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rality of inclusion in Chapter 7, we provide some of the distinctions and principles needed for a sound ethical response to the issues raised in the Genetic Communitarianism and The Quest for a Perfect Baby scenarios.

The Morality of Inclusion

The dawning of the age of genetic intervention also pushes the limits of theories of justice in another way - by calling into question the manner in which the fundamental problem of justice is characteristically framed.

Theories of justice generally begin with the assumption that the most fundamental problem is how to distribute fairly the burdens and benefits of a society - understood as a single, cooperative framework in which all members are active and effective participants. This way of formulating the issue of Justice overlooks two vital points: first, that increasingly human beings can exert some control over the character of the basic cooperative framework within which the most fundamental questions of fair distribution arise; and second, that the character of the most basic cooperative framework in a society will determine who is and who is not "disabled." In other words, what the most basic institutions for production and exchange are like will determine the capacities an individual must have in order to be an effective participant in social cooperation (Wikler 1983; Buchanan 1993,

1996).

But if the choice of a framework of cooperation has profound implications for whether some people will be able to participate effectively, there is a prior question of 'Justice: What is required for fairness in the choice of a society's most basic and comprehensive cooperative scheme? Attempting to answer this question stimulates us to gain a deeper understanding of the very nature of disability.

In Chapter 7, we distinguish genetic impairments from disabilities that have a genetic corhponent, noting that whether or to what extent a genetic impairment results in disability depends on the character of the dominant cooperative framework and the kinds of abilities required for effective participation in it. We then argue that there is an important but often ignored obligation to choose a dominant cooperative framework that is inclusive -that minimizes exclusion from participation on account of genetic impairments. If obligations of inclusion are to be taken seriously, they too impose significant restrictions on the personal choice model for the ethics of genetic intervention.

Justice in the choice of cooperative schemes turns out to be complex, however. The obligation of inclusion is not the sole morally relevant factor, so it cannot be a moral absolute. There is also the morally legitimate interest that persons have in having access to the most productive, enriching, and challenging cooperative scheme in which they are capable of being effective participants. Where there are significant differences in persons' natural assets, the obligation of inclusion and this legitimate interest can come into conflict.

However this conflict is resolved, we argue, a just society of considerable powers of genetic intervention may require changes in both directions: genetic interventions to enable individuals to be effective participants in social cooperation who would not otherwise be able to, and efforts to design the structure of cooperation in ways that make it possible for more people to be effective participants. Appreciation of the problem of justice In the choice of cooperative schemes leads us to the conclusion that regardless of whether we choose to use genetic interventions to promote inclusiveness or refuse to do so, we are in a very real sense choosing who will and who will not be disabled.

ETHICAL THEORY AND PUBLIC POLICY

Our investigation of ethical principles for a just and humane society capable of powerful genetic interventions is not an attempt to advance concrete policy recommendations for our own society at the present time. We offer no model statutes for regulating genetic interventions. We provide no definitive list of genetic interventions that should be included in the package of benefits required by the right to health care.

Instead, our aim is to explore the resources and limitations of ethical theory for guiding deliberations about public policy. To borrow a metaphor from molecular genetics, we only hope to produce a map featuring the most important moral markers, nothing like a complete sequence of ethical steps into the genetic future. We do this by articulating and refining the basic ethical principles that policyrnakers ought to take into account in responding to issues on the development and deployment of genetic intervention technologies, and by critically evaluating current attempts in the bioethical literature to narrow the range of permissible policy alternatives by using certain distinctions, such as

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that between treatment and enhancement or between germline and somatic cell interventions. Our aim is to provide some of the essential materials for constructing a framework for discourse about the ethics of genetic intervention.

The eighth and final chapter draws out the major implications of' our analysis for how we ought to think about public policy if we are to avoid the errors and abuses associated with eugenics and to harness our burgeoning genetic powers to help create a more just and humane society. Because our moral map alms to provide guidance for some considerable distance into the future, we have tried to take the longer view. Doing so inevitably means, however, that we do not achieve a fine focus on objects in the foreground. We do not, for example, explore some of the more urgent concrete policy issues our society faces today, such as the problem of genetic privacy or insurance discrimination on genetic grounds. There is already a sophisticated literature on these issues. Our objective is to explore other and in some cases more fundamental issues that are often overlooked or not attacked in a systematic fashion.

SCIENCE FICTION EXAMPLES, REFLECTIVE EQUILIBRIUM,

AND THE IDEOLOGICAL USES OF GENETIC DETERMINISM

We began this introduction with several hypothetical scenarios, some more farfetched than others. Is there any reason to include such science fiction cases as the genetic enhancement certificate and genetic communitariamsm in serious moral deliberations?

The use of concrete cases - both real and hypothetical, complex and simplified - to stimulate moral reflection is essential to the method we use in this book. Our procedure here is far from novel; we rely on the now-familiar method of reflective equilibrium. (A more detailed explanation of our methodological assumptions is found in Appendix z.)

The aim of systematic moral reasoning is to develop a coherent set of beliefs that includes moral principles, other elements of moral theory (such as an account of which sorts of beings have rights), and beliefs about what is right and wrong in particular cases - actual and hypothetical - as well as beliefs about how the world is and how people in it behave. Moral arguments appeal to some elements of this system of beliefs in order to bring critical reflection to bear on others. This process aims at what Rawls calls "wide reflective equilibrium"

INTRODUCTION

(Rawls 11971, 1974 ; Daniels 1996). Our moral beliefs are thus held to be revisable in light of other things we believe or reasonably come to believe (Buchanan -1975).

The Risk of Reinforcing "Gene-mania"

Given the subject matter of this book, there are good reasons to use science fiction examples, and equally good reasons for exercising caution in so doing. Because we are concerned with genetic interventions and because the rate of scientific discoveries about genes is now accelerating enormously, we face a painful dilemma. We can refuse to speculate about how extensive our powers of genetic intervention may become, but at the price of failing to provide guidance for significant choices that our society may well have to make in the future. Or we can speculate about the powers human beings may come to wield, but at the risk of being ridiculed for having been swept away by the religious fervor of what might be called "gene-mania," or delusions of biotech grandeur.

If in an effort to provide ethical guidance for the longer run, we overestimate the developing powers of genetic intervention and the impact of genes on individual and social life, we run the risk of reinforcing genetic determinism. This is more a set of attitudes than a creed. To succumb to genetic determinism is, most simply put, to think of genes as self-sufficient or autonomous causes of traits or behaviors.

Genetic determinism betrays, above all, a failure to understand that genes are always only contributing causes. Whether a given trait will be present depends not just on the gene or genes in question, but also on the environment, including the environment of the organism's body at a particular stage in the organism's development. In the vocabulary of social anthropology, genetic determinism is a variety of fetishism. (A fetish is an object that people endow - in their imaginations - with supernatural powers, or at least with powers that the object does not have.)

The fetishism of genes in our society's popular culture has been eloquently documented by Lindee and Nelkin (L995). A glance at mass media coverage of these issues shows how pervasive gene-mania is. Virtually every week headlines proclaim the discovery of "the gene for X" (obesity, anxiety, homosexuality, etc.). Genetic determinist thinking feeds gene-mania because it goes far beyond the assumption that genes play a significant role in all of the traits or behavior in which we

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are interested to the patently false claim that genes are autonomous causes.

Genetic Determinist Fallacies

The various confusions and fallacies of genetic determinism are carefully exposed in Appendix i, written by Elliot Sober, a preeminent philosopher of biology. Sober's analysis of the concept of genetic causation helps clarify an essential point: Genetic determinism is not merely a tendency to make erroneous causal judgments about genes; it is a cognitive error that fosters the abdication of moral and social responsibility.

Genetic determinism promotes a worshipful attitude toward genes and genetic science. Given the assumption that, as James Watson (1989) has said, "our fate is in our genes," our admiration for the achievements of genetic science leads us to look to our genes for the source of all our problems and to molecular biology for their solutions. We thereby conveniently blind ourselves to the uncomfortable possibility that many of our most serious problems result from our social practices and institutions.

Ideological Functions of Genetic Determinism

Genetic determinism thus plays an exculpating role. If academic and economic "underachievement," aggression, depression, "criminal behavior," and sexual infidelity are all caused by genes, then there is indeed a double exculpation. Individuals are not responsible for their behavior (tiny chemical factories embedded within them are), nor are we responsible for critically evaluating and perhaps reforming existing institutions and social practices, since these are largely irrelevant to the problems that most concern us. If there were an all-powerful and all-knowing being who was resolutely committed to shielding the existing social and political order,from critical scrutiny, it is unlikely that it could hit upon a better strategy than implanting genetic determinist thinking in peoples' heads.

There is, of course, no such evil demon. There are, however, scientists who sometimes foster gene-mania by a combination of excessive enthusiasm for their own projects and breathless public relations rhetoric aimed at securing social and financial support. And there are biotechnology firms poised to unleash sophisticated marketing tech

INTRODUCTION

25

niques that will no doubt encourage unrealistic hopes for genetic solutions to all sorts of problems. Finally, there is the interest that ordinary people - especially those who benefit quite nicely from the existing social and political order - have in avoiding anything that might require them to question whether they should continue to support and benefit from the status quo.

As the next chapter shows, the exculpatory functions of genetic determinism attained their most dramatic expression in the eugenic preoccupation with "the problem of degeneration." Despite its heterogeneity in other regards, eugenic thought tended to "geneticize" a remarkable number of the most important social problems, and on the basis of remarkably little evidence that genes played any significant role in them.

Those who scoff at the suggestion that our society is in danger of a resurgence of eugenic thinking should ask themselves two questions. Is genetic determinist thinking significantly less prevalent today than it was in the heyday of eugenics? And are the interests in avoiding the conclusion that most of society's problems are to a significant degree rooted in our institutions any less powerful today than they were a hundred years ago? Unfortunately, the answer to both questions seems to be "no" (Hubbard and Wald 1993; Lewontin 1992).

Given the serious risk of encouraging genetic determinist thinking and its exculpatory ideological functions, would it be better to avoid the use of "science fiction" examples of genetic interventions, even if this means that we may fall to consider some ethical issues that our society may in fact have to face? We believe that predictions about which genetic interventions will never become possible are often almost as unfounded as the extravagant view that virtually everything will eventually become possible. So although we have tried to engage in science fiction, not science fantasy, we have considered some interventions that may become possible while recognizing that they may in fact never actually become so. (For example, in Chapter 3 we consider the possibility that genetic intervention might in the very distant future produce changes that lead us to revise our conception of human nature or even to dispense with it.)

It would be a poor strategy to make our ethical conclusions rest on empirical premises about what will never happen, given the very real possibility that they may prove false. Developing a proactive ethical stance is a better defense against genetic determinism and its politically conservative implications than a policy of failing to engage with the

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ethical issues by dismissing the possibility that they will arise. More important, our analysis will show that a dramatic expansion of our knowledge of the role of genes as (contributing) causes and a corresponding increase in the capacity for genetic intervention would do nothing to Justify a conservative and uncritical attitude toward existing social practices and political institutions.