Abstract
Although the philosophical literature on the ethics of human prenatal genetic alteration (PGA) purports to inform us about how to act, it rarely explicitly recognizes the perspective of those who will be making the PGA decision in practice. Here I approach the ethics of PGA from a distinctly virtue-based perspective, taking seriously what it means to be a good parent making this decision for one’s child. From this perspective, I generate a sound verdict on the moral standing of human PGA (research): given the current state of the art, good parents have compelling reason not to consent to PGA (research) for their child, especially as part of the first wave(s) of PGA research participants and especially for non-medically oriented purposes. This is because doing otherwise is inconsistent with a plausible and defensible understanding of virtuous parenting and parental virtues, founded on a genuine concern for promoting the overall flourishing of the eventual child. In essence, given the current and foreseeable state of the art, parents who allow prenatal genetic alteration of their children are less-than-virtuous parents to those children, even in cases where they have a right to do so and even if PGA turns out to be beneficial to the eventual child.
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Although the philosophical literature on the ethics of human prenatal genetic alteration (PGA) purports to inform us about how to act in that context, it rarely explicitly adopts the perspective of those who will be making the PGA decision in practice. Despite receiving much recent attention (see, for example, Savulescu and Bostrom 2009; Buchanan 2011; Harris 2007), the moral standing of PGA remains indeterminate. Reasons for this include that the issue is complex and that we do not yet have an empirical understanding of the effects of PGA, since no one has ever been genetically altered in this manner before. Another reason, perhaps, is that we have yet to ask whether good prospective parents, as front-line decision-makers in this context, would have good reason to condone PGA for their future children and whether their doing so would be in line with them being good parents to those children.
Here I approach the ethics of PGA from a distinctly virtue-based perspective, for reasons I discuss in the following section (and have defended elsewhere). I do not claim that there is no role for considerations of rights, duties, or consequences to play in our normative assessment of PGA. What I do argue is that these perspectives cannot settle the debate (on their own) and that virtue-based considerations advance our understanding of the morality of PGA in helpful and important ways. I ask whether good (virtuous) prospective parents are behaving in line with the seminal parental virtues when they pursue PGA (research) for their future children. From this perspective, I generate a sound, if only tentative, verdict on the moral standing of human PGA: given the current state of the art, good parents have compelling reason not to consent to PGA (research) for their future children, especially as part of the first waves of PGA research participants and especially for non-medically oriented purposes. This is because pursuing PGA is inconsistent with a plausible and defensible understanding of virtuous parenting and the parental virtues, founded on a genuine concern for promoting the overall flourishing of the eventual child. In essence (and to be elucidated below), given the current and foreseeable state of the art of PGA technology, parents who allow prenatal genetic alteration of their children are less-than-virtuous parents to those children (in the sense that they are unwise, imprudent, inappropriately beneficent, etc.), even in cases where they have a right to access and use such technology and even if PGA turns out to be beneficial to the eventual child.Footnote 1
For the purpose of this paper, I take PGA to be the manipulation of the genetic constitution of unborn human beings (e.g., embryos), with the goal of ameliorating genetically-based traits or capacities (e.g., intelligence, memory capacity, immune system functioning, etc.) or correcting for hereditary disease or impairment (e.g., Huntington’s, Alzheimer’s, and spina bifida) through biotechnological means. “Genetic alteration” stands for biotechnological procedures (germ-line or somatic) that work directly on the genetic constitution of an individual, where the goal is to cure devastating illness or to ameliorate or introduce certain capacities beyond what would ordinarily have been possible given the result of the random combination of the genes of the genetic parents.
In order to focus my account, I consider the ethics of PGA exclusively, leaving related technologies and practices to the side (e.g., prenatal genetic diagnosis, pre-implantation treatment for mitochondrial disease, etc.). While I note that what I argue for here may have implications for closely related technologies that are being developed (or are already in use), attempting to say something new and important about the ethical use of such related technologies is beyond the scope of this paper. At present, PGA technology is not yet available for use. Because of this, although I will often use PGA and PGA research interchangeably, the pressing ethical issue under analysis here concerns the latter, as the initial instantiation of the former in practice. I follow others (e.g., Agar 2004; Baylis and Robert 2004) in thinking that there is good reason to believe that human PGA is on its way, and thus we should prepare ethically for its arrival. Yet part of our decision to permit PGA will depend on whether research in human PGA is morally permissible in the first place.
In the following section (section one), I motivate my virtue-based approach to the ethics of PGA by identifying important flaws in some of the competing normative approaches to this issue. These flaws force us to look beyond (exclusive) appeal to rights, consequences, and duties, in order to generate a sound moral verdict on PGA. From there, I articulate my positive account by examining some of its central tenets, including how it determines virtuous action and the nature of the flourishing of the child (section two). In section three, I offer an examination of two seminal moral virtues in this realm, namely parental wisdom and prudence. The argument presented here is sufficient to show that, in the great majority of cases, virtuous parents would not consent to PGA for their children. Yet, since not all parents are virtuous, we may expect that PGA will come to be practised by some parents, for uses beyond the exceptional ones conceded to. Because of this, there is reason to examine issues beyond the decision about whether or not to consent to PGA for one’s child. Thus, in section four, I offer an analysis of two additional parental virtues, namely creativity and honesty, which speak to the decision about which trait(s) to alter in one’s child and how to treat one’s child who has been the subject of prenatal genetic alteration. While I cannot provide a complete account of virtuous parenting here, I highlight the plausibility and promise of a virtue-based approach and generate a sufficiently rich account so as to be able to say something new and important about the issue of the ethics of PGA (research) under that lens.
The Importance of Character in the PGA Context
There is a robust and growing literature in bioethics that is devoted to developing virtue- or character-based approaches to specific bioethical issues (e.g., Oakley 2009; McDougall 2013). At minimum, the goal of such character-based approaches is to supplement and complement consequentialist and deontological approaches to those ethical issues and to remedy shortcomings in the analyses that depend exclusively on those considerations. While consequences, duties, and rights are important to consider in the moral realm, the task of settling complex and novel bioethical issues is advanced further once we (also) look beyond these features and ask questions about the moral character of the ones performing the action. And virtue-based considerations are especially informative for cases in which we have little to no knowledge of the consequences and where the nature and scope of duties and rights remain contentious.
The PGA debate is dominated by consequentialist and deontological views. I have argued against the feasibility of consequentialist perspectives on PGA elsewhere (Tonkens 2011a, 2011b) and will not rehash those arguments here. In a nutshell, the major problems are (i) that we do not have an empirical understanding of the effects of any given PGA, since PGA is not yet being practised on humans, and thus consequence-based verdicts are presently unacceptably speculative, and (ii) that there may be cases where PGA could yield good consequences (for the child), and yet pursuing it would nevertheless be morally unacceptable (e.g., unfair, irresponsible, imprudent, reckless). Deontological approaches to this issue are similarly problematic. In the remainder of this section, I reject rights as the proper foundation for this debate, after first taking up Savulescu’s principle of procreative beneficence as a potential tool for assessing the moral standing of PGA.
PGA and Procreative Beneficence
Savulescu (2001) offers an influential proposal in his “principle of procreative beneficence,” culminating in a duty to have the best child possible: of the possible children one could have, one ought to (i.e., has good reason to) bring about the best child possible, i.e., the child who is expected to have the best life, given the available information. Given that part of the promise of PGA is that it could help to produce better children, then PGA may be consistent with, and approved by, Savulescu’s principle. According to this principle, parents should use the available information and choose the reproductive option most likely to bring about the best outcome for the eventual child. Although I am sympathetic to the general air of this principle, it is ultimately unhelpful in the PGA debate (despite certain merits it may have as a procreative principle in general).
Savulescu understands this principle as identifying an obligation to have the best child possible, with his main concern being selection for the embryo that has the best chance at having the best life of the embryos available (see Savulescu and Kahane 2009). Yet PGA is different from embryo selection in important ways and may or may not be the method best suited for bringing this about of the methods available to prospective parents for attempting to do so. If the prophesied benefits of PGA actually come to fruition, then this may be the mode of human reproduction that can bring about the best children, given the options available. Yet appealing to this principle alone leaves us helpless for deciding whether we actually ought to pursue PGA in the first place; we ought to pursue it insofar as it yields the best child possible, something we cannot know ahead of time given the current (and foreseeable) state of the art. In other words, although the goal is to have the best child possible, the means of securing this end make a moral difference, and procreative beneficence cannot determine what method of reproduction will bring about the best child. In order to do so, we need rich empirical data regarding the safety and effectiveness of the various methods available, including PGA (among many other things).
Lack of empirical data surrounding PGA (and human genetics in general) means that we do not know the likelihood (i.e., we cannot generate a reliable probability) that PGA will bring about the best child possible, and (good) parents contemplating PGA for their child cannot justifiably (and thus will not) assume the safety and effectiveness of any given prenatal genetic intervention for their child—as discussed below, this would be a sign of a lack of parental wisdom. Although Savulescu may be correct to argue that parents have a general duty to birth the best children possible, the principle of procreative beneficence cannot tell us how that duty is to be fulfilled. If we settle for using traditional reproductive means and less radical forms of assisted reproduction, since they are known to reliably and relatively safely yield “good” children, we may thereby be sacrificing our ability to bring about the best child, consequently violating this principle; “natural” reproduction has very little chance at bringing about a child who can mega-flourish, and (presumably) a mega-flourishing child is better than a flourishing child. Yet we do not know whether PGA will bring about a child who will mega-flourish (or flourish at all), although this is what such technology is intended to do.
Lastly, there are numerous other virtues that are relevant to the PGA context that do not get the attention they deserve if we appeal exclusively to procreative beneficence in our parental decision-making (which includes the decision to have children and whether to genetically alter them). Although something like the principle of procreative beneficence could make up part of the content of the virtue of beneficence, other virtues like love, acceptance, prudence, and honesty (etc.) get entirely overlooked by it. Importantly, (i) other relevant parental virtues may sometimes conflict with parental beneficence, (ii) the virtuous thing for parents to do may sometimes be to forgo certain (intended) benefits for their children, and (iii) the beneficent parent is not necessarily a good parent overall, for he or she may also be imprudent, greedy, selfish, etc. Indeed, one could exercise one’s (putative) duty to have the best child possible in ways that are responsible or irresponsible, wise or unwise, fair or unfair, etc.; appealing to duties, like the one captured by the principle of procreative beneficence, does not tell the whole moral story (in the context of the ethics of PGA). For example, a parent is obligated not to physically harm his or her child, and children have the right not to be physically harmed. Yet we can imagine a father or mother not beating his or her child because s/he is scared to go to prison, or believes the child is not worth the effort, or does not want to lose a spouse to divorce, or is too intoxicated to stand up, or does not want to scar and bruise a well-manicured hand, etc. Parents who refrain from beating their child for these reasons, although they may be beneficent and are satisfying their parental obligation and not violating the child’s right to protection, are nevertheless selfish, uncaring, irresponsible, and cowardly, rather than respectful and compassionate: they are being beneficent for the wrong reasons.
PGA and Rights
As with appealing to duties, appealing to rights, while important, cannot tell the whole moral story here either. Just because a parent has the ex hypothesi right to secure PGA for his or her child, it does not mean that s/he ought to exercise that right or that all ways of (not) exercising that right are morally appropriate. It will not be enough, morally speaking, for a parent to argue that condoning PGA for one’s child is morally permissible since the parent is acting within his or her reproductive rights in pursuing it (even assuming that doing so does not conflict with any of the child’s rights). Analogously, just because parents have the (negative) right to dictate the number of children they are to have, it does not mean that having any number of children is necessarily morally permissible, for these parents (of these children). Considerations of the quality of parenting, the resources available to them, and a deep understanding of the nature of the child’s flourishing (etc.) may mean that conceiving some number of children, for some parents, is to overstep their moral bounds, to exercise their rights in an unacceptable manner. Although reproductive rights will be important to consider in order to ensure that those who deserve to have access to PGA do have access, knowing that a parent acted within his or her procreative rights does not tell us whether exercising those rights in that way was morally acceptable or not. Thus, even if we grant that parents have a right to PGA, we are still left wanting in our moral verdict on PGA.
Virtuous Parenting and the Flourishing Child
I take it to be an asset of a character-based approach to normative ethics that it does not focus or depend on rights, duties, or consequences at its foundation. Rather, it assesses the moral standing of actions by making appeal to the character of the agent performing the action (e.g., the parent, the geneticist). Virtues are thought to be fine inner states of character, and their possession and sustained exercise gives the agent his or her best chance at flourishing (as a human moral agent, in a specific role) in the face of the demands of the world (Hursthouse 1999; Swanton 2003). Although consequences matter—especially with respect to virtues such as beneficence—reasons, motivation, attitudes, and emotions of the acting agent are (also) central, and consequences of actions, good or ill, can be the result of virtuousness or viciousness.
This is important (at least) because parents—rather than bioethicists, philosophers, or policymakers—are most likely going to be the ones who will be making these procreative decisions for their (future) children in practice, and they will need to do so in the absence of input from the child receiving the prenatal genetic alteration and, in the first instance, in the absence of any empirical data regarding the consequences of PGA. We can assess the moral standing of a particular instance of PGA by asking whether it is consistent with the behaviour of a parent who is beneficent, wise, honest, loving, and committed (etc.), that is, whether the reasons, motivation, attitudes, and emotions represented in the act of allowing one’s child to be prenatally genetically altered are consistent with these and other parental virtues. Thus, on this account, determining the moral standing of human PGA will not depend on appeal to prophesied potential benefits and harms, or the rights of intending parents, but rather on whether or not virtuous parents, acting in character, have good reason to consent to a specific PGA procedure for their future child. PGA of one’s future child will be morally permissible only if doing so is in line with the parent possessing and exercising those character traits necessary for promoting the overall flourishing of that child (in the absence of corresponding parental vices).
Parental virtues are those traits of character that are necessary for promoting the overall flourishing of one’s children in an excellent (or good enough) way in the face of the demands of the world. The possession and exercise of the parental virtues is a parent’s best bet for meeting the ends of parenting well, in his or her role as parent. This understanding of parental virtue has the benefit of not depending on the eventual flourishing of the child and recognizes that having vicious parents does not necessarily condemn a child to a life devoid of any chance at flourishing (although it is something that is morally condemnable on the parents’ behalf). Indeed, this is one way in which virtue ethics distances itself from consequence-based normative frameworks; although virtuous parents will care deeply about whether their child flourishes, their flourishing qua parent is grounded on what it takes to parent well, which is the promotion of the child’s flourishing. One problem with the vicious parent is that he or she has a poor chance at flourishing as a parent, since s/he does not act so as to effectively promote the flourishing of the child. Indeed, s/he acts in ways that (reliably, predictably) hinder the child’s chances at flourishing. And, insofar as parenthood is an important and central role that one may adopt in one’s life, failing to flourish as a parent goes some way towards that agent not living a good life.
Although I recognize that much debate ensues about “flourishing” and what it means for a human life to go well, here I suggest that the flourishing of the child is a tripartite notion, including health, happiness, and good character. I take each of these elements to be necessary conditions, although it is likely that different combinations and degrees of health, happiness, and good character will find different children flourishing to different degrees and perhaps even in distinct ways.Footnote 2 There are myriad ways for a human life to go well, and there are myriad ways for children to flourish, given their agent- and context-specificities.
What seems clear is that a child who is unhealthy, miserable, and/or vicious has failed to flourish to that extent, and all human agents who are not flourishing are unhealthy, unhappy, and/or of poor moral character to some extent. While actually securing the child’s flourishing is the parental goal, parents’ virtuousness is gauged by the extent to which they promote that flourishing, determined by their possession and exercise of the character traits necessary for doing so. Moreover, at bottom, it is crucial that the child have the capacity to flourish in the first place, i.e., the capacity to be happy, healthy, and of good moral character. Preserving a child’s capacity to flourish is a fundamental aspect of promoting the child’s flourishing, since the former is a necessary condition for the possibility of the latter.
While a complete list of parental virtues has yet to appear, there has been some discussion of a few parental virtues in related bioethics literature, including, for example, parental love (Herissone-Kelly 2007) and acceptance, commitment, and future-agent-focus (McDougall 2005, 2007; Malek 2013). Here I focus on four less discussed parental virtues and their role in the PGA debate specifically. Part of my motivation in doing so is to expand the scope of serious thinking in this area and to highlight the richness of a virtue-based account. I do so also because two seminal parental virtues (i.e., parental wisdom and prudence) have thus far been overlooked in the literature and need to begin to be attended to.
In the following section, I discuss the virtues of parental wisdom and parental prudence and their role in helping the good parent decide whether or not to condone PGA for one’s child. In section four, I discuss the role of the virtues of creativity and honesty after the decision to consent to PGA has been made by the (ostensibly less-than-virtuous) parent(s).
Parental Wisdom and Prudence
According to Aristotle, the exercise of practical wisdom represents a state of character that allows one to deliberate and reason well about what is conducive to human flourishing and how to behave in line with the virtues that promote it (Aristotle 1941). Hursthouse (1999) stresses that being practically wise entails getting things right; acting virtuously involves having the practical wisdom necessary for deciding how to act properly, which involves knowing and doing the right thing (which may demand abstaining from action), for the right reasons, under the right circumstances, etc. It entails an ability to identify the relevant virtues in a given context, the scope and target of those virtues, and hitting those targets in an excellent way (Swanton 2003).
Surprisingly, parental wisdom, as a distinctly parental virtue, has yet to be discussed in the literature, although elsewhere I have argued that it is an important role-specific virtue in the realm of procreation and parenting (Tonkens 2011b). Parental wisdom (or being parentally wise) is a parent’s capacity to deliberate well about what actions promote the overall flourishing of his or her child; parental wisdom lies at the foundation of parents knowing what being a virtuous parent entails for them, as a parent to their child, and is essential for effectively shaping their actions in the circumstances that they encounter as a parent.
Being parentally wise entails having children for the right reasons and under the right circumstances, knowing how to rear those children in the right way(s), practising informed decision-making about the well-being of one’s children, assessing the calibre of one’s parenting abilities and the resources one has available, etc. None of this is to say that parents who are not practically wise (or are even unwise) could not rear children who go on to flourish. Rather, parental wisdom is a virtue since its possession and exercise (along with that of other parental virtues) represents a parent’s best bet for promoting the overall flourishing of his or her children, given the demands of the world. Identifying and hitting the targets of the relevant parental virtues (and balancing one’s roles excellently) is better achieved by the agent who is practically wise. And a parent who accomplishes these feats will be better positioned to promote the overall flourishing of his or her children than a parent who does not.
Given the nature of the PGA context as one that is novel and where the risk of potentially unforeseen and unpredictable serious harm exists (amid the possibility of significant benefit), another important moral virtue here is parental prudence. This virtue involves exercising the appropriate amount of caution, demanded in a particular context. It is related to practical wisdom in that such wisdom will be necessary for determining what the appropriate expression of parental prudence is in a given situation. The great majority of serious thinkers on the ethics of PGA recognize that it has the potential to bring both positive and negative effects (for the altered child, for humans in general) and that, in general, some caution may be necessary, especially at this early stage in developing the technology. What is under dispute is what the appropriate exercise of caution is, the extent to which the potential (prophesied) benefits of PGA outweigh the risks, and what considerations ought to lie at the foundation of our decisions in this regard.
Parental prudence involves knowing when a situation calls for caution (whether this be proceeding with caution, waiting to act until more information is available, or inaction) and adopting the appropriate position of caution with respect to contexts where the well-being of one’s child may be at stake. Exercising the virtue of prudence well entails guarding against being cautious to the point of irrational overprotectiveness, or being ignorantly reckless or dismissive of the potential risks, or being inappropriately fearful of adverse consequences, etc. Exercising appropriate parental prudence entails recognizing and assessing potential dangers present in a child’s environment, as well as allowing the child to take his or her own risks and learn from his or her own non-lethal mistakes. (Assessing the moral character of the risk-taker is an especially helpful approach in cases where there is no reliable, empirical understanding of the consequences of taking the risk under issue. For an account of virtuous risk-taking, see Athanassoulis and Ross 2010). Being a good parent involves being prepared to help one’s child in case undesirable or hurtful circumstances arise, rather than always eliminating the possibility of their occurrence in its entirety, and hence prudence is related to other virtues such as commitment and courage. The target of prudence will typically allow for performing actions that carry some risk of harm, or danger, or failure, and hence parental prudence does not by definition reject all activities that carry risk of adverse consequences for the child. Thus, it is not the case that just because PGA risks compromising the well-being of the child or just because it is experimental, it is necessarily always imprudent for a parent to condone it for one’s future child. Rather, one element of exercising prudence well is to determine when a particular risk calls for a cautious stance and the exact nature of that caution, which will require (in part) appropriate emotional responsiveness (e.g., keeping fear in check, avoiding acting on inflated parental ambition, etc.) but also a clear understanding of the risk itself and what is at stake.
In order to determine what hitting the target of parental prudence entails in the context of PGA, we need to know how central we ought to hold the potential threat of serious harms of PGA. I am inclined to agree with Buchanan (2011, 203) when he argues that the “most serious worry about biomedical enhancement [and PGA more generally] is the risk of bad unintended consequences.” On the virtue-based approach being developed here, risks may be assessed with respect to a deep commitment to the flourishing of the child, and appropriate expression of prudence will be guided by refined parental wisdom: Will a particular manifestation of PGA actually help to promote the flourishing of the child, or what is the likelihood that this PGA will threaten the flourishing of the child? Is the child’s capacity to flourish already at risk in some way (e.g., is it known that the child will suffer from a devastating genetic illness), where PGA is used as a tool for potentially mitigating that threat? Has this sort of PGA ever been performed on humans? Are there alternative methods for generating the same or similar intended benefits, ones that do not involve the same degree of risk of adverse outcome? What is the likelihood that the child will retain the capacity to flourish if his or her parents do not accept this risk?
Virtuous Parenting and Experimental Lives
The most salient feature of the PGA context is the fact that, at present, all PGA procedures on humans are experimental—elsewhere I have argued that they are radically so (Tonkens 2011b). PGA has never been tested on humans, let alone humans who have been brought to term and have lived as genetically altered persons thereafter. PGA has the potential for widespread and significant physical and psychological impacts on the child and wider social impacts as well, including unforeseeable ones. In short, while PGA has the potential to better the child in certain ways, it also has the potential to undermine the child’s capacity to flourish.
Although PGA research on humans may be necessary for determining the consequences of PGA for humans, and thus for adding content to our presently content-less risk analyses of PGA, it needs to be asked whether PGA research is something that virtuous parents would consent to for their children and, if so, under what circumstances. In other words, it needs to be asked whether PGA research is something that virtuous parents have good reason to consent to for their children. One of the upshots of the previous section is that parents have good reason not to act in ways that are imprudent or unwise, as doing so threatens to compromise the overall flourishing of the child, something that is of paramount importance to the good parent. Accepting the risk of compromising the child’s overall flourishing (or, indeed, the child’s capacity to flourish) is not something that wise and prudent parents would do, outside of highly qualified circumstances, i.e., where that child’s capacity to flourish is already being threatened more forcefully from another direction and the parental intervention is pursued in the reasonable hope of attempting to mitigate or eliminate that threat.
The virtue-based approach being developed here helps us to avoid making unfounded, question-begging assumptions about how participation in PGA research will affect the child and thus for generating a non-speculative verdict on the moral standing of PGA research; from this perspective, we do not assume the safety and effectiveness of PGA, as, for example, Savulescu (2005) and Harris (2007) do, which is more in line with how (good) parents would enter deliberations in this context. This is because such an approach does not depend on (exclusively, foundationally) making predictions about the actual effects of such research on the child but rather on whether or not particular parents would be behaving in line with their promotion of that child’s overall flourishing, possessing and exercising the traits necessary for doing so. Somewhat counter-intuitively perhaps, we can say very much about whether an activity is in line with the promotion of the child’s overall flourishing without being required to assess the actual level of flourishing of that child (retrospectively). We do so by identifying those traits in parents that offer them the best chance at promoting the child’s flourishing (e.g., parental wisdom, prudence, creativity, honesty, etc.) and then assessing whether their actions are consistent with their possession and exercise of those traits. The flourishing of the child is central to this role-specific set of moral and intellectual virtues, and the parent who possesses and exercises them well is a virtuous parent to that extent.
It matters whether there are alternatives for bringing about the same or relevantly similar intended ends through other means and whether the child’s capacity to flourish is expected to be intact without requiring prenatal genetic intervention. With respect to the former, many traits can be influenced without the need for genetic intervention (or prenatal intervention, for that matter), through environmental, dietary, and pharmaceutical means. Given the risk and uncertainty, parental wisdom would favour the latter means over the former. With respect to the latter, while there are certainly genetic diseases that compromise or undermine a child’s capacity to flourish (e.g., anencephaly, spina bifida, and other ciliopathies, where the prognosis is too often a short and painful life), many if not most of the targets of PGA so far proposed in the literature (e.g., cognitive ability, height, intelligence, athleticism, etc.) are ones that do not guard against something that directly threatens the child’s capacity to flourish, even if the child may be better off overall were he or she to receive those (presumably safe and effective) alterations. This is especially true of “genetic enhancements,” where the goal is the betterment of an otherwise “normal” child, whose capacity to flourish (not to say mega-flourish) would typically be intact.
Given the current state of the art, i.e., that all human PGA represents unprecedented research, parental wisdom and prudence speak heavily against enlisting one’s unborn child as a participant in PGA research, especially as a participant in the first wave(s) of such research, even if this research could serve to improve the lot of future humans somewhere down the line.Footnote 3 Although the specifics of a given instance of PGA research make a difference, the default position of the wise and prudent parent will be one of being extremely hesitant to consent, and most likely not to consent at all. A wise parent would recognize that there is no data to suggest the likely outcome of such research for one’s child (in either direction), and thus acting in the face of this epistemological blindness is presumptively foolish and perhaps reckless. Moreover, in the great majority of cases, a child can be healthy, happy, and of good character without PGA, even if this means that the child does not have the chance at mega-flourishing. A prudent parent would not accept the risk of potentially seriously harming one’s child for the sake of generating empirical data on the outcomes of PGA research, as this would be demonstrative of a certain carelessness and callousness towards one’s child, especially in cases where there does not already exist an impending serious harm to that child’s capacity to flourish that the PGA research is intended to remedy. Moreover, a prudent parent would not seriously risk the well-being of his or her child in order to pursue superfluous (however laudable) potential benefits for the child. Such a parent would be imprudently beneficent, among other things.
To the extent that PGA research is necessary for giving a particular child a chance at being able to flourish in the first place, then it may be something that a wise and appropriately prudent parent would consent to, recognizing the situation as the non-ideal one that it is (i.e., one in which the parent is acting blindly and one where the well-being of the child is at stake). It is important to note that other issues will be important to consider here as well. For instance, while we can imagine cases where PGA could be a last-ditch effort at restoring the capacity to flourish in one’s future child, it is not necessarily true that desperate times call for desperate measures or that one has behaved virtuously in the face of such desperation—much of this will depend on the context, including the extent to which one’s reproductive options are limited.
From these considerations, there is enough to suggest that good parents would not consent to PGA research for their children, in the great majority of cases, especially as participants in the first wave(s) of PGA research on humans. This is so because doing otherwise is to act in a way that is inconsistent with virtuous parenting and the parental virtues that constitute it. Parents are not obligated to (justifiably do not) concern themselves primarily with social utility, health-related benefits of PGA at the social level, or fuelling scientific progress, especially if doing so seriously risks impacting their child negatively; according to the (virtuous) parent, in this context the embryo is not a research subject but rather a child who will come to be born, and the goal is to promote as much as possible its overall flourishing. If the child’s flourishing is somehow known to be legitimately and significantly threatened (at this very early, prenatal stage) by devastating genetic disease, then the goals of not harming one’s child and promoting flourishing may then coincide, perhaps culminating in being morally justified in choosing PGA for that child, at least in some highly qualified cases.
Not all instances of PGA are necessarily vicious, and not all parents who decide to condone PGA (research) for their children will necessarily be less-than-virtuous thereby—there may be nothing inherent in PGA that violates the parental virtues canvassed here. This is important to consider given that the continuation of the PGA enterprise may be inevitable (Baylis and Robert 2004). However, at present there is good reason to suggest that most instances of PGA research on humans who are intended to be brought to term are inconsistent with (at least) parental prudence and wisdom, which is enough to suggest that virtuous parents would not consent to PGA for their future children. Defending their decision to subject their embryo to PGA (research) based on their procreative rights does not eliminate the fact that they are being foolish and reckless parents, and bringing about (merely potential) benefits through these means is to attempt to be beneficent in inappropriate (imprudent, short-sighted) ways.
At the outset, I noted that the virtue-based verdict on the moral standing of PGA offered here is tentative. The crux of my analysis of parental wisdom and prudence is grounded on the idea that intending parents seeking to reproduce right now must make their decision about PGA in the face of a thick empirical blindness. Yet, as Agar (2004) and others have recognized, the PGA enterprise is likely to continue, even if it means that (if my account is on the right track) it is fuelled by the actions of less-than-virtuous intending parents and even if it will be done so “underground.” Assuming this is true, there may come a time where assessments of the moral standing of PGA will need to focus on (a) the selection of traits for the child who is to be altered and (b) how parents of children who have been prenatally genetically altered ought to act towards those children once they are born, rather than on whether it is parentally virtuous to pursue it in the first place. Because of this, in the remainder of this paper I briefly discuss each of these related issues, grounded on an account of the parental virtues of creativity and honesty.
Trait Selection and Life With PGA
Creativity
Creativity is a moral virtue whose value saturates the realm of parenting and child-rearing. For example, creativity is an invaluable asset to have during playtime and for active participation in artistic, theatrical, and musical activities as well as in less playful circumstances, like negotiation in the face of a child exercising his or her independence or stubbornness, meal preparation to meet taste and dietary needs (especially in the face of limited resources), finding effective ways to get a sick child to take medication, etc. These and other domestic undertakings can all be creative pursuits, and all benefit from being approached creatively. Although raising a healthy and happy child may not require that a parent is creative, meeting the demands of the world adequately and figuring out how to hit the targets of the various virtues puts demands on parents to find creative solutions to problems and appropriately creative ways to behave towards their children. Possessing and exercising creativity well serves to promote the overall flourishing of the child and helps one to meet the demands of parenting well.
There is very much that could be said about the parental virtue of creativity and how it could intersect with the ethics of PGA. Here, I would like to consider one potential objection to PGA, recently advanced by Frances Kamm (2005). Her Lack of Imagination Objection goes as follows: Our conception of the goods (traits, capabilities) to be genetically enhanced is significantly limited, due to our lack of imagination in this regard. Because of this, the goods that we genetically enhance in individuals will likely conform to a predictable and limited set. “When creatures of limited imagination (like us) do not design themselves, the range of positive goods that emerges is likely to be less limited than if they were to design themselves” (Kamm 2005, 13). Hence, “in seeking enhancements, people will focus on too simple and basic a set of goods” (Kamm 2005, 13). Therefore, where greater goods are more likely to be achieved by chance rather than (unimaginative) control over our genetic constitutions, this mitigates against control by means of PGA.
Even if we assume with Kamm that we should pursue that course of action that is most likely to reap the greatest amount of positive goods, there are several problems with this argument. It is false to suggest that there is a lack of imagination surrounding the traits and capabilities that we are hoping to be able to genetically alter. Although the range of plausible enhancements typically proposed in the literature restricts itself to things such as intelligence, memory capacity, and immune system functioning, other targets for enhancement also have been proposed, such as altruism (or empathy), humour, lessened predisposition towards aggression, skin tone (e.g., to increase resistance to ultraviolet sunlight), obesity, prenatal HIV vaccination, pigeon-like colour detection, and even bat-like echolocation. Indeed, in theory any trait with a genetic component is open to being genetically manipulated. Moreover, one reason for banning the creation of chimeras seems to be that we may get too imaginative in our design of future humans and seek to blend traits and capabilities from different animals into human beings that perhaps ought not to be combined.
Being charitable to Kamm, perhaps she means that the combination of traits and capacities that we (parents) contemplate may be limited, and so we may miss out on happy coincidences that emerge from the workings of the natural lottery. Along these lines, she suggests that
we are constantly surprised at the great range of good traits in people, and the incredible range of combinations of traits that turn out to be good. For example, could we predict that a very particular degree of irony combined with a certain degree of diffidence would constitute an interesting type of personality? (Kamm 2005, 13).
Kamm’s answer seems to be “no,” or at least “not likely.” So, the problem is not really that our imaginations are limited but rather that they are too limited, in the sense that greater diversity is available if we do not intervene via PGA (i.e., take creative control over the genetic dispositions of our children).
But the demands that Kamm puts on our (procreative) imagination are too strong. As the above indicates, we seem to have at least some imagination in this regard, and it is not restricted to “limited, predictable” forms of enhancement. Moreover, even relatively mundane genetic enhancements coupled with all of the non-enhanced traits that coexist in an individual will likely produce a variety of unexpected dispositions as well (some good, some not so good), of the sort currently produced through uncontrolled genetic distribution. Environmental factors and a significant level of ordinary genetic interaction will continue to saturate human development alongside biotechnological influences that all along contributes to bringing about a diverse range of (unpredicted, unpredictable) traits and capabilities, making up for any putative lack of imagination that designers may suffer from. In other words, it is not the case that we would be relying solely on our creative powers to design traits and capacities in humans, even if PGA becomes a common element of human procreation in the future.
Lastly, I would like to suggest that this method of influencing human development is inherently creative in a dual sense: (1) through PGA, we would literally be creating humans in a way that has never been done before, and, more importantly for our response to Kamm, (2) parents who pursue PGA for their children will be forced to offer original insight into their conception of those children, something not present in “natural” reproduction, where the expression of the child’s genetic traits and capabilities rests largely outside of the parent’s direct control and design. Now, just because parents who use PGA for “designing” their children will be creative, it does not mean that they will necessarily be appropriately creative. For example, choosing traits in their future children that would reliably and predictably threaten their capacity to flourish would be callously creative, and seeking to create a “master race” would be to be creative in unjust and discriminatory ways, etc.
It is an open and empirical question whether or not all parents who choose PGA would be creative in the manner emphasized by Kamm, and not being creative may in certain kinds of circumstances be a mistake in the activities of those specific parents, rather than an inherent problem with the PGA enterprise. And, as Kamm herself alludes to, in certain contexts appropriate creativity may entail placing certain limitations on our imagination, suggesting that exercising creativity well in the PGA context will be context- and agent-variable.
As it stands, Kamm’s argument does not support the conclusion that PGA is wrong (or that the PGA enterprise is misguided) because demonstrative of a lack of creativity in those who pursue it. The crucial point is that, when considering which traits are to be the targets of PGA, decisions should be in line with the virtuous activity of a parent concerned with promoting the overall flourishing of that child. One constraint on this (among many others) is that PGA be pursued through the exercise of appropriate imaginative expression (i.e., creatively), if it is pursued at all. But insofar as being appropriately creative is something that good (virtuous) parents do, then the Lack of Imagination Objection advanced by Kamm does not seem to apply to them; if they cannot exercise appropriate creativity through pursuing PGA in certain ways, then this would be a reason against their pursuing it for their children in these ways. Yet in cases where they can pursue PGA appropriately creatively (which, I have argued, Kamm’s objection fails to show otherwise), then Kamm’s objection is unfounded.
It is important to emphasize at this point that it could turn out that there is nothing inherently problematic with (certain kinds of) PGA on humans, if and when our empirical blindness subsides. If prospective parents decide to pursue PGA for their children, even though doing so is less-than-virtuous given the current state of the art, then we may come to have a better understanding of the longitudinal empirical effects of PGA, which could turn out to be good overall. Nothing that I have said about creativity, and the prospect of PGA being the sort of thing that could be an aspect of appropriately creative parenting, is contradictory with what I argued for above, i.e., that pursuing PGA at this point is (at least) imprudent and unwise.
The final aspect of the PGA context that I consider here concerns how a good parent would approach and treat his or her child who has been prenatally genetically altered. One parental virtue that is important to highlight here is parental honesty.
Honesty
Being honest with one’s children helps to foster important elements partially constitutive of the child’s overall flourishing, including the ability to found and foster meaningful relationships with others and fortifying the loving, trusting bond between parent and child. Conversely, routinely lying to one’s children or withholding the truth without justification is inimical to their flourishing and weakens that bond and relationship.
Honesty is often bordered with privacy and potentially competing considerations for the child’s well-being, where “white lies” may seem like necessary evils (if they are evils) that are required in order to promote the best interests of the child. Although parental honesty may not always require full disclosure, being an honest parent entails telling the truth in the right ways and for the right reasons and teaching children to be open and honest, fostering their moral development as a result.
Parental honesty can manifest itself in many ways, including a parent conveying information accurately and comprehensively, expressing distaste for children lying, etc. Much of what shape parental honesty will take will depend on the nature of the situation and the stage of development of the child, among other things. Importantly, honesty should be executed without the baggage of associated vices, such as overprotectiveness, selfishness, disrespect, and callousness. The parent who lies to his or her child because telling the truth is difficult, or because the parent wants to guard the child from the harsh realities of life and death, or because the parent wrongfully assumes that the child cannot comprehend the truth, or because the parent is irrationally fearful of the child’s reaction to the truth, or because the parent is mean-spirited, etc., would be to overextend the potential morally innocuous role of lying and find the parent being inappropriately dishonest. Conversely, one could tell the truth meanly or in a manner that is inconsiderate.
The intersection of PGA and parental honesty is quite specific, namely whether the parent will be honest with the child about the latter’s genetic prehistory. (I have chosen to examine the intersection of PGA and parental honesty in part because of this narrowed scope and also because it is something that has not yet received much attention in this literature.) The main issue is whether exercising the virtue of honesty well in the context of PGA puts demands on the parent for informing the child that he or she has been genetically altered. This issue is somewhat analogous to disclosure to an adoptive child of having been adopted. Even if there are no laws that require a parent to tell an adopted child of his or her genetic history, the child may have a right to know, especially since this information is crucial for promoting the child’s ability to flourish in certain ways. Not disclosing important information about the child’s history may be inimical to the happiness and character development of that child and thus is the sort of information that honest parents would not withhold from their children without good reason.
In the postscript to The Future of Human Nature,Footnote 4 several interlocutors challenge the legitimacy of Habermas’ assumptions underlying his description of the post-PGA context. Notably, Dworkin charges Habermas with assuming that the child will know the truth about his or her genetic prehistory (“the affected person maintains retrospective awareness of the prenatal intervention” [Habermas 2003, 86]), one which includes the child being genetically altered, since this seems to be a necessary epistemic condition for the possibility of the child developing a maladjusted ethical self-understanding.Footnote 5 In cases where the child is unaware of his or her genetic prehistory, this issue becomes moot. On the one hand, being dishonest, in the sense of not providing full disclosure, may work towards preventing the harm of the child developing a maladjusted ethical self-understanding. On the other hand, this information is important for the child to have, and the child may have a right to be provided with it.
This is a plausible objection to Habermas’ view; if developing an inappropriate understanding of oneself as being a less-than-full moral agent depends on having a specific sort of knowledge of one’s genetic history, and a specific orientation towards that knowledge, then one way to avoid this problem would be to have that information kept from the child. However, Habermas suggests that lying to one’s child about the nature of his or her genetic prehistory would only put off the inevitable (Habermas 2003, 87).
Yet one may challenge Habermas on this point: If a determined parent (or set of parents) decides to keep this information from his or her child, there may be nothing that the unsuspecting child can do. Moreover, even if the child does stumble onto this information, despite the sustained efforts of the parent(s) to prevent the child from doing so, the parent(s) could simply continue to pile on the lies, explaining away the genetic heterogeneity in the family by claiming the child was adopted, for example. Even if it is true that adding deception like this to the PGA context could add to the severity of the potential “identity crisis” of the child if the child were to learn of the deception, this does not say why it would be impermissible to withhold this information in the first place.
However, lying to the child about his or her genetic prehistory would be morally problematic, as it would be an inappropriate exercise of parental honesty, attempting to benefit one’s child through deception rather than respect, conversation, and understanding. Virtuous parents would want to be honest with their children wherever possible. Because of this, there is already something presumptively wrong with a parent lying to a child about something as central to personal identity as genetic history. Whereas not telling the child about his or her genetic prehistory may be an option considered by virtuous parents in certain situations (given that there is a chance that such information may be psychologically harmful), it would likely not be the one chosen. There is some potential harm in telling the child of his or her genetic prehistory (assuming Habermas’ view is on the right track). There is also a potential harm in not telling the child about his or her genetic prehistory, as this information is essential for self-identity formation and, importantly, the relationship and bond that the child has with the parent(s). The harms associated with the latter are more significant with respect to the overall flourishing of the child, and there may be ways to readjust a child’s maladjusted ethical self-understanding, especially with the help of devoted and caring parent(s), whereas regaining trust and repairing a weakened bond may be less forthcoming.Footnote 6 Lying or withholding information of this calibre and relevance to the child’s self-identity formation contradicts the goal of promoting the overall flourishing of that child. Indeed, this sort of non-disclosure may be representative of other parental flaws , for example an unwillingness to help a child cope with challenging circumstances that may arise (laziness or lack of commitment) or a desire not to be challenged regarding the reasons one had for seeking the alteration in the first place (closed-mindedness or hyperactive paternalism). (Equally, not lying to one’s child about his or her prehistory because of the potential that the child will catch you in the ruse is a dishonest reason for the parent to be honest.)
The presumption ought to be in favour of full disclosure of the child’s genetic prehistory, even if there is a chance that this information could have negative effects on the child’s understanding of him- or herself. This information is vital for self-identity formation and the child’s relationship with the parent(s) and is an important family matter that involves the child as well as the parent(s). While there may be nothing inherently dishonest about the act of PGA, it would be inappropriately dishonest of parents to not tell their child of his or her genetic prehistory (or at least of the child being prenatally genetically altered in some way and then allowing the child to decide the extent to which s/he wants further details about this prehistory), and parents ought to disclose such information to their children, even if there is a chance of the genetically altered child developing a maladjusted ethical self-understanding thereby. If the latter occurs, then devoted and compassionate parents would be available to help the child cope.
There may be some exceptional cases here. For example, if it turns out that Habermas is correct and there are no effective ways to combat the child’s “inevitably” compromised ethical self-understanding, or if the child/adolescent has a demonstrated history of handling similar situations in radical and self-detrimental ways (e.g., a history of attempting suicide), then the demands of appropriate honesty may change. Having this information ahead of time, however, would give parents further reason not to pursue PGA in the first place, knowing that this would be one of the consequences for the resulting child to emerge in its wake, if their deception is unveiled as such.
Another upshot of this discussion of honesty is that, given that full disclosure ought to be the default, the reasons that parents have for pursuing PGA in the first place become essential from another direction; after learning that one was prenatally genetically altered, we can expect that one of the main questions the child will have will be “why?”—and parents will do well to have good justification for putting the child’s well-being at risk through enlisting him or her as a participant in (currently unprecedented, risky) PGA research.
Conclusion
There are very many more parental virtues that are relevant to the context of PGA, including justice, acceptance (of one’s children for who they are), parental love, respect, etc. And a full virtue-based account of this issue will also need to consider complementary perspectives, like that of the (virtuous) genetic engineer, (virtuous) policymaker, and filial virtues as well. The modest goal of the second half of this paper was to begin to examine some of the issues in this context, after the decision to pursue PGA has been made and executed, and to examine two relevant virtues in some detail.
The main argument provided in the first part of this paper is that pursuing PGA (research) at this point in the development of such technology violates the appropriate expression of (at least) two seminal parental virtues, namely parental wisdom and prudence. An important implication of this is that, if virtuous parents have their way, we should not get to the point where we would know the consequences and effects of human PGA, insofar as doing so requires the recruitment and participation of many prenatal humans for the requisite research. Once we adopt the perspective of parents deciding whether or not to have their child prenatally genetically altered, there is good reason to argue that doing so is inconsistent with good (virtuous) parenting, and to that extent morally unacceptable (qua unwise and imprudent). This is true even if prospective parents have the right to access PGA technology and even if PGA would benefit the child in the end.
Notes
There is also an argument along these lines to suggest that, given the current state of the art, children who have been prenatally genetically altered have good reason not to be grateful to their parent(s) for the PGA and to be resentful of the way that they were treated during the prenatal stages of their development. If children ought to be grateful to their parent(s) and if PGA puts pressure on the child’s ability to feel filial gratitude, then this would make PGA morally suspicious from a different direction as well.
For example, nothing in this understanding of flourishing necessarily denies autistic children from being able to flourish, qua autistic child.
A parent is justified in being primarily (not to say exclusively) concerned with the well-being of his or her child, before s/he is required to concern him- or herself with the prospect of bettering future generations of humans, especially if this requires subjecting one’s child to unprecedented experimental genetic research.
Habermas does not defend a virtue-based approach to PGA but rather a Kantian-inspired deontological account. However, his discussion on informational disclosure in the post-PGA context is helpful for understanding the shape of (the virtue of) parental honesty in this context.
This may work the other way as well; we may expect some placebo effect to occur if the non-altered child is told of having an “augmented” genetic code, even in cases where the child does not.
It is worth noting that this aspect of Habermas’ theory has been the target of bountiful criticism. Moreover, as Harris (2007) and others have argued, there is no reason to believe that sustained and targeted psychological counselling could not help the child overcome this sort of maladjusted self-understanding, founded as it is on an untenable genetic determinism, i.e., the (false) belief that we are determined by our genes—genes ground predispositions, which may or may not manifest themselves phenotypically, depending on environmental influences, diet, etc.
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Acknowledgements
I am grateful to Duff Waring, Alice MacLachlan, Robert Myers, Udo Schuklenk, Françoise Baylis, D. Robert McDougall, Tamara Kayali, Tim Krahn, Jacqui Shaw, and four reviewers at the JBI for their engaging and helpful comments on earlier drafts of this manuscript. This work was supported (in part) through a Canadian Institutes of Health Research grant, FRN 111389.
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Tonkens, R. Parental Virtue and Prenatal Genetic Alteration Research. Bioethical Inquiry 12, 651–664 (2015). https://doi.org/10.1007/s11673-015-9650-8
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DOI: https://doi.org/10.1007/s11673-015-9650-8