[1] Fritz Oehlschlaeger and Paul Hinlicky are gentlemen and scholars who walk their talk here at the southern end of the Shenandoah Valley. I am honored to work alongside them. We are allies at most points, but assigned dialogs such as this one call for highlighting differences. In fact there is not much higher praise for the character of treasured colleagues than to trust them with honest conversation where we might disagree. So I will focus on chapters seven to the end of Procreative Ethics that argue for a difference between genetic therapy and enhancement as the key distinction between appropriate and inappropriate genetic intervention. Oehlschlaeger is right that human genetic intervention warrants our best attention and discernment. We agree on that, but his counting on a distinction between therapy and enhancement is not as clear a line of demarcation as he hopes, and implemented would cause significant harm in multiple levels and ways. Harm, broadly recognized and among many other concerns, is something Oehlschlaeger says we should avoid.
[2] Oehlschlaeger pummels human genetic enhancement mercilessly. Without trying to equal his eloquent rhetoric, I will respond briefly to eleven of the objections that he raises. I appreciate these concerns for all they are worth, but I do not want them to buttress a decisive line in the wrong place. Such would frustrate good that should be done. Christian ethics is as much about moving us to act rightly with God and one another, as it is about what we should not do. Acts of omission matter as much as acts of commission. My summary of the objections that he is evoking and my responses to them will be short in this format, not to be glib, rather to raise alternative starting points for further conversation.
[3] Objection 1: Genetic enhancement is morally repugnant. Appealing to the ‘yuck factor’, as the National Bioethics Commission did not too many years ago, listens as we should to the appropriate warning of moral intuition. If something immediately seems wrong or even questionable, it probably does warrant more careful consideration. But taking such reticence seriously should not be the final word. Blood transfusions, autopsies, and organ transplantation were long perceived by most as repugnant or worse, yet are now valued and routine. Immediate moral intuition appropriately draws attention. It should not end consideration.
[4] Objection 2: We should not try to duplicate ourselves as a kind of enhancement. As Hinlicky joins in, cloning in particular is seeking to insure “the sovereign self’s immortality” (14). Such a motivation would be doomed by the impossibility of achieving it. Duplicating a human being’s genes in a newborn is technically already within reach. Many mammal species have been successfully cloned. But such would not duplicate a particular person, any more than naturally occurring clones (identical twins) are the same person. Human beings are so much more than their genes. One identical twin, with by definition the same genes as the other twin, can become a physician while the other an airline pilot, one a Buddhist and the other a Lutheran. People with identical genes are still different persons developing by their unique experiences and choices. Cloning for individual immortality is self-defeating.
[5] Objection 3: Genetic enhancement could be used to predestine children to the plans of parents or society. Parents deeply shape their children as when deciding where a child will be born and what language the child will learn first. These are choices that human beings never make on their own for themselves. The influence of others is always deeply formative. It cannot be avoided. The best response to the danger of undue influence is to make choices that increase the child’s choices. Teaching a child to read does not predestine them to life in the book stacks. It gives them a tool that opens up worlds. There are many genetic enhancements that would likewise increase a child’s possibilities, not predestine them. It should be noted here that this is not to assume that life is only about having choices, but expanding choices rather than restricting them, allays the issue of predestination by genetic enhancement.
[6] Objection 4: Genetic enhancement treats children as artifacts of our own making. Would this include doing invasive surgery on a child born with a cleft palate so that they can eat and speak more easily? Such could be motivated out of love for the newborn, not out of thinking of the child as a manmade object. Human interaction is always at risk of objectifying the other, but it can be an expression of genuine care and respect. The medical team can start to think of Mrs. Jones as the pancreas in room 314, or they can seek to heal her pancreatitis specifically because they respect and care for her.
[7] Objection 5: Genetic enhancement may relieve suffering that should be experienced. Oehlschlaeger and Hinlicky are quite right that some suffering should not be immediately relieved. For example, it is better to recognize and correct the cause of justified guilt than to drown it in alcohol or cover it with dulling medication. What is causing suffering makes a difference in how one should treat it.1 While suffering in some cases can be an important warning that something needs attention before the damage is worse, it is not a good in itself. One can quite rightly take aspirin with thanksgiving for a flu-based headache.
[8] Objection 6: “Detaching eugenics as idea from its worst effects in practice requires some subtle rhetorical work by authors.” Actually the distinction can be as dramatically clear as when distinguishing the sadistic torture called medical research by the Nazi doctor Felix Mengele, from the rightful practice of medical investigation today. ‘Eugenics’ literally means seeking a good physical start for a child at birth. Nazi ‘eugenics’ was a cover for violent, coercive, and racist attack. None of those are present when eugenically, a gene for Tay Sachs disease is eliminated from a family’s line of inheritance. Ashkenazi Jews murdered by the Nazis in the name of eugenics have been the most successful practitioners of current eugenics. They have offered genetic counseling in their communities before marriage and procreation to eliminate largely the conception of children afflicted with what was a predominant and devastating baby-killer, Tay Sachs disease. There is no cry among them against eugenics. They are living the difference between eugenics as they practice it and the so-called eugenics that the Nazis claimed as an excuse for mass murder.
[9] Objection 7: Genetic enhancement and eugenics are associated with abortion. It is true that abortion is too often used to avoid the birth of differently-abled children, but it is a small percentage of abortions today that are for eugenic purposes and eugenics does not require abortion. Eugenics and abortion are each complicated enough without conflating them. Abortion can be aimed at eugenic ends, but eugenics does not require abortion and eugenics can also save the unborn. In the present natural course, two-thirds of conceptions abort on their own. Giving parents a way to avoid passing on a lethal genetic condition, a eugenic enhancement, could allow them to have children that survive, where none or few had before. That is life affirming.
10] Objection 8: Genetic enhancement will not be distributed justly. This concern sounds like the guests who complained on their Caribbean cruise that the food was terrible and the portions were too small. It seems in this case that the discussion has shifted to thinking of genetic intervention as a positive good that warrants fair distribution. If the concern is that the good of genetic enhancement will not be distributed widely enough, the counter balance is that interventions will be tested on rich kids first. The parents who lavish discretionary income on their children’s education (rather than casino entertainment or something else they value), in order to give their children the best start that they can, would likely be the first to provide genetic enhancement for their offspring. When it is proven over time to be safe and efficacious, it is in the interest of government to provide it widely. The economic pressure will be to offer it, not to withhold it. We have seen that pattern before with the development and introduction of vaccinations.
[11] Oehlschlaeger states further, “Maintaining a strong distinction between enhancement and treatment is a way of insisting that any meaningful consideration of justice in health care must focus on an ever-expanding circle of those considered within the reference group- a circle as large, finally, as the human species itself.” This could eventually be a call for full global distribution, not for abstinence. Enhancing immune systems through vaccination has moved in this direction. Yet in the meantime an ethical approach might be more complex than simply a worldwide equal share to all. Otherwise all tooth cavities in Africa would have to be filled before my kids could see the orthodontist.
[12] Objection 9: “…prevention or correction of undue harm, not provision of equal opportunity, is the goal of medical treatment.” But why is lacking opportunity not a harm? How precisely is undue harm being defined? Also, why separate correction of harm from equality of opportunity as contraries? Why not seek to address both? If it was discovered that eating salmon in the fourth month of pregnancy increased IQ of the developing child ten percent compared to not eating salmon at that point, would it be treating the child as an artifact to do so? No. Trying to duplicate oneself? No, to surpass oneself possibly. Predestining the child to our plans? No, increasing the different directions that the child could go. Would such be an unjust advantage? No, with a little help it could be in reach of every parent and developing child. Manipulative? It may be more manipulative and censurable not to provide it.
[13] Objection 10: Enhancement is beyond “ordinary functioning”.
First, what is currently ordinary function? Eight dental cavities per adult? 20/30 vision? Life expectancy of 32 in many countries? Second, why make ‘ordinary’ function the goal? Our generation is taller than past ones. Are we less human? If we come to remember better, would we therefore be less human? Most of us will live longer than our grandparents. Is that therefore an evil?
[14] Objection 11: “The beginning of the evil of eugenics lies in the premise that some are “unfit.” No, “unfit” implies useless or worthless. That is not entailed in eugenics. What is entailed in eugenics is the idea that some genetic inheritances are better than others. It is better to be born able to see than not to be able to see. Those who are born blind have every right to fulfill their lives and may enjoy and contribute greatly, but that does not mean that they started with as many choices and therefore opportunities to serve as those who can see. If a babysitter greeted you home from a dinner out and said all was well, and oft-hand mentioned that baby Johnny blinded himself, but no harm done, blindness is as good as seeing, one would be horrified. That is not to cast aspersions on people who are blind, simply to recognize that some physical conditions are more desirable than others. There are better genetic inheritances. Oehlschlaeger’s book ends with the admonition that parents should want children in the image of God, not of themselves. Yes, with fewer of our limitations, better reflecting God’s image and in a small way foreshadowing the promised new bodies to come at the resurrection.
Conclusion
[15] As Hinlicky so rightly states, giving people a better physical start or present will not make them more loving or just. However, we are bodily creatures. The Christian scriptures say that we will eventually have bodies that far surpass our current ones. When our bodies function well now that can be appreciated with thankfulness and as a taste of what is to come in our new bodies in the next life. To move a modicum in that direction is not a rejection of God’s plan or intent for us. For example, enhancing my ability to learn a neighbor’s language, is not inherently contrary to learning to be loving. It might even give me an opportunity to live faith active in love by listening to one I could not have understood before. We will in the future and in some small degree now, be able to experience genetic improvement to serve more than we could before. This would be a good, not the sole end of life or its greatest fulfillment, but an improvement nonetheless. Of course being more capable does not assure that we will use such capability well. Simul justus et peccator (at the same time righteous and sinner), the application will be mixed, but could still be on the whole for the better. I have no desire to return to the way we lived before the physical enhancements of fluoride and vaccination enhanced my body’s abilities beyond their natural state.
[16] Alarm bells are needed and a blessing when they alert us to change course before greater damage is done. Rightly functioning physical pain serves that purpose. But false pain can distract from what is needed. Indeed it is dangerous when false pain or other alarms misdirect from the real threats or keep us from doing what we should. Oehlschlaeger has rightly called for attention and caution for the formative matters of human genetic intervention, but he has not made an adequate case for clearly distinguishing between cure and enhancement, nor for banning the later. Accepting genetic therapy but not enhancement, would forbid both enhancements that would be genuinely helpful and cures with enhancement effects. As we seek to love and serve God and our neighbors, we should develop and apply genetic enhancement incrementally, reversibly, thoughtfully, prayerfully, with more discerning guidelines.
NOTES
1 James C. Peterson and Kelvin F. Mutter, “Some Pains are Worth Their Price: Discerning Pain to Guide its Alleviation,” The Journal of Spirituality in Mental Health, vol. 12, issue 3 (2010) 182-194.