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Human Perfection through Biotechnology: Should we go for it?

The Case Against Perfection: Ethics in the Age of Genetic Engineering, Michael J. Sandel, 128 pages plus Notes and Index. The Belnap Press of Harvard University Press, Cambridge, Massachusetts, 2007. S12.85.

Humans have long mystified, sanctified, or otherwise places special significance on their own reproductive process. Evidence for this ranges from 28,000-year-old Venus figurines of the Gravettian culture celebrating female fertility to in vitro fertilization (IVF) clinics and the high technology neonatal units of modern hospitals. Birth and first breath mark our entry into the world of opposites-good and evil, truth and falsehood, peace and violence. Not many years after taking our first breath, which some religious traditions mark as the moment of ensoulment, we develop into agents of choice-autonomous creatures making moral decisions about our own lives and our interactions with others. Now modern genetic and reproductive biotechnologies present us with new moral decisions associated with procreation itself. In The Case against Perfection, an expansion of an essay by the same title published in The Atlantic in 2004 (1), Harvard political philosopher/ethicist Michael Sandel argues against attempts to "perfect" humanity through genetic enhancement, while supporting the future use of gene therapy and embryonic stem cell technology to relieve human suffering. This position presumes that one can clearly distinguish between enhancement and therapy, a feat that no bioethicist has yet successfully accomplished; nevertheless, Sandel forges ahead to explain why he believes that using biotechnologies to enhance human physical and cognitive characters beyond normality toward "perfection" will ultimately desanctify human procreation.

What knowledge and technologies are so powerful as to bring up the notion of human "perfectability?" Completion of the Human Genome Project in the early years of this century revealed humans to be constructed from the products of about 25,000 genes (2). The Online Mendelian Inheritance in Man (OMIM) site lists the complete base sequences and chromosomal locations for over 12,000 of these whose inheritance is easily predictable.

Specific disease and nondisease traits are known for almost 400 of these genes, (3) and once a disease-causing allele is identified it can be detected using the DNA from a single cell removed from an 8-cell embryo created by IVF. Single-cell embryo biopsy to detect disease-causing genes or chromosomal abnormalities is called pre-implantation genetic diagnosis (PGD). Since 1989 PGD has been used to detect embryos bearing disease-causing chromosomal abnormalities and to allow for the selection of genetically healthy embryos for transfer to the womb. The possibility now exists to test a pre-implementation embryo for any one of the 12,000 genes (and their variants) listed on the OMIM site. Moreover, within a decade it is likely that human geneticists will link hundreds (perhaps thousands) of these with non-disease physical and personality traits ranging from stature to shyness. Such functional genomic information, coupled with IVF, PGD, and the approaching ability to introduce modified or designed genes into the human germline will give humankind the power to direct its future evolution toward its own concept of perfection. This power is what troubles Michael Sandel.

In the first of five chapters, Sandel argues convincingly that traditional arguments against (or for) realizing the prospect of genetically enhancing cognitive and physical human traits such as athletic prowess, stature, musical ability and memory do not cut to the core of the morality of such enhancements. Traditional arguments against human genetic enhancement include (1) that parentally designed genetic enhancement of unborn children, particularly germ line enhancements apt to remain in the descendants of those children, violate the autonomy of the unborn, (2) that genetic enhancements in some would be unfair to others attempting to compete on the same "playing field," and (3) that distributive justice in the availability of such enhancements would not be possible. Traditional arguments for moving ahead to develop technologies of human genetic enhancement usually invoke the importance of protecting individual rights. According to Sandel, all of these arguments miss the mark because they do not focus on the rightness or wrongness of aspiring to enhancement itself. Sandel writes that "to grapple with the ethics of enhancement, we need to confront questions largely lost from view in the modern world-questions about the moral status of nature, and about the proper stance of human beings toward the given world" (p. 9). Sandel addresses these questions in the final chapter of the book after discussing examples of what he believes would be inappropriate human interventions into nature: the genetic enhancement of athletic prowess and the genetic selection/design of children.

For Sandel, what is fundamentally wrong with drug or genetically enhanced performance in athletes, or even musicians, goes deeper than breaking rules or risking one's health. "The real problem with genetically altered athletes," Sandel writes, "is that they corrupt athletic competition as a human activity that honors the cultivation and display of natural talents: (p. 29).

For similar reasons, he argues against the current use of PGD by some parents to select the gender of their children, and against future use of the technology to select for traits that have no medical significance.

Currently PGD is used primarily to screen preimplantation embryos for potential genetic disabilities. The world is not perfect, and sometimes our intervention seems appropriate. How could anyone find it objectionable to use PGD to prevent a child from being born with some horrible disease or disability? But herein lies a debate over ambiguity: namely, how one ought to distinguish between what is normal and abnormal, between what interventions count as therapy and which ones constitute enhancement. There are conditions that may be considered debilitating by some but valued by others. There are conditions that may be considered debilitating by some but valued by others. To illustrate, Sandel cites the instance of a deaf, lesbian couple which desires to give birth to a deaf child. In choosing a sperm donor who had a family history of deafness, the couple succeeded in giving birth to a deaf son. Public criticism immediately followed the birth, proclaiming that the couple had deliberately and unethically disabled their child. The couple argued that they viewed deafness as a "cultural identity" that they were proud of, and wanted their child to share in this identity with them.

Down syndrome presents a similar study in ambiguity. PGD allows detection of Down syndrome embryos prior to pregnancy, but more commonly Down syndrome is diagnosed during the first trimester by chorionic villus sampling or during the second trimester by amniocentesis. Parents whose fetus is diagnosed with Down syndrome must then decide whether to terminate the pregnancy. Is it right to abort a fetus or reject an embryo with trisomy in chromosome 21? Given the learning and motor skills disabilities a Down syndrome child; however, others point to the joys of having a child with special needs in the family and cite the loving and joyful characterstics of many Down syndrome persons as natural gifts. Should societal consensus, individual parents' values. physicians' values, or biology dictate what is "normal" or what constitutes a "gifts?" Clearly, answers to questions like these will reflect the cultural, religious, and experiential diversity of our pluralistic society and of the global village itself.

Beyond therapy and the gray areas between therapy and enhancement and "normal" and "abnormal" lies the realm of enhancement via genetic engineering and/or PGD for nonmedical purposes such as height, musculature, skin color, cognitive characters like memory, personality traits, and perhaps even propensities for abilities in mathematics, music, art, etc. Enhancement proponents point out human genetic enhancement would not differ qualitatively from what many parents already do to influence the development of their children or to give them advantages in life, i.e. music/sports lessons, summer science camps, college educations. Sandel acknowledges that good parents take responsibility for the welfare of their children; however, he views the "heavily managed, high pressure childrearing practices" of hyperparenting, and the bioengineering of children to be similar in spirit and equally undesirable (pp. 61-62). Both are manifestations of human hubris. Even if motivated by society's competitive demands, hyperparenting and genetic enhancement represent "an anxious excess of mastery and dominion that misses the sense of life as gift" and are disturbingly reminiscent of past eugenics programs (pp 61-62).

Forced sterilization of over 60,000 genetically "deficient" Americans in the early 20th century and the horrors of Nazi death camps are extreme examples of the old eugenics. Today "an influential school of Anglo-American political philosophers" promote a so-called liberal eugenics (p 75). In this new version of eugenics, the only requirement is that whatever human genetic engineering is to be performed must no violate the autonomy of the person at whom it is directed. Though neither an embryo nor a child can be autonomous, it is essential that any care provided by the parents must not willingly influence the future plans of that child or embryo. While liberal eugenics attempts to justify genetic enhancement by protecting the future decisions of those affected (e.g. via reversible genetic engineering), Sandel argues that it still represents "a stance of mastery and dominion that fails to appreciate the gifted character of human powers and achievements, and misses the part of freedom that consists in a persisting negotiation with the given" (p 83).

The ethical theme running throughout the book is that humans ought to appreciate and respect the giftedness of life. By "gifts," Sandel means talents or conditions that are bestowed upon us: "the talent in question is not wholly the athlete's or the musician's own doing; whether he has nature, fortune, or God to thank for it, the talent is an endowment that exceeds his control" (p. 93). Sandel denies that belief in a supernatural Gift-Giver is required to view the genetic hand dealt by life as a gift. We can just as well thank nature or chance for our biological gifts. Without this idea of giftedness, Sandel believes that "three key features of our moral landscape-humility, responsibility, and solidarity" (p. 86)-would be transformed for the worse and would "leave us with nothing to affirm or behold outside our own will" (p. 100). In response to those who view bioengineering as an exercise in human freedom, Sandel writes that "changing our nature to fit the world, rather than the other way around is actually the deepest form of disempowerment) (p 97).

So what about persons who are disempowered due to their genetic lot in life? Sandel believes one can draw a clear distinction between healing and enhancing. He acknowledges that the goal of medicine is to restore normal human functioning, and that it therefore does not represent and attempt to master our surroundings. Medicine does intervene in nature, and Sandel is not bothered by this, stating that, "Not everything is good. Smallpox and malaria are not gifts, and it would be good to eradicate them" (p 101). For the same reason, Sandel favors human embryonic stem cell (ESC) research and use if it is directed toward relieving suffering caused by disease or injury, but the opposes ESE research aimed at human enhancement. Use of human embryos for ESC therapy does not bother Sandel. He believes that human embryos deserve respect for their potential to develop into persons but that they do not have the moral status of newborns.

In our view, one weakness in Sandel's argument is his failure to acknowledge and deal with the great difficulty in distinguishing between enhancement of the normal and therapy for the abnormal. When " normality" is viewed largely as a social construct, a subjective valuation of traits such as height, amount of body fat, or even cognitive talents that may vary between groups and through time, the line between gene therapy and genetic enhancement also becomes dependent on place and time. Some authors have creatively addressed the therapy/enhancement difficulty, and Sandel would have done well to discuss their ideas. For example, Erik Parens suggests adding to treatment and enhancement a third category, prevention, (4) in order to help determine what interventions ought to be covered by health insurers or be considered proper goals of medicine. Parens notes that enhancement of the immune system via vaccinations belongs in the "prevention" category and is a proper goal of medicine. Secondly, we are uncomfortable with Sandel's notion that "negotiation with the given" is morally superior to suing our knowledge of nature for self-improvement. Would Sandel take a similar stance within the agricultural domain and maintain that it is morally preferable to negotiate with the "given" of weeds and insect pests rather than to develop herbicide-resistant beans and insect resistant corn through genetic engineering? Or what if we someday have the power to divert hurricanes away from highly populated areas? Would negotiating what nature throws at us by evacuating and boarding up windows be superior to exercising that power? But perhaps Sandel is only concerned about the enhancement of human traits and not with the engineering of plant traits or weather events; if so, he ought to say so and explain why he singles out humanity as the one component of nature in which science-based improvements should be constrained.

In summary, Sandel's book is clearly written, scientific and ethical concepts are explained with a general audience in mind, and a new argument ("giftedness") is offered to the debate about how modern biotechnologies ought to be used. Whether one is for or against human genetic enhancement, a close reading of The Case Against Perfection will give important information and a fresh perspective on the issue.

* Drew Humphries is a recent graduate in Zoology at Auburn University. This review was written for a senior level Bioethics Research course with mentoring and editing by James T.Bradley, Department of Biological Sciences, 331 Funchess Hall, Auburn, AL 368449.

(1) Sandel. Michael J., 2004. The Case Against Perfection. The Atlantic 293 (3): 50-62.

(2) The total number of genes in the human genome is still contested, but recent estimates range between 20.000 and 30.000 as reported on the official website of the Human Genome Project: http://www.ornl.gov/sci/techeresoureces/Human_Genome/faq/genenumber.html

(3) http://www.nebi.nlm.nih.gov/Omim/mimstats.

(4) Parens, Erik. 2007. Is Better Always Good? The Enhancement Project. In: Enhancing Human Traits: Ethical and Social Implications, Erik Parens, ed., Georgetown University Press, Wahsington, D.C.,pp. 1-28.

Drew Humphries * and James T.Bradley

Department of Biological Sciences, Auburn University

Auburn, AL 36849

Correspondence: James T. Bradley (bradljt@auburn.edu)
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Publication:Journal of the Alabama Academy of Science
Date:Aug 1, 2008
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