Julian Savulescu Uehiro Chair Oxford Centre for Practical Ethics


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Julian Savulescu Uehiro Chair Oxford Centre for Practical Ethics

  1. 1. The obligation to have the best children Professor Julian Savulescu
  2. 2. Having the Best Child <ul><li>Selection </li></ul><ul><li>Enhancement – Ch 5 Chance to Choice </li></ul>
  3. 3. Why Not Enhance <ul><li>Eugenics </li></ul><ul><li>Skepticism about value </li></ul><ul><li>BUT </li></ul><ul><li>Parents have wide freedom in selecting environment which shapes children </li></ul>
  4. 4. What is the best? <ul><li>Brave New World </li></ul><ul><ul><li>Thank you very much arg </li></ul></ul><ul><li>Lazy vs hard working </li></ul><ul><li>Monogamous vs polygamous </li></ul><ul><li>Response: all purpose means (natural primary good) </li></ul>
  5. 5. Specific talents <ul><li>Perfect pitch </li></ul><ul><li>Acts/omissions problem </li></ul><ul><li>Specific talents increase the options for the good life </li></ul><ul><ul><li>Children punished for the parents </li></ul></ul><ul><li>Objections </li></ul>
  6. 6. Right to an Open Future <ul><li>Capacity for practical judgements and autonomous life </li></ul><ul><li>BUT parents have considerable freedom to shape this </li></ul><ul><li>Wisonsin vs Yoder – Amish removing children from school at 14 rather than 16 </li></ul>
  7. 7. Limits to Pursuit of the Best <ul><li>Family interest </li></ul><ul><li>State interest </li></ul><ul><li>Communitarian eugenics – community shapes choice </li></ul><ul><ul><li>Would give rise to communities with different natures </li></ul></ul><ul><li>Social structure </li></ul>
  8. 8. Multiple phenotypes <ul><li>Cynthia con artist or social worker </li></ul><ul><li>But this applies to all valuable traits </li></ul><ul><ul><li>Intelligence and the bomb </li></ul></ul>
  9. 9. Objections <ul><li>1 self-defeating </li></ul><ul><ul><li>Sex selection </li></ul></ul><ul><ul><ul><li>Sex ratio imbalance </li></ul></ul></ul><ul><ul><ul><li>Increases injustice </li></ul></ul></ul><ul><ul><li>Height </li></ul></ul><ul><ul><ul><li>Coercive pressure </li></ul></ul></ul>
  10. 10. Objections <ul><li>2 Unfair </li></ul><ul><ul><li>market </li></ul></ul><ul><li>3 Risk </li></ul>
  11. 11. Conclusion <ul><li>Parents should be allowed considerable freedom to ENHANCE their children </li></ul>
  12. 12. Kant and Enhancement <ul><li>Categorical Imperative – act only in a way that my maxim should be a universal law </li></ul><ul><ul><li>Sex selection – sex ratio imbalance </li></ul></ul><ul><ul><li>Height increase: expensive. uses resources and no benefit </li></ul></ul><ul><li>Problem: depends on the specification of the maxim: if you have two or more children of the same sex, you should sex select if you desire a child of the opposite sex (or will make you happier) </li></ul>
  13. 13. Kant and Enhancement <ul><li>Humanity principle: treat humanity as an end and never merely as a means </li></ul><ul><li>“ Enhancement” treats children as a means </li></ul><ul><ul><li>To achieve success </li></ul></ul><ul><ul><li>To satisfy parental expectations </li></ul></ul><ul><ul><li>To achieve glory </li></ul></ul>
  14. 14. Kant and Enhancement <ul><li>Consent </li></ul><ul><ul><li>Can never obtain </li></ul></ul><ul><li>People have moral significance </li></ul><ul><ul><li>Treat with equal concern (for interests) and respect (for autonomy) </li></ul></ul><ul><ul><li>Enhancement may be imperative just as assisting the suffering </li></ul></ul><ul><ul><ul><li>The unenhanced are suffering </li></ul></ul></ul><ul><li>Kant should be no enemy of enhancement </li></ul>
  15. 15. Treating children as a means <ul><li>Slavery </li></ul><ul><li>Sex abuse </li></ul><ul><li>Sedating or drugging them </li></ul><ul><li>Making them docile </li></ul><ul><ul><li>harmed </li></ul></ul>
  16. 16. Procreative Beneficence <ul><li>Procreative beneficence: </li></ul><ul><ul><li>couples (or single reproducers) should select the child, of the possible children they could have, the one who is expected to enjoy the best life, or at least as good a life as the others </li></ul></ul>
  17. 17. Procreative Beneficence <ul><li>Procreative Beneficence implies couples should employ genetic-tests for non-disease traits in selecting which child to bring into existence </li></ul><ul><ul><li>we should allow selection for non-disease genes in some cases even if this maintains or increases social inequality </li></ul></ul>
  18. 18. Definitions <ul><li>A disease gene: </li></ul><ul><ul><li>a gene which causes a genetic disorder (e.g. cystic fibrosis) or predisposes to the development of disease (e.g. the genetic contribution to cancer or dementia). </li></ul></ul><ul><li>A non-disease gene: </li></ul><ul><ul><ul><li>is a gene which causes or predisposes to some physical or psychological state of the person which is not itself a disease state, e.g. height, intelligence, character (not in the sub-normal range). </li></ul></ul></ul>
  19. 19. Behavioural Genetics <ul><ul><ul><ul><li>Aggression and criminal behaviour </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Alcoholism </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Anxiety and Anxiety disorders </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Attention Deficit Hyperactivity Disorder (ADHD) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Antisocial personality disorder </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Bipolar disorder </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Homosexuality </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Maternal Behaviour </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Memory </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Neuroticism </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Novelty Seeking </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Schizophrenia </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Substance Addiction </li></ul></ul></ul></ul>
  20. 20. Selection <ul><li>It is currently possible to select from a range of possible children we could have: </li></ul><ul><ul><ul><li>Fetal selection occurs through prenatal testing and termination of pregnancy. </li></ul></ul></ul><ul><ul><ul><li>Selection of embryos is now possible by employing in vitro fertilization and preimplantation genetic diagnosis (PGD). </li></ul></ul></ul><ul><ul><ul><ul><ul><li>Selection of sex by PGD is now undertaken in Sydney </li></ul></ul></ul></ul></ul>
  21. 21. Selection <ul><li>In the future, it may be possible to select gametes according to their genetic characteristics. </li></ul><ul><ul><li>This is currently possible for sex, where methods have been developed to sort X and Y bearing sperm. </li></ul></ul>
  22. 22. The Simple Case: Disease Genes <ul><li>IVF produces 2 embryos </li></ul><ul><li>Battery of tests for common diseases is performed </li></ul><ul><ul><li>Embryo A has no abnormalities on the tests performed </li></ul></ul><ul><ul><li>Embryo B has no abnormalities on the tests performed except it has a strong predisposition to developing cancer later in life. </li></ul></ul><ul><li>Which embryo should be implanted? </li></ul>
  23. 23. The Simple Case <ul><li>Embryo B has nothing to be said in its favour over A and something against it </li></ul><ul><li>Embryo A is “pareto optimal” </li></ul><ul><li>Embryo A should (on pain of irrationality) be implanted </li></ul>
  24. 24. Wheel of Fortune Analogy <ul><li>The Wheel of Fortune </li></ul><ul><ul><li>Win 0-$1 000 000 </li></ul></ul><ul><ul><ul><li>Wheel is spun: </li></ul></ul></ul><ul><ul><ul><ul><li>an amount unknown to you is put in Box A </li></ul></ul></ul></ul><ul><ul><ul><ul><li>an amount unknown to you is put in Box B </li></ul></ul></ul></ul><ul><ul><ul><li>You are also told that, in addition to the sum already put in the boxes, if you choose B, a dice will be thrown and you will lose $100 if it comes up 6 </li></ul></ul></ul><ul><li>You should choose Box A </li></ul>
  25. 25. The Simple Case: Cancer <ul><li>Cancer reduces length and quality of life. </li></ul><ul><li>Lung cancer causes </li></ul><ul><ul><ul><ul><li>severe breathlessness </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Pain </li></ul></ul></ul></ul><ul><ul><ul><ul><li>death </li></ul></ul></ul></ul>
  26. 26. Morally relevant properties <ul><li>The morally relevant property of “cancer”: it is a state which reduces the well-being a person experiences. </li></ul>
  27. 27. “ But Embryo B Could Be Mozart.” <ul><ul><li>Objection: if you choose A (without cancer), you could be discarding Mozart or Lance Armstrong. </li></ul></ul><ul><ul><li>True: but if you choose B, you could be discarding Mozart or Lance Armstrong without cancer. </li></ul></ul><ul><ul><li>A and B are equally likely (on the information available) to be Mozart or Lance Armstrong (and B is more likely to have cancer). </li></ul></ul>
  28. 28. The Simple Case: 3 Other Principles Tested <ul><ul><li>1. Procreative autonomy: couples should be free to decide, when and how to procreate, and what kind of children to have </li></ul></ul><ul><ul><ul><li>if this is the only decision-guiding principle, it implies parents might have reason to choose the embryo with a predisposition to asthma </li></ul></ul></ul><ul><ul><li>2. Principle of Non-Directive Counselling </li></ul></ul><ul><ul><ul><li>Only provide information about risk and options. </li></ul></ul></ul><ul><ul><ul><li>Do not give advice </li></ul></ul></ul>
  29. 29. The Simple Case <ul><li>3. The “Best Interests of the Child” Principle </li></ul><ul><ul><ul><li>the Victorian Infertility Treatment Act 1995 states “ the welfare and interests of any person born or to be born as a result of a treatment procedure are paramount.” </li></ul></ul></ul><ul><ul><ul><li>Irrelevant </li></ul></ul></ul><ul><ul><ul><ul><li>could choose the embryo with cancer and still be doing everything possible in the interests of that child </li></ul></ul></ul></ul>
  30. 30. Defence of voluntary procreative beneficence <ul><ul><li>A woman has rubella. If she conceives now, she will have a blind and deaf child. </li></ul></ul><ul><ul><li>If she waits 3 months, she will conceive another different but healthy child. </li></ul></ul><ul><ul><li>She should choose to wait until her rubella is passed. </li></ul></ul>
  31. 31. Extension to Abortion <ul><li>This argument extends in principle to selection of fetuses using prenatal testing and termination of affected pregnancy </li></ul><ul><li>However, selection by abortion has a greater psychological harms than selection by PGD and these need to be considered </li></ul>
  32. 32. What is the Best Life? <ul><ul><ul><li>Life with the most well-being </li></ul></ul></ul><ul><ul><ul><ul><li>There are various theories of well-being: hedonistic, desire-fulfilment, objective list. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Not just absence of disease. </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>ability to engage in deep personal relations, achieving worthwhile things with your life, having dignity, having children and raising them, gaining knowledge of the world, developing one’s talents, appreciating beautiful things, and so on. </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><li>Buchanan et al: general purpose means - those useful to any plan of life </li></ul></ul></ul></ul>
  33. 33. Non-Disease Genes and the Best Life <ul><ul><li>It is not disease which is important, </li></ul></ul><ul><ul><ul><li>it is its impact on my life in ways that matter which is important. </li></ul></ul></ul><ul><ul><li>People trade length of life for non-health related well-being </li></ul></ul><ul><ul><li>Non-disease genes may contribute significantly to well-being as much as disease genes </li></ul></ul>
  34. 34. Non-Disease Genes and the Best Life <ul><ul><ul><ul><li>a gene which contributes significantly to a violent, explosive, uncontrollable temper, and that state causes people significant suffering. </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>violent outbursts lead a person to come in conflict with the law and fall out of important social relations. </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>The loss of independence, dignity and important social relations should be treated in the same way as if they were the result of a disease which impacts on that person’s well-being, eg autism </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><li>Procreative beneficence thus extends to non-disease genes, including “genes for criminality” </li></ul></ul></ul></ul>
  35. 35. The “Should” in “Should Choose” <ul><ul><ul><ul><li>“ You are 31. You will be at a higher risk of infertility and having a child with an abnormality if you delay child-bearing. But that has to be balanced against taking time out of your career now. That’s only something you can weigh up.” </li></ul></ul></ul></ul><ul><ul><ul><ul><li>“ You should stop smoking.” </li></ul></ul></ul></ul><ul><ul><ul><ul><li>“ You must inform your partner that you are HIV positive or practise safe sex.” </li></ul></ul></ul></ul><ul><ul><li>The “should” is that present in the second example: persuasion, not coercion (third case), but stronger than first </li></ul></ul>
  36. 36. Genes for Criminality <ul><ul><ul><ul><li>Buchanan, Brock, Daniels, Wikler, From Chance to Choice , p. 173 </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>“… there is already some evidence of genes associated with dispositions to violent criminal behavior. Just as the criminal law is a justified coercive social means aimed at preventing or reducing such behavior, society might in the future attempt genetic interventions to do so as well. These interventions would not be made for the benefit of the subject of the genetic intervention…, but for the benefit of the broader society and to protect the rights of its members against violent assault.” </li></ul></ul></ul></ul></ul>
  37. 37. Behavioural Genetics Today: the Dutch Family <ul><ul><ul><ul><li>For over 30 years this family recognised that there were a disproportionate number of male family members who exhibited aggressive and criminal behaviour. </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>aggressive outbursts: arson, attempted rape and exhibitionism. </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><li>the behaviour has been documented for almost forty years ago by an unaffected maternal grandfather </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>could not understand why some of the men in his family appeared to be prone to this type of behaviour </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><li>a female family member who reported this apparent familial trait to Hans Brunner in 1978. </li></ul></ul></ul></ul>
  38. 38. The Dutch Family: Remarkable Features <ul><ul><ul><ul><li>male relatives who did not display this aggressive behaviour did not express any type of abnormal behaviour. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>unaffected males reported difficulty in understanding the behaviour of their brothers and cousins. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>sisters of the males who demonstrated these extremely aggressive outbursts reported intense fear of their brothers. </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>one of the affected males responded to an innocuous request made by his sister by holding a knife to her throat, threatening to cut her </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><li>did not appear to be related to environment. </li></ul></ul></ul></ul>
  39. 39. Clinical Findings <ul><li>All affected males were also found to be mildly mentally retarded with a typical IQ of about 85 (females had normal intelligence) </li></ul><ul><li>“X-linked recessive pattern of inheritance” </li></ul><ul><ul><ul><li>Roughly, women can carry the gene without being affected; 50% of men at risk of inheriting the gene get the gene and are affected by the disease. </li></ul></ul></ul>
  40. 40. Locating the gene <ul><li>Genetic analysis suggested that the likely region was a part of the X chromosome known as the Monoamine Oxidase (MAO) region. </li></ul><ul><li>The MAO region: </li></ul><ul><ul><ul><ul><li>2 genes which encode two enzymes: monoamine oxidase A (MAOA) and monoamine oxidase B (MAOB). </li></ul></ul></ul></ul><ul><ul><ul><ul><li>normal functioning of these enzymes in the brain is to assist in the breakdown of neurotransmitters </li></ul></ul></ul></ul>
  41. 41. Correlating Genetics to Behaviour? <ul><ul><ul><ul><li>Neurotransmitters are substances that play a key role in the conduction of nerve impulses in our brain </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Enzymes like the monoamine oxidases are required to degrade the neurotransmitters after they have performed their desired task. </li></ul></ul></ul></ul>
  42. 42. Correlation <ul><ul><ul><ul><li>It was suggested that the monoamine oxidase activity might be disturbed in the affected individuals. </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>This hypothesis was supported by urine analysis that indeed showed a higher than normal amount of neurotransmitters being excreted in the urine of affected males. </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><li>The results found were consistent with a reduction in the functioning of monoamine oxidase A </li></ul></ul></ul></ul>
  43. 43. Correlating Genetics to Behaviour? <ul><li>How could such a mutation result in violent and antisocial behaviour? </li></ul><ul><ul><li>A deficiency of MAOA results in a build up of neurotransmitters, and it is these abnormal levels of neurotransmitters that are thought to result in excessive, and even violent, reactions to stress </li></ul></ul><ul><ul><li>genetically modified mice which lack MAOA are more aggressive </li></ul></ul>
  44. 44. The Dutch Family in Context <ul><li>Limitations of this study </li></ul><ul><ul><li>Only applies to one family </li></ul></ul><ul><ul><li>Inhibitions of MAO have not been associated with aggressive behaviour in adults (but effects of lifelong deficiencies are unclear) </li></ul></ul><ul><ul><li>Most genetic contributions to behaviour will be weaker predispositions </li></ul></ul>
  45. 45. Commoner “Genes for Criminality” <ul><li>genes are involved in “criminality” </li></ul><ul><ul><li>predominance of males in violent crime </li></ul></ul><ul><li>genes will be correlated with behaviours which are more likely to lead to criminal prosecutions </li></ul><ul><ul><li>aggressiveness, inability to control behaviour, inability to foresee the consequences of behaviour, greed, inability to emphathise </li></ul></ul>
  46. 46. Eugenics? <ul><li>female carriers may come forward in the future requesting that genetic technology be employed to ensure that they do not have affected sons </li></ul><ul><li>should female carriers be advised to use genetic technologies to ensure they do not have affected sons? </li></ul>
  47. 47. Objections <ul><li>1. Harm to the child </li></ul><ul><li>2. Maintains or creates inequality </li></ul>
  48. 48. Harm to the child <ul><ul><ul><li>excessive parental expectations </li></ul></ul></ul><ul><ul><ul><li>parents not loving the child </li></ul></ul></ul><ul><ul><ul><li>using the child as a means, and not treating it as an end </li></ul></ul></ul><ul><ul><ul><li>the couple’s desire to select represents dysfunctional psychology and so they will be bad parents </li></ul></ul></ul><ul><ul><ul><li>closes the child’s future (right to an open future) </li></ul></ul></ul>
  49. 49. Responses <ul><li>1. Deny that the harms will be significant </li></ul><ul><ul><li>parents love their child and rearing levels excessive expectations </li></ul></ul><ul><ul><li>counselling can reduce excessive expectation </li></ul></ul><ul><li>2. Accept greater risk in selection </li></ul>
  50. 50. Selection and Risk <ul><li>If you select embryo A, it might still get cancer, or have a much worse life than B, and you would be responsible. </li></ul><ul><li>Selection is preferable to manipulation in one way: </li></ul><ul><li>Imagine you perform gene therapy to correct a predisposition to to cancer and you cause a mutation which results in cancer later in life </li></ul><ul><ul><li>you have harmed the child </li></ul></ul>
  51. 51. The Advantage of Selection <ul><li>Imagine you select Embryo A and it develops cancer in later life </li></ul><ul><li>You have not harmed A unless A’s life is not worth living (hardly plausible) because A would not have existed if you had acted otherwise </li></ul>
  52. 52. Distinction <ul><li>There is an important distinction between: </li></ul><ul><ul><ul><li>interventions which are genetic manipulations of a single gamete, embryo or fetus </li></ul></ul></ul><ul><ul><ul><li>selection procedures (eg sex selection) which select from among a range of different gametes, embryos and fetuses. </li></ul></ul></ul>
  53. 53. Conclusion <ul><li>We should aim for the best children </li></ul><ul><ul><li>even if there is a risk of harm (outweighed by the expected benefits) </li></ul></ul>
  54. 54. Second Objection: Inequality <ul><li>selection will maintain or even increase inequality in society. </li></ul><ul><ul><ul><li>if we allow selection for intelligence, there will be an increasing gap between those who can afford or access genetic tests for intelligence for their children, and those who do not. </li></ul></ul></ul><ul><ul><li>The less intelligent will be left behind by a super race of increasingly intelligent nerds who dominate the world </li></ul></ul>
  55. 55. Responses <ul><li>In some cases, it is possible to deny selection would maintain or increase inequality. </li></ul><ul><ul><li>Sex selection in West </li></ul></ul><ul><ul><ul><li>Parents were in their mid thirties, had 2 or 3 children and only wanted one more. In both the US and UK, just over half of couples choose a girl </li></ul></ul></ul>
  56. 56. What if selection does increase inequality? <ul><li>Sex selection in Asia (?), intelligence, favourable physical or psychological traits, etc </li></ul>
  57. 57. Compare with selection for disease genes <ul><li>Down syndrome screening industry. </li></ul><ul><ul><ul><li>In 1986, there were 120 pregnancies involving Down syndrome and 15 terminations, </li></ul></ul></ul><ul><ul><ul><li>In 1997, there were more pregnancies (147), but many more terminations (81) - roughly 5 fold increase </li></ul></ul></ul>
  58. 58. Disability Discrimination Claim <ul><li>prenatal testing for disabilities such as Down syndrome results in discrimination against those with Down syndrome and other disabilities both by: </li></ul><ul><ul><li>the statement it makes about the worth of such lives </li></ul></ul><ul><ul><li>by the reduction in the numbers of people with this condition. </li></ul></ul>
  59. 59. Reason to Restrict Selection for Disease Genes? <ul><li>Even if the Disability Discrimination Claim were true, it would be a drastic step in favour of equality to inflict a higher risk of having a child with a disability on a couple (who do not want a child with a disability) to promote social equality. </li></ul><ul><ul><li>Eg Rubella epidemic </li></ul></ul><ul><ul><ul><li>embryos produced prior to and during the epidemic </li></ul></ul></ul>
  60. 60. Extension to Non-Disease Genes <ul><ul><li>Even if the Disability Discrimination Claim were true, most people would still accept testing for disease genes. </li></ul></ul><ul><ul><li>Why should we treat testing for non-disease genes differently? </li></ul></ul><ul><ul><li>It is not disease which is important but its impact on well-being. </li></ul></ul><ul><ul><li>Does a non-disease gene impact significantly on well-being? </li></ul></ul>
  61. 61. 1. Selection: positive impact on well-being and promotes inequality <ul><li>treat as disease gene case above </li></ul><ul><li>allow selection </li></ul><ul><li>note: if a non-disease gene (or disease gene) has a significant effect on well-being, selection related to it should be funded by State </li></ul><ul><ul><li>reduces reinforcement of privilege </li></ul></ul>
  62. 62. Implications <ul><li>Imagine in a country women are severely discriminated against and treated badly. </li></ul><ul><ul><ul><ul><li>abandoned as children, </li></ul></ul></ul></ul><ul><ul><ul><ul><li>refused paid employment </li></ul></ul></ul></ul><ul><ul><ul><ul><li>serve as slaves to men. </li></ul></ul></ul></ul><ul><ul><ul><li>My argument implies that couples should test for sex, and should choose males as these are expected to have better lives in this society. </li></ul></ul></ul>
  63. 63. Responses <ul><li>1. it is unlikely selection on scale that contributes to inequality would promote well-being </li></ul><ul><ul><li>Imagine 50% of the population choose to select boys. </li></ul></ul><ul><ul><li>3 boys to every 1 girl. </li></ul></ul><ul><ul><ul><li>The life of a male in such a society would be intolerable </li></ul></ul></ul><ul><ul><ul><li>For this reason we should not encourage couples to have girls to reduce the crime rate </li></ul></ul></ul>
  64. 64. Responses <ul><li>2. social institutional reform, not interference in reproduction </li></ul><ul><ul><li>what is wrong in such a society is the treatment of women, which should be addressed separately to reproductive decision-making. </li></ul></ul><ul><ul><li>Reproduction should not become an instrument of social change, at least not mediated or motivated at a social level. </li></ul></ul>
  65. 65. Sex Selection and Equality <ul><ul><ul><ul><li>It may well be that a sex ratio of 5 males to 6 females best promotes women’s interests and equality. Does that imply couples must select girls? </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Or it may be that having more children with Down syndrome promotes the interests of people with Down syndrome. Would that imply that people have an obligation to have children with Down syndrome? </li></ul></ul></ul></ul><ul><ul><ul><li>Social ideals should not control reproduction - that is the lesson from Nazi eugenics. </li></ul></ul></ul>
  66. 66. 2. Selection: Negative Impact on Well-Being But Promotes Equality <ul><ul><li>David and Dianne are dwarfs. They wish to use IVF and PGD to select a child with dwarfism </li></ul></ul><ul><ul><li>Sam and Susie live a society where discrimination against women is prevalent. They wish to have a girl to reduce this discrimination. </li></ul></ul><ul><ul><li>These choices would not harm the child produced if selection is employed (non-identity problem). </li></ul></ul>
  67. 67. Conflict of principles <ul><ul><li>Irresolvable conflict of principles. </li></ul></ul><ul><ul><li>procreative autonomy combined with concern to promote equality </li></ul></ul><ul><ul><li>procreative beneficence </li></ul></ul><ul><ul><ul><li>the principle of procreative beneficence does not have such weight that we should say a couple should select a male in a sex discriminatory society. </li></ul></ul></ul>
  68. 68. Implications <ul><ul><li>Those with Down syndrome, dwarfism, deafness or other disabilites should be allowed select a child with disability (without any sanction) </li></ul></ul><ul><ul><li>But best option is that we correct discrimination in other ways, by correcting discriminatory social institutions. </li></ul></ul><ul><ul><ul><li>both equality and a population whose members are living the best lives possible. </li></ul></ul></ul>
  69. 69. Conclusions <ul><li>With respect to non-disease genes we should provide </li></ul><ul><ul><li>Information (through PGD and prenatal testing) </li></ul></ul><ul><ul><li>Free choice of which child to have </li></ul></ul><ul><ul><li>In a social environment which maximises the value of all choices (supports all kinds of lives) </li></ul></ul><ul><ul><li>State funding of genetic selection </li></ul></ul>
  70. 70. Procreative Beneficence <ul><ul><li>In such an environment, selection for non-disease genes which significantly impact on well-being is morally required (voluntary procreative beneficence) </li></ul></ul><ul><ul><ul><ul><li>morally required implies moral persuasion but not coercion is justified. </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Persuasion is only justified when social institutions support all choices </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Couples should have the child with the greatest genetic opportunities but choice must ultimately be up to couples </li></ul></ul></ul></ul></ul>