Tuesday, May 22, 2007

Designer Baby or Sensible Precaution?

My wife edits a section of a commercial website devoted to medical information about breast cancer. She is more than casually interested in the subject, since she just celebrated her five-year anniversary of being free from the disease after undergoing a mastectomy and chemotherapy in 2002. My mother died of the same malady in 1980, so it is safe to say I'm as familiar with it as anybody can be who hasn't had it personally.

Two families in Great Britain have also had more than their share of experiences with breast cancer, having lost ancestors to the disease over three generations. So they decided to do something about it. Both couples found a physician named Serhal who has developed a way to test a fertilized embryo at the eight-cell stage for a defective BRCA1 gene, which if present increases the risk of eventually developing breast cancer to about a fifty-fifty chance. If Dr. Serhal receives governmental approval for his plan, and it looks like he will, the couples want to proceed with in-vitro fertilization using only embryos which do not have the defective BRCA1 gene. The embryos with the defective genes will be disposed of. In this way, the couples can "annihilate the gene from the family tree," as Dr. Serhal puts it.

Where is engineering in this situation? Everywhere: in the instruments and equipment Dr. Serhal uses to do the tests, in the procedures for in-vitro fertilization (IVF), and, most importantly, in the selection of embryos. In applying the sciences of genetics and embryology to a commercial end (it is unlikely that Dr. Serhal is working for free), he is doing engineering, broadly defined. And the subject being engineered is a human being, or rather, several human beings, many of whom do not survive the process. Remember, harboring a defective BRCA1 gene does not guarantee you'll have breast cancer; it just increases the risk. Many people with that gene live long lives and die of something else altogether. So we can be pretty sure that some of the embryos that get thrown away would have developed if implanted into healthy human beings living normal lives, whatever that means these days.

Now I'm going to go off in a direction that you may not follow, but I have come to believe it is the most direct way to express what I see to be the basic problem here. A few hundred years ago, back before much was known about embryology, the development of a baby in the womb was mostly a matter of speculation. People talked metaphorically about clay gradually being molded, and for all they knew, there was some amorphous protoplasm to begin with which only gradually became the individual who made his or her first public appearance nine months after conception. But now, with everything we know about DNA, genetics, and the fabulously intricate machinery that comes together to produce a mathematically distinct individual after the process of conception is finished (which can take just a few minutes), the empirical scientific evidence supports the idea of humans as substantial beings more strongly than ever.

Substantial say what? "Substantial beings." I'm using the word "substance" in a technical philosophical sense that goes back ultimately to Aristotle. To explain it in detail would take far more room than I have, but briefly, a substantial being is one which has a wholeness or completeness or integrity. A substantial being is more than the sum of its parts. For example, you can look at a dog in a number of ways: an assembly of atoms, a combination of bones, muscles, internal organs, hair, teeth, etc., even a set of behaviors that can be predicted (more or less, depending on how well you trained your dog). But when you say, "Heel, Fido!" you don't mean, "Heel, you assembly of atoms that just happens to be moving in front of me on the sidewalk." You mean a single being—your dog—continuous in time and localized in space, a real entity that has life (another philosophical term) and will some day die.

This concept of people as substantial beings is not popular these days. Few of us think of ourselves as substantial beings in fact, never mind the terminology. We think of ourselves as just collections of needs, or inclinations, or desires, or bits of knowledge and skills. Nevertheless, substantial beings are what we are—we've just forgotten the name for it.

What has this got to do with the case of the selected defective-BRCA1-free embryos in Britain? An embryo is what the substantial being called human looks like when it's a few days old. You, I, every human on the planet was once an embryo. And one day mortality will catch up with us and we'll die of something. No exceptions so far. The couples who are trying to eliminate the defective gene from their family tree are probably motivated by some generous motives and some fears. The generous motive is to give birth to a baby that won't have an increased risk of dying of breast cancer. The fear is of seeing their child die of the same disease that killed so many other relatives. So they decided to "eliminate" the children who might die of it and bear only those who probably—but not certainly—won't.

There is an old and unpopular name for this sort of thing: eugenics. In the first half of the twentieth century, followers of Francis Galton (Charles Darwin's cousin, both biologically and intellectually) promoted the idea that we should take steps to improve the human gene pool, both individually (by marrying into "good stock" for example) and collectively (by allowing governments to sterilize those "unfit" to bear children). There are boodles of problems with these ideas, but that did not stop them from spreading in both the U. S. and Europe, and in particular Nazi Germany, where Hitler took aggressive means to eliminate "undesirables" such as mental defectives, homosexuals, the Romani (gypsies), and most famously, the Jews.

Hitler, more than anyone else, gave eugenics a bad name, although it took until 1969 for the journal Eugenics Quarterly to rename itself Social Biology. But the desire is still there, and since 1950 the tremendous advances in genetics and molecular biology have put powerful technology at the disposal of those who would use it for the same kinds of purposes that the old eugenicists had.

The British couples are not doing anything like advocating the genocide of a race. But, enabled by Dr. Serhal, they are doing the same kind of thing as Hitler did, only on a much smaller scale. On a personal level, there is nothing intrinsically wrong with desiring to produce offspring who are healthy, happy, intelligent, and possessed of other good qualities. But the end does not always justify the means. Now that you're prepped on vocabulary, I can make my point: destruction of human substantial beings is a wrong means of achieving this goal.

Sources: The article describing Dr. Serhal and his plans originally ran in The Times of London, and can be found at http://www.theaustralian.news.com.au/story/0,20867,21624095-30417,00.html. Wikipedia's article on eugenics has an abundance of historical and current information in its fairly balanced treatment.


  1. I'm not sure if any of these comments will be quite to the point, but they're what this post suggests to me.

    First, I agree that it's difficult, philosophically, to come up with a time OTHER than conception at which a human life begins, or a new human life is present, or however you want to put it. The other candidates all seem arbitrary. Implantation? "Quickening"? Viability? Obviously the legal fictions about trimesters are intellectually ridiculous. On the other hand, I find it equally difficult to think of a freshly-fertilized egg, or an 8-cell embryo, as having the same dignity and right to life that you or I do.

    Legally, the question is not "when does life begin?" but "at what point does someone become a legal person?" I'm pretty confident about my answer to that -- define the end of life as we do the beginning, with brain waves and a heartbeat. But this isn't a legal blog, it's an ethics blog, and things that are legal may not be ethical.

    Also, "feelings" (mine or anyone else's) are not a proper basis for determination. An 8-cell embryo may not "feel" to me like a fully human being. But some self-proclaimed medical ethicist once declared that human babies don't achieve full ethical humanity until some time after they are born. (To be fair, I THINK he was referring to how babies are PERCEIVED -- why it's seemingly so easy for some people to kill them -- not necessarily what he felt to be a correct or defensible position.)

    So mark me down "confused" on the subject of the full personhood of a freshly-fertilized egg.

    Second, as to Nazis and eugenics, is what we object to in their approach the eugenics, or the coercion? China's "one baby" policy, featuring coerced abortions, is widely, and I feel rightly, condemned. But does that mean that all family planning is bad? (Or, for that matter, that China doesn't have a legitimate population problem?) Or merely that coercion is bad? Then the next question is, in the situation under discussion, is anyone being coerced? Obviously the potential parents and the doctor are acting voluntarily. If there's coercion, it's of the embryo. In which case, see my first confused comment.

    Lastly, whenever I think of eugenics, I think of my own genome. I've never fathered a child and am not likely to, but if I were ever in the position to contemplate doing so intentionally, I would be torn, and the reason would be that my body is a lemon. I've been plagued my entire life by allergies and acne, and I could fill a paragraph with other minor (that is, not fatal, and not significantly impairing normal physical function) imperfections that make my body a disappointing nuisance to live in. I would not want to give any of those genes to a helpless child, who, after all, never asked to be created, much less saddled with lousy genetics. The seemingly endless stream of discoveries about mental and emotional traits that are genetically influenced makes this consideration even stronger. If happiness and political philosophy are in our genes, we must consider if we want those traits passed along, too.

    All you said, in your conclusion, was that destroying embryos is the wrong way to practice eugenics. (This brings up the issue of embryo destruction being a routine part of ALL in vitreo fertilization, even if no genetic culling is done, but this post is already too long to tolerate a digression.) Still, I can't help getting the feeling you think eugenics is, itself, wrong. So I'll ask -- if the intervention could be done before fertilization, if genetic manipulation could be done to the sperm and egg before combining them, would that be ethical?

    I have heard (though I cannot prove) that when anesthetic was first introduced, it was held to be against Christian morality because it was an attempt to avoid "God ordained" suffering. We breed dogs and cattle to improve them, without anyone objecting, but tinkering with ourselves is held to be interfering with God's handiwork. Some people feel our imperfections are what make us human -- or, at any rate, that to try to avoid them is to try to avoid God's post-fall judgment.

    I know the problems about everyone wanting their son to be the tallest in class or their daughter to have DD breasts. And, indeed, that sort of trivial thing might be what was first desired if humanity could successfully be genetically engineered on a large scale. But if we could get rid of Type I diabetes, and muscular dystrophy, and male pattern baldness, and bad eyesight, and crooked teeth, and flat feet, by getting rid of the genes that cause them, would it be unethical to try? Or unethical NOT to?

    None of us asks to be born. Most of us are born with stuff wrong with us that will hound us our entire lives. I, for one, would consider it a moral duty to prevent that, if it could be done.

    Cousin Mike

  2. Something I said in passing in my earlier comment has stuck in my mind and seems to deserve elaboration.

    IVF involves the routine destruction of many early-stage embryos, just because they are unneeded, doesn't it? So my question is, is the destruction of embryos for genetic culling more wrong (a greater wrong) than that? Motives obviously do matter. Is destroying an embryo because it might be defective worse than destroying it because it's an extra? Or are they equally wrong, but genetic cullling is undesirable because it creates a NEW reason why embryos created for IVF will be destroyed? (If so, is IVF undesirable only if it leads to the destruction of more embryos? Would it be acceptable if it merely led to the destruction of fewer spares?) Or is it less wrong (because from a seemingly noble motive), but still wrong?

    It would be ironic if, for some logical reason I'm missing, it was worse to destroy something in an attempt to avoid suffering than to destroy it because it was left over, as is happening already.

    Maybe the problem here isn't eugenics so much as it's IVF in the first place. And that's a whole 'nother issue. Is it cruel to deny people who want to be parents the right to try every technical means to do so? Or for any technique that involves embryo destruction, is it our ethical duty to harden our hearts and say "give it up, or adopt, but you can't do THIS"?

    Cousin Mike