At the beginning of the Bible, the Creator of all things commands his followers to “be fruitful and multiply.” But he doesn’t say how. In vitro fertilization is only five decades old, but it is already responsible for nearly 2% of all births in the USA and about 5% in Israel.
Now that the human genome is better understood, and we can rank embryos for different diseases and traits, it’s time to think about the ethics of reproduction.
This is where Jonathan Anomaly comes in. Dr. Anomaly recently published the 2nd edition of Creating Future People: the science and ethics of genetic enhancement. As he explains in the book, women who use in vitro fertilization usually create more embryos than they need. And it’s been common for a long time to do genetic testing on the embryos to figure out which one to implant.
Historically embryos could be tested for chromosomal problems like Down syndrome, and single-gene disorders like sickle cell anemia.
But as Dr. Anomaly explains, parents can now test their embryos for traits that are influenced by hundreds or thousands of genes. These include diseases such as diabetes and schizophrenia, and aesthetic traits such as eye color and intelligence. The tool that makes this all possible is “polygenic scores.” Polygenic scores are made possible by the fact that many countries now have biobanks with millions of people from around the world. Scientists can use data from these biobanks to reveal the relative risks that different embryos have.
The Logic of Collective Action
Louise Perry says in a recent Spectator column that whether we want to call this technology “eugenics” or “genetic enhancement” is beside the point. Parents will use it. As Mrs. Perry stresses, what matters is the potential benefits of allowing parents to reduce disease risks for their kids, and the risks that parents will not always make the best choices for their children.
In general, however, parents will tend to make the best choices they can for their kids. The real question is whether when each parent chooses what they think is best for their kids, this will lead to an ethically defensible distribution of traits in the general population. In Creating Future People, Anomaly worries that sometimes parents will choose in a way that’s good for their child, but bad from a social point of view. The most obvious examples are sex imbalances and arms races for height.
Suppose your society has a slight preference for girls over boys, or for tall men over short ones. We could end up with a society with far more women than men, which could lead to more loneliness by women (who are already choosier than men), or a society full of tall men with health problems like heart disease, which is associated with extreme height.
In these kinds of cases, what should we do? Dr. Anomaly spent his career in academia thinking through this kind of problem, having studied game theory and ethics.
The Ethics of Enhancement
Some religious conservatives worry about the use of embryo selection simply because in vitro fertilization creates more embryos than parents can use, meaning some of those embryos will be discarded. Those on the political left often worry more about the likely inequalities to arise if some parents (or countries) have better access to technology than others.
While he does not spend much time responding to religious objections – some will complain he should take religious objections more seriously – Anomaly spends quite a lot of time thinking through the consequences of genetic inequalities.
First, he thinks we should worry more about inequality in access than inequality in outcome. To solve the access problem, insurance companies may be made to subsidize IVF and genetic testing, or governments like the United Kingdom or Israel might do it more directly via the NHS.
Dr. Anomaly also emphasizes that not all inequalities are morally problematic. Many professional athletes have genetic advantages that math professors lack, and vice-versa. We accept some inequality as part of the natural order.
Where is it all heading?
The future is even stranger than the past. It’s hard enough for us to imagine living life without electricity or music or antibiotics – a life in which we work our whole lives as illiterate farm hands or blacksmiths, having a dozen children, half of whom die before they reach their teenage years. The future may have better medicine and technology and opportunities that are hard to imagine. But it will also have its perils.
What will happen to us when we have the power not only to select embryos for slightly lower disease risks or higher intelligence but also when we can massively edit our embryos?
While the author of Creating Future People is a “cautious optimist,” it is hard to avoid the conclusion that we may end up in a situation in which some people are left behind genetically while others possess what some would think of as superpowers. Time will tell, but we should probably start thinking about the social implications of polygenic selection before it becomes powerful enough to create the kinds of problems discussed in Creating Future People.