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Human capabilities, mild autism, deafness and the morality of embryo selection

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Abstract

A preimplantation genetic test to discriminate between severe and mild autism spectrum disorder might be developed in the foreseeable future. Recently, the philosophers Julian Savulescu and Guy Kahane claimed that there are strong reasons for prospective parents to make use of such a test to prevent the birth of children who are disposed to autism or Asperger’s disorder. In this paper we will criticize this claim. We will discuss the morality of selection for mild autism in embryo selection in a hypothetical in vitro fertilization (IVF) situation where preimplantation genetic diagnosis is performed and compare this with a similar selection for congenital deafness. To do this we first discuss relevant human differences. We then introduce the principle of human capabilities (PC) and compare this principle with the principle of procreative beneficence (PB) introduced by Savulescu and Kahane. We apply the two principles to selection for mild autism and selection for congenital deafness. We argue that PC allows for the selection for mild autism but rules out selection for congenital deafness. PB will not give clear answers; the ruling of PB depends to a large extent on expected social, cultural and political developments. We will argue that PC is preferable to PB. We will discuss arguments for the value of mild autism for individuals who have this condition and argue that they are able to lead a life with human dignity provided autism-friendly social circumstances are present. Neither PC nor PB yields strong reasons for prospective parents to seek to prevent the birth of children who are disposed to mild autism spectrum disorder.

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Notes

  1. In a fertilized human egg (an early embryo) consisting of up to eight cells, one of the cells can be removed for genetic investigation. That cell is destroyed in the process, but the rest of the embryo develops in a normal way.

  2. The Diagnostic and Statistical Manual of Mental Disorders (fourth edition, text revision) states that the primary diagnostic abnormalities in autistic disorder are qualitative impairment in social interaction, qualitative impairments in communication, and restricted repetitive and stereotyped patterns of behavior, interests, and activities. Asperger’s disorder is at the mild end of autism spectrum disorders, and severe autistic disorder is at the other end. Asperger’s disorder differs from ‘classic’ autism in that those diagnosed with Asperger’s do not show evidence of intellectual deficiency or language delay.

  3. The term ‘neurotypical’ is used by people with autism spectrum conditions for people without such conditions.

  4. A neurotypical person appears to be able to change into a person with autistic-like behavior. When young children are reared in depriving circumstances, they may develop post-institutional autistic syndrome, also called ‘quasi-autism’ (Rutter et al. 2010).

  5. Contemporary research suggests the presence of minicolumnopathy (minicolumnar abnormalities in the brain) in autism (Williams and Casanova 2010; Casanova et al. 2010).

  6. According to Kruijver et al. (2000), there may be a neurobiological basis of gender identity disorder. Recent research using magnetic resonance imaging sheds a different light on this matter. “[r]egional gray matter variation in MTF (male to female) transsexuals is more similar to the pattern found in men than in women (Luders et al. 2009).” However, Luders et al. support the assumption that brain anatomy plays a role in gender identity.

  7. According to Garcia-Falgueras and Swaab (2010), our gender identity (the conviction of belonging to the male or female gender) is intrauterinely programmed or organized into our brain structures.

  8. This ‘psychological’ explanation is highly debatable. “Some studies, […], suggest that instead of being preconditions for the development of GID (Gender Identity Disorder), psychiatric problems may be the consequences of persistent psychological difficulties due to the incongruence of biological sex and gender identity on the one hand and the social rejection on the other (Lajos et al. 2011)”.

  9. Although this is a very influential theory, we do not wish to suggest that the extreme male brain theory of autism has reached scientific consensus.

  10. “All we know about the extreme female brain is that, […] it is predicted to arise. […] Their empathizing would be significantly better than other people in the general population, but their systemizing would be impaired. These would be people who have difficulty understanding maths or physics or machines or chemistry as systems, but who are extremely good at tuning into others’ feelings and thoughts (Baron-Cohen 2002b, p. 253)”.

  11. “Through a mutation, a recessive gene brought out by inbreeding, a form of hereditary deafness existed for 250 years on Martha’s Vineyard, Massachusetts, following the arrival of the first deaf settlers in the 1690’s. By the mid nineteenth century […] the incidence of deafness had risen to one in four. In response to this, the entire community learned Sign, and there was free and complete intercourse between the hearing and the deaf. Indeed the deaf were scarcely seen as ‘deaf’, and certainly not seen as being at all ‘handicapped’ (Sacks 1989, p. 33)”.

  12. The blind hen analogy may seem a bit farfetched. However, we believe it serves pretty well to illustrate the intuition that is at work in the (for humans) more important matter of choosing embryos without one or more central human functional capabilities. The function of the analogy is not to convince, but merely to compare it with the intuition (‘emotion’ or ‘upheaval of thought’) at work in the case of choosing embryos without one or more central human functional capabilities.

  13. “All these capabilities are implicit in the idea of a life worthy of human dignity (Nussbaum 2006, p. 70).” “Any child born into a species has the dignity relevant to that species, whether or not it seems to have the “basic capabilities” relevant to that species. For that reason, it should also have all the capabilities relevant to the species […] (Nussbaum 2006, p. 347)”.

  14. Emphasis added.

  15. e.g. autosomal recessive deafness 1A (DFNB1A) (Barashkov et al. 2011).

  16. See e.g. Clarke and van Amerom 2008.

  17. Assuming there is a genetic marker for homosexuality.

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Acknowledgments

We are grateful to the anonymous reviewers for valuable comments.

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  1. Division of Health and Society, IMH, University of Linköping, SE-581 83, Linköping, Sweden

    Pier Jaarsma & Stellan Welin

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  1. Pier Jaarsma
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Correspondence to Pier Jaarsma.

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Jaarsma, P., Welin, S. Human capabilities, mild autism, deafness and the morality of embryo selection. Med Health Care and Philos 16, 817–824 (2013). https://doi.org/10.1007/s11019-013-9464-6

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