MANAGING ENHANCEMENT--ETHICAL AND PUBLIC POLICY ISSUES

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For the past year we have been examining the ethical and legal issues raised by the prospect of using the products of human genome research for enhancement purposes. That project was to have two phases: attempting to glean lessons about the issues to anticipate from a range of biomedical precedents and, drawing from those analyses a set of basic ethical considerations to inform social policy. The first phase of this work is nearly complete and has produced the papers listed in Appendix 1. During 1998 we are pursuing the second phase by jointly authoring a monograph that attempts to articulate an ethics of enhancement at the levels of personal decision-making, professional ethics, and public policymaking. Meanwhile, our first year's work has already identified three critical challenges in applying our analysis to the development of effective social policy in this area. First, most interventions that can be used for enhancement are likely to be initially developed and approved for therapeutic use. However, once so approved, the current regulatory structure provides no adequate means of managing the "off-label" use of such interventions for enhancement purposes by clinicians and their clients. Second, any enhancement interventions performed on pre-implantation embryos are likely to be undertaken in the largely unregulated context of clinical reproductive biology and infertility medicine. While our current project will allow us to outline the considerations relevant to professional ethics in this area, it is still not clear how those standards would be best enforced. Finally, the availability of either pre-implantation or post-implantation genetic enhancement interventions will also depend on our policies regarding access to these interventions outside the boundaries of the U.S. In our next project we propose to undertake a close-grained analysis of these three problems as they will challenge the management of genetic enhancement technologies, and to develop specific policy recommendations for public policy makers that would allow the issues to be addressed within the framework of considerations we will have already set out. The project's methods will be primarily analytic and discursive: we will be critiquing, constructing, and proposing policy positions on the basis of the literature about the closest precedents for each of these problems by continuing the regimen of regular research meetings and collaborative writing that has propelled our work to date.