CHAPTER SIX: WHY NOT THE BEST?
I. Having the Best Children We Can
"Be All You Can Be," the Army recruiting poster urges young men and women. Many parents share the sentiment. They want their children to be the best they can be. For many parents, their most important project in life is to pursue that goal, and they make sacrifices to see it happen. And why shouldn't parents aim to make their offspring the best they can be?
Of course, means matter. That is why we consider in this chapter whether parents should be free to use genetic intervention techniques to produce the best offspring they can. Posed this way, the question immediately raises many anti‑eugenic hackles: Won't screening and selective abortion mean we eliminate many lives that are worth living? And won't it devalue the lives of people with disabilities? Anyway, who is to say what is the "best" (some parents have peculiar ideas)? Won't the economically and socially privileged be those best placed to pursue the "best"? Doesn't "best" for some mean worse for others? Isn't it wrong for parents to think of their children as something they design?
These objections deserve attention, and we will return to them shortly, but it is important to understand the presumption behind the original question. Shouldn't parents seek the best‑‑even through genetics‑‑for their offspring? Don't we expect them to?
What Could Be More Natural Than Parents Seeking the Best?
Parents are generally regarded as having permission, and some would say an obligation, to produce the "best" children they can. They are expected, for example, to keep their children as healthy as possible. Society expects them to try to keep their children away from drugs, from street crime, from hazardous play. They may be required to put seat belts and bicycle helmets on their children. They are even required to boost their children's resistance to certain diseases, for example through vaccinations‑‑even if doing so runs counter to their religious beliefs. If genetic techniques gave parents a way to enhance the resistance of their children to certain diseases, and the intervention posed only risks comparable to those posed by vaccination, should parents be free, or even required in some instances, to use them?
Parents are expected to heed nutritional and dietary concerns for their children. We applaud parental efforts to shape their children, even over the children's protests, by moderating their fat intake, increasing fruit and vegetables in their diet, and restricting their access to "junk" foods. Where we have some claims to know scientifically what is "best" for children, we encourage parents to pursue it (though our primarily educational campaigns have their largest effects on the best‑educated and best‑off sectors of the population). At the same time, parents are allowed considerable leeway to pursue these goals as they see fit‑‑or not at all. For some parents, only a vegetarian diet will do. For others, "good" food is the food they were raised on, whatever their ethnic background. These diets vary in their benefits and risks to children. But parents are allowed to pursue what is nutritionally best for their children as they see it. From a nutritional perspective, this means that parents are allowed to pursue what is not best, as long as it is not so bad that it constitutes neglect or abuse.
Parents also pursue the best for their children‑‑as they see it ‑‑through exercise and sports. Some children are enrolled in Little League baseball, soccer, basketball, football, or hockey. They get tennis and swimming lessons, or go to running clinics and camps; minimally they are encouraged to develop their skills at pick‑up basketball games or sandlot football. For some parents, the goal is to teach their children a lifelong appreciation of exercise, and they urge them to avoid contact sports that threaten serious injury; for them, athletics is but one dimension of life. For others, contact in sports is ritualized combat, an important preparation for the rigors of competition in life. For still others, the goal is to develop a special athletic excellence that will give their children access to college or even professional sports; for them, athletics is a way up or out. The investment of some parents in tennis or skating or swimming lessons for a child with competitive talent may be enormous.
Of course, parents who have the means often invest in the development of capabilities other than athletic ones: they give their children violin or piano or ballet lessons, or they enroll them in chess clubs and tournaments, or encourage their computer skills or interest in math teams or science fairs. For some parents, the general strategy is to expose children to many activities, to develop a broad array of capabilities, and to broaden the options open to their children. For others, the key strategy is to spot special skills or talents and to invest heavily in developing these strengths. For some parents from modest backgrounds, the economic sacrifice in developing their children's capabilities is very great; better-off families may quite easily afford whatever investment is necessary. Some scholarship assistance is available for the most talented children from poor backgrounds, at least in some areas of artistic and athletic development, but generally the burden of investment in "human capital" falls on families. For the poorest, both in the United States and elsewhere, seeking the best for their children may mean doing what is possible to assure their survival.
Many parents also aim to make their children the best prudential and moral agents they can be. For them, being the best means having the virtues necessary to planning life and coping and adapting to its vicissitudes. It also means having the virtues necessary to respond well to the needs of others, to stand up for what is right, and to treat others fairly. They place considerable emphasis on teaching children the importance of doing chores and helping others. They insist their children work at jobs to encourage in them an appreciation for the demands of work and the value of money--a work ethic. They compel their children to undergo many hours and years of religious training or participation in community service activities‑‑shaping their sense of belonging to a community, their capacity to respond to others in their group, and their social consciousness and moral conscience.
Here too parents are granted extensive leeway to pursue the best as they see it; "giving leeway" here means only that there is a presumption in favor of not interfering with parents. Raising children to accept the limitations imposed by some religious sects can significantly reduce preparation for other ways of living, but parents may believe this is a way to ensure that their children lead "the good life" as they see it. Our courts have recognized, for example, the rights of Old Order Amish to restrict schooling for their children to age 14 rather than the age of 16 required by state law (Wisconsin v. Yoder 1972). Some educational opportunity for these children has been traded for enhanced rights to pursue religious practices and a communal way of life. The "best" as perceived by society at large does not here constrain a religious community's pursuit of its vision of the best for their children.
Some find the court decision in Wisconsin v. Yoder problematic (we return to this case later in this chapter): they think educational opportunity should not be restricted in the ways the Yoder decision permits, fearing that children who later want a different way of life will be at a disadvantage in the larger society. But the court argued that the harms imposed on children in this way are speculative and are not of the same quality as the harms that we ordinarily prevent parents from imposing on children. Society prohibits harms that result from malice or neglect, even reserving the right to remove children from parental guardianship if necessary. Despite the leeway granted parents, children are not property to be disposed of as parents wish.
Neglect and abuse aside, however, parents remain free to pursue producing the best offspring they can. Interference with this would be seen by most as interference with the most fundamental elements of the parents' conception of a good life.
Environmental Versus Genetic Pursuits
If this liberty of parents to pursue the best for and in their offspring is so fundamental, why not extend it to the use of genetic means? Why are the anti‑eugenic hackles we noted earlier raised so quickly?
The leeway parents are generally allowed to pursue the best for their children may seem unproblematic because there is a tendency to think of their efforts as "environmental" factors that help to develop the capacities or capabilities their children already have or are capable of having. The parents are only "bringing out the best in them," or developing "the potential" that is already there. In contrast, the use of genetic information and intervention (whether somatic or germline) suggests parents are changing their children in some fundamental way, making them different from what they otherwise would have or could have been.
This contrast is problematic. To see why, it is useful to reconsider some of the distinctions noted in our earlier discussion of genetic determinism. When parents use their control over environmental factors to "bring out the best" in their children, much of what they do actually modifies phenotype. Given their children's genotypes, the range of traits and capabilities‑‑physical and behavioral‑‑that constitute the phenotype, the child we see and interact with, is very much a result of the environments parents and others create. How the child is fed, for example, will affect height, strength, and resistance to illness. How the child exercises will affect body shape, muscle development, strength, and physical capabilities and even neurological development. How the child is spoken to, read to, and interacted with will affect the development of cognitive and emotional capabilities. There is no pre‑existing ("essential") "best" in the child that is brought out by parental manipulation of environmental causes; such manipulation has enormous effects in shaping phenotype.
If parents modify phenotype in pursuit of their goal of producing the "best" offspring they can, then why not add to their arsenal of methods whatever genetic interventions may make it easier to accomplish some of those goals? Part of what may disturb us is the (mistaken) belief that genotypic interventions modify the essence or essential features of the individual, whereas environmental interventions only modify accidental features. The idea seems to be that genetic interventions result in a different individual, whereas environmental interventions merely modify the same individual. These metaphysical metaphors are misleading. The relationship between genotype and phenotype cannot be reduced to any traditional metaphysical relationship, such as that between matter and form, or substance and attribute, or essence and accident.
The heart of the point can be illustrated by reconsidering some examples already noted. When an infant is vaccinated, the vaccine triggers an immune reaction that permanently affects the ability of the immune system to respond to particular bacteria or viruses. Suppose the operation of the immune system could be enhanced with similar‑‑or broader‑‑effect by a genetic intervention. If this were a somatic cell intervention, we would not think there had been any "essential" modification of the individual, though some cell lines may be permanently and even essentially modified and immune capabilities will be permanently improved. If this were a germline intervention, we might have more complicated reactions to the change, but it still seems likely we would think of this as a change to the same individual or person. If it were any one of us, we would not be inclined to muse, "I wonder who I would have been had my parents not altered my immune‑system gene in this way."
We might have similar reactions if we learned our parents had changed our eye or hair color. We might have very different responses if they had altered genes that produced major effects on aspects of the self that are treated as central to our sense of self or personal identity. For each of us, it is particular elements of our phenotype, not every element of our genotype, that we take to be central to our conceptions of self and to our essence as an individual.
There is some irony in the fact that our compunctions about genetic interventions seem to rest on some underlying confusions about genetic determinism ("we are essentially what our genes make us"). The irony is that we allow parents the environmental leeway we do. Understood properly, leaving the extensive room we do for environmental causes should undercut our acceptance of genetic determinism.
II. What is the Best and Who Decides?
This section takes up two kinds of worries about using genetic interventions to make the best children possible. The first concerns whether there are adequate or defensible standards for determining what would be the best children possible--that is, what changes would be for the best for our children. The second concerns who‑‑parents or the public‑‑would be making decisions about what kinds of children would be best and then pursuing genetic interventions involving children on the basis of those criteria. The two worries interact, of course.
We postpone until the final section of the chapter constraints on pursuit of the best that might derive from harms to others. Before considering what is best and who decides, it is worth highlighting the specific form of the ethical issue about public policy that underlies the title to this chapter, "Why Not the Best?" The point rests on the familiar distinction in moral philosophy between actions that are morally required, morally desirable and permissible, or bad or wrong but not properly interfered with by others.
A Moral Distinction Between Actions
The strongest position supporting attempts to perfect children through genetic intervention would be that it is morally required of parents or others to seek to produce the best children possible. This is not a plausible ethical position and not the policy issue which this chapter addresses. It is a general feature of typical attitudes about parental responsibilities in childrearing that parents are not morally required to do everything within their power to produce and raise the best children possible. Parents can legitimately give weight to their own interests and to the interests of others besides themselves and their children in making decisions that involve use of their resources or efforts, and in so doing they do not do all that they might do for their children. This would be an unreasonably high standard.
Moreover, if the standard was to make as perfect children as possible, the standard of what would be the most perfect children possible for particular parents in particular circumstances would be highly morally controversial. It is compatible with rejection of this standard, however, that there might be some specific genetic enhancements that were morally required of specific parents.
A weaker position supportive of genetic enhancements would be that it is morally desirable or morally good for parents to use a variety of means, including genetic interventions, to attempt to produce the best children possible. This is a considerably more plausible position because it allows that there may be other interests that may compete with and override the reasons supporting attempts to produce the best children possible, even if it is always good, other things being equal, to seek to improve our children. The core of the plausibility of this position is that, if we do in fact improve our children by one or another form of genetic intervention, it would seem that we have benefited them, and benefiting them is at least a moral reason for having taken those steps. It is a reason why what we have done is, all other things being equal, morally good or desirable.
A genuinely beneficial enhancement for a child might nevertheless be--all things considered--morally wrong, and so impermissible, if, for example, it prevented the parents from meeting their more important responsibilities to others. But in the absence of any such conflicting moral considerations, genuinely beneficial enhancements, even if not morally required, would be morally permissible.
Of course, in trying to perfect our children by genetic intervention, just as with other means that parents now typically pursue, our efforts might misfire and the attempt to benefit might result in making them worse off. But this is a possibility for any attempt to improve our children, or to prevent harm to them, and does not argue especially against genetic intervention in order to do so.
The weakest position supportive of genetic enhancements, and in that respect the easiest to defend, is that it is within the legitimate authority of parents (or perhaps others) in having and raising their children to use at least some forms of genetic intervention in seeking to improve their children. This position is compatible with having serious moral doubts about whether parents or others should be encouraged to take such steps, doubts that could have a number of different sources, while acknowledging that taking such steps is within the rights or legitimate authority of parents in raising their children. It is also compatible with believing that some genetic enhancements would--all things considered--be bad, or even impermissible and wrong, but still within parents' legitimate authority in raising their children. It is a general feature of both moral and legal rights that they authorize their possessors to take actions that it would be wrong of others to interfere with and that may be unwise or bad, or, on a more extreme position, may even be morally wrong.
This chapter examines two main questions. First, is the use of genetic interventions to improve children morally good or desirable, other things being equal, in the same way that environmental interventions, such as attempting to give them the best education possible, are often thought to be morally good or desirable? And second, even if some genetic intervention is on balance undesirable, is it nevertheless morally permissible for parents to use it because doing so is within their legitimate authority in producing and raising their children?
Why should anyone think that there is a special problem determining what genetic as opposed to environmental intervention would be best for children? We have already given many examples from nongenetic contexts of parental actions that are uncontroversially good for their children. Some of these are commonly considered morally required (such as minimal education), but virtually all are commonly considered morally permissible and desirable. Is there something about genetic enhancements that makes them especially morally controversial?
The history of eugenics movements and the frequency and importance of racist attitudes in them should surely give us pause. Moreover, those movements have often uncritically accepted a variety of other stereotypes and prejudices about what characteristics it would be desirable to produce in children. Individual parents might be just as susceptible to such stereotypes and prejudices as the historical eugenics movements have been. So history alone gives strong grounds for caution about attempts to use genetic interventions to perfect our children.
But this caution should be tempered with recognition of the importance, for both parents and children, of parents having substantial discretion and freedom to decide how to raise their children without interference. Also, it is worth remembering that if stereotypes or prejudices are a problem, they are a problem for environmental interventions as well.
Pursuing the "Best" for the Child
It is important that the attempts to produce the best children possible be understood as making the life of the child best for the child from the standpoint of that particular child's good, not best from some other standpoint, such as the good of the parents or of society. There are certainly social standpoints from which producing certain kinds of children might be best for the society but would not for the children in question. To take an extreme example, in Brave New World Aldous Huxley imagined producing children with significantly limited capacities that would make them well suited for and likely to be satisfied with quite limited and menial roles in the society. If a society has a need to fill such roles, it might be best from its standpoint that sufficient children be produced who will be suited for and content with filling such roles. But that is quite different from claiming that it would be best for the children in question to be created with these limited capacities and expectations.
Our concern is with genetic intervention that purports to be for the good or benefit of the children who are subject to it, not for the good or benefit of others. (We note that this perspective is similar to the generally thought to be appropriate in providing medical treatments: the focus is on patient welfare and not on the social contribution or value of patients in deciding about appropriate care.)
One way to put the point is to insist that the judgment of parents or others about what would be best for their child as a result of genetic intervention should be made from a standpoint that they can reasonably expect the child to come to share. When, in the course of childrearing, parents impose limits or take other steps concerning their children that the children either oppose or are not yet able to endorse or oppose, a typical justification for doing so is that the child will later come to see and accept that the actions taken were for its own good, and in this sense later come to endorse the earlier action.
In one important respect, this standard is too weak. It is too weak when the actions taken not only change a person's capacities and opportunities in some way, but also lead the individual to endorse those changes in ways that he or she might not have done in their absence. The Brave New World example took this form: persons were deliberately created with severely limited capacities, but also with expectations that would lead them to be satisfied with those capacities despite the limitations.
There is a more subtle version of this same problem that is more difficult to avoid and that commonly arises in childrearing. Whatever the relative contributions, either in general or in particular cases, of children's genetic endowments and the various environmental factors to which children are exposed, the process of childrearing inevitably shapes in important ways the later standards and values that the child will apply to his or her own life and to other evaluative questions. Thus, for example, when membership in a particular religious group is a deep and pervasive part of the lives of parents and of families, children raised in those families will likely affirm that their membership in the religion in question is an important good in their lives. In this respect, successful religious education leads to the children coming to support the results of that education; they come to endorse their having been subjected to it. The standards the person uses to evaluate what childrearing practices were good for him or her are tainted by the very practices in question.
The case of children who are raised in, or have become subject to, what are thought of as religious cults shows another version of the Brave New World difficulty. Here the very process of initiating children into the group, and inculcating in them the beliefs that the group shares, undermines their capacity to evaluate independently whether having been subjected to this process has been a good or benefit to them. Thus, if the child's later endorsement of the steps that improve or affect him or her is sufficient to justify them, those steps must at least not have destroyed or limited the child's capacity independently to evaluate them.
A further difficulty with this subsequent endorsement standard is that people typically have strong motives to find ways to regard themselves positively. If someone has undergone a procedure that changes in a fundamental way what kind of person he or she is, the desire for positive self‑regard provides a motive for endorsing the parents' decision to subject the child to that procedure, even when from other more objective standpoints the choice was not a good one.
The depth of the difficulty can be brought out by considering an example from everyday, noncultist childrearing. Suppose a father, successful in business as a salesman, undertakes to train his somewhat shy and introspective son to be more outgoing and aggressive. As the son matures, having negotiated group therapy sessions, high‑school student government elections, and carefully focused parental rewards and punishments, he begins to succeed in his new persona. He acquires his father's values and applauds having been so shaped. Had he not been so cultivated, that shy, contemplative youth might have become a fine writer or scientist, thankful he had dodged forever the "superficial" bustle of his father's world.
There is a similar problem for the notion of individual self-determination if it is understood as individuals choosing their own character uninfluenced by external factors and sources. It is only by a process of interaction with one's environment during child development that a child comes to have values by which to make later evaluations and choices. When those values are endorsed in the right sorts of ways, the later choices using them will be the child's own.
Yet the notion of choosing our own character, where this includes some fundamental values, is incoherent when taken literally. First one must have a character, in the sense of a set of values, preferences, and behavioral dispositions in order to make any choices, and so there is no way to get behind having those values, preferences, and dispositions in order to choose them. There would be nothing in the person, no character, on the basis of which the choices of character could be made. But if the process of changing and shaping a child leaves the child's critical capacities substantially intact, or better yet helps to develop and improve them, then there is a good deal to be said in support of the criterion that the changes, by genetic means or otherwise, should be ones that the child can be expected later reasonably to affirm as having been for his or her own good or benefit.
Yet the standard of the child's subsequent endorsement is not only insufficient to justify a particular attempt to shape a child's character, it is also not necessary. For example, if a parent recognizes a deep streak of cruelty in a child, the parent might be justified in attempting to reduce or limit it even if the trait is so deep‑seated that the child is not likely later to endorse the efforts. This standard of the subject's later endorsement of the earlier changes cannot put to rest all concerns about what the standard of "best" is for perfecting children.
Harms, Benefits, and General Purpose Means
In Chapter Five, we discussed many uncontroversial examples of conditions harmful to a child. Why is it that enhancements seem more ethically problematic in their effects on children than treatments, that steps to provide benefits or goods to a child seem more ethically controversial than steps to prevent harms? Why is it that what counts as a benefit to someone seems more controversial than what counts as a harm to that same person? Loss of sight or hearing, or the ability to move a person's limbs, is typically and uncontroversially taken to be a harm, whereas it is more controversial whether gaining the ability to play a musical instrument or to excel in athletics is a benefit. Someone might say, for example, "I couldn't care less about playing the bassoon or competing in the pole vault."
First we should note that it is not entirely uncontroversial that each of these harmful conditions are indeed harms. On some views found in disabilities rights movements, the loss of hearing is not uncontroversially a harm and need not create a disability. Some groups stress the deaf culture, the richness of deaf people's alternative sign language, insisting that deaf people should be thought of as "differently abled" but not "disabled." Disabilities rights groups have been important in forcing the broader public to recognize the abilities that disabled persons do possess, despite their disabilities, as well as the ways in which accommodations can be made to disabilities that can remove much or even all the disadvantages they otherwise suffer.
To some significant extent, it is because the larger society is structured and ordered for the needs and interests of the "normally abled" that disabilities carry the extent of disadvantage that they often do (see Chapter Seven). Despite such cautions, however, it is widely thought that the loss of an ability like sight is uncontroversially a harm in a way that many benefits are not similarly uncontroversial. Why is that?
The typical human's capacity for sight may be thought of as a general purpose means--useful and valuable in carrying out nearly any plan of life or set of aims that humans typically have. It is not a "good" only from a distinct perspective or plan of life that some may adopt but many others may reject. Instead, there are few perspectives from which the loss of sight is not a harm, and few perspectives from which having sight is not a benefit in carrying out the plan of life a person has adopted. It can be thought of as a "natural primary good," analogous to what John Rawls (1971) has called "social primary goods"--in each case general purpose means useful or valuable in carrying out nearly any plan of life.
This is not to deny either that individuals who lose their sight can compensate and adjust their plans so as to still have satisfying and valuable lives, or that loss of sight may make some new goods possible, such as experience of the rich inner life of the blind. But the loss of a general purpose capacity like sight at the least significantly diminishes the range, and makes more difficult the pursuit, of life plans that humans value and choose.
Not all harms to persons, however, constitute the loss of valuable all‑purpose natural capacities. Some are only harms from the standpoint of a particular comprehensive plan of life. And, more important, the relative importance or seriousness of many harms to persons can only be determined from the particular comprehensive perspective or plan of life of the specific individual in question, not from a more general and shared perspective. For example, the loss of fine motor skills in one hand may be devastating to a musician to whom those skills are irreplaceable, whereas they would be a much less serious loss of ability to a person whose work and other activities are largely mental or cognitive and do not make use of those fine motor skills. But this comparison is not between harms and benefits; it is between, on the one hand, general purpose means whose possession is a good and whose loss is a harm for nearly all plans of life and, on the other hand, specific abilities or capacities whose value and importance depends on the particular plan of life of the person who either has them or loses them.
There are enhancements of capacities and abilities that are as plausibly a benefit from nearly any evaluative perspective as the comparable loss of the capacity or ability would be a harm. For example, a very substantial increase in the capacity for memory of normal humans would also be a general purpose benefit improving people's capacity to pursue nearly any plan of life. (We assume the enhanced memory is functionally integrated with other cognitive capacities, as is normal memory, and does not, for example, interfere with or intrude on other functions and capacities.) The relative importance of the benefit might significantly differ with different plans of life, but so of course might the relative importance of a harm such as the loss of hearing or sight.
Thus there is no systematic contrast between harms and benefits according to which what constitute harms is uncontroversial and objective from the perspective of any life plan, while what constitute benefits is controversial and subjective, and beneficial only from the perspective of such life plans. Rather, there are both benefits and harms that are uncontroversial because they are general purpose means or impediments to nearly any plan of life, and there are both benefits and harms whose value or disvalue, and especially whose relative value or disvalue, depends on the particular plan of life of the person in question. So harms and benefits do not systematically differ in a way that would make genetic interventions to improve children ethically problematic or controversial in a way that similar genetic interventions to treat a harmful genetic disease or condition are ethically unproblematic or uncontroversial.
There is a sense in which disease, understood as an adverse deviation from normal species function, is a condition that is at least prima facie bad for anyone who has it, although this is compatible with a particular disease not being, all things considered, bad for a particular person in particular circumstances. Genetic intervention to treat disease can consequently be understood as prima facie beneficial for any individual who has that disease. A limitation of genetic intervention to treatment or prevention of specific diseases does then provide more objective limits on the use of interventions, although that is in part just because conditions are only judged to be diseases if they are in general harmful.
On the other hand, the use of genetic interventions by parents to make their children "the best that they can be," the limits of the children's given genetic inheritance, are more open-ended and based on various concrete and sometimes idiosyncratic conceptions of parents of what would be best for their children. (Of course, environmental interventions to promote the best may also be based on similarly idiosyncratic or biased conceptions.)
It was noted in Chapter Two that the old eugenicists have been criticized, with some reason, for failing to take value pluralism seriously. A fundamental feature of liberal political philosophy is that it accepts an irreducible and permanent pluralism among its citizens in regard to concrete, comprehensive values and conceptions of a good life (cf Rawls 1993). Respecting this irreducible pluralism about the good is one ground of the liberal commitment to state neutrality between different conceptions of a good life.
Many have quite correctly argued that a very strong position of complete neutrality between different conceptions of a good life in all actions and policies of the state is not possible, but there remains an important distinction concerning the degree of neutrality that liberal states, as opposed to nonliberal states, will seek to achieve. This neutrality properly limits enhancements that a liberal state should undertake.
Is there any reason to expect some degree of neutrality between different conceptions of the good as well from parents in shaping and raising their children? That reason would have to be different than reasons grounding the proper neutrality of the liberal state, since the coercive authority claimed by the state over its citizens and its responsibility to promote toleration both distinguish it from the family and parent‑child relations. If there is some reason to expect a degree of neutrality from parents toward different conceptions of the good, it could rest in part on a concern about parents using genetic interventions to make their children suitable for only a particular and idiosyncratic conception of a good life that the parents happen to have.
The Right to an Open Future
Though the degree and grounds of neutrality in the kinds of children to be produced properly expected of the state and of parents differ substantially, there is a kind of neutrality that can be expected of parents. Joel Feinberg (1980) has characterized what we have in mind through the concept of a child's "right to an open future." The idea is that parents have a responsibility to help their children during their growth to adulthood to develop capacities for practical judgment and autonomous choice, and to develop as well at least a reasonable range of the skills and capacities necessary to provide them the choice of a reasonable array of different life plans available to members of their society. (We stress the two qualifications of a reasonable range and array, since Feinberg sometimes asserts a stronger right to a maximally open future.)
On this view, it would be wrong for parents substantially to close off most opportunities that would otherwise be available to their children in order to impose their own particular conception of a good life, or in order to continue their own community that is committed to that conception of a good life.
Thus, in Wisconsin v. Yoder, had the Amish community wanted to withdraw their children from school at the age, for example, of 10 on the grounds that education beyond that age was not necessary for their particular way of life, it would have violated their children's right to an open future to do so. In the actual case of Wisconsin v. Yoder, the Amish sought to withdraw their children two years before the age of 16, when any child has the right to withdraw from school on his or her own. Typical state laws that permit children to leave school at age 16 arguably do not violate their right to an open future because children have by then generally received sufficient education to fit them for many jobs and achieved sufficient maturity of judgment to be permitted to decide whether they want to continue their education further. The court in Yoder might have argued (indeed, an argument along these lines was made in a minority concurring opinion) that this two-year difference did not make a substantial enough difference in the opportunities available to the Amish children to violate the children's right to an open future.
There is obviously no precise, nonarbitrary point at which genetic intervention, although it makes someone more fit for a specific way of life that parents favor, makes her less fit for a substantial enough range of other ways of life to violate the right to an open future. But any society such as our own, which accepts a very strong commitment to individualism and individual self-determination or autonomy, may reasonably put at least some limits on genetic or other interventions with children in the interest of maintaining reasonable opportunities for those children, even if those interventions might make the child more fit for a specific way of life that its parents favor.
Recognizing the right to an open future is compatible with according substantial discretion to parents to use genetic interventions, just as they would other environmental interventions, to attempt to give their children what they might consider to be the best life possible. What is required is that those interventions do not so narrow children's range of opportunities as to violate their right to an open future.
Whether there is a moral right of children to an open future, much less whether such a right should be enforced and protected by public and legal policy, is of course controversial. Some parents would insist that there are no moral limits on their right to shape their children in the parent's own image, or in any other image they please. But a more plausible reason why the right is controversial is that it comes at a cost in some cases to the child's future welfare.
Some pursuits, such as becoming a professional pianist or tennis player, require early and intense training to make adult success more likely; in other cases, substantial choice leads to anxiety and indecision that firm commitment to a clear path at an early age might have avoided. These considerations must be balanced against the right in interpreting its scope and weight, and what specific interventions, genetic or environmental, would violate it in particular cases. Nevertheless, the limits of such a right on efforts to shape children would not provide any systematic bar to parents using genetic or other kinds of interventions with their children in order to give them better lives.
The requirement that parents respect their children's right to an open future is important not only because it preserves some prospect of adult autonomy for children, but also because it hedges against various kinds of uncertainty and error. Autonomy aside, the best interests of a child may not coincide with parental judgments about what is best. Parents may erroneously project what is good for themselves onto their children. They may tie their judgments about what is good to what is currently socially valued, not what is of enduring value. Their judgments may be tainted by racism, classism, or sexism. The history of the eugenics movement makes all too apparent what the risks of error are. A broader array of capacities should usually provide individuals with greater adaptive capacities to correct for the errors and mistakes of their parents.
In current discussions, however, it is not simply error about what is best that is key to reservations about genetic interventions, but the enormous uncertainty about risks that surrounds their use. We revisit the issue of risks at the end of this chapter.
Limits on Pursuit of the Best
Problems in defining and defending a specific account of the best that parents might pursue in genetic interventions for their children, together with children's right to an open future, place some limits on the nature of interventions and the circumstances in which they can be justified. However, besides worries about the nature of the view of the best on which attempts to intervene might be based, there are also concerns about who might be initiating, encouraging, or even enforcing the interventions.
For a variety of complex reasons, social practices and the law accord significant discretion to families in having and raising children. Doing so recognizes deep and important interests of parents concerning their children, the important ways children benefit from membership in at least reasonably well functioning families, and the value of the family in developing capacities for intimacy and in providing privacy, both of which require that the family have significant freedom from external oversight and control. Yet children are not chattels; they are individuals with moral and legal claims in their own right. Nevertheless, considerable but not unlimited discretion in having and raising children is in the interests of children and is a necessary and desirable concomitant of the valuable institution of the family.
However, the family, and specifically an individual child's parents, are not the only persons or institution who might seek to encourage, initiate, or require genetic interventions to give children the best lives possible. Huxley imagined the state taking on some such role in Brave New World, and any such prospect raises additional moral worries. We have already noted the ethically problematic nature of any such interventions to produce the best children, when the perspective of the best is society's and not one the children affected could be expected to come to share. And there is reason to worry that interventions undertaken by or at the initiative and urging of the state would be more likely to be motivated by a societal, not an individual, perspective about what kind of children it would be best for the society to have.
An important complexity in the state's proper role in possible genetic enhancements is that it is not plausible to rule out completely enhancements for the benefit of society, as opposed to the subject of the enhancement. For example, there is already some evidence of genes associated with dispositions to violent criminal behavior. Just as the criminal law is a justified coercive social means aimed at preventing or reducing such behavior, society might in the future attempt genetic interventions to do so as well. These interventions would not be made for the benefit of the subject of the genetic intervention (even if that individual also benefited), but for the benefit of the broader society and to protect the rights of its members against violent assault.
While violent behavior is not a disease, these genes would be similar to genes that transmit diseases in that they dispose individuals who have them to deviations from the social norm for violence. But suppose that direct or indirect genetic intervention would reduce the normal human disposition for violence and increase the normal human disposition for cooperative behavior and altruistic concern for others. It is not at all clear why it would be wrong for a society to support or undertake these genetic interventions for the benefit of the society. Genetic enhancements of individuals for the benefit of society cannot be absolutely barred, nor can the need to evaluate the social purpose of the intervention. (A word of caution, however, since we have already seen in Chapter Three that traits such as altruism--which used to be called virtues--are complex, and that there can be disagreement as to precisely what combination of their constitutive elements, in what proportions, really are desirable. This point receives further attention later in the present chapter, in the section on "Virtues and the `Best'".)
Interventions by the state intended to be for the benefit of children who are subject to the intervention would often raise troubling conflicts with fundamental principles of liberal democracy. The only such interventions that would be compatible with a strong liberal commitment to neutrality between different comprehensive conceptions of the good would be enhancements of capabilities that are what we called natural primary goods‑‑capabilities that are general purpose means, useful in carrying out virtually any plan of life.
It would be a mistake, of course, to suppose that capabilities are either fully all‑purpose means or useful only in some very few specific plans of life. Instead, capabilities fall across a broad spectrum in the breadth of kinds of life plans or conceptions of the good for which they are useful, as well as in the degree to which they are useful. Nevertheless, what we have called general purpose means are capabilities that are broadly valuable across a wide array of life plans and opportunities typically pursued in a society like our own.
The closer such capabilities are to truly all‑purpose means, the less objection there should be to the state encouraging or even requiring genetic enhancements of those capabilities. Most now accept government requirements that parents secure medical care, both acute and preventive, for their children in order to prevent harm to them. Most accept public programs of water fluoridation to enhance normal human capacities to resist tooth decay. Most in our society also accept government requirements that parents ensure that their children receive the benefit of a reasonable minimum level of education. If genetic interventions become possible that would prevent comparable harms, or secure comparable benefits, they too could be justifiably encouraged or required by the state.
The neutrality properly expected of the state in liberal societies, nevertheless, is greater than what is properly expected of individual parents. Indeed, no such neutrality is properly expected of parents in the plan of life or conception of the good that they adopt and pursue for themselves and for their own lives. Strong rights to self‑determination or autonomy protect people's right to choose and pursue their own specific plan of life or conception of the good. Nor, of course, would it be desirable or possible for parents to maintain any such complete neutrality about what is a good life in raising their children.
The neutrality that parents must practice toward their children is that required by the child's right to an open future. Parents must foster and leave the child with a range of opportunities for choice of his or her own plan of life, with the abilities and skills necessary to pursue a reasonable range of those opportunities and alternatives, and with the capacities for practical reasoning and judgment that enable the individual to engage in reasoned and critical deliberation about those choices.
Difficult and controversial judgments are involved in distinguishing when parents, in living out their own conception of a good life, also unduly impose that life on their child and excessively close down his or her abilities and opportunities to choose a life. It will often be difficult to know what effects parents are having on their child, and it will be morally controversial how much influence on their child is too much and too constricting. But the general point is that no neutrality is expected in their influence and effects on their children like that expected of the state in a liberal democracy in the genetic or other interventions the state might encourage or require for children.
There is another perspective from which to characterize the limits on parental pursuit of the best for their children. In a recent work, Rawls (1993) describes what he calls "reasonable pluralism." Let us characterize as "reasonable" people who are concerned to live with others on fair terms, assuming the others are so willing. Such people understand that to be fair, the terms of cooperation must be ones that other free and equal persons can accept (Rawls 1993:48‑54; Cohen 1994:1537). Reasonable people, despite their deep commitments to their own comprehensive moral views and conceptions of the good life, must incorporate within their views a view of others who reasonably disagree about such matters (Daniels 1996:Ch.8).
If reasonable people want their children to be able to live on terms of fair cooperation with others, and we are supposing they do, then they must aim to create in their children the intellectual and emotional capacity to respect as reasonable people those with other reasonable comprehensive views. Inculcating those capacities in their own children, however, requires viewing them as free and equal as well. The suggestion, which we shall not pursue further, is that this view of their own children requires preserving for them much of what the right to an open future requires.
Finally, sometimes it is assumed that decisions about what genetic enhancements would be permitted would be left to scientific experts in basic and applied genetics. Scientific experts certainly have an important role to play in any such decisions‑‑they should be in the best position to inform others of the expected consequences of any genetic interventions under consideration, together with the risks and uncertainty those interventions carry. But their expertise does not extend beyond this to the value judgments necessary to weigh potential benefits against potential risks. Indeed, inevitable professional biases would make them unsuited to be the sole decisionmakers about these interventions.
Pluralism and Liberalism
So far our discussion has contrasted parental pursuit of "the best" with pursuit of "the best" through the coercive and persuasive powers of the state in the eugenics movement. Our analysis has lent some weight to the view that parents should be free to pursue the best, even through genetic means, by contrasting it with the evil of statist imposition of reproductive goals. However, this picture is too simple.
Individuals do not just contrast themselves with the state and pursue individual goals. They form themselves into associations united by comprehensive moral, political, and religious views about the good life, and these shared views produce communitarian goals. Hence, the standard challenge to liberalism is to respect not just individual autonomy, but the form this autonomy takes when it is expressed through group associations or communities of this sort. The challenge is to articulate a fair basis for social cooperation in the context of an unavoidable pluralism regarding views about the good life.
We currently think of such communities as linked by their shared beliefs and practices. In the presence of a "genetic marketplace," however, communities could try to forge links that rest on more than beliefs or practices. They might try to shape their offspring genetically in ways that facilitate pursuit of their ideals for a good life. (See the Genetic Communitarianism scenario in Chapter One.) To put this point simply, if fancifully, if their ideals are Spartan, they would pursue particular genetic traits in their offspring that would be of lower priority among Athenians. If they were Christian fundamentalists, they might pursue traits that promote agape or love, but if they were survivalists, they might seek traits that supported fierce independence or even aggression and ruthlessness. The shaping here is not the creation of human nature in their own ideal image but a redistribution of the diverse traits that comprise our varied natures. (We are supposing as well that this fanciful--probably science fiction--scenario could be fleshed out so that it does not involve the erroneous beliefs involved in genetic determinism; see Appendix One.)
Where we might have thought a genetic marketplace would banish the sorts of concerns about state‑based eugenics, we now see a new cause for concern. The effect of old‑style eugenic pursuits might be achieved without the coercive role of the state. Indeed, our whole focus in this chapter has been on individual and, now, community efforts to improve offspring, because we wanted to avoid rehearsing the obvious problems of social control involved in national or international eugenic efforts. Defending individual reproductive rights and the autonomy to pursue the best for our children could create the opportunity for some communities, using the strong pressure of group inclusion and exclusion, to shape pursuit of the best, setting the stage for outcomes that are disturbing in many of the ways that state‑endorsed eugenics had been.
One troubling outcome of communitarian eugenics, as it might be called, is that it could undermine the possibility of social cooperation among communities within a liberal state in a way that traditional pluralism does not. By altering phenotype through genetic means or through somatic interventions that use genetic knowledge, offspring might be locked into suitability for a particular community in a way that shared beliefs and values do not trap them.
Beliefs and values can be revised. Indeed, one reason members of different communities have for supporting a liberal view of individual liberties is that each can imagine changing those beliefs and values and requiring the liberty to do so, even though each person is as committed as possible to the conception of a good life they have at the moment. If someone has been made more competitive or aggressive "by nature" through parental use of the genetic marketplace, however, it may be more difficult to imagine being in a community bound by love of neighbor and turning the other cheek. Even if an individual is no more locked in by the effects of a parental choice than he or she would have been by unmodified nature, most of us might feel differently about accepting the results of a natural lottery versus the imposed values of our parents. The force of feeling locked in may well be different.
The threat to the political fabric of a liberal society comes from the communities coming to believe that they no longer share a common human nature. Recall that in Chapter Three we considered the possibility that deliberately produced genetic divergences among groups of humans might undermine the sense of common humanity upon which moral respect is based. Here we consider a related but different possibility: genetic communitarianism might result in different communities coming to view their differences as no longer the result merely of commitment and persuasion, but of their different "natures," with the result that these differences come to be regarded as irreconcilable. Under these conditions any suggestion of compromise with the values of another community might be regarded as literally a threat to the identity and hence the survival of one's group. Consequently, members of one community might find it harder to see the value of the ways of others, and might reasonably fear that others would find it harder if not impossible to appreciate theirs.
Support for toleration might erode as people no longer believed that we are all "reasonable people" who have come, for complex reasons having to do with the limits of human judgment and facts of history, to believe different things. Even if this perception that a group has come to have a different nature would be no more powerful than many of the cultural factors for group differentiation and identity that now exist, it might still be significant and its results might be quite pernicious.
The threat of locking‑in is thus not just a threat to the individual and his or her rights to an open future. It is a threat to the basis for political cooperation in a liberal society that involves a respect for individual liberties and toleration for those who are different. The threat is that people will come to think of themselves as different in ways even more fundamental than they do today.
This threat puts considerable weight‑‑perhaps more than it can bear‑‑on the appeal made earlier to an individual right to an open future. We suggested that right might better be respected if the modifications we seek for our children involve "all purpose" means--traits that are of value regardless of our conception of a good life. But the boundary between all‑purpose means and more specific traits is not always clear or easy to draw. And insisting on it puts us at odds with the autonomy that individuals and communities want to assert. We are left with considerable vagueness in our answer to the question, When can we interfere with presumed parental rights to pursue the best for their children?
Virtues and the "Best"
Some of the ways in which parents want their children to be "the best they can be" involve what are traditionally called virtues. Parents may want their children to possess certain "prudential" virtues: to be temperate or moderate in emotions and appetites, self‑controlled, judicious, resourceful, persevering, determined, far‑sighted, affable, and reflective. They may want them to possess certain moral virtues as well: to have courage--especially moral courage--and to be fair, benevolent, kind, and forgiving.
Early eugenicists thought that one of their central goals was the production of morally better and socially more efficient societies: they looked to genetics to improve the distribution of virtues in a society. Less desirable traits‑‑like lack of self‑control, inability to plan ahead and delay gratification, intemperance and imprudence‑‑were believed more prevalent among lower classes and nonwhite races. More desirable traits‑‑self‑discipline, foresight, creativity, resourcefulness‑‑were thought more prevalent among the ruling classes and races.
The appeal of the Social Darwinists and of the eugenics movement more generally was to the idea of building superior societies‑‑where virtues were more directly selected for. In its current reincarnation, eugenic thinking--bemoaning the low reproduction rates of the upper classes and the high rates of the lower, for example--concentrates on what might appear to be somewhat simpler traits, such as IQ, that are used to explain differential success of different groups. Still, the considerable interest in the sociobiological and ethics literature on the evolution of altruism indicates a continuing belief that moral virtues or character traits have genetic origins.
We limit our discussion here to deepening and drawing the implications of one point advanced in Chapter Three: most virtues of interest to us because they make people "better," whether prudential or moral virtues, are exceedingly complex traits. They are contextually highly sensitive and specific, they require considerable perception and discrimination for their exercise, and their exercise often requires balancing their appeal with other virtues. Many underlying capabilities or dispositions that might enhance virtues, such as sensitivity to the feelings of others, intelligence, ability to modulate emotional response--all capabilities that we might think have some significant genetic basis--can just as easily be put into the service of vice as well as virtue.
Consider Cynthia, for example. Cynthia has great intuition about the feelings of others. She can read their emotions well, she knows how to feel their pain and anxiety. Indeed, people find her empathetic: they see that she resonates with their pain. At the same time, she does not lapse into pity, and she is not incapacitated by her emotions. She keeps a level head. She puts people at ease, and is able to say the right things to them. Without being condescending or pandering‑‑which would put people off if they too were perceptive‑‑she judiciously exhibits her responsiveness.
Cynthia is blessed in other ways: she is extremely good at planning a detailed but flexible course of action. She is willing to make sacrifices, even painful ones, in the short term to improve her situation‑‑or that of others she is advising‑‑in the long run. She knows how others will respond to the steps she takes and how to anticipate their reactions. Like a good chess player, she thinks her way through several courses of action, but she does not seem calculating or cunning to others so much as careful and thoughtful. She does not seem calculating because she seems responsive to the wishes of others in her planning: she builds on their intentions and encourages their desires to do well for themselves. She incorporates their desires and goals into her own planning.
Cynthia exhibits many of the dispositions and traits that would make her an excellent social worker. She might even win an award for excellence: Virtuous Social Worker of the Year. Alas, Cynthia is a very successful con artist, not a social worker: she sells phoney real estate to unsuspecting retirees. Or at least she was successful until she met an equally successful former con artist who ran a sting operation for the FBI. She clearly lacks the direct concern for the well‑being of others that would make her many capabilities serve as components of a moral virtue.
The moral of Cynthia's story is that we should be leery of any genetic (or environmental) intervention that enhances a trait or disposition that is merely a necessary condition for having a virtue that would result in morally better offspring. If we could genetically enhance the various capabilities that contribute to Cynthia's arsenal, it does not follow she will be morally virtuous. These are component capabilities, the mechanical underpinnings as it were, not the virtue itself. Similarly, if her parents had read literature to her in order to make her grasp better the sensitivities of others, the capacity that results may not be moral empathy but the ability to manipulate. We do not intend to make moral virtue mysterious with these remarks, but neither do we want it viewed in a simplistic, reductionist way.
III. Constraints on Permissions Allowed Parents
Thus far in this chapter we have considered the following argument: Parents are given wide leeway to produce the best offspring they can through various environmental interventions. Many of these environmental interventions result in phenotypic changes‑‑for example, in height, strength, resistance to disease, and cognitive and emotional capabilities. Although there may be social agreement on which changes are "best" in some cases (such as improved health), on many others there is no societal consensus, and the "best" is judged from the perspective of different and sometimes incommensurable views of the good life. We respect pluralism and autonomy by allowing parents considerable permission to pursue the "best" as they see it, though a child's right to an open future implies some restrictions on both environmental and genetic pursuits. And last, where genetic interventions facilitate pursuit of these goals without imposing unacceptable harms or risks, and where a child's right to an open future is respected, there should be no objection to parents using genetic interventions to produce the best offspring they can.
This argument leaves open just when parents pursuing the best for their children may involve imposing unacceptable harms or risks on others, and thus when we may have grounds for restricting the liberty allowed them. In this section we address this issue of risk, thus completing the discussion begun in Chapter Four, in our examination of the widely held view that enhancements are somehow more problematic than treatments. We postponed until now a more detailed discussion of when permissions to pursue enhancements might be restricted.
Now we will explore the following claims, each of which, if true, would provide reasons for restricting parents' freedom to pursue genetic enhancement for their children: that seeking competitive advantage through enhancements will, in important cases, be collectively self‑defeating and thus harmful or wasteful for everyone; that allowing a market to determine who may pursue competitive advantage will be unfair to those who lack means; and that the pursuit of the best‑‑with the exception of eliminating or preventing disease or disability‑‑will generally involve unfavorable ratios of risks to benefits. We set aside until Chapter Seven a related claim that bears less on enhancements than on the treatment or prevention of disabilities--namely, that restrictions are in order here too because these actions impose harms on people with disabilities.
Enhancements, Coordination Problems, and Harms to Others
In Chapter Four, it was argued that the distinction between treatment and enhancement does not coincide with either of two morally important distinctions. It does not map precisely onto the boundary between interventions we are obliged to help others receive and those for which we have no such obligations, nor does it match the boundary between permissible and impermissible interventions, as some commentators have proposed. At the same time, we suggested that there is good reason to think that many enhancements will pose serious problems not posed by treatments. For whole classes of cases, certain enhancements may be impermissible for reasons that are unlikely to arise for treatments or for reasons that can be more easily dealt with in the case of treatments. Knowing that something is an enhancement thus should raise a moral warning flag. That warning must be examined more carefully now to see what restrictions, if any, it is justifiable to impose on parental pursuit of "the best."
Let us begin with a contrast that is evident in current rather than future practice. To avoid some sex‑linked genetic diseases, current genetic counselling practice sometimes calls for screening for the sex of a fetus followed by selective abortion if the fetus is, say, male. This practice raises important moral issues, depending on the severity of the disease and its probability of transmission. Still, it is very unlikely to produce any significant shift in sex ratios, given the frequency of its use. There might be a slightly higher probability that more carriers of the condition will result (females in this case), but that consequence might seem quite predictable and acceptable in light of the alternative, which is more males with a devastating condition. In this example, the selection against males (or against females, in other examples) does not act on or signal acceptance of any general bias or attitude toward one gender or another. It sends no "message" reinforcing such a bias, though it may send a message to those with the disease or disability that is being prevented through these means.
In some parts of the world--India, for example--widespread ultra‑sound screening is practiced followed by selective abortion of female fetuses. In some cultures, the reason for the preference is that only males may preside at the funeral of a head of household or officiate in other religious rituals. In other cultures, the anti‑female selection may be the result of economic considerations favoring male offspring, perhaps in the context of marriage and inheritance customs. In some areas of India and elsewhere, access to ultra‑sound technology has led to dramatic shifts from the normal 105:100 male to female ratio to ratios approaching 135:75. The problem is so serious that India has imposed legal restrictions on screening for sex selection (as have some other countries).
The reasons for sex selection will affect how people evaluate the consequences of gender imbalance. If the goal is to produce a male offspring to preside at a funeral, a religious (nonconsequentialist) requirement for some Hindus, then it still holds even if the social consequences of the shift impose considerable hardship on the many extra males. The action is thus not self‑defeating in light of the reason for performing it. (Even in this case, however, this reason might be outweighed, in the eyes of those making the decision, if the costs to the family of having male offspring who cannot marry and reproduce are seen to outweigh the costs of violating or modifying a funeral custom.)
On the other hand, if the reasons for sex selection are the presumed economic advantages of having more male offspring, then the effect of many people making the same decision will defeat the very reason for the action. In fact, each family that selects for males may be at a disadvantage since it will be even more difficult for those extra males to gain the advantages of maleness that would have existed without sex selection. Whether the reasons are religious or economic, however, the effects are similar: the imbalance in sex ratios makes the situation worse for more families.
Society has good, if not conclusive, reason to restrict the liberties of individuals if the exercise of those liberties undermines a public good. In this case, the public good is the natural balance represented by the biologically determined sex ratio (not equality, but something approximating it). The balance creates a condition that is advantageous to each in the sense that it makes it more likely that each individual can successfully marry and reproduce. It is against the background of a normal sex ratio that the actions of individuals seeking to have more male children makes sense: they "freeride" on the cooperative behavior of others who refrain from disturbing the balance. If too many aim at sex selection, the public good is destroyed and all are worse off. This provides a rationale for limiting the liberty of those who might be inclined to act as free riders.
There are other reasons a society might act to restrict the liberty to select for sex. Where sex selection is achieved by selective abortion, the practice is viewed by some as a form of genocide--specifically, gendercide. But even if the practice did not involve killing female fetuses, but only involved avoiding conceiving them, there would be other objections. The practice depends on and reinforces a systematic bias against women. That bias is indefensible on grounds of justice and works in various ways to produce injustice against women. Acting to take advantage of unjust arrangements, or acting in ways that reinforce them, is thus itself objectionable, and permission to pursue "the best" through this means is appropriately restricted. (In Chapter Seven, we argue that decisions to avoid disabilities in offspring do not in the same way reinforce discriminatory practices or take advantage of them. Indeed, a policy designed to encourage prospective parents to avoid the birth of persons with serious disabilities might be implemented while still pursuing strong antidiscriminatory policies to support people with disabilities, without any inconsistency. In contrast, seeking more male offspring while at the same time opposing social practices that favor them would be self‑defeating.)
One should not assume that all reasons parents have for gender selection can be criticized on these grounds. Some parents might have reasons for wanting a male or female child that do not depend on and reinforce a systematic bias against women. Parents having two or three children of the same sex may just want to have the different experience of raising a child of the opposite sex, for example.
It might be objected that gender selection for nontherapeutic reasons is not really a case of "enhancement." Those who do may see a male offspring as simply "better" than a female one‑‑a better earner, a better ritual‑performer--but that judgment does not make this a true case of enhancement since it is not an instance of improving a normal capability, as would be an intervention to improve immune capability or short‑term memory. We do not want to argue this issue, for the real point of the example is that nontherapeutic medical interventions, whether they are true enhancements or only resemble enhancements, can have social effects that are very harmful, sometimes unforeseen, and sometimes self‑defeating.
Consider how similar points can be made about a true case of enhancement. Suppose it becomes possible to use a germline or somatic intervention to increase the height of offspring by up to six inches, regardless of how tall they would have turned out to be without it. Presumably, parents of children who would have been quite short without it would have a strong reason for approving the intervention. So too would many parents of children who would have been of average height or even fairly tall without it. Some parents would want their children to have the option of playing basketball, or of retaining whatever height advantage they might have had prior to widespread use of the new intervention. Let us further suppose that there are no clear medical risks‑‑a supposition that is unlikely to be true. (This supposition is necessary because parents ought not to be allowed to make proxy decisions for children when the risk‑benefit ratios are so adverse, a point we return to shortly.)
To the extent that extra height is desirable only because of the competitive advantage it brings with it, widespread use of the intervention is self‑defeating. Perhaps some very short people for whom there is true inconvenience living in a world geared to taller people would gain temporary relief, but if the variance in height remains unchanged except that most people are six inches taller, then markets will end up discriminating against the shortest (and tallest) again. Competitive advantage of additional height in (some) sports or in social acceptance would not change from what it was before the intervention. The intervention is thus self‑defeating for those whose reasons are strictly competitive.
Actually, the situation is worse than being simply self‑defeating, since spread of the technology would create great pressures for people to use the intervention even if they originally saw no benefit of added height. Although they might have been content with their height earlier, they would not be content to being made shorter than everyone else, or even much shorter (relatively) than they would otherwise have been. If there were slight risks to the intervention, contrary to our original hypothesis, then the pressures to use the intervention become more insidious. People would then be pressured to take risks, even slight ones, that they would not have had to face before.
There may be a model for this situation in the current "hype" surrounding mood altering drugs such as Prozac. The (slight) risks‑‑including those of unintended personality transformation‑‑may be worth taking if there is significant depression. But if people in large numbers use such drugs to enhance their personalities, then others may feel pressured to follow suit, fearing that they will be missing out on the advantages that drug users obtain. They will then be pressured to take risks they would not otherwise have considered taking.
Even if there are no risks, however, there are costs. There are the costs of the intervention itself, which might be considerable. There may be other costs as well, such as the expense of redesigning houses, cars, and so on if the population rapidly became much taller. So what seemed advantageous, given the individual cost, on the assumption that few others would do it becomes collectively self‑defeating in several ways. The same point might be made about many other traits that offer "positional advantage." Perhaps "blonds have more fun," but not if everyone is blond; an "exquisite nose" may lose its charm if everyone on the block has one.
Some traits offer an improvement whether or not they provide competitive advantage, and this may mean that coordination problems of the type we have been describing may arise only for some types of enhancements that parents might seek. Someone might prefer a nose to be shaped a certain way whether or not many others are, if that is how the beautiful nose is supposed to appear. Enhanced immune capabilities are beneficial whether or not they offer competitive advantage. Certain cognitive capabilities might contribute to competitive advantage, but provide noncompetitive benefits as well. Slowing memory loss late in life, for example, appears desirable regardless of any competitive advantage it might offer. And increasing memory capabilities or powers of concentration might enable individuals to pursue activities of intrinsic worth to them regardless of whether there are any competitive advantages.
Even our sketchy discussion of this issue shows its complexity. Some "positional" traits that seem desirable largely because they confer competitive advantage will not be desirable for all to pursue. If we could simply demarcate which traits these were, we might argue that no one is worse off if we simply restrict efforts to the "best" in these cases. But many traits that provide competitive advantage also have some instrumental and intrinsic value to people independently of those advantages. For traits valued in these more complex ways, their pursuit by everyone need not produce self‑defeating coordination problems. For example, suppose everyone's intellectual performance could be enhanced in certain areas; no competitive advantage would result, but (arguably) society might be better off because of the enhanced abilities of all. Further, other traits may be valued even though they are not positional and confer no competitive advantage: they are just what some individuals view as the best.
These considerations suggest no grounds for blanket prohibitions that cut across all these categories, nor grounds for outright permissions regardless of coordination problems. The policy issue is how to draw reasonable constraints in those cases where the harms or costs are so great that some restrictions seem warranted.
Enhancements and Fairness
The coordination problems described above arise if everyone seeks to improve certain traits that confer competitive advantage. But if the technology for pursuing the best is not available to everyone, these coordination problems will not come up. Issues of fairness arise instead, however, especially for positional traits that confer competitive advantage. If only the wealthy could enhance the immune capabilities or the cognitive capabilities of their offspring through genetic interventions, many would consider this unfair. We must consider, then, objections to the pursuit of the best that rest on claims of unfairness.
In Chapter Three we made the basic case for regulating access to genetic enhancements to prevent inequalities of opportunity. Here we pursue those issues in more detail, in the particular context of parental efforts to improve their children. We may begin by taking some cues from the analogous claims about unfairness that might arise if ability to pay determined access to medical treatments.
First notice an interesting contrast between pursuit of the best through treatments and enhancements. The kinds of self‑defeating effects we observed for cases in which everyone pursues a trait that confers competitive advantage are not present for treatments. If everyone pursues elimination of departures from normal functioning, the outcome is not self‑defeating. (We ignore the very special case of antibiotics losing effectiveness after widespread use or overuse.) The limited goal of health care, on the view discussed in Chapter Four, is to maintain normal functioning. There is a fairly broad consensus that it is important to restore to the status of "normal competitors" those whose opportunities are diminished by disease and disability. Consequently, the healthy do not‑‑or at least should not‑‑feel a sense of loss when their competitive advantages over the sick or disabled are thereby lost.
Issues of fairness are raised, however, when not everyone can pursue normal functioning. If the poor could not eliminate the competitive disadvantage produced by disease or disability but others could, that would be considered unfair. Similarly, if there is a treatment that only the wealthy can afford and resource limits prevent us from providing it to everyone else, then many feel it is unfair for the wealthy to have the treatment. Some want to prohibit the treatment if not all can get it (Gutmann 1981); others are willing to accept it as regrettable but not something to which we can prohibit access (Daniels 1985, 1993). These issues of fairness arise in similar ways for some enhancements, and not just treatments. Thus, if only the well‑off could improve their competitive advantage through genetic enhancements, that too will seem to many unfair (recall the "Genetic Enhancement Certificate" scenario in Chapter One).
Three key factors affect these judgments about the unfairness of differential access to either treatments or enhancements. First, if we believe that the socioeconomic inequalities that exist in a social arrangement are themselves unfair and unjust, perhaps the result of classist, racist, and sexist practices, then ramifying or compounding those inequalities with further advantages resulting from treatment or enhancement will seem particularly unfair. Many people think that many of the inequalities we experience in our society are not fair or just. The richest groups enjoy income and wealth many thousand times greater than the poorest groups. With the income and wealth come vast inequalities in political influence and power. The gulf we see is clearly influenced by a history of racist and sexist practices. Over the last two decades in the United States, income and wealth inequalities have been increasing, not decreasing.
Those who object to these inequalities as unjust would have grave objections to the use of genetic techniques that further increase the ability of those who are best off to transmit advantages to their offspring. Of course, others might reply that our society already allows the best off to pursue the best in many other ways: why single out genetic interventions for special restrictions? Presumably, if it is wrong to ramify one injustice by adding another, genetically-produced one on top of it, and the need to avoid this wrong warrants restrictions, then comparable restrictions may be warranted in other, nongenetic cases as well.
If the inequalities in society are just, however, then the additional resources available to the best‑off groups are theirs to use as they see appropriate: there are no further claims of others on those resources or the inequalities would not yet be just. So individuals could then use their resources to improve the quality of their lives, to pursue the best as they see it.
The second key factor is the structure of the inequality in access to benefits. A health care system that rations beneficial services to the poorest 25 percent of the population but makes those services available to everyone else seems easier to criticize on grounds of fairness than one whose rationing applies to the bottom 75 or 90 percent of the population and permits extra advantages only to the best‑off groups (Daniels 1991). The point is that the poor in the former can reasonably complain that they are being left behind in important ways by most of the rest of society, whereas no minority can feel that way in the latter system. In the latter, but not the former, it is more likely that the worst-off groups are as well off as they can be.
Third, the significance or degree of the benefit or advantage matters crucially. If a treatment has only modest effect on restoring normal functioning, it is less objectionable if it is available to the best-off groups but not to most others than if has a major effect on health outcomes. If the competitive advantage an enhancement provides is marginal, people will object less to it being available on a market basis only to those who can afford it. If the advantage is decisive or distinctive and highly visible, however, people may object much more strenuously on grounds of fairness.
To see how these factors affect how one should think about fairness, let us explore further the analogy between pursuing the best through genetic interventions and doing so by providing the best education we can afford for our children. In our society, for example, there is a significant private sector for secondary and higher education. Many of the very best high schools and universities are private. It is well known that an education at an elite private high school improves the chances of admission to an elite university. Similarly, admission to an elite university improves the chances for admission to superior professional schools. The "networking" advantages of these superior schools is also a way that initial social, political, and business advantages are maintained.
It is also well understood that alumni and families capable of making substantial charitable contributions to private institutions at all these levels may have some extra leverage in seeking favorable consideration for their offspring: "legacies" carry weight in admissions offices. Thus inequalities in wealth and income work through an educational market to compound advantages. At the other end of the spectrum, the chances of children from the poorest inner‑city ghetto schools finding their way into elite colleges and universities are very small. Inequalities in public school education thus work to compound advantages and disadvantages as well.
Reactions to this situation in the educational system reflect beliefs about all three factors mentioned in connection with differential access to treatments or enhancements. If we are greatly troubled that existing economic inequalities (in the United States) are unjust, we will think the way they work to secure educational advantage is unjust. If we think the public school system is largely adequate, believing that no significant minority is left behind by it and that exceptional educational advantages accrue only to those at the very top, we may find the problem less serious. We might then be satisfied with efforts to add a meritocratic component to private schools through special scholarships for the needy.
If, however, we think the public schools effectively eliminate prospects for higher education for millions of Americans, then we will be much more troubled by the resulting structure of inequality. Finally, if we think that success in life is only marginally advanced by educational advantages, then we might be less concerned by the educational privileges the wealthy maintain for themselves. We might, for example, think that many other factors swamp in importance the advantages gained through an elite secondary school or college. Then we would be less troubled by the workings of the market for educational advantage.
Our reaction to market inequalities in access to genetic interventions that pursue the best will likewise depend on the judgments we are prepared to defend about these same three factors. To the extent that existing inequalities in income and wealth are seriously unjust, this weighs against marketing the means to further advantages. To the extent that access to advantages are denied only to the worst off groups, rather than available only to the best off, this too weighs against marketing these methods of pursuing the best. And to the extent that the advantages are truly significant, in the sense that they confer increased opportunities on those who already have them, and to the extent that most people can agree they are significant, this weighs against a system that makes them available only to those who are best off.
Uncertainty and the Risks of Pursuing the Best.
Although we have examined several important reasons for constraints on parental efforts to pursue the best offspring through genetic enhancement, we have set aside until now the main argument in the literature against some forms of genetic intervention. The argument starts, quite reasonably, by pointing out the enormous uncertainties and risks that would face attempts at genetic enhancements, whether somatic or germline, but especially the latter. The claim is then made that there are ethical objections to the types of experiments on humans that might reduce some of this uncertainty.
As we saw in Chapter Four, some infer that it may be acceptable to pursue either somatic or germline efforts to prevent or cure certain diseases, where risk/benefit ratios might prove acceptable, but that genetic enhancements should not be attempted because risk/benefit ratios would always prove unfavorable (Anderson 1990; see also Anderson 1980, 1985, 1989). Others argue that the risk/benefit ratios involved in all germline interventions are too high, and therefore only somatic treatments for genetic disease would be permissible (Council for Responsible Genetics 1993). Both of these arguments attempt to establish a moral boundary between negative and positive uses of genetic engineering, a topic discussed in Chapter Four, to which we return now, this time in the context of parents pursuing the best for their children by genetic means.
Let us consider in more detail the reasons for concerns about the risks of genetic interventions. First, scientists currently lack the ability to deliver a gene to its proper site within a chromosome or to remove a defective gene whose function it is to replace. Instead of precisely repairing the genetic machinery of somatic cells, they simply send the proper gene into the host on a crude vector that deposits it at some location or other, hoping it will function to supply the relevant proteins not produced by the defective gene, which remains where it is.
Without a precise vector or vehicle, however, genetic interventions leave room for many unintended genetic effects with unknown risks (Walters 1991). An analogy might be soldering a circuit board to correct for some defective circuits. If one simply delivered new solder at random, one might make things worse, not better. Such an approach is not only unlikely to produce the desired result, but is likely to produce other problems by destroying even more circuits. Still, germline modification has proved technically easier than might have been predicted, in part because germline cells can take up artificially introduced DNA more readily than more highly differentiated somatic cells (Council 1993:670) can. The modification so far, however, does not solve the problem of the crudeness of vectors.
Second, the crudeness of current technology matters less in somatic interventions than it would in germline interventions. Errors made in somatic interventions do their damage only in the individual being treated. We cut our losses with the affected individual. It would be unconscionable, however, to use such crude vectors in germline interventions, where misplacement of genes can do serious damage that could be disseminated more widely to further generations. For example, as the Council for Responsible Genetics notes, "Introduction of a foreign gene (even if there is a copy of one already present) into an inappropriate location in any embryo's chromosomes can have unexpected consequences...the offspring of a mouse that received an extra copy of the normally present myc gene developed cancer at 40 times the rate of the unmodified strain of mice" (Council 1993:670 citing Leder et al. 1986).
Third, current capabilities focus on corrections of catastrophic defects caused by malfunctions in single genes. In such cases, the risk of nonintervention are enormous and certain: the disease is manifest and often life‑threatening or severely debilitating. Accordingly, the risks of intervention, however large and uncertain, may seem worth taking after a careful risk/benefit assessment. Enhancements, however, are an attempt to improve on what is already functioning normally, if suboptimally. The worst case scenario for nonintervention is no improvement on the suboptimal but normal functioning. In contrast, the uncertainties and risks of intervention may be very great. That is why Anderson and others have concluded that sound risk/benefit assessment would lead us to avoid all enhancements.
Fourth, interventions to correct for defects in single genes, however complicated and uncertain, are far simpler than what would be involved in multigene or multifactorial cases. Yet most diseases that are influenced by genetic factors are likely to involve the functioning of many genes. Similarly, most functions one might want to enhance will also be causally influenced by many genes. The uncertainties thus grow geometrically for these cases.
The problem does not derive simply from the likelihood of technical error, but also from the inability of biologists "to predict how genes or their products interact with one another and with the organism's environment to give rise to biological traits. It would have been impossible to predict, a priori, for example, that someone who has even one copy of the gene for a blood protein known as hemoglobin‑S would be protected against malaria, whereas a person who has two copies of this gene would have sickle cell disease" (Council 1993:670). This source of uncertainty must be added to the reasons already given for thinking germline interventions are riskier than somatic interventions and for thinking that enhancements generally will have worse risk/benefit ratios than treatments of disease.
Fifth, special uncertainties surround the ability to integrate improvements in a component function so that overall functioning actually improves as well, rather than being harmed. For example, suppose it becomes possible to boost a particular component of memory, say short‑term memory, and the goal is to improve some more comprehensive level of functioning, such as language learning or mathematical abilities. It would be necessary to know that improvement in this particular component of memory will actually be integrated properly into overall functioning by higher level or coordinating functions. Otherwise, we might simply create interference with the overall function‑‑the distraction of inescapably intrusive memory, for example, perhaps modeling the capabilities of some "idiot savants" suffering from autism. The analogy here is to upgrading memory on a computer: one cannot simply add more memory chips unless there is appropriate hardware and software to integrate the additional capacity. This sort of uncertainty arises even where we have good information about the kinds of interactions genes and gene products have with environment, and even where, using that information, we have evidence we can improve some particular function.
Sixth, the only way to eliminate some of the sources of uncertainty about risks would be through human experimentation, but some of the kinds of experiments we would need to perform may not be performed for ethical reasons. Even if, for example, some seriously ill adults were allowed to consent to risky experimentation on somatic interventions, there would be special problems with germline interventions, since consent cannot be obtained from future offspring who might be affected, nor from the embryos upon whom the intervention would be performed.
Many of these concerns about risks are serious and have important policy implications. It does not follow, however, that there should be permanent prohibitions on germline interventions or enhancements. Let us consider more carefully what conclusions should be drawn from the six concerns about risks.
It is certainly true that a proper vehicle for precise genetic repair is currently lacking, and it is also true that this problem poses greater risks for germline therapies. What follows from this current limit on our capabilities is the need for very careful scrutiny of any protocols for experiments involving these interventions, which in fact is current practice. Is this a short or long‑term problem? At present no one can make well-grounded predictions about how long this technical problem will persist.
If one went back a century and surveyed predictions made by scientists in different fields about technological changes that have actually occurred in our time, one would place little confidence in the ability of contemporary geneticists and microbiologists to predict where their fields will be a century from now. Some are true believers and the source of great "hype" about astonishing progress. Others, concerned to remain staid and cautious scientists, want to discuss only what seems to be a very modest extension of current technology. But we cannot place much weight on predictions that particular technical problems will be intractable, and so taking a long‑term view of the prospects of genetic intervention seems a reasonable flirtation with the future, provided it does not undermine the extreme caution that should be exercised in the short run.
Even with significant breakthroughs in the ability to make precise substitutions in DNA, it will still be true that germline interventions pose important risks that somatic interventions do not. But that implies only that we should proceed very cautiously with these interventions, scrutinizing carefully each protocol. It does not mean that the possible transmission of harm to future offspring through germline interventions makes such interventions never worthwhile.
The argument that risk/benefit ratios are generally more problematic for enhancements than for treatments of disease has some plausibility. Still, the strong conclusion drawn by some that no enhancements would be justifiable does not follow. There is likely to be considerable agreement among persons about the seriousness of certain diseases and the value of avoiding their effects. To the extent that disease impairs opportunities for individuals, there may even be a clear basis for thinking that we are obliged to assist in restoring functioning where we can. There is likely to be more disagreement about the value of many enhancements, for reasons already indicated. Different individuals, judging from the perspective of different conceptions of a good life, may value enhancements quite differently. (The same can be said for the effects of some diseases or disabilities.) But if individuals‑‑or groups of individuals‑‑value some enhancement very highly, they may well be willing to take significant risks to produce it in themselves and even in their children.
A parent who detects musical or athletic potential in a child may begin to push that child into a rigorous course of training that dramatically shapes a child's life all the way through adolescence and beyond. This is a serious gamble: will the talent be there and will it be developed adequately to pay off the sacrifices made? If not, there may be great frustration, and a sense of great loss at the foregone opportunities and the narrowed prospects for success. Being free to take such gambles, however, is a highly valued liberty, and a society restricts it only at great cost and with great reason. A medical perspective on the risk/benefit assessment of a potential enhancement may vary widely from a parental assessment, even assuming full knowledge of risks and uncertainty.
The difference between treatment and enhancement does warrant very careful examination of any experimental protocols for enhancements, and greater caution may be merited here than in the case of potential treatments. It might also be wise to insist on a research priority‑‑and funding priority‑‑for treatment of disease. But we do not think what follows is a long‑term prohibition on enhancements or research leading up to them. It may be possible to produce great benefit for individuals and even for society as a whole through some kinds of enhancement, as our earlier discussion suggests.
Some enhancements may come to be regarded as things society is obliged to make available to everyone, just as some treatments are. To assimilate the value of all enhancements to the level of the value of purely cosmetic surgery is unfair to the potential of enhancements. And our society does permit people to take the risks of cosmetic surgery, albeit at their own expense.
The fifth concern, that enhancements are likely to be multifactorial and quite complex, is no doubt true. But this is also true for many treatments. As we acquire knowledge appropriate to intervening in the case of diseases that are multifactorial, then we will be in a better position to consider some enhancing interventions as well. Again, extreme caution in experimentation is the only plausible policy recommendation. This caution should make us more skeptical of enhancment protocols than of treatment protocols, and of multifactorial interventions as opposed to single gene interventions, but what counts as appropriate caution is a function of knowledge at the time of the decision, not knowledge we now have.
Finally, what about the serious worries about consent to experimentation when the risks will fall on those not making the decisions? In the case of treating diseases through genetic interventions, it might be preferable to get consent from the affected person where possible by waiting to attempt a somatic intervention rather than attempting a germline intervention. However, this strategy cannot cover an important range of cases. Many somatic interventions would be too late to prevent some manifestation of the effects of the condition, and in general it would be better to prevent the problem thnn to treat it. So it will often be necessary to weigh the greater benefits of a germline intervention against the possibly greater harms, including those in later generations. Without examining particular cases and protocols, it would be unwise to make a blanket prohibition against germline interventions because of uncertainties in subsequent generations (cf. Kitcher 1995 for a similar conclusion).
A particular technique of genetic manipulation that has received a great deal of recent attention is cloning. Following Ian Wilmut's announcement of the cloning of an adult sheep in early 1997, the possibility of human cloning no longer seems merely science fiction. In the process of cloning by nuclear transfer, the nucleus from the cell of an adult mammal is inserted into an ennucleated ovum (an egg from which the nucleus has been removed) and the resulting embryo develops following the complete genetic code of the mammal from which the inserted nucleus was obtained. Public and professional responses to the prospect of human cloning were often highly emotional and did not await a careful assessment of the reasons for and against the practice. We cannot undertake that full assessment here, but will touch on a few issues that are related to our earlier discussion in this and the preceding chapter.
Some critics of cloning have argued that it would rob an individual of a sense of freedom or spontaneity in creating a unique life for him or herself, and thereby violate what we earlier called, following Feinberg, a right to an open future. (Jonas 1974; Feinberg 1980). Jonas argued that human cloning in which there is a substantial time gap between the beginning of the lives of the earlier and later twin is fundamentally different from the simultaneous beginning of homozygous twins that occur in nature. Although contemporaneous twins begin their lives with the same genetic inheritance, they also begin their lives or biographies at the same time, and so in ignorance of what the other who shares the same genome will by his or her choices make of his or her life. To whatever extent one's genome determines one's future, each begins ignorant of what that determination will be and so remains as free to construct a particular future from among open alternatives, as are individuals who do not have a twin.
A later twin created by human cloning, Jonas argues, knows, or at least believes he or she knows, too much about him or herself. For there is already in the world another person, one's earlier twin, who from the same genetic starting point has made the life choices that are still in the later twin's future. It will seem that one's life has already been lived and played out by another, that one's fate is already determined, and so the later twin will lose the spontaneity of authentically creating and becoming his or her own self, of freely creating one's own future. It is tyrannical, Jonas claims, for the earlier twin to try to determine another's fate in this way.
One difficulty with this argument is its apparent assumption of an indefensible genetic determinism according to which one's entire life course is fully determined by one's genetic inheritance. But that assumption is plainly false as we have frequently emphasized because it neglects not only the range of phenotypic expression of specific genes, but also the importance of environment and an individual's choice in constructing a unique life.
One might try to interpret Jonas's objection so as not to assume either genetic determinism, or a belief in it. A later twin might grant that he is not determined to follow in his earlier twin's footsteps, but that nevertheless the earlier twin's life would always haunt him, standing as an undue influence on his life, and shaping it in ways to which others' lives are not vulnerable. But the force of the objection still seems to rest on a false assumption that having the same genome as his earlier twin unduly restricts his freedom to choose a different life than the earlier twin chose. A central difficulty in evaluating the implications for human cloning of a right either to ignorance or to an open future, is whether the right is violated merely because the later twin may be likely to believe that his or her future is already determined, even if that belief is clearly false and supported only by the crudest genetic determinism. It seems more plausible to say that if the twin's future in reality remains open and his to freely choose, that someone's acting in a way that unintentionally leads him to believe that his future is closed and determined has not violated his right to ignorance or to an open future. Likewise, suppose you drive down the twin's street in your new car that is just like his, knowing that when he sees you he is likely to believe that you have stolen his car, and therefore to abandon his driving plans for the day. You have not violated his property right to his car even though he may feel the same loss of opportunity to drive that day as if you had in fact stolen his car. In each case he is mistaken that his open future or car has been taken from him, and so no right of his to them has been violated.
So, our argument in this chapter that genetic enhancements or interventions must respect the right to an open future does not provide a reason to oppose human cloning. This is not to say that there are not strong, even decisive, reasons to oppose attempts at the present time to clone humans based on the risks of the procedure. One version of this objection to human cloning concerns the research necessary to perfect the procedure, the other version concerns the later risks from its use. Wilmut's group had 276 failures before their success with Dolly, indicating that the procedure is far from perfected even with sheep. Further research on the procedure with animals is clearly necessary before it would be ethical to attempt to use the procedure on humans. But even assuming that cloning's safety and effectiveness is established with animals, research would need to be done to establish its safety and effectiveness for humans. Could this research be ethically done? There would be little or no risk to the donor of the cell nucleus to be transferred, and his or her informed consent could and must always be obtained. There might be greater risks for the woman to whom a cloned embryo is transferred, but these should be comparable to those associated with IVF (in vitro fertilization) procedures and the woman's informed consent too could and must be obtained.
What of the risks to the cloned embryo itself? Judging by the experience of Wilmut's group in their work on cloning a sheep, the principal risk to the embryos cloned was their failure successfully to implant, grow, and develop. Comparable risks to cloned human embryos would apparently be their death or destruction long before most people or the law consider them to be persons with moral or legal protections of their lives. Moreover, artificial reproductive technologies now in use, such as IVF, have a known risk that some embryos will be destroyed or will not successfully implant and will die. It is premature to make confident assessment of what the risks to human subjects would be of establishing the safety and effectiveness of human cloning procedures, but there are no unavoidable risks apparent at this time that would make the necessary research clearly ethically impermissible.
Could human cloning procedures meet ethical standards of safety and efficacy? Risks to an ovum donor (if any), a nucleus donor, and a woman who receives the embryo for implantation would likely be ethically acceptable with the informed consent of the involved parties. But what of the risks to the human clone if the procedure in some way goes wrong, or unanticipated harms come to the clone? For example, Harold Varmus, director of the National Institutes of Health, has raised the concern that a cell many years old from which a person is cloned could have accumulated genetic mutations during its years in another adult that could give the resulting clone a predisposition to cancer or other diseases of aging. Moreover, it is impossible to obtain the informed consent of the clone to his or her own creation, but of course no one else is able to give informed consent for his or her creation either.
We believe it is too soon to say whether unavoidable risks to the clone would make human cloning unethical. At a minimum, further research on cloning animals, as well as research to better define the potential risks to human, is needed. But we should not insist on a standard that requires risks to be lower than those we accept in sexual reproduction, or in other forms of assisted reproduction. It is not possible to now to know when, if ever, human cloning will satisfy an appropriate standard limiting risks to the clone.
If and when safety concerns are satisfied for human cloning, we will have to assess what benefits and harms might come from letting it take place. As best we can tell at this time, human cloning is not the unique answer to any great or pressing human need and its benefits would be at most limited. Nevertheless, there are a few circumstances in which individuals might have good reasons to want to use human cloning. First, it would allow women who have no ova or men who have no sperm to produce an offspring that is biologically related to them (Eisenberg 1976; Robertson 1994b and 1997). Second, it would enable couples in which one party risks transmitting a serious hereditary disease, a serious risk of disease, or an otherwise harmful condition to an offspring to reproduce without doing so (Robertson 1994b). Of course, by using donor sperm or egg donation, such hereditary risks can generally be avoided now without the use of human cloning. But those procedures may be unacceptable to some couples, or at least considered less desirable than human cloning because they introduce a third party's genes into their reproduction, instead of giving their offspring only the genes of one of them. Third, cloning a later twin would enable a person to obtain needed organs or tissues for transplantation (Robertson 1994b; Harris 1992), so long as it is done compatible with respecting the rights of the donor clone. Fourth, human cloning would enable individuals to clone someone who had a special meaning to them, such as a child who had died (Robertson 1994b).
There is no denying that if human cloning were available, some individuals would want to use it in order to clone someone who had special meaning to them, such as a child who had died. However, that desire usually would be based on a deep confusion. Cloning such a child would not replace the child the parents had loved and lost, but rather would create a new different child with the same genes. The child they loved and lost was a unique individual who had been shaped by his or her environment and choices, not just his or her genes, and more importantly who had experienced a particular relationship with them. Nevertheless, if human cloning enabled some individuals to clone a person who had special meaning to them and doing so gave them deep satisfaction, that would be a benefit to them even if their reasons for wanting to do so, and the satisfaction they in turn received, were based on confusion. In addition, human cloning and research on human cloning might make possible important advances in scientific knowledge, for example about human development (Walters 1982; Smith 1993). Each of these possible benefits needs much more careful assessment for its extent and probability, but at this time we believe human cloning does not seem to promise great benefits or uniquely to meet great human needs.
Typical feared harms from human cloning are even more speculative than its possible benefits. They include various possible psychological harms to a later twin, for example a diminished sense of one's own uniqueness and individuality (McCormick 1993; Verhey 1994). Even if such an effect, like the possible feeling of a loss of freedom and an open future discussed above, is grounded in a confused and false belief in genetic determinism, the psychological distress could nonetheless be real. Opponents of human cloning also fear social harms, such as lessening the worth of individuals or diminishing respect for human life. For example, human cloning might result in persons' worth or value seeming diminished because we would now see humans as able to be manufactured or "hand-made." This demystification of the creation of human life would reduce our appreciation and awe of it and of its natural creation. It would be a mistake, however, to conclude that a human being created by human cloning is of less value and less worthy of respect. Others fear that individuals using cloning to create children genetically identical to themselves represents a narcissistic attitude to parenting that could be harmful to the family.
Human cloning is a means of reproduction. Consequently, individuals' important interests in reproductive freedom, discussed in Chapter Five, do establish a moral presumption for permitting its use in some circumstances. In a few circumstances, human cloning could be the only or best means for individuals to pursue successfully their reproductive interests. It could be argued, however, that use of human cloning is not properly part of reproductive freedom because whereas current assisted reproductive technologies and practices are remedies for inabilities to reproduce sexually, human cloning is an entirely new means of reproduction; indeed, its critics see it as more a means of manufacturing humans than of reproduction. Human cloning is a different means of reproduction than sexual reproduction, but it is a means that can serve individuals' interest in reproducing. If its use is not properly part of reproductive freedom, that must be not because it is a new means of reproducing, but instead because it has other objectionable moral features or harms.
Fortunately, concerns about safety are sufficient that human cloning should not go forward at this time and so society has time for continued public and professional debate to clarify and evaluate people's concerns and objections to cloning, together with the reasons to permit it. Such a continuing debate will be especially important in arriving at informed and reasoned public policy on such a new and complex issue which generates in many people strong but often not well-articulated reactions.
In Chapter Four, we began to examine whether firm moral boundaries could be drawn among different categories of genetic interventions (including interventions using genetic knowledge). We argued that the distinction between treatment or prevention of disease and disability and enhancement of otherwise normal traits does not provide us with a clear moral boundary between what we are obliged to do for people and what may be merely morally permissible. There may be no obligation to provide such treatments, and some enhancements may be obligatory. We also argued, however, that the boundary between treatment and enhancement offers a plausible, publicly usable boundary for saying what society's primary obligations are in the delivery of health care. we also argued that certain moral warning flags should be heeded when we consider using genetic (or other medical) technologies to pursue the enhancement of otherwise normal traits.
In this chapter we have pursued the issue of enhancements in more detail, focusing on the scope and limits of parents' moral authority to pursue the best for their children. Our main goal was to chow that a different moral boundary, between the permissible and impermissible, does not coincide with the boundary between treatments and enhancements, contrary to arguments some have made. To motivate our skepticism about calling genetically based or influenced enhancements impermissible, we examined the considerable liberty parents have to pursue the best for their children. Their pursuit seeks to influence phenotype in ways that confer competitive or other advantages on children. We found no reason to object in general to using genetic influences any more than environmental ones in the pursuit of such advantages. We did, however, find that some efforts to pursue advantage (whether genetic or environmentally influenced) may reasonably be restricted. In some cases, these are self-defeating and pose threats to public goods. In others, they raise objections to fairness. In still others, the risks involved in the pursuit may make them unacceptable.
Our discussion has complexified rather than simplified. Rather than finding the clear moral boundaries that some claim, we find quite blurred ones. Even where we raise objections to some efforts of parents to seek the best for children as they see it, the guidance we can give to limits on these efforts is limited to offering principles that are themselves plagued by unavoidable vagueness. Just what, for example, is meant by preserving an open future for children? Just which differences in benefits create unacceptable problems of fairness? Our defense for muddying the waters is that the moral world is often complex and defies simplified heuristics for drawing moral lines in the sand.
In the next chapter we consider in detail a quite different reason for constraining the use of genetic interventions, whether undertaken willingly by parents or required by social policies designed to prevent harm: the claim that the attempt to prevent genetic impairments devalues persons with disabilities.
.. We are not claiming that the structure of inequality is the sole basis on which to judge the fairness of different cooperative schemes, only that it is a relevant basis. A feudal system that gave special rights, privileges, and wealth to an upper 10 percent of the population but treated all below that level the same way is not, therefore, as fair or just as the British National Health Service, which also has the top 10 percent of the population buying better service, while the remaining 90 percent are treated similarly. The structure of inequality nevertheless is relevant to distinguishing between the British and Oregon systems of rationing health care (for we can then assume rough equality between the populations with regard to the distribution of other important liberties and even with regard to overall wealth of the two systems).