Part 1 The Case against Perfection

Breakthroughs in genetics present us with a promise and a predicament. The promise is that we may soon be able to treat and prevent a host of debilitating diseases. The predicament is that our newfound genetic knowledge may also enable us to manipulate our own nature — to enhance our muscles, memories, and moods; to choose the sex, height, and other genetic traits of our children; to make ourselves “better than well.” When science moves faster than moral understanding, as it does today, men and women struggle to articulate their unease. In liberal societies they reach first for the language of autonomy, fairness, and individual rights. But this part of our moral vocabulary is ill equipped to address the hardest questions posed by genetic engineering. The genomic revolution has induced a kind of moral vertigo.

Consider cloning. The birth of Dolly the cloned sheep, in 1997, brought a torrent of concern about the prospect of cloned human beings. There are good medical reasons to worry. Most scientists agree that cloning is unsafe, likely to produce offspring with serious abnormalities. (Dolly recently died a premature death.) But suppose technology improved to the point where clones were at no greater risk than naturally conceived offspring. Would human cloning still be objectionable? Should our hesitation be moral as well as medical? What, exactly, is wrong with creating a child who is a genetic twin of one parent, or of an older sibling who has tragically died — or, for that matter, of an admired scientist, sports star, or celebrity?

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Some say cloning is wrong because it violates the right to autonomy: by choosing a child’s genetic makeup in advance, parents deny the child’s right to an open future. A similar objection can be raised against any form of bioengineering that allows parents to select or reject genetic characteristics. According to this argument, genetic enhancements for musical talent, say, or athletic prowess, would point children toward particular choices, and so designer children would never be fully free.

At first glance the autonomy argument seems to capture what is troubling about human cloning and other forms of genetic engineering. It is not persuasive, for two reasons. First, it wrongly implies that absent a designing parent, children are free to choose their characteristics for themselves. But none of us chooses his genetic inheritance. The alternative to a cloned or genetically enhanced child is not one whose future is unbound by particular talents but one at the mercy of the genetic lottery.

5 Second, even if a concern for autonomy explains some of our worries about made-to-order children, it cannot explain our moral hesitation about people who seek genetic remedies or enhancements for themselves. Gene therapy on somatic (that is, nonreproductive) cells, such as muscle cells and brain cells, repairs or replaces defective genes. The moral quandary arises when people use such therapy not to cure a disease but to reach beyond health, to enhance their physical or cognitive capacities, to lift themselves above the norm.

Like cosmetic surgery, genetic enhancement employs medical means for nonmedical ends —ends unrelated to curing or preventing disease or repairing injury. But unlike cosmetic surgery, genetic enhancement is more than skin-deep. If we are ambivalent about surgery or Botox injections for sagging chins and furrowed brows, we are all the more troubled by genetic engineering for stronger bodies, sharper memories, greater intelligence, and happier moods. The question is whether we are right to be troubled, and if so, on what grounds.

In order to grapple with the ethics of enhancement, we need to confront questions largely lost from view — questions about the moral status of nature, and about the proper stance of human beings toward the given world. Since these questions verge on theology, modern philosophers and political theorists tend to shrink from them. But our new powers of biotechnology make them unavoidable.

Muscles. Everyone would welcome a gene therapy to alleviate muscular dystrophy and to reverse the debilitating muscle loss that comes with old age. But what if the same therapy were used to improve athletic performance? Researchers have developed a synthetic gene that, when injected into the muscle cells of mice, prevents and even reverses natural muscle deterioration. The gene not only repairs wasted or injured muscles but also strengthens healthy ones. This success bodes well for human applications. H. Lee Sweeney, of the University of Pennsylvania, who leads the research, hopes his discovery will cure the immobility that afflicts the elderly. But Sweeney’s bulked-up mice have already attracted the attention of athletes seeking a competitive edge. Although the therapy is not yet approved for human use, the prospect of genetically enhanced weight lifters, home-run sluggers, linebackers, and sprinters is easy to imagine. The widespread use of steroids and other performance-improving drugs in professional sports suggests that many athletes will be eager to avail themselves of genetic enhancement.

Suppose for the sake of argument that muscle-enhancing gene therapy, unlike steroids, turned out to be safe — or at least no riskier than a rigorous weight-training regimen. Would there be a reason to ban its use in sports? There is something unsettling about the image of genetically altered athletes lifting SUVs or hitting 650-foot home runs or running a three-minute mile. But what, exactly, is troubling about it? Is it simply that we find such superhuman spectacles too bizarre to contemplate? Or does our unease point to something of ethical significance?

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10 It might be argued that a genetically enhanced athlete, like a drug-enhanced athlete, would have an unfair advantage over his unenhanced competitors. But the fairness argument against enhancement has a fatal flaw: it has always been the case that some athletes are better endowed genetically than others, and yet we do not consider this to undermine the fairness of competitive sports. From the standpoint of fairness, enhanced genetic differences would be no worse than natural ones, assuming they were safe and made available to all. If genetic enhancement in sports is morally objectionable, it must be for reasons other than fairness.

Sex selection. Perhaps the most inevitable nonmedical use of bioengineering is sex selection. For centuries parents have been trying to choose the sex of their children. Today biotech succeeds where folk remedies failed.

One technique for sex selection arose with prenatal tests using amniocentesis and ultrasound. These medical technologies were developed to detect genetic abnormalities such as spina bifida and Down syndrome. But they can also reveal the sex of the fetus — allowing for the abortion of a fetus of an undesired sex. Even among those who favor abortion rights, few advocate abortion simply because the parents do not want a girl. Nevertheless, in traditional societies with a powerful cultural preference for boys, this practice has become widespread.

Sex selection need not involve abortion, however. For couples undergoing in vitro fertilization (IVF), it is possible to choose the sex of the child before the fertilized egg is implanted in the womb. One method makes use of pre-implantation genetic diagnosis (PGD), a procedure developed to screen for genetic diseases. Several eggs are fertilized in a petri dish and grown to the eight-cell stage (about three days). At that point the embryos are tested to determine their sex. Those of the desired sex are implanted; the others are typically discarded. Although few couples are likely to undergo the difficulty and expense of IVF simply to choose the sex of their child, embryo screening is a highly reliable means of sex selection. And as our genetic knowledge increases, it may be possible to use PGD to cull embryos carrying undesired genes, such as those associated with obesity, height, and skin color. The science-fiction movie Gattaca depicts a future in which parents routinely screen embryos for sex, height, immunity to disease, and even IQ. There is something troubling about the Gattaca scenario, but it is not easy to identify what exactly is wrong with screening embryos to choose the sex of our children.

One line of objection draws on arguments familiar from the abortion debate. Those who believe that an embryo is a person reject embryo screening for the same reasons they reject abortion. If an eight-cell embryo growing in a petri dish is morally equivalent to a fully developed human being, then discarding it is no better than aborting a fetus, and both practices are equivalent to infanticide. Whatever its merits, however, this “pro-life” objection is not an argument against sex selection as such.

15 The latest technology poses the question of sex selection unclouded by the matter of an embryo’s moral status. The Genetics & IVF Institute, a for-profit infertility clinic in Fairfax, Virginia, now offers a sperm-sorting technique that makes it possible to choose the sex of one’s child before it is conceived. X-bearing sperm, which produce girls, carry more DNA than Y-bearing sperm, which produce boys; a device called a flow cytometer can separate them. The process, called MicroSort, has a high rate of success.

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If sex selection by sperm sorting is objectionable, it must be for reasons that go beyond the debate about the moral status of the embryo. One such reason is that sex selection is an instrument of sex discrimination — typically against girls, as illustrated by the chilling sex ratios in India and China. Some speculate that societies with substantially more men than women will be less stable, more violent, and more prone to crime or war. These are legitimate worries — but the sperm-sorting company has a clever way of addressing them. It offers MicroSort only to couples who want to choose the sex of a child for purposes of “family balancing.” Those with more sons than daughters may choose a girl, and vice versa. But customers may not use the technology to stock up on children of the same sex, or even to choose the sex of their firstborn child. (So far the majority of MicroSort clients have chosen girls.) Under restrictions of this kind, do any ethical issues remain that should give us pause?

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The case of MicroSort helps us isolate the moral objections that would persist if muscle-enhancement, memory-enhancement, and height-enhancement technologies were safe and available to all.

It is commonly said that genetic enhancements undermine our humanity by threatening our capacity to act freely, to succeed by our own efforts, and to consider ourselves responsible — worthy of praise or blame — for the things we do and for the way we are. It is one thing to hit seventy home runs as the result of disciplined training and effort, and something else, something less, to hit them with the help of steroids or genetically enhanced muscles. Of course, the roles of effort and enhancement will be a matter of degree. But as the role of enhancement increases, our admiration for the achievement fades — or, rather, our admiration for the achievement shifts from the player to his pharmacist. This suggests that our moral response to enhancement is a response to the diminished agency of the person whose achievement is enhanced.

Though there is much to be said for this argument, I do not think the main problem with enhancement and genetic engineering is that they undermine effort and erode human agency. The deeper danger is that they represent a kind of hyperagency — a Promethean aspiration to remake nature, including human nature, to serve our purposes and satisfy our desires. The problem is not the drift to mechanism but the drive to mastery. And what the drive to mastery misses and may even destroy is an appreciation of the gifted character of human powers and achievements.

20 To acknowledge the giftedness of life is to recognize that our talents and powers are not wholly our own doing, despite the effort we expend to develop and to exercise them. It is also to recognize that not everything in the world is open to whatever use we may desire or devise. Appreciating the gifted quality of life constrains the Promethean project and conduces to a certain humility. It is in part a religious sensibility. But its resonance reaches beyond religion.

It is difficult to account for what we admire about human activity and achievement without drawing upon some version of this idea. Consider two types of athletic achievement. We appreciate players like Pete Rose, who are not blessed with great natural gifts but who manage, through striving, grit, and determination, to excel in their sport. But we also admire players like Joe DiMaggio, who display natural gifts with grace and effortlessness. Now, suppose we learned that both players took performance-enhancing drugs. Whose turn to drugs would we find more deeply disillusioning? Which aspect of the athletic ideal — effort or gift — would be more deeply offended?

Some might say effort: the problem with drugs is that they provide a shortcut, a way to win without striving. But striving is not the point of sports; excellence is. And excellence consists at least partly in the display of natural talents and gifts that are no doing of the athlete who possesses them. This is an uncomfortable fact for democratic societies. We want to believe that success, in sports and in life, is something we earn, not something we inherit. Natural gifts, and the admiration they inspire, embarrass the meritocratic faith; they cast doubt on the conviction that praise and rewards flow from effort alone. In the face of this embarrassment we inflate the moral significance of striving, and depreciate giftedness. This distortion can be seen, for example, in network-television coverage of the Olympics, which focuses less on the feats the athletes perform than on heartrending stories of the hardships they have overcome and the struggles they have waged to triumph over an injury or a difficult upbringing or political turmoil in their native land.

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But effort isn’t everything. No one believes that a mediocre basketball player who works and trains even harder than Michael Jordan deserves greater acclaim or a bigger contract. The real problem with genetically altered athletes is that they corrupt athletic competition as a human activity that honors the cultivation and display of natural talents. From this standpoint, enhancement can be seen as the ultimate expression of the ethic of effort and willfulness — a kind of high-tech striving. The ethic of willfulness and the biotechnological powers it now enlists are arrayed against the claims of giftedness.