Situated problems: Ethics and pharmaceutical enhancement in contemporary Germany

This dissertation examines the problem of "pharmaceutical enhancements" in contemporary Germany. Pharmaceutical enhancements (enhancements for short) are medications that are typically used for therapy, but which can also supposedly increase function in or "improve" some aspect of healthy individuals (e.g. concentration, mood). Near the end of the last decade, news media in Germany began widely reporting on enhancements: a large insurance study claimed that 5% of German employees were taking medications to boost performance at work. Other reports have stated that university students were regularly taking medications to study; and that schoolchildren were being given attention-deficit disorder medications to improve their academic performance. These reports have been accompanied by a wide-ranging debate about the ethics of enhancements, which has included a number of official position statements and research projects. The central goal of this dissertation is to develop a framework for anthropologically studying "ethical dilemmas" attributed to advances in biomedicine/biosciences, specifically those technologies that claim to be able to "redesign" human beings. Through this ethnographic account I reframe the ethical concerns at stake in pharmacological enhancement, adding to the questions typically voiced by a dominant strand of the bioethics literature. Using the German debate, I show how ethical concerns emerge out of a specific, situated context. Rather than following standard accounts assuming that ethical dilemmas are created solely by technological advances that raise novel and troubling possibilities, I argue for an understanding of ethical dilemmas as "situated" problems, showing how technological ability converges with a set of meanings and biomedical rationalities to delineate a set of ethical concerns around pharmacological self-improvement.