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A Moderate Approach To Enhancement
Michael Selgelid offers a cautionary perspective on genetic enhancement.
Revolutionary developments in biomedical science, particularly in genetics, may lead to new cures or preventative therapies for a wide variety of human diseases. Just about everyone agrees that this would be a good thing. However, the very same kinds of developments that may be used to combat disease might also be used for the purpose of human enhancement – that is, to make people ‘better than well’.
Consider genetic testing, for example. Genetic testing of embryos produced by in vitro fertilization (IVF) can allow us to detect genetic sequences known to be associated with a wide variety of diseases before embryos are implanted in the mother’s uterus. Couples can thus increase the likelihood of having healthy offspring by choosing to implant only those embryos that test negative for genetic diseases. As knowledge about the relationship between genes and human traits increases, we will be able to detect genetic sequences associated with a wide variety of positively desired characteristics too. Many parents might then want to select for traits such as increased height, intelligence, strength, beauty, and so on, with the aim of giving their children higher-quality lives. The limits would depend on the extent to which a genetic basis for such traits is eventually demonstrated by genetic science. We can imagine a future where each embryo produced via IVF receives a ‘genetic report card’, indicating predispositions to a large number of advantageous as well as disadvantageous human traits.
Similar possibilities may arise via genetic engineering. When diseases are caused by an individual lacking an important genetic sequence, or having a disease-causing genetic sequence, it might eventually become possible to insert the missing sequence, or replace the pathogenic sequence with a normal sequence, via ‘genetic therapy’. If and when such procedures are perfected, it might also be possible to alter an individual’s genome purely for enhancement purposes. Genetic sequences associated with normal stature, for example, might be replaced by those associated with greater than average, or even exceptional, height; genetic sequences associated with normal cognitive capacity might be replaced by those associated with greater than average, or even exceptional, cognitive capacity, and so on. The limits will depend again on the extent to which relationships between genes and human traits are eventually demonstrated by genetic science, and in this case, also on the extent to which it becomes technically possible to make precise changes to human genomes.
This of course raises questions about whether or not non-therapeutic enhancement-oriented genetic interventions are morally permissible, and whether or not they should be permitted legally. Most people agree that using such procedures to reduce disease would be relatively non-problematic, at least if these procedures can be shown to be safe and effective. On the other hand, many object to the idea of using biomedical technology for the purpose of enhancement. But why should this be so?
The Good of Individuals Versus the Good of Society
Advocates of enhancement often point out that enhancement is, by definition, a good thing. ‘To enhance’ means ‘to make better’. So when we are talking about true enhancements, we are necessarily talking about making people better off than they otherwise would have been in terms of their overall wellbeing. In the case of genetic screening in the context of IVF, we are talking about parents choosing embryos that, based on the best available information, they expect to have the healthiest or happiest lives. What, one wonders, could possibly be wrong with that?
The best objection to true human enhancement appeals to potential adverse social consequences. In other words, it might be good for enhanced individuals, but bad for society as a whole. In particular, the practice of human enhancement would be expected to lead to increased social inequality. If the kinds of genetic technologies discussed above are indeed developed, then they will presumably only be available to those with the money to pay for them. It is hard to imagine that they would be made freely available to all via universal healthcare systems, which, due to resource constraints, are often unable to provide even medically necessary services to all who need them. So the relatively wealthy will then be able to enhance themselves and their children while the relatively poor and their children will remain unenhanced, or at least less enhanced. The (more) enhanced richfolk will then have even greater competitive advantages than previously. The divide between the haves and have-nots will inevitably increase, and become more intractable. Or so the argument goes.
This kind of appeal to equality is routinely made by those opposed to genetic enhancement. Advocates of genetic enhancement routinely reply by pointing out that we already tolerate a wide variety of inequality-promoting non-genetic enhancements. The wealthy send their children to special schools, sports camps, music lessons, and so on – and these things increase the advantages of those children who are already advantaged in other ways. What, genetic enhancement advocates ask, could be so different about genetic enhancements that they would be wrong, while other non-genetic kinds of enhancements are perfectly acceptable? Given that it is hard to imagine what could be so special and different about (true, safe and effective) genetic enhancement per se, they conclude that genetic enhancement must be acceptable too. They often appear to think this should be an argument stopper.
However, this argument in defense of enhancement is not altogether convincing. It might be true that there is no inherent moral difference between genetic enhancement and the other kinds of enhancements enumerated above. But there could very well turn out to be important differences in scale. If enough genetic enhancements become available, their use becomes sufficiently widespread, and they turn out to be especially powerful in their effects on people’s capacities, then the extent of their impact on equality could turn out to be much greater than that which results from currently available non-genetic means of enhancement. According to some authors, the threat to equality posed by genetic enhancement may be unprecedented. Existing kinds of enhancements might be tolerable because we value the liberty of individuals to pursue them, and because the inequalities that result are not bad enough to justify our infringing on this liberty. On the other hand, if the consequences of the inequalities were bad enough, then liberty considerations might be outweighed by equality considerations.
In addition to being unjust, deep inequality can compromise democracy and social stability. Severe inequality can thus make everyone significantly worse off. And the use of genetic enhancements could have adverse effects on society in other ways. One less frequently discussed concern about the social consequences of enhancement is that if it becomes especially profitable to develop and offer genetic enhancement services, then this will drain medical research and healthcare provision resources away from disease treatment and prevention.
We are already faced with a situation known as the ‘10/90 divide’: 90 per cent of medical research resources focus on diseases that account for 10 per cent of the global burden of disease. This is because the majority of medical research focuses on developing the drugs and other interventions expected to make the most profits, rather than those that are most important from a global public health perspective. We can imagine that this situation will only be exacerbated if the provision of genetic enhancement services turns out to be highly profitable. If a drain of resources thus occurs, the quality of life improvements overall made by enhancement may turn out to be less than would have been achieved if those resources had instead focused on disease reduction and the prevention of suffering.
Questions about the ethics of genetic enhancement thus turn both on unresolved empirical questions and on unresolved philosophical questions.
There are unresolved empirical questions about (1) the extent of inequality that would likely result from an unrestricted practice of human enhancement, and (2) the overall impact that an unrestricted practice of human enhancement would have on human wellbeing. We cannot predict such consequences with certainty, of course, but interdisciplinary social science research, including sophisticated modeling and so on, could shed some light on the potential impact of genetic enhancement under various scenarios – that is, depending on the kinds of genetic enhancements projected to become possible. In the meantime, it is surprising and unfortunate that so many philosophers have spilt so much ink on speculative discussion about what the social consequences of genetic enhancement are likely to be – telling just-so stories about why the impact of genetic enhancement on social equality or welfare will or won’t turn out to be problematic. These philosophers should more often admit that questions about the likely impact of enhancement ultimately require empirical research by those with the appropriate expertise for conducting it. They should refrain from pretending that these empirical questions are really philosophical questions.
The spectre of genetic enhancement does, however, also raise important and difficult philosophical questions – but these have received insufficient attention, being only very rarely explicitly addressed in the burgeoning literature. The key unresolved philosophical questions concern how the value of personal liberty should be weighed against social equality and welfare in cases where these values conflict.
Liberty is an important value, and there are widely-accepted presumptions in favour of its protection unless there are very good reasons for interfering with it. Liberty is rightly considered especially important in the context of reproduction in particular. Insofar as we place an especially high value on reproductive liberty, we should be reluctant to restrict parents’ choices regarding the genetic enhancement of their offspring.
However, liberty should not be thought to have absolute priority over all other values. Liberty, equality and welfare all matter, so none should have absolute priority over the others. Thus if the social costs of the unrestricted practice of genetic enhancement are sufficiently great (ie, disastrous) for welfare or equality, then the importance of individual liberty might be outweighed by the importance of these other values. The unresolved philosophical question is thus: How socially damaging would enhancement need to be in order for personal liberty to be justly overridden? This points to a need for theoretical development in the fields of ethics and political philosophy.
At present there are three main approaches on the table. First, utilitarians argue that aggregate benefit is the only thing that ultimately matters to society, and so ‘utility’, the greatest benefit for the greatest number of people, should always be promoted, even at the expense of liberty and equality. By contrast, egalitarians often place extreme weight on the value of equality; and libertarians place extreme weight on the value of liberty. Each of these perspectives gets something right, because the values they respectively emphasize each matter. But they each arguably get something wrong too, insofar as they each tend to place absolute or overriding weight on the values they emphasize. In this latter respect they are out of line with commonsense ethical thinking and what is generally considered to be good policy-making. To resolve questions about genetic enhancement, and many other difficult issues in practical ethics, we need a fourth approach that provides a principled way of striking a balance or making trade-offs between liberty, equality, and utility in cases of conflict. Development of a ‘moderate pluralist’ theory such as this would be necessary to determine how great the costs of enhancement would need to be for us to be justified in denying people the freedom to enhance themselves and their offspring, and to what extent.
© Dr Michael J. Selgelid 2012
Michael Selgelid is Director of the Centre for Human Bioethics at Monash University in Melbourne.