Undergraduate Bioethics Intern, Raafay Syed, examines the ethics of preimplantation genetic selection and the benefits of a virtue-based approach.

 

By Raafay Syed

 

There is continuing controversy over couples who elect to have children of a particular sex through techniques such as preimplantation genetic diagnosis or sperm sorting. These techniques were initially used in IVF (In Vitro Fertilization)  clinics so that couples could avoid the presence of harmful genetic disorders in their children. However, many people have opted to use these techniques to select traits in their children, like sex, in cases where there is no medical relevance. Although there are some sex-linked genetic disorders in many cases decisions to choose one sex over another are not based on any reasonable medical justification.

 

In some countries, sex selection is illegal. For example, in the UK, the Human Fertilisation and Embryology Authority has banned choosing the sex of children unless there is an important medical reason. On the other hand, in the United States, there are no explicit laws regulating the traits that couples can select for or against. Lack of regulation opens the door not only for sex selection, but also for selection based on a wide variety of traits that may not have any medical significance.

 

Genetic traits can be organized into three categories for thinking about selection: negative  (traits pertaining to harmful genetic disorders); positive (traits thought to be beneficial such as intelligence or strength); and neutral (traits that do not confer any significant harm or benefit). It’s important to keep in mind that enduring disagreement is likely, in some cases, about which traits are positive, negative, or neutral. Framing selection around these three categories is consistent with two principles that are often cited as a rationale for this selection. Non-maleficence can be used to argue in support of negative selection, deciding to avoid traits that will result in a significant harm to the future child. The principle of beneficence can be used to explain the parents’ obligation to select traits to help ensure the benefits of the most “open future” for their child. These principles, non-maleficence and beneficence, do not offer much guidance in thinking about neutral selection. This, and the potential for a lack of consensus in neatly evaluating and categorizing positive and negative traits, underscore the limitations of relying on these principles as a framework for thinking about the ethics of selection.

 

An approach based on the principle of non-maleficence would claim that it is morally impermissible for parents to select for negative traits such as severe genetic disorders because these traits would cause pain and suffering in the future child, or would at least cause the child to be dependent on others in some fashion. In this sense, the existence of these traits in the child might constitute a “harm” imposed by the parents. While this approach has its merits, it seems less persuasive when confronted with Parfit’s non-identity problem. The non-identity problem points out that there is no child that can be said to have been harmed, because the alternative potential child (the one without the trait in question) is non-identical to the one that was supposedly “harmed.” In this scenario, the child at risk of harm will have never existed, thus could not actually be at risk of harm. A proponent of the harm-based approach might suggest that the child exhibiting the trait that was selected for can still be “harmed” if the quality of life of the child is so poor that it would be worse than non-existence. However, if the sole criterion for evaluating the ethical permissibility of selection for a particular trait is whether or not a child exhibiting that trait has a quality of life better than non-existence, then we’ve set the bar quite low and this may allow for a range of ethically dubious selections. Moreover, it’s not clear how we would decide between two or more particular traits, when all options are considered to be better than non-existence.

 

In thinking about an approach that relies on the principle of beneficence to select certain traits, the traits consistent with the most “open future” are seen as a pre-condition for true happiness or well-being. While this approach avoids some of the philosophical problems associated with identity and harm, it is still not completely satisfactory. For instance, there is considerable ambiguity surrounding what counts as an “open” future, as well as whether or not particular traits such as intelligence or strength will actually lead to a more open future. Secondly, it is not obvious that the most open future always leads to happiness or well-being. The most significant limitation of this approach is the fact that it doesn’t say anything meaningful about the neutral category of selection. If there are certain traits that don’t have any bearing on the openness of the child’s future, then this beneficence-based approach probably does not have much to say regarding the ethics of such a decision.

 

This brings us back to the case mentioned at the beginning of this article, that of sex selection. Taking sex to be a neutral trait, and recognizing important limitations of both harm-based and open future approaches, I propose Rosalind McDougall’s virtue ethics framework as an alternative. A virtue-based approach asks, “what would a virtuous person do in these circumstances?” In the case of reproductive decisions, the question might read, “what would a virtuous parent do in these circumstances?” The main idea, here, is that the focus of ethics is not so much on the action itself. Rather, it is on the character traits of the agent who is performing the action. As a result, a robust virtue ethics account needs a list of virtues that one can appeal to. Usually, though not always, the virtues are chosen based on whether or not they are conducive to human flourishing or well-being. McDougall applies a virtue ethics account to cases of sex selection by creating a list of parental virtues, or virtues that are conducive to parental flourishing. She also suggests that parental flourishing is intimately connected to the flourishing of the child. “Acceptingness” is one such parental virtue, since an accepting parent is conducive to the flourishing of a child. Thus, sex selection is morally wrong because it does not reflect what an accepting parent would do. A truly accepting parent wouldn’t prefer one sex over another, and even if the parent was willing to raise a child of the other sex, the decision to select on the basis of sex (irrespective of willingness to raise) is itself non-virtuous and therefore morally wrong.

 

While McDougall’s virtue-based approach is the most detailed application of virtue ethics to reproductive decision-making, there are a plethora of questions that can be raised. What is the difference between flourishing as a parent, and flourishing as a human being more generally? How is the notion of flourishing distinct from other notions such as happiness or well-being? Are parental virtues a  sub-set of  more general human virtues? To what extent does parental flourishing involve the child’s flourishing, and are there cases in which a parent might flourish as a parent, even though the child isn’t flourishing? It is also important to think about whether or not McDougall’s list of three parental virtues (acceptingness, committedness, and future-agent-focus) is accurate and exhaustive.

 

Much work remains to be done in the realm of virtue ethics and its application to cases in bioethics. While applied virtue ethics is just getting off the ground, its potential to contribute to the field of bioethics can be seen in the above examples. A virtue-based approach avoids the non-identity problem, allows for the ethical evaluation of neutral selections, and, for the most part, does not heavily depend upon vague and subjective distinctions between negative and positive traits.

 

Virtue ethics can enhance the discourse in reproductive ethics and bioethics more broadly, because it reminds us that there is more to moral deliberation than analyses of harms and benefits, consequences and rules, and abstract principles. The importance of character seems to be missing from the picture of bioethics today. Virtue ethics should take its place alongside other dominant moral theories in contemporary bioethical discourse.

 

Raafay Syed is an undergraduate intern at the Johns Hopkins Berman Institute of Bioethics, and is majoring in Philosophy and Public Health Studies. He is primarily interested in virtue ethics, research ethics involving the cognitively impaired, and philosophical issues related to end-of-life care.

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