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The first moves in their argument relate to the status of the conceptus C, siding with Elliot,[i] they agree that CT does not necessarily change the identity of C, that the replacement or alteration of small amounts of genetic material is unlikely to alter C’s identity and if this was the case the "CT does not involve Killing C, let alone killing anything else."[ii] Even if it were the case that the CT was such that it did alter or replace the identity of C, this would not constitute the killing of a person, as "the conceptus does not have the psychological properties that are necessary for personhood."[iii]
It is from this point that Holtug and Sandoe move forward to confront the problem that Zohar sees with Radical CT, that is that radical CT does not benefit the person on whom it is conducted and that therefore there can be no person-regarding reasons for the therapy only impersonal value judgements as to its benefits, which Zohar views as not being strong to motivate the calls for genetic interventions. Holtug and Sandoe “claim that there is no morally relevant difference between radical and non-radical CT.”[iv]
Zohar’s reasoning on this appears to be tied a narrow person-affecting principle NP which is “In order for there to be a person-affecting reason to bring about outcome X rather than Y, there must be at least one person that exists in both X and Y and is better off in X.”[v] The problem for radical CT is that it appears not to satisfy the above principle and therefore there cannot be person-affecting reasons for its performance only impersonal value judgements. This combined with the claim person-affecting moral reasons have a much higher moral value than do impersonal ones provide the basis for Zohar’s claim that while we have good reasons for performing non-radical CT, we do not have them for radical CT. It is the contention of Hotug and Sandoe that this is not the case.
To highlight their argument with respect to their claims they put forward examples derived from Parfit’s examples in relation to his non-identity problem.[vi] The examples relate to two women who live in an area where the dumping of chemical waste in a local lake, cause any woman who stays in the area while pregnant to give birth to a child with severe birth defects. The first young woman is pregnant and when she consults her doctor is told that there is a drug available that if she takes it her child will not have disease in question. Due to the fact she is already pregnant NP shows that there are person-affecting reasons for her to take the drug as the same child will exist whether or not she takes the drug and will be better off if she takes the drug.
The second woman goes to see her doctor at a time six months before the drug available to the first woman is available, with respect to her wishing to become pregnant. The doctor tells her that if she waits for six months before she becomes pregnant then there will be available a drug that will allow her child to be born without the defects, but if she decides to become pregnant now the child will have the disorder. In this case it appears that NP tells us that the woman does not have person-affecting reasons for postponing her pregnancy as there is not currently an existing child who will be better off if she waits.
Holtug and Sandoe say that this brings us to the conclusion that “the first woman is doing something much worse if she did not take the drug than the second woman would be doing if she went ahead and had a child before the drug was available to her.”[vii] This is at situation that is extremely counterintuitive as “both women would be deliberately having a child with a severe disease where they could have had a child without the disease”[viii] and this would seem to be something equally wrong in both cases. When this is applied to the case of radical CT versus non-radical CT it appears that the moral difference between the two that has been pointed out by Zohar ceases to be a problem.
The following example points out the problem that this line of thinking brings to Zohar’s argument. If a conceptus is found to have a genetic disorder such as cystic fibrosis, and this disorder can be treated by the use of non-radical CT, easily and effectively, then there seem to be a moral responsibility all other things being equal for the parents of the conceptus to allow it to undergo the treatment and for us to say the parents are morally irresponsible if they do not allow the treatment. Now consider the situation where no non-radical CT treatments are available for the disease in question, however radical CT is available and will fix the problem as easily and effectively as non-radical CT would have in the first case. If the parents in this, the second case, refuse to allow the conceptus to have the treatment, the claim that they have done nothing wrong, or at least are not as morally irresponsible as he parents in the first case seems strange. Both sets of parents have an easy and effective way in which to give the child that develops from the conceptus a better life, both appear to be as morally irresponsible if they decide not to allow the interventions.
The next claim that Holtug and Sandoe want to make is that if we reject NP, it is possible for us to have person-affecting reasons for the use of radical CT. It is their claim that “one can benefit a person by causing her to exist”[ix] and that this claim can be made even though the person in question would not have come into existence was it not for the radical CT. There are two problems faced in attempting to motivate this claim. The first is the problem of identification and the second the problem of comparing existence and non-existence.
The problem of identification relates to the possibility of the placement of harm or benefit on a particular person. Taking an example from Hare it is possible to show that a person can be harmed by someone performing an act, even if at the time of performing the act the actual person who would be harmed in not identifiable. Hare’s example relates to a person leaving a pin hidden in a chair, so that the next person who sits on the chair will be harmed by the pin sticking into them.[x] Hare claims that in order to say that someone has harmed another person by their action, w need only to identify the particular person when the harm occurs, that is in his example when the harmed person sits on the pin.
If we consider this view in relation to the earlier example of the women living by the lake, both women can be said to cause harm to an identifiable child by either not taking the medication or by not postponing their pregnancy for six months, the particular children in question are those that would be born had they followed through with this course of action. The same rational it seems can also be claimed in relation to benefits. A particular child can benefit from the woman’s choice to take the drug, postpone pregnancy or from someone’s choice to allow CT to be performed and again the particular child in question is the child who would actually be born as a result of these choices. To identify the person who will benefit we do not need to know all of the particulars about them, all we need to be able to say is that the person who benefits is the person who will be born as a result of the procedures.
The second problem relates to the possibility of comparing existence and non-existence, which occurs because non-existence is not a state in which a person can be and therefore cannot be compared to existence that is. Holtug and Sandoe claim that this mistake occurs because “it may be thought that in order for this comparison to be possible, both existence and non-existence must be states of the same person,”[xi] which obviously they cannot be and it is this mistake that is be basis for NP. It is the position of Holtug and Sandoe that this claim is mistaken and that it is possible for a person to have preferences about existence in comparison to non-existence in relation to himself and further that is also possible for persons not the affected person in question to make judgements about the relative values of existence and non-existence in relation to the affected person. I as a person who exists can express preferences about various particulars of my life including whether or not it would have been better for me if I had not existed. I am able to consider two possibilities one in which I exist and one where I do not and make a judgement about which one of these I have a preference for.
If we take the situation where I have been involved in a very serious car accident, which while having left my mind as functional as before has robbed me of all other bodily functions and my continued existence depends entirely on complicated and invasive medical interventions to keep me alive. I am it appears able to make a decision with respect to my continued existence versus my non-existence and decide which of these is preferable. I can conceive of two possible worlds, one where I continue to exist in the manner I currently am and another where I no longer exist and decide which of these is preferable.
Now consider the situation where since birth I have been afflicted with such physical disabilities that when I look at two possible worlds, on which corresponds with the world I actually exist in and one in which I do not exist and have not existed at all, it does not seem implausible that I can express a preference for the world in which I was never brought into existence and to suggest that I would have preferred that world to this one.
It further seems plausible that other people can make these kinds of preference evaluations with respect to me and my existence and non-existence. In relation to the first situation where I have been involved in an accident, it would seem plausible that a person other than myself, perhaps a relative or partner could make a preference evaluation on my behalf with respect to my continued existence or my non-existence. It also appears plausible that a person other than myself, could consider the situation of my life presented in the second example, make a preference on my behalf. If these are plausible examples of preference evaluations with respect to existence and non-existence then a parent may make the claim that with respect to preference evaluations I would have the preference for non-existence even though at the time of the parent making this claim I do not actually exist, which would seem to be what could apply to CT. None of the preceding discussion should be taken to show that it is the case that other persons necessarily should be allowed to make preference evaluations for others with respect to non-existence or existence as suggesting that allowing other persons to make those kinds of evaluations for others is in all situations morally applicable would set in motion a dangerous course of events. All that is needed by me at this stage is the agreement that such preference evaluations can plausibly and coherently made.
In answering these two problems Holtug and Sandoe suggest that it is now possible for them to make the following claims with respect to the example of the woman living near the poisoned lake. The first of these is that there are good person-affecting reasons for the woman to delay her pregnancy and therefore not have a child that would have a miserable life. The second is that it solves the non-identity problem because “although having a child now with a life just barely worth living would not harm this child, having a child later with a life very much worth living would be better because this child would benefit more.”[xii]
When we move from the examples given back to the situations of radical CT and other forms of germ-line gene therapies we can say the following, firstly that there seems to be “person-affecting reasons to perform radical CT if the original person would have had a life not worth living.”[xiii] Secondly we can claim “there would also be overall person-affecting reasons to perform radical CT if the new person would benefit more than the original person from existence.”[xiv]
These claims have a number of implications for germ-line genetic therapies; the first of these is that they make the issue of personal identity one that needs to be taken into consideration with respect to moral deliberations about whether germ-line therapies should in general be performed. Further it suggests that there may in fact be very good person-affecting reasons, aside from any impersonal reasons that may exists for the implementation of these procedures as well. This is not to suggest that the claims made here answer all of the problems associated with identity change occurring as a result of germ-line interventions, disability advocates may and do have arguments which suggest that there may be reasons related to changes in identity and the views of society with respect to certain groups of persons that complicate the issue further. We must also remember that while the arguments put forward here have an impact on gene therapies where there is a clear therapeutic value and the additional benefits of the interventions can be fairly easily seen[xv] in other cases of germ-line intervention, in particular germ-line enhancement where the benefits accrued may not be substantial or even benefits at all in a normal therapeutic sense, it becomes more difficult to rely on the arguments put forward here to motivate claims that in these case germline interventions should be undertaken.
[i] Elliot, 1993: 31
[ii] Holtug, 1996: 159
[iii] Holtug, "Who Benefits? Why Personal Identity Does Not Matter in a Moral Evaluation of Germ-Line Therapy."
[iv] Holtug, "Who Benefits? Why Personal Identity Does Not Matter in a Moral Evaluation of Germ-Line Therapy."
[v] Parfit, Reasons and Persons.
[vi] Derek Parfit, "Rights, Interests and Possible People," Moral Problems in Medicine, ed. S. Gorovitz (New York: Prrentice-Hall, 1976).
[vii] Holtug, "Who Benefits? Why Personal Identity Does Not Matter in a Moral Evaluation of Germ-Line Therapy."
[viii] Holtug, "Who Benefits? Why Personal Identity Does Not Matter in a Moral Evaluation of Germ-Line Therapy."
[ix] Holtug, "Who Benefits? Why Personal Identity Does Not Matter in a Moral Evaluation of Germ-Line Therapy."
[x] Richard Hare, "When Does Potentially Count," Essays on Bioethics (Oxford: Claredon Press, 1993).
[xi] Holtug, "Who Benefits? Why Personal Identity Does Not Matter in a Moral Evaluation of Germ-Line Therapy."
[xii] Holtug, "Who Benefits? Why Personal Identity Does Not Matter in a Moral Evaluation of Germ-Line Therapy."
[xiii] Holtug, "Who Benefits? Why Personal Identity Does Not Matter in a Moral Evaluation of Germ-Line Therapy."
[xiv] Holtug, "Who Benefits? Why Personal Identity Does Not Matter in a Moral Evaluation of Germ-Line Therapy."
[xv] It needs to be remembered however that it is whether or not this additional value or benefit should be viewed as a benefit is one issues with respect to disabled persons and certain genetic interventions.
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