Within the last few months, a couple of studies by researchers at UCL have been released demonstrating the potential benefits of gene therapy. Six patients with Hemophilia B were treated; four of whom no longer need their usual treatment. And 14 out of 16 children with two different immune system disorders have been successfully treated. These, and a number of other studies, demonstrate that gene therapy is likely to help treat a wide range of diseases over the coming decades. Faulty genes will be replaced with functional ones, many being delivered to us using nature’s very own cell-invasion specialists: viruses.
But why stop at disease? If one views medicine as something that should be concerned with maintaining or increasing our well-being and not merely about fighting disease (for example, by providing access to abortion and providing palliative care), then we should be using genetic engineering for enhancement, as well as therapeutic, purposes. Indeed, if one is concerned about well-being, then there is no clear dividing line between enhancement and therapy.
As well as limiting genetic disease, it will become possible to create designer babies with genetically-enhanced intelligence, strength, beauty, even happiness and (arguably) moral virtues (or at least an increased potential for empathy). In fact, designer babies already exist to an extent: whenever a woman has an abortion on grounds of a foetal genetic disability or disease, she is choosing not to accept the non-intentional ‘design’ nature has provided her baby with. The same is true of IVF, where embryos can be selected on grounds of expression of certain genes. Whether these forms of selection can be considered ethical depend on both the traits being selected for/against, and the attitude of the parent(s). Genetic technology could be used to enhance beneficial traits or fix defective traits without requiring selection of ‘good’ embryos and the associated death of those embryos not selected.
It can be argued that genetic engineering should be restricted to individuals who consent: embryos and gametes cannot consent, therefore we should not attempt to enhance them. Under this view, genetic engineering becomes just another tool alongside other forms of enhancement for individuals to use if they desire once they are old enough to be capable of autonomous decisions. These other forms of enhancement include already-existent drugs (e.g. Modafinil, caffeine, ritalin, steroids) and ones not yet developed. Computer devices that directly interact with the brain, allowing improved memory and intelligence, are a possible future form of enhancement. Arguably current calculators, phones and computers are a form of ‘extended cognition’ and therefore a form of cognitive enhancement.
However, by relegating genetic engineering to consenting individuals, we would be severely limiting the benefits of it both to society, and to the individual, who may well have consented to his enhancement before his birth had he been able to. Certainly, it seems unlikely many people would object to being created as more intelligent, healthier and happier. Enhancement of consenting adults would likely be far more costly and carry more risks than enhancement of an IVF embryo. I shall take it as given that most people would support genetic enhancement of embryos for these general traits (even if intelligence, health and happiness are not easy to define).
But when you look at specific traits, it is far less clear whether people would support being selected according to the wishes of their parents in a sort of ‘genetic supermarket’ (as Robert Nozick puts it). It could lead to children being used solely as a means to their parents end. Perhaps the parents really want their child to be a professional athlete. So they select genes that will lead to a physically stronger, more muscular, child than if left to chance. Yet what if the child rejects this, and grows up wishing to be a violinist, but finds the type of physical strength imposed upon him actually limits his ability to perform the instrument? It seems that letting parents choose particular traits will remove or limit what some philosophers have called ‘the child’s right to an open future’, and what Habermas calls being ‘an author of one’s own life’*.
Allowing parents to choose could lead to traits being selected purely based on cultural norms, leading to generations of genetically-similar babies, depending on what is in fashion at that time. It could lead to the selection of traits, that whilst being beneficial to an individual if few others possess that trait, becomes pointless or even detrimental if enhanced on a society-wide scale. Any advantage of being taller is pointless (and a waste of resources) if everyone is taller by the same degree (the benefits of height relative to others is a ‘positional good‘). If everyone was made more competitive rather than accepting/cooperative, it would arguably reduce quality of life and lead to increasing conflicts across society. There are also issues of distributive justice; could only rich parents afford to shop at such a supermarket, leading to greater social inequality as the rich reap the benefits of enhancement, maintaining their privileged position?**
These problems with letting parents choose imply there should be some level of state regulation. Yet excessive regulation would likely lead to the creation of a black-market. Allowing the state to dictate which traits are acceptable or not to enhance implies it has a better or more valid conception of a ‘good life’ than individual parents. Certainly there will be some parents out there capable of making ethical choices that may be superior to that sanctioned by the state, whose choices would be lost in such a system. It would also instigate fears of a slippery-slope towards a Nazi-esque eugenics policy where traits are unjustifiably selected against, or where certain nationalism-promoting traits are selected for (though I feel this is highly unlikely to occur within a stable existing liberal democracy and is merely unhelpful scaremongering).
Given the potential problems with both a free-market and a government-regulated approach to genetic enhancement, it is tempting to argue we should stop all forms of genetic engineering in humans. But this would likely lead to even bigger black-market and the associated criminality, with parents trying to hide their genetically enhanced children from the law etc. And it would mean abandoning the massive benefits genetic enhancement could bring across society. It seems we must accept some forms of genetic enhancement. But what forms? And is there a particular system we could set up to minimise the potential harms of both parental and governmental selection of traits, whilst maximising the benefits?
* Given that the child would arguably not exist (as psychologically the same person) without the parents making this selection means it is difficult to claim that the child has been harmed by the parents, unless the parents deliberately select a trait that causes such severe suffering that death/non-existence would be preferable to experiencing life with that suffering. However, a child that does come into existence solely as a consequence of parental choices could be seen to have a better or worse existence than one that would have come into existence had the parents made other choices.
The fact that parents already often seek to impose their wishes on their children does not justify extending this to genetics. It is equally wrong to impose excessive social pressure, for example, in the form of unwanted athletics coaching…though just because a child doesn’t want something doesn’t mean it is always wrong to impose it upon them!.
**I do not view unequal access to be a serious problem, provided steps are taken to ensure access is opened up to all. Most new technologies are expensive when they first come out, but that is not a reason to oppose them. We do not oppose the development of cars, computers or expensive chemotherapy just because poor people in other countries cannot afford them. Many technologies experience a rapid fall in cost after originally only being available to the richest few, ultimately benefitting the whole of society.