Henry T. Greely’s The End of Sex and the Future of Human Reproduction defends the idea that “Easy PGD” (Preimplantation Genetic Diagnosis) will soon replace sexual reproduction as the primary way human beings enter the world.
“Easy PGD” is a logical scientific development beyond in vitro fertilization (IVF). IVF involves fertilizing an egg harvested from a woman with a sperm and then placing the embryo into a uterus. “Difficult” PGD combines IVF with a genetic screen of the prospective embryos for attributes that parents would find desirable in their children and implanting the chosen embryo into the uterus. The “Easy” version is the same as the “Difficult” version except that the embryo comes from stem cells instead of egg and sperm. PGD is already practiced some; it is, however, expensive, inaccurate, time-consuming, and “Difficult.”
Moving from “Difficult” to “Easy” depends upon technical advances in stem cell research and genetics. Genetic advances would include a more thorough mapping of the human genome so that researchers would better grasp how the 6.4 billion base pairs in the human genome contribute to disease risks, physical traits, sex, behaviors, and intellectual traits. These advances, Greely estimates, require a thorough understanding of about 1.5 percent of the bases that spell out the “instructions” for the rest of genome; it may also require a grasp of the 5 to 10 percent of the genome that regulates protein-coding regions. Sometimes such knowledge will reveal destiny (that is, when a certain combination of proteins at a particular gene will produce a particular disease); other times it would yield odds, a 30 percent increase in the likelihood of a cancer diagnosis, for example, or a 50 percent increase in the likelihood of musical ability.
Advances in stem cell technology would make the harvesting of cells necessary to produce the child much easier and less intrusive. Instead of harvesting eggs through laparoscopy, stem cell harvesting allows scientists to make gametes from samples of the mother’s skin. The general process of gamete production has been successfully carried out in mice, suggesting that it could apply to human beings as well. Such harvesting may eventually allow for cells from males to create eggs and cells from females to create sperm, which would mean the possibility of creating gametes from one parent alone.
Advances in both genetic sequencing and in our ability to turn stem cells into gametes are proceeding apace. Greely, a lawyer who directs several programs at Stanford (its Center for Law and the Biosciences, its Steering Committee of the Center for Biomedical Ethics, and its Program in Neuroscience and Society) and is listed on the Stanford Law School web site as “a professor (by courtesy) of genetics at the Stanford School of Medicine,” disclaims any interest in declaring such changes “good or bad.” It is what “will actually happen” in the “next twenty to forty years,” he writes. “Easy PGD” will, he prophesies, lead to
a world where most pregnancies . . . will be started not in bed but in vitro and where most children have been selected by their parents from several embryonic possibilities based on the genomic variations of those embryos and hence the genetically influenced traits of the eventual children.
Imagine. Parents will be handed a profile for dozens of embryos produced from the stem cells provided. Profiles would include risk factors for diseases, traits such as complexion and hair color, sex, the odds of having above average intelligence or artistic ability, and other traits.
Perhaps Embryo One would have no serious diseases, but a 50 percent increased risk of adult colon cancer, dark eyes, moderate height and a 60 percent chance of being in the top 10 percent on the SAT test. Let’s say Embryo Two would have a lower than average risk for Alzheimer’s disease, but would have blue eyes, above average muscle mass and height, hair subject to early graying, and a 80 percent chance of above average SAT scores with a 15 percent increased risk of being in the lowest 25 percent on the SAT. And so on. Parents would then choose which embryo to implant in the womb in the hopes that the embryo would carry to term.
Greely is at pains to point out that “Easy PGD” does not produce “designer babies” or strictly speaking allow for genetic editing. He says it promises only “selected babies.” Reproduction would still be a lottery of sorts. He predicts, in a sense, only modest results from “Easy PGD” if it were practiced widely. It may “produce humans that are about 20 percent healthier and, say, 10 percent better looking and more talented,” he speculates. This healthier population will, he argues, bring down healthcare costs. “Easy PGD” will “pay for itself many times over.”
Occasionally the author soft pedals the likely effects of “Easy PGD” as a merely incremental change in the way things are now done. Not much to see here! Births would still be vaginal. Mothers and fathers may still have “their” children. “Easy PGD” is just a more economical, efficient, accurate, and egalitarian version of IVF that will, Greely predicts, foster a marginally healthier and more talented population pool. He likens the cumulative effect on humanity of “Easy PGD” to better nutrition or sanitation, or a new treatment for disease.
The author is a lover of humanity and a lover of freedom, hoping as he does that this technique will be a safe way to alleviate human suffering while making a “closer match between the children parents want and the children parents get.” Why not welcome such changes for the sake of a better humanity and more parental choice?
Sometimes the demands of humanity conflict with the demands of freedom. Greely worries that “Easy PGD” will become mandatory and that the state may require certain choices when risk factors for disease or character traits are present. Perhaps the state will only allow embryos falling within a certain range of intelligence to be brought to the womb. Society would, Greely knows, certainly have some role to play in the selection of children (in preventing parental decisions that would lead to a severely disabled child, for instance).
In conditions of pluralism, he seems to suggest, people will have to wade through decisions about whether and how to use “Easy PGD.” Yet it is clear that these decisions will be informed by the predominant culture—a culture dedicated to, in the words of one respectable enthusiast, the “right of every child to be born with a sound physical and mental constitution, based on a sound genotype.” Greely brings this reality home when he relates a story about a disabled colleague at an academic conference who accused him of saying that he wished she hadn’t “been born.” That “rocked me,” he writes. “I didn’t wish that she had never been born. Did I?”
“Easy PGD” may be a genetic lottery of sorts, but, to pile up metaphors, the cultural deck would be stacked against the disabled. “It is impossible for me to object to a parental decision to have a child without serious disability,” he says, but he does not say the same thing about the decision to have a child with a disability, serious or otherwise.
If the principle that guides public opinion is the “right of every child to be born with a sound physical and mental constitution, based on a sound genotype,” then “Easy PGD” is but the latest step toward more efficient and better things. Despite his occasional modesty, Greely thinks the coming embrace of this technique “will shape, in some ways, the future of humanity.” Far from a modest amendment to current practice, it will “change fundamentally how our species reproduces.”
The justification for “Easy PGD,” Greely realizes, paves the way, technologically and morally, for additional reforms such as genetic editing, genetic cloning, and greater construction of human genotypes. His major objections to other advances involving greater engineering concern feasibility and safety. He discusses these reforms throughout, showing what the obstacles are to genetic cloning and artificial wombs, and predicting how long it will be until we could develop such technologies. “Easy PGD” enthrones that justification ever more deeply in the popular mind.
As Greely himself asks, “You want the best for your child: why not have the best child you can?” And, “You spend $30,000 on getting the car you want; how much is the baby you want worth to you?” A society that accepts these principles would accept much more than “Easy PGD.”
The author’s contribution to securing the “right of every child to be born with a sound physical and mental constitution” cannot divorced from the larger project and all that it might entail. What if reproduction through actual human sex stands in the way of such a prospect of improving humanity? He seems open to the use of artificial wombs if they can be made to work, so that women would be free to live their normal lives without the “interruption of pregnancy.” He promises to take reproduction beyond sex and beyond marriage, and seems unconcerned that this will affect the commitment adults make to parenting. This book’s proposals and the further changes that its author’s reasoning justifies liberate reproduction from the monogamous, heterosexual family, allowing children to have one parent, or more than two parents, of either sex or of almost any age.
Would parents still want to have children when they are the products of technology? Greely thinks “the drive to procreate” is “an immensely strong drive.” Recent developments show that that drive is variable, as birth rates have sunk well below replacement level in many countries. Parenthood calls forth much responsibility and love from adults—and there are reasons to worry that not every generation is as up to the task as every other generation.
There are also good reasons to think that such “drive” as there is is grounded in the sexual nature of reproduction. When children are ever-more-strictly-speaking choices, and when choosing is valued above all else, fewer people seem inclined to have them. Further detaching children from a context of enduring love probably erodes the human desire for having them. It is also a question whether parents (or whoever) will really love a child of technology (and a question of when a child is seen as a child of technology).
If these are the ramifications, it may indeed become necessary for the state to take responsibility for the production and education of children if people will not do it themselves. Perhaps this state role arises because parents make the “wrong” choices from the public’s perspective. Perhaps the state replaces parents. In any event, Greely, at his headier moments, recognizes that “Easy PGD” and its progeny, so to say, further detach reproduction from its normal human environment.
For this reason those who imagine a future of artificial reproduction (as envisioned in Aldous Huxley’s Brave New World, H.G. Wells’s Time Machine, and Mary Shelley’s Frankenstein, among others) have associated its development with the tyrannical passions of a creator—with the advent of a modern, therapeutic tyranny, and the withering away of the family. Such a tyranny is exercised over the character of future generations through limiting how they will reproduce.
When it comes to the future of the species, “modest proposals” like “Easy PGD” must be understood in the context of the larger project and possible outcomes. Literature and art serve as guides and warnings about the tendencies that flatter technological and tyrannical ambitions. That these ambitions are wrapped in a dedication to humanitarianism does not make them less real or dangerous. Better, it seems, would be the old idea of protecting and building the loving context in which people will choose to have and raise children.