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| Preface | |
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| Introduction | |
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| Challenges of the Genetic Age | |
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| Previews of Perplexities | |
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| Genetic Communitarianism | |
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| Personal Choice or Public Health Concern? | |
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| The Quest for the Perfect Baby | |
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| Health Care in the Age of Genetic Intervention | |
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| The Genetic Enhancement Certificate | |
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| The Need for Systematic Ethical Thinking | |
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| Genomic Research and Genetic Intervention | |
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| The Human Genome Project and Related Genetic Research | |
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| Modes of Genetic Intervention | |
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| The Shadow of Eugenics | |
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| Two Models for Genetic Intervention | |
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| The Public Health Model | |
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| The Personal Service Model | |
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| A Third Approach | |
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| Ethical Analysis and Ethical Theory | |
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| Principles for Institutions | |
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| Justice | |
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| Preventing Harm | |
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| Limits on the Pursuit of "Genetic Perfection" | |
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| The Morality of Inclusion | |
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| Ethical Theory and Public Policy | |
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| Science Fiction Examples, Reflective Equilibrium and the Ideological Uses of Genetic Determinism | |
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| The Risk of Reinforcing "Gene-Mania" | |
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| Genetic Determinist Fallacies | |
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| Ideological Functions of Genetic Determinism | |
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| Eugenics and its Shadow | |
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| The Relevance of Eugenics | |
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| Optimism and Anxiety | |
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| Eugenics as a Cautionary Tale | |
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| Eugenics: A Brief History | |
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| Origins and Growth | |
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| Varieties of Eugenics | |
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| The Nazi Debacle | |
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| Decline and Fall | |
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| Common Themes of Eugenicists | |
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| Degeneration | |
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| Heritability of Behavioral Traits | |
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| Eugenic Ends | |
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| Ethical Autopsy | |
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| A Creature of Its Time | |
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| Why Was Eugenics Wrong? Five Theses | |
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| The Public Health and Personal Service Models | |
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| Cost-Benefit Justifications for Genetic Intervention | |
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| The Social Dimension of Genetics | |
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| Genetics Constrained by Justice | |
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| Genetics in Pursuit of Justice | |
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| Conclusion | |
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| Genes, Justice, and Human Nature | |
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| Distributive Justice Issues Raised by Genetic Intervention | |
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| Including the Distribution of Natural Assets in the Domain of Justice | |
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| The Traditional View: Natural Inequalities Are Not a Concern of Justice | |
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| Challenging the Traditional View | |
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| Equality of Opportunity | |
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| Two Variants of the Level Playing Field Conception | |
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| Resource Egalitarianism and the Domain of Justice | |
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| Individual Liberty and Genetic Intervention | |
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| Genetic Equality? | |
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| A "Genetic Decent Minimum"? | |
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| Points of Convergence | |
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| The Colonization of the Natural by the Just | |
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| Blurring the Distinction Between the Subjects and Objects of Justice | |
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| Justice, Human Nature, and the Natural Bases of Inequality | |
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| Three Conceptions of the Relation of Human Nature to Ethics | |
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| Genetic Causation, Freedom, and the Possibility of Morality | |
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| Human Nature and the Idea of Moral Progress | |
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| Genetic Intervention in the Name of Justice | |
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| Intervening to Prevent Limitations on Opportunity | |
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| Regulating Access to Interventions to Prevent a Widening of Existing Inequalities | |
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| Ratcheting Up the Standard for Normal Species Functioning | |
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| Tailoring Environments to Special Genetic Needs | |
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| The Obligation to Prevent Harm | |
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| Conclusions | |
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| Positive and Negative Genetic Interventions | |
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| Old Distinctions in New Clothes | |
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| Positive and Negative Eugenic Goals for Populations | |
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| Positive and Negative Interventions and the Health and Welfare of Individuals | |
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| Moral Boundaries and the Positive/Negative Distinction | |
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| Treatment Versus Enhancement: Wide Use, Hard Cases, Strong Criticism | |
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| Insurance Coverage and "Medical Necessity" | |
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| Treatment/Enhancement and Moral Hazard | |
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| Treatments and the Limits of Obligations | |
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| Hard Cases and Expansion of Obligations | |
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| The Microstructure of the Normal and Moral Arbitrariness | |
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| Two Objections to the Treatment/Enhancement Distinction | |
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| A Limited Defense of the Treatment/Enhancement Distinction and Its Circumscribed Use | |
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| Treatment/Enhancement and the Obligatory/Nonobligatory Boundary | |
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| The Primary Rationale for Medical Obligations | |
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| Hard Cases and Expansive Views of Medical Obligations | |
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| Three Philosophical Models of the Relationship Between Equal Opportunity and the Goals of Health Care | |
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| The Normal Function Model as Better Public Policy | |
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| Is the Normal Function Model a Moral "Second-Best"? | |
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| Is the Treatment/Enhancement Distinction a Natural Baseline? | |
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| Positive Versus Negative Genetic Interventions and the Permissible/Impermissible Boundary | |
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| A Reminder about Science Fiction | |
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| Negative and Positive and the Permissible/Impermissible Boundary | |
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| Treatment/Enhancement and Moral Warning Flags | |
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| Why Not the Best? | |
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| Having the Best Children We Can | |
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| What Could Be More Natural Than Parents Seeking the Best? | |
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| Environmental Versus Genetic Pursuits | |
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| What Is the Best and Who Decides? | |
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| A Moral Distinction Between Actions | |
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| Pursuing the Best for the Child | |
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| Harms, Benefits, and General-Purpose Means | |
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| The Right to an Open Future | |
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| Limits on Pursuit of the Best | |
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| Pluralism and Liberalism | |
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| Virtues and the Best | |
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| Constraints on Permissions Allowed Parents | |
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| Enhancements, Coordination Problems, and Harms to Others | |
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| Enhancements and Fairness | |
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| Uncertainty and the Risks of Pursuing the Best | |
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| Cloning | |
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| Conclusion | |
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| Reproductive Freedom and the Prevention of Harm | |
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| The Wider Context: Conflicts Between Liberty and Harm Prevention | |
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| What Is Reproductive Freedom? | |
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| Rights and Freedoms | |
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| Positive and Negative Freedom | |
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| Summary of the Scope of Concern | |
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| The Interests and Values That Determine the Moral Importance of Reproductive Freedom | |
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| Self-Determination | |
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| Individual Good or Well-Being | |
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| Equality of Expectations and Opportunity | |
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| Use of Genetic Information to Prevent Harm | |
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| Distinguishing Cases | |
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| Post-Conception Interventions to Prevent Harms Compatible with a Worthwhile Life | |
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| Prevention of Harms across Many Generations | |
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| Pre- and Post-Conception Interventions to Prevent Harms Incompatible with a Worthwhile Life | |
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| Pre-Conception Interventions to Prevent Conditions Compatible with a Worthwhile Life | |
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| Conclusion | |
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| Genetic Intervention and the Morality of Inclusion | |
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| Objectives | |
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| The Morality of Inclusion | |
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| Neglect of the Morality of Inclusion in Ethical Theory | |
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| The Allegation That the New Genetics is Exclusionary | |
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| The Public Promise of the New Genetics: Better Lives for All Through Medical Genetics | |
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| Challenging the Rhetoric: The Radical Disabilities Rights Advocates' Complaints | |
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| Sorting Out the Concerns of Disabilities Rights Advocates | |
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| The Loss of Support Argument | |
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| The Justice Trumps Beneficence Argument | |
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| The Expressivist Objection | |
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| The Deaf Culture Argument | |
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| The Social Construction of Disability and the Morality of Inclusion | |
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| Distinguishing Disabilities from Impairments | |
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| Options for Eliminating Disabilities | |
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| Choosing a Dominant Cooperative Framework | |
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| The Concept of a Dominant Cooperative Framework | |
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| Why the Choice Is a Matter of Justice | |
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| How Genetic Interventions Might Affect the Character of the Dominant Cooperative Scheme | |
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| Knowledge of Genetic Differences and the Morality of Inclusion | |
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| Conclusion | |
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| Policy Implications | |
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| Where Does the Shadow of Eugenics Fall? | |
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| The Inevitable Comparison | |
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| Public Concern about Genetic Research | |
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| Beyond Rules of Thumb | |
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| Distributive Justice | |
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| The Right to Health Care | |
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| Additional Arguments for Access to Genetic Interventions | |
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| Securing Equality | |
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| If People Are Not Equal Should We Treat Them So? Should We Make Them So? | |
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| Will Human Genomic Research Push Society to the Right? | |
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| Must Everyone Have Access to Enhancements? | |
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| Enhancements versus Treatments | |
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| Families | |
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| Reproductive Freedom and Coercive Eugenics | |
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| Restrictions on Parental Choice | |
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| Citizenship and Inclusion | |
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| A Ghetto Walled by Data | |
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| Devaluing the Less Than Perfect | |
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| Reducing the Risk of Exclusion | |
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| State, Society, Individual, and Markets | |
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| The Threat of the Eugenic State | |
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| Eugenics as a Moral Obligation? | |
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| Eugenic Public Policy? | |
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| Utopian Eugenics? | |
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| Markets and Individual Liberty | |
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| Commercial Genetics | |
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| Liberal Neutrality and Democratic Decisionmaking | |
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| The Permissibility of Rights-Respecting Genetic Perfectionist Policies | |
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| The Meaning of Genetic Causation | |
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| Three Modes of Intervention | |
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| Four Key Questions | |
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| Do Genes Causally Contribute to the Trait? | |
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| How Much Do Genes, as Opposed to Environment, Contribute to the Trait? | |
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| Which Genes Contribute to the Trait? | |
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| How Do These Genes Contribute to the Trait? | |
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| Conclusion | |
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| Acknowledgments | |
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| Methodology | |
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| The Method of Reflective Equilibrium | |
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| The Charge of Parochialism | |
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| The Communitarian Challenge | |
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| The Limits of "Principlism" | |
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| A Liberal Framework | |
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| Negative and Positive Rights: Freedom and Well-Being | |
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| Justifying the Liberal Framework | |
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| References | |
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| Index | |