The other day I noted that the Journal of the American Medical Association editorialized in favor of health-care rationing because medical costs are growing out of control. How could they not be? Medicine isn’t limited anymore to treating illness, palliating symptoms, or educating us to live more healthily. We increasingly expect the sector to empower us to live happier and more fulfilling lives.
Here’s another example of that cultural inflation. Two of the world’s most influential bioethicists want health insurance to pay the cost of applying expensive biotechnologies to allow people to have their progeny engineered to possess “desirable” characteristics that will flow down the generations — a new form of eugenics.
Let’s call this eugenic engineering. It isn’t science fiction but becoming a reality with the birth of two babies in China who were germline gene edited.
Princeton’s Peter Singer, best known for defending infanticide, and Oxford’s Julian Savulescu, who supports deploying “bio-enhancements” to hard-wire a person’s moral sensibilities, write in “An Ethical Pathway for Gene Editing,” published in Bioethics:
Further into the future, gene editing could be used for enhancement of the genetic contribution to general intelligence. China is currently funding research that is trying to unravel the genetics of high intelligence. Perhaps the best we can hope for is harm reduction and a regulated market to make important enhancements, such as resistance to disease or the enhancement of intelligence (should it ever be possible), part of a basic healthcare plan so that the benefits of gene editing are distributed equally.
Brave New World won’t come cheap. Germline genetic engineering requires the editing of sperm, eggs, or early embryos — all of which would then require IVF procedures to bring engineered babies to birth. Each attempt at IVF costs about $12,000-$15,000 now, and that’s without gene editing.
That is why it is also worth noting that Singer and Savulescu also favor health-care rationing. Singer, for one, pushes the discriminatory Quality Adjusted Life Year (QALY) rationing scheme in which the cost effectiveness of the same treatment is judged differently based on the perceived quality of respective patient’s lives.
QALY rationing denies people with a perceived “low” quality of life interventions that are provided to people with a perceived higher quality of life. It essentially denies the equal moral worth of all people. Here’s a quote from a piece Singer wrote in support of QALY systems for the New York Times:
Some will object that this discriminates against people with disabilities. If we return to the hypothetical assumption that a year with quadriplegia is valued at only half as much as a year without it, then a treatment that extends the lives of people without disabilities will be seen as providing twice the value of one that extends, for a similar period, the lives of quadriplegics.
By declaring that health insurance should pay for eugenic engineering, Singer and Savulescu favor policies that would stretch health-care resources even thinner than they are now, adding fuel to the rationing fire that threatens the vulnerable with being culled from the health-insurance coverage pool. Alas, I suspect that is just fine with them.
We could call their utilitarian arguments many things, but “ethical” sure isn’t one of them.