Choosing our children’s traits

The ethics of choosing the kinds of children we might have, using a range of modern techniques, but in particular genetic ones, is the subject of widespread and intense debate. While some treatments of the issue are wildly futuristic and speculative, it is also the case that some choices can be made today, and it is likely that the range of possible choices will grow steadily in the years to come.

In this thought-provoking book, Choosing Tomorrow’s Children: The Ethics of Selective Reproduction, Stephen Wilkinson combines a general discussion of ethical issues, often with futuristic aspects, with a concrete examination of contemporary issues and cases, including the policy approaches and choices of the UK government and the UK regulator, the Human Fertilisation and Embryology Authority (HFEA) (which, the Lib-Con government announced this week, will soon be disbanded, its regulatory powers dispersed to other groups). Issues covered include: sex selection for non-medical reasons; saviour siblings (when the genetic make-up of a child is chosen such that she can be a tissue match and thus a possible tissue donor for an existing ill child); and the deliberate selection of disability.

British policy is often characterised as ‘permissive’, meaning that parents are permitted by law and the regulator to make many of the choices they typically want to make, such as avoiding the birth of a child with a disability. But, as Wilkinson highlights, permissiveness in the UK has its critics and its limits. For those of us who support and want to expand choices, there are some very interesting and useful discussions in this book. I particularly liked his discussion of the ‘expressivist’ arguments against selection and the social model of disability. His critiques of the HFEA’s arguments against allowing the selection of a ‘saviour’ for a parent and against social sex selection in the UK because it would send the ‘wrong signal’ to the rest of the world are nicely constructed.

In this book Wilkinson focuses pretty much exclusively on selection. This is a strength on the whole: it usefully directs attention to some key issues and sidesteps some others that are distinct and / or diversions in some contexts, such as the abortion debate. For Wilkinson, an important distinction is choices between different possible future children and decisions about how many children to have (if any). Another distinction is between analyses that focus mainly on the individual level and those that take a more impersonal or aggregate viewpoint in considering welfare or wellbeing, of which what he calls the Same Number Quality Claim plays an important role in his argument in places. In analysing a concrete case, Wilkinson often finds it useful to consider it from more than one angle, using more than one category, and in doing so he sometimes sheds new light on a familiar debate. For example, contrary to a popular argument, he finds it less problematic if a saviour sibling is the product of a different number choice than if she is the product of a same number choice, thus eschewing the popular defence ‘but we wanted another child anyway’. As he argues it:

‘Is it morally better if the prospective parents of saviour siblings want another child anyway and are not having an additional child just in order to save the existing child? The answer to this is that it is better in one way and worse in another. It is better because (arguably at least) the fact that they wanted another child anyway suggests that they are not regarding the saviour sibling as merely a means to an end, that they are not wrongfully instrumentalising her. It may be worse, however, in terms of child welfare. In particular, same number cases (ones where they would have had the child anyway) will often fall foul of the Same Number Quality Claim whereas different number cases (those where they are only having the child because of the need for a saviour sibling) will not.’

Whether or not one fully agrees with his reasoning, and specific conclusions he arrives at, the focus on selection in this example and many others discussed in the book is illuminating and thought-provoking. There are, however, some areas where the focus on selection as a defining issue seems a little misplaced. In particular, comparisons between selection and other approaches, such as genetic manipulation, are sometimes mishandled in my view, or at the very least require greater attention than he gives them.

The discussion of the deliberate selection of an embryo with a genetic impairment is one example. For Wilkinson, individual child welfare arguments allow the selection of an embryo with an impairment over a healthy one (a same number choice). This is because the child, once she exists, could not have existed otherwise and, presuming her to have a life worth living, she can only welcome the parents’ choice. He contrasts this situation sharply with a hypothetical one in which a healthy embryo is genetically manipulated to give it an impairment. In this case, he argues, the future child could complain that she had been adversely affected by the parents’ actions (or the embryologist’s, under parental instruction). But is the distinction really so clear?

Suppose a parent wanted a deaf child and was sitting discussing the issue with her embryologist, after test results on embryos that were ready to be implanted had shown that one had an impairment that would cause the future child to be deaf. What if the prospective parent were to say, ‘rather than throwing the rest away could you deafen one and implant it as well, to give me a greater chance of a child?’. If a child were to be born from the deafened embryo the parent could say to that child, just as she could to the child with the congenital deafness, that it was a choice between being born deaf and not being born at all, because there was no way she wanted a healthy child and it was her clear choice to have the healthy embryos destroyed.

While there are no doubt distinctions to be drawn between selection and manipulation, I would suggest that Wilkinson gives too much weight in this context, inadvertently perhaps, to essentialist and teleological arguments, and too little weight to the issues of parental motivation and broader impersonal welfare considerations. What if, for example, we took the manipulation back a stage or two (which we might be encouraged to do by Wilkinson’s insistence that we try to get away from issues to do with the status of the embryo) and considered, hypothetically, the manipulation of sperm and egg, or the cells that produce sperm and egg, so as to create a child who was deaf. How different is that from the real-life case discussed in the book of the couple who, successfully, sought a sperm donor with many generations of deafness in his family history so that they could have a deaf child by choice?

A second example where his focus on selection seems misplaced is his treatment of two topics, eugenics and enhancement, focusing on the selection of traits. In the case of eugenics this is too narrowly logical. Eugenics of old was more about the moral character of people, and the fear that the national ‘stock’ was degenerating because the ‘wrong’ kind of classes or races of people were having more children than the ‘right’ groups. Trying to untangle this through a philosophical study of different kinds of trait selection, in particular using the idea that negative selection against one trait is necessarily positive selection for another, is to use the wrong tools in my view.

Wilkinson then connects the discussion of positive and negative trait selection with the debate about enhancement. For different reasons this also seems strained to me. In his view, selection can be a defining aspect of enhancement or can create an enhancement. To give a concrete example, according to both of the definitions of enhancement he discusses, selection in favour of extremely high intelligence (a futuristic and contentious scenario) is classed as enhancement. What would be happening in that situation is what might occur through sexual intercourse without selection – the birth of an individual at the extreme end of the existing naturally-influenced spectrum, with a genome produced through the fusion of sperm and egg, unmodified by human manipulation. Is the selection of what can occur by chance enhancement? He acknowledges that some writers view enhancement as meaning modification rather than selection, but unfortunately he doesn’t discuss their arguments or his reasons for not using their definition.

Deliberate choice of disability, eugenics and enhancement are points for ongoing debate, of course. Overall the book is quite evidently based on a deep understanding of the issues. If there is an problem with it, and this is sometimes a strength rather than a weakness, it is that there are many issues that could have been dealt with in more depth, that Wilkinson is forced to touch on but then plead lack of space to develop. But such deficiencies, if they are such, leave the reader with plenty to chew on and discuss.

John Gillott is co-author of Science and the Retreat from Reason published by Monthly Review Press. (Buy this book from Amazon(UK).)

Choosing Tomorrow’s Children: The Ethics of Selective Reproduction, by Stephen Wilkinson, is published by OUP Oxford. (Buy this book from Amazon(UK).)