Designer children

Townsend Letter for Doctors and Patients,  Dec, 2004  by Jule Klotter

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In an essay for The Atlantic Monthly, Michael J. Sandel, who teaches political philosophy at Harvard University, raises moral questions about the use of medical and genetic enhancement to create exceptional children. He points out that some parents already enroll their children in prestigious schools and fund numerous extracurricular lessons in order to increase the likelihood that they will excel. "If it is permissible and even admirable for parents to help their children in these ways," he asks, "why isn't it equally admirable for parents to use whatever genetic technologies may emerge (provided they are safe) to enhance their children's intelligence, musical ability, or athletic prowess?"

Some doctors already face this kind of ethical question when parents ask them to provide their healthy children with human growth hormone. When first introduced in the 1980s, human growth hormone was approved by the FDA for children with a hormone deficiency that resulted in under-average height and other problems. But some parents asked doctors to increase the height of their healthy children. Some children are perfectly healthy; they simply come from a genetic line of short people. Forty percent of human-growth hormone prescriptions, written in 1996, were for 'off-label' use; and, Eli Lilly and Co. has convinced the FDA to extend its approval of human growth hormone to include healthy children with a projected adult height under five feet three inches for boys and four feet eleven inches for girls. If this manipulation of a healthy child's features is acceptable, "what about a child of average height who wants to be taller so that he can make the basketball team?" Sandel asks.

Although genetic engineering seems unrelated to these other means of enhancement, Sandel views it as a natural extension of the "high-pressure child-rearing practices we commonly accept." Such "hyperparenting" stems from anxiety and a desire to create a particular outcome. Yet, parenthood is the one relationship in which we commit to another being without knowing who that person is or what qualities (s)he will express. Ultimately, parents have no control over who their children will become. Children teach 'openness to the unbidden,' says Sandel, drawing on a concept from theologian William F. May. They teach how to live with the unexpected. To believe that we can control who our children become and how they live their lives by employing whatever means of enhancement available is hubris. Sandel contends that such a belief brings selfishness into our dealings with one another and isolates us from the kinship of humanity. "If our genetic endowments are gifts," he explains, "rather than achievements for which we can claim credit, it is a mistake and a conceit to assume that we are entitled to the full measure of the bounty they reap in a market economy. We therefore have an obligation to share this bounty with those who, through no fault of their own, lack comparable gifts."

Genetic engineering opens the possibility of a new eugenics: "Rather than segregating and eliminating the unfit, it would improve them." Sandel says, drawing on the writings of Robert L. Sinsheimer, a molecular biologist at the California Institute of Technology. As we increase the ability to manipulate life into some form of society-defined perfection, will we become less open, less generous, less compassionate, less accepting of those forms that do not meet our aspirations? How will we decide who is "unfit"?

Many years ago, I read a book by Mother Teresa, No Greater Love, in which she told about a mother of twelve whose youngest daughter was horribly mutilated and another woman in Venezuela with a severely crippled son. Mother Teresa offered to take the daughter back to her home so that the woman would be better able to care for her other eleven children. To Mother Teresa's surprise, the woman began to cry and begged her to let her child remain with the family: "This creature is the greatest gift of God to me and my family. All our love is focused on her. Our lives would be empty if you took her from us." Similarly, the woman with the crippled son said, "We call him 'Teacher of Love,' because he keeps on teaching us how to love. Everything we do for him is our love for God in action."

How do we decide who is unfit?

Sandel, Michael J. The Case Against Perfection. The Atlantic Monthly, April 2004

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