This is a lecture for my Summer 2012 Medical Ethics Course at Bowling Green State University. It focuses on ethical issues related to genetic interventions, particularly whether the distinction between treatment and enhancement is ethically useful.

1. What’s Wrong With Genetic
Enhancement?
BOWLING GREEN STATE UNIVERSITY
SUMMER 2012
MEDICAL ETHICS-ELI WEBER

2. Lecture Goals
 Identify the various kinds of genetic
intervention available
 Identify some of the ethical concerns with
each
 Focus on the ethical debate regarding
treatment of genetic diseases versus genetic
enhancement
 Formulate some arguments for and against
genetic enhancement

3. What is Genetic Disease?
 Carrier versus Disease
 Predispositions versus Disease
 Genetic versus Developmental

4. Types of Genetic Intervention
 Genetic Screening
 Some Concerns:
1. Cost-effectiveness
2. Potential for Discrimination

5. Types of Genetic Intervention
 Genetic Counseling
 Some Concerns:
1. Selective abortion on the basis of
probabilities
2. No basis for denying couples the right to
reproduce

6. Types of Genetic Intervention
 Pre-Natal Genetic Diagnosis
 Some Concerns:
1. Possibility of Selective Abortion
2. How Extensively to Test

7. Arguments for Genetic
Intervention
 Allows for an increase in patient autonomy
 Reduces health care costs overall
 Prevents avoidable suffering
 Prevents the spread of genetic disease

8. Arguments Against Genetic
Intervention
 Potential for discrimination
 May lead to an increase in abortions
 Slippery slope to (Positive) Eugenics

9. Treatment vs. Enhancement
 What’s the Issue?
It is frequently thought that if genetic
interventions are ever permissible, they
should be limited to interventions that count
as treatment. Interventions that constitute
enhancement are not similarly permissible.

10. What’s the Difference?
 Treatment involves either the prevention of
disease or the restoration of the patient to
normal functioning.
 Enhancement does not involve either of
these things, but instead involves elevating
the patient beyond normal functioning.

11. Why That Can’t Be Right?
 Certain interventions that we regard as
treatment are clearly a type of enhancement.
(vaccinations, treatments for osteoperosis
designed to increase bone density,etc.)
 The concept of normal functioning is socially
and historically relative.

12. An Alternative Approach
 Whatever a disability is, it is something that
involves a harm to the person who suffers it,
irrespective of any notion of normal
functioning or the person’s attitudes about
their condition .
 Whether a genetic intervention is permissible
depends on whether it prevents a harm and
protects life and health.

13. Against Enhancement
 Gives some people an unfair advantage over
others, and would most likely increase already
existing inequalities.
 Threatens the ideal of human equality
 Potentially undermines autonomy
 May have unforeseen cognitive and emotional
costs.

14. Another Argument Against
Enhancement
 Is it possible to give informed consent to enhancement?
Presumably, it will be some time before we understand the full
range of potential side effects and costs of genetic
enhancement.
Because it is not possible to acquire the necessary level of
informed consent in the case of genetic enhancement, we
ought not allow it, because we ought not allow medical
interventions without informed consent.

15. Related Issues
 The Sorities Problem of Genetic Intervention
 Genetic Interventions that Cause Disability
 Selective Abortion in Non-Futile Cases

16. The Bottom Line
 There are a variety of ethical concerns related to
various forms of genetic enhancement; there is
no single ethical concern
 The distinction between treatment and
enhancement is not an obvious guideline for
when an intervention is permissible.
 It may be that whether an intervention is
permissible has little to do with this distinction.