Genes, justice, and obligations to future people

Social Philosophy and Policy

Volumn 19, Issue 2, 2002, Pages 360-388

  Kamm, F M ^a  

^a NEW YORK UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ANALYTICAL APPROACH; ARTICLE; DISABLED PERSON; ETHICS; FETUS; GENE THERAPY; GENETIC ENGINEERING; GENETIC ENHANCEMENT; GENETICS AND REPRODUCTION; HUMAN; MEDICAL GENETICS; MORALITY; PARENT; PERSONAL AUTONOMY; PERSONHOOD; PHILOSOPHICAL APPROACH; POLICY; REPRODUCTION; SOCIAL BEHAVIOR; SOCIAL JUSTICE;

ANALYTICAL APPROACH; GENETICS AND REPRODUCTION; PHILOSOPHICAL APPROACH;

DISABLED PERSONS; ETHICAL ANALYSIS; EUGENICS; FETUS; GENE THERAPY; GENETIC ENGINEERING; GENETIC ENHANCEMENT; HUMANS; MORAL OBLIGATIONS; PARENTS; PERSONAL AUTONOMY; PERSONHOOD; PUBLIC POLICY; REPRODUCTION; SOCIAL JUSTICE; SOCIAL RESPONSIBILITY;

EID: 0038189840     PISSN: 02650525     EISSN: None     Source Type: Journal    
DOI: 10.1017/S0265052502192156     Document Type: Article

References (40)

1. Germ-line changes will be carried into future generations; somatic changes only affect the individual altered.
2. Allen Buchanan et al., From Chance to Choice: Genetics and Justice (Cambridge: Cambridge University Press, 2000).
3. See John Rawls, A Theory of Justice (Cambridge, MA: Harvard University Press, 1970).
4. I base this summary on what CC says in chaps. 3, 5, and 7. I interpret the last sentence as applying only to valuable enhancements. If a very valuable trait were widespread without this being the result of an enhancement, I do not believe CC claims that the minority is entitled to that trait as a matter of justice. The question is, why the difference? Perhaps what is said below in Section III, Subsection B pertains to this question.
5. CC 292-94.
6. I think that by accepting balancing, CC rejects to some degree the deontological conception of justice. Related to this is CC's refusal to speak of rights to reproductive freedom. CC's authors consciously choose to speak of interests in free reproduction, which suggests that they think the balancing of interests is appropriate in this area. But how, without the idea of a right, can we explain why a less important interest of one person (e.g., in bodily integrity) may trump a more important interest of another person (e.g., in staying alive, when this can only be achieved by using the body of another person)?
7. It would be better to call the sort of lives described in the parenthetical as "lives worth not living, " since they are worse than comatose states that also are lives not worth living. Derek Parfit suggested (in conversation) this new phrase. I assume throughout that CC's "lives not worth living" refers to such worse lives.
8. In discussion of this issue, CC's authors assume that eliminating a person's serious disability is not enough of a change to make that person someone else. Elsewhere in the book, however, they argue that our phenotype (the set of our actual properties, which are the result of genetic and nongenetic factors) is crucial to our identity, to who we are. Preventing someone from being severely retarded leads to a big change in his phenotype: does this mean that by preventing such retardation in someone we change his identity in the sense that we have a new person? CC's authors must be denying this in the case of person-affecting principles. Typically, the philosophically strict sense of identity allows that one can undergo large changes in phenotype yet remain the same individual.
9. The distinction between person-affecting and nonperson-affecting principles was first offered by Derek Parfit; see Derek Parfit, Reasons and Persons (Oxford: Oxford University Press, 1985), 370.
10. Peterr Singer, in a public lecture delivered at Stanford University on October 25, 2001, said that a regime of individual parents "shopping at the genetic supermarket" preserves free choice, unlike a regime featuring a state genetic program. But this does not seem correct, because free choice is not necessarily preserved when some are given the right to determine outcomes for another person-namely, a child.
11. In the lecture I cite in note 10, Peter Singer noted that the policy of eliminating more female fetuses than male fetuses would come back to haunt societies when men looked for brides. But even if women who were selectively aborted would not have become brides, there is, I believe, a moral problem with their elimination. Furthermore, even if the number of males and females is equal, but only because some people eliminate fetuses because they do not want any males and others eliminate fetuses because they do not want any females, there would be a moral issue. The issue is whether such preferences for females or males is justified.
12. For more on this, see F. M. Kamm, Creation and Abortion (New York: Oxford University Press, 1992).
13. Perhaps this latter use of the idea of equal concern and respect lies at the heart of Ronald Dworkin's political philosophy.
14. For more about my concerns regarding the relation of FEO to health, see F. M. Kamm, "Health and Equality of Opportunity, " American Journal of Bioethics 1, no. 2 (2001): 17-19.
15. Pibbe Jogge argues that the authors of CC fail to distinguish between (a) treating a disease and (b) bringing someone to the state they would have been in without the disease, without treating the disease. She argues that (b) is no more required by the idea of treatment than is enhancement. So consider CC's case contrasting someone who is very short because of a disease preventing him from producing his own growth hormone with someone who is very short because his parents are (see CC 115). Jogge's view implies, I believe, that giving growth hormone to someone with the disease, or in some other way making him as tall as he would have been without the disease, is as little mandated by a theory that would require us to cure the disease as is giving growth hormone to someone who is normally short. See Pibbe Jogge, "Does Billy Have a Right to Grow Up?: The Moral Relevance of the Distinction between Treatment and Enhancement"(manuscript).
16. See Thomas Nagel, "Justice and Nature, " Oxford Journal of Legal Studies 17, no. 2 (1997): 303.
17. CC also draws attention to the analogy between education and enhancements; see CC 189-90. Note also that while initially only the rich may be able to afford the Procedures, the market itself may eventually lead to lower prices.
18. For the data on this point, see Norman Daniels, "Justice, Health, and Healthcare, " American Journal of Bioethics 1, no. 2 (2001): 2-16.
19. See Peter Singer, Practical Ethics, 2d ed. (Cambridge: Cambridge University Press, 1993).
20. This case was put to me by Dan Brock.
21. For more on all this, see Kamm, Creation and Abortion, chap. 5.
22. I first presented this argument in ibid., 207.
23. Unlike the duty not to take away from (what is already) a person what she is entitled to, the duty to provide aid does not rely so strongly on the presence of the person. For this reason, one may sense less of a difference in the fetus and child variants of cases when aiding is in question.
24. Note that nothing I have said implies that it is better for someone acting in the interests of a future person to (1) cause a large loss to the future person by acting at his fetus stage rather than (2) cause a small loss to that person through an action one takes when he exists. If I know that I have to do one or the other, it is ex ante in the future person's interest to waive his right against my doing (2) so that I do not do (1). Hence, I think I should, in this case, do (2) rather than (1). (I thank Richard Arneson for the question to which this is a response.)
25. This case is imaginary, since many things we do could change the identities of the people who will actually exist in one hundred years. Derek Parfit first noted this in Parfit, Reasons and Persons, 361-64.
26. Kenneth Arrow argues this way in Kenneth Arrow, "Intergenerational Equity and the Rate of Discount in Long-Term Social Investment" (manuscript). Arrow uses the notion of the prerogative introduced in Samuel Scheffler, The Rejection of Consequentialism (Oxford: Clarendon Press, 1982).
27. Kenneth Arrow argues this way in Kenneth Arrow, "Intergenerational Equity and the Rate of Discount in Long-Term Social Investment" (manuscript). Arrow uses the notion of the prerogative introduced in Samuel Scheffler, The Rejection of Consequentialism (Oxford: Clarendon Press, 1982).
28. This criticism of Scheffler's views on the agent-centered prerogative was made by me in F. M. Kamm, "Supererogation and Obligation, " Journal of Philosophy 82, no. 3 (1985): 118-38; and by Shelly Kagan in Shelly Kagan, "Does Consequentialism Demand Too Much?" Philosophy and Public Affairs 13, no. 3 (1984): 239-54. The criticism is related to the issue of the existence of a moral distinction between harming and not aiding. For more on this issue, see F. M. Kamm, Rights, Duties, and Status, vol. 2 of Morality, Mortality (New York: Oxford University Press, 1996).
29. This criticism of Scheffler's views on the agent-centered prerogative was made by me in F. M. Kamm, "Supererogation and Obligation, " Journal of Philosophy 82, no. 3 (1985): 118-38; and by Shelly Kagan in Shelly Kagan, "Does Consequentialism Demand Too Much?" Philosophy and Public Affairs 13, no. 3 (1984): 239-54. The criticism is related to the issue of the existence of a moral distinction between harming and not aiding. For more on this issue, see F. M. Kamm, Rights, Duties, and Status, vol. 2 of Morality, Mortality (New York: Oxford University Press, 1996).
30. This criticism of Scheffler's views on the agent-centered prerogative was made by me in F. M. Kamm, "Supererogation and Obligation, " Journal of Philosophy 82, no. 3 (1985): 118-38; and by Shelly Kagan in Shelly Kagan, "Does Consequentialism Demand Too Much?" Philosophy and Public Affairs 13, no. 3 (1984): 239-54. The criticism is related to the issue of the existence of a moral distinction between harming and not aiding. For more on this issue, see F. M. Kamm, Rights, Duties, and Status, vol. 2 of Morality, Mortality (New York: Oxford University Press, 1996).
31. See Richard Revesz, "Environmental Regulation, Cost-Benefit Analysis, and the Discounting of Human Lives, " Columbia Law Review 99, no. 4 (1999): 941-1017.
32. See Peter Singer, "Shopping at the Genetic Supermarket, " available on-line at http: //www.stanford.edu/dept/DLCL/geneticshopping.html.
33. I argue for this in F. M. Kamm, "Disability, Discrimination, and Irrelevant Goods" (manuscript).
34. I believe Robert Adams originally made this point. The example he gives is someone who marries a particular woman. If he loves this woman, he does not wish that he had instead loved someone else with whom his life would have been objectively better. See Robert Adams, "Existence, Self-interest, and the Problem of Evil, " Noûs 13 (1979): 53-65.
35. This point may also bear on the legitimacy of suicide in cases of illness. Ronald Dworkin emphasizes the impersonal value of a life considered independently from its value for the person who will live it in Ronald Dworkin, Life's Dominion (New York: Knopf, 1993).
36. See Singer, "Shopping at the Genetic Supermarket."
37. Much of what I have said in Subsection C draws on my discussion in Kamm, Creation and Abortion.
38. CC 53.
39. See John Stuart Mill, Utilitarianism, ed. Oskar Piest (Indianapolis, IN: Bobbs-Merrill, 1957).
40. CC itself notes this problem; see CC 54. I think that CC's authors mistakenly believe that they deal with the problem by noting that parents' desires are not sufficient for social intervention (if parents want something bad). But the question is whether parents' desires are necessary.