Is It Unethical to Pass on the Risk of Genetic Disease?

[Marat]

Society usually defines a criminal act as imposing either injury on another person or being reckless with respect to imposing a injury on another person, as in criminal negligence. Especially if you owe someone a duty of care, you can be found guilty of a crime by acting so as to endanger them. From these principles, it would seem that parents who know that there is a high risk that they will pass on to their children a serious genetic disease should be punished as criminals or criticized as immoral for deciding to have children.

 

Someone might object that the parents give the children a precious gift of life along with the serious risk of inheriting the genes for a serious disease, but perhaps the children would have preferred never to have been born rather than to suffer an especially hideous genetic illness. Also, even if I give someone a million dollars when I shoot him in the foot, I am still guilty of the crime of shooting him in the foot, even though I have also given him a precious gift.

 

But even if we accept that it is criminally immoral for parents to have children if in doing so they impose on their children a very high risk of serious disease, it is difficult to determine how large the risk has to be and how serious the disease has to be for the decision to have children to be immoral. If I impose on future children a 50% chance that they will develop very serious diseases like Huntington's Disease or polycystic kidney disease, that seems to qualify as immoral. But it represents an intermediate case if I decide to impose a 7% risk (as a male parent) or a 4% risk (as a female parent) of a child developing a less horrible disease such as type 1 diabetes. Imposing the risk on the child that he will be short and thus have poorer chances of getting a girlfriend or making a good impression on potential employers to get a good job seems much too minor an injury for the decision to risk having a short child to be immoral. But where do we draw the line?

[Mr Skeptic]

I think that we draw the line at diseases. Reducing our genetic diversity just because people don't quite like some attributes as much as others would also be a problem. Given modern technology, even people who have genetic disorders can have children without passing on the risk to them -- it just takes more effort.

[Marat]

Though of the diseases I cite as examples, there is no way to prevent them, no way to cure them, and no way adequately to control them. If the parents who know of the genetic risks in advance but still decide to have children were to impose the same risks or harms on their children after they were born, they would be criminally charged -- as some wanted to do to Michael Jackson after he dangled his child over the edge of a hotel balcony in Berlin. But for some reason our culture not only refuses to regard parents who impose genetic diseases on their children as innocent of all blame, but genetic counsellors even encourage them to do so with the theory that 'your chances of having a sick child are small.' The issue is not, however, whether the parents would be harmed by having a sick child, but how they might harm their child, to whom they owe a duty of care which the child does not owe to them.

 

Another argument we could make would be that since the children do not yet exist when their parents decide to produce them, the parents cannot yet owe any duty not to harm the children, since they still have no rights because they are not yet humans. However, we now generally recognize that we owe a duty to pass on the planetary environment intact to future generations of people, just as we owe a duty not to burden future generations with debt, so to be consistent we would have to recognize a duty not to burden future people with diseases we could avoid by just not breeding.

[DctrZaius]

I suppose people may argue that this is a really slippery slope kind of idea. Perhaps nobody wants to have a daughter who will develop breast cancer and so preimplantation genetic diagnosis is used to avoid implanting embryos with a BRC1 mutation. Only this allele merely attributes a particular risk of developing breast cancer, the daughter may not necessarily develop cancer. Should you avoid implanting the embryo anyway? Prevent the existence of a possibly healthy person? And then we can get into all of the discussions regarding what we classify as disease. At the moment in Australia PGD can be used to avoid 'serious disease' but there is no definition of serious. What about diseases that can be tolerated relatively easily, like Type 1 diabetes? The injection of insulin isn't really such a burden on quality of life that diabetics would rather be dead, is it? Using PGD to avoid a baby with diabetes is almost an enhancement. What about instances where disease is actually an advantage? The best example is sickle cell anemia helping to avoid malaria infections.

 

By the way, I'm doing a biotech in context course at the moment which is really philosophical and I absolutely love these discussions as a change from hard science!

[lemur]

Ultimately, everyone gets sick or dies from some disease and what disease isn't either directly caused or in some other way the result of genes? Would you want to prevent all births because the bodies will eventually get sick and die? What would make more sense might be to say it is more ethical for people with problematic genetic propensities to seek reproductive partners with non-similar propensities in order to maximize the chance that problems will not be expressed. The other side of this would be that it is more ethical for people with less genetic risks to reproduce with partners with more risk to "water down" the problem-propensities in their genes. That way, recessive genes become more likely to be erased without reducing the overall genetic diversity of the species by the loss of individual genetic material due to non-reproduction.

[Janus]

As someone who has both polycystic kidney disease and a child, I come to this from a personal viewpoint.

 

I wasn't diagnosed until after I already had my daughter, and of my first thoughts was the concern as to whether I had passed it on to her. If I had known of the chance beforehand, I'm not sure what I would have decided. I mean, would I rather that my parents, if they had known, had decided not to have children? How do you compare non-existence with existence, even if that existence may be somewhat prematurely truncated?

[Mr Skeptic]

But it's not non-existence vs existence. Usually people who choose not to have a genetically sick child will still have a child, either via a donor, adoption, screening of sperm, or screening of zygote. What if your parents had used birth control, huh? Oh wait, they probably did until they decided to have a child.

[Janus]

But it's not non-existence vs existence.

It would have been for me!

Usually people who choose not to have a genetically sick child will still have a child, either via a donor, adoption, screening of sperm, or screening of zygote. What if your parents had used birth control, huh? Oh wait, they probably did until they decided to have a child.

 

Not exactly, my folks pretty much started trying to have children once they were married, however nature had other plans . My mother had 9 late term miscarriages before I was finally born. ( I technically have one older sibling that lived long enough to get a birth certificate)