Creation Ethics: Reproduction, Genetics and Quality of Life

By David DeGrazia
OUP 2012234 pp
ISBN 9780195389630

Reviewed by Richard Brown

Reported to have first been coined by Lee Silver in his book, Remaking Eden, the term reprogenetics has fast become the byword for describing the merging of reproductive and genetic technologies. As new technologies such as genetic testing and enhancement evolve they place considerable power in the hands of humans to shape their offspring. Concurrent to these advances must run the development in the ethics and values focused conversation which will undoubtedly shape and direct the decisions taken using these technologies.

Creation Ethics: Reproduction, Genetics and Quality of Life by David DeGrazi is a welcomed contribution to this discussion, providing scholarly analysis of both what has been achieved to date and what is yet to come.

An American moral philosopher specializing in bioethics and animal rights, David DeGrazia is Professor and Chair of the Department of Philosophy at George Washington University, Author and editor of several books on ethics, Creation Ethics: Reproduction, Genetics, and Quality of Life is his latest book, published by OUP in 2012.

The book offers an excellent grounding in the key ethical and philosophical issues surrounding reproduction and genetics which can sometimes be overlooked or given a cursory review by other books.  Not surprisingly given the author’s experience and expertise, the book boasts rigorous engagement from a standpoint of moral philosophy with the issues surrounding reprogenetics, challenging and provoking the reader as they are taken on a well–guided tour of the ethics of creating people.

Drilling down and analysing meta–ethics and issues of identity, justice and moral status as the book does could mean that the book becoming turgid, filled with jargon and terms which only those who are familiar with the field are able to understand and comprehend. Creation Ethics manages to navigate past this and represents a book which is lucid in style and assumes very little on the part of the reader.  This means that the book should appeal to many from across the disciplines; from legal scholars to philosophers, sociologists and public policy scholars to scientists (although understandably scientific discussion is light).   The space given to consider policy formation and development in this field is strong and informed, making it of value to those involved in public policy in particular – even if you don’t agree entirely with the recommendations!

One of the key strengths of the book lies in the fact that it has a clear focus. It is as clear in what it addresses as it is clear in what it does not. There are plenty of other books which look at the same issues which Creation Ethics addresses in far more depth and analysis. Nevertheless, what the book helps to do is bring together breadth of issues which are then treated with a level of philosophical analysis rarely seen. The author acknowledges in the introduction that this can lead to superficiality but hopes that this is not the case in this instance. I would tend to agree; superficiality is one word you cannot use to describe this book. It serves as a well researched and well formed starting point for those interested in the intersection of reproduction and genetics. Having read the book, the reader may well move onto other more nuanced volumes in order to further explore the issues at greater length or from a particularly perspective.

Another distinguishing feature which is invaluable to a book of this nature is the fact that the reader engages with both sides of the argument, giving as much time to assessing and analysing the protagonist as the antagonist.  When issues such as prenatal moral status, abortion and embryo research are being addressed it can be easy to adopt one–sided arguments or simply re–run deeply entrenched lines of argument and rebuttals which have been played out so many times previously.  Understandably the author’s own perspective and opinions do come through in the book and it is clear that DeGrazia favours framing the ethics of creating humans with a liberal vision of the world. Nevertheless, he does attempt to give a fair hearing to all participating voices in the conversation, pursuing their lines of thinking systematically exposing strengths as well as weaknesses.

Key themes

Not surprising given the focus of DeGrazia’s previous book, Human Identity and Bioethics published in 2005, the issue of identity forms the key strand of Creation Ethics. The author believes – along with many others – that the question of the moral status of human embryos and fetuses is of profound importance in establish a clear starting point for discussing ethical issues at the beginning of life. This key question is answered by determining when prenatal human beings become “one of us” and according to DeGrazia the answer is reached by establishing a theory of numerical identity based on a biological understanding and interpretation.  In the author’s opinion, such a perspective is more plausible than the other perspectives such as personhood (even Jeff McMahan’s variant theory of personhood is rejected) which are often given.  As noted earlier the author treats with respect these differing perspectives but nevertheless argues his point and lays out his reasoning to regard them as counter intuitive.  For instance if the basis for defining a person as a being with the capacity for forms of complex forms of consciousness (thoughts, language and self–awareness) then in DeGrazia’s view it would bring us to conclude that in fact none of us was ever a newborn.

Structure

The book opens with an introduction followed by six chapters.  Chapter three tackles biomedical enhancement and specifically looks at the confusion which can often arise between two senses of identity: numerical identity and narrative identity (how the individual conceives him/her–self.  Here the author picks up on the argument posed by some that if gene therapy is used to treat someone with a cognitive disorder that it might somehow change the person’s identity. Unpacking this line of argument and demonstrating his ability to synthesise different perspectives and thinking, DeGrazia finds that it is implausible to think that enhancement of this kind could affect a person’s numerical identity and so it must refer to narrative identity. From closer analysis though, DeGrazia goes onto argue that in fact the argument is less to do with numerical viz–a–viz narrative identity and more to do with change as an inherent evil or change being considered as desirable but rejected on the basis of how it is reached (i.e. through changes in the gene pool). Clearly not a proponent of the precautionary principle, nevertheless the author builds a case for appropriate precautions in order to help protect unenhanced humans from abuse and exploitation.

An excellent overview of reprogenetics opens up chapter four which proceeds to discuss prenatal genetic diagnosis (PGD), prenatal genetic therapy (PGT) and prenatal genetic enhancement (PGE). This allows further opportunity for the author to develop his discussion of identity in terms of how much change can be permitted given a human being’s origination or continued existence.

Sympathetically and compassionately, the author tackles the question of ‘wrongful life’ in chapter 5. Framed by a discussion of the profoundly disruptive genetic conditions Tay–Sachs disease and Lesch–Nyham condition, the author proceeds to look at the question of whether or not children can be wronged by bringing them into existence under seriously disadvantageous conditions. If so, how can we inherently explain the nature of the wrong?  The discussion here shows the author at his best, clearly unpacking key themes and analysing them with meticulous dexterity and detail. Having explored various arguments for making sense of the charge of wrongful life, he concludes that there are wrongful life cases, where by someone is wronged by being brought into existence. 

Following this line of thought further one of the obvious questions which arises is what criteria should prospective parents therefore use in deciding whether or not to have children? This question is the focus of chapter six which focuses on procreation with the intention of raising the created child as opposed to giving him or her up for adoption, although the ethical considerations of adoption are addressed as well. This idea of considering what parents owe their children is an interesting question to consider and one that is not readily given much consideration in discussion concerning reprogenetics. With recent discussion within the public square focusing on who should be allowed or given the chance to be a parent, it is all the more important to think more seriously about the issue of parenthood. It is therefore encouraging to see space being given to discuss it here.

The final chapter continues the logical progression demonstrated by the book and looks at obligations to future generations, within the context of the non–identity problem in relation to global climate change.  A variety of issues are explored but stem from the central premise of the chapter that “procreative acts of a given generation create a new generation; and of course, the new generation will go onto create another generation, and so on for as long as humanity exists” (p.13). DeGrazia tackles the implications which arise from the choices that we make and the impact they have on the quality of life of future generations.

The author goes onto argue that despite the fact that on the face of it, it is easy to recognise that decisions taken today will affect future generations, our moral obligations apply more immediately in our interaction with our contemporaries. Thus, consideration of our obligations to those who will exist only in the future is more challenging to recognise and appreciate. DeGrazia tackles this head on and explores the following questions: do future persons have interests, moral status and rights? Can we have obligations to them and not just regarding them? This is indeed a fascinating chapter and certainly provokes the reader to think more deeply about the future implications of how we use reprogenetic technologies.  Shaking the reader free from what might be termed the default cultural norm of “my rights” and “my needs”, it brings into sharper focus the question of how we think about the long term and how, if at all, “my decisions” need to be made with future generations in situ, more than just in mind.

Creation Ethics is a rich volume, skilfully written and which has philosophical rigor running throughout. It does not shy away from the difficult and complex questions which surrounding new advances in reproduction and genetics; in fact it makes these questions its key focus. In so doing the book’s contribution to the conversation is found in opening up clear and fresh perspectives on these important issues.

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