Historically, the concepts of human dignity and rational self-determination have played a major role in shaping ethics. Throughout history, many social and political projects have been defined by acceptance or a rejection of these ideals. The idea that every human life is supremely valuable has deep roots in ancient Abrahamic religious and stoic philosophical traditions that have greatly influenced the character of modern societies. Early Enlightenment liberalism utilized these traditions of human dignity for upholding core principles of equality, fraternity, and rational self-determination. However, other modern traditions rejected these ideas by labeling them as a threat to human progress. Examples of this tendency in action include late modern European colonialism, the fascist movements of the early 20th century, and the eugenics movement, all of which were rooted in traditions of social Darwinism.
In this essay, I will be exploring the complex relationship between genetic engineering, and the intertwined concepts of human dignity and rational self-determination. I will not answer all possible questions regarding this relationship, but I will explore some of the most foundational considerations and apply those considerations to the topic of patient consent to genetic engineering treatments. By exploring these two important moral concepts, I am providing valuable insights about how to fully respect genuine patient consent to genetic engineering treatments.
To begin with, I will describe a very important gene editing tool. CRISPR technology is a gene editing tool which uses natural defense mechanisms in bacteria and archaea; these microorganisms attack viruses and foreign bodies by chopping up their DNA (Vidyasagar 2018). Essentially, CRISPR technology utilizes these defensive mechanisms in microorganisms to edit the genes of more complex organisms (Vidyasagar 2018). CRISPR cuts out DNA strands and manipulates the DNA’s repair mechanism to introduce the intended change (Vidyasagar 2018).
Gene editing is not the first attempt to re-engineer human nature. Even agriculture manipulates biological entities to transform the human diet and along with it the human physiological condition. For this reason, CRISPR gene editing may not represent as radical of a departure from the past as it might seem. If ethicists are to succeed in managing the latest gene editing technologies, then they must study closely the failed social projects of the past which tried to re-engineer human nature through violence, coercion, forced castration, or brutal medical experiments. When approaching a new attempt to scientifically alter human nature, we need to make sure we are not embracing the philosophical attitudes of these historical failures. Noticeably, these disastrous projects lacked any fundamental belief in the importance of human dignity and autonomy.
How should new gene editing technologies relate to the notion of human autonomy? Human autonomy, for many philosophical systems, is deeply intertwined with the idea of human dignity. Importantly, editing a person’s genes before they are born and without their consent might violate many of our most important concepts about human autonomy.
In the thought of the medieval theological philosophers of Judaism, Christianity, and Islam, the human ability to reason was seen as an intrinsic aspect or even the defining aspect of human dignity. For Moses Maimonides and Thomas Aquinas, the rational intellect was the attribute which constituted humanity’s likeness to God. In The Guide for the Perplexed Maimonides wrote, “Collect your thoughts and examine the matter carefully, for it is not to be understood as you at first sight think, but as you will find after due deliberation; namely, the intellect which was granted to man as the highest endowment, was bestowed on him before his disobedience. With reference to this gift the Bible states that “man was created in the form and likeness of God (2007, p.15).””
In the 14th century, Eike von Repkow composed the Sachenspegel, a German language law book of the Holy Roman Empire. According to Professor Dr. Hans Frambach, the text is the first to offer a condemnation of slavery; more specifically, it condemns the practice as a violation of humanity’s likeness to God (2012, p.33). Prior to this medieval innovation, the Abrahamic religions offered no direct condemnation of slavery and many classical philosophers such as Aristotle praised slavery as an intrinsic aspect of the natural order. The innovation of anti-slavery theology prioritized the moral importance of the imago Dei (image of God) concept in governing human affairs.
As we can see from the historical examples above, the ideas of human dignity and human autonomy are intimately intertwined. In fact, even in the ideas of the great Prussian Enlightenment philosopher Immanuel Kant, we can see an example of this connection. Kant rejected many of the ideas essential to medieval theological philosophy such as the ontological arguments for God, the unity of ethics and theology, and many aspects of medieval metaphysics. However, Kant maintained an even stronger emphasis on human autonomy while linking this notion to the dignity of human rationality. In this way, he affirmed one idea that was also articulated by some medieval theological philosophers.
For Immanuel Kant, freedom is not only a lack of external coercion, but it is also defined by self-legislation through reason. According to the Stanford Encyclopedia of Philosophy, “The idea of freedom as autonomy thus goes beyond the merely “negative” sense of being free from causes on our conduct originating outside of ourselves. It contains first and foremost the idea of laws made and laid down by oneself, and, in virtue of this, laws that have decisive authority over oneself (Johnson & Cureton 2016).” For Kant, morality does not originate from some form of enlightened self-interest; instead, morality requires the altruism of respecting the universal right to self-operate through reason. Importantly, Kantian ethics strongly emphasizes always treating others as an end rather than as a means to an end.
From the examples above, we can see that the notions of human dignity and autonomy have origins in theological traditions. However, the ideas were shown to be adaptable, and they were successfully incorporated into secular philosophies. For this reason, these concepts can be respected by people with diverse religious and philosophical beliefs. Importantly, the scientific fact of the unique complexity of the human brain can serve as a foundation for belief in the importance of human dignity and autonomy.
If we affirm the ethical importance of rational autonomy and human dignity, then how should these ideas apply to the ethics of gene editing? A full answer to this question would likely require multiple books exploring specific applied ethical dilemmas. There are several reasons why this question is so complicated. Firstly, there are many circumstances in which the rational and autonomous intellect is not properly informed about a complex decision; within such circumstances, it is not possible for a patient to genuinely consent to a given medical procedure involving genetic engineering.
So, what does it mean for a patient to be properly informed? Firstly, it is essential that the patient has access to all information necessary for reasoning their way to a proper conclusion. For a logical argument to be true, then all the premises must be true. Therefore, a patient needs all the true and relevant premises that are necessary for them to reason their way to a genuine expression of rational self-determination.
The patient would need to understand the changes that would be made to their genetics, and how these changes would interact with their complete biological system. A full list of potential benefits and risks would need to be provided to the patient. Furthermore, an estimate must be provided about the scope of unforeseen benefits and risks involved in the procedure. An understanding of this scope would be based upon prior applications of a given procedure. If a given procedure had been applied many times in the past, then there would be a lesser extent of unforeseen consequences. Therefore, it is necessary to provide the patient with knowledge of past applications of the procedure.
In addition to being fully informed, a patient must also be given a sufficient amount of time to think through their decision. An impulsive decision cannot be understood as a genuine expression of rational self-determination. A complex decision requires time and careful logical reflection. Therefore, medical institutions must not pressure patients into making decisions very quickly about genetic engineering operations.
However, there are limitations to the moral validity of rational self-determination. When operating under the principles of human dignity and autonomy, we ought to let each unique person operate independently as long as they do not seek to inflict harm or tyranny on other people. It is not ethical to give people the right to weaponize their rational self-determination against other people. Furthermore, the power of rational self-determination is a universal human right, and people should not be allowed to use this power to deny this same right to others.
Additionally, rational self-determination is not a valid reason for allowing some people to acquire unfair advantages through genetic engineering. If a given treatment functions not as a medicine for an illness but as an enhancement of human capabilities, then it might not constitute an ethical expression of rational self-determination. Firstly, the very notion of genetic enhancements implies value judgements about what are desirable and undesirable genetic features. Such judgements will always be conditioned by cultural and societal biases and traditions that are not universally to all societies. Furthermore, even if such judgements are universal, it would not necessarily follow that they are valid judgements.
If a given genetic feature is perceived as an enhancement, then it follows that it would be considered as desirable. And if it is perceived as desirable then any opposite or dissimilar genetic features would be considered undesirable. Furthermore, if a genetic feature is deemed desirable, then this judgement would impose a stigma against any opposite or dissimilar genetic features. It is not hard to imagine that societal prejudice and oppression would follow almost immediately from the attitudes implicit within the concept of genetic engineering for enhancements.
Furthermore, if genetic enhancements are available, then this might threaten the genetic diversity of humanity. Genetic features are derived from millions of years of evolution and genetic diversity is a highly beneficial aspect of the ecological condition of our planet. Furthermore, these genetic features are a response to diverse ecosystems that require different features for survival and reproduction. We do not understand which genetic features will be necessary for future ecological conditions. We are currently living within an age of massive environmental destruction due to human activity. However, it is not clear if this age of environmental destruction will continue indefinitely. It is possible that new technologies may reduce humanity’s environmental impact and allow for an age of environmental restoration. However, even if an age of environmental restoration does occur after the current age of extreme destruction, the result would still be a very different environmental condition than exists within the present.
Changing environmental circumstances will likely lead to cultural change. Different cultures have always been shaped by unique environmental changes. And along with cultural change, there will be new subjective understandings of what constitutes a genetic enhancement. Environmental change will alter which diseases our immune systems will need to fight. It will also change the type of weather that we will need to survive within. Likewise, global food systems will change in response extreme environmental change, and our genetic characteristics will also need to adapt to changing diets. Ultimately, these are changes that have always been occurring and evolution has always been shaping how our genetic system adapts to such changes.
Such facts beg the question of whether human intervention within these processes is wise or if it is a self-destructive form of hubris. Due to this remarkably different future, we cannot be certain about which genetic features will be the most beneficial within future circumstances. Indeed, it might be wiser to allow nature to determine the genetic future of humanity without any human intervention. And if genetic engineering does reduce the genetic diversity of humanity, this could result in many unforeseen harmful consequences.
Another problem with using genetic engineering for enhancements is that diverse forms of beauty, fitness, and intelligence exist. Likewise, there are no objective criteria for labeling these diverse features as relatively superior or inferior. And there always exists the need for diversity to exist within humanity, so that diverse talents exist within society.
Furthermore, if society becomes obsessed with genetic engineering enhancements, where does that leave those with genetic characteristics deemed undesirable? The result is likely that such people would feel enormous social and cultural pressures to modify their genetics to match up with harshly judgmental cultural preferences. In such cases, the integrity of the concept of consent would be threatened. Consent is not valid if there is intimidation or harsh social pressure interfering with the decision-making process. If a person would suffer from societal prejudice or discrimination if they did not decide to undergo a genetic enhancement treatment, then they would no longer be able to genuinely consent to such a treatment. In this case, such societal conditions would therefore render the concept of consent meaningless.
Another problem with genetic enhancements is that if a parent were to genetically enhance their baby, then the child would likely grow up under the oppressively high expectations from their parents. Their parents would likely put enormous pressure on their children to be perfect and successful within every aspect of life. Additionally, if the children knew that they were genetically enhanced by their parents, they would likely feel obligated to be perfect in every aspect of life. Along with such perfectionist attitudes there would inevitably be severe mental health problems. It is impossible to be perfect and successful in every aspect of life, and if a person becomes intolerant of their own failures, then this will lead to severe problems with depression, disappointment, low self-esteem, and even suicide.
Importantly, parents genetically enhancing their children violates the primacy of individual rational self-determination. It fundamentally violates the human right to control one’s own destiny and one’s own unique identity. It would also imply the objectification of children into products of parental purchasing power. It would unethically deny them the status of independent people who are not the possession of others. It would violate a person’s sense of independence and wholistic self-completion to know that other people had chosen to enhance them without their consent. Likewise, the state does not possess the right to enhance people without their consent either.
Using AI as a foundation for creating genetic engineering treatments further complicates the need for autonomous and informed consent to such treatments. AI algorithms are often extraordinarily complex, which would add obscurity to the logic that was involved in the process of creating the resulting genetic engineering treatment. Furthermore, even AI engineers sometimes struggle to understand why AI systems make the decisions that they make. Given the obscurity of AI generated output, it becomes more difficult to explain to a patient why a certain genetic engineering treatment was developed in the way that it was. It would also likely increase the difficulty involved in explaining the benefits and risks involved in the genetic engineering treatments. And given that informed consent requires knowledge of benefits and risk and sometimes might require extensive knowledge of how a treatment was developed, AI certainly has the potential to complicate the ethics of informed consent to genetic engineering treatments.
Importantly, we should not use individuals as tools for accomplishing utilitarian or utopian goals. All people possess the right to use reason to make decisions about their genetics. In fact, a person’s genetics might be their most fundamental possession. And if a given regime seeks to instrumentalize people for accomplishing what they perceive to be the optimization of societal systems or a superior genetic future for humanity, then this would be a fundamentally immoral regime that violates essential human rights.
The primacy of individual self-determination when it comes to their own genetics is not absolute. However, it is a primacy that overrides other concerns within the majority of circumstances. And yet rational self-determination is not possible for babies, who are too young to reason their way to a decision about whether their genetics should be edited or not. So, who has the moral right to make such decisions? If a baby suffers from a severe genetically rooted disease or disorder, it might be ethical for the doctors or the parents to make such a decision in their place. Adults are morally obligated to offer protection to minors, and in some cases, this requires adults to make decisions on their behalf.
All humans naturally avoid suffering. And if a given disease or disorder is severe and will cause suffering without also providing any known benefits, then it is logical that any person would want to cure such a disease or disorder. It is therefore safe to assume that if a given baby were capable of such a decision, they might decide in favor of a genetic engineering treatment rather than suffering from a disease or a disorder.
However, there are genetic conditions that offer complex benefits and disadvantages for a given person. In such cases, doctors and parents do not have the right to decide for a baby whether they would like to live with such a condition. Due to the primacy of rational self-determination, individuals must be granted the right to decide for themselves. However, a large grey area can exist in between categories such as enhancements and disease treatments. And therefore, a lot of highly specified reasoning is necessary to determine ethicality.
All the concerns listed above are valid reasons to be cautious about genetic engineering applied for enhancements. Due to these concerns, a person’s rational self-determination cannot always be allowed to have its way. If a person’s rational self-determination violates an important principle rooted in societal, environmental, or biological concerns, then it is not ethical to proceed with the operation.
Editing human genetics might become a form of self-governance or a form of self-destruction. In some sense, most human decisions are forms of self-creation as many decisions will shape one’s character and many other decisions will influence a person’s physical and intellectual development. Human personality is defined by habit. Likewise, habits are developed through the accumulation of a person’s decisions. For this reason, human personalities are to some extent created through decision making. At the core of the ethic of human dignity and autonomy is respect for each unique human mind and its ability to shape its own humanity. In particular, the notion of human dignity should ideally involve respect for the uniqueness of each personality, especially regarding a personality’s origins in self-governance. Gene editing, if imposed on a human person without their consent, would almost always violate this principle. In contrast, if a gene editing process was accepted by the rational consent of a person, then it might constitute a valid expression of that individual’s right to self-determination. In the case of CRISPR technology, this self-expression might legitimately take place through a process of rational self-determination that is well-informed and not exceeding the moral boundaries that limit autonomous decision making.
List of References
Vidyasagar, A 2018, ‘What Is CRISPR’, Live Science, 21 April, viewed 22nd March 2020, <https://www.livescience.com/58790-crispr-explained.html>
Maimonides, M 2007, The Guide for the Perplexed, Cosimo, Inc., New York.
Frambach, H 2012, ‘Liberation of the Serfs: The End of Forced Labor?’, in JB Backhaus (ed.), The Liberations of the Serfs: The Economics of Unfree Labor, Springer Publishing Company, New York, p.33.
Johnson, R & Cureton, A 2016, ‘Kant’s Moral Philosophy’, Stanford Encyclopedia of Philosophy, N.A., N.A., viewed 22nd March 2020, <https://plato.stanford.edu/entries/kant-moral/#Aut>.