‘Enhancing the lives of children: How far should we go?’

A conference at the Royal Society of Medicine raised some interesting and important questions about how today’s society should view the role of genetic, chemical and behavioural techniques in shaping children’s health and behaviour. Jennie Bristow reports.

This conference, held on 29 June, was distinctive in bringing together a number of different ‘forms’ of enhancement. Professor Julian Savulescu, Uehiro Professor of Practical Ethics at the University of Oxford, gave a skilfully-argued presentation on the theme of ‘The moral imperative to enhance human beings’.

He noted that as society has developed, it has become more demanding of people’s cognitive abilities, providing a compelling argument to enhance these abilities where possible. Explaining that a 20 percent of the US population cannot complete simple tasks that enable them to function in modern society – for example, reading bus timetables – he posed the question of whether such people should be considered ‘effectively disabled’, and ‘if we had could improve this through biology, why wouldn’t we?’ Professor Savulescu argued that using enhancement techniques was preferable to ‘pathologising normal human variation’, which he suggested may be the case in the expanding diagnoses of Attention Hyperactivity Disorder (ADHD). He argued that parents are best placed to decide issues to do with how their children are enhanced.

In a presentation on whether reproductive technologies can enhance the lives of future babies, Dr Alastair Sutcliffe, Senior Lecturer in General and Adolescent Paediatrics at the Institute of Child Health, London, focused on the limitations of Artificial Reproductive Technologies (ARTs): including that IVF has only a 20 per cent success rate, and a high proportion of multiple births, which are more likely to result in disability. His main argument was that whatever techniques, such as Preimplantation Genetic Diagnosis (PGD) exist that could enhance the babies born, the difficulties of conceiving with IVF provide a significant reason to reproduce naturally – and certainly not to delay one’s childbearing until later.

Professor Neil Marlow, of the Directorate of Women’s Health at University College London, discussed findings from the 2006 EPICure study on extremely premature infants. While there has been an increase in survival at very low gestations – such as 24 and 25 weeks – the outcomes for these extremely premature babies in terms of health, physical and learning disability remain very poor. He discussed the effect of extremely preterm birth upon families, who often face a lifetime of care, and concluded by arguing that those who work with extremely premature infants ‘have to think very carefully about what we’re doing’, as ‘the cost to society and families is huge’.

A presentation by Professor Stephen Scott, of the Institute of Psychiatry at King’s College London and Director of Research at the National Academy for Parenting Practitioners, was entitled ‘Enhancement of children’s lives through improving socialisation by parents: New Jerusalem or Big Brother?’ He claimed that there was some evidence that ‘good parenting’ techniques work, for example by encouraging desirable behaviour and setting firm limits, and presented a graph indicating young people’s outcomes at the age of 25 relative to how antisocial they had been at the age of seven.

Scott argued that parent training should be done by professionals, as untrained parent trainers can have a negative impact, and raised the ethical issue of to what extent birth parents should be forced to attend parenting classes: should it be like the French system promoting immunisation, where children who have not been immunised cannot go to school?

Mr Robert Wheeler, Consultant in Paediatric and Neonatal Surgery, Southampton University Hospitals Trust, discussed the use of surgery to enhance lives of children. He noted that surgery is routinely carried out on children to correct physical oddities, even if these are not dangerous – for example, the removal of breast-buds in adolescent boys – and argued that such techniques could have important benefits for the self-confidence of children and adolescents, and also their families. He also spoke about the difficulties involved in negotiating cultural practices, such as male circumcision (which is permitted in the UK, with consent from both parents) and female circumcision (which is prohibited).

Professor Eric Taylor, of the Institute of Psychiatry at King’s College London, gave an eloquent presentation on ‘Enhancing children’s cognition and behaviour by chemicals: what’s possible; what’s right?’ He noted the positive effect that treatment for conditions such as ADHD can have, but also addressed some of the issues involved in enhancing children who are not impaired. For example, if a particular drug encourages compliance, care has to be taken because we do not want a society that is too compliant. The use of cognitive enhancing drugs, as is widespread amongst students at Yale and Harvard universities, can potentially replicate and increase social inequalities, when it comes to those who cannot afford the drugs.

Professor Taylor also raised the issue of young people’s autonomy and sense of authenticity – expressed, for example, in the question amongst many families of children taking drugs for ADHD about whether they should take their medication at weekends.

Professor Jonathon Montgomery, Professor of Law at Southampton University and Chair of the Human Genetics Committee, discussed some of the complexities of regulating techniques intended to enhance lives of children. He discussed the argument that a child’s right to self-determination is damaged by enhancement techniques, noting that to some extent enhancement is what parenting is all about. Professor Montgomery argued that ‘whatever we do’ – whether regulation by law, or through prescription of drugs – is regulation in one form or another, and said that ‘we will end up doing something, but it is not clear how much good it will do’.

The final presentation was given by two members of the Youth Advisory Panel of the Royal College of Paediatrics and Child Health, London, giving a ‘young person’s perspective’ on enhancement. These young people were more wary of enhancement techniques than the speakers had been, raising issues to do with personal autonomy and identity. One drawback of a focus on enhancement through drugs were, they noted, ‘the impression upon youth that medicine can be a quick fix to problems’.

Taken all together, the presentations and the discussion that flowed from them provided a number of interesting insights and raised one key question. As scientific understanding of the human body and brain has increased, so more and more technologies are being developed to detect and modify disability, and to enhance characteristics such as cognitive function that are perceived as desirable. But to what extent can – and should – science and medicine be perceived as the key route for human improvement?

Much of the debate about ‘designer babies’ has been stuck in an argument about nature vs science, where the opposition to using technology for human enhancement is largely grounded in fears about ‘playing God’. When it comes to parents using techniques such as PGD or sex selection to ‘choose’ their future children, the debate tends to focus on the problems of individuals making the wrong choices, for the wrong reasons - and thereby insulting people with disabilities, or creating a society dominated by girls (or boys). But these preoccupations miss what seems to me to be the genuinely disturbing feature of the ‘enhancement’ discussion today.

Individuals making choices about their future children – whether through ‘natural’ means such as partner selection, ART, or abortion – have personal and generally reasonable reasons for doing so. Furthermore, what individuals decide in relation to their own families rarely makes a major impact upon society: if a few couples used ART for sex selection in the UK today, it would not result in a massive demographic change in the gender ratio.

Professor Stephen Wilkinson’s recent book, Choosing Tomorrow’s Children: The ethics of selective reproduction, does a superb job of engaging with the ethics of selective reproduction, and demolishing from an ethical standpoint many of the contemporary fears that parents making choices in this area are engaged in practices that are morally wrong or socially problematic.

Specifically, Wilkinson challenges the argument that individuals making choices about selective reproduction through ART are practising a form of eugenics, for which he adopts the working definition of ‘”the attempt to improve the human gene pool”’. Such an attempt, argues Wilkinson, is not wrong per se, but the means by which eugenic ends are pursued can be wrong: for example, with compulsory sterilisation programmes.

A key distinction is between individual decision-making and social policies. If individuals make decisions for health and welfare reasons, which relate to their own circumstances and to pursuing broader social ends, this cannot reasonably be problematised as eugenics.

However, eugenic means are not entirely absent from discussions about reproductive decision-making today. It has been argued, for example, that the official focus on preventing teenage pregnancy has eugenic overtones, in its desire to use birth control to stop the ‘wrong people’ having babies. Similarly, neo-Malthusian arguments that encourage people to have no more than two children in the interests of reducing global promote restrictions on reproductive choice as a means to achieving broader social ends. These arguments are a cause for concern amongst those committed to reproductive autonomy and choice.

There is also a tension inherent in the promotion of science as a means to human enhancement, when such enhancement is understood in such narrow terms as cognition or behaviour. An argument that recurred over the course of the RSM conference was that society has traditionally enhanced children’s cognitive development through education, so why should it balk at cognitive-enhancing drugs?

For those who accept the improvements that science and health have made to human wellbeing, and are open to the exciting possibilities of future developments, it is difficult to have a principled objection to cognitive-enhancing drugs. Yet there is surely an important difference between enhancing children’s brains through education, and through drugs. Education is a social project, facilitating the generational transmission of knowledge and values from older people to younger people, involving a range of different influences and personalities. Cognitive enhancement through drugs does not contain this broad human aspect – for all the benefits that such drugs might bring, in their own terms they treat interact with children, not as young people, but as purely biological beings.

The somewhat one-sided focus on technical methods for enhancing children is not restricted to discussions about chemicals, or ARTs. Stephen Scott’s presentation revealed the extent to which the narrow focus on particular parenting techniques, which are measured in terms of behavioural outcomes and tend to be promoted to particular groups of parents, echo the determinism of sociobiology and intrude on people’s intimate practices and personal choices in matters of child-rearing. The idea that parenting classes could even be discussed in the same way as childhood immunisation reflects the narrowness of contemporary ‘parenting science’.

The focus on enhancing individual children also sits uncomfortably with a socially-oriented outlook. It is easy to understand why parents might choose almost any attempt to improve their children’s life chances – to a parent, the individual child is the focus and the priority. But to policymakers and medical institutions, there is no one special child: the question on the agenda has historically been about improving the life chances of children as a group. To focus on individual solutions to what have historically been understood as social problems – differences in educational achievement, for example, or anti-social behaviour – arguably pushes the search for social solutions further down the agenda.

In raising all these questions, the RSM conference made a valuable contribution to the debate about enhancing children. A further discussion of these issues will take place in October 2010, in a session sponsored by BPAS at the London Battle of Ideas festival, where Professor Stephen Wilkinson will discuss the ethics of selective reproduction. For further information, contact .