Intergenerational justice

Every parent, or intending parent, wishes the best for their children; indeed, for their children's children. Protecting the interests and welfare of these children is generally something which parents take seriously, choosing - where possible - the best schools, diet, and so on, to give their children the best possible lives. Indeed, women will often make considerable lifestyle changes, both before and during pregnancy, to ensure the best possible start in life for their children. There is nothing contentious about this, generally speaking.

Largely deriving from the advances in genetics and environmental concerns, UNESCO (United Nations Educational, Scientific and Cultural Organization)  has made a convention-based commitment to securing the interests of future generations. Article 1 of the declaration reads as follows: 'The present generations have the responsibility of ensuring that the needs and interests of future generations are fully safeguarded.'

Traditionally, this declaration has been interpreted as applying most significantly to the responsibility to protect bio-diversity and to avoid prejudicing the environment (personal and social) of future children. However, the commitments undertaken as a result of the declaration could also be expanded to cover a responsibility to do anything which we could do to maximise the interests of those who come after us.

The implications of this are potentially far-reaching. First such obligations might extend to using the genetic knowledge we have now to advance these interests. As Fletcher and Wertz put it: 'The completion of the human genome project will provide a basis for acting on a moral obligation for future generations, a claim that has appeared weak in the past. A generation with such knowledge who neglected to use it to minimise the risks in reproduction could hardly be said to respect the requirements of intergenerational justice.'

Thus, there is reason to postulate the increasing encroachment of genetic information into human reproductive choice, at least in so far as this can be clearly seen to enhance the interests of future generations. If this is accepted, then there is also reason to explore whether or not such intrusion is acceptable as interventions may be positive or negative. We will, of course, require more clarity on what is meant by interests, but these are very plausibly encapsulated in 'the clinical health and social well-being of offspring'.

Medically speaking, genetics can do this in two main ways. First, it can be used to identify embryos or fetuses which are unlikely to have a healthy life, and avoid this by terminating affected pregnancies, or failing to implant embryos which are affected by a genetic condition. Second, it can contribute to the development of therapeutic techniques which may provide palliation or cure, thus avoiding the need for abortion.

Gene therapy is the use of genetic material, either DNA or its close chemical relative, RNA, to treat disease symptoms. It is generally held that somatic gene therapy is acceptable, whereas germline therapy is not. Somatic gene therapy involves adding genes to somatic cells (that is, all body cells except egg and sperm), rather than germ cells (egg and sperm). Germline gene therapy is any genetic treatment that would introduce permanent genetic changes that could be passed on from a patient to their children. This is currently considered to be unsafe, unethical and undesirable and is not allowed. So gene therapy on human embryos, which could result in germline genetic alterations, is also not permitted. However, the commitment to intergenerational justice may mean that germline therapy is acceptable, since, by undertaking it, we potentially get rid of a rogue gene for ever.

Perhaps more controversially, however, the commitment to intergenerational justice may not simply be restricted to medical interests. Although interventions which are clinically indicated are usually presumed to be value-neutral (or even benign), there is less consensus about those which are based on social, cultural or other indications. There are a number of such possibilities, but for the sake of brevity, I will only consider one: sex selection.

It is clear that sex and gender are not neutral phenomena. In every culture, they can have a profound impact on the potential of future children. Equally, they may have an impact on family life. Thus, it is not implausible to argue that selecting for characteristics such as sex is not significantly different from choosing other characteristics designed to benefit future children.

Opinion on this is, of course, deeply divided. Article 14 of the Council of Europe's Convention on Human Rights and Biomedicine prohibits the use of assisted reproduction techniques to choose sex, except where this is intended to avoid 'serious hereditary sex-related disease...'. The standing of this provision is, however, dubious in the UK; which has not signed up to the Convention, and arguably there may be human rights implications, derivative from the Convention on Human Rights, which would in any case challenge this position.

The recent report from the HFEA 'Sex Selection: options for regulation' concluded that 'there would need to be substantial demonstrable benefits of such a policy if the state were to challenge the public consensus on this issue.' A recent survey of 1094 men and women between the ages of 18 and 45 in Germany found that 75.6 percent claimed to have no gender preference and 92 percent said that they could not imagine themselves taking advantage of sex selection were it available. The HFEA's 'public consensus', seems however to have been based on responses from 66 organisations and 575 individuals - scarcely representative of public opinion.

The evidence that permitting sex selection would result in demographic or other disaster is simply not there. Demographic disaster is unlikely to arise, as most people are either indifferent to the sex of their children, (in Canadian research, for example, a large majority of Canadians were found not to prefer children of one sex over another) or would prefer one of each. Further, where there is prejudice based on sex, it is for our cultural and political authorities to ensure that the fabric which sustains it is destroyed, rather than seeking to do so by way of intervention with reproductive choice, a freedom which we value highly. Thus, if we take our commitments to future generations seriously, and are wise enough not to constrain them within the confines of medical interests alone, the arguments against selection for other characteristics which could benefit future generations need to be more strongly made if they are to convince.

In any event, why should not parents achieve by way of reproductive choice what they could do by other means? If it benefits a child to be born intelligent (assuming it were ever possible to identify a gene or genes which gave the best possible chance of intelligence) why is this different from paying for additional tuition or paying to send a child to the best school?  Equally, if existing families can benefit from a child of a particular sex (and that child will also benefit) then on what grounds can we deny this reproductive choice?

Further, as Savulescu says: 'It is easy to grant people the freedom to do what is agreeable to us.' On the other hand, he concludes, 'freedom is important only when it is the freedom for people to do what is disagreeable to others.' Thus, for a number of reasons, including the obligation of intergenerational justice, restrictions on making reproductive decisions which are likely to be life-enhancing for future children will need to be based on considerably stronger ethical arguments than they currently are.

Professor Sheila McLean is the International Bar Association Professor of Law and Ethics in Medicine at the University of Glasgow, Scotland and directs the Institute of Law and Ethics in Medicine based there