This one was written in late-2016. Please don’t shoot me for expressing a potentially controversial argument! My view (then and now) is that genetic modification therapies are minimally permissible to the extent that they improve an individual’s well-being, notwithstanding other morally relevant factors.
1. Introduction
With such a negative connotation, the term ‘eugenics’ is often dismissed as some dying artefact belonging to a morally substandard time period, one which we have surely surpassed. However, upon consideration of the principles which it seeks to promote, one finds inescapable parallels with itself and the employment of modern biomedical research, insofar as they both aim to control and regulate of selected genetic traits. These similarities seem to indicate that eugenics is not a mere fragment of the past, but that it exists now and continues to shape the course of our future.
In this paper I shall argue that some cases of eugenics in biomedicine are morally acceptable. §2 of this paper I shall consider both historic and current instances of eugenic use, to demonstrate its return. Continuing, I shall separate, identify and assess the three categories of eugenic practice – an important distinction to make, for moral reprehensibility is not equal among all instances of eugenics. In §3 I shall expand upon my thesis statement, arguing in defence of two of these types, then condemning the third type. §4 shall include a rebuttal to my argument, as outlined in §3, from the philosopher Michael Sandel – to which I shall respond and defend my argument against. To conclude, §5 shall provide a brief summary detailing the course of this paper, accompanied with some light commentary on how we ought to proceed with eugenic practice in the future.
2. What is Eugenics?
Before stating my position, it is necessary to define the kind of eugenics I shall refer to throughout the course of this essay, for there is much dispute in how it ought to be understood. Eugenics, though practiced as early as 400 B.C.E. in ancient Greece, became first popularised by Francis Galton in 1883. Galton’s conception of eugenics was, to the moral standards of our society, abhorrent, believing it to describe the “science of improvement of the human race germ plasm through better breeding”1. Though I agree with Galton’s sentiment of human enhancement, I disagree with his ill-conceived notion of subnormal human traits – that is, the traits which Galton considers to be morally deficient. And although eugenics tended towards the marginalization of socially dependant qualities in the years following Galton’s exposition of the subject, this, I argue, is not sufficient grounds to condemn the practice as a whole, merely the means by which inferiority was determined in the human genome.
2b. Eugenic Types in Biomedicine
Prenatal genetic diagnosis (PGD, hereafter) is a good example of biomedicine with the potential to engage in eugenic practice. As its name suggests, PGD is a form of diagnosis which attempts to identify certain genetic features of a foetus in the womb, so that decisions regarding its livelihood can be made prior to its birth 2 3. These decisions concern the moral standing of interventive action to avoid birthing a child with life threatening illness, usually achieved through abortion, or, more recently, the possibility of gene editing techniques. Such techniques, predicted by Eugene Pergament to be made viable for use in medicine by 2020, imagine gene therapy as a tool to both identify and alter defective genetic sequences in a foetus 4.
“Such related technologies would make possible [the] implementation of targeted molecular interventions […] in the prenatal period of human development”, achieved through “the ability to physically and chemically manipulate cells, tissues or organ systems” 5. And indeed, Pergament’s prediction seem ever more probable as time passes. The recent – though already widespread – availability of CRISPR cas-9 in gene therapy seems to indicate this kind of paradigm shift, from mere identification of the issue to actual intervention and resolve.
2c. Categorising Eugenics
In theorising about eugenic application in PGD along with many other biomedical practices, we can identify three different types. The first type includes cases which tend to act in minimising consequences of negative moral value, whose constituents include illness and disease, but generally refer to any kind of genetic condition which directly causes harm to an agent. Cases such as these, based on defective genomes, shall be referred to as negative eugenic practice (NEP, hereafter). Circumvention of genetic qualities which indirectly cause harm to an agent, perhaps based on external factors such as race and social class, shall be subject to a different kind of philosophical consideration in their eugenic application; I name conditional eugenic practice (CEP). Lastly, implantation of genetic qualities which directly enhance the bodily processes of an agent, unlike the former class, whose augmentation rely on externally determined factors, shall be referred to as positive eugenic practice (PEP).
It is important for my argument that I categorise these three forms of eugenic practice. The classical distinction of positive and negative, I believe, reflects an outdated method of thinking that is no longer applicable, given the scope of contemporary biomedicine. Returning, however, to consider the moral implications of PGD, it is apparent that all three of these eugenic types can be satisfied. But if it is to be used as Pergament imagines, we must limit it only to the first and last – that of NEP and PEP.
3. My Argument
As my brief foray into the categorisation of eugenic types has shown, there are different kinds of eugenics, each (I argue) with different levels of moral reprehensibility. Thus, one cannot condemn eugenic practice as a whole without first showing that each and all of these types are, too, immoral. To argue my position, I would like to show that cases of CEP are not conditionally morally permissible, but that cases of NEP and PEP are. My reasoning for this justification is simple – on a weak negative-utilitarian basis (that is, granting preference to consequences which favour the negation of harm over the attainment of pleasure), the consequences of absolute eugenic impermissibility are of lesser value than if they were to be practiced. Thus, they ought to be practiced.
3b. In Defence of NEP & PEP
Prevention of common genetic diseases – for instance: Cystic Fibrosis, Gaucher, Tay-Sach’s, Huntington’s… (et al) – all fall under the category of NEP. In addition, the commonality and severity of these diseases, paired with their social infamy, make it relatively certain that their circumvention will be met with little resistance. From a moral standpoint, the evasion of pain and suffering can surely justify the means by which these ends are achieved. And furthermore, in accordance with my weak-negative utilitarian position, we are able to justify the prevention of pain and suffering (in most cases) over the enhancement of already working genomes. As such, I propose that we ought to give preference to cases of NEP rather than PEP – yet this is not to say that we ought not to use PEP altogether.
We can suppose, if the use of eugenics in biomedicine becomes widespread as Pergament predicts, that genetic diseases will become increasingly less commonplace among the general population. Indeed, there may reach a point whereupon individuals with untreated genetic disease are regarded with the same disdain as those who, now, reject vaccinations. At this point in time, cases of PEP ought to be seriously considered. In absence of an otherwise overriding moral requirement, such as NEP poses, it seems fair to consider the maximisation of good as an option for resource allocation, perhaps in the distant future.
3c. Why Exclude CEP?
I shall not delve deep into the impermissibility of CEP, as it seems a matter of little dispute in the ethics of biomedicine. However, I ought to give some explanation as to why I shall not include it in my main argument. Simply put, although isolated cases of CEP might yield better moral outcomes – we do not make moral decisions in a vacuum. The consequences of moral decisions in biomedicine can and do affect the greater population, and this is a consideration we must take into account in establishing moral frameworks.
4. Rebuttal to this Position
Few philosophers, it seems, reject the conduct of NEP, nor is CEP widely endorsed. The promotion of PEP in my argument is, however, a topic of dispute. Among these philosophers is Michael Sandel, who presents an argument against the ethics of human enhancement and of eugenics in biomedicine, such as the case of PGD. Sandel’s dispute criticises the application of PEP on the basis that it undermines the qualities that make us human; our make-use of the seemingly random assortment of genetic traits one is born with. The drive to mastery which underlies PGD, to control our offspring both in nature and in nurture, robs us of our will – our resourcefulness to cultivate the natural talents we were born into. Gene therapy, in the way I have described, “misses and may even destroy [… the] appreciation of the gifted character of human powers and achievements”6.
It is noteworthy to add that Sandel’s position, adopted also by many other philosophers, is echoed in the United Nations ‘Universal Declaration on the Human Genome and Human Rights’. In article 11 of the declaration, it is stated that “[p]ractices which are contrary to human dignity […] shall not be permitted”, and later, in article 24, it refers to “practices that could be contrary to human dignity, such as germ-line interventions”7.
Continuing on, Sandel argues that designer babies, as a result of PGD gene therapy, would come into being “as objects of our design or products of our will or instruments of our ambition”8. Taking a Kantian position, Sandel argues that PGD gene therapy would be immoral on the grounds that it treats children as mere means to the ends of their parents. This would, in turn, fracture the parent-child relationship in which an “openness to the unbidden” is necessary. In allowing parents to choose the genetic future of their children, the parent-child relationship becomes permanently disfigured. On this basis, he suggests that we ought not to introduce PEP as an available option in biomedicine.
4b. A Reply to Sandel
From the outline of Sandel’s position above, we see that he objects to PEP on the basis that it creates a desire for mastery over bodily processes – and indeed, too, life processes. In PGD, he argues that gene therapy is sure to disfigure the relationship between parent and child, by nature of the parent treating the child as a means to their ends. But I ask; does the treatment of one as a means to an end ensure the disfigurement which he imagines? I think not. Frances Kamm responds to Sandel on this occasion.
First, Kamm puts forward the notion that an actual desire for mastery is not morally synonymous with an intended desire for mastery9. Surely we can imagine cases in which PEP occurs, yet actual mastery not itself the end of the exercise. To desire mastery, Kamm argues, might be to desire it as a means to yet another end. And in most cases, we can reasonably infer that the desire for mastery of a parent exists only to serve the purpose of a higher desire, perhaps being the good health of their child. Given, I am willing to admit that if desire for mastery were the ultimate end for a parent involved in PGD gene therapy, that person would likely be of diminutive moral substance, using PEP for selfish and immoral reasons. But, I argue, this is not the case – at the very least, not to the extent that Sandel imagines it being. With this established, Kamm continues to argue that desire for mastery as a means does not necessarily entail the consequences which Sandel imagines.
“Such a desire for mastery”, he claims, “is not inconsistent with an openness to the unbidden that Sandel emphasizes”10.The disfigurement of parent-child relations which might come about by conduct of PEP is not certain – if at all likely! And surely there are many cases we can imagine in which parents exhibit this desire, the consequences of which strengthening their relationship rather than fracturing it. Consider the desire for mastery which a parent might exercise in enrolling their child for after-school piano lessons. This desire indicates a further desire of the parent for their child’s wellbeing and excellence in extra-curricular activities. Shall we treat it as harmful to their relationship? Of course not. We ought, then, to transpose this reasoning into cases of PEP, and not rule it out for the future of biomedicine.
5. Conclusion
To conclude, in this paper I believe I have identified, explained and addressed the moral issue of eugenic practice in contemporary biomedicine. Beginning by explaining the state of contemporary eugenic practices and enabling technologies, I continued on to argue for the use of NEP and PEP, then, to condemn cases of CEP. Following from this, my paper considered the position of Michael Sandel, a notable critic of my position; and then, a reply from myself and Frances Kamm to the rebuttal of Sandel.
Though I am aware of my futility in attempting to prove a definitive answer to the question of eugenic permissibility (at least, over the course of this short essay), I believe that in this paper I have brought forward valuable contributions to the discussion. There are many other morally important areas of inquiry which I have not yet considered – constituents of which include the monopolisation of gene therapy, the accessibility of such technologies to people with fewer means of attainment, and the practical concerns which come with mandating PEP in biomedicine. These issues, however, ought to be dealt with in further bioethical discourse, for I have greatly exhausted the word count of this assignment.
Bibliography
Charles Epstein, “Is modern genetics the new eugenics?,” ACMG presidential address (2003), vol. 5, no. 6, pp. 469-475. Available from: The University of British Columbia Canadian Library Course Materials Online. [12 Nov. 16].
Eugene Pergament, “The Future of Prenatal Diagnosis and Screening,” Journal of Clinical Medicine (2014), vol. 3, pp. 1291-1301. Available from: The University of British Columbia Canadian Library Course Materials Online. [12 Nov. 16].
Frances Kaam, “Is There a Problem With Enhancement?,” American Journal of Bioethics (2005), vol. 5, no. 3, pp. 5-14. Available from: The University of British Columbia Canadian Library Course Materials Online. [15 Nov. 16].
Gregory Pike, “What really is Eugenics,” Bioethics Research Notes (2010), vol. 22, no. 4, pp. 47-53. Cites Francis Galton, Inquiries into Human Faculty and its Development (1883). Available from: The University of British Columbia Canadian Library Course Materials Online. [09 Nov. 16].
Marianne Talbolt, Bioethics: An Introduction (England: Cambridge University Press, 2012), pp.181-202.
Michael Sandel, “‘The Case Against Perfection,” The Atlantic (2004), COURSE MATERIALS.
Stephen Wilkinson, “Eugenics talk: Journal of Medical Ethics”, BMJ Journals (2008), vol. 34, no. 6, pp.467-471. Available from: The University of British Columbia Canadian Library Course Materials Online. [09 Nov. 16].
UNESCO, Universal Declaration on the Human Genome and Human Rights (1997). Available from: http://portal.unesco.org/en/ev.php-URL_ID=13177&URL_DO=DO_TOPIC&URL_SECTION=201.html. [15 Nov. 2016]
- Galton, Inquiries into Human Faculty and its Development, 14. Cited in Pike, “What Really is Eugenics?,” 47. ↩︎
- Epstein, “Is modern genetics the new eugenics?” ↩︎
- Talbolt, Bioethics: An Introduction ↩︎
- Pergament, “The Future of Prenatal Diagnosis and Screening” ↩︎
- Pergament, “The Future of Prenatal Diagnosis and Screening,” 1297 ↩︎
- Sandel, “The Case Against Perfection,” 5 ↩︎
- UNESCO, Universal Declaration on the Human Genome and Human Rights, articles 11 & 24 ↩︎
- Sandel, “The Case Against Perfection,” 6 ↩︎
- Kamm, “Is There a Problem With Enhancement?” ↩︎
- Kamm, “Is There a Problem With Enhancement?,” 6 ↩︎