Monday, September 13, 2021

The Genetic Lottery of Life: A Primer

This morning I teach my first in-person class in 18 months, since the pandemic and closure of universities in Ontario in March 2020.  I am really looking forward to seeing and interacting with students in-person again.  

My class is my 4th year seminar "Science and Justice", which focuses on the ethical, social and legal implications of the genetic revolution (with a focus on the prospect of "enhancing humans").  Here I will lay out a few of the thoughts I emphasis in the first class to frame the course and help motivate the students to get excited about tackling these issues.

Firstly, I begin the class with a conjecture I have started the class with for some 15 years now, which has been borne out by the COVID-19 pandemic- namely, that science policy is the most important area of public policy decision-making in the 21st century.   And thus students of political science must have some understanding of what science is, and what constitutes "well-ordered" science and responsible science policy decision-making if we are to have any hope of meeting the societal challenges of the 21st century,  This century human populations face significant risks from infectious and chronic diseases, climate change, global aging, artificial intelligence, etc. Scientific innovation (or the lack thereof) will profoundly influence humanity's capacity to meet the novel predicaments of the 21st century.

My course focuses on a specific area of science and policy- advances in the biomedical sciences (especially biomedical "enhancement"). The fact that the class focus is on "enhancing" humans is apt since the singular focus of public health, politicians and the media for the past 18 months has been on enhancing the human immune system to make us less vulnerable to serious illness and death from SARS-CoV-2.  This pandemic is not a focus of this course, though I am offering a new course in the winter term on the "politics of pandemics", which has 2 weeks dedicated to these issues as they pertain to the COVID-19 pandemic. 

I start my course this morning with a brief insight made by the philosopher John Rawls, with respect to the role 2 different types of lotteries play in our lives- the social and natural lotteries of life.  The social lottery of life determines the family one is born into, which can have a profound influence on our life prospects.  Being born into a wealthy family can open up many opportunities that would be lacking if one was born into a family that has little money or lacked a steady income and adequate housing.  What parents invest in their children- financially, emotionally and intellectually, can have a profound (positive or detrimental) impact on a child's wellbeing and the (eventual) adult they grow into.  While society cannot "control" the social lottery of life, Rawls argues justice requires we try to mitigate such "unchosen" inequalities by ensuring fair equality of opportunity for education, for example.  Society's institutions can at least help guard against the vulnerabilities of the social lottery of life, and ameliorate some of it's inequalities via progressive taxation and (re)distributive justice.  

The second lottery of life is the natural lottery of life.  We all enter this world having inherited two copies of most genes, one from our biological mother and one from our biological father.  Writing in the early 1970s Rawls argued that society could not directly influence the natural lottery of life, and thus he focused only on the distribution of what he called "social" (e.g. wealth) vs "natural primary" goods like health, intelligence and imagination and vigour.  But science has advanced significantly over the past 50 years, so much so that this Rawlsian assumption is no longer valid.

The "genetic inheritance" we begin life, like the social lottery, also profoundly influences our life prospects.  If we are born with 1 of the 10 000 known single gene  disorders, then this genetic inheritance will adversely impact our health and wellbeing, depending on the severity of the disorder.  Serious early onset conditions might cause physical and intellectual disability, and reduce life expectancy by decades.  However, at the other end of the spectrum are those rare individuals who inherit the genetics of exceptional longevity which can increase the likelihood that they might enjoy a century of disease-free life, delaying (or even escaping) the most common diseases (like heart disease, cancer and stroke) that typically kill people in their 70s or 80s.

Over the past few decades advances in our understanding of the role genes play in health, cognition, mood, behaviour and personality has resulted in the lifting of a real "veil of ignorance" which normative theorists were functioning from behind with respect to conjecturing about the role of "nature" vs "nurture".  We now know that both nature and nurture are important.  With other 3000 gene therapy trails worldwide, and more precise technologies like CRISPR, the prospect of directly and intentionally modifying human biology is upon us.  We are living in the midst of a "genetic revolution" which is altering the moral landscape so that the "natural lottery" of life is shifting from the realm of "beyond human control" to "within our influence".  And this means a revision of the moral landscape is also in order, as the demands of morality and justice will also shift.

The ambitious project that now awaits bioethicists and political philosophers is to canvass how we navigate a sage path forward which takes seriously the benefits and risks of intentionally modifying human biology.  From eugenics and the the safety and efficacy of gene therapy, to respect for reproductive freedom and the challenges of promoting health in late life, the genetic revolution presents us with some of the most important and fascinating ethical and societal predicaments of the 21st century.  By encouraging students to address these novel issues and debates, and helping them refine the intellectual skills needed to think cogently, creatively and sagely, we have a better chance of implementing well-ordered science.  I look forward to teaching the course this term!