Germline Gene Editing and Savulescu's Procreative Beneficence Principle

The possibility of using engineered enzymes to alter DNA means germline editing seems to be becoming a practical possibility with CRISPR. Such a possibility raises important ethical concerns. Some of these ethical concerns are concerned with safety but in this posting I will assume these safety concerns can be successfully adressed. In this posting I want to consider whether these possibilities mean parents should adopt Savulescu’s procreative beneficence principle using such editing. I will then consider two objections to doing so. Firstly it might be objected that the adoption the principle would lead to inequality and create some sort of genonobility. Secondly that the adoption of the principle might mean that in the future parents who use germline editing to enhance their future children damage these children’s autonomy.

Savelescu’s procreative beneficence principle states that prospective parents using IVF should choose among embryos so that the embryo selected if it became a child would be expected to have the best life, or at least as good a life as any other resulting child, based on the relevant available information. This principle can be broadened. It seems that in the reasonably near future that a combination of IVF and germline editing means that prospective parents would be able to use these techniques to enhance any possible child so she is expected to have the best possible life based on the available information. It appears follow from the procreative principle that provided germline editing is completely safe parents should select children who are expected the best life possible. Savelescu’s argument is a consequentialist one and if we accept the premise, that it is possible to predict the sort of life a child will lead, then provided we are consequentialists we should accept Savelescu’s principle. Should we accept the above premise? I would question whether we can really predict now that some possible future child will have the best life possible in thirty or forty years time. I would suggest that whilst we might possess some relevant information we don’t possess enough of it to make accurate predictions. If we accept the above then it follows prospective parents would have no reason why they should adopt Savelescu’s procreative beneficence principle, even if they could afford to do so and safety concerns had been allayed. However even if prospective parents cannot be certain that they are acting beneficently if they adopted the principle when conceiving future children does this mean that they shouldn’t do so in the hope that these children have the best possible lives? I would suggest it doesn’t. If we can’t choose to do x for beneficent reasons then this doesn’t mean we can’t choose to do x provided by doing so we don’t do any harm. If we can’t use the principle of beneficence then we can use the principle of non-maleficence. In the light of the above it might be suggested that provided germline editing is safe then it should be permissible for prospective parents to use it to apply principle when conceiving a future child in the hope that they are acting beneficently provided in doing so they aren’t doing any harm.

I now want to consider two objections to the above suggestion. It might be objected that the use of the procreative beneficence principle to conceive future children might harm society and might also harm these future children by damaging their autonomy. I will consider each of these objections in turn.

For many parents the costs involved with using the procreative beneficent principle are likely to be prohibitive and this means the use of the principle would not be open to all. Let us assume that some parents use the principle and that as a result their children have, on average, greater cognitive skills or physical abilities. It might then be argued that permitting the use of the principle would create a less equal society and that because a less equal society is damaging we should prohibit the use of such gene editing. It might even be suggested that over time the use of the principle would lead to a two tier society with a genenobility. However such a strict prohibition would harm some people affected by genetic diseases which might be treated by germline editing. Let us accept that germline editing should be permitted to combat specific diseases. However even if we permit germline editing for therapeutic purposes it doesn’t mean we shouldn’t prohibit it if it is being used to apply the procreative principle.

Let us now specifically consider germline editing with the express aim of creating children who are expected to have the best possible lives. However even if germline editing does create a less equal society this fact doesn’t alone mean it should be prohibited. Kant famously argued ought implies can. It might be that whilst a prohibition on such germline editing is desirable that achieving it is impractical. For instance whilst doctors in the US are presently prohibited from using gene editing tools on patients those in China aren’t, see Wall Street Journal . However even if a worldwide prohibition is possible it doesn’t mean it is desirable. For instance private healthcare and education also lead to inequalities. If we are prepared to accept the inequalities caused by private health care and education it might be argued by analogy that we should also be prepared to accept inequalities caused by some parents using germline editing to apply the procreative principle. The soundness of this argument depends on closeness of the analogy. It might be that such editing would lead to far greater inequalities than those caused by private healthcare or education. The question whether we should prohibit germline editing becomes no longer solely dependent on the creation of inequality but also depends on the degree of inequality created. Let us assume for the sake of argument that germline editing produces greater inequality than private health care or education. It might then be argued that this greater inequality means that it should be prohibited provided that this is possible. Such an argument also seems to be unsound. Even in these circumstances it still might be acceptable to accept germline editing, provided that the inequalities it created were only for a limited period. Inequality matters, the degree of inequality matters and the length of time this inequality persists for also matters. Clearly any permanent inequality such as that which might lead to a genenobility is unacceptable and in these circumstances we should prohibit germline editing provided of course we can do so on a worldwide basis. However it is possible that germline editing might be acceptable if it only produced greater inequalities for a limited period. It seems probable that many people would be prepared to undergo some inequality if this inequality was for a short period and they benefitted from it in in the long term. Would the introduction of germline editing only produce inequalities for a limited period? I would suggest we have two reasons to suggest it would. Firstly experience teaches us that the cost of any new technology falls over time. Secondly I would argue governments have reason to subsidise germline editing. If germline editing is likely to cause inequalities then this is likely to be due it creating children with better cognitive and physical abilities. Citizens with better cognitive and physical abilities are likely to be less costly to society and as a result the state has reason to encourage such citizens. Presently it does this by means of health campaigns and education. Perhaps in the future it might do so by subsidising germline editing. In light of the above before permitting germline editing in order to apply the procreative principle we should consider how long any inequality produced by such editing is likely to persist. If after careful consideration we come to believe that such inequality will be a temporary matter then have no reason based on inequality to prohibit germline editing in order to apply the procreative principle.

Let us now consider the second objection to parents using germline editing to apply Savulescu’s procreative beneficence principle. It might be objected that any parents who do so damage their future children’s autonomy. This objection can be split into two parts. Firstly it might be argued that any children conceived using the principle might not have consented in retrospect thereby damaging their autonomy. Secondly it might be argued that any children born using the principle have already had their future partly determined and this again damages their autonomy. I will consider each of these parts of the objection in turn.

Let us first consider the autonomy of someone whose germline has been altered by the decision of her parents. It might be argued that because such a person couldn’t have consented to these changes that her autonomy has been damaged. I believe that such an argument is unsound. Let us accept that consent and autonomy are sometimes connected. Let us also accept that if a doctor operates on a competent patient without her consent, when it is possible to obtain her consent, that her autonomy is damaged. However a failure to obtain consent isn’t always linked to damaging autonomy. Consider someone who is unconscious after a serious road accident and needs surgery. If a doctor operates on her without her actual consent in what he perceives to be his best interests then he is acting in accordance with her presumed consent. In these circumstances it would be wrong to say that he has damaged her autonomy. Indeed, it might be argued that he preserved her autonomy. She might have died or been severely handicapped without his intervention. Let us now consider someone whose germline has been altered. It might be argued by analogy that someone who could not consent to her germline being edited hasn’t had her autonomy damaged because her parents have acted in accordance with her presumed consent. However the analogy between the two cases is not a close one. In the case of the accident victim an actual person already exists making it easier to foresee her wishes. In the case of germline editing we would be trying to foresee the wishes of a hypothetical person at least a decade and a half later.

In the light of the above it might appear that it should be impermissible for parents to adopt the procreative principle because any child conceived using this principle because they have no reason to presume that she would have consented. I would argue this appearance is also unsound. The above appearance depends on connecting our inability to obtain consent or presume consent with doing nothing. Let us assume that sometime in the future germline editing becomes reasonably cheap to use and will not result in any future children having cognitive or other health problems. In these circumstances potential parents have to decide whether or not to use the procreative principle when conceiving a future child. Not adopting such editing is a decision. I have suggested that it would be difficult for parents to ascertain what would be in a child’s best interests decades later. In these circumstances it is hard for potential parents to make a decision based on beneficence. However provided safety concerns can be fully allayed there seems to be no reason why parents shouldn’t use germline editing to apply the procreative principle. In response to the above it might be objected that children whose germlines have been edited would most probably not consented rather than consented. I find this objection based on hypothetical probabilities unconvincing. The present discussion is concerned with germline editing for beneficial reasons. In this scenario is it really more probable that the recipient would think in hindsight that she would have refused consent? If we reject the above suggestion above, then once again we have no reason to reject germline editing used to apply the procreative principle due to our failure to secure consent.

Let us now return to the second part of the objection to prospective parents use germline editing to apply the procreative principle based on damaging autonomy. It might be objected that the use of the procreative beneficence principle to conceive future children might harm these future children by damaging their autonomy. Autonomy roughly speaking is the ability to govern oneself by deciding what is best for you. How might this ability to decide be damaged? It might be damaged in two ways. Firstly the mechanism by which we decide might be damaged. Secondly our ability to decide might be damaged by limiting the choices we can make. If parents use germline editing to apply the procreative principle the any resulting children are likely to have improved cognitive or physical abilities in order for them to live the best possible life. If someone has improved cognitive or physical abilities then these abilities are more likely to enhance her mechanism to decide than damage it. It follows that if we only improve these abilities that we can discard the first reason not to permit germline editing. If parents use germline editing to apply the procreative principle might any resulting children have more limited options when making decisions than if no editing had been applied? Options might be limited in two ways. First there might just be less options and secondly someone might be less able to exercise the options available. It seems improbable that altering someone’s germline will alter the number of potential options. It also seems improbable that germline editing will alter someone’s ability to exercise some of these potential options. If someone parents used germline editing to apply the procreative before she was born then her cognitive and physical abilities should at least be equal to those which would have pertained had not such editing taken place. It follows that germline editing to apply the procreative principle won’t damage her ability to exercise potential options.

I have concluded that whilst we don’t have solid reasons to apply Savulescu’s procreative principle using germline editing that we do not have reasons based on inequality or damaging autonomy to make it impermissible. However a note of caution is needed at this point. The above conclusion depends on the assumption that germline editing is completely safe. The truth of this assumption might be difficult to ascertain in practice as some of the effects of such editing might not become evident in humans for decades. For this reason if we are ever to use germline editing extremely rigorous safety standards would need to be applied.

Why I'm not a Stoic

I admire fortitude, detachment and many other stoic virtues but believe full blown stoicism is damaging. Let us accept that for someone living in an extremely deprived environment with limited options that these virtues can help him to survive. An account of how stoicism can help people survive in such circumstance is given by James Stockdale who was shot down in the Vietnam War and detained in Hanoi, see Stockdale . Someone who suffers from a life limiting disease might also find himself in an extremely deprived environment and once again with few options. In these deprived circumstances adopting a stoical perspective seems to be a sensible option.

Fortunately, most of us don’t live in such circumstances. The question I wish to address is this, in more normal circumstances should we lead a stoic life? Some stoics believe that the only thing that always makes us happy in life is leading a life of virtue.

“The only thing that always contributes to happiness, as it is necessary and sufficient for the condition, is virtue. Conversely the only thing that necessitates misery and is “bad” or “evil” is the corruption of reason, namely vice.” Internet Encyclopedia of Philosophy

Perhaps virtue is the only thing that always makes us happy but I will argue there are some things which even if they don’t always make us happy are nonetheless essential for a happy life. Certain things such as fame and material goods might make us happy temporarily.  However, we can’t always attain these goods and once attained these goods might not always make us happy. Let us accept that the excessive pursuit of these goods can damage our happiness in three ways. Firstly, we might be disappointed if we fail to obtain these goods, secondly even if we do obtain them they might fail to meet our expectations once again leading to disappointment, lastly the pursuit of these goods might divert us from the one thing that always makes us happy namely virtue. Let us consider the harm done by disappointment first. A stoic would argue that in order to avoid such disappointment that whilst we might prefer such goods we should remain indifferent to them. I would suggest that with regard to disappointment stoicism is a philosophy of pessimism by rejecting hope. A stoic shouldn’t hope because hope would make him vulnerable to disappointment. Let us assume that the excessive pursuit of fame or material goods hinders us from pursuing the only thing that always makes us happy, virtue. A stoic would argue we should always pursue virtue and as a result we not pursue those things which damage this pursuit. Let us agree with our stoic that we should first of all pursue virtue. Let us also agree that the excessive pursuit of fame or material goods damages this pursuit. However, it is by no means clear that using balanced Aristotelian moderation in pursuit of these goods will damage our pursuit of virtue. Accepting the above means that in normal circumstances that we have no clear reasons to accept or reject Stoicism.

 

At this point someone might object I am misunderstanding the stoic idea of happiness. I am confusing stoic ideas with Epicurean ones. An Epicurean is concerned with hedonistic happiness whilst to a Stoic happiness is concerned to living our lives in accordance with essential nature as rational creatures. For the sake of argument let us accept my objector’s point. Let us also accept that stoics believe that if someone leads his life in accordance with his essential nature that he will flourish.

 

I now want to examine what is meant by flourishing. Flourishing is a slippery concept. For instance, could it really be said that a creature, which leaves behind plenty of descendants, flourishes? Using a Darwinian idea of flourishing it certainly does. Moreover, it might be argued evolution means leaving behind plenty of descendants is selected for and hence is part of the nature of all living things. However, a Darwinian idea of flourishing, at best, plays only a small part in most people’s idea of flourishing. A stoic idea of flourishing seems to depend on the essential nature of a creature which defines it. For instance it is part of the nature of bees to collect nectar to make honey and a bee flourishes if it makes lots of honey. It is part of bee eater’s nature to eat bees and it flourishes if it eats lots of bees. The stoics emphasise it is an essential part of human nature to act rationally. According to the stoics a human being who acts completely rationally should flourish. Let us now consider a rational person who is virtuous, ratiomal, rich and healthy but lacks any positive affection for any of these things. According to a stoic this person flourishes. However intuitively we would not say such a person was flourishing. Indeed, we might feel that there is something defective about him. He lacks something that is necessary for flourishing. Perhaps one of the things he lacks is happiness and we should leading a stoic life can lead to happiness. I won’t pursue this point any further here. However, I would suggest one of the things a stoic lacks is a caring attitude to things in general.

 

Let us accept that stoics belief it is our nature to be rational. I have suggested above that such a belief is too simplistic and that other things are an essentIAL part of our nature. I will now present two arguments in an attempt to show that caring about things is An essential part of our nature. First, let us accept that someone’s ideals are defined by what he cares about. Now according to Harry Frankfurt,

“a person without ideals, there are no volitional laws he has bound himself to respect and to which he unconditionally submits. He has no inviolable boundaries. Thus he is amorphous with no fixed shape or identity.” (1)

Someone without fixed shape or identity is still of course a human being but she isn’t really a person. Almost all human beings develop into persons. Being a person is part of our nature. It follows caring about something must also be part of our nature. Secondly let us assume that caring about things is not part of our nature. If this is so being rational becomes pointless. It is impossible to apply rationality unless we care about something; it is impossible for rationality to get any purchase if we don’t care about anything. All our rational decisions are equally good and we have no basis to choose between competing options. It follows if caring about something is not an essential part of our nature then it isn’t possible to act rationally without caring about some things. Rationality is one of these things but isn’t sufficient. In the rest of this posting I will assume that caring about something is an essential part of our nature.

 

Even if we accept that caring about things is an essential part of our nature this give us reason why we should reject stoic ideals. A stoic might point out that he cares about virtue and rationality. The question is not whether a stoic cares about things but whether he cares about enough things. I will argue that he doesn’t. In order to make my argument I must make it clear what I mean by ‘care about’. David Hume famously argued reason is the slave of the passions. However, I want to argue what we care about doesn’t simply means that we feel passionate or emotional about something. Indeed, I would agree with the stoic idea that reason can control our emotions, at least to some degree. Reason can sort out our conflicting emotions and add stability to our sense of ever changing emotions. However, let us accept that reason alone cannot cause us to act. Our actions are based on what we will which is based on what we care about. According to Frankfurt “the formation of a person’s will is most fundamentally a matter of his coming to care about certain things, and of his coming to care about some of them more than others” (2). Also according to Frankfurt cares about’ something then he, “identifies himself with what he cares about in the sense that he makes himself vulnerable to losses and susceptible to benefits depending upon whether what he cares about is diminished or enhanced”. (3) A similar but slightly different approach concerning identity is taken by Bennett Helm who argues we are identified by what we love (4). If we accept the above definition of ‘caring about’ it can be regarded as a form of loving. In the rest of this posting I will use the word love to mean ‘caring about’ as defined above. It is important to note the use of the word love in this way is using a broader definition of love than simple romantic or erotic love. Let us accept that loving is an essential part of our nature, let us now also accept that to love something or someone means to identify oneself with that thing or persin and that to identify with something makes one vulnerable.

 

I want to argue that if someone leads a stoic and limits his love to virtue and rationality that he stunts himself and denies himself of the opportunity to lead a good life. First however I must introduce the stoic idea of an indifferent. Sometimes being indifferent to something may be the only sensible attitude. I for instance am indifferent to my grandson’s Aspergers, see Aspergers, Autism and Love . Sometimes being indifferent can be admirable as when a patient bears his illness with great stoicism. However, I will argue someone cannot remain indifferent to some things without causing serious damage himself as a person. What then is an indifferent? If we accept the above then a stoic only really cares about virtue and being rational and he tries to be indifferent to everything else. Stoics of course don’t deny other things such as health and even wealth might help us to flourish.  However even though these other things usually contributed to someone’s flourishing they might not do so in all circumstances. Stoics split indifferents into two types. Things such as health and wealth, which usually contributed to flourishing, are called preferred indifferents. Dispreferred indifferents are things that usually damage our flourishing such as disease or poverty.

 

The idea of a preferred indifferent appears at first sight to be nonsensical. How can someone prefer something but be indifferent to it at the same time? The answer is of course he can’t. Nonetheless it is possible to prefer something in some circumstances and be indifferent to it others. For instance, someone may prefer cream cakes normally but not if he is on a diet. I will now argue that whilst the idea of preferred indifferents may make sense when applied to cream cakes that it makes no sense when applied to the things we care about or love.

 

Let us consider a mother fleeing across the Sahara desert from persecution together with her children. Let us assume on the way one of her children dies from lack of water. A stoic would argue that this mother should be indifferent to her child’s fate. He might point out that in these circumstances the mother cannot change the fate of her child so reason dictates she should indifferent towards its fate. Of course in different circumstances she would have preferred her child to live. However I would argue such a mother cannot suddenly become indifferent to her child’s fate because she loved him and still loves him because love doesn’t suddenly die. Moreover because she loves him she identifies herself with him and someone cannot change her identity suddenly. Lastly because she loves him she makes herself vulnerable to what benefits and harms him. She feels grief. According to a stoic grief is both harmful and pointless. I have argued that love is impossible without the possibility of grief and that if we seek to limit our ability to grieve we limit our ability to love, see grief . It follows if we love something we cannot suddenly become indifferent towards it even if its circumstances change and we cannot alter these circumstances.

 

If we accept the above then stoics have a problem with love because as I have argued loving is essential to being a person. A stoic might respond that stoics can love but that this love is restricted to virtue and reason.I accept that someone who only loves virtue and reason could be a person. But I would suggest she would be a deficient or incomplete sort of person. She would lack true friends because to have friends you must love your friends see Helm (4).She might of course have friends of utility, people she uses, or friends of pleasure, people who please her, but I would not class these as true friends. A stoic might respond that she can love other things but I would argue the same problem remains. For instance if a stoic loved a childhood home in which she was happy she cannot immediately become indifferent towards it if it is burnt down..

It seems to me in trying to make themselves less vulnerable to fate stoics damage that which makes us persons; the ability to love. Persons are by their very nature vulnerable and if we try to remove this vulnerability we damage our personhood. We become soulless people somewhat akin to virtuous robots. Accepting the above would explain why a stoic who loves only virtue is a deficient or incomplete sort of person. The stoic belief that the only thing which is necessary and sufficient for someone to flourish is for her to be virtuous is wrong, for someone to flourish she must be able to love. It would appear that sometimes stoic ideas damage persons.  A stoic might respond to the above by pointing out that our turbulent emotions are equally damaging to our personhood. She might then suggest that because stoicism dampens down our turbulent emotions without the need for drugs such as anti-depressants that far from damaging our personhood stoicism actually enhances it. I have two responses to my stoic First, I would suggest that most people should be cautious about dampening down their emotions and should instead use their rationality to judge how appropriate they are and if nessary to control them. Secondly I would suggest experiencing emotions is part of being a person as we regard sociopaths as being deficient persons in some way.

In conclusion I have argued that in most circumstances the stoic’s quest to reduce or eliminate his unhappiness damages his capacity to love which in turn damages his ability to experience happiness and I wouldn’t recommend a stoic life. However for a few people who live in extremely deprived circumstances a stoic life might be the best option,

1. Harry Frankfurt, 1999, Necessity, Volition and Love, Cambridge University Press, page 114
2. Harry Frankfurt, 1988, The Importance of What We Care About. Cambridge University Press, page 91.
3. Frankfurt, 1988, page 83.
4. Bennett Helm, 2010, Love Friendship & the Self, Oxford University Press, page 122.
5. Bennett Helm, chapter 8.