The code breaker, p.32
The Code Breaker, page 32
Suppose there was a genetic edit that could add eight inches to a kid’s height. Would it be proper to use it on a boy who would otherwise be under five feet tall to turn him into someone of average height? What about using it on a boy who would otherwise be average height to make him six-foot-five?
A way to wrestle with these questions is by making a distinction between “treatments” and “enhancements.” For various traits—height, eyesight, hearing, muscular coordination, and so on—we could use a statistical method to define “typical species functioning.” A significant variation below that would be defined as a disability.9 Using that standard, we might approve of treating a kid who would be less than five feet tall but reject the idea of enhancing a kid who would otherwise be of average height.
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By pondering the question of height, we can make another distinction that is useful: the difference between an absolute improvement and a positional improvement. In the first category are enhancements that are beneficial to you even if everyone else gets them. Imagine there was a way to improve your memory or your resistance to virus infections. You’d be better off with it, even if others got the same enhancement. In fact, as the coronavirus pandemic shows, you would be better off especially if others had that enhancement as well.
But the advantages of increased height are more positional. Let’s call it the standing-on-tiptoes problem. You’re in the middle of a crowded room. To see what’s going on in the front, you stand on your tiptoes. It works! But then everyone else around you tries it. They all get two inches higher. Then nobody in the room, including you, sees any better than the people in the front row.
Likewise, suppose I’m an average height. If I were enhanced by eight inches, I’d be way taller than most people, and that could be a benefit to me. But if everyone else got the same eight-inch enhancement I did, then I would get no real benefit. The enhancement wouldn’t make me or society as a whole better off, especially given the legroom of airline seats these days. The only sure beneficiaries would be carpenters who specialized in raising door frames. So enhanced height is a positional good, while enhanced resistance to viruses is an absolute good.10
That doesn’t answer the question of whether we should allow genetic enhancements. But as we grope for a set of principles to include in our moral calculus, the distinction does point to a factor we should consider: favoring enhancements that would benefit all of society over those that would give the recipient a positional advantage.
Super-enhancements and transhumanism
Perhaps some enhancements will gain broad social acceptance. Then what about super-enhancements? Should we ever want to engineer traits and capacities that exceed what any human has ever had? The golfer Tiger Woods had laser surgery to improve his eyesight to be even better than 20/20. Might we want our kids to have super-eyesight? What about adding the capacity to see infrared light or some new color?
DARPA, the Pentagon’s research agency, might someday want to create superior soldiers with night vision. They could also imagine an enhancement that allowed human cells to be more resistant to radiation in case of a nuclear attack. Actually, they aren’t just imagining that. DARPA already has a project going, in conjunction with Doudna’s lab, to study how to create genetically enhanced soldiers.
One odd result of allowing super-enhancements could be that children will become like iPhones: a new version will come out every few years with better features and apps. Will children as they age feel that they are becoming obsolete? That their eyes don’t have the cool triple-lens enhancements that are engineered into the latest version of kids? Fortunately, these are questions we can ask for amusement but not for an answer. It will be up to our grandchildren to figure these out.
Psychological disorders
Two decades after the completion of the Human Genome Project, we still have little understanding of how human psychology is influenced by genetic dispositions. But eventually, we may isolate genes that contribute to a predisposition to schizophrenia, bipolar disorder, severe depression, and other mental challenges.
Then we will have to decide whether we should allow, or perhaps even encourage, parents to make sure that these genes get edited out of their children. Let’s pretend to go back in time. If some of the genetic factors predisposing James Watson’s son Rufus to schizophrenia could have been edited out, would that have been a good thing? Should we have allowed his parents to make the decision to do that?
Watson has no doubt what the answer should be. “Of course we should use germline therapy to fix things like schizophrenia that nature got horribly wrong,” he says. Doing so would lead to a lot less suffering. Schizophrenia, depression, and bipolar disorder can be brutal, often deadly. No one would want to inflict it on a person or on any person’s family.
But even if we agree that we want to rid humanity of schizophrenia and similar disorders, we should consider whether there might be some cost to society, even to civilization. Vincent van Gogh had either schizophrenia or bipolar disorder. So did the mathematician John Nash. (And also Charles Manson and John Hinckley.) People with bipolar disorder include Ernest Hemingway, Mariah Carey, Francis Ford Coppola, Carrie Fisher, Graham Greene, Julian Huxley (the eugenicist), Gustav Mahler, Lou Reed, Franz Schubert, Sylvia Plath, Edgar Allan Poe, Jane Pauley, and hundreds of other artists and creators. The number of creative artists with major depressive disorder is in the thousands. A study by schizophrenia-research pioneer Nancy Andreasen of thirty prominent contemporary authors showed that twenty-four had experienced at least one episode of major depression or mood disorder, and twelve were diagnosed with bipolar disorder.11
To what extent does dealing with mood swings, fantasies, delusions, compulsions, mania, and deep depression help spur, in some people, creativity and artistry? Is it harder to be a great artist without having some compulsive or even manic traits? Would you cure your own child from being schizophrenic if you knew that, if you didn’t, he would become a Vincent van Gogh and transform the world of art? (Don’t forget: Van Gogh committed suicide.)
At this point in our deliberations, we have to face the potential conflict between what is desired by the individual versus what is good for human civilization. A reduction in mood disorders would be seen as a benefit by most of the afflicted individuals, parents, and families. They would desire it. But does the issue look different when asked from society’s vantage point? As we learn to treat mood disorders with drugs and eventually with genetic editing, will we have more happiness but fewer Hemingways? Do we wish to live in a world in which there are no Van Goghs?
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This question of engineering away mood disorders gets to an even more fundamental question: What is the aim or purpose of life? Is it happiness? Contentment? Lack of pain or bad moods? If so, that may be easy. A painless life was engineered by the overlords in Brave New World, who made sure the masses had soma, a drug that enhanced their sense of joy and allowed them to avoid discomfort, sadness, or anger. Suppose we could hook our brains to something the philosopher Robert Nozick called an “experience machine,” which allowed us to believe that we were hitting home runs and dancing with movie stars and floating in a beautiful bay.12 It would make us always feel blissful. Would that be desirable?
Or does the good life have aims that are deeper? Should the goal be that each person can flourish, in a more profound fashion, by using talents and traits in a way that is truly fulfilling? If so, that would require authentic experiences, real accomplishments, and true efforts, rather than engineered ones. Does the good life entail making a contribution to our community, society, and civilization? Has evolution encoded such goals into human nature? That might entail sacrifice, pain, mental discomforts, and challenges that we would not always choose.13
Smarts
Now let’s deal with the final frontier, the one most promising and frightful: the possibility of improving cognitive skills such as memory, focus, information processing, and perhaps even someday the vaguely defined concept of intelligence. Unlike height, cognitive skills are beneficial in more than just a positional way. If everyone were a bit smarter, it probably would make all of us better off. In fact, even if only a portion of the population became smarter, it might benefit everyone in society.
Memory may be the first mental improvement we will be able to engineer, and fortunately it is a less fraught topic than IQ. It has already been improved in mice, such as by enhancing the genes for NMDA receptors in nerve cells. In humans, enhancing those genes could help prevent memory loss in old age, but it could also enhance memory in younger people as well.14
Perhaps we will be able to improve our cognitive skills so that we can keep up with the challenges of using our technology wisely. Ah, but there’s the rub: wisely. Of all the complex components that go into human intelligence, wisdom may be the most elusive. Understanding the genetic components of wisdom may require us to understand consciousness, and I suspect that’s not going to happen in this century. In the meantime, we will have to deploy the finite allocation of wisdom that nature has dealt us as we ponder how to use the gene-editing techniques that we’ve discovered. Ingenuity without wisdom is dangerous.
CHAPTER 42 Who Should Decide?
The National Academy’s video
The tweet was provocative, a bit more provocative than it was intended to be. It read:
Dream of being stronger? Or smarter? Do you dream of having a top student or star athlete? Or a child free of inheritable #diseases? Can human #GeneEditing eventually make this and more possible?
It was an attempt by the usually staid National Academy of Sciences in October 2019 to spur a “broad public discussion” of gene editing, just like all of those conferences on the topic had recommended. The tweet linked to a quiz and a video explaining germline gene editing.
The video began with five “everyday people” putting sticky notes onto a diagram of a body and fantasizing about what changes they would make in their genes. “I guess I would like to be taller,” said one. Other personal desires included: “I would like to change body fat”; “Let’s prevent baldness”; “Take away dyslexia.”
Doudna was in the video explaining how CRISPR works. Then it showed people discussing the prospect of designing the genes of their future children. “Create the perfect human being?” one man mused. “That’s pretty cool!” Said another, “You want the best qualities to be put into your offspring.” A woman chimed in, “If I had the chance to choose the best DNA for my child, I would definitely want her to be smart.” Others discussed their own health problems, such as attention-deficit disorder and high blood pressure. “I would take that out, for sure,” a man said of his heart disease. “I don’t want my kids to deal with it.”1
Bioethicists immediately erupted on Twitter. “What a mistake,” tweeted Paul Knoepfler, a cancer researcher and bioethicist at the University of California, Davis. “Who at National Academy of Sciences’ media office is behind this bizarre tweet & page it links to that seems troublingly upbeat about human heritable gene editing & to trivialize idea of designer babies?”
Twitter, unsurprisingly, is not the best forum to discuss bioethics. There is a truism about internet comment boards: any discussion descends to shouting “Nazi!” within seven responses. In the case of the gene-editing threads, it was more like by the third response. “Are we still in 1930s Germany?” one person tweeted. Another added, “How did this read in the original German?”2
Within a day, the folks at the National Academy of Sciences had sounded retreat. The tweet was deleted and the video pulled off the web. A spokesperson apologized that they had “left the misimpression that the use of genome editing for the ‘enhancement’ of human traits is permissible or taken lightly.”
The brief tempest showed that the bromide of calling for greater societal discussion about the morals of gene editing was easier preached than practiced. It also raised the question of who should get to decide how gene-editing tools should be used. As we saw in the thought experiments in the previous chapter, many of the difficult questions about gene editing involve not just how to decide the issue, but who should decide. As is the case with so many policy issues, the desires of an individual might conflict with the good of the community.
The individual or the community?
On most great moral issues, there are two competing perspectives. One emphasizes individual rights, personal liberty, and a deference to personal choice. Stemming from John Locke and other Enlightenment thinkers of the seventeenth century, this tradition recognizes that people will have different beliefs about what is good for their lives, and it argues that the state should give them a lot of liberty to make their own choices, as long as they do not harm others.
The contrasting perspectives are those that view justice and morality through the lens of what is best for the society and perhaps even (in the case of bioengineering and climate policy) the species. Examples include requirements that schoolkids be vaccinated and that people wear masks during a pandemic. The emphasis on societal benefits rather than individual rights can take the form of John Stuart Mill’s utilitarianism, which seeks the greatest amount of happiness in a society even if that means trampling on the liberty of some individuals. Or it can take the form of more complex social contract theories, in which moral obligations arise from the agreements we would make to form the society we want to live in.
These contrasting perspectives form the most basic political divide of our times. On the one side are those who wish to maximize individual liberty, minimize regulations and taxes, and keep the state out of our lives as much as possible. On the other side are those who wish to promote the common good, create benefits for all of society, minimize the harm that an untrammeled free market can do to our work and environment, and restrict selfish behaviors that might harm the community and the planet.
The modern foundations for each of these perspectives was expressed in two influential books written fifty years ago: John Rawls’s A Theory of Justice, which comes down on the side of favoring the good of the community, and Robert Nozick’s Anarchy, State, and Utopia, which emphasizes the moral foundation for individual liberty.
Rawls seeks to define the rules that we would agree to if we had gathered to make a compact. In order to make sure things are “fair,” he said that we should imagine what rules we would make if we didn’t know what place we would each end up occupying in society and what natural abilities we would have. He argues that, from behind this “veil of ignorance,” people would decide that inequalities should be permitted only to the extent that they result in benefits for all of society, and specifically for the least advantaged. In his book, this leads Rawls to justify genetic engineering only if it does not increase inequality.3
Nozick, whose book was a response to that of his Harvard colleague Rawls, likewise imagined how we might emerge from the anarchy of a state of nature. Instead of a complex social contract, he argues that social rules should arise through the voluntary choices of individuals. His guiding principle is that individuals should not be used to promote a social or moral goal devised by others. This leads him to favor a minimalist state that is limited to functions of public safety and enforcement of contracts but avoids most regulations or redistribution efforts. He addresses, in a footnote, the question of genetic engineering, and he takes a libertarian, free-market view. Instead of centralized control and rules set by regulators, he says that there should be “a genetic supermarket.” Doctors should accommodate “the individual specifications (within certain moral limits) of prospective parents.”4 Since he wrote his book, the term “genetic supermarket” has become a catchphrase, used by fans and foes, for leaving genetic engineering decisions to individuals and the free market.5
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Two science fiction books can also help shape our discussion: George Orwell’s 1984 and Aldous Huxley’s Brave New World.6
Orwell conjures up an Orwellian world in which information technology is used by “Big Brother,” a leader that is always watching you, to centralize power in a super-state and exert control over a cowed populace. Individual freedom and independent thinking are crushed by electronic surveillance and total information control. Orwell was warning about the danger that a Franco or Stalin would someday control information technology and destroy individual freedom.
It didn’t happen. When the real 1984 actually rolled around, Apple introduced an easy-to-use personal computer, the Macintosh, and in the words that Steve Jobs wrote for its ad, “you’ll see why 1984 won’t be like 1984.” That phrase contained a deep truth. Instead of computers becoming an instrument for centralized repression, the combination of the personal computer and the decentralized nature of the internet became a way to devolve more power down to each individual, thus unleashing a gusher of free expression and radically democratized media. Perhaps too much so. The dark side of our new information technology is not that it allows government repression of free speech but just the opposite: it permits anyone to spread, with little risk of being held accountable, any idea, conspiracy, lie, hatred, scam, or scheme, with the result that societies become less civil and governable.
The same may be the case for genetic technologies. In his 1932 novel, Huxley warned of a brave new world of centralized government control of reproductive science. Human embryos are created at a “hatchery and conditioning center” and then sorted to be engineered for different social purposes. Those chosen for the “alpha” class are enhanced physically and mentally to become leaders. At the other end of the spectrum, those in the “epsilon” class are bred to become menial laborers and conditioned for a life of induced blissful stupor.
