Kennedy Institute of Ethics Journal

The normative significance of the distinction between therapy and enhancement has come under sustained philosophical attack in recent discussions of the ethics of shaping future persons by means of advanced genetic technologies. Giving up the idea that whether a condition is normal or not should play a crucial role in assessing the ethics of genetic interventions has unrecognized and strongly counterintuitive implications when it comes to selecting what sort of children should be brought into the world. According to standard philosophical accounts of the factors one should take into account when making such decisions, women are “better than men.” Given the biological differences between the sexes, then, if the only concern is the capacities of an embryo rather than its capacities relative to some normatively significant baseline, there is compelling reason to choose only female embryos. In order to avoid this radical and counterintuitive conclusion, one must embrace the idea that both sexes are normal. The strength of the prima facie reasons to select or reject embryos depends on their sex, which is to say that it depends on the normal capacities of their sex. The therapy/enhancement distinction therefore plays a crucial role in determining the ethics of interventions into the genetics of future generations.