Genetic screening - should parents seek to perfect their children genetically

Do parents really have a right and duty to ‘perfect’ their children genetically, including their already normal children?. In this chapter, I will argue that although parents have a limi

Genetic screening: should parents seek to

perfect their children genetically?

Rosemarie Tong

Department of Philosophy University of North Carolina at Charlotte, Charlotte, USA

As the Human Genome Project nears completion, our knowledge about genes linked to human diseases and defects is growing at a dramatic rate It is already possible to test embryos for several conditions at the pre-implanta-tion stage (through pre-embryo biopsy) and to test fetuses for even more conditions during the course of their gestation (through amniocentesis, chorionic villus sampling and umbilical cord blood sampling) (Robertson, 1994: pp 155–60) At present, pre-implantation and prenatal screenings focus on severe genetic diseases (Strong, 1997: p 137) In the near future, however, there will be increased ability to test for mild diseases, late-onset diseases, treatable diseases, propensities for common diseases, and even non-disease characteristics such as longevity, height and body-build (Strong, 1997: p 137)

Although genetic knowledge of this type may strike us as an unalloyed blessing, ethicists worry that such information might fuel parents’ increasing desire for perfect progeny Up until very recently, parents could not do much

to guarantee for themselves the child of their dreams At most, if their moral views permitted, they could discard a pre-embryo or abort a fetus that tested positive for a relatively small range of genetic maladies, such as Tay–Sachs disease, Down’s syndrome and Fragile X (Robertson, 1996) However, as soon as safe, eVective and beneWcial genetic therapies for embryos and fetuses are developed, parents will have the option of repairing or changing rather than destroying their progeny, an option bound to please those who believe that human life should be protected from the moment of conception on-wards (Mehlman and Botkin, 1998: pp 55–87) But the availability of gene therapy will produce in its wake a new set of ethical issues, no less serious than the ones currently preoccupying us Some people will not want to use gene therapy for any reason whatsoever, claiming it is too risky, unpredict-able or ‘unnatural’ Others will argue that gene therapy should be used, but

for therapeutic purposes only (i.e for the elimination of genetic diseases and

defects) Still others will insist that provided it works well, gene therapy

should be available for non-therapeutic or enhancement purposes (i.e for the

‘engineering’ of a better-than-normal child) as well as for therapeutic pur-poses (Parens, 1998)

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Since it is the position of this last group of people that most concerns us, the question I wish to pose is this Assuming the successful development of a wide range of safe and eYcacious genetic therapies, should parents be encouraged to perfect their children through genetic means – as well as traditional environmental means such as education? To this query many people will, I suppose, answer with an immediate ‘yes’ They will reason that parents should do everything in their power to enhance their children SpeciWcally, parents should begin by striving to create the best possible uterine environment for their progeny In particular, pregnant women should refrain from drinking alcohol, smoking tobacco and ingesting a wide range of illicit and licit drugs during pregnancy (Matthieu, 1996: pp 9–11)

As prenatal gene therapies develop, pregnant women should also permit physicians to penetrate their bodies, more or less invasively, in order to treat their fetuses’ genetic maladies or simply to improve upon their genetic endowments Finally, parents should provide their children with as many safe, eVective and beneWcial postnatal genetic and environmental enhance-ment therapies as they can reasonably aVord After all, isn’t it only right for parents to provide their children with such opportunities?

Conceding that the above line of reasoning sounds level-headed and enlightened, I none the less fear its darker side Do parents really have a right and duty to ‘perfect’ their children genetically, including their already normal children? For that matter, do parents really have a right and duty to ‘perfect’ their children environmentally? In this chapter, I will argue that although parents have a limited right to enhance their already normal children geneti-cally, and, conceivably, also a limited duty to do so, they should not be encouraged to do so Indeed, society should actively discourage parents’ quests to ‘make’ perfect babies (Kass, 1985) It should do so, however, not through legal bans or prohibitions on the development of genetic therapies, but through: (1) the development of practice guidelines for health care researchers and practitioners specializing in genetic screening, testing, diag-nosis, counselling and therapy; and, even more importantly, (2) the creation

of democratic fora designed to achieve some sort of public consensus about the extent of parents’ procreative and rearing rights

Do parents have a right to enhance their children

genetically?

The US lawyer John A Robertson has analysed in great detail parents’ rights

to select their oVspring’s characteristics (Robertson, 1994: p 152) As Rober-tson sees it, the speciWc right to select oVspring characteristics is linked to two

more general rights: (1) a parent’s right not to procreate children because of

the more or less burdensome aspects (physical, psychological and social) of

reproduction; and (2) a parent’s right to procreate a child with particular

characteristics (e.g., a child who will resemble his or her parents, or a ‘normal’ child) This second right derives from ‘the great importance to individuals of having biologic oVspring – personal meaning in one’s life, connection with future generations, and the pleasures of child rearing’ (Robertson, 1994:

p 153) Since negative selection activities (carrier screening, pre-implanta-tion screening, prenatal screening and aborpre-implanta-tion) and positive selecpre-implanta-tion activ-ities (therapeutic ex utero or in utero genetic manipulation) enable parents to select oVspring traits, Robert-son views these activities as protected by a person’s procreative liberty

Robertson notes, however, that like all rights, procreative rights are limited They protect ‘only actions designed to enable a couple to have

normal, healthy oVspring whom they intend to rear’ (Robertson, 1994:

p 166) Actions that aim to produce oVspring who are supernormal (enhan-cement), subnormal (intentional diminution) or clones, says Robertson,

‘deviate too far from the experiences that make reproduction a valued experience’ to be protected by procreation liberty rights However, some of these non-therapeutic actions – those aimed at enhancement – might be viewed as part of ‘parental discretion in rearing oVspring’ (Robertson, 1994:

p 167) Parents presently seek to improve their children in a variety of ways For example, many parents send their children to the best schools, give them music, art and drama lessons, have their teeth straightened, and so on Some parents go much farther than this, however In the name of ‘bettering’ their children, parents submit their children to sex-alignment operations, certain cosmetic surgeries, growth-hormone treatments, Ritalin therapy and multiple doses of Prozac So long as parents can show that such interventions are safe, eVective and beneWcial, state authorities will not interfere with parents’ child-rearing activities Given that this is the case, Robertson reasons

that state authorities are not likely to interfere with genetic enhancement interventions, although they would be likely to interfere with genetic

dimin-ution interventions.

Implicit in Robertson’s view is the idea that, ordinarily, enhancement of a fetus is beneWcial, but that diminution of a fetus is harmful Robertson’s ideas about what constitutes a harm seem to be roughly equivalent to those of Norman Daniels, who views as harmful any actions that detract from so-called species-typical functioning (Daniels, 1986: p 28) If it is typical for the human species that its members be able to hear and see, for example, deliberately deafening or blinding a fetus is harmful to the fetus But the

question remains whether, according to Daniels’s view, actions that add to

species-typical functioning are also harmful My reading of Daniels’s argu-ments suggests that, on the contrary, he would view such actions as beneWcial

So long as every member of the species can do what is typical for the species reasonably well, it matters not that some members of the species can do it

exceptionally well In fact, it might be a good thing if every member of the species could be a ‘peak performer’

Given the reasonability of Robertson’s and Daniels’s implied positions on enhancement, it is diYcult to identify what might, in the end, be harmful about enhancing one’s progeny Interestingly, in the course of explaining why

it would be wrong for deaf parents, who view deafness as a valuable culture rather than a disability, to use genetic therapy prenatally to ensure deaf children for themselves, the lawyer Dena Davis (1997) provides some clues Davis concedes that since people have diVerent ideas about what counts as an enhancement and what counts as a diminution, deaf parents, wishing to ensure deaf children for themselves, might reasonably argue that the lifestyle

in the deaf community is a good one for children – indeed, according to Lennard Davis (1995), a better one than the lifestyle for children in the non-deaf community In essence, deaf parents might argue in the manner Amish parents argue when they defend their practice of limiting their children to an elementary school education on the grounds that further formal education interferes with the Amish system of home-based vocational training – i.e learning from your parents how to live a simple, ‘God-fearing,

agrarian life’ (Wisconsin v Yoder, 1972).

Although the majority of US society believes that it is the prerogative of parents to shape the values and lives of their children, comments Dena Davis, they still think that it is wrong for Amish parents, for example, to conWne their children to the Amish community before these children are mature enough to decide for themselves whether such a small world is the best world for themselves Davis notes that by depriving their children of the opportun-ity to secure a high-school diploma, Amish parents virtually ensure ‘that their children will remain housewives and agricultural laborers’ (Davis, D., 1997:

p 565) An Amish child who rebels against the Amish way of life for one reason or another willWnd himself or herself without the basic education he

or she needs to be anything other than an agricultural labourer or housewife

In Davis’s estimation, the parents of this child will have harmed him or her by

substantially limiting their child’s presumed right to control the course of his

or her own destiny Davis then reasons that if Amish parents harm their children by denying them educational opportunities, the lack of which will set them back considerably in the larger, non-Amish community should they decide to enter it, deaf parents would even more egregiously harm their children by using genetic diminution therapies to deprive them permanently

of their ability to hear Davis (1997: pp 569–70) comments:

[D]eliberately creating a child who will be forced irreversibly into the parents’ notion

of ‘the good life’ violates the Kantian principle of treating each person as an end in herself and never as a means only All parenthood exists as a balance between ful Wlment of parental hopes and values and the individual Xowering of the actual child

in his or her own direction Parental practices which close exits virtually forever are insu Yciently attentive to the child as an end in herself By closing oV the child’s right

to an open future, they deprive the child as an entity who exists to ful Wll parental hopes and dreams, not his own.

Although Davis’s arguments are directed against the practice of genetic diminution, the crucial question to ask for our purposes is whether geneti-cally enhancing a child ‘closes’ or ‘opens’ doors for him or her On the one hand, it seems that an enhanced child might have a more open future than a

‘normal’ child For example, a person with exceptional intellectual capabili-ties has the opportunity to pursue a much wider range of career options than

a person with minimal intellectual capabilities On the other hand, an enhanced child might have a future more closed than a ‘normal’ child if, for example, his parents enhanced his intellectual and rational capacities to such

a degree that his physical and emotional capacities shrivelled There is historical precedent for such a concern Using simply environmental means (education), John Stuart Mill’s father, for example, overdeveloped his son’s rational and philosophical talents, and underdeveloped his son’s emotional and poetic talents As a result, John Stuart Mill suVered a mental breakdown

as a young adult (Mill, 1956) Clearly, as in the case of parents who argue that they have a right to discipline, educate and medically treat their children as they seeWt, parents who argue that they have a right to alter their children genetically as they seeWt are subject to state interference if their actions prove harmful to their oVspring Parents do not have a right to harm their children, whether this harm consists in physical or psychological abuse, or in using genetic therapy to determine their children’s future

Do parents have a duty to enhance their children genetically?

The fact that parents have a limited right to enhance their children genetically does not mean they have a duty to do so, unless the term ‘enhancement’ is interpreted to include not only instances of making normal children better than normal, but also instances of making less-than-normal children normal (Juengst, 1998) SpeciWcally, if the necessary gene therapies were available, parents might have a limited duty to provide their oVspring with what LeRoy Walters and Julie Gage Palmer term ‘health-related’ physical, intellectual and moral genetic enhancements, but not also with ‘non-health-related’ ones (Walters and Palmer, 1997: pp 109–11) Among those health-related enhan-cements listed by Walters and Palmer are eliminating the genes associated with deleterious physical, intellectual and psychiatric conditions Since health-related enhancements are calculated to bring abnormal individuals up

to species-typical functioning only, they are, according to Walters and Palmer, to be distinguished from non-health-related genetic enhancements

intended to improve normal individuals who already meet the criteria for species-typical physical, intellectual and psychiatric functioning Among these non-health-related enhancements, Walters and Palmer include gene-mediated growth hormone treatment for short-statured children who are not growth hormone deWcient, increasing the eYciency of long-term memory and otherwise improving the cognitive functioning of people who already fall

in normal intelligence ranges, and, as a matter of speculation, stimulation of

‘friendliness’ genes in non-sociopathic persons Whether Walters and Palmer have drawn the line between health-related and non-health-related enhance-ments correctly is not the issue here, since some such division is plausible enough (Frankford, 1998) Here, the issue is whether parents really have a duty to use gene therapy to make their less-than-normal children normal One way to approach this issue is to reXect on the debate between those who think that parents have a duty to use contraceptives, sterilization procedures

or abortion to prevent the birth of a so-called defective child and those who

do not

Proponents of not procreating persons who fall substantially short of

‘species-typical functioning’ argue that it can be emotionally and economi-cally draining to raise less-than-normal children, especially if they have a serious genetic disease Furthermore, they argue it is not in the best interests

of such children that they should be brought into existence In this connec-tion, the feminist philosopher Laura Purdy (1996: p 58) has stated:

When I look into my heart to see what it says about this matter, I see, I admit, emotions I would rather not feel – reluctance to face the burdens society must bear, unease in the presence of some disabled persons But most of all, what I see there are demands of love: to love someone is to care desperately about their welfare and to

want for them only good things The thought that I might bring to life a child with

serious mental problems when I could, by doing something di Verent, bring forth one without them, is utterly incomprehensible to me.

Purdy believes it can be wrong to bring into the world a child with a serious genetic disease or defect She would prefer, however, that this type of child should never be conceived rather than it should be aborted subsequent to conception Purdy argues,Wrst, that since a non-existent entity can neither be harmed nor deprived of the kind of rights only existent entities have, it is not wrong to prevent its conception Second, she argues that people ought to have children only if they can provide them with a normal opportunity for a good life Thus, Purdy concludes that because of what most people presum-ably desire – namely, to nurture and love children who willXourish and live so-called good lives – carriers for genetic disorders which preclude a normal opportunity for a good life should not procreate with their own gametes Critics of Purdy’s statement express concern that her view reinforces the view of those who long for a society in which only perfect or nearly perfect

people are tolerated, precisely the kind of society which the ‘imperfects’ among us should fear The fact that our society is routinizing and normaliz-ing genetic screennormaliz-ing is, accordnormaliz-ing to these critics, a sign that our society might have eugenic aspirations after all Although in the past, clinicians recommended prenatal screening only for women over 35 years of age, women or couples carrying genes for genetic disorders, and women or couples who had previously procreated a child with a genetic disorder, they now oVer amniocentesis to women under 35 upon request (Asch, 1995:

p 387) Increasingly, pregnant women feel that they have not simply a right

to this kind of information, but a duty to get it and seriously to consider aborting their fetus in the event of serious genetic disease

The bioethicist Adrienne Asch is worried about society’s growing tendency

to view not only genetic disabilities such as anencephaly, Tay–Sachs disease, Hunter’s syndrome and certain other conditions that cause degeneration and death within theWrst months or years of life (Asch, 1995: p 386), but also non-fatal genetic maladies such as Down’s syndrome, spina biWda, cystic Wbrosis and muscular dystrophy, as reasons to terminate a pregnancy Asch believes that women should think long and hard before deciding to abort their less-than-normal fetuses She claims that there is no signiWcant moral

diVerence between a woman deciding to abort her fetus because the man with whom she planned to rear the child has suddenly decided to divorce her, and

a woman deciding to abort her fetus because it has a limb deformity In other words, as Asch sees it, it is one thing to abort one’s fetus because of something

‘wrong’ with one’s own life circumstances, and quite another to abort one’s fetus because of something ‘wrong’ about it Asch also claims that if it is unacceptable to abort a normal fetus simply because it is the ‘wrong’ sex, for example, it is also unacceptable to abort a less-than-normal fetus simply because it has a genetic malady Asch insists if it is wrong to abort a normal fetus solely because it is female, because doing so sends to women and girls the message that they are not valued as highly as males, then it is also wrong

to abort a fetus solely on account of its genetic malady, because doing so sends to persons with genetic maladies the message that they are not valued as highly as persons without genetic maladies Ableism, says Asch, is no less harmful than sexism

Since it is all too easy to cross the line that supposedly separates the ‘bad’ eugenics of the past from the ‘good’ genomics of the present (Pernick, 1996:

pp 159–66), I am inclined to agree with the view that parents have no moral

duty to abort their less-than-normal fetuses unless their fetuses’ genetic

maladies are incompatible with leading a meaningful life – i.e a reasonably happy and productive life Nevertheless, I am also inclined to think that should gene therapies be developed for conditions such as Down’s syndrome, for example, parents would have a moral duty to use them to treat a fetus or child aVected with Down’s Parents who would not avail themselves of such

an opportunity would have a diYcult time justifying their omission as being

in the best interests of their progeny Disability is not a good in itself Rather,

it is something with which all human beings, to a greater or lesser degree, must cope, so that they can discover or shape meaning for themselves within its limitations

But even if it is reasonable to argue that parents might have a duty to provide their less-than-normal fetuses and children with genetic therapies intended to make them normal, I do not think it is also reasonable to argue that parents have an equivalent duty to provide their already normal fetuses and children with genetic therapies intended to make them supernormal or extraordinary Although society praises parents who take care of their children, it does not believe that parents have an obligation to lavish all of their resources on their children to the extent of ‘spoiling’ their children with too many of society’s goods and services On the contrary, society believes that parents have a right to spend or not spend their resources on their children, so long as they do not abuse or neglect their children Thus, it is not wrong for a mother to spend money on dancing lessons for herself instead of for her child, so long as she does not, for example, spend the family’s entire food, clothing, rent and health care budget at the Arthur Murray Dance Studio It is wrong for a mother to spend money on luxuries for herself, if by doing so, she deprives her children of basic necessities A similar line of reasoning would Wt the case of genetic therapies intended to make one’s already normal children somehow ‘perfect’ Parents would not be obligated

to use their resources to improve on their already normal children, if the parents wished to use these resources for other purposes

Should parents genetically enhance their children?

Assuming, as concluded in the two previous sections, that although parents

do not have a duty to use genetic therapy to improve their already normal children, they have a limited right to do so – should parents be encouraged to exercise this right? To this query the lawyer John Robertson answers that if parents are bent on improving their children, it might be preferable to allow them to do so at the genetic rather than the environmental level He com-ments (Robertson, 1994: p 167) that:

If special tutors and camps, training programs, even the administration of growth hormone to add a few inches to height are within parental rearing discretion, why should genetic interventions to enhance normal o Vspring traits be any less legitimate?

As long as they are safe, eVective, and likely to beneWt oVspring, they would no more impermissibly objectify or commodify o Vspring than postnatal enhancement eVorts

do Indeed, prenatal enhancement might turn out to be preferable because an existing child will not be the immediate object of the e Vort.

Rather than subjecting an existing child to cosmetic surgery to straighten his

or her ‘ugly’ nose, why not make sure instead that the child is born with an appropriately-shaped nose so that he or she never has to feel badly about his

or her ‘ugly’ nose?

Robertson’s point is not to equate all prenatal and postnatal enhance-ments, nor to imply, for example, that since using Prozac to enhance a child’s personality is morally acceptable, then using gene therapy to stimulate a hypothetical ‘friendliness’ or ‘liveliness’ gene would also be morally accept-able Rather, Robertson’s point is that pre- and post-birth enhancements should be judged by the same criteria It remains an open question for Robertson whether parents should try to enhance their children at all, be it at the prenatal or postnatal stage The crucial issue is the nature and function of the proposed intervention and not its timing It may be just as wrong or right

to use Prozac as a postnatal personality pill as it is to alter a gene for shyness

or unfriendliness prenatally

Among the bioethicists who agree with Robertson that prenatal and postnatal enhancements aimed at one’s oVspring need to be scrutinized with the same lens is the philosopher Glenn McGee He makes the case (McGee, 1997: p 117):

that reproductive genetic enhancement can best be understood within a wider range

of other, more mundane parental decisions The basic choices parents make about schools and nutrition and our ambitions for our oVspring are inevitable and appro-priate enhancement decisions The question is not whether but how to enhance the lives and character of our children All parental enhancements are subject to some dangers common to our cultural experiences of parenting Paying attention to these takes us half the way to understanding why many genetic enhancements may turn out

to be a mixed blessing indeed.

McGee (1997: pp 123–33) claims that parents intent on enhancing their children are prone to sins such as ‘calculativeness’, ‘being overbearing’,

‘short-sightedness’ and ‘hasty judgement’ Parents might, for example, choose to enhance traits in their children which society suddenly views as undesirable instead of desirable; or they might become so systematic and rational about improving their children that they deprive themselves and

their children of a genuinely human parent–child relationship; or they might

put so much faith in the power of genetics that they forget the strong role which environment plays in human development; or they mightWnd them-selves with a child who, despite all their interventions, still falls short of their expectations Although such sins are ‘not-so-deadly’, says McGee, they should nonetheless be avoided by an ‘intelligent’ and ‘cautious’ approach to genetic enhancement Society should, he insists, ‘work toward developing

protocols and therapies [for genetic enhancement] experimentally and

grad-ually’ (McGee, 1997: p 132).

Some of McGee’s points are reinforced by feminists, such as the philos-opher Maggie Little She worries that parents might be tempted to use genetic therapies as well as environmental therapies, like cosmetic surgery, in order

to shape their oVspring to Wt societal standards of perfection, a largely media-driven set of criteria for human value, and one which reXects some of the worst features of a society that remains racist, sexist, homophobic, ableist, and so on For example, in a worst-case scenario, African–American parents might request lighter skin for their children, or parents of any race might request thin bodies and blond hair for their daughters Little views such requests as morally disturbing because ‘the norms of appearance at issue are grounded in or get life from a broader system of attitudes and actions that are

in fact unjust’ (Little, 1998: p 166) For African–Americans to want their

children to look more white than black is probably not ‘some aesthetic whimsical preference’ (Little, 1998) It is more likely a function of a racist history in which being black is devalued and being white is valorized Similarly, for parents to want their daughters to look like fashion models or movie stars is probably not some aesthetic whimsical preference either, but more likely, a function of a sexist history in which being an obese woman is penalized economically and emotionally, and being a thin woman is re-warded Rather than welcoming and encouraging diversity and change, many genetic enhancement activities would, in Little’s estimation, aim instead for homogeneity and the further ossiWcation of the unjust status quo

Concerns about justice also occupy Maxwell Mehlman and JeVrey Botkin

in their analyses of genetic technologies, including those aimed at ment As they see it, most of these technologies, but particularly enhance-ment therapies, will be accessible only to those parents who have insurance coverage, or who can aVord to pay for them out-of-pocket Mehlman and Botkin (1998: p 99) speculate that, as a result of this situation, society will be divided into two classes: a ‘genetic aristocracy’ and a ‘genetic underclass.’ They comment that the former group ‘would be virtually free of inherited disorders, would receive powerful genetic therapies for acquired diseases, and would be engineered with superior physical and mental abilities’ and that the latter group ‘would continue to suVer from genetic illnesses and would have

to content itself with less eVective, conventional medical treatments Its members would be able to improve their mental and physical traits only through comparatively laborious traditional methods of self-improvement’ (Mehlman and Botkin, 1998)

As bad as the consequences of this divide would be for the individuals in the genetic underclass, Mehlman and Botkin think that the worst conse-quence of this state of aVairs would be the destruction of democratic society

As they see it, a genetically stratiWed society would undermine social equality

in three ways First, it would increase actual inequality by enabling the genetic

aristocracy to secure greater genetic health and talent than the genetic