The obligation to have the best children Professor Julian Savulescu

1
The obligation to have the best children
Professor Julian Savulescu
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Having the Best Child

• Selection
• Enhancement Ch 5 Chance to Choice

3
Why Not Enhance

• Eugenics
• Skepticism about value
• BUT
• Parents have wide freedom in selecting
  environment which shapes children

4
What is the best?

• Brave New World
• Thank you very much arg
• Lazy vs hard working
• Monogamous vs polygamous
• Response all purpose means (natural primary good)

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Specific talents

• Perfect pitch
• Acts/omissions problem
• Specific talents increase the options for the
  good life
• Children punished for the parents
• Objections

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Right to an Open Future

• Capacity for practical judgements and autonomous
  life
• BUT parents have considerable freedom to shape
  this
• Wisonsin vs Yoder Amish removing children from
  school at 14 rather than 16

7
Limits to Pursuit of the Best

• Family interest
• State interest
• Communitarian eugenics community shapes choice
• Would give rise to communities with different
  natures
• Social structure

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Multiple phenotypes

• Cynthia con artist or social worker
• But this applies to all valuable traits
• Intelligence and the bomb

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Objections

• 1 self-defeating
• Sex selection
• Sex ratio imbalance
• Increases injustice
• Height
• Coercive pressure

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Objections

• 2 Unfair
• market
• 3 Risk

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Conclusion

• Parents should be allowed considerable freedom to
  ENHANCE their children

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Kant and Enhancement

• Categorical Imperative act only in a way that
  my maxim should be a universal law
• Sex selection sex ratio imbalance
• Height increase expensive. uses resources and no
  benefit
• Problem depends on the specification of the
  maxim if you have two or more children of the
  same sex, you should sex select if you desire a
  child of the opposite sex (or will make you
  happier)

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Kant and Enhancement

• Humanity principle treat humanity as an end and
  never merely as a means
• Enhancement treats children as a means
• To achieve success
• To satisfy parental expectations
• To achieve glory

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Kant and Enhancement

• Consent
• Can never obtain
• People have moral significance
• Treat with equal concern (for interests) and
  respect (for autonomy)
• Enhancement may be imperative just as assisting
  the suffering
• The unenhanced are suffering
• Kant should be no enemy of enhancement

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Treating children as a means

• Slavery
• Sex abuse
• Sedating or drugging them
• Making them docile
• harmed

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Procreative Beneficence

• Procreative beneficence
• couples (or single reproducers) should select the
  child, of the possible children they could have,
  the one who is expected to enjoy the best life,
  or at least as good a life as the others

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Procreative Beneficence

• Procreative Beneficence implies couples should
  employ genetic-tests for non-disease traits in
  selecting which child to bring into existence
• we should allow selection for non-disease genes
  in some cases even if this maintains or increases
  social inequality

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Definitions

• A disease gene
• a gene which causes a genetic disorder (e.g.
  cystic fibrosis) or predisposes to the
  development of disease (e.g. the genetic
  contribution to cancer or dementia).
• A non-disease gene
• is a gene which causes or predisposes to some
  physical or psychological state of the person
  which is not itself a disease state, e.g. height,
  intelligence, character (not in the sub-normal
  range).

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Behavioural Genetics

• Aggression and criminal behaviour
• Alcoholism
• Anxiety and Anxiety disorders
• Attention Deficit Hyperactivity Disorder (ADHD)
• Antisocial personality disorder
• Bipolar disorder
• Homosexuality
• Maternal Behaviour
• Memory
• Neuroticism
• Novelty Seeking
• Schizophrenia
• Substance Addiction

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Selection

• It is currently possible to select from a range
  of possible children we could have
• Fetal selection occurs through prenatal testing
  and termination of pregnancy.
• Selection of embryos is now possible by employing
  in vitro fertilization and preimplantation
  genetic diagnosis (PGD).
• Selection of sex by PGD is now undertaken in
  Sydney

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Selection

• In the future, it may be possible to select
  gametes according to their genetic
  characteristics.
• This is currently possible for sex, where methods
  have been developed to sort X and Y bearing sperm.

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The Simple Case Disease Genes

• IVF produces 2 embryos
• Battery of tests for common diseases is performed
• Embryo A has no abnormalities on the tests
  performed
• Embryo B has no abnormalities on the tests
  performed except it has a strong predisposition
  to developing cancer later in life.
• Which embryo should be implanted?

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The Simple Case

• Embryo B has nothing to be said in its favour
  over A and something against it
• Embryo A is pareto optimal
• Embryo A should (on pain of irrationality) be
  implanted

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Wheel of Fortune Analogy

• The Wheel of Fortune
• Win 0-1 000 000
• Wheel is spun
• an amount unknown to you is put in Box A
• an amount unknown to you is put in Box B
• You are also told that, in addition to the sum
  already put in the boxes, if you choose B, a dice
  will be thrown and you will lose 100 if it comes
  up 6
• You should choose Box A

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The Simple Case Cancer

• Cancer reduces length and quality of life.
• Lung cancer causes
• severe breathlessness
• Pain
• death

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Morally relevant properties

• The morally relevant property of cancer it is
  a state which reduces the well-being a person
  experiences.

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But Embryo B Could Be Mozart.

• Objection if you choose A (without cancer), you
  could be discarding Mozart or Lance Armstrong.
• True but if you choose B, you could be
  discarding Mozart or Lance Armstrong without
  cancer.
• A and B are equally likely (on the information
  available) to be Mozart or Lance Armstrong (and B
  is more likely to have cancer).

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The Simple Case 3 Other Principles Tested

• 1. Procreative autonomy couples should be free
  to decide, when and how to procreate, and what
  kind of children to have
• if this is the only decision-guiding principle,
  it implies parents might have reason to choose
  the embryo with a predisposition to asthma
• 2. Principle of Non-Directive Counselling
• Only provide information about risk and options.
• Do not give advice

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The Simple Case

• 3. The Best Interests of the Child Principle
• the Victorian Infertility Treatment Act 1995
  states the welfare and interests of any person
  born or to be born as a result of a treatment
  procedure are paramount.
• Irrelevant
• could choose the embryo with cancer and still be
  doing everything possible in the interests of
  that child

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Defence of voluntary procreative beneficence

• A woman has rubella. If she conceives now, she
  will have a blind and deaf child.
• If she waits 3 months, she will conceive another
  different but healthy child.
• She should choose to wait until her rubella is
  passed.

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Extension to Abortion

• This argument extends in principle to selection
  of fetuses using prenatal testing and termination
  of affected pregnancy
• However, selection by abortion has a greater
  psychological harms than selection by PGD and
  these need to be considered

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What is the Best Life?

• Life with the most well-being
• There are various theories of well-being
  hedonistic, desire-fulfilment, objective list.
• Not just absence of disease.
• ability to engage in deep personal relations,
  achieving worthwhile things with your life,
  having dignity, having children and raising them,
  gaining knowledge of the world, developing ones
  talents, appreciating beautiful things, and so
  on.
• Buchanan et al general purpose means - those
  useful to any plan of life

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Non-Disease Genes and the Best Life

• It is not disease which is important,
• it is its impact on my life in ways that matter
  which is important.
• People trade length of life for non-health
  related well-being
• Non-disease genes may contribute significantly to
  well-being as much as disease genes

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Non-Disease Genes and the Best Life

• a gene which contributes significantly to a
  violent, explosive, uncontrollable temper, and
  that state causes people significant suffering.
• violent outbursts lead a person to come in
  conflict with the law and fall out of important
  social relations.
• The loss of independence, dignity and important
  social relations should be treated in the same
  way as if they were the result of a disease which
  impacts on that persons well-being, eg autism
• Procreative beneficence thus extends to
  non-disease genes, including genes for
  criminality

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The Should in Should Choose

• You are 31. You will be at a higher risk of
  infertility and having a child with an
  abnormality if you delay child-bearing. But that
  has to be balanced against taking time out of
  your career now. Thats only something you can
  weigh up.
• You should stop smoking.
• You must inform your partner that you are HIV
  positive or practise safe sex.
• The should is that present in the second
  example persuasion, not coercion (third case),
  but stronger than first

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Genes for Criminality

• Buchanan, Brock, Daniels, Wikler, From Chance to
  Choice, p. 173
• there is already some evidence of genes
  associated with dispositions to violent criminal
  behavior. Just as the criminal law is a justified
  coercive social means aimed at preventing or
  reducing such behavior, society might in the
  future attempt genetic interventions to do so as
  well. These interventions would not be made for
  the benefit of the subject of the genetic
  intervention, but for the benefit of the broader
  society and to protect the rights of its members
  against violent assault.

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Behavioural Genetics Today the Dutch Family

• For over 30 years this family recognised that
  there were a disproportionate number of male
  family members who exhibited aggressive and
  criminal behaviour.
• aggressive outbursts arson, attempted rape and
  exhibitionism.
• the behaviour has been documented for almost
  forty years ago by an unaffected maternal
  grandfather
• could not understand why some of the men in his
  family appeared to be prone to this type of
  behaviour
• a female family member who reported this apparent
  familial trait to Hans Brunner in 1978.

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The Dutch Family Remarkable Features

• male relatives who did not display this
  aggressive behaviour did not express any type of
  abnormal behaviour.
• unaffected males reported difficulty in
  understanding the behaviour of their brothers and
  cousins.
• sisters of the males who demonstrated these
  extremely aggressive outbursts reported intense
  fear of their brothers.
• one of the affected males responded to an
  innocuous request made by his sister by holding a
  knife to her throat, threatening to cut her
• did not appear to be related to environment.

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Clinical Findings

• All affected males were also found to be mildly
  mentally retarded with a typical IQ of about 85
  (females had normal intelligence)
• X-linked recessive pattern of inheritance
• Roughly, women can carry the gene without being
  affected 50 of men at risk of inheriting the
  gene get the gene and are affected by the disease.

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Locating the gene

• Genetic analysis suggested that the likely region
  was a part of the X chromosome known as the
  Monoamine Oxidase (MAO) region.
• The MAO region
• 2 genes which encode two enzymes monoamine
  oxidase A (MAOA) and monoamine oxidase B (MAOB).
  
• normal functioning of these enzymes in the brain
  is to assist in the breakdown of
  neurotransmitters

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Correlating Genetics to Behaviour?

• Neurotransmitters are substances that play a key
  role in the conduction of nerve impulses in our
  brain
• Enzymes like the monoamine oxidases are required
  to degrade the neurotransmitters after they have
  performed their desired task.

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Correlation

• It was suggested that the monoamine oxidase
  activity might be disturbed in the affected
  individuals.
• This hypothesis was supported by urine analysis
  that indeed showed a higher than normal amount of
  neurotransmitters being excreted in the urine of
  affected males.
• The results found were consistent with a
  reduction in the functioning of monoamine oxidase
  A

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Correlating Genetics to Behaviour?

• How could such a mutation result in violent and
  antisocial behaviour?
• A deficiency of MAOA results in a build up of
  neurotransmitters, and it is these abnormal
  levels of neurotransmitters that are thought to
  result in excessive, and even violent, reactions
  to stress
• genetically modified mice which lack MAOA are
  more aggressive

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The Dutch Family in Context

• Limitations of this study
• Only applies to one family
• Inhibitions of MAO have not been associated with
  aggressive behaviour in adults (but effects of
  lifelong deficiencies are unclear)
• Most genetic contributions to behaviour will be
  weaker predispositions

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Commoner Genes for Criminality

• genes are involved in criminality
• predominance of males in violent crime
• genes will be correlated with behaviours which
  are more likely to lead to criminal prosecutions
• aggressiveness, inability to control behaviour,
  inability to foresee the consequences of
  behaviour, greed, inability to emphathise

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Eugenics?

• female carriers may come forward in the future
  requesting that genetic technology be employed to
  ensure that they do not have affected sons
• should female carriers be advised to use genetic
  technologies to ensure they do not have affected
  sons?

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Objections

• 1. Harm to the child
• 2. Maintains or creates inequality

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Harm to the child

• excessive parental expectations
• parents not loving the child
• using the child as a means, and not treating it
  as an end
• the couples desire to select represents
  dysfunctional psychology and so they will be bad
  parents
• closes the childs future (right to an open
  future)

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Responses

• 1. Deny that the harms will be significant
• parents love their child and rearing levels
  excessive expectations
• counselling can reduce excessive expectation
• 2. Accept greater risk in selection

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Selection and Risk

• If you select embryo A, it might still get
  cancer, or have a much worse life than B, and you
  would be responsible.
• Selection is preferable to manipulation in one
  way
• Imagine you perform gene therapy to correct a
  predisposition to to cancer and you cause a
  mutation which results in cancer later in life
• you have harmed the child

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The Advantage of Selection

• Imagine you select Embryo A and it develops
  cancer in later life
• You have not harmed A unless As life is not
  worth living (hardly plausible) because A would
  not have existed if you had acted otherwise

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Distinction

• There is an important distinction between
• interventions which are genetic manipulations of
  a single gamete, embryo or fetus
• selection procedures (eg sex selection) which
  select from among a range of different gametes,
  embryos and fetuses.

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Conclusion

• We should aim for the best children
• even if there is a risk of harm (outweighed by
  the expected benefits)

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Second Objection Inequality

• selection will maintain or even increase
  inequality in society.
• if we allow selection for intelligence, there
  will be an increasing gap between those who can
  afford or access genetic tests for intelligence
  for their children, and those who do not.
• The less intelligent will be left behind by a
  super race of increasingly intelligent nerds who
  dominate the world

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Responses

• In some cases, it is possible to deny selection
  would maintain or increase inequality.
• Sex selection in West
• Parents were in their mid thirties, had 2 or 3
  children and only wanted one more. In both the US
  and UK, just over half of couples choose a girl

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What if selection does increase inequality?

• Sex selection in Asia (?), intelligence,
  favourable physical or psychological traits, etc

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Compare with selection for disease genes

• Down syndrome screening industry.
• In 1986, there were 120 pregnancies involving
  Down syndrome and 15 terminations,
• In 1997, there were more pregnancies (147), but
  many more terminations (81) - roughly 5 fold
  increase

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Disability Discrimination Claim

• prenatal testing for disabilities such as Down
  syndrome results in discrimination against those
  with Down syndrome and other disabilities both
  by
• the statement it makes about the worth of such
  lives
• by the reduction in the numbers of people with
  this condition.

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Reason to Restrict Selection for Disease Genes?

• Even if the Disability Discrimination Claim were
  true, it would be a drastic step in favour of
  equality to inflict a higher risk of having a
  child with a disability on a couple (who do not
  want a child with a disability) to promote social
  equality.
• Eg Rubella epidemic
• embryos produced prior to and during the epidemic

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Extension to Non-Disease Genes

• Even if the Disability Discrimination Claim were
  true, most people would still accept testing for
  disease genes.
• Why should we treat testing for non-disease genes
  differently?
• It is not disease which is important but its
  impact on well-being.
• Does a non-disease gene impact significantly on
  well-being?

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1. Selection positive impact on well-being and
promotes inequality

• treat as disease gene case above
• allow selection
• note if a non-disease gene (or disease gene) has
  a significant effect on well-being, selection
  related to it should be funded by State
• reduces reinforcement of privilege

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Implications

• Imagine in a country women are severely
  discriminated against and treated badly.
• abandoned as children,
• refused paid employment
• serve as slaves to men.
• My argument implies that couples should test for
  sex, and should choose males as these are
  expected to have better lives in this society.

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Responses

• 1. it is unlikely selection on scale that
  contributes to inequality would promote
  well-being
• Imagine 50 of the population choose to select
  boys.
• 3 boys to every 1 girl.
• The life of a male in such a society would be
  intolerable
• For this reason we should not encourage couples
  to have girls to reduce the crime rate

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Responses

• 2. social institutional reform, not interference
  in reproduction
• what is wrong in such a society is the treatment
  of women, which should be addressed separately to
  reproductive decision-making.
• Reproduction should not become an instrument of
  social change, at least not mediated or motivated
  at a social level.

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Sex Selection and Equality

• It may well be that a sex ratio of 5 males to 6
  females best promotes womens interests and
  equality. Does that imply couples must select
  girls?
• Or it may be that having more children with Down
  syndrome promotes the interests of people with
  Down syndrome. Would that imply that people have
  an obligation to have children with Down
  syndrome?
• Social ideals should not control reproduction -
  that is the lesson from Nazi eugenics.

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2. Selection Negative Impact on Well-Being But
Promotes Equality

• David and Dianne are dwarfs. They wish to use
  IVF and PGD to select a child with dwarfism
• Sam and Susie live a society where discrimination
  against women is prevalent. They wish to have a
  girl to reduce this discrimination.
• These choices would not harm the child produced
  if selection is employed (non-identity problem).

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Conflict of principles

• Irresolvable conflict of principles.
• procreative autonomy combined with concern to
  promote equality
• procreative beneficence
• the principle of procreative beneficence does not
  have such weight that we should say a couple
  should select a male in a sex discriminatory
  society.

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Implications

• Those with Down syndrome, dwarfism, deafness or
  other disabilites should be allowed select a
  child with disability (without any sanction)
• But best option is that we correct discrimination
  in other ways, by correcting discriminatory
  social institutions.
• both equality and a population whose members are
  living the best lives possible.

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Conclusions

• With respect to non-disease genes we should
  provide
• Information (through PGD and prenatal testing)
• Free choice of which child to have
• In a social environment which maximises the value
  of all choices (supports all kinds of lives)
• State funding of genetic selection

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Procreative Beneficence

• In such an environment, selection for non-disease
  genes which significantly impact on well-being is
  morally required (voluntary procreative
  beneficence)
• morally required implies moral persuasion but not
  coercion is justified.
• Persuasion is only justified when social
  institutions support all choices
• Couples should have the child with the greatest
  genetic opportunities but choice must ultimately
  be up to couples