Choosing tomorrow's children: the ethics of selective reproduction
By John Gillott
Many of the issues discussed in this book have been debated in the literature and a number of academic and semi-popular book-length treatments of the issues exist, such as the excellent From Chance to Choice and Choosing Children by Allen Buchanan et al and Jonathan Glover respectively. Wilkinson's USP is his focus on selection, and in particular his critical engagement with arguments against free parental choice in this area. Throughout he combines an informative and insightful analysis of concrete cases, including: sex selection for non-medical reasons; saviour siblings; and the deliberate selection of disability, with a discussion of more speculative future possibilities.
Reflecting his professional expertise the analysis is largely philosophical. An important distinction is choices between different possible future children and decisions about how many children to have (if any). This distinction - between same and different number choices - sheds an interesting light on some familiar issues. For example, contrary to a popular argument, he finds it less problematic if a saviour sibling is the product of a different number choice than if she is the product of a same number choice, thus eschewing the popular defence 'but we wanted another child anyway'. His own primary interest is in the former, same number choices, for these are, he argues, the kinds of choices and decisions that are commonly made. Wilkinson is very much in favour of parental choice. He does however argue that some choices are morally problematic.
There is much in this book with which I agree. I particularly liked his discussions of the 'expressivist' arguments against selection and the social model of disability. His critique of the HFEA's arguments against allowing the selection of a 'saviour' for a parent and against social sex selection in the UK because it would send the wrong signal to the rest of the world are nicely done.
There are though some areas where the focus on selection as a defining issue seems a little misplaced. The discussion of the deliberate selection of an embryo with a genetic impairment is one example. For Wilkinson, individual child welfare arguments allow the selection of an embryo with an impairment over a healthy one (a same number choice). This is because the child once she exists could not have existed otherwise and, presuming her to have a life worth living, she can only welcome the parents' choice. He contrasts this situation sharply with a hypothetical one in which a healthy embryo is genetically manipulated to give it an impairment. In this case, he argues, the future child could complain that she had been adversely affected by the parents' actions (or the embryologists, under parental instruction).
But is the distinction really so clear? Suppose a parent wanted a deaf child, and was discussing the issue with her embryologist after test results on embryos that were ready to be implanted had shown one had an impairment that would cause the future child to be deaf. What if the prospective parent were to say, 'rather than throwing the rest away could you deafen one and implant it as well, to give me a greater chance of a child?' If a child were to be born from the deafened embryo, the parent could say to that child, just as she could to the child with the congenital deafness, that it was a choice between being born deaf, or not being born at all, because there was no way she wanted a healthy child and it was her clear choice to have the healthy embryos destroyed. While there are no doubt distinctions to be drawn, the distinctions, I would suggest, give too much weight, inadvertently perhaps, to essentialist and teleological arguments, and too little weight to the issue of parental motivation.
A second example is his treatment of two topics, eugenics and enhancement, focusing on the selection of traits. In the case of eugenics this is too narrowly logical. Eugenics of old was more about the moral character of people, and the fear that the national 'stock' was degenerating because the 'wrong' kind of classes or races of people were having more children than the 'right' groups. Trying to untangle this through a philosophical study of different kinds of trait selection, in particular using the idea that negative selection against one trait is necessarily positive selection for another, is to use the wrong tools in my view.
Wilkinson then connects the discussion of positive and negative trait selection with the debate about enhancement. For different reasons this also seems strained to me. In his view selection can be a defining aspect of enhancement, or can create an enhancement. To give a concrete example, according to both of the definitions of enhancement he discusses, selection in favour of extremely high intelligence (a futuristic scenario) is classed as enhancement. What would be happening in that situation is what might occur through sexual intercourse without selection - the birth of an individual at the extreme end of the existing naturally-given spectrum, with a genome produced through the fusion of sperm and egg, unmodified by human manipulation. Is the selection of what can occur by chance enhancement? He acknowledge that some writers view enhancement as meaning modification rather than selection, but unfortunately he doesn't discuss their arguments or his reasons for not using their definition.
Deliberate choice of disability, eugenics and enhancement are points for ongoing debate of course. Overall the book is quite evidently based on a deep understanding of the issues. If there is an overall problem with it, and this is sometimes a strength rather than a problem, it is that there are many issues that could have been dealt with in more depth, that Wilkinson is forced to touch on but then plead lack of space to develop. But such deficiencies, if they are such, leave the reader with plenty to chew on and discuss.
John Gillott is Innogen Postgraduate Student at the Open University