Banning genetic enhancement technologies will only encourage medical tourism and worsen social inequality

Banning genetic enhancement technologies will only encourage medical tourism and worsen social inequality

by Dr Alexis Heng Boon Chin

In a recent large-scale survey conducted in the USA that was published in the prestigious journal “Science”, it was revealed that the desire to utilize preimplantation genetic testing with polygenic scoring (PGT-P) and germline gene editing to enhance the cognitive ability and academic performance of one’s offspring is not confined only to idiosyncratic and fringe elements of society.

Out of the approximately 6,800 people being polled, 38% of them indicated that they are more likely than not to utilize genetic testing to enable their child to enter top-ranked elite universities.

More surprisingly, 28% of respondents indicated that they would even be willing to resort to germline gene editing to achieve this goal.

Perhaps, corresponding figures could likely be much higher in hypercompetitive Asian countries such as Singapore, which has a pervasive “kiasu” (afraid to lose) mentality within society.

Besides high IQ, other socially-desirable traits include athletic prowess and beauty standards related to tallness, fair complexion, eye and hair color. Because parents naturally and instinctively want the best for their child, including the desire to give them the best start in life, such technologies therefore represent a lucrative business opportunity.

Indeed, some bioethicists have put forward the theory of “procreative beneficence”, which holds that parents have a significant moral right and reason to select, of the possible children they could have, to beget the child who is most likely to experience the greatest well-being – that is, the most advantaged child, the child with the best chance at having the best life.

Nevertheless, there are many safety, ethical and moral concerns in the use of such technologies for human enhancement.

At the forefront of these is the fear of worsening social equality and racial stratification, based on the rationale that only the more affluent sections of society can afford to use such expensive technologies to beget genetically-advantaged offspring.

Whereas those at the lower rungs of the socioeconomic ladder, including disadvantaged ethnic minorities, will be rigorously excluded due to their lack of financial resources.

Over several generations of cumulative genetic enhancement, it is posited that this may possibly lead to permanent stratification and divergence of humankind into gene-edited ‘Haves’ and ‘Have-nots’, which could, in turn, lead to new forms of slavery and exploitation.

Such fears have thus prompted calls from various sections of society to impose an outright ban on these new technologies for genetic enhancement.

Nevertheless, the dark reality of human nature would mean that whenever there is high pent-up demand for a banned product or service, then it becomes extremely profitable to provide such products or services through either illegal means or legally through another channel.

History is replete with numerous examples of such failed bans.

For example, the prohibition of alcoholic beverages in the USA in the 1920’s led to the rise of organized crime syndicates (Mafia), and was finally repealed in 1933. Likewise, self-righteous jurisdictions that have attempted to enforce morality by banning gambling, pornography and prostitution have always failed miserably.

In our present day, the widespread ban on poached wildlife products such as ivory and rhinoceros horns have not stopped illicit trade in these products. On the contrary, such bans have only driven up prices and made it more lucrative for individual smugglers and organized crime syndicates.

Within the context of clinically assisted reproduction, this is best exemplified by the widespread phenomenon of fertility tourism, whereby patients travel to a more liberal jurisdiction to access fertility treatment procedures banned in their home country, most commonly egg donation and surrogacy, donor insemination of single women and sex selection through preimplantation genetic testing (PGT).

A case in point is the utilization of the controversial mitochondrial transfer technique (three-parent technique) to conceive a baby in Mexico by New York-based fertility specialist Dr John Zhang in 2016.

Indeed, fertility tourism is particularly relevant in the case of Singapore, given the stringent regulation of various fertility treatment procedures in the country.

For example, surrogacy, non-medical sex selection, and the use of sperm donors by single women are banned in Singapore, and there are strict prohibitions against payment for sperm and egg donation, leading to a severe shortage of such donors for IVF patients in need.

This, in turn, has led to many Singaporean couples travelling abroad to access such banned procedures in more liberal jurisdictions.

Hence, it is thus anticipated that any attempt to ban polygenic testing and germline gene editing for enhancing intelligence and other socially desirable non-disease traits will only worsen social inequality and racial stratification within that particular jurisdiction. Because more affluent citizens can always afford to travel abroad to access such banned genetic enhancement procedures in another country where these are legally permitted.

The net result is that such technologies become even less accessible to poorer citizens and disadvantaged ethnic minorities within that particular jurisdiction that enacted the ban.

The pertinent question that therefore arises is whether there could be a better alternative to just an outright ban?

Perhaps once the safety and effectiveness of genetic enhancement technologies have been confirmed, government intervention and policy-making can facilitate mass participation and democratization of such technologies by making these affordable and accessible to the masses, so that it would no longer be an elitist privilege.

Of course, the immediate question that arises is where to get the money for such subsidies? Perhaps this maybe achieved through differential pricing based on income levels, such that the rich will be required to pay more to subsidize access for the poor, which can be viewed as a form of “social tax”.

Moreover, there is also economy-of-scale and competitive pricing, whereby large-scale provision of a particular service by multiple competitors would ultimately lead to a substantial reduction in per capita costs. This would be somewhat analogous to mass participation in higher education, which has already been achieved by many developed countries worldwide in the twenty-first century. Whereas in the past, this was a rare privilege available only to a few wealthy elites.

Dr Alexis Heng Boon Chin is an Associate Professor of Biomedical Science at Peking University, China. He had previously worked in the field of human clinical assisted reproduction research in Singapore, and has authored 50 international journal publications on ethical and legal issues relating to new reproductive technologies, in addition to also having published more than 280 scientific journal articles, which have garnered a cumulative H-index of 53. 

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