In contemporary ethical discussion widespread concern about the potential risks of genetic engineering is raising new and fundamental questions about our responsibilities towards unborn generations. Newly acquired knowledge in genetic engineering techniques has brought about not only potential benefits but also immense risks for the well-being of both present and future generations. This book raises a number of ethical issues concerning the impact of genetic engineering on generations yet to be born. The four topical areas that constitute the focus of the volume, namely (1) from laboratory to germ-line therapy, (2) the concept of human nature: theological and secular perspectives, (3) genetic intervention and the common heritage view, and (4) social responsibilities of geneticists towards future generations, raise intriguing ethical and legal questions, as well as important policy issues. As much as any set of issues, they reflect the hopes and fears, prejudices and uncertainties that people associate with germ-line intervention and the future of human kind.
This group of 13 very thoughtful essays addresses the difficult question of just how we should think about using -- or refrain from using -- our radically enhanced abilities in molecular biology and genetic engineering to improve the lot of current and future generations. This question assumes that we could eventually have a well-accepted set of opinions regarding when genetic therapies ought to be deployed and that we are entitled to have a view regarding what future persons would prefer to be like. The question also suggests that we can have well-defined responsibilities to generations that are remote from us in time.
In any case, although this question is a new one (or at least a more pressing one) given current developments in biomedical science, the query itself belongs to a very ancient and difficult class of issues that relate to how society decides to use new knowledge. As noted by one of the authors, even the question of altering the gene pool of future generations has been with us for some time as we have speculated about various eugenic schemes and adopted such widely accepted practices as contraception and prenatal screening.
The quiet and thoughtful approach of these essays is welcome, because a good deal of contemporary discourse in science, science policy, and "bureaucratic bioethics" regarding our responsibilities to future generations is shrill and often thoughtless. Sadly, there is a great deal of rather pugnacious discourse pronouncing alternatively on the sacred nature of scientific progress or the unnatural, inhuman, or even blasphemous territory into which scientific progress is taking us. On the whole, philosophers have been more careful than most scientists and public policy makers in their rhetoric, and their contributions to the debate have been not only more thoughtful but also surprisingly useful.
The essays are authored by a wide variety of careful thinkers, including scientists, philosophers, public servants, and a Zen priest. They are both measured and modest in tone and are full of interesting insights. The essays are grouped into four sections. They deal with the movement of new knowledge from the laboratory to therapy, the concept of human nature, the role of genetic interventions and the common heritage view of the human genome, and finally, our social responsibilities to future generations.
Some of the many important questions that are addressed and clarified in this book are as follows: What types of agreements can a secular and morally diverse society strive for on controversial moral issues, and of what help can moral philosophy be in this respect? Does it make sense to think coherently about the plight of future generations, whose interests we can barely define? Should one think of future generations as dependents or as persons with their own independent (or God-given) wills? Can one make any sense out of the notion of human nature, and should it be regarded as fixed or open to change? Why have so many people and policy makers become attracted to the idea of trying to bequeath a fixed human genome or a fixed system of values to future generations? How do we distinguish between health and disease and, therefore, decide when to use, for example, genetic therapies? Can any person have property rights in the human genome, or is it humankind's common inheritance?
There are many lessons one can learn from the essays in this slim book. One concerns the importance of tolerating, indeed welcoming, a diversity of moral communities and, therefore, a diversity of visions regarding the well-being and flourishing of humans. A second is that the rules of conduct that best serve our collective interests must be reviewed and perhaps revised as the scientific and cultural environment around us changes in important ways. As a result, we can anticipate a continued and never-ending search for the social processes and public policies that will improve our chances of selecting the most ethically acceptable uses of our expanding knowledge base. A third lesson is that our prevailing confidence in human competence may turn out to be just another myth.
Perhaps most important, these thoughtful essays remind us that it is important not just to celebrate discovery, but also to consider the possible moral repercussions of new knowledge and to develop social processes that will enable us to maximize the benefits of our new knowledge. Needless to say, the questions noted above are not all answered in this short book, but anyone interested in these issues can benefit from the thoughtful approach of the authors.
Reviewed by Harold T. Shapiro, Ph.D.
Copyright © 1999 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
