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Human bioenhancement Place one enhancement-advocate in dialogue with a religious thinker in opposition to enhancement.
Julian Savulescu - Deaf Lesbians Is it wrong for a deaf lesbian couple to select, via pre-implantation genetic diagnosis, an embryo that will become a deaf person? Savulescu says no - this would only be the case if the disability on the basis of which they had chosen their child was such that the child's life would not be worth living. This is not true of deafness, so the child has not suffered harm in being brought into existence. So parents should be able to choose disabled embryos pre-implantation, even though they may be giving that child worse life prospects, so long as the disability in question does not make that child's life not worth living. The goal of reproductive decision-making such as this is to allow couples to select, from the children it is possible for them to have, the child that has the best chance of having the best life possible. Thus, antenatal screening for Down's syndrome, cystic fibrosis and other such genetic diseases is now routine, but should such screening be extended such that intellectual disability or deafness are included?
Savulescu stresses the importance of respect for autonomy and that freedom (in this case, reproductive freedom) is always truly characterised in societal terms by the capacity to do what may be disagreeable to others. Savulescu also asserts that the value of a liberal approach lies in freedom as a means to discovering what life is best, not simply as a value in its own right (Mill: 'it is important to give the freest scope possible to uncustomary things, in order that it may appear in time which of these are fit to be converted into customs... If a person possesses any tolerable amount of common sense and experience, his own mode of laying out his existence is the best, not because it is the best in itself, but because it is his own'). Mill again: 'free scope should be given to varieties of character, short of injury to others... that the worth of different modes of life should be proved practically'. This is the essence of the utilitarian conception of liberty that enhancement-advocates employ. 'Reproduction should be about having children with the best prospects' - clearly something a Christian thinker would not agree with! Equally, the notion that these best prospects are determined by the value judgements of the parents themselves - this seems to suggest a level of ownership and determination over other lives that a Christian cannot see as acceptable, if we are all indebted to God for our lives. The principle of reproductive autonomy: in reproduction, parents should be free to do what others disapprove of or judge to be wrong, so long as the exercise of this freedom does not cause others harm. This principle is used by Savulescu in tandem with his assumptions that 1) a child is only harmed by being selected for existence if its life would be considered 'not worth living', and is not harmed by being brought into the world with a relatively minor disability (such as deafness) because no other life is available to that child, and equally that 2) a child is not harmed by not being brought into existence. The principle of procreative beneficence: in reproduction, it is the duty of the parents to have the child that will, of all the children that could have been had, who will have the best opportunity for the best life. If accepted, this principle would naturally have widespread implications for the extent of antenatal screening and embryo selection, and for the use of other reproductive technologies in the avoidance of disability.
Michael Parker - 'The best possible child' in J Med Ethics 2007 33: 279-283 (arguing against the principle of procreative beneficence) The case of Sharon Duchesneau and Candy McCullough raises a number of important moral issues: Do we have a moral duty to have a fully healthy child if there is a choice to do so?
How do we characterise 'fully healthy' as opposed to 'disabled', and who should decide in each case?
Does the principle of reproductive autonomy set appropriate limits on the extent of reproductive freedom?
For Robertson and Savulescu, parents have a duty to bring into the world the child with the best opportunity of the best life, not because to do otherwise would harm the child that is eventually born, but because they have a duty to bring about the best lives that they can. Thus Parfit's example: if a woman is told that in getting pregnant now, while on a course of medication, she will give birth to a child with a mild disability or deformity, but that if she waits a month (when her course of medication is complete) she will give birth to a fully healthy child, then if she becomes pregnant now, she has not harmed the child, since it could only have been born this way. If we still wish to conclude that her actions were wrong (since a brief wait could have enabled her to give birth to a fully healthy, if different, child), it is not because she has done any actual harm, but because she has contravened this principle that we should endeavour to bring about the best lives possible, and the norm that we should not engender gratuitous suffering. Take the case of 'Rachel', who has an equal 1 in 4 chance of giving birth to: an SEDT-affected son; a non-SEDT-affected son; an SEDT-carrier daughter; and a non-SEDT-carrier daughter. Do the principles of beneficence and autonomy clash here? Savulescu would say no, since the latter principle is concerned with regulation and ethics in professional medical practice, and the former is concerned with personal morality. Thus while no child is being harmed, it would be wrong to prevent Rachel's autonomous decision not to use PGD to select an SEDT-unaffected child, it would be morally wrong for her to actually use this freedom to allow a child to be born that did not have the best opportunity at the best life of the potential lives available. Parker intends to argue that whilst Savulescu is right that potential parents do have important obligations of beneficence when bringing about one of a number of possible lives, Savulescu is not right to characterise these obligations in terms of the duty to have the child with the best opportunity at the best life, nor to separate the personal from the social in this characterisation: 'the principle of procreative beneficence is under-determining, paradoxical, self-defeating and overly individualistic' (p281)
1. under-determining The beneficence principle should, minimally, be capable of ranking possible lives as better or worse than any other particular possible life, in terms of the concepts involved in making a life the best possible life. Naturally, what constitutes these involved concepts is highly complex, and the notion of the 'best life' can only be used in relation to equally complex concepts such as 'well-being', 'the good life' or 'human flourishing'. Even without requiring that these concepts be fully established and understood before we can understand what makes 'the best life' and without asserting that nothing can be said of what makes a life good or bad, Parker asserts that we cannot use testable features of embryos to determine a sufficient number of conditions conducive to a good life to enable us to meaningfully rank possible lives as better or worse. Thus the notion of 'best opportunity of the best life' is under-determining, since at the stage of possible lives it is not possible to identify sufficient characteristics that will later make any of those lives the best available. Further, even those concepts relating to the 'best opportunity' that we can adequately characterise are subject to a diversity of preferences and beliefs that it is impossible to identify as a general principle the rational choice with respect to any particular feature of a possible child. This means, then, that in any given instance it is in fact not possible to make a reproductive choice that respects the principle of procreative beneficence in its current form. This is not to say that there is no
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