Are we ready for babies on spec?

NON-FICTION
The End of Sex and the Future of Human Reproduction
by Henry T. Greely
Harvard University Press (2016)
RRP US$35.00

Hank Greeley, a law professor who has long been a witty and warm presence in American bioethics, has written a book that tells us that sex, as we know it, will no longer be necessary. Got your attention? Good. That was his point, and why he called his book “The End of Sex.”

What he means is not really the end of sex, but what he thinks the reasons that “wealthy people” or “people with the means” will no longer have reproductive sex, because they will be making their babies on spec to be sure that the baby in question is the right sort – healthy, with desirable traits, a high IQ and nice eyes.

If all of this sounds horrifying, don’t be alarmed. For despite Greeley’s argument, very little of the science on which it depends really exists, which gives the book feel of fantasy – rather like a book about unicorn regulation.

Greeley is a masterful writer, realistic about his hunches, a calm and careful guide through the science, even though he reminds the reader – frequently – that his last science class was decades ago.

And because he is such a good guide, this is a compelling book, even if you don’t agree with his argument.

Greeley’ fascination for genetics, genomics and stem cell biology is quite contagious and persuasive. As a watcher of science, he became convinced that people would want to know as much as possible about the embryo that would become their child. For many people with a family history of genetic disease, and for many people who are infertile, embryos are made in the lab and tested before being implanted in a womb. But retrieving eggs is arduous and possibly dangerous.

For test tube babies to become routine, Greeley suggests the answer lies in our skin cells. Scientists are now able to scrape a few off the side of your cheek and turn them into stem cells – so-called iPS cells. Being stem cells, they can form any cell type; scientists have also been able to coax them to make rudimentary sperm and egg cells.

Greeley is happily optimistic that, instead of making love to the person who you intend to have a child with, people will use iPS to create plenty of embryos, instrumentalising the process entirely. Such a plan, he adds, will be available to wealthy people first but, as avoiding disabilities is a cost-saving policy, it would quickly become widespread.

If you have seen the movie Gattaca, I know what you are thinking. What would keep us from eventually living in a society where the people with the most access to social goods also have the “best” children, not only free of disease but more beautiful and stronger?

Would people born to the poor, to the spontaneous, or the old-fashioned end up regarded as failures? Would we despise disability? Or worst of all, would some perfected embryos become a commodity? An object of state control?

Once you take responsibility for human creation, each decision is fraught.

Greeley’s book is not quite science fiction. It is too smart for that and it is grounded in some scientific possibilities that may – or may not – work. Whether they come to pass is another issue entirely. Whether iPS cells can make normal gametes and normal embryos is not at all certain. These uncertainties are daunting if what you want is a healthy child.

Many years ago, I was a clinical bioethicist, the sort of person who aims to sort through competing arguments at hard crossroads in medicine. One day, on the bioethics committee we were discussing whether to stop care on a very sick baby who, if he lived, would likely be disabled. The baby’s father looked up and said: “I don’t care if he is smart or a great baseball player. I just want a kid I can take to the mall, and you know, just be a normal dad, because he is my kid, and I will love him no matter what.”

It is this “no matter what” which is the essence of being a parent. And that is why the future Greeley longs for may be a long time coming.