Statistics from Altmetric.com
In their paper Chris Gyngell, Hilary Bowman-Smart and Julian Savulescu offer a careful analysis of the Nuffield Council on Bioethics report, Genome Editing and Human Reproduction: social and ethical issues but they challenge us to go further still.i I want to suggest that, although their analysis is clear and accurate, its rather ‘molecular’ approach neglects the overall arc and orientation of the report. Furthermore, their conclusions about prospective parents’ reproductive obligations lack sensitivity to the proper evaluative context and offer littlein the way of policy prescriptions.
A neglected aspect of the report is the dialectical relation of the three sets of considerations through which it advances: those relating to the individuals directly involved, the wider society in which they live, and the future of human being in general. In particular, Gyngell et al.’s analysis does not attend to how the second principle advanced in the report (that of solidarity and social justice) interacts with the first (that of the welfare of the future person). It also ignores an important implication of the refusal of a final synthesis (which would be that heritable genome editing – HGE – is categorically at odds with the interests of humanity), namely, to inaugurate a continual process of reflection between the first two sets of considerations. And it therefore inevitably glosses over practical questions of the mode and venue for this reflection.
Something that has not been well understood in the reception of the report, perhaps due to the way in which the two principles in the third chapter are drafted, is that these should be read not as conditions that must be satisfied but as orientational principles for the development of practical governance. In insisting on this reading, I realise that I may lose some of Gyngell et al.’s approval. They see operational specificity, after all, as one of the virtues of the Nuffield report; they would, I think, like to make the Nuffield report ‘ethics committee-ready’.ii This, however, would be to short circuit the work of elaborating ethical governance, in the light of broad and inclusive societal debate, in a particular set of sociotechnical circumstances.iii Unlike for Gyngell et al, then, a particular concern of the Nuffield report is how the moral argument in Chapter three relates to the discussion of political governance in Chapter 4.
Let me now briefly address the main ways in which Gyngell et al. ‘pick up’ and depart from the Nuffield report. They argue:
Some uses of HGE can be morally imperative.
Morally acceptable uses of HGE can extend beyond the avoidance of serious, heritable, medically recognised conditions.
The ‘goldilocks problem’
The first of these arguments rests on how welfare figures in the moral appraisal of the potential uses of HGE. If we think that welfare matters (and I agree that it does) we need to understand how it matters in the peculiar context of a prospective reproductive project. On one hand, it can matter too little. If one accepts the necessary non-identity of (incom)possible future offspring, then one might argue that a life worth living will always have been a good-enough choice. On the other hand, it can matter too much. If one represents the future person as a present subject, discretely affected by reproductive decisions, then failure to take benign preconception measures to optimise welfare can look morally negligent.
In the Nuffield report, the future person’s interests are considered proleptically and subjunctively, in the context of their prospective parents’ choices. Gyngell et al seem to approve of the broad notion of welfare we adopt, which makes it odd when they themselves seem to revert to one that is deterministic and one-dimensional, which reflects an unusual class of cases (highly penetrant conditions). It is an important feature of our conception of welfare that it acknowledges multidimensionality, uncertainty and the importance of circumstances. Prominent among these is a future person’s relationship with their parents: while they can be in tension, the welfare of future offspring and their parents are essentially interrelated. Our welfare principle is, accordingly, ‘satisficing’.
A(nother) word on ‘enhancement’
According to the Nuffield report, the use of the term ‘enhancement’ is at best confusing and often misleading. In the first place, talk of enhancement is not helpful: even if it is possible to provide a stable rationale for categorising a particular intervention as ‘enhancement’, that does not help to evaluate whether intervening in this way is right or wrong (at least without some further argument about the rightness or wrongness of enhancement). Talk of ‘enhancement’, in fact, tends to obscure the question of whether given preferences offer a good reason to make a heritable genome editing intervention or not. The Nuffield report does not scruple over acknowledging that good reasons to use HGE might not be limited to the avoidance of ‘serious inherited disease’. What counts as a good reason, however, may depend as much on the circumstances of the intervention as on the ontology of the condition the intervention is intended to avoid (or to secure).
There is, moreover, another reason to avoid the language of enhancement, namely, that it muddles private and public morality. Since the future person does not exist prior to or independently of the conditions in which their conception is brought about, there is no one who is being ‘enhanced’. What is at stake in the reproductive decision is bringing about the birth of a human being with one set of genetically conditioned features rather than another set (among which features may be genetic relatedness and the absence of inherited disease). Talk of ‘enhancement’ through intervention in reproduction makes sense only within a different order of discourse: that concerning the population or the species. I don’t think Gyngell et al shrink from this owing to any squeamishness but they have a tendency to re-inscribe the confused term ‘enhancement’ in the register of private decisions; on the other hand, for all their hectoring about private morality, I don’t think that they want to advocate policies of ‘enhancement’ or penalise ‘suboptimal’ procreation.
↵i Gyngell C,1 Bowman-Smart H and Savulescu J (2019) available at: http://nuffieldbioethics.org/project/genome-editing-human-reproduction.
↵ii In particular, they contrast the Nuffield report with the principles advanced by the US National Academies, which they see (rightly, in my view) as being capable of licensing contradictory states of affairs; see: National Academies of Sciences, Engineering, and Medicine (2017)2. It is ironic, then, the NAS report envisions moral discourse primarily in the mode of an institutional review board. (For my response this, see: http://nuffieldbioethics.org/project/genome-editing-human-reproduction).
↵iii This inclusive process may offer a way of collectively examining ‘social harms’ and broaching ‘collective action problems’, for which Gyngell et al 1 propose broadening the second Nuffield principle.
Contributors PM is the sole author of this work.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Correction notice This article has been amended since it was first published online. This article has been changed from a Response to a Commentary article.
Patient consent for publication Not required.
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.