SPARROW-2011-Hastings_Center_Report(2)

32 HASTINGS CENTER REPORT January-February 2011 A s Nick Agar noted in the pages of this jour- nal in 2007, there now exists a significant body of work in bioethics that argues in favor of enhancing human beings. 1 Writers includ- ing Gregory Stock, Lee Silver, Nick Bostrom, Julian Savulescu, John Harris, Ronald Green, Jonathan Glover, and Agar himself have suggested that there is little reason to fear the scientific application of ge- netic technologies to human beings, as long as the choice of whether—and how—to use them is left up to individuals. 2 They argue that a “new” or “liberal” eugenics, which would be pluralistic, based on good science, concerned with the welfare of individuals, and would respect the rights of individuals, should be distinguished from the “old” eugenics, which was perfectionist, unscientific, concerned with the health of the “race,” and coercive. 3 According to the advocates of the new eugenics, the horrors associated with the old eugenics should not prevent us from embracing the opportunities offered by recent ad- vances in the biological sciences. Two of these writers in particular, John Harris and Julian Savulescu, have independently advanced the argument for human enhancement with espe- cial fervor in their recent works. In Enhancing Evo- lution: The Ethical Case for Making Better People , Harris takes to conservative critics of enhancement with gusto and argues that a commitment to human enhancement follows naturally from our willing- ness to accept the improvements in our welfare and capacities that other technologies have made pos- sible. 4 Moreover, he suggests, a proper concern for the welfare of future human beings implies that we are morally obligated to pursue enhancements. 5 Simi- larly, in a series of influential and oft-cited articles in prestigious medical and bioethical journals and in A Not-So-New EUGENICS Harris and Savulescu on Human Enhancement BY ROBERT SPARROW John Harris and Julian Savulescu, leading figures in the “new” eugenics, argue that parents are morally obligated to use genetic and other technologies to enhance their children. But the argument they give leads to conclusions even more radical than they acknowledge. ultimately, the world it would lead to is not all that different from that championed by eugenicists one hundred years ago. Robert Sparrow, “A Not-So-New Eugenics: Harris and Savulescu on Human Enhancement,” Hastings Center Report 41, no. 1 (2011): 32- 42.

January-February 2011 HASTINGS CENTER REPORT 33 edited collections published by major academic presses, Julian Savulescu has argued that we are morally obli- gated to use genetic (and other) tech- nologies to produce the best children possible —a strong claim indeed! 6 Sa- vulescu has also used his role as direc- tor of the Oxford Uehiro Centre for Practical Ethics to promote human enhancement in the popular press. 7 When learned professors at the University of Manchester and Ox- ford start to agitate on behalf of en- hancing human beings, it behooves us to take notice. For reasons that will become obvious below, I hope that Savulescu and Har- ris are wrong about the existence of an obligation to enhance future human beings, but it is not my in- tention to try to establish that here. Rather, my pur- pose is to point out that if we have such an obliga- tion, then its implications are much more radical than Harris or Savulescu admit. Both Harris and Savulescu approach the ethics of human enhancement from a consequentialist perspective. 8 Given the notoriously demanding nature of consequentialism and its lineage as a philosophy of radical social reform, one might expect that their conclu- sions would include a strong role for the state in encouraging or even re- quiring people to meet their obliga- tions to have better babies. Instead, both Harris and Savulescu deny that the state should pursue eugenic goals and insist that the decision about whether to pursue enhancement (and which enhancements to pur- sue) should be left up to individuals. There is, therefore, a tension between their consequentialism and their (ap- parent) libertarianism when it comes to the rights of individuals to use—or not use—enhancement technologies as they see fit. 9 Only through a very particular and not especially plausible negotiation of the uneasy relation- ship between their moral theory and their policy prescriptions can Harris and Savulescu obscure the fact that the gap between the new and the old eugenics is not that large at all, and that their philosophies have impli- cations that most people would find profoundly unattractive. Consequentialism and Enhancement T he two technologies that offer the most realistic prospect of achieving dramatic improvements in the capacities of human beings in the foreseeable future are preimplantation genetic diagnosis (possibly in combi- nation with “embryo splitting”) and somatic cell nuclear transfer. PGD allows parents to learn about the ge- netics of the embryos they have cre- ated through in vitro fertilization, so that they can choose which embryo to implant into a woman’s womb and try to bring to term. It is currently widely used as a powerful technique to prevent the birth of children with severe disabilities. The use of PGD for enhancement would involve se- lecting embryos on the basis of genes for “above-species-typical” capacities. Our rapidly improving knowledge of human genetics, especially since the completion of the human genome program, has greatly increased the potential of using PGD to this end. Employing “embryo splitting” in con- junction with PGD would improve its efficiency as an enhancement tech- nology by allowing the creation of multiple, genetically identical copies of a desirable embryo, increasing the chances of successfully implanting an embryo with those genetics. 10 Should somatic cell nuclear transfer cloning of human beings become possible, then parents could create children with the genome of some existing person who has above-species-typical characteristics. Consequentialism has a distinct theoretical advantage when it comes to discussing the ethics of these tech- nologies. Both PGD and SCNT in- volve choosing which people are born rather than enhancing the traits of existing persons. As Derek Parfit ob- served, such decisions are not “per- son affecting”: there is no particular person who will be better or worse off depending on how the decisions are made, because if the deci- sions are made differently, then a different person is brought into the world. 11 It is difficult for noncon- sequentialist moral theo- ries to gain any purchase on decisions of this sort. Rights-based or Kantian approaches founder be- cause, in the absence of an affected individual, decisions about enhancement are only about how we treat embryos, rather than how we relate to rational agents, and at- tributing “rights” to embryos has extremely counterintuitive implica- tions in other policy areas. 12 More- over, insofar as we are concerned with the rationality of future agents, some enhancements might be desirable be- cause they might facilitate rational agency. Perhaps virtue ethics stands a better chance of generating conclu- sions about the appropriate attitude toward enhancement, 13 or about the impact that altering human nature would have on future human be- ings’ capacity to exercise important virtues. 14 However, it is difficult to develop an uncontroversial account of the virtues that has enough con- tent to motivate definite conclusions about the appropriate attitude toward enhancement. And while altering hu- man nature might have implications for the nature and role of the virtues, T hus, once we adopt a consequentialist perspective, the argument for enhancement follows straightforwardly.

January-February 2011 HASTINGS CENTER REPORT 35 These implications are, of course, contingent on the science advanc- ing in certain ways. However, there are other perverse implications of a consequentialist approach to en- hancement that could be realized with existing technologies. By its very nature, the argument for enhance- ment downplays the moral signifi- cance of normal human capacities. In particular, our reasons to reshape the capacities of future human beings do not stop at ensuring normal spe- cies functioning. This is, of course, what establishes the obligation to enhance, but it also means that the fact that some particular set of capacities is “nor- mal” is no reason to settle for it. This, in turn, has unsettling implications for cases in which social cir- cumstances interact with genes within the normal range of human variation, so that the genes correlate with reduced welfare. The prospects for an individual’s flourishing will always be a function of interaction between genes and environment. Indeed, advocates for enhancement make much use of this fact; they typically argue that our obligation to manipulate genes is precisely the same as our obligation to manipu- late the environment and arises for the same reason—out of a concern for the implications of our child’s phenotype for his or her welfare. 22 However, the consequentialist ver- sion of this argument does not easily allow a distinction between cases in which the environmental conditions that mediate the relationship between genetics and phenotypical impact on the organism are the result of social factors, and those in which they re- sult from other processes. In many parts of the world today, prevailing social circumstances are likely to have a much greater impact on the welfare of individuals than are other envi- ronmental factors. When thinking about which genes are best for our children, then, Harris and Savulescu’s argument implies that we should take these factors into account. Thus, for instance, in a racist society, where children born with particular racial markers—skin color, hair type, shape of nose and lips, presence or absence of an epicanthic fold, and so on—will have reduced life prospects, a proper concern for their children’s well-being requires that parents work to mitigate the impact of racism by altering the child’s environment, or by manipu- lating the genes associated with these markers, or both. 23 Unfortunately, it will often be much easier to alter a child’s genet- ics than the social conditions that will shape the ultimate impact of their genetics. In particular, one “genetic condition” associated with reduced life prospects in many soci- eties—the sex of the child—is easily shaped prior to birth using existing technologies such as sperm sorting, PGD, or ultrasound-plus-selective- termination. Where girls face reduced life prospects as a result of entrenched sexism, Harris and Savulescu’s argu- ments imply that parents are obli- gated to choose male children. 24 If it becomes possible to select for genes for skin color, then parents will have strong reasons to prefer a child with the skin color of the dominant social group in order to avoid the destruc- tive effects of racism. 25 Similarly, if there are genes that elevate the chance that an individual will be attracted to others of the same sex, then parents will be obligated to select against these genes in homophobic societies. While the prospect of identifying and selecting for (or against) genes for race or sexual preference might seem remote, so, too, does the prospect of eliminating the impact of entrenched racism and homophobia on indi- vidual well-being. Thus, in most of Europe, North America, and Australia, Harris and Savulescu’s ar- gument would have par- ents choosing white male children who would grow up to be tall and (prob- ably) blonde haired and blue eyed. When it comes to the sorts of people the consequentialist argument would have us choose to bring into the world, then, the ultimate conclusions of the new eugenics are re- markably similar to those of the old. 26 Of course, it is always possible to adduce further consequentialist considerations, or perhaps even deontological side con- straints, to explain why parents are not obligated to choose children who will be able to pass as members of privileged groups. Savulescu explic- itly addresses this objection and sug- gests that we are obligated to respond to injustice with social rather than genetic interventions. 27 It is worth observing, though, that pointing to the social consequences of various eugenic policies is a risky argumenta- tive strategy for advocates of the new eugenics. The new eugenics is, after all, supposed to be concerned with individual well-being—and, as we have seen, it will always be to an in- dividual’s benefit to be born with the genetic markers of social privilege. As soon as we begin sacrificing the well- being of individuals for the sake of social goals, such as diversity, we are W hen it comes to the sorts of people the consequentialist argument would have us choose to bring into the world, then, the ultimate conclusions of the new eugenics are remarkably similar to those of the old.

36 HASTINGS CENTER REPORT January-February 2011 firmly back in the territory of the old eugenics. Even if a consequentialist account of the ethics of enhancement can avoid the repugnant conclusion that we should take social prejudices into account in our reproductive decision- making, this possibility is but one im- plication of a deeper dynamic within the consequentialist argument. As I will discuss further below, Harris and Savulescu tend to present the case for enhancement as though it opens up space for diversity and experimenta- tion in relation to the character of future persons. However, the logic of a concern with improving the well- being of future persons points toward quite a different conclusion—that, in any given environment at least, there is a “best” genome, which par- ents are obligated to provide for their children. Once we start to assess the conse- quences of being born with different genetic make-ups—and especially if we use such narrow metrics as “happi- ness” or “well-being”—then, in a giv- en environment, of any two genomes, one will nearly always be better than the other. Harris and Savulescu’s ap- proaches, with their emphasis on im- proving welfare, are premised on the idea that we can rank different lives according to the amount of welfare in them—and, therefore, that we can rank genomes-in-an-environment. 28 It will be rare indeed for two genomes to offer precisely the same prospects for welfare, and where this appears to be the case it will usually be the re- sult of our lack of knowledge rather than an objective equality of genetic potential. Thus, even though there will often be reasonable disagreement about which is the best embryo to implant after PGD, there will almost always be a right answer to this ques- tion. The only objective grounds that might justify parents selecting differ- ent sorts of embryos will be in situa- tions where children can be expected to grow up in different environments. For instance, because of variations in the level of ultraviolet radiation at dif- ferent latitudes, parents should have children with fair skin in countries near the poles, whereas near the equa- tor they should have children with dark skin (setting questions about the impact of racism aside). In any given environment, however, parents will be obligated to choose the same ge- netics for their children. Indeed, there is nothing in Sa- vulescu’s argument to explain why parents’ obligations end at having the best child they can have—if by this Savulescu means the best of the genetic offspring they have managed to conceive via IVF. 29 Unless the bio- logical children of rearing parents always have higher expected welfare than any (and every) other unrelated child the same parents might rear (perhaps because parents turn out to have an instinctual aversion to raising an unrelated child), there will often be cases where none of the embryos that a couple manage to create have life prospects as good as those of an- other embryo—for instance, a “sur- plus” embryo from an IVF program. If so, then they will be obligated to implant that other embryo. If there is an embryo available somewhere in the world with sufficiently “good” genes, then it might turn out that everyone has morally compelling rea- sons to have a child who is genetically identical. As I discuss below, Harris and Savulescu downplay this impli- cation of their account by allowing that parents should not be censured if they fail to live up to their obliga- tions in this regard. However, the fact remains that what all parents should do is aspire to have a child with the same genes. The convergence of parental ob- ligations on a “best” embryo is a function of the maximizing nature of (most) consequentialism. It would be possible to avoid this implication by adopting some sort of “satisficing” consequentialism (that is, a conse- quentialism according to which ac- tions are justified only if they bring about a state of affairs that is “good enough”). As a number of other writ- ers have observed, it seems ludicrous to suggest that we are obligated to give our children the best chances in life; hardly any parents attempt that, let alone accomplish it. 30 However, the problem with limiting the obli- gations of parents to an obligation to have a child that is “good enough” is that we then need some plausible way of deciding what “good enough” is and explaining why parental obliga- tions stop at this point. The notion of “normal human capacities” is one plausible place to draw this line; it is difficult to see that there are any oth- ers. 31 Once we set off on the project of human enhancement, it is hard to see where we could—or why we should—stop. The ends of a consequentialist program of human enhancement are therefore likely to be much more radi- cal than Harris and Savulescu allow. 32 However, the purported distance be- tween the new and the old eugenics is supposed to be as much a matter of means as of ends. Let us now turn, then, to Harris and Savulescu’s ac- counts of the means appropriate to a “new” eugenics. Libertarianism U tilitarianism, historically the most important form of con- sequentialism, originated as a radi- cal philosophy dedicated to social reform. Many of the early utilitar- ians struggled for social and political change, believing that the greatest happiness of the greatest number could be achieved only by redistrib- uting wealth and that the state was sometimes the only available mecha- nism to help us achieve important social goals. But Harris and Savulescu do not follow this example. Rather than advocate for a strong program of social engineering or legislation to bring about a world in which en- hanced human beings have the best prospects for happiness and well- being, Harris and Savulescu defend the right of individuals to reject their conclusions. In particular, they deny that the obligations they identify are of such a nature as to justify the use of state power to try to ensure that

38 HASTINGS CENTER REPORT January-February 2011 never coerce others in order to ensure that they have enhanced children. For a consequentialist, human rights are justified only insofar as they further well-being, and if the consequences that might be achieved by infringing a right outweigh the consequences of its infringement, then so much worse for the right and the interests it pro- tects. Harris and Savulescu properly emphasize the weight of the interests that are protected by and that justify a right to reproductive freedom. 42 Historically, the consequences of try- ing to force people to have certain sorts of children have been disas- trous, and there are good reasons to fear the consequences if we try again. However, it is also true that the con- sequences of coercion depend on the sort of coercion involved. Just as there are many noncoercive means of shap- ing behavior, so, too, are there many different means of coercion available, some very subtle. If the amount of welfare at stake in a particular en- hancement is large, then some forms of coercion will probably sometimes be justified. 43 Indeed, most societies already act on the assumption that some coer- cion is justified to protect the wel- fare of future generations. When it comes to the destruction of the en- vironment, for instance, where deci- sions may not only affect the welfare of future generations but also affect who will be born, 44 the fact that our choices are not person affecting does not prevent us from concluding that regulation is appropriate. In some cases, the penalties for polluting the environment may be severe and may include substantial fines and even jail time. If we are prepared to jail people for threatening the welfare of persons not yet existing by polluting the en- vironment, then it seems we should also be prepared to coerce people who threaten the welfare of future genera- tions by failing to enhance them. These subtleties are largely aca- demic when it comes to the policy implications of the consequentialist argument for enhancement because existing individuals clearly can be harmed by other people’s decisions about enhancement. There are any number of social or economic mech- anisms whereby the well-being of some affects the well-being of others, so that actions that affect the welfare of one group—even actions that do not harm them—may harm others. Most obviously, in any society that acknowledges an obligation to provide for the welfare of its mem- bers and relies on taxation to achieve that goal, the welfare of each affects the welfare of all. Consequently, if parents choose to have children with lower expected welfare than other children they might have had, then they are imposing a cost on the rest of the community. If this cost is sub- stantial enough, then coercion may well be justified in order to avoid it. One might argue that the real source of the harm here is the redis- tributive taxation, and that rather than restrict the liberty of parents in order to keep them from impos- ing demands on others, we should instead restrict the scope of redis- tribution: we should deny that the unenhanced have any claim on the resources of other individuals. The shape of a just health care policy in a society in which enhancement is available is too large a topic to ad- dress properly here. 45 However, I will venture two brief observations about this line of argument. First, it is one thing to deny that parents have a right to extra resources to compensate them for the low wel- fare of children they have chosen not to enhance, but it is quite another to deny that these children have a right to some social support. In a world in which enhancement was widely prac- tised, it would no more be the fault of the unenhanced that their welfare was lower than those around them than it is the fault of people born with genetic disorders today that they require additional resources to achieve the same well-being as those born “normal.” Denying that soci- ety has an obligation to redistribute (some) resources to compensate for inequalities in welfare that result from unevenness in the distribution of en- hancements would therefore require a significant revision of our intuitions about the proper response to the exis- tence of unchosen disadvantage. Second, Harris and Savulescu’s ar- gument runs into difficulties in any society with a welfare state because a failure to enhance will then impose costs on others via the mechanism of redistributive taxation. Therefore, their libertarianism about reproduc- tive decision-making is tenable only if we adopt a more comprehensive lib- ertarian politics. Yet such a politics is even less compatible with Harris and Savulescu’s consequentialism than is their laissez-faire attitude toward enhancement. In any case, there are other ways in which decisions about enhancement of future people may harm others. 46 The presence of social and economic inequality often has significant im- plications for the quality of life of all citizens. There is some evidence that inequality in a society itself has bad consequences for the health of citizens, rich and poor alike. 47 To the extent this is true, parents who fail to enhance their children will harm other individuals. There are also less controversial and more everyday ex- amples of the negative consequences of inequality. If enhanced individuals are at risk of mugging by desperate “normals” who have been locked out of social and economic opportuni- ties by their lacklustre genetic in- heritance, if they must step over the sleeping bodies of normal individuals in the street on the way to their lim- ousines, and if they must constantly refuse the entreaties of unenhanced children for aid and assistance, then enhanced individuals may have rea- son to rue the birth of normal chil- dren. Parents who continue to have normal children will impose these costs on their fellow citizens. Finally, there are arguably cases in which the harms that result from oth- ers’ failure to enhance their children are brought about by less political mechanisms. Consider a case mod- eled on the ethics of introducing a

January-February 2011 HASTINGS CENTER REPORT 39 childhood vaccination against an in- fectious disease. Imagine that select- ing for some particular set of genes conveys resistance to a dangerous infectious disease; children with this enhancement are much less likely to catch the disease, but unfortunately they are not totally immune. This is precisely the sort of enhancement that Harris and Savulescu believe we would be obligated to provide to our children. 48 Yet the benefits of this en- hancement will be entirely realized only if a sufficient number of parents adopt it. If only some children in the community can resist infection, then the disease may still become an epidemic and threaten the lives of those who have received the enhancement. The failure of others to en- hance their children there- fore imposes a risk—and a harm—on the rest of the community. If the cost of the enhancement is low, then the harm caused by failing to use it might jus- tify a law requiring parents to enhance their children. Thus, there is at least one sort of case in which the flourishing of the commu- nity depends on parents’ decisions about enhance- ments, yet the relationship is not mediated by social and political institutions. Where this is the case, Savulescu and Harris’s ar- guments risk licensing the use of coer- cion to secure enhancements in order to prevent harm to the community. Nothing I have said thus far es- tablishes that any particular form of coercion is justified in order to secure any particular enhancement for fu- ture generations. Our obligations to bring about improvements in welfare by enhancing future beings, and to avoid imposing costs on others by failing to enhance, must be weighed against the harms involved in frustrat- ing the interests normally protected by the right to reproductive liberty. 49 Perhaps parents’ interests will usually win the day, as Harris and Savulescu maintain. However, as we have seen, there is no reason to believe that they always will, and indeed there is good reason to worry that they often will not, when “subtle” forms of coercion are at stake. The greater our obliga- tion to enhance our children—or to put the same point another way, the more likely it is that enhancements will offer significant improvements in expected welfare—then the more likely it is that this calculation will ar- gue in favor of strongly encouraging or even coercing parents to choose enhanced children. 50 There is, therefore, a profound tension between Harris and Sa- vulescu’s philosophical commitments and their own account of the policy implications of their arguments. Their consequentialism fails to sup- port their libertarianism. Alterna- tively, their libertarianism can be maintained only at the cost of their theoretical commitment to maximiz- ing welfare—the commitment that generates the obligation to pursue non-person-affecting enhancements in the first place. A Brave New World T he champions of the “new” eu- genics are understandably anx- ious to dissociate themselves from the eugenic movements of the 1920s and 1930s. A close reading of Harris and Savulescu’s work, however, suggests that they, at least, are less successful at distancing themselves from the old eugenics than they suppose. If parents acted on the obligation that Har- ris and Savulescu cham- pion, then the result would be a world eerily similar to that dreamed of by previ- ous generations of eugeni- cists. According to their accounts, in any given so- ciety parents should all aim to have the same sort of child, where the nature of this “best baby” is properly sensitive to the prevailing bigotry of the times. Harris and Savulescu’s philosophy also implies that right- thinking people should engage in social campaigns to influence the reproduc- tive decision-making of other citizens and encour- age them to live up to their procreative obligations. Moreover, despite Har- ris and Savulescu’s gestures toward respect for individual freedom, their arguments place this freedom at the mercy of a calculation about conse- quences, which is a poor guarantor that the state will not be justified in coercing parents to have particular sorts of children to maximize wel- fare. In short, while the avowed mo- tivations of the new eugenics may be new, the world its advocates would bring about turns out to be not all that different from that championed by the old eugenics. Of course, as I observed at the outset, there are other advocates of a “new” eugenics, some of whom T here is a tendency for advocates of human enhancement to represent themselves—and perhaps also to see themselves—as the philosophical descendants of Voltaire, bravely defying the forces of irrationality and conservatism in order to reach the difficult conclusions that others dare not.

January-February 2011 HASTINGS CENTER REPORT 41 unclear whether anything like an obligation to have “the best child” would appear in such accounts. 9. W. Glannon, “CQ Review: Enhanc- ing Evolution: The Ethical Case for Making Better People , by John Harris,” Cambridge Quarterly of Healthcare Ethics , 17 (2008): 473-76, at 473. Harris’s homepage at the University of Manchester states that “John Harris has, throughout his career, defended broadly libertarian - consequentialist ap- proaches to issues in bioethics,” http:// www.law.manchester.ac.uk/aboutus/staff/ john_harris/default.htm, accessed October 5, 2010. 10. J. Cohen and G. Tomkin, “The Sci- ence, Fiction, and Reality of Embryo Clon- ing,” Kennedy Institute of Ethics Journal 4, no. 3 (1994): 193-203. If the technology to create germ cells from somatic cells via induced pluripotent stem-cells is realized, then this will further extend the potential of PGD by greatly increasing the number of embryos a couple can create. 11. D. Parfit, Reasons and Persons (Ox- ford, U.K.: Clarendon Press, 1984), 351-79. 12. The most high-profile and challeng- ing attempts to make an argument along these lines is Jurgen Habermas, The Future of Human Nature (Cambridge, U.K.: Polity Press, 2003). 13. C. Farrelly, “Virtue Ethics and Pre- natal Genetic Enhancement,” Studies in Ethics, Law, and Technology 1, no. 1 (2007): 1-13. 14. L.R. Kass, Life, Liberty and the De- fense of Dignity: The Challenge of Bioethics (San Francisco, Calif.: Encounter, 2002), 267-68; E. Parens, “The Goodness of Fra- gility: On the Prospect of Genetic Tech- nologies Aimed at the Enhancement of Human Capacities,” Kennedy Institute of Ethics Journal 5, no. 2 (1995): 141-53; M.J. Sandel, The Case against Perfection: Ethics in the Age of Genetic Engineering (Cambridge, Mass.: Harvard University Press, 2007). 15. A. Buchanan, “Human Nature and Enhancement,” Bioethics 23, no. 3 (2009): 141-50. 16. This is not to deny that such a deci- sion raises serious ethical issues or that some writers have objected to the use of PGD to prevent the birth of children with disabili- ties. See A. Asch, “Prenatal Diagnosis and Selective Abortion: A Challenge to Prac- tice and Policy,” American Journal of Public Health 89, no. 11 (1999): 1649-57; A. Asch, “Why I Haven’t Changed My Mind about Prenatal Diagnosis: Reflections and Refine- ments,” in Prenatal Testing and Disability Rights , ed. E. Parens and A. Asch (Wash- ington, D.C.: Georgetown University Press, 2000); D. Kaplan, “Prenatal Screening and Its Impact on Persons with Disabilities,” Clinical Obstetrics and Gynecology 36, no. 3 (1993): 605-612; M. Saxton, “Disability Rights and Selective Abortion,” in Abor- tion Wars: A Half Century of Struggle , ed. R. Solinger (Berkeley and Los Angeles: Univer- sity of California Press, 1997); S. Wendell, The Rejected Body (New York: Routledge, 1996). However, while there are good rea- sons to think carefully about what counts as “severe” disabilities or a “serious genetic disorder,” there is a broad consensus in the literature that the use of PGD to prevent the birth of children with such conditions is morally acceptable and significant support for the thought that it is morally obliga- tory; Buchanan, “Choosing Who Will Be Disabled.” 17. Harris, Enhancing Evolution , 8-9; Sa- vulescu, “Procreative Beneficence: Why We Should Select the Best Children,” at 419. 18. Harris, Enhancing Evolution , 9 and 185. 19. Ibid., 9. 20. Savulescu endorses engineering psy- chological character traits with the goal of improving individuals’ welfare; “Genetic Interventions and the Ethics of Enhance- ment of Human Beings.” 21. This argument is developed at more length in R. Sparrow, “Procreative Benefi- cence, Obligation, and Eugenics,” Genom- ics, Society, and Policy 3, no. 3 (2007): 43-59; and R. Sparrow, “Should Human Beings Have Sex? Sexual Dimorphism and Human Enhancement,” American Journal of Bioethics 10, no. 7 (2010): 3-12. 22. Agar, Liberal Eugenics , 111-120; A. Buchanan, D.W. Brock, N. Daniels, and D. Wikler, From Chance to Choice (Cam- bridge, U.K.: Cambridge University Press, 2000), 156-61; Harris, Enhancing Evolu- tion , 1-7; Harris, Clones, Genes and Immor- tality , 171-74, 203; Savulescu, “Procreative Beneficence: Why We Should Select the Best Children”; Savulescu, “New Breeds of Humans,” 37. 23. Savulescu, “Procreative Beneficence: Reasons Not to Have Disabled Children,” 60-61. 24. I. de Melo-Martin, “On Our Obliga- tion to Select the Best Children: A Reply to Savulescu,” Bioethics 18, no. 1 (2004): 72-83, at 81. 25. L. Cannold, “Reprogenetic Tech- nologies: Balancing Parental Procreative Autonomy and Social Equity and Justice,” in The Sorting Society , ed. L. Skene and J. Thomson (Cambridge, U.K., and New York: Cambridge University Press, 2008). 26. It is true that in different social set- tings the ideal child will also differ. For instance, Harris and Savulescu’s arguments imply that parents in China should have children that instantiate Chinese ideals of health and beauty. However, this does not distinguish the new from the old eugenics; it has always been the case that eugenic ide- als have had such local character. 27. Savulescu, “Procreative Beneficence: Why We Should Select the Best Children,” 424; Savulescu, “Procreative Beneficence: Reasons Not to Have Disabled Children,” 60-62. See also Savulescu and Kahane, “The Moral Obligation to Create Children with the Best Chance of the Best Life,” 288. 28. Savulescu, “Procreative Beneficence: Reasons Not to Have Disabled Children.” 29. The revised formulation of the prin- ciple of procreative beneficence offered in Savulescu and Kahane (“The Moral Ob- ligation to Create Children with the Best Chance of the Best Life”) stipulates that the principle “assumes that the child created will be the reproducers’ biological child” (note 3, 274-75). However, the authors of- fer no defense of this stipulation. 30. Buchanan, Brock, Daniels, and Wikler, From Chance to Choice ; Cannold, “Reprogenetic Technologies,” 70; Glover, Choosing Children , 54-55; M. Parker, “The Best Possible Child,” Journal of Medical Ethics 33 (2007): 279-83. 31. R. Sparrow, “Better than Men? Sex and the Therapy/Enhancement Distinc- tion,” Kennedy Institute of Ethics Journal 20, no. 2 (2010): 115-44, at 122, 129-31. 32. Sparrow, “Should Human Beings Have Sex?” 33. Denton, Enough Rope ; Harris, En- hancing Evolution , 72-85, 94-95; Savulescu, “Genetic Interventions and the Ethics of Enhancement of Human Beings” and “Pro- creative Beneficence: Why We Should Se- lect the Best Children.” 34. J. Savulescu, “Deaf Lesbians, ‘De- signer Disability,’ and the Future of Medi- cine,” British Medical Journal 325 (2002): 771-75. 35. Glannon, “CQ Review: Enhancing Evolution ,” 273. In describing Harris and Savulescu as libertarians in what follows, I intend to characterize only their opposition to the use of state power to bring about en- hancements and make no claims about their wider politics elsewhere. 36. Harris, Enhancing Evolution , 71-72. 37. J. Feinberg, “Wrongful Life and the Counterfactual Element in Harming,” So- cial Philosophy and Policy 4, no. 1 (1987): 145-78. 38. Glover, Choosing Children , 50; Sa- vulescu, “Deaf Lesbians, ‘Designer Disabil- ity,’ and the Future of Medicine.” This is an important point on which Harris and Sa- vulescu appear to part company—although I believe that this is more a matter of the language they prefer than a substantive dis- agreement. Harris insists that people can in fact be harmed by decisions that resulted in their birth, if they are born in a “harmed condition” (where a harmed condition is one that a rational person would prefer not to be in); J. Harris, Enhancing Evolution , 91- 93; J. Harris, Clones, Genes and Immortality , 109-113. Harris also holds that individuals

42 HASTINGS CENTER REPORT January-February 2011 are harmed if they are not enhanced—as it would be rational to prefer to have superior capacities. However, he denies that children who were born when other, better-off chil- dren might have been born are wronged by the decision that led to their birth, as long as they have “lives worth leading.” More- over, he denies that parents should be re- quired by legislation to avoid harming their children in this fashion, which suggests that the moral weight of this harm is, on his ac- count, negligible. I have therefore chosen to follow Glover ( Choosing Children , 25) and interpret Harris as claiming that choices about which individuals to bring into the world “harm” the resulting individuals only in a technical, nonstandard use of the term. To the extent that Harris wishes to maintain that people may be harmed by circumstanc- es that also determine their identity, then the argument that coercion will sometimes be justified in order to prevent such harm will have that much more force. 39. Savulescu, “Deaf Lesbians, ‘Designer Disability,’ and the Future of Medicine”; J. Savulescu, M. Hemsley, A. Newson, and B. Foddy, “Behavioral Genetics: Why Eugenic Selection Is Preferable to Enhancement,” Journal of Applied Philosophy 23, no. 2 (2006): 157-71, at 162. 40. Harris, Enhancing Evolution , 72-85, 94-95; Savulescu, “Deaf Lesbians, ‘Design- er Disability,’ and the Future of Medicine,” and “Procreative Beneficence: Why We Should Select the Best Children.” 41. D.J. Kevles, In the Name of Eugen- ics: Genetics and the Uses of Human Hered- ity (New York: Alfred A. Knopf, 1985); L.L. Lovett, Conceiving the Future: Prona- talism, Reproduction, and the Family in the United States, 1890–1938 (Chapel Hill, N.C.: University of North Carolina Press, 2007); P.M.H. Mazumdar, Eugenics, Hu- man Genetics, and Human Failings: The Eugenics Society, Its Sources and Its Critics in Britain (London and New York: Rout- ledge, 1992); D.B. Paul, Controlling Hu- man Heredity, 1865 to the Present (Atlantic Highlands, N.J.: Humanities Press, 1995); and W.H. Schneider, Quality and Quan- tity: The Quest for Biological Regeneration in Twentieth-Century France (Cambridge, U.K.: Cambridge University Press, 1990). 42. Harris, Enhancing Evolution , 72-80; Savulescu, “Deaf Lesbians, ‘Designer Dis- ability,’ and the Future of Medicine” and “Procreative Beneficence: Why We Should Select the Best Children.” 43. It might be possible to finesse the argument here and hold—as Harris and Savulescu apparently do—that we should always prioritize the welfare of existing persons over the welfare of future persons. However, there is a significant risk that any such attempt would make the consequen- tialist case for enhancement effectively col- lapse. Presumably the force of the claim that we have an obligation to enhance our children is that it will sometimes give us rea- sons to do things we would otherwise not be inclined to do. Yet if the welfare of future persons is always trumped by that of exist- ing persons, then parents will never have reasons to change their minds about their reproductive decisions because their exist- ing preferences—which would be frustrated were they to do something else—will settle the matter. 44. Parfit, Reasons and Persons , 361-64. 45. The most thorough and impressive investigation of this topic to date remains Buchanan, Brock, Daniels, and Wikler, From Chance to Choice . 46. Importantly, the mere existence of the option of enhancement may harm oth- ers by coopting them into a genetic rat race in order to secure access to important goods that include a positional component; Can- nold, “Reprogenetic Technologies.” This fact may ground an argument in favour of denying people access to enhancement in order to avoid establishing a destructive collective action problem—although this is controversial; Agar, Liberal Eugenics , 128- 31; Buchanan, Brock, Daniels, and Wikler, From Chance to Choice , 182-87; Bostrom, “Human Genetic Enhancements,” 501-3; Glover, Choosing Children , 80-81. How- ever, my interest here is in arguments that suggest people might be required to enhance their children. 47. R. Wilkinson, Unhealthy Societies: The Afflictions of Inequality (London: Rout- ledge, 1996); R.G. Wilkinson and K.E. Pickett, “Income Inequality and Population Health: A Review and Explanation of the Evidence,” Social Science and Medicine 62 (1996): 1768-84. 48. Harris, Enhancing Evolution , 21- 22; Harris, Clones, Genes and Immortality , 223-25. 49. This “right” will, of course, be only a useful fiction according to a consequen- tialist account of our obligations; Harris, Clones, Genes and Immortality , 257, and The Value of Life , xvi. 50. It should also be noted that there are some enhancement technologies that would affect persons, such as gene therapies, phar- maceuticals like hGH or modifinal, and cybernetic implants. Any obligation to em- ploy such technologies would have much more dramatic implications for the extent to which we should respect the liberty of parents not to provide these to their chil- dren, as failure to provide these enhance- ments would directly harm existing persons. While Harris and Savulescu also believe that we should pursue such enhancements, discussion of the policy implications of this position is a matter for another paper. 51. Agar’s Liberal Eugenics is perhaps the leading candidate here. 52. After the cover illustration, perhaps the next most striking feature of Harris’s book Enhancing Evolution is its tone, which conveys its author’s obvious contempt for the arguments he is dismissing. 53. Kass, Life, Liberty and the Defense of Dignity ; F. Fukuyama, Our Posthuman Fu- ture: Consequences of the Biotechnology Revo- lution (London: Profile Books, 2003); M. Sandel, The Case against Perfection . 54. Harris, Clones, Genes and Immortal- ity , 238-39; Savulescu, “New Breeds of Hu- mans,” 38. 55. Z. Bauman, Modernity and the Holo- caust (Ithaca, N.Y.: Cornell University Press, 2000); M. Horkheimer and T.W. Adorno, Dialectic of Enlightenment: Philosophical Fragments , trans. E. Jephcott (Stanford, Ca- lif.: Stanford University Press, 2002).