Julian Savulescu's blog

X Factor Abortion: Is it Wrong?

Paije Richardson's dreams of a new life were crushed tonight as the public voted him from the X Factor final rounds. On Dec 9, the fate of another young hopeful will be decided by the people’s choice. But this time it will be a life and death choice. A couple have allegedly given the life of their baby over to popular vote; they are considering having an abortion and have created a public poll which will decide whether they have an abortion or not (http://www.dailymail.co.uk/news/article-1330860/Should-abortion--decide-U-S-couple-set-website-unborn-child.html)

The abortion vote has been described as “spine-chilling.” The baby is 17 weeks gestation and a healthy boy called “Wiggles.” One pro-lifer was outraged:

'This is shocking.The first thing that came to my mind when I heard of this was the Roman Colosseum, when the mob picked who lived and who died. They are talking about a baby that is 17 weeks old, it has a beating heart, its brain is working and nerve endings throughout its body' 

Deciding human life by vote is shocking, but is it wrong?

An Argument in Favour…

Here is one crude argument why it is not wrong. If abortion is available on demand, then any reason suffices to ground a right for abortion. One could have an abortion if one was raped, became unintentionally pregnant, or because the public voted for it. 

Consequentialists or utilitarians hold that what matters is the consequences of actions. On these ethical theories, how or why abortion occurs does not matter, apart from their consequences. Either abortion is wrong because a fetus dies or it is permissible because a fetus is not a being with moral status. It would not be more wrong for at least crude consequentialists and utilitarians for a couple to have an abortion because the public voted for it than it would be for any other reason, such as rape, career pressure or the desire for a holiday.

Most people claim not to be consequentialists or utilitarians. They will be concerned with the motivations and reasons of this couple. Virue ethicists are concerned with people's characters, deontologists such as Kantians are concerned with their motivations. So what are their reasons? 

Mrs Arnold “fears the pressure of juggling motherhood and a career could cause her to have a nervous breakdown.”

She wrote: 'I'm not convinced that I want to change the status quo. I feel that as I age I've actually gotten more selfish and set in my ways.

'I'm afraid that I will eventually regret starting a family and "settling down", as they say.

'I fear that the constant pressure to be the perfect wife and mother while maintaining a full-time job will eventually cause my brain to implode and lead to a nervous breakdown.'

This couple have apparently desperately wanted to become pregnant: they have suffered two miscarriages in the past ten months - the first at 16 weeks and the second at five weeks. Despite falling pregnant for the third time, the couple are now getting cold feet at the prospect of a life time of parenthood, “unsure whether to proceed because they have put off having a child for so long.”

Mr Arnold said: 'We've put off having a kid for so long that I worry there is stagnation in our desire to do so. 

'At first we put it off to finish our childhood, and then I decided mine was not going to end without a push. 

'By that time Alisha had just gotten a new job and was getting settled, so we put it off longer. 

'Now, nearly ten years after our marriage the prospect of being in my 50s when a kid graduates childhood is a bit unnerving.'

If one did have finely balanced reasons for and against having a child, it would be reasonable to ask the advice of a friend. What about a popular vote?  The Arnolds state: 'Voting is such an integral part of the American identity. We vote on everything from the best singer on American Idol to who the next leader of the free world will be.

'Wouldn't it be nice to voice your opinion and have it actually make a difference in the real world? Why not vote on whether to continue or abort an actual pregnancy?'

Utilitarians would surely approve. The utility generated by satisfying these “external preferences” would be a reason in favour of the vote. Indeed, the Arnolds appeal sympathetic to utilitarianism: they want to 'make a difference in the real world'.

If it would be reasonable to either have an abortion or not have one, then the reasons are finely balanced. If the decision were finely balanced, employing some other mechanism which provides external utility is not merely permissible but desirable in virtue of the external utility it provides. If you could reasonably wash your car or read a book, there is nothing wrong with giving the decision over to someone else if they enjoy making the decision for you. The X Factor without the public vote would virtually worthless.

But…

There are two objections to this line of argument. Firstly, the difference between voting for President and voting on the Arnold’s abortion is that we are all a part of a democracy and should vote for our leader who represents us. Yet the Arnold’s abortion is their affair and one which they should take responsibility for.  There is a blurring of the public and private, in a rather perverse manner. It is a failure to take responsibility and a failure to act autonomously that is their problem, the objection goes. As one blogger wrote, voting for abortion,

'If you're dumb enough to let random strangers on the internet decide the fate of your family, then you are certainly not mature enough to be parents. You need professional help.'

To be an autonomous person, or an autonomous couple, is to take the responsibility for one’s own decisions. John Stuart Mill, the champion of liberty and autonomy, famously argued that the one freedom we do not have is the freedom to become slaves to another’s will. That is the very antithesis of freedom. The Arnolds, by placing a decision about their lives and their family’s lives, are slaves to the will of a majority. 

However the Arnolds are evidently intelligent people. They are not going to necessarily abide by the vote … 

'It's kind of like Congress. They might vote for something, but the president has the final veto. 

'If it's overwhelming one way or the other, that will carry a lot more weight.'

 The second objection is that, although the Arnolds have reasons, those reasons are not strong enough to favour abortion, or deferral to a vote. That is, based on the reasons that they provide, they should have the baby. Their reasons are not good enough to warrant an abortion or, a fortiori, a vote. After all, they have wanted a baby, suffered two miscarriages in one year, have good jobs, and the only reasons they give are selfishness and their older age. But older age is a consequence of delaying child-rearing to establish financial security and is still perfectly compatible with having family successfully. There is nothing wrong with being in your 50s when your children are 20. My own father was 53 when I was born. Aren’t they just being superficial, selfish and narcissistic? Aren’t they just the epitome of the consumerist, materialist modern American who puts themselves ahead of family, children, fundamental values and even life itself?

Here the distinction between law and ethics is important. Ethics is about what people have good reason to do; law is about what people should be compelled to do. It is very difficult for us to evaluate the quality of other people’s reasons and their strength. It may be that the Arnolds have more reason to have the baby. But from a perspective of law and public policy, whether they can have an abortion, or whether they should be compelled to raise a child, should not be determined by some external scrutiny of their reasons because we do not have the public or external means to adequately evaluate their reasons. People can have an abortion for all sorts of reasons, including because they want to have a holiday in the Bahamas. That is the price of liberty – people will make bad or wrong choices. But this is far preferable overall to a system where the state required us to justify our choices and the quality of their reasons and some individual, committee or body was charged with evaluating whether these were good enough to have or not have a family.

The Arnolds may be making the ethically wrong choice, and we should then criticise them, but they should be free to make such a choice. Perhaps that is what they are seeking to demonstrate.

For my own part, I personally believe we have a reason to have children who expect to have good lives: the goodness of the life of a future person. I think abortion is wrong not because it kills a being of moral status but because it deprives the world of being with a valuable life. I believe one must have a good reason to have an abortion.

How strong is this reason to have children? It is not overriding and must be weighed against our other reasons. We can have reasons related to other children or our own lives, or our commitments to the world. But we must be able to cite these for our decisions to be justifiable. The point of being a rational and good person is being able to act on the basis of good reasons and to weigh competing reasons to decide overall what to do.

Somebody who decided to have an abortion just because a coin came up heads would be acting wrongly. The famous novel, Dice Man, tells the story of a man who lives his life by assigning options to a die and follows the throw of a die. It becomes a life of disintegration and incoherence, not a human life.

So, ethics requires that abortion should be for good reason; but from a legal perspective, abortion should be available for any reason.

So much for the arguments … what is really going on?

One thing I have learnt in practical ethics is that there are the arguments and then the rest: the emotions, the real motivations, the politics. What is really going on?

The couple could, of course, really be uncertain and genuinely concerned for people to make a difference …

Or it could be an attention-seeking stunt.

The couple are both in the IT industry and keen bloggers. This is a good way to get hits.

Usually when the competing explanations are incompetence or conspiracy, incompetence is the best explanation. But let’s explore the conspiracy theory in this case.

The Arnolds told U.S. website Gawker: 'We are taking this very seriously. It's definitely not a pro-life campaign, we believe in a woman's right to choose.’ However, on her Facebook page, Mrs Arnold, a methodist, it states she is a fan of right-wing commentator Glenn Beck. 

Mr Arnold, a non-practicing Catholic, has made comments in the past in support of former US President George W Bush, who is pro-life.  The abortion vote will run right up to 2 days before the legal limit in that state (20 weeks) for an abortion. It is hard to see how one could be organized in 2 days. The couple have had two miscarriages within a year then backflip on their desire to have a child. Their stated reasons are precisely those which would be roundly criticized by prolifers: selfishness, superficiality, failure to grow up and immaturity. This is a calculated extreme version of abortion on demand.

So far, the latest results have favoured abortion, with 43.71 percent voting to keep the baby and 56.29 percent wanting the couple to have an abortion. But the couple have retained the right to veto the final result. It will be interesting to see if they do have abortion if the people decide they want one. My prediction is that they won’t.  Just as it is difficult to evaluate the quality of another person’s reasons, it is difficult to ever know their real motivations.

Questions for Students

1. Is abortion wrong?
2. For which reasons is abortion permissible?
3. Is the X- Factor Abortion wrong?
4. Should people's motivations matter when considering whether they should be allowed to have an abortion?
5. When should other people be allowed to decide for us?
6. How would you vote? Why?

Is Low Libido a Brain Disorder?

Having started to work in the field of neuroethics a couple of years ago, I have become staggered by the misunderstanding of what neuroscience can tell us. The best example is a recent BBC story which goes by the wonderful title “Libido problems: 'brain not mind'” . It starts by pointing out, [italics are mine]

“In recent years, a diagnosis of "hypoactive sexual desire disorder" (HSDD) in women has become more accepted by science. However, there remains controversy about whether the term can or should be used to describe a lack of sexual desire, which may be caused by a variety of psychological, emotional and physical factors.

The latest study, highlights differences in mental processing in women who have low sex drives.

Its author, Dr Michael Diamond, said it suggested that HSDD was a genuine physical problem…He recruited 19 women who had been diagnosed with the condition, and compared their brain responses with those of seven others using a functional magnetic resonance imaging scanner, which can measure levels of activation in different parts of the brain by detecting increased blood flow.

The women were asked to watch a screen for half an hour, with everyday television programmes interspersed with erotic videos.

In the seven women who did not have the HSDD diagnosis, increased activity in the insular cortices - parts of the brain believed to be involved in the processing of emotion - could be seen. The same did not happen in the women with HSDD.”

On the basis of this Dr Diamond posits a physical “explanation” for low sex drive in women: "Us being able to identify physiological changes, to me provides significant evidence that it is a true disorder as opposed as opposed to a societal construct."

There is obviously a physical explanation for sex drive, at one level of explanation. Every mental state has a physical explanation because mental events occur because of activity in the brain. It would be impossible for the brains of two women experiencing different sexual desire (or different thoughts, motivations, sensations or any other mental states) to be exactly alike. There must be differences which explain their different mental states. But these differences in brain activity tell us nothing about what caused the differences in brain activity, which is what Dr Diamond wants to assert.

If I am bored and you are not, our brains will have different activity. If we get a high enough resolution scanner of their activity, we will of course see that the bored brain works differently. But this does not show that boredom is a “true disorder” or “social construct” or anything else.

The brains of women with low sex drive must be different to the brains of women with high sex drive, because they have different drives and mental states! Of course they have different mental processing – they experience different things.

The very title of this foray into false explanation illustrates the profound folk confusion between causation and correlation, “Libido problems: brain, not mind”

Our mind is not some spiritual or mysterious thing disconnected from our brain. Our brain activity gives rise to our mind, to our thoughts, feelings and desires.

Dualism is the idea that the brain and mind are separate entities. People like Dr Diamond and the author of the BBC article are folk dualists. Dualism causes us to misunderstand the nature of the relationship between ourselves and our brains.

Even the opponents of this study get it wrong. Sandy Goldbeck-Wood, from the Camden and Islington Mental Health Trust, said that, while interesting, the study could be a "complete red herring". “She said a bigger study would be needed to make sure that the brain differences identified were truly related to sexual function, as opposed to depression, which could cause sexual problems.

A bigger study will not solve this issue. And this kind of approach, at least in this simple form, cannot tell us what causes the differences in brain activity.

We can be sure that the brains of women who have low libido are different to brains of women with high libido just as we can be sure that the brains of people who see green are different to the brains of people who see red. What causes those differences could be genetic, environmental or some combination. It is highly likely to be a combination of our inherent biological differences together with key features of our social history.

Looking at a colourful brain scan is amusing, and it makes for an interesting conference presentation, but it can’t tell us that our problems are or are not just “in our minds”, are psychological problems or disorders based on strong intrinsic biological differences. It just tells us which bits of the brain are active when there are differences in emotion.

Why We Should Criminalise Dangerous Sexual Behaviour

Imagine that Herman has toxic radioactive waste from his laboratory. He decides to bury it in the ground next to his laboratory, knowing that it will expose the surrounding houses to dangerous radiation. As a result, Gertrude develops cancer some years later and dies at the age of 37.

Herman never intended to cause Gertrude to get cancer. He merely foresaw that his actions risked giving her cancer. However, the defence that he merely foresaw but not intend her developing a malignancy is empty. He should, ethically, be as blameworthy as if he put the waste in her food. He is responsible and blameworthy for her cancer. 

Nadja Benaissa, 28, of the German band, No Angels, is on trial in the city of Darmstadt. She has admitted to having unprotected sex with several partners knowing that she was HIV positive and without warning them (http://www.bbc.co.uk/news/world-europe-10983227).

"I am so sorry," she said. 

She denied deliberately infecting anyone. "No way did I want my partner to be infected."

Imagine that Herman said that he was sorry and “No way did I want Gertrude to get cancer and die at the age of 37."  This would be no excuse at all. He should be held fully accountable for her avoidable and foreseeable death.

But when it comes to HIV, this principle is resisted.  AIDS campaigners have resisted criminalising this kind of behaviour.

"By singling out HIV, it really promotes fear and stigma," one spokesperson said.

Of course there is an obvious response: hold everyone who foreseeably and avoidably exposes another person to risk accountable. It should not matter whether it is HIV, syphilis, TB, toxic waste or dangerous driving. When we know our behaviour could kill people, and fail to warn them to allow them to protect themselves, we should be held accountable.

Herman is a bad man.

"The Charade of Blood Dope Testing

The latest weapon in the arsenal of doping tests is the blood passport. It aims to track the red blood cell count over the last year. Changes during competition indicate doping.

Of course it is doomed to fail. The reason is red blood cells vary from individual to individual, and the count varies within an individual over time. One way to get around the dope test is to take small amounts of doping agents during the year. See http://news.bbc.co.uk/1/hi/world/europe/10484158.stm

Another way would be to donate some of your own blood after the test and have it retransfused prior to a later test. Even if these methods fail, you can be sure cyclists will find a way around it.

As I have said for the last 10 years, there is a simple solution. Measure the one end point that cant be manipulated – the red cell count during competition – and set some safe maximum level, say 50% of total blood volume. This is cheap and reliable. Cyclists could dope themselves from 46% to 50%, using whatever means, and everyone would start on a level playing field which is easily, cheaply and reliably enforceable. The blood doping scandals would evaporate over night.

The current blood doping tests are a charade. We know and the International Cycling Union knows that most if not virtually all cyclists are doping. A few have to be caught and made examples of, to reassure the public that the war on doping is being effectively prosecuted, but they could never eliminate all the stars from the Tour. It would ruin the sport.

It is the inexperienced, stupid and extremely unlucky who happen to be caught.

When will we take the only rational approach to blood doping and allow it to safe levels?

[I will discuss these issues on the BBC World Service at 1pm, July 1]"

Against Equality

I justed posted this on the Practical Ethics Blog. Equality is an ideal born of the vice, or one of the seven deadly sins, of envy. It has no intrinsic value but panders to our vicious nature to be envious of others. Levelling down is absurd. And why level up if we can raise everyone, improving all of their lives instead of just some? To reduce people’s envy of others, when their own lives are good and better? That is no reason.

Imagine that in our society, people are divided into two groups. One group, Short, lives for a maximum of 60 years and another, Long, for 120, for inherent genetic reasons. We could achieve equality by levelling down, by shortening the lives of Long, so they live 60 years (perhaps by introducing painless toxins into their water). That would level down. It is absurd. It is absurd even if Short remain envious and jealous of Long.

A therapy becomes available which can prolong healthy life by 60 years. A more attractive version of egalitarianism is  levelling-up egalitarianism.  This would require giving the therapy to Short so that they can live 120 years, the same as Long. This would create equality and reduce envy and jealousy.

But why should we stop at levelling up. We could adopt a maximising consequentialist strategy and give the therapy to everyone, equally. Short would live 120 years and Long would live 180 years. Everyone would be better off but inequality would be preserved. But so what?

Why should we deny Long an extra 60 good years simply to reduce the envy and jealousy of Short, for no material benefit to them?

Equality has no intrinsic value. Our commitment should be to the lives of individual people not to human ideals like equality.

Equality is a dominant moral ideal in contemporary society. Egalitarianism is the stated principle for the NHS: equal treatment for equal need. Equality might be a good rule of thumb but it should not be a final regulative ideal.

[I wrote this blog in response to Alex Erler’s “Levelling Up”: In Defence of Equality]

Putting GM in a Lead Coffin

It is time to put the GM debate in a lead-lined coffin. To lay it finally to rest. And get things in perspective again.

It is the role of a father to educate his children, if he can. That includes dispelling myths, belief in witches and ghosts and other false views of the world. To this end, I would try to educate my daughters when we would go shopping about the dangers of GM or their complete absence. I would point out vegetables and fruits that had been produced by cross-breeding and crude genetic modification, like tiger tomatoes. We would hunt for the most genetically modified, which was hard because most things had been engineered. I encouraged them to seek out products which included GM ingredients and to shun those which claimed to be GM free. One has to support the good and at least discourage the bad.

In one of my more zealous moments, I contemplated getting a T shirt made saying “I ONLY eat GM”

I looked into the GM debate in the late 90s to see if there were interesting ethical issues. The only ethical issue I could find at that time was the unethical resistance to a safe, useful and well tried technology. I was shocked at the level of public debate in Europe over GM.

Colin Blakemore has written a thoughtful exposition of the treatment and regulation of GM in this country and in Europe. What is interesting from a perspective of practical ethics is how such a negative debate could persist about GM for so long. Is it vested farming interests? Luddite lack of education? Religion, including rabid runaway environmentalism?

The rest of the world will utilise the benefits of GM. Europe will just be left behind with more expensive, inferior quality, less useful, less healthy foods. If they resist GM, how would they ever embrace nanotechnology that holds the promise of healthier everyday foods, including less fattening fats?

I recently bought a 60s or 70s house in Oxford. I was looking at the plumbing and realised it had lead pipes supplying the water. I nearly fell over with shock. Lead is a dangerous substance known for years to cause cognitive impairment and a number of health problems. It makes you dumber. It reduces your IQ, or at least that of growing children. I was even more shocked to find that 40% of dwellings have lead pipes supplying drinking water and lead was used until the 1980s. Since December 2003, a standard of 25 µg/l has been applied to the point of use by the consumer (commonly regarded as the kitchen sink tap).  In 2013, the standard in the UK will tighten to 10 µg/l. This implies that even by those standards, we are drinking water with 2.5 times too much lead. And it is likely to be substantially higher in individual supplies. The government and people don’t test their water.

Lead is much more likely to be harming people’s health than GM foods. Yet this has attracted not one iota of attention compared to the monster of GM.

Risk and harm surround us every day. The challenge is to evaluate these with good evidence, rationally. The story of lead and GM is sadly a common one. We place vastly too much attention on the miniscule risks and fail to attend to the elephants in the room. People are biased. The availability bias explains why people believe homicide is more common than suicide, despite that latter being much more common.

Yet bias, fear, irrationality, faith and misplaced values dominate and lead public debate. We will be the ones who are worse for it.

 

The Fiction of Affliction in Addiction

Audio: See interview with Walter Sinnott-Armstrong on addition too: http://tinyurl.com/386ltlx

Walter argues that addiction is:

1. a disorder of self-control that comes in degrees. It is essentially pathological self-control, like compulsive hand-washing, where the addict has limited control in some circumstances but not enough self-control.

2. a mental disease.

Bennett Foddy and I have argued that while addicts may have poor self-control and act imprudently, poor self-control and imprudence are not diseases. They are features of the human condition. People become addicted to all sorts of things: heroin, alcohol, nicotine, gambling, sugar, sex, the internet and food. What is common to all these addictions is that involve the reward system. Heroin may be more potent at activating this system than sugar, but they all act in a similar way. There are differences in degree, not kind.

It is true that addicts can come to be driven by cues, want their drug rather than like it, take drugs to relieve distress, boredom, anxiety or loneliness. But so too for all addictions.

People can choose to stop. Addicts offered $100 dollars to stay clean in the Virginia study stayed clean. This is not a disease. You cannot receive $100 and cure your own cancer or schizophrenia. They are diseases; addiction is not.

Many people have poor self control and our ability to exercise self control varies according to our nature and environment. Some people have an uncontrollable temper. They don’t have a disease, even if psychiatrist invent such a category.

There is no doubt that drug addicts harm themselves. But so too do young men who drive too fast and recklessly. Risking harm and poor self control are not diseases.

The reward system drove human learning and development. It is no surprise that this powerful force can run amok. There is no surprise we can become addicted or prey to it. But that is a part of being human, not having a disease.

We should help addicts to lead better lives or realise their goals. But this is an enhancement not treating a disease.

If we accept addiction is not a disease, it is easier to accept harm reduction strategies to enable people to use the pleasure inducing effects of drugs in good life. We would not think we need a war on food because some people become addicted to food. Why then do we need a war on drugs? What we need is a rational approach to addiction and drugs of addiction. The first place to start is to demedicalise addiction and accept its place in normal human behaviour. It may be bad and ruin lives. But that does not make it a disease.

Audio: See interview with Walter Sinnott-Armstrong on addition too: http://tinyurl.com/386ltlx

Walter argues that addiction is:

1. a disorder of self-control that comes in degrees. It is essentially pathological self-control, like compulsive hand-washing, where the addict has limited control in some circumstances but not enough self-control.

2. a mental disease.

Bennett Foddy and I have argued that while addicts may have poor self-control and act imprudently, poor self-control and imprudence are not diseases. They are features of the human condition. People become addicted to all sorts of things: heroin, alcohol, nicotine, gambling, sugar, sex, the internet and food. What is common to all these addictions is that involve the reward system. Heroin may be more potent at activating this system than sugar, but they all act in a similar way. There are differences in degree, not kind.

It is true that addicts can come to be driven by cues, want their drug rather than like it, take drugs to relieve distress, boredom, anxiety or loneliness. But so too for all addictions.

People can choose to stop. Addicts offered $100 dollars to stay clean in the Virginia study stayed clean. This is not a disease. You cannot receive $100 and cure your own cancer or schizophrenia. They are diseases; addiction is not.

Many people have poor self control and our ability to exercise self control varies according to our nature and environment. Some people have an uncontrollable temper. They don’t have a disease, even if psychiatrist invent such a category.

There is no doubt that drug addicts harm themselves. But so too do young men who drive too fast and recklessly. Risking harm and poor self control are not diseases.

The reward system drove human learning and development. It is no surprise that this powerful force can run amok. There is no surprise we can become addicted or prey to it. But that is a part of being human, not having a disease.

We should help addicts to lead better lives or realise their goals. But this is an enhancement not treating a disease.

If we accept addiction is not a disease, it is easier to accept harm reduction strategies to enable people to use the pleasure inducing effects of drugs in good life. We would not think we need a war on food because some people become addicted to food. Why then do we need a war on drugs? What we need is a rational approach to addiction and drugs of addiction. The first place to start is to demedicalise addiction and accept its place in normal human behaviour. It may be bad and ruin lives. But that does not make it a disease.

Artificial Life?

Check out the latest blog with Tom Douglas http://www.abc.net.au/unleashed/stories/s2905343.htm

And just did a podcast with Nigel Warburton http://virtualphilosopher.com/2010/05/julian-sa.html

 

How to Prescribe Smart Drugs to Children Ethically

Ilina Singh and colleagues are said argue that the use of drugs such as Ritalin among young people is becoming so common that family doctors should be able to prescribe them as study aids to school pupils aged under 18 in arecent article in the Guardian. While the Guardian article rather cherry-picks from the range of Singh’s arguments in her original article, I have made similar arguments to those in the Guardian broadly supporting cognitive enhancement myself.

However, one might ask whether the prescription of enhancement for young children who are incapable of consenting for themselves raises unique issues. The limits to should  be:

1. Safety – the drug should be safe enough and benefits clearly outweigh the harms
2. Harm to others – the drug should not cause the child to harm others, by for example, increasing violent behavior
3. Distributive justice – the delivery of the drug should not use up limited societal resources unfairly, for example, by consuming resources which would do more good if directed towards educational strategies
4. The parent’s choices are based on a plausible conception of well-being and a better life for the child
5. The effects are consistent with development of autonomy in child and a reasonable range of future life plans

These last two limits are important.  It makes for a higher standard of “proof” that an intervention will be an enhancement because the parents are making choices for their child, not themselves. The critical question to ask is: would the change be better for the individual? Is it better for the individual to to be relaxed but failing and lazy or hardworking, successful and tense?  We require good data on the effects on normal children and we won’t get this until we do proper double blind controlled trials on normal children. These questions are difficult to answer.  While we might let adults choose to be take the risks themselves, and decide whether upsides outweigh the downsides, we should not let parents choose interventions which are harmful to their children, like denying them blood transfusions or cochlear implants. If smart drugs are as safe and effective as they appear to be, paradoxically, it may be harmful not to prescribe. There might be a moral obligation to provide smart drugs just as there is one to provide a cochlear implant to a deaf child.
There will be cases where some intervention is plausibly in a child’s interests: increased empathy with other people, better capacity to understand oneself and the world around, or improved memory.  One quality is especially associated with socioeconomic success and staying out of prison: impulse control.  If it were possible to correct poor impulse control, we should correct it.  Whether we should remove impulsiveness altogether is another question.

Joel Feinberg has described a child’s right to an open future.  An open future is one in which a child a reasonable range of possible lives to choose from and an opportunity to choose what kind of person to be. That is, to develop autonomy. Some  critics of enhancement have argued that genetic interventions are inconsistent with a child’s right to an open future.   Far from restricting a child’s future, however, some biological interventions may increase the possible futures or at least their quality.  It is hard to see how improved memory or empathy would restrict a child’s future.  Many worthwhile possibilities would be open.  But is true that parental choices should not restrict the development of autonomy or reasonable range of possible futures open to a child. In general, fewer enhancements will be permitted in children than in adult.  Some interventions, however, may still be clearly enhancements for our children and so just like vaccinations or other preventative health care.

Sometimes, you hear the argument that in the case of kids, decisions should be deferred until the child is old enough to decide for itself. This is right when waiting has not costs. But in the case of education, the horse may have bolted by the time the child is 16 or older, old enough to decide. That cost has to be weighed into the equation. Some choices cannot be reversed.

The key, as I have said, is to make these choices with a wide conception of what is plausibly good for the child and good data on the effects on smart drugs on that well-being. This requires a societal dialogue on what is a good life and the willingness to do scientific research on normal children in large numbers. The cost of not doing this is likely to be large numbers of children getting these drugs on the “grey market” with unknown and potentially serious side-effects. Or short-sighted, nervous policy makers banning them, with the potential huge opportunity costs.

Time to do some proper research.

Response to: Embrace the controversy: let's offer Project Prevention on the NHS

Dominic is right thataddicts are competent to decide on sponsored sterilisation. I have argued that addicts can be autonomous and can consent to research trials involving drugs of addiction (Foddy, B., Savulescu, J.. (2006). ‘Addiction and Autonomy: Can Addicted People Consent to the Prescription of Their Drug of Addiction?’ Bioethics. 20 (1): 1-15 (Feb). DOI: 10.1111/j.1467-8519.2006.00470.x). I have also argued that paying people large amounts of money to participate in risky experiments does not coerce them or unreasonably induce them (Savulescu, J. (2001) ‘Taking the Plunge’. New Scientist; 169:50) and elsewhere that it is reasonable to offer people money for their organs – the only real ethical issue being to settle on a fair minimum price.

So there is nothing intrinsically wrong with offering addicts money to be sterilised. The only issue is – why stop at addicts? The principle behind this would seem to be that addicts are unfit to parent. But what about paedophiles, the mentally ill, or intellectually disabled? It is hard to see how the principle would not extend to a form of passive eugenics, like what the Nazis imposed in more extreme forms.

The obvious way to avoid this is to offer the inducement to everyone. This has the lovely consequence that those who don’t really want to or value parenting would take the money. And they are not likely to be any more model parents that addicts are.

The benefit of a policy of offering inducements to sterilisation is that it would select those who do not value, do not understand, do not want the role of parent. And it is precisely these people who are likely to be the worst parents.

Being a parent is, at best, a difficult job. Why not excuse those with the least motivation and determination? There are plenty of others willing to take their place. And the earth can only sustain a finite number of people.