Margaret Somerville is the Author of Bird on an Ethics Wire: Battles about Values in the Culture Wars.
"Editing" the human germline – the genes passed on from generation to generation that have evolved naturally over millions of years to create each unique one of us – has gone from science fiction to science fact. We can now design our descendants.
Most bioethicists and many major institutions had agreed that would be wrong. Now, some are arguing that it should be allowed because of its potential to do "good." How should we decide? We can look to the history of assisted human reproduction technologies for some lessons.
In 1978, the world was shocked by the birth of Louise Brown, the first baby conceived outside a woman's body through in-vitro fertilization. But IVF quickly became a routine procedure.
Then ethical questions arose about the freezing of human embryos "left over" from IVF. Could they be donated to an infertile couple, a single woman, a same-sex couple, used for research, or as a source of stem cells to manufacture therapeutic products to benefit others? If the parents die, do the embryos deserve a chance at life? If the parents divorce, who "owns" the embryos?
Was the postmortem use of frozen sperm by a dead man's parents to "replace" him with a grandchild ethically and legally acceptable? And what about young women who freeze their own eggs, to use in their 50s or even 60s to create a family?
Preimplantation genetic diagnosis, meanwhile, meant certain groups of people (for example, those with Down syndrome) could be eliminated. Sex selection became easy.
Although Canada prohibited commercialization, the fertility industry has exploded into a global business, expected to be worth about $22-billion (U.S.) by 2020. The sale of ova and sperm and paid surrogate motherhood (even where prohibited) are flourishing, raising ethical and human-rights issues, especially the exploitation of poor and vulnerable women. The "products" of these transactions – children – reached an age when they can protest their origins; they called themselves "genetic orphans" and demanded to know their biological parents and other family members. Some Canadian provinces changed their law to require such disclosure.
On another front, making a baby with three biological parents was approved this year in the Britain. Those who support it minimize the momentousness of what this means and argue that the procedure, a modified version of IFV, is just another medical treatment.
So what ethical, legal and human-rights issues might reproductive technologies spark in future?
The debate about editing the human germline has shifted from almost universal agreement that it's inherently wrong to asking whether allowing it would do more good than harm – a utilitarian approach. What if we could delete just one gene and cure a terrible disease such as Huntington's? It will be difficult to say no. And if we allow this, could we effectively prohibit "designer children," whether for reasons of vanity or human enhancement?
Many people believe that human cloning is unethical, but would they change their minds if they needed an organ, and they could be cloned, a surrogate mother used and the unborn child aborted to obtain tissue or organs for transplant? (I know of parents who wanted to create IVF embryos, genetically screen them for a best match to their severely diabetic daughter and abort the "saviour sibling" at five months gestation to take its pancreas for transplant.)
What about using artificial uteruses when these are developed? The image of a laundromat comes to mind – machines containing babies instead of clothes. Some celebrities who are able to bear a child are already using surrogate mothers; they might prefer this.
And when such manufacturing becomes possible, why limit the number of children for those who can afford the cost? The son of a Japanese billionaire had at least 10 children by Thai surrogate mothers in 2014; why not 500?
What about creating artificial sperm or ova so that a same-sex couple could have a genetically shared child?
Ethically, we must place the future child at the centre of the decision-making. Does a human being have a right not to be designed, not to be manufactured, not to be the object of commercial deals, to come into existence with his or her own unique, naturally created ticket in the great genetic lottery of the passing on of human life?
We must also protect society. What would be the impact on our most important values, especially the respect for human life and beliefs that parents have unconditional love for their children and that human life is priceless and must never be a commodity?
These technologies bring momentous possibilities to change not only human life but also its transmission, and entail momentous decisions.