Bioethics. Группа авторов

Hope of Progress, London, 1972.

      3 3 Genes. Dreams and Realities, London, 1971, p. 81.

      4 4 ‘Already they have pushed Cline’s results further, obtaining transfer between rabbit and mouse, for example, and good expression of the foreign gene in its new host. Some, by transferring the genes into the developing eggs, have managed to get the new genes into every cell in the mouse, including the sex cells; those mice have fathered offspring who also contain the foreign gene.’ Jeremy Cherfas: Man Made Life, Oxford, 1982, pp. 229–30.

      5 5 Out of the Night, New York. 1935. To find a distinguished geneticist talking like this after the Nazi period is not easy.

      6 6 John Maynard Smith: On Evolution, Edinburgh, 1972; the article is reprinted from the issue on ‘Utopia’ of Daedalus, Journal of the American Academy of Arts and Sciences, 1965.

      7 7 Anarchy, State and Utopia, New York, 1974, p. 315.

      8 8 Anarchy, State and Utopia, p. 315.

      9 9 This kind of unworldly innocence is part of the engaging charm of Nozick’s dotty and brilliant book.

      10 10 Decision‐taking by a central committee (perhaps of a dozen elderly men) can be thought of as a ‘Russian’ model. The genetic supermarket (perhaps with genotypes being sold by TV commercials) can be thought of as an ‘American’ model. The mixed system may appeal to Western European social democrats.

14 The Moral Significance of the Therapy–Enhancement Distinction in Human Genetics

       David B. Resnik

Introduction

The therapy–enhancement distinction occupies a central place in contemporary discussions of human genetics and has been the subject of much debate.^1–7 At a recent conference on gene therapy policy, scientists predicted that within a few years researchers will develop techniques that can be used to enhance human traits.⁸ In thinking about the morality of genetic interventions, many writers have defended somatic gene therapy,^9,10 and some have defended germline gene therapy,^11,12 but only a handful of writers defend genetic enhancement,¹³ or even give it a fair hearing.^14–16 The mere mention of genetic enhancement makes many people cringe and brings to mind the Nazi eugenics programs, Aldous Huxley’s Brave New World, “The X‐Files,” or the recent movie “Gattaca.” Although many people believe that gene therapy has morally legitimate medical uses,^17,18 others regard genetic enhancement as morally problematic or decidedly evil.^19–21

The purpose of this essay is to examine the moral significance of the therapy–enhancement distinction in human genetics. Is genetic enhancement inherently unethical? Is genetic therapy inherently ethical? I will argue that the distinction does not mark a firm boundary between moral and immoral genetic interventions, and that genetic enhancement is not inherently immoral. To evaluate the acceptability of any particular genetic intervention, one needs to examine the relevant facts in light of moral principles. Some types of genetic therapy are morally acceptable while some types of genetic enhancement are unacceptable. In defending this view, I will discuss and evaluate several different ways of attempting to draw a solid moral line between therapy and enhancement.²²

Somatic versus Germline Interventions

Before discussing the therapy–enhancement distinction, it is important that we understand another distinction that should inform our discussion, viz. the distinction between somatic and germline interventions.^23,24 Somatic interventions attempt to modify somatic cells, while germline interventions attempt to modify germ cells. The gene therapy clinical trials that have been performed thus far have been on somatic cells. If we combine these two distinctions, we obtain four types of genetic interventions:

      1 Somatic genetic therapy (SGT)

      2 Germline genetic therapy (GLGT)

      3 Somatic genetic enhancement (SGE)

      4 Germline genetic enhancement (GLGE)

While I accept the distinction between somatic and germline interventions, it is important to note that even interventions designed to affect somatic cells can also affect germ cells: current SGT trials carry a slight risk of altering germ cells.²⁵ Even so, one might argue that this is a morally significant distinction because somatic interventions usually affect only the patient, while germline interventions are likely to affect future generations.²⁶ In any case, the therapy–enhancement distinction encompasses somatic as well as germline interventions, and my discussion of this distinction will include both somatic as well as germline interventions.

The Concepts of Health and Disease

Perhaps the most popular way of thinking about the moral significance of the therapy–enhancement distinction is to argue that the aim of genetic therapy is to treat human diseases while the aim of genetic enhancement is to perform other kinds of interventions, such as altering or “improving” the human body.^27–29 Since genetic therapy serves morally legitimate goals, genetic therapy is morally acceptable; but since genetic enhancement serves morally questionable or illicit goals, genetic enhancement is not morally acceptable.^30–33 I suspect that many people view the distinction and its moral significance in precisely these terms. W. French Anderson states a clear case for the moral significance of genetic enhancement:

On