I originally wrote this as a piece for a campus group at the University of Pennsylvania, about a year ago. Bioethics is a tricky area because it makes us confront not only our ethical intutitions on morally sketchy issues, but it also throws in metaphysical curveballs by making us ask “for whom?” and “how exactly?” on issues that are otherwise grounded in certainty.
What would be the existential implications if we could cure basic ailments via genetic and biological engineering? What if we could extend our lives by 20 years? 50? 100? Would you live any differently?
We could be free of an infinitude of maladies both of body and mind, and even also possibly the infirmities of age, if we had sufficient knowledge of their causes, and all the remedies with which nature has provided us.
— Rene Descartes
The modern age has brought with it a slew of advances that improve not only our material lives — high speed internet, cheap air travel, smartphones, refrigeration, plastics, etc — but also great advances in the field of medicine. Typically, medicine has existed in two states: preventative and curative. Preventative care is primarily concerned with health and fitness, keeping potential patients in good mental, physical, and emotional shape so that they don’t require future care. Curative care is primarily concerned with treatment of ailments currently afflicting the patient. With the development of wide-scale vaccinations in the 20th century, preventative care extended itself into the realm of near-sureness. In addition to boosting the patient’s immune system and guarantee a generally healthy outlook, medicine could now be used to nearly guarantee that patients won’t require treatment for ailments formerly left up to chance (e.g., polio, smallpox, diphtheria). We had entered the beginning of what was sure to be a brave new world.
Fast forward nearly half a century, and preventative care has extended itself into the realm of prenatal care. With advances such as ultrasounds and chromosomal testing & mapping, we now present potential parents with knowledge they formerly would have waited until birth or later to discover of their children. For some cases, this allows potential parents to abort the fetus before birth if it is found the fetus suffers from horrific birth defects or will live a truly miserable and brief existence. Separate from the ethics of abortion, this brings with it little in the way of moral debate. That doesn’t mean advances haven’t brought with them a moral debate, though.
Before looking at this debate, let us remind ourselves what wondrous and beautiful potential our ability to alter the genetic makeup of humanity gives us. We hold in our (metaphorical) hands the ability to cure some of the worst and most horrific human afflictions, either by removing them from our genes or by hardening our genetic disposition against them to the point that they will not bother us. In the long run, we are looking at the potential to cure humanity of the oldest curse to afflict it: death. In time, we can genetically modify ourselves and our offspring to the point that the days of people dying from disease (or even old age!) will seem like the dark ages of human existence. A fear of this bright new age, unless it is couched in something else like a fear of abuse by parents or by the state, is tantamount to fearing industrialization because it will put the shoe cobblers out of work, or of being afraid of vaccines because of the scary names of the chemicals of which they consist. Do not be bullied into fearing this bright age of human progress by those who don’t understand it. Embrace it, and embrace it with the skeptical questions that progress deserves.
Engineering Humanity: Whose Choice?
Recent advances in genetics bring more murky moral water to the table than vaccines may. Not only can we map out and test chromosomes, looking for potential genetic disorders and diseases, we are on the verge of actually being able to alter these chromosomes. A gene for Klinefelter’s Syndrome? Gone with a quick genetic altering. Increased risk for destructive behaviors? No longer there after a trip to the genetic consultant. Though these may seem uncontroversial enough — surely everybody would want to make sure their child was born healthy — what happens when we delve further down the genetic rabbit hole? Who should get to call the genetic engineering shots? And, furthermore, which shots should be on the table?
The first question can go one of two ways if we grant the permissibility of genetic engineering: state-imposed or liberal eugenics. Consider them in that order.
State-imposed eugenics: This need not call to mind horrific pictures of 1930s and 1940s Nazi Germany (or even the Progressive states of the early 20th century United States…), but perhaps a more charitable view is that of the quasi-utopian-quasi-dystopian world of Huxley’s Brave New World. After conception, all potential parents are required by law to report to the hospital for a genetic screening. Traits deemed unhealthy or undesirable by an agency such as the Department of Health and Human services would be treated and removed by genetic counselors. In this view, the shots are called by health professionals in conjunction with state administrators.
Liberal eugenics: Liberal eugenics, on the other hand, is generally not associated with eugenics qua eugenics. In fact, liberal eugenics is practiced every day by nearly every reproductive couple on the planet. Liberal eugenics simply refers to a system in which the potential parents make the calls as to which traits they wish their offspring to possess. With genetic counseling, the scenario would appear as such: after conception, potential parents decide whether or not they wish to visit a genetic counselor. Should they choose to do so, after genetic testing is completed, they make the call as to what they want treated in their potential offspring.
Each system has pros and cons associated with it.
For state-imposed eugenics, its positive effects can be imagined in “think of the children!” objections. If parents choose not to genetically alter their offspring despite an incredibly high, even certain, possibility that the offspring will be born with a horrific genetic disorder or birth defect, the state can intervene and require the genetic treatment to take place for the sake of the child, on this account. Similarly, if potential parents choose to alter their children to the point that they will live horrible lives, or even altered to be made worse-off, then the state can prevent these alterations.
However, the costs associated with a state-imposed eugenics program likely outweigh any benefits. For one, the state-imposed paradigm could easily be abused to institute a highly undesirable level of eugenics, similar to that of the early 20th century United States or to 1930s and 1940s Nazi Germany. Socially-marginalized groups who may have some worries under a liberal eugenics program would surely have greater worries under a state-imposed program, as any state administrator who decided that any trait was “undesirable” could have it removed from the populace by force. On a less-societal level, the state-imposed program is a clear violation of not only the parental rights of the the potential parents, but also of the bodily rights of the mother (or surrogate). It would take a shockingly utopian view of government and blind trust in it as an institution to trust the state-imposed system.
Liberal eugenics sidesteps many of these problems by leaving the choices to the parents. Any concerns about the bodily rights of the mother (or surrogate) are avoided since the mother would have to choose to attend the therapist herself, and not at the point of the state’s guns (concerns about the mother being pressured into treatment by the husband are not unique to worries of liberal eugenics…they’re problems generally associated with reproductive and marriage law in general). Parents and their doctors and consultants would know better than any bureaucrat what best fits their future offspring. Denying them the right to do so, either by denying the right to genetically modify outright, or by transferring that right to the state, is not only a violation of a basic tenet of liberal society, but also a violation of that future child’s autonomy. “Designer babies” should be a realistic option for potential parents.
Let’s Abolish Afflictions
There arise two sets of objections when asking to what extent we should allow potential parents to genetically alter their offspring. The first is set is one of identity-politics: what do we consider undesirable? If we allow parents to genetically alter out a trait, do we deem people with those traits as “worth less”? The second set is one of child-welfare: What even counts as bettering the offspring? Should we let parents make questionable decisions?
Undesirable Desireds: A Choice Between Realistic Alternatives
The first objection is grounded in a fear that genetic engineering will lead to potential parents designing their babies with a desire to remove certain traits the parents deem undesirable. These may be legitimate medical conditions such as deafness (which is a decision attacked by the Deaf community), or preprogrammed genetic preferences such as sexual preference. Modifying your child to be able to hear sends the message that a deaf version of the child is undesirable, and that, therefore, deaf persons are undesirable or worth less than their hearing counterparts. Modifying your child to be straight, rather than gay, sends the message that the straight version of the child is more desirable than the gay version of the child. This scenario can be played out with almost any trait that groups of persons use to identify themselves.
It is a serious and legitimate objection to genetic modification, as we would not want to create a society of first and second-class citizens out of this gift of modern medicine. Persons should feel comfortable in their bodies, regardless of the decisions of their parents while they were a fetus in the womb.
However compelling this objection may seem at first glance, it makes two errors. First, it commits what is known as the composition fallacy. Simply because a certain trait is undesirable, or simply because it would be preferred that the trait not exist in the child (e.g., deafness, or having hearing is better than not having hearing), that value judgement does not automatically transfer to make a statement about the child itself. I can prefer that my child have 20/20 vision without thinking they are less worthy of my love because they are nearsighted. This even applies to traits and characteristics that some persons use to identify themselves by. Members of the deaf community identify with their deafness and see it as an integral part of themselves. But simply because some parents decide they would not want their children being able to join that community because it comes at far too high a cost for them does not mean that their community is without value. Furthermore, who are the members of these identity communities to tell parents what rights they do and do not have over not only their bodies, but their offspring?
Even deeper, though, is a serious practical concern when approached with issues of non-medical relevance — such as altering a child’s genetic makeup so that their sexual preferences are more heterosexual than homosexual. In a world of tradeoffs, we must choose between realistic alternatives. Failure to do so subjects us to a nirvana fallacy. While it would be great to say that a child who is predisposed to be born gay should be born that way and accepted by their parents, this may not always be a realistic choice. If the parents, for whatever irrational reason, are staunchly homophobic, is it not better for the child that it is born straight? In other words, is it not cruel to say that homosexual children should be subjected to being raised by staunchly homophobic parents because we think that genetically altering the child to be born predisposed to heterosexuality may make a statement about the value of homosexuality? The options are to allow a gay child to be born to bigots and to suffer for it, or to allow a straight child to be born to bigots, and to suffer to a much smaller extent. The latter option seems immensely more humane.
Think of the Children! But how?
Another concern with allowing parents to genetically modify their children is that sometimes they will make the wrong choices. Generally, when adults make bad choices, we allow them to suffer the consequences of doing so. To do otherwise would be to infantilize them and act paternalistically. But what about when their decisions harm other future people? This is an unsettled question in bioethics, but it shouldn’t prevent us from trying to tackle it.
Questions concerning children are unique because they generally are not autonomous and lack many of the decision rights that adults can make. Parenting rights are even more problematic, because the children are treated as wards of their parents until they reach a certain (undetermined) point. What do we do, then, when we have potential parents who want to make their childrens’ lives worse-off than they would otherwise have been?
This could be boiled down to a debate on what constitutes “worse-off,” and that can then be translated into a debate on welfare. Without entering too deep into the weeds on welfare ethics, we want to strike a balance between granting the future child autonomy, but also making them physically better off (i.e., a balancing act between autonomy theories of welfare and hedonism).
At a point in the future, the child will have more rights than their parents to decide what happens to them and to their body. At this point, we generally no longer refer to this person as a child, but as an adult. The kind of adult they mature into is contingent on decisions made by their parents, though. So the decisions the parents make are going to influence what options they have in life. This is a problem for raising children in general, of course, but it grows even more worrisome when it is not just the material decisions of the parents that will affect how the child grows up, but the medical decisions. We generally perceive that women who do hard drugs or drink while pregnant are not only doing something unethical, but that they should be held liable for the pain and lost opportunities they bring their offspring.
At this point, one is tempted to shift closer to the state-imposed eugenics system, where the state may offer a buffet of options that a potential parent may choose at genetic therapy sessions. This isn’t necessary, though, and we should worry about any moves towards the state-imposed system for the reasons outlined above. Rather, one possible solution is to impose civil court penalties to parents who are knowingly reckless with their genetic therapy. This solution does run into metaphysical problems of its own, but provides a realistic alternative to the state-imposed system. Under this system, a person who is born with a disorder due to the reckless therapeutic decisions of their parents can sue in civil court for damages. Having this option available would be a disincentive to potential parents and a reason for them to seriously consider the pros and cons of any genetic alterations they choose to make or not to make.
Genetic Engineering: A Beacon of Hope
Genetic engineering provides a beacon of hope not only for humanity as a whole, something to free us from the afflictions which have haunted us since our birth as a species, but also for the millions of potential parents and their offspring who may suffer from genetic and birth disorders. There are serious concerns about what should and shouldn’t be permissible within the realm of genetic engineering, but these concerns are not great enough to give us cause to snuff out this beacon.