Making Medical Spending Decisions: The Law, Ethics, and Economics of Rationing Mechanisms Book

For me, philosophy is about intellectual curiosity and exploration. And like all good explorers, you must be willing to take risks and put yourself out there. Philosophers select an issue, survey the available evidence, evaluate the perspectives, and defend a position. Without making a point - that is, without allowing yourself to be vulnerable - you risk nothing. But you also don't really discover anything, either. That's how I felt after reading Jonathan Glover's book, Choosing Children - a book that says practically nothing and risks practically nothing.

Toward the conclusion, Glover broaches the question of genetic engineering and whether there should be limits to our intervention with 'human nature'. He writes: "[...] my own conception of the desirable boundaries of the protected area [of human nature] is far from worked out. No doubt this is partly because my own thinking has not penetrated far enough". But isn't that the whole point of writing a book, to explore further? Shouldn't we take intellectual risks and say something of substance, if only in that moment?

The book is full of lukewarm argumentation like this. For instance, Glover says "I accept both the conservative thought that we need to keep the boat afloat on an even keel and the radical thought that we may also need to do some rebuilding as well". Again, this sentence left me wondering what, if anything, Glover is trying to say. Is he maintaining a cautious optimism in the future of genetic engineering? Fair enough, but that's not really a thesis, and it's certainly not assertive enough.

When Glover is assertive, I found some of his positions to be pretty bogus. Another Goodreads reviewer already highlighted his stance on women's carceral reproductive rights, so I won't dwell on that point (I think it's noteworthy, though). However, he also claimed that "[...] we do not owe anything to unconceived potential children". Considering that Glover is a bioethicist writing specifically about human potential, that one was a bit of a noggin-scratcher for me...

That isn't to say that Choosing Children doesn't have any redeeming qualities. Indeed, Glover explored some promising ideas within the hundred-or-so pages of his book. In particular, he presents and challenges what he refers to as the "expressivist argument". According to Glover's precis, expressivists argue that the private decisions we make about genetic engineering are not merely individual decisions. Rather, they contain and express certain ideas about health, beauty, and normalcy that reflect a wider set of cultural values. These cultural values demonstrate which qualities we consider desirable and, conversely, which ones we consider undesirable. Individual decisions are, therefore, relational decisions with broader socio-cultural implications.

It's an intriguing premise, and one that I think should be taken very seriously. Glover doesn't really buy what the expressivists are selling, but he doesn't do a very good job rejecting their claim. "Choosing to have a child without certain disabilities", he says, "need not come from any idea that disabled people are inferior. Nor does it entail that the world, or the gene pool, should be cleansed of disabled people". I'm not convinced that this is true. Since bio-engineering and eugenicist decisions are based upon perfectionistic ideals, they have a very real capacity to signal to others what it means to be - and not to be - a human being. This can become extremely dangerous if such private decisions are adopted more broadly as socio-cultural models.

However, Glover thinks that the most promising response to the expressivist problem is within the domain of intentionality: "I think that, other things being equal, it is good if the incidence of disabilities is reduced by parental choices to opt for potentially more flourishing children. But we should not deny the potential cost to which the expressivist argument draws attention. And we should try to reduce that cost as far as possible". He continues on: "To do this, we need to send a clear signal that we do not have the ugly attitudes to disability. […] To think that a particular disability makes someone's life less good is not one of the ugly attitudes. It does not mean that the person who has it is of any less value, or is less deserving of respect, than anyone else". This is not a satisfactory answer to the expressivist problem. I find it difficult to accept the moral authority of good intentions, especially when history is full of examples where good intentions have produced horrific results. What Glover is recommending here feels something like a bioethical rendition of the 'it's not you, it's me' breakup line (rough translation: it's always you).

Overall, Glover's book is a frustrating collection of missed opportunities. Although there is something to be said for a more liberal approach to "human flourishing", we can't pretend that these private decisions exist somehow outside of the public realm. State-mandated or not, all eugenicist decisions have social implications - and that's true irrespective of John and Jane's good intentions.