Lately it seems a whole commercial culture and social conversation has grown up around "enhancements." Some are quite controversial: Prozac and other antidepressants have been increasingly reported to be performance-enhancers, and, as Peter Kramer points out, are even prescribed for that purpose. Lawrence Diller's recent essay in these pages highlights an increase in enhancement-based rationale for use of the stimulant Ritalin, originally prescribed to combat attention deficit disorder. Some enhancements only barely raise our collective ire, such as the now well-established use of cosmetic surgery to modify appearance, the selection of offspring gender, or the sale of "genius" germ-line cells by one California sperm bank. Still others seem uncontroversial, or seem not to count as "enhancements" at all, such as the use of private schools, vaccinations, and vitamin supplements.
Bioethicists have attempted to draw distinctions between enhancements and the conventional development of genetically determined potential, and to differentiate enhancement from restoration or therapy. In the former case, struggling for a rationale as to why cosmetic surgery is fundamentally different from and more objectionable than a new haircut, Kathy Davis argues that through cosmetic surgery patients attempt to change the kind of person that they are. In the latter case, Norman Daniels and others attempt to distinguish enhancement from therapy or restoration with an idea they term "species-typical functioning." In an era of limited resources, species-typical functioning is the attempt to divine from aggregate medical data and data "in society a theoretical account of the design of the organism" that describes "the natural functional organization of a typical member of the species." Bringing an organism to within species-typical parameters is therapy or restoration, while improving on those norms is enhancement.
Elsewhere I argue at length that attempts to distinguish between conventional development of potential and artificial enhancement rely on an outmoded account of human nature and of genetic causality, and that species-typical functioning misses the point that health and illness are experienced and defined in terms of their meaning in human social experience. Parents and others engage in a variety of attempts to enhance human life, and the important differences between these enhancements seem tied to their social context. In the present essay I focus on the ethical implications of genetic enhancement in parenting. The reason for this focus is partially technological: many current and proposed genetic services will primarily, or first, be useful in a reproductive context or for children. For example, most genetic tests have immediate implications for would-be parents. As tests, technologies, and gene therapies begin to move into the less conventional realm of improvement, parents will be the first to make choices about the best means and most appropriate ends of enhancement. My reasoning is also personal. Parenthood can feel like a laboratory in enhancement. All of us with children experience the pressure to develop the life of an infant, a young person, a young adult. Children present themselves to us as so many interwoven needs: for support, for care, for attention. The struggle to parent feels like a perilous and wonderful dance as we balance the need to transmit and inculcate values and culture with the need to give children what Joel Feinberg terms "an open future." As we make choices about our children, we pick up some cultural lessons that work not only for mundane parental decisionmaking but also for the radical possibility of making, perhaps sooner than we think, some systematic choices about the enhancement of our children through genetic technologies.
It may turn out, in this quest for some social improvement, that genes are among the least effective tools for advancing personal, familial, and social goals. …