“Better Children”
Background
The President’s Council on Bioethics (chaired by Leon Kass) presented its report, Beyond Therapy: Biotechnology and the Pursuit of Happiness, a few years ago. It is available at www.bioethics.gov. It starts with the premise that we should be thinking now about the ethical implications of future medical developments that will make possible, to a much greater extent than today, not just standard therapies but medications and procedures that enhance human capabilities. The cases below are my invention but stimulated by the discussion in chapter 2 of the Report, “Better Children.” --Elias Baumgarten
Case 1: 2007
“Ms. Safi, we’ve done a pretty full evaluation, and we don’t really see any indication that Tayssir has ADHD. How is he doing in school?”
“His teachers say he is doing well, but we feel he could be doing much better. His father and uncle are both engineers, and we feel that Tayssir has the ability to become a great doctor or medical researcher. But his mind is unfocused, and he needs more discipline to achieve the things we know he is capable of. We want to be sure he qualifies for the new Richards School of Science and to do well enough there to get admitted to Harvard or Yale. Tayssir’s cousin started on Ritalin Turbo Pro II when it first came out last year, and it’s done wonders for him.”
Dr. Carlson knows about the competitive pressures in local schools both from her patients and her own children. But she is concerned that Ms. Safi is carrying things to an extreme. “Tayssir is only ten years old, and he’s doing well for his age. These medications are very powerful and effective, but they are intended to treat diseases. I don’t see that Tayssir has any disease.”
“I was afraid you would say that,” Ms. Safi counters. “To us it’s not a matter of whether he has a disease or not. We’ve heard that Ritalin Turbo Pro II can help him achieve more—to concentrate better and not scatter his energies in so many different directions. And that’s what we want for him. And according to what I’ve read, Ritalin Pro is not a risky drug.”
“It’s not especially risky; that’s true. But every medication has risks, and I’m not sure it’s a good idea to subject Tayssir to any risks if he doesn’t have a medical condition we can treat. You seem to be asking that we use medication to improve a child who is already very healthy.”
Ms. Safi was not lacking in concentration or focus. “Dr. Carlson, I see it this way. The job of a parent is to help a child become as good as that child can be. We drive 10 miles each way to take Tayssir to his music lessons. We drive 5 miles to take him to the library each week and another 5 miles for his soccer games and practice. There is more risk in those drives than there is in this medication. But music and books and athletics are worth it, not because they correct diseases but because they enhance Tayssir’s abilities and make him a better child. What could be a more worth while use of medicine than to make children better?”
Dr. Carlson knows that Ms. Safi has zeroed in on exactly the right question. She just isn’t entirely sure of the answer.
Should Dr. Carlson prescribe “Ritalin Turbo Pro II” for Tayssir?
In terms of helping children, is there any important ethical difference between the activities parents like the Safis undertake for Tayssir and the use of medication?
Even if the risks are no greater than activities parents routinely undertake, does enhancement of the kind Ms. Safi is asking for stand outside the range of activities appropriate to medicine? Given that we use medicine for cosmetic reasons like “nose jobs,” is there any way Dr. Carlson can argue that improving Tayssir’s concentration is outside the purpose of medicine?
Is it even possible to draw a clear distinction between therapy and enhancement?
Case 2: 2012
In the years 2004-2012, with the increased understanding of genetics, IVF (in vitro fertilization) and PGD (preimplantation genetic diagnosis) have become increasingly popular both to screen for genetic diseases and to select embryos for positive traits. Although some couples insist on traditional sexual reproduction, there is increasing social pressure to take advantage of the new technology. Some argue that we should use it enhance the human gene pool, but the greatest pressure comes from those who see its potential to lower spiraling health costs.
A bill is introduced in Congress to change the standard income tax exemption for children. The standard exemption would be cut by 50%, but parents who choose IVF and PGD would receive a 50% increase in the current exemption for the first 5 years (and the standard exemption after that). This, it is argued, would be enough to subsidize the costs of IVF and PGD so that no parents would lack access to these procedures for financial reasons.
Advocates of the bill frequently quote Bentley Glass in his 1971 presidential address to the American Association for the Advancement of Science. Glass spoke of “the right of every child to be born with a sound physical and mental constitution, based on a sound genotype” and even back then predicted our current capabilities and claimed that “no parents will in that future time have a right to burden society with a malformed or a mentally incompetent child.” [Quoted in Beyond Therapy, p. 50]
Leaving aside details at first, should we support a bill such as this? Does it benefit both the child and society at large?
If a bill like this were passed and physicians needed to recommend which embryos should be rejected and which selected, can we draw a reasonably clear line to help us make these judgments? Should embryos genetically linked to blindness and deafness be excluded? Embryos with a significantly increased risk for obesity? Homosexuality? Below average intelligence?