Perspectives in Biology and Medicine

This book provides scientific background on human inheritable genetic modifications (IGM, also referred to as germ-line interventions) and analyses of the ethical, religious, and policy implications of IGM by members of an interdisciplinary working group convened by the American Association for the Advancement of Science (AAAS). Co-editors Audrey Chapman and Mark Frankel each led AAAS projects related to the topic. Chapman is Director of the Science and Human Rights, and the Dialogue on Science, Ethics, and Religion Programs of AAAS; Frankel is Director of the Scientific Freedom, Responsibility and Law Program.

Two introductory chapters delineate the relevant issues and clarify terms employed in debates about genetic interventions. The next five chapters survey the available and anticipated technologies for IGM and describe its potential effectiveness for treatment of disease and promotion of "enhancing" characteristics [End Page 468] or behaviors. As many authors recognize, the distinction between "therapy" and "enhancement" raises slippery slope concerns because the same interventions may be used to serve both goals, only one of which (therapy) is widely supported. Moreover, what individuals or society considers enhancement or therapy varies considerably. Some potential applications of IGM are uncontroversially regarded as therapeutic or enhancing, but many are not.

Nine chapters are devoted to ethical and religious positions about IGM. Some authors focus on traditional teachings of Judaism, Protestantism, and Roman Catholicism; differences within these traditions are not explored. Some articles by theologians are more philosophically astute than those written by philosophers. Ronald Cole-Turner, for example, develops an intriguing and attractive insight about the implications of "designer progeny." "A designed child is not a child at all," he writes, "for being a child implies having a relationship with parents," and that relationship is impossible if the child "is a product of a technology in the service of a human will." For Cole-Turner, "if I design you, you are to me not a you but an it" (191). Sondra Wheeler explicitly incorporates theological considerations of creation and eschatology into her analysis of parental power, as "liberty for their children, not simply liberty over-against them" (242). Because parents are procreators rather than creators of their children, parental authority is to be "exercised as God's agents and not as God's replacements" (244). Accordingly, "when we enter into the relationship, we don't know who is coming" (244). For Wheeler, this unconditional commitment of parenthood serves as a criterion for assessing the ethics of IGM.

Theologians as well as non-theologians consider the potential of IGM for exacerbating injustices based on class and race, and one author critiques bioethicists for their "trained incapacity" to attend to group-based differences associated with inequality (157). No one, however, explicitly explores the potential of IGM for gender injustice, ignoring the fact that women, not men, undergo risks and harms through generation or gestation of embryos on which IGM may be performed.

Like most anthologies, some articles are more clearly written and more scholarly than others. Pilar Osario's account is especially nuanced and well-argued. The complex but related philosophical issues she confronts are the replacement argument and the non-identity problem. The replacement argument is based on the claim that parents have an obligation to insure, to the extent that they can, that their children are born without serious disabilities. If they would otherwise have a child who is genetically disabled, they should take measures to replace him or her with a child who is not disabled. The non-identity problem stems from the fact that a replaced child is not the same as the one whose birth was prevented: "how can we do something on somebody's behalf if she or he never exists?" (253).Therapeutic IGM may be considered preferable to embryo testing and selection because it avoids concerns about "replacement." For Osario, however, IGM may also constitute a form of replacement: "Changing even one gene or one nucleotide could so significantly alter a person...