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Two decades ago, James Rachels challenged the moral significance of the active–passive euthanasia distinction in a widely anthologized essay.⁷³ This paper has attempted to perform a similar debunking of the therapy–enhancement distinction in human genetics. It has considered and rejected a variety of different ways of arguing that the therapy–enhancement distinction in human genetics marks a solid, moral boundary. Genetic enhancement is not inherently immoral nor is genetic therapy inherently moral. Some forms of enhancement are immoral, others are not; likewise, some types of therapy are immoral, others are not. The implication of this view is that we should not use the therapy–enhancement distinction as our moral compass in human genetics. In evaluating the ethical aspects of any particular genetic intervention, we should ask not whether it is therapy or enhancement but whether the intervention poses significant risks, offers significant benefits, violates or promotes human dignity, is just or unjust, and so on.

Having said this much, I think some forms of enhancement can be morally justified, provided that they can be shown to be safe and effective. For example, using genetic technology to protect people against diseases could be justified on the grounds that it benefits patients. I think one can even justify the use of genetics for cosmetic purposes in terms of benefits to patients. We can also view some forms of genetic therapy as unacceptable (at present) because they pose unjustifiable risks to patients or future generations. For example, all forms of GLGT and some types of SGT, such as a procedure for fighting cancer at the genetic level, are too risky, given our current scientific and technical limitations. In any case, the moral assessment of these procedures depends on considerations of probable benefits and harms (as well as other moral qualities), not on their classification as “therapy” or “enhancement.”

So what is the significance of the therapy–enhancement distinction? What role should it play in thinking about the ethics of human genetics? Can it guide public policy? The most I can say in favor of the distinction is that it defines moral zones without any sharp boundaries. The significance of the distinction may lie in its ability to address our fears and hopes: we hope that genetic therapy will help us treat diseases and improve human health, but we fear that genetic enhancement will lead us down a slippery slope toward a variety of undesirable consequences, such as discrimination, bias, eugenics, injustice, biomedical harms, and so on.⁷⁴ Genetic enhancement will probably always dwell in the shadow of the slippery slope argument, while genetic therapy will probably always bask in the glory of modern medicine. Our hopes and fears may or may not be warranted; only time will tell. In the meantime, even if the therapy–enhancement distinction does not draw any solid moral boundaries, we need to be aware of the distinction in public dialogues about genetics. In these dialogues, it may be useful to address the fears of enhancement and the hopes of therapy while attempting to grapple with the realities of the genetic revolution.