When it is used as a medical boundary concept, enhancement, like futility, plays both descriptive and normative roles. To use these concepts, we need to be able to identify our efforts as either futile or enhancing and we need to know what the boundary means for going further. Part of the practical challenge for policy-makers is that for enhancement interventions, these descriptive and normative implications seem to be at cross-purposes. While futile treatments do no good, enhancements are by definition and description improvements in personal welfare. Yet, the boundary function of calling them “enhancements” in health policy settings is to place them outside of sanctioned interventions. For a field dedicated to pursuing improved welfare for its patients, the fact that enhancements often look just like all the other improvements that health care strives to achieve makes it difficult to discern when an intervention transgresses the normative boundary that the concept purports to mark.