
ment’: the use of genetic, biomedical or pharmacological knowledge to make improvements in
human characteristics. This enhancement can involve people’s appearance, performance or per-
sonality. At present, the best-known forms of enhancement are found in cosmetic surgery and,
more covertly, in the use of anabolic steroids in sports. However, there is an impression that
conventional medicines (for example Prozac, Ritalin and Viagra) are also being used more and
more often for non-medical purposes. Furthermore, during the next decade, new substances and
methods for engineering healthy people will probably emerge in a rapid tempo. They vary from
cosmetic gene therapy and a new generation of anxiety inhibitors and mood modulators, to psy-
chotropic medication that boosts cognitive abilities (concentration, memory) and a drug that
would allow women to optimise their sexual functioning. Billions are being invested in develop-
In our society, all adult and competent individuals are themselves responsible for the use of
enhancers, at least in so far as they cause no harm to others. In principle, the government
should adopt a neutral position towards ideas about personal well being which are at the root
of this use of enhancers. It does, however, have a major responsibility to ensure that adequate
information is provided, to protect minors and legally incompetent individuals, to safeguard
quality, to protect public goods in so far as the use of enhancers constitutes a threat to them, to
monitor access to enhancement and to encourage a public discussion. This should cover the
conditions for the inclusion of enhancement in the responsibilities assigned to doctors. In any
case, it is clear that this question will not be answered on conceptual grounds (for example on
the basis of a concept of disease). The question is normative in nature and moral considerations
Ethics and Health Monitoring Report 2003 _ Health Council of the Netherlands
Health Council of the Netherlands
The Centre for Ethics and Health (Dutch abbreviation CEG) is a joint venture of the Health Council (Gezondheidsraad) and the Cou.
The CEG’s annual ‘Ethics and Health Monitoring Report’ (in Dutch) provides a compilation of these alerts. In May 2003, the first.
Via its website www.ceg.nl the CEG also functions as a source of information on ethical issues in the field of (public) health.
This report has been drawn up by the Health Council’s Standing Committee on Medical Ethics and Health Law (see Appendix 1 for composition).
Author: Alex Bood, scientific secretary of the Standing Committee on Medical Ethics and Health Law.
Preferred citation: Health Council of the Netherlands. Human enhancement (Ethics and Health Monitoring Report 2003 no. 4). The Hague: Health Council of the Netherlands, 2003. Publication no. 2003/08-04E. ISBN: 90-5549-585-9.
This publication can be downloaded from www.healthcouncil.nl.
3.3 Individual responsibility and autonomy
3.4 Minors and mentally incapacitated individuals
4.2 Ensuring that adequate information is provided
4.3 Protecting minors and mentally incapable individuals
4.6 Monitoring access to enhancement
5 Conclusions and recommendations
Standing Committee on Medical Ethics and Health Law
(Beraadsgroep Gezondheidsethiek en Gezondheidsrecht)
prof. JA Knottnerus, president of the Health Council of the Netherlands; Health Council, The Hague, president
prof. JKM Gevers, professor of health law; Academic Medical Centre, University of Amsterdam, vice-president
prof. ID de Beaufort, professor of medical ethics; Erasmus University Medical Centre, Rotterdam
dr GCML Christiaens, gynaecologist; University Hospital, Utrecht
prof. RPTM Grol, professor of quality of care; University Medical Centre St Radboud, Nijmegen
prof. JCJM de Haes, professor of medical psychology; Academic Medical Centre, University of Amsterdam
prof. GA den Hartogh, professor of ethics; University of Amsterdam
prof. HAMJ ten Have, professor of medical ethics; University Medical Centre St Radboud, Nijmegen
dr AC Hendriks, health lawyer; Dutch Equal Treatment Commission, Utrecht
dr WLM Kramer, pediatric surgeon and traumatologist; Wilhelmina Childrens’ Hospital, University Medical Centre, Utrecht
prof. FE van Leeuwen, professor of epidemiology; Netherlands Cancer Institute, Amsterdam
dr M van Leeuwen, executive director of the Health Council of the Netherlands, adviser
dr J Legemaate, health lawyer; Royal Dutch Medical Association (KNMG), Utrecht
prof. HDC Roscam Abbing, professor of health law; Utrecht University
prof. M de Visser, vice-president of the Health Council of the Netherlands; Health Council, The Hague
prof. GMWR de Wert, professor of biomedical ethics; Institute of Health Ethics, Maastricht University
prof. DL Willems, professor of medical ethics; Academic Medical Centre, University of Amsterdam
A Bood; Health Council of the Netherlands, The Hague, scientific secretary
dr WJ Dondorp; Health Council of the Netherlands, The Hague, scientific secretary
Original Article Clinical Care/Education Diabetes Metab J 2013;37:465-474 http://dx.doi.org/10.4093/dmj.2013.37.6.465 D I A B E T E S & M E T A B O L I S M J O U R N A L Glycemic Effectiveness of Metformin-Based Dual-Combination Therapies with Sulphonylurea, Pioglitazone, or DPP4-Inhibitor in Drug-Naïve Korean Type 2 Diabetic Patients Young Ki Lee1,2, Sun Ok Song2,3, Kwang Joon Kim1,
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