Enhancement – Genetic and
Cosmetic Pharmacology
Orla Sheils
Enhancement
• Breakthroughs in genetics present us with a
promise and a predicament.
• The promise is that we will soon be able to treat
and prevent a host of debilitating diseases.
• The predicament is that our newfound genetic
knowledge may enable us to manipulate our
nature –
– to enhance our genetic traits and those of our children.
• Although most people find at least some forms of
genetic engineering disquieting, it is not easy to
articulate, why?
Enhancement
• What is wrong with re-engineering our nature? “
• In this session we will explore these and other
moral quandaries connected with the quest to
perfect ourselves and our children.
• Some argue that the pursuit of perfection is
flawed for reasons that go beyond safety and
fairness.
• The drive to enhance human nature through
genetic technologies is objectionable because it
represents a bid for mastery and dominion that
fails to appreciate the gifted character of human
powers and achievements.
Enhancement
• Perhaps the genetic revolution will change the
way philosophers discuss ethics and will force
spiritual questions back onto the political
agenda.
• In order to grapple with the ethics of
enhancement, we need to confront questions
largely lost from view in the modern world.
• Since these questions verge on theology,
modern philosophers and political theorists tend
to shrink from them.
• But our new powers of biotechnology make
these questions unavoidable. ..
Enhancement
• controversial issue regarding
biotechnology is the prospect of
employing it for the purpose of human
enhancement .
• demarcation problem:
– What is enhancement and what is it being
contrasted with?
– primary modification people have in mind is
genetic, but it is worth looking at non-genetic
modifications
Demarcation
• therapeutic modification is one that
brings a trait that was below a
recognizable, species-wide norm up to
that norm.
• an enhancement modification in
contrast as one that is a non-therapeutic
improvement.
– The norm referred to here is the one that
separates conditions of health from those of
disease
BUT
• the health/disease distinction is of
limited use in explaining the
enhancement/therapy distinction
Value judgments
• what constitutes the norm?
• Is the judgment that someone is
diseased ?
• Is a particular condition a disease
independent of whether we think it is
bad or undesirable?
• Can a condition be a disease in one
culture and not in another?
• If what constitutes enhancement
varies with individual or culture
– -if enhancement is in the eye of the
beholder –
• then it is not clear that we can
sensibly articulate an (ethical) issue
about enhancement as such.
Enhancement/therapy distinction
• One class of cases are modifications that,
strictly speaking are enhancements, but
whose purpose is to respond to (the
threat of) a disease.
• For example, a modification that improves
people's resistance to particular diseases
beyond the normal capacity would count
as an enhancement but its purpose would
be disease prevention and so arguably
therapeutic.
– Cf vaccination
• ambiguity in the idea of "normal
traits."
• Moreover, normality itself often
refers to a range within a trait rather
than to a sharp line.
– Short stature
Biotechnology covers a range of
technologies and procedures, many of
which could conceivably be employed
for enhancement.
But the most discussed
enhancement technology
is one in which a person's
genome is altered.
• Genetic modifications are often separated
into two kinds - somatic and germline.
– difference is whether the particular genetic
modification affects the individual's gametes
so that the modification can be passed on to
the individual's offspring.
– The object of a somatic modification is a
modified individual,
– but the object of a germline modification is a
modification that becomes part of the
individual's legacy or inheritance.
Designer Children
• Used pejoratively to describe children of
parents more concerned with fashion than
valuing children for their own sake.
• Is choosing a same race child designing
the child you will have?
• It is a truism that bears repeating that
once a person has capacity to choose
and awareness of that capacity- then
choice is inevitable.
• The Nuffield Council report on genetic
screening distinguishes between
legitimate and illegitimate uses of genetic
screening.
• It makes the boundary between legitimate
choices and unacceptable eugenics
choices at the point where:
– “the decisions are subjugated to those aims
considered to be of benefit to the population
or the state”.
How it still happens
Truth
• One in six couples have problems
conceiving.
Male infertility
• Male has poor sperm
• Intrauterine insemination (AIH)
• Assisted Reproduction
Male infertility
• Male has no sperm
• Artificial insemination by donor (AID)
• Assisted Reproduction
Female infertility
• Anovulation (PCO/ HH)
– Ovulation induction
• Assisted Reproduction
Female infertility
• Tubal factor/ Endometriosis
• Assisted Reproduction
Female infertility
• Ovarian failure
• Assisted Reproduction with donor eggs
The solution or the
problem?
Let’s copy nature
+
egg (oocyte)
sperm
The first
25th July 1978
Louise Brown, Oldham General
Hospital
The media
The team
Favoured by chance
The downs?
•
•
•
•
Emotional, physical drain
Poor success rates, still.
Not state funded
Passing on the “problem”?
• What about ethical issues?
Endless list…
• Informed consent
• Confidentiality
• Research involving
genetic material
• Screening (PGD,
antenatal)
• Sex selection
• Saviour siblings
• Selecting for disability
• Surrogacy
• Sperm, egg donation
• Sale of gametes
• Postmenopausal
motherhood
• Rationing access to
reproductive services
• Human reproductive
cloning
• Fetal material in research
and treatment
• Genetic enhancement and
therapy
Informed consent
• Relevant information
• Opportunity for deliberation
• Capacity (competence) to understand
information
• Voluntary
– Relevant cases
• Natalie Evans –UK
• MR v TR
– concerning a separated couple that disagree about whether
frozen embryos (fertilised and stored when the couple was
still together) can be used to impregnate the woman over
the objections of the man.
Research on genetic
material
• Consent
• Adequate information/ counselling
• Impact
• Relevance
Screening
• Preimplantation
– Most acceptable
– Risks not known
– Does the embryo
have moral status?
• Antenatal
– Visible embryo
– Involves
destruction of life
already
established
– Justified?
– Does the fetus
have moral status?
Screening
• Moral status came into focus during the
abortion debate.
What is it to have moral
status?
• It means that harm matters to the
given thing (the moral status of
which we are assessing).
The fetus
• Part of the human species
• Sentient (feels pain)
• Qualifies for personhood (potential)
PGD
Sex selection
• Preimplantation Genetic Diagnosis
• One blastomere
• PCR/ FISH
Sex selection
• Therapeutic
– Avoid inheritable
disease
– Haemophilia
– Duchenne
muscular
dystrophy
• Non-therapeutic
–
–
–
–
Family balancing
Preference
Replacement
Procreative
autonomy (how
far?)
Saviour siblings
• One created to cure/ save other
sibling.
• Tissue match
• Designer babies?
• Not creating child for itself.
• This is a commodity rather than a
person.
Saviour Siblings
• Kantian prohibition on using people
merely as a means to and end ?
– might justifiably be argued if the new
sibling were created solely for the
purposes of generating a donor for the
existing child
Postmenopausal
motherhood
• Welfare of the child
• Resource allocation
• Natural?
Surrogacy
• Arrangement (altruistic)
• Contract (commercial/ US)
• Surrogate – carry the pregnancy
• Genetic
• Gestational
Is it right?
• Allows couples to have a child which
otherwise could not have been born.
• Women with very high risk for pregnancy
can contemplate a genetic offspring.
• Women who enjoy pregnancy can do it
for money.
• Altruistic
• Traditional way of producing children
is subject to prejudice or preference
– not only for a certain type of partner but
– subconsciously at the particular type of
child mating with that partner will
produce.
Genetic Choices –
Disability
• Serious practical possibility for people to
choose the type of children they will have:
– Ante-natal testing followed by abortion
– Selection using IVF -only implant embryos
with required genetic makeup
• Is the central issue one of procreative
liberty?
– Freedom to procreate is not something limited
to the individual
– It is different to freedom of speech etc
• In the UK and US ante-natal testing is run
on the basis of personal choice.
• Nevertheless, the state has set up the
programme. Is there a danger that the
state/society has a subliminal influence
on parents to produce the best child they
can.
• Are there economic motives relating to
cost benefit analysis and expense
incurred by society if a disabled baby is
born?
Selecting for disability
• Is it acceptable to deliberately
choose to have a disabled child?
Deaf Lesbian Case
• Lesbian couple decided to have a
deaf baby.
– Many deaf people assert deafness is not
a disability rather a social construct.
– Criticised for their choice –saying it was a
pity to deprive a child of the full range of
abilities open to it.
– If it is ok to select a child without
disability is it ok to select for one with?
• Not always a sharp boundary between
knocking out a disability and enhancing a
trait.
– More clear-cut with single gene disorders, but
this applies to a small proportion of disease
types.
• Not a sharp boundary between bottom of
normal range and disease.
– Often a subtle spectrum
– e.g. Achondroplasia or clinical depression
Genetic Inequality
• Unlikely Government will fund
enhancement
• Market driven
– rich will purchase genotypes the poor
can’t afford?
– We are used to inequality wrt wealth
– In principle wealth can be redistributed
• Not so with genetic inequality
Positional Goods –Fred Hirsch
• Social limits to growth
• If everyone stands on tiptoe –
nobody can see any better
• Were enhancement to become
pervasive – there is no net benefit
for an individual.
Cosmetic Neuropharmacology
• Prozac
• Ritalin
• Memory enhancement
• Arguments against use of prozac type
drugs for non-clinically depressed
patients.
• What is the societal impact?
• But what is wrong with their use?
– Personal identity
– Human nature
– If you take 2 routes to get to a place does it
matter if you end at the correct place?
• Worries that the kind of person
Prozac makes you is the type valued
in society.
– Promotes masculine, assertive values
• Societal Medicalisation
– Tendency to view social, personal and
political problems in biological or
medical terms
• Effect on personal identity
– Elliot- we have a ‘true’ self
– Previously achieved through spiritual
means
– Currently society demands ‘quick fix’
– Or we decide how we want to be and
assess methods of achieving that goal.
• ?temperament altering drugs for
criminals?