APA Newsletters
Fall 1999
Volume 99, Number 1

A central claim by Kitcher behind the passage just cited is that we are beyond the age of genetic innocence; we have irrevocably entered the age of genetic responsibility. No matter what sort of decisions we make (individually or collectively), including foregoing or forbidding the use of all interventions aimed at shaping the genetic endowment of future generations, such decisions will require moral justification. We can no longer take the status quo as either presumptively morally permissible or morally indifferent. "For even if we compel one another to do nothing, that is to judge it preferable not to intervene in the procreation of human life, even to subordinate individual freedom to the goal of ‘letting what will be, be’" (Kitcher, 197).

Kitcher is very much aware of the tainted history of eugenics (see Kevles, 1995). There is no doubt in his mind that that history is morally despicable. He would certainly not want to be seen as advocating a return to that sort of eugenics. More precisely, what he would clearly reject is any sort of eugenic practices that involved some powerful and arrogant elite group coercively restricting the reproductive options of some socially disfavored, less powerful group, especially if it were the case that such practices reflected the worst sort of social prejudices and were based upon distorted and inaccurate scientific information (Kitcher, 193). These sorts of practices can easily be shown to be both grossly immoral and grossly illiberal.

We might be inclined to think that the necessary and sufficient corrective to these kinds of distorted practices would be accurate and socially undistorted scientific information related to genetics, neutral counseling from trained genetic counselors regarding reproductive options for potential parents, and virtually absolute respect for the procreative liberty of suitably informed potential parents who would assess their procreative options in the light of their own goals and values. But Kitcher is not at all sanguine about this possibility either, which he refers to as "laissez-faire eugenics" (196–97). (As nearly as I can tell, Kitcher may have in mind the views of John Robertson (1994), to attach an academic name to the view. But it is also likely that that view comes closest to the somewhat inchoate prereflective views of a large majority of Americans.)

Kitcher sees the following moral deficiencies in laissez-faire eugenics. First, there are justice problems, fair access to needed resources. Nothing in laissez-faire eugenics provides assurances that all in our society would have effective access to the resources needed to make more responsible reproductive decisions, whether that is broad genetic testing, prenatal genetic testing, in vitro fertilization, preimplantation genetic diagnosis, etc. A likely consequence of such uneven access is that some genetic disorders would become much more common among the poor and less well-off in our society; and hence, the middle class and rich would be less likely to be willing to support with their taxes programs aimed at ameliorating the effects of these disorders, which would no longer be their disorders.

Second, laissez-faire eugenics is supposed to enhance reproductive freedom. However, Kitcher notes, this outcome is likely only in the appropriate sort of social environment. Again, for those who are economically less well-off, it will be much more difficult to make some sorts of decisions that are congruent with their deepest beliefs and values, such as choosing to give birth to a Down’s syndrome infant, if social support programs are lacking, and if there are prevailing social values that say such children ought not to be born. In the strict sense, such social attitudes are not coercive in the way that government policies from earlier this century would be coercive, but the net effect of such attitudes will be very much the same. That is, we would be deluding ourselves if we believed that the reproductive freedom of such couples had been enhanced. Further, as Kitcher points out, if such couples are to make maximally free decisions, it is not enough that they know all the relevant medical facts regarding a potentially affected child; for, as disability activists point out, a disease will be a disability only if society fails to reconstruct the social environment in a way that will permit the flourishing of such lives to the extent possible. Kitcher concludes, "Only if they [at-risk couples] are assured that all people have a serious chance of receiving respect and the support they need can prospective parents decide on the basis of their own values [whether or not to have children of their own]" (200).

Third, there is the flip side of the justice argument described earlier. A number of deep social values can potentially come into conflict when we try to make morally appropriate eugenic decisions. We want to maximize reproductive freedom; we want to meet the health needs of all in our society, including those with expensive genetically imposed needs. But we have only limited resources for meeting virtually unlimited health needs. "In a callous society, as we have seen, individual reproductive freedom is severely constrained. In a caring society individual reproductive freedom may lead to social disaster" (Kitcher, 201). That is, some severely affected individuals may make unjust claims on social resources. They may require extraordinary social investments that will yield only the most marginal of benefits for that individual, at the same time taking those resources away from others who both had stronger just claims to those resources and would have benefited more from them.

Kitcher himself is an advocate for what he calls "utopian eugenics" (202). He sees this as a variant of laissez-faire eugenics, perhaps because reproductive freedom remains the basic value that he sees should shape our eugenic practices. However, it might be more accurate to describe his views as "liberal eugenics" (something with a Rawlsian flavor), since he insists that there must be equal reproductive freedom for all in our society, not simply for those who have the personal financial means to access reproductive options. But it might be equally justified to rename his proposal "responsible eugenics," since he is clear that there are limits on reproductive freedom. At the very least there are considerations of social justice that justifiably limit the reproductive freedom we permit in our society. In addition, there may well be other "public interests" that would justify restricting reproductive freedom in some fashion.

In the remainder of this essay I want to explore a tentative proposal. In brief, it is that we (citizens of our society) ought to strive to come to social agreement regarding our understanding of the notion of "responsible eugenics" through a process of rational democratic deliberation. In offering this proposal, I am rejecting the idea of giving this concept operational meaning through interest group politics, the implication is that political power and political strategic ability would determine how this notion was to be socially interpreted. I am also rejecting the idea that some group of experts (philosophers, geneticists, policy analysts, etc.) should have primary responsibility for giving operational content to this notion of "responsible eugenics." No doubt many such experts can offer invaluable assistance in making these democratic deliberations more rational and self-critical. But what they have to say should not ultimately determine the normative content of that notion.

I begin by asserting that I believe Kitcher’s basic intuitions are fundamentally correct. That is, (1) we are beyond the age of genetic innocence. (2) We (individually and professionally and politically) must take responsibility for shaping, in some fashion, the genetic endowment of future generations (and this, in the broad sense, is what we have in mind in our use of the concept of "eugenics"). That is, we do not have the morally neutral option of continuing to allow nature to take its course when it comes to the genetic endowment of future individuals. More precisely, if we allow nature to take its course, if we allow the genetic lottery alone to determine the genetic endowment of any individual, then we will have to be prepared to offer a moral justification for that choice. (Note: For the foreseeable future, for the vast majority of conceptions and births, it might not take much effort to construct such a justification. So long as it is the case in the family backgrounds of a couple that there are no serious genetic disorders that would seriously threaten the length of life or quality of life of a future child, there will be no obligation to undergo the effort and expense and risk associated with genetic testing and [possibly] a nonstandard means of conception. In other circumstances [which we need to leave unspecified for the moment], however, this will not be the case.)

(3) We remain committed to the fundamental political structure of our society. That is, following the Rawls of Political Liberalism, we want to preserve a society that is liberal, pluralistic, tolerant, and democratic. Hence, if we are going to have social or professional policies that express our commitment to responsible eugenics, we are going to have to accept what Rawls refers to as "reasonable pluralism." That is, our politically shared conception of responsible eugenics ought not to reflect any one comprehensive moral or philosophic vision. Ideally it ought to be rationally endorsable from the point of view of any number of reasonable comprehensive doctrines; or, if that puts the matter too strongly, then (following Scanlon, 1999) it ought to be a conception that is not reasonably rejectable.

What we seek, using Rawls’ language, is an "overlapping consensus" regarding a political conception of responsible eugenics. We cannot reasonably hope to achieve that if we have to rely upon strong metaphysical assumptions tied to specific comprehensive doctrines. Similarly, for political reasons we have to be equally abstemious in matters of epistemology. We have to recognize what Rawls refers to as the "burdens of judgment" (1993, 54–58), the fact that, among other things, we are dealing with very complex and controversial scientific and social matters, that reasonable differences of interpretation are to be recognized and respected if we are to live peaceably with one another as members of a single political community, that even though we are contemplating making important judgments about the basic future well-being of future individuals, it is still the case that "many of our most important judgments are made under conditions where it is not to be expected that conscientious persons with full powers of reason, even after free discussion, will all arrive at the same conclusion" (Rawls, 58). Recognizing this is fundamental for preserving the democratic value of toleration. It is also fundamental for preserving as broad a range of individual liberty as is compatible with protecting both the equal rights/liberties of others and the integrity of other equally fundamental values in our society, such as the value of social justice.

(4) A further implication of our commitment to "reasonable pluralism" is that in the matter of responsible eugenics there will be no one set of public policies or professional policies, or one coherent set of individual moral judgments, that will most rationally and most completely capture our ideal of responsible eugenics. There is an indefinitely large number of possible policies and judgments that will reflect what we will call a "responsible enough eugenics." But "indefinitely large" does not mean "boundlessly large." That yields laissez-faire eugenics, which we wish to reject. There is a need to balance what in the abstract are equally legitimate and equally deep competing social values.

Perhaps the three most important of those values would be procreative liberty, genetic justice, and responsible commitment to the well-being of future children. In the real world these abstract values need to be expressed and concretized in ways that are extremely sensitive to contextual circumstances, including some range of cultural and religious beliefs. Very often it will be quite appropriate to allow that precise balance to be the product of parental judgment. But the scope of morally and politically tolerable parental judgment is not limitless. There are appropriate social incentives and social constraints that can be offered or imposed as part of our shared political understanding of responsible eugenics. This is because many alternate approaches to reproduction make substantial claims on social resources; and hence, it will often be the case that considerations of social justice will justifiably limit access to those resources. Similarly, it is widely understood and accepted that our society has broad social responsibilities with respect to the welfare of children, that we cannot entirely trust that responsibility will be carried out by parents. Thus, we mandate a certain level of formal education for all children, and we do not allow parents the option of entirely foregoing all formal education for their children. This does represent a constraint on parental autonomy, but it does seem warranted by the need to protect the long-range interests of that child in our society. It protects what Feinberg (1980) refers to as the child’s right to an open future, or what we might also describe as effective equality of opportunity (see also Davis, 1997).

It is important to note that this commitment is intended to protect larger social interests; we would be economically a lot less well-off as a society if we had a largely uneducated work force. But it is equally important to note that this is not the primary intent of such policies; the primary intent is to protect the rights and interests of each individual immature citizen who is otherwise unable to protect those interests for themselves. It is for this reason that these policies remain fundamentally liberal in character, though they constrain parental liberty interests. The future challenge we face as a society is whether there are comparable circumstances regarding the genetic endowment of future children that would warrant comparable social policies that would shape in some fashion the reproductive options of potential parents.

The broad features of the model of rational democratic deliberation I have in mind are these. First, there need to be what I refer to metaphorically as "constitutional principles of responsible eugenics." These principles establish the boundaries for rational democratic deliberation. Proposed policies or practices that violated these boundaries would, by virtue of that fact, represent genetically irresponsible, politically illegitimate choices. It is primarily (but not exclusively) the responsibility of philosophers to articulate those responsible principles of responsible eugenics. Again, following Rawls (1993, Lecture III) and Dewey and other philosophers in a broad pragmatic tradition, there is no outside standard that we can appeal to for purposes of knowing when we have gotten those principles right. What we have to recognize is that reflective equilibrium among these principles, a suitable fit with our best scientific knowledge as it pertains to matters of genetics and reproduction, and reasonable effectiveness in helping to resolve the multiple and complex concrete problems of responsible eugenics, are the best we can do by way of judging the adequacy of these constitutional principles. As in the real world of constitutional law, these metaphorical principles will evolve historically in response to evolving medical technologies and the social environment for their application.

Second, one of the specific tasks of these constitutional principles will be to establish at least a rough boundary between the domain of "pure procreative liberty" and the domain of "rationally and democratically determined responsible eugenics." In the domain of pure procreative liberty we are saying (as a matter of stipulation) that there are no public interests or other social values that are enough at stake to warrant some form of public management. (Note: I use the broad term "management" here to reflect the fact that we are talking about incentives, as well as regulations and prohibitions.) A quick example of what I have in mind as a matter of pure procreative liberty is that we allow citizens to determine what number of children they will have, whether they will have children at all, when they will have children, and so on. This may seem obvious and trivial to us in the United States, but in other current societies this would be neither obvious nor trivial.

The virtues of rational democratic deliberation, by way of contrast, would seem to be the following. (1) Our conception of and concretization of what we believed to be responsible eugenics would be public, visible, explicit, readily available for critical scrutiny by all whose rights or interests could be substantially affected. This is precisely what is not true of laissez-faire eugenics of the second sort above. (2) Our democratic deliberative processes would be morally constrained by widely accepted social values expressed in the form of constitutional principles that were constantly reassessed in the light of changing social and technological circumstances, and that captured our shared sense of responsible eugenics. (3) Our democratic deliberative process would be deliberative, thoroughly critically reflective, relying upon the best scientific knowledge available and the best methods of moral and political inquiry available for citizens in a liberal, pluralistic society. (4) Our democratic deliberative process would be democratic in the best sense of that term; all participants in the conversation would be free and equal participants in the conversation aiming to find for themselves just, liberal, responsible eugenic policies and practices. (5) Our democratic deliberative process would be liberal, aiming to respect a diversity of comprehensive visions of what counted as a good life as we sought to achieve an overlapping consensus regarding a reasonable conception of responsible eugenics that could guide the development of relevant social policy.

Notes

1. There is a large literature that has developed over the past ten years around the topic of deliberative democracy. This essay fits squarely with that literature. Space does not permit a detailed review and assessment of that literature. In the proposal I am outlining in this essay, I believe my views are most congruent with the views of Cass Sunstein, especially as they are presented in his most recent book One Case at a Time: Judicial Minimalism on the Supreme Court (1999). The title of the book may suggest topics that are very remote from the focus of this essay. But the core methodology reflected in Sunstein’s work is very relevant to our topic, and how I believe it is most fruitfully approached. Sunstein is a critic of the judges in Roe v. Wade for trying to address the very complex problem of abortion with one grand principle, a right to privacy. He is similarly a critic of Dworkin and the other authors of the so-called "Philosopher’s Brief," filed in connection with the Supreme Court’s ruling on physician-assisted suicide. Sunstein believes that much more fine-grained, contextually sensitive, retail-level legal and political work needs to be done regarding these issues, and that the large principles philosophers favor have only minimal utility for doing such work. I believe this is true, too, in the work that needs to be done in articulating in great detail a morally defensible conception of "responsible eugenics." I maintain that this is a task for philosophers who are engaged in rational democratic deliberations about such issues, as opposed to philosophers who only speak to one another. I also commend to the reader’s attention Sunstein’s earlier book Legal Reasoning and Political Conflict (1996).

2. Though there may be no social practices in place for the kind of democratic deliberation I would advocate, I have been working with a number of other researchers, under an NIH ELSI grant, to test models of what such a rational democratic deliberative process might look like in regard to issues of genetics and reproductive decision making. In the first version of that project, we convened seven dialogue groups (30–50 participants per group) in seven different Michigan communities for thirteen evening sessions each, two hours each evening. The first six of these sessions addressed a series of specific issues related to genetics and reproductive decision making from a moral point of view; the remaining sessions looked at the same issues as potential policy matters. The results of those dialogues are summarized in two preliminary reports under the title "Genome Technology and Reproduction: Values and Public Policy." Each report is about eighty pages long. They may be obtained by writing to the author at Michigan State University. (If we receive too many requests, we may have to ask for $5 to defray mailing costs; checks only, made out to Michigan State University.)