“Feeling Better Than Ever” : Are there any internally consistent responses to the challenge of ‘better than perfect’ human health enhancement technology in a health technology appraisal context?

Bates, Alex and Mateus, Ceu and Clark, Sam (2022) “Feeling Better Than Ever” : Are there any internally consistent responses to the challenge of ‘better than perfect’ human health enhancement technology in a health technology appraisal context? PhD thesis, Lancaster University.

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Abstract

Most modern publicly funded national healthcare systems (NHSes) make decisions about which technologies to fund and which to reject through the principles of health economics, and specifically the principles of ‘Health Technology Appraisal’ (HTA). Current HTA methods implicitly assume that health is anchored between zero (worst possible health) and one (best possible health), but the mathematics underlying HTA does not require this – mathematically the concept of ‘better than perfect’ health is entirely meaningful. However, to date there are no examples of technologies which actually create ‘better than perfect’ health and so the problem has never really been considered by health economists. This PhD thesis proposes that human enhancements – technologies which can “modify basic parameters of the human condition, which were previously thought immutable” (Bostrom & Roache, 2008) – might be able to create ‘better than perfect’ health states, and traces some of the implications of this for NHSes under current HTA rules. The key observation is that there is no obvious practical limit to how much better than ‘perfect’ health could get, and therefore a risk that following HTA rules blindly could lead to an NHS becoming ‘Subverted’ – NHSes becoming vehicles for prescribing this wonderful enhancement rather than making sick people healthier. It is therefore critical that the NHS regulators – and most specifically HTA agencies – adopt a systematic approach to ‘better than perfect’ healthcare to prevent this outcome if they believe it to be unjust. To begin to develop such a systematic approach, this thesis creates an economic theory of human enhancement and tests whether there is any approach which is consistent with all implications of this theory. The study draws heavily on interdisciplinary readings of the relatively developed bioethics literature on ‘better than perfect’ health and the health economic methods of health technology appraisal. It is hoped that the results from this approach will inform the response of HTA agencies and other regulators to the emerging issue of ‘better than perfect’ healthcare technologies in a health technology appraisal context, as well as providing meaningful avenues of further research on the same topic.