A Confucian Appraisal of Justice in Genetic Therapy and Genetic Enhancement

Graduate Institute of Philosophy

National Central UniversityChungli, Taiwan ROC Chou Wan-ling

Introduction

Since the completion of the Human Genome Project, biomedical development has entered the era for genetic interference and it sheds new hopes for the treatment of genetic diseases. It will bring along rapid increases both in our understanding and our capability in the control of genetic constitutions of our life and a new era of genetics has dawned before us.

Once the technology of genetic therapy and genetic enhancement matured, we shall face the ethical problem of how to make use of them. Should we employ these techniques for the treatment of genetic diseases as well as enhance our power through genetic enhancement? Do we need to provide such services to all in terms of justice?

This paper will examine the issues with Norman Daniels’ first and goes on with a Confucian evaluation of the problem and degree of employment of genetic interference. Whether there are reasons for the acceptance of genetic therapy and/or genetic enhancement. What difference the Confucian view makes in comparison with Daniels’.

Daniels’ right to health Care

Daniels’ theory of just health care derives from John Rawls. He thinks being healthy is the qualification condition for everybody to enjoin a fair equality of opportunity. An individual need to have health for him/her to compete fairly with others, and can strive after one's own expectation of one’s life . So, the right for fair equality of opportunity is to have everybody's health taken care of first.

Health means a state without disease, and everybody have a right for cure if possible. Therefore the definition of health will influence the range and restrictions that healthcare should cover.

Daniels’ concept of health is adopted from Christopher Boorse.

Boorse ' definition contains a teleological view and regards various kinds of bodily organs have a definite purpose and they serve the various functions of the species.

To put it simply. Boorse regards health as the ability that a member of a species normally possesses. It is a kind of standard frame of reference for a normal individual of the species.Disease is an interference or destruction of the standard normal function of the species, that is, disease deviates from species normal function operation.

Daniels divides medical institutions into four layers and accord to them a sort of priority in the sharing of medical resources. It is based on the principles of justice especially the socalled fair equality of opportunity while in effect, it is in accordance with the concept of species normal functioning.

Daniels emphasized that there is but one concept of justice, not four different principles of justice. It is in their relation to the maintaining or restoring an individual to the normal species functioning that it is thus stratified.

First Layer: Prevention Daniels seems to assume that our health state

is usually at our species normal functioning. Hence, the first thing is to maintain our health, that is, prevent our health being deteriorated. Such suitable precautionary measures, including public health service, environmental cleanliness, preventive personal medical service, occupational health and safety, nutrition education and so on, which promotes healthy life.

Second Layer： Restore. Because not all deviation from health co

uld be prevented, the system must offer service for the recovering of health, to help patients returning into the state of normal species function.

Third Layer: Compensation. Some kind of diseases or disabled could

not be restore to the normal species functioning level, we need to extend medical service for the compensation of such deviation to make the patient as close to normal as possible.

It includes diseases such as chronic patient, the disabled, the frail elderly.

Fourth Layer: Terminal Care Some serious diseases and terminal

patients, they could not be brought near to normal functioning at all and thus require related health and social care. This kind of patients brings issues with justice, they involve the virtue of benevolence.

These four layers contain more or less a person's health care needs in life. It is ideal that the nation could look after all four layers. However, the extent that these needs be satisfied depends on social and public resources, including its economic and political states.

Daniels on Genetic Therapy and Genetic Enhancement

According to Daniels’ concept of right to health care, any medical treatment that could restore a patient’s health is morally acceptable. In other words, since genetic therapy could help to restore patients to their normal species functioning, they are acceptable and under the first three layers of institutional medical services. People could request such kind of service or therapy, under the condition that society could afford the resources,.

In this sense, those diseases that could not be brought back to normal species functioning through genetic therapy would not be eligible for such treatment. They are beyond the call for justice and would fall into the fourth layer of health care services.

Genetic enhancement is beyond the normal species functioning thus not what a just society needs to provide.

Confucianism on Genetic therapy and Genetic Enhancement

The development of genetic technology inevitably brought forward genetic therapy and genetic enhancement as a new kind of medical treatments. They are often dubbed playing God by religious groups. Would Confucianism regard them as moral or not?

According to Confucian conception, Tao has the virtue of procreation and nourishing all living things. However, the procreation process may not fully realize and some lives may have defects and crippled. To cure such defects and diseases is for Confucianism a moral responsibility and a way that human being participates Tao.[1]

[1] Professor Shui Chuen Lee calls this the participation of the nourishing process of Heaven and Earth, see his, Confucian Bioethics, chatter 4, pp.53-69

Diseases is a kind of defects and medical treatment is regarded basically a human act in the direction of assisting the procreation and nourishing process of Tao, hence, whatever kind of curing of diseases and saving of life is morally acceptable for Confucianism

For Confucianism, a human being has two sorts of natural endowment, one is his or her talent, the other is morality as a human being, that is, his or her acting as a moral agent. According to Confucian principle to let every living thing manifest to the utmost of their natural endowment[1], a just society should provide every member in his or her different life stages an opportunity for the utmost manifestation of his or her talents and morality.

[1] Concerning the details of this principle, please refer to Shui Chuen Lee’s Confucian Bioethics, pp.53-69, and his paper on “Justice and Equality in Health Care: A Confucian Critique’, presented in the Eighth World Bioethics Congress, Beijing, August 2006.

The first kind of endowment means that a just society should let its members develop their talents without any unnecessary interference; while the second kind of endowment is what makes a human being reach the full manifestation of the highest value of a human being, that is, participating the procreating process of Tao or Heaven and Earth and becomes a sage in the full sense.

Hence, the principle of utmost extension of one’s nature requires our health care provide more service than Daniels’ right to health care.

In general, Confucians will accept Daniels broad distinction of the different kinds of medical service but will not limit the right to health care to the first three layer and must extend it to the fourth layer as well.

Genetic therapy is basically included in the first three layer and will be accepted by Confucianism as appropriate as such institutions will lessen pains and sufferings of human beings.

Some may doubt that Confucianism lays great emphasis on naturalness, would not approve the kind of artificial interference of genetic therapy. However, this misses the Confucian conception of nature and the nature.

Confucian would not take the Taoist attitude of objection to any human interference of nature, but instead a sense of nature that is in line with Tao and humanity. The act from humanity for the assistance of the procreation of Heaven and Earth is a participation of Tao and raises human being into the status of forming a trinity with Tao. Confucianism regards it as a highest virtue achievable for a moral agent.

In fact, for Confucianism, general medical practice, saving endangered species, environmental protection, are perfectly acts participating the nourishing process of Tao, or what should be morally done.

If genetic therapy could cure patients, Confucian would not object it because it is a kind of interference.

Three different forms of Genetic Therapy

1.Potential Genetic Diseases 2.Manifested Genetic Diseases 3.Therapy that brings also Genetic

enhancement

The first kind refers to the kind of genetic diseases that are regarded as having a definite probability of infliction to the subject.

If genetic screening discover the potential risk of a genetic disease which could be cured through direct genetic interference, Confucianism will endorse such genetic therapy as long as the kind of genetic treatment is matured to a reasonable degree.

For Confucianism, diseases are painful and such suffering, no matter it is physical or psychological, it will affect the personal development of the person. According to the principle of utmost extension of each one’s natural endowment, any element that obstruct personal development should be removed, a just society need to provide resources for such relief.

The second kind are those genetic diseases that have already infected the subjects and thus would be off the mark of normal species functioning.

It is not prevention but a need for restoration and thus in accord with the second layer. Genetic therapy could stop such genetic diseases to have further worsening effects on the body as a whole and it may provide cure through regeneration of lost parts so that the patient may return to normal functioning and relieve from sufferings. It is definitely approved by Confucianism as morally compelling for the society to offer to such patients.

The third kind is more controversial for it involves genetic enhancement. For instance, it may happen that in curing retardation in intelligence, the patient may become a genius of some sort. It would impinge on the problem with enhancement.

Is it morally acceptable that when curing a defective gene, the treatment brings along enhancement?

For Confucianism, genetic therapy is for the curing of genetic diseases which affects the subject’s development, the side effect of enhancement will not be a counter reason for such treatment.

As with genetic therapy, if genetic enhancement could help people to have a fuller development of his or her natural endowment which leads to better social harmony, Confucianism will accept it with qualifications.

For Daniels, the difference between genetic therapy and genetic enhancement is that the former fits into the definition of disease while the latter is not. If it is a genetic disease, it is genetic therapy and has the right to proceed, if not, it is enhancement and the society has no responsibility for its provision.

Though Confucianism accepts the distinction of genetic therapy and genetic enhancement as Daniels did, social justice is not defined according to the criteria of a disease. It encompasses more. It includes those that could be labeled as defects. If certain enhancement could enhance such defects, Confucianism would accept it as a remedial for justice.

The Content of Genetic Enhancement

There are two kinds of personal traits that may be enhanced:

One that is judged as socially good, excellent genes, such as high intelligence, logical power, understanding, as well as kind, considerate, benevolent, generous, etc, which are socially approved personal traits.

Another one is the socalled negative personal traits, such as indifferent, cruel, selfish, and certain special features that could distort the normal body functioning such as being very elastic.

For the first kind of personal traits, if they could promote a better and more harmonious society, so that human society as a whole improves, Confucianism would be likely to allow such kind of enhancements, though Confucian may think the key lies with education and social relationship development rather than genetic determination.

Hence, if one’s request for enhancement is solely for personal gains would not be approved by Confucianism, for consideration purely for personal gain is a somewhat selfish act and would lead to others being in a less competitive situation. It would cause more conflict and bigger gap between social classes.

Besides, if only those who could afford the cost for enhancement could be accessible to it, it would result in more social injustice and wealthy people will have better resources for the accumulation of further wealth, while the poor will be harder to move upward.

In other words, Confucianism would approve enhancement under the condition that all members have equal access to such resource and that the quality of life in the society as a whole is improved.

Concluding Remarks

There is not much objection to genetic therapy as it likes traditional medical practice, only that it makes use of more direct interference with the source of illness. There seems no moral reason to stop it. The difference lies only with the range and restrictions of such manipulations which is guided by the concept of justice.

Daniels will limit the application of justice only to the case of deviations from species normal functioning. Thus, genetic therapy is parallel to traditional therapy and will be limited to the prevention, curing and restoration for normal functioning. Genetic diseases which could not be released by genetic therapy are not subjected to the requirement of justice and would be out of the reach of justice and right to treatment. They are more likely fall into the realm of social welfare which depends on the resources that a society could afford.

Confucianism would regard the extension of the right for treatment to the fourth layer is a requirement for justice. Social benevolence is included in the realm of social justice. Genetic therapy should be extended to the fourth layer, though the service provided depends upon the resources of the conditions of the society.

Daniels would regard all kinds of genetic enhancement as out of the bound of social justice. Confucianism approves enhancement with qualifications.

Genetic era will leads to our better control of our body but only cautious and restrictive employment of such technology would bring happiness and prosperity for human being as a whole.

Thanks for your attention