Choosing Children By Jonathan Glover Oxford University Press, 2006. vi + 120pp. £15.95 cloth Choosing Children, the publication of Jonathan Glover‟s 2004 Uehiro Lectures at the University of Oxford, is the natural successor to his far-sighted 1984 book, What Sort of People Should There Be? In it, Glover considers what restrictions should apply to our use of genetic interventions to choose what sort of children we have. A pervasive view is that such techniques are permissible to ensure that our children are born without inherited disabilities, but not to improve the capacities of healthy children. Following a careful examination of disability and human flourishing, Glover argues that this therapyenhancement distinction is indefensible. Without this neat distinction to map the proper limits of our activity, he considers the future for genetic intervention. In the first of the book‟s three chapters, “Disability and Genetic Choice”, Glover asks what disability is; answering: a limitation of normal functioning which impairs the capacity for human flourishing. He then considers what flourishing involves, noting that different types of people flourish in different ways, and the impact that disability can have on it. This discussion is made vivid by several first-hand accounts of disability, which demonstrate that the effect of disability on a person‟s life is not always straightforwardly negative: many deaf people value the deaf community so highly that some deliberately aim to have a deaf child; and losing one‟s lifelong blindness in adulthood can be traumatic. Despite these considerations, Glover concludes that conditions like deafness and blindness are obstacles to flourishing, and that any desire disabled people have to embrace their disability is due to such factors as valued compensations, „sour grapes‟, and lack of knowledge about what a disability-free life would be like. This conclusion is unsatisfactory, if intuitively attractive. Having conceded that what flourishing consists in can vary between people, Glover argues that deafness and blindness are obstacles to flourishing not just because they impair “safe navigation through the world” (p. 23), but also because the sufferer misses out on “a whole dimension of enriching experience”. It is not clear, however, why such sensory experience is necessary for the flourishing of those who lack the capacity for it; and why benefits unique to deaf or blind people—such as membership of a certain community— should count as compensations rather than as important components of flourishing for them. Glover needs to demonstrate why an ability to see or hear is more fundamental to flourishing than other abilities that may be important to the flourishing of some people but not others, such as an ability to play a musical instrument. Glover then considers the use of antenatal screening and pre-implantation genetic diagnosis (PGD) to choose a child without inherited disability. Having rejected claims that such choices are comparable to Nazi eugenics, and that they necessarily embody a disrespect for disabled people, he questions in the second chapter—“Parental Choice and what we Owe to our Children”—whether and how parental choices about what sort of children to have should be restricted. Starting from a principle of reproductive autonomy—the idea that the decision whether to have a child should be taken by the prospective parents themselves—he asks whether this autonomy should extend to choices about what kind of child to have.
    
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    If there ought to be limits on procreative choices, what moral considerations determine these limits? Glover only briefly alludes to moral concerns surrounding the fate of unimplanted embryos generated by PGD, which is perhaps understandable given that in vitro fertilization—a treatment not generally deemed unethical—also involves discarding embryos. He then asks us to consider two „dimensions‟ of ethics: making the world a better place, and what we owe to people. If there are bad choices about what kind of children to have, the badness of many such choices cannot consist in failing to give the child what it is owed. If parents choose an embryo with a deafness gene over a genetically healthy embryo, for example, the resulting child is not harmed by the choice. If the choice is bad, this must be because it makes the world a worse place than it would have been had the other embryo been chosen. However, this explanation is insufficient. Many of our choices make the world a worse place than it would have been had we chosen differently—such as the choice to spend money on a holiday instead of donating it to charity—but not all such choices are immoral. If choosing a disabled child is different, Glover needs to explain why. Glover claims next that we owe our children “a decent chance of a good life” (p. 50). He remains vague about what counts as a good life, noting that it falls somewhere between the „zero line‟ below which life would be unbearable and the „perfectionist‟ ideal of the best human life; but he claims that if parents can remove an obstacle to their children‟s flourishing without unreasonably burdening themselves, they owe it to their children to do so. As technology advances, this may entail a duty not only to cure disabilities, but also—Glover does not make this explicit—to enhance capacities in healthy children. Glover then sketches some general principles which should guide procreative choices. This allows him to dispel some prejudices about genetic choice: applying a Kantian test, he argues that the controversial practices of cloning and having a child so that its stem cells can save its sibling‟s life are acceptable provided that the resulting children are not used simply as a means, but are also valued in their own right. Furthermore, parents wishing to choose what sort of children they have need to strike a balance between avoiding undermining children‟s freedom to shape their own future, and making choices for them that will improve their chances of flourishing. In chapter three, “Human Values and Genetic Design”, Glover considers the extent to which society should restrict procreative choice. Employing a version of Mill‟s harm principle, he argues that restrictions of parental liberty should be considered only to safeguard human flourishing. The “medical boundary” (p. 75)—the idea that therapeutic, but not enhancing, interventions are morally acceptable—cannot justify such a restriction: if disability is bad because it impairs flourishing, then non-disease states like shyness are also bad if they prevent our flourishing. Restrictions may be needed to prevent social evils like “a genetically based caste system” (p. 78), in which the rich ensure the superior genetic quality of their descendents; but Glover is pessimistic about the effectiveness of such measures, citing the limited success of existing attempts to “regulate the market in the interest of wider values” (p. 80). Such pessimism may be unwarranted: whilst, for example, global restrictions on carbon emissions have been difficult to enforce, international cooperation to tackle terrorism has been more successful, and so it may be difficult to determine antecedently whether governments will cooperate to regulate genetic choice.
    
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    Glover then discusses whether human nature itself is worth preserving. This is a hot topic in bioethics, and despite only briefly entering the debate, Glover arrives at two sensible conclusions. First, some qualities that parents choose for their children may not benefit society: these are „positional goods‟ whose value to those who have them depend on others not having them. Second, in considering which human qualities to preserve, the relevant question is not „Are they part of human nature?‟ but „Are they valuable?‟, so human nature is something of a red herring. (However, some have attempted to define human nature in terms of what is valuable. See Martha Nussbaum, „Aristotle on Human Nature and the Foundations of Ethics‟ in J. Altham and R. Harrison, World, Mind, and Ethics (Cambridge University Press, 1995).) And, whilst we may disagree about what parts of our nature are most valuable, Glover is optimistic about the existence of certain shared values, which he sees as accounting for some cross-cultural points of consensus about what constitutes good and bad lives. To finish, Glover urges “optimism in principle, caution in practice” (p. 101), a view that hints at an awareness of the pitfalls of utopian visions. In “the further future” (p. 99), genetic intervention may offer some startling opportunities, such as the ability radically to increase our intellectual capacities. However, any change must take place gradually, and guided by our existing values—and as our values change, so might the genetic choices we make. In summary, Choosing Children is an engaging, careful, and lucid discussion of some important issues in contemporary bioethics. Its limitations stem chiefly from the length of the book: several points would benefit from more extensive discussion; and greater consideration of the more radical ambitions for genetic intervention would have taken the book beyond what occasionally reads as a reaction to conservative intuitions, and into the realm of visionary ideas that we saw in What Sort of People Should There Be? University of Oxford Published in Philosophical Books 49/1 (2008): 76-78. Rebecca Roache
    
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