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.