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THE END OF SEX AND THE FUTURE
OF H U MA N REP RODUCTION
TH E E N D OF S EX
and the Future of Human
Reproduction
H E N RY T. G R E E LY
First printing
Introduction: Changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317
Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 369
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 373
THE END OF SEX AND THE FUTURE
OF H U MA N REP RODUCTION
INTRODUCTION
Changes
This is a book about the future of our species, about the likely develop-
ment of revolutionary biological technologies, and about the deep ethi-
cal and legal challenges our societies will face as a result. But the best
way to sum it up, I think, is to say that it is about the coming obsoles-
cence of sex.
It is not about the disappearance of all the things we mean by the
word “sex.” Humans will still (usually) appear at birth having physical
attributes of one sex or the other and will be loudly pronounced as either
baby girls or baby boys, with the appropriately colored, and gendered,
accessories. Our descendants will still (almost all the time) have genetic
contributions from both an egg and a sperm, thereby achieving the mix-
ing of parental genes that is also sex or, at least, sexual reproduction.
And, I am confident, people will continue to practice sexual intercourse
in myriad different ways and for almost all of the current varying, com-
plicated (and uncomplicated) reasons. Except one.
I expect that, sometime in the next twenty to forty years, among hu-
mans with good health coverage, sex, in one sense, will largely disap-
pear, or at least decrease markedly. Most of those people will no longer
use sexual intercourse to conceive their children. Instead of being con-
ceived in a bed, in the backseat of a car, or under a “Keep off the Grass”
sign, children will be conceived in clinics. Eggs and sperm will be united
through in vitro fertilization (IVF). The DNA of the resulting embryos
will then be sequenced and carefully analyzed before decisions are made
(passive voice intentional) about which embryo or embryos to transfer
1
2 INTRODUCTION
legal, and political factors that will make it not just acceptable, but wide-
ly adopted. Part III examines the broader implications of Easy PGD. It
looks at issues of safety, family, equality, coercion, and nature, along
with some other more practical consequences of the technology.
I’ve gotten lots of good advice in writing this book, but I haven’t
taken all of it. Although IVF, the fountainhead of modern assisted repro-
ductive technologies, is less than forty years old, it has already spawned
a vast literature on a wide range of issues, including many fascinating
and important matters for which Easy PGD would be relevant, such as
surrogacy, parental status, gamete donor rights (and duties), and the
positions and roles of religious beliefs, among others. This book could
and perhaps should be longer; however, practical considerations mean
that the likely interactions between Easy PGD and other issues I do not
analyze must await future treatments.
More fundamentally, some people have told me to make an argu-
ment—to take a position and fight for it, guns blazing. But I’m a law
professor, trained as a lawyer. Lawyers do many things. Sometimes they
argue zealously in court for their clients’ positions, whether they believe
them or not. But sometimes they lay out all the facts and implications,
as they see them, to help clients make their own decisions. I have some
views about ways we might want to regulate Easy PGD, but they are
tentative, based on glimpses and guesses of the future and on my own
preferences and principles. I will share them, but I do not insist on them.
But I will ask you to develop opinions. Easy PGD will give prospective
parents—including perhaps some who are reading these words—more
choices but it will also set some hard questions for all of us. My goals
are, first, to get you interested in those questions—as parents, as grand-
parents, as citizens, as humans—and second, to give you information to
help you come to your own conclusions.
Aldous Huxley’s famous novel takes its title from one of Shakespeare’s
last plays, The Tempest. Years before the play starts, plotters abandon
Prospero, who is both the Duke of Milan and a magician, at sea with his
infant daughter, Miranda. They survive on an island with only non-hu-
man company. The years go by—Miranda grows up, and fate, working
through Shakespeare, delivers the plotters to the island and into Pros-
pero’s hands. Miranda sees them, almost the very first humans she ever
remembers seeing, and, not knowing that some of them had long ago
plotted her death along with her father’s, she famously exclaims:
Changes 5
O, wonder!
How many goodly creatures are there here!
How beauteous mankind is! O brave new world,
That has such people in’t!3
The Science
This part of the book sets out, in six chapters, the scientific background
that I think is useful for understanding Easy PGD and its implications.
The chapters cover basic information about cells, DNA, and genes;
“normal” reproduction among living things, including humans; assisted
reproduction in humans, genetics, genetic testing, and stem cells. I have
tried to write about them to make the information understandable to
anyone interested, even those of you who, like me, last took a biology
course at the age of fifteen.
Some of you will have educational and professional backgrounds that
give you far more knowledge of the areas than I can convey, or know
(although, given the increasing specialization of science and medicine,
I suspect very few of you will be expert in all of these fields). I will not
be offended if you skip some or all of these chapters. Others of you,
without a background in these sciences, will be determined to stay that
way and will not want to read these chapters. I hope you change your
minds. I came to biology late in life, as an amateur, and I fell in love
with it—with its breadth, its combination of deep unities and myriad
complexities, its many rules—each with exceptions and every exception
with provisos—and its infinite surprises. In many ways it reminds me of
my professional field, the law. One of my goals for this book is to bring
to some of you a love of biology. For that, I need you to read the next
six chapters. And I think even those of you who plan to read the next
six chapters may want to read the rest of this introduction—it should be
useful to guide your deeper reading, though it does mean that some parts
of the next chapters will be familiar.
7
8 THE SCIENCE
the egg and sperm eventually merge to form a new nucleus, which begins
to divide. After four or five days of dividing, the resulting embryo is a
hollow ball, about five one-thousandths of an inch wide, perhaps visible
to someone with good eyes in good light. Shortly thereafter, it needs to
be in the womb, attaching to its lining and becoming implanted, if it is
to have any chance to be born.
Some couples cannot have babies the usual way. Sometimes the prob-
lem is with the woman’s eggs getting to or implanting in the womb,
sometimes it is with the man’s sperm getting to and fertilizing the eggs,
and sometimes the cause is unknown. In many cases assisted reproduc-
tion can help, often through IVF.
In IVF, the woman’s ovaries are artificially forced to ripen extra
eggs, which are then surgically extracted. This process is expensive,
unpleasant, and somewhat risky for the woman involved. The eggs
are usually mixed with sperm and become fertilized, although often a
procedure called intracytoplasmic sperm injection (ICSI) is used. (Of
course, if one of the would-be parents has no eggs or sperm, IVF alone
is insufficient and the couple will need “donated” eggs or sperm—often
sold.) Either way, some of the eggs will be fertilized successfully, and
the resulting zygotes will begin to divide in containers in the clinic.
If the zygotes divide successfully for a long enough time, they will be
transferred into a woman’s womb sometime between the third and
sixth day after fertilization, in the hope that they will implant and
eventually become babies.
Now we need to go back to the chromosomes and the DNA they
contain. DNA is famously called “the double helix.” For those of you
who, like me, don’t have a good mental image of a double helix, think
of a very long ladder that has been twisted into a spiral. The sides of
the DNA ladder are unimportant; the rungs are crucial. Each rung is
made up of two out of four molecules: adenosine, cytosine, guanine,
and thymine—widely known as A, C, G, and T. But A will only com-
bine with T to make a rung and C will only combine with G. The
rungs, therefore, are made up of “base pairs” consisting of either A-T,
C-G, G-C, or T-A. By reading the bases attached to one side of the lad-
der, you get the DNA’s “sequence”—for example, AGCGAGTTTTCG.
(The “other” sequence, attached to the other side of the ladder, must
read TCGCTCAAAAGC.) But instead of just the twelve bases in that
example, the sequence of a whole human chromosome is between 50
and 250 million bases long.
10 THE SCIENCE
(less than 1 percent of people), or a version that is not normal but may
or may not be dangerous (another roughly 5 percent).
It has only been possible to sequence a person’s entire genome for less
than fifteen years. The first whole genome sequence cost about $500 mil-
lion and took years. Today you can get your genome sequenced in a few
days for about $1,500. Observers expect this price to continue to fall,
very soon to about $1,000 and eventually much further. Most people
expect whole genome sequencing to be widely used for genetic tests in a
few years as the price drops.
Genetic testing can be used in many different contexts. Adults or chil-
dren can be tested to diagnose, or predict, diseases or traits. Fetuses
can be tested before birth, through three different technologies, starting
between the tenth and the eighteenth weeks of pregnancy. And embryos
created through IVF can be tested before they are transferred for pos-
sible implantation and pregnancy, usually about five days after fertiliza-
tion. The later process, PGD (short, recall, for preimplantation genetic
diagnosis), involves taking a few cells from the embryo and then testing
those cells. The results of those tests are then used to decide whether to
transfer an embryo. In the past twenty-six plus years of PGD’s use, it
could only be used to test any particular embryo for one or a handful
of genes. PGD has been used to look for DNA associated with a genetic
disease found in the family, for DNA that would allow an embryo to
become a baby that could be a cord blood donor to a family member, or
for the embryo’s future sex.
What all can genetic testing tell us? It depends. For some things, ge-
netic tests reveal destiny. Anyone whose DNA has the version of the
Huntingtin gene associated with Huntington disease can only avoid dy-
ing of that disease by dying first of something else. But a woman with a
genetic variation of the BRCA1 gene has only about a 60 to 85 percent
chance of being diagnosed with breast cancer during her lifetime and
only about a 30 percent chance of an ovarian cancer diagnosis. A man
with a dangerous variation in the BRCA2 gene has about 100 times the
normal man’s risk of breast cancer, but his risk is still only a few percent.
The percentage of people with a particular DNA variation who will get
a disease or a trait associated with that variation is called the variation’s
“penetrance.”
Today, genetic testing can give us strong information about a few
thousand genetic diseases, almost all of them rare, as well as some
12 THE SCIENCE
nondisease traits, like ABO blood type. It can give us weaker informa-
tion about other diseases or traits and very weak to no information
about others. In the long run, though, DNA sequences should be able
to reveal much, though not everything, about disease and trait “risks”
that can be lumped into five categories: highly penetrant, serious, early-
onset diseases; other diseases; cosmetic traits (hair color, eye color, and
so on); behavioral traits (math ability, sports ability, personality type);
and sex—boy or girl.
Whole genome sequencing has now been used experimentally on early
embryos. Today it is too expensive and inaccurate to be widely used but
that will change and when it does, PGD should become more popular
because it will be able to make far more predictions about an embryo’s
possible future. But there is still one more barrier—PGD requires IVF
and IVF is difficult. The answer is our last area of science: stem cells.
Most human cells have limited lifespans. After a certain number of
divisions, usually about forty to eighty depending on the cell type, they
stop dividing and die. Stem cells don’t—they just keep dividing, perhaps
indefinitely. Furthermore, some stem cells divide into different kinds of
cells. So blood-forming stem cells can eventually make all the scores of
different kinds of blood cells in our bodies.
Human embryonic stem cells (hESCs) are created by taking the cells
inside the hollow ball that is a five-day-old embryo and growing them
in a laboratory. They can become any cell type in the human body.
We know that because those cells on the inside of the embryo go on
to become every cell type in your body and mine. Extraction of hESCs
has been extremely controversial because it requires the destruction of a
human embryo. In 2007, Shinya Yamanaka in Japan produced the first
human “induced pluripotent stem cells” (iPSCs). These are cells from
normal body tissue (usually from the skin) that he treated in a way that
made them act like hESCs. They, too, are expected to be able to become
every human cell type, including eggs and sperm. And, in fact, baby mice
have already been created from mouse eggs and mouse sperm derived
from both mouse embryonic stem cells and mouse iPSCs.
If ripe human eggs could be derived from a person’s skin cells, it would
avoid most of the cost, almost all of the discomfort, and all of the risk of
IVF. It should also provide an unlimited supply of eggs, from women at
any age. Along with accurate, inexpensive whole genome sequencing of
early embryos, that should make PGD much easier and more attractive,
leading to what this book calls Easy PGD.
The Science 13
1
Collected Writings, ch. 58.
2
Chine Moderne, p. 351.
3
Ch. 59.
4
Ch. 1. This passage is, however, also rendered according to the
metaphor of a road. See Wu-ch‘êng’s note.
5
Chs. 47, 49, 73, 77.
6
See Ch. 25.
7
Chs. 25, 26.
8
Ch. 41.
9
Ch. 1. The word chʽang (常), however, may mean lasting,
eternal.
10
Chs. 14, 35.
11
Ch. 1, &c.
12
Ch. 25.
13
Chs. 25, 37.
14
Chs. 14, 21.
15
Chs. 1, 51.
16
See chs. 18, 38.
17
Ch. 6. The character 谷 is, however, also rendered otherwise
in this page. See Yi-yuan’s edition and that in the 十子全書.
18
Ch. 4.
19
Ch. 32.
20
Chs. 24, 52.
21
Ch. 51. The Tao is also, however, said not to rule over the
world. See ch. 34.
22
Chine Moderne, p. 351.
23
Mélanges Posthumes, p. 167, and in the Mélanges Asiatiques.
See also Julien’s Introduction, p. xii.
24
Introduction, p. xiii.
25
Introduction, p. xiii.
26
See Wu-ch‘eng’s note to the passage.
27
E.G., chs. 16, 14, &c.
28
There are several passages in the Tao-tê Ching where Nature
could not be used to translate Tao; but this may in some cases
arise from the fact that Lao-tzŭ’s conception of Nature was very
different from ours.
CHAPTER V.
SPECULATIVE PHYSICS.
What was Lao-tzŭ’s conception of the Cosmos? To this question
we are unfortunately unable to give a clear and satisfactory answer.
It is only occasionally, and then usually by way of illustration, that he
alludes to the material world or to the physical and mental
constitution of man. All that we can do, accordingly, is to examine
the miscellaneous passages in which he refers to these subjects, and
collect from them what information we can as to the notions which
Lao-tzŭ entertained about the origin and nature of the universe; and
we must be prepared to find under the head of speculative physics
many more matters than ought properly, according to our ideas, to
be so included.
The first point to be noticed is that, as has been already seen,
Lao-tzŭ refers all existing creatures to an eternal, all-producing, all-
sustaining unity, which he calls Nature (Tao). He does not distinguish
between mind and matter, nor would he, in my opinion, have
recognised any fundamental or generic difference between them.
Whether, however, spirit and matter were identical or diametrically
opposite, they had a common origin in Tao. But though usually he
thus refers all things to nature (Tao) as their first cause, yet he
1
sometimes seems to speak of the universe as coming from nothing.
Nor is there any contradiction here, since Lao-tzŭ regarded non-
existence (Wu 無 ) as in circumstances identical with existence (Yu
有 ); the latter being merely the former contemplated from a
different point of view. This opinion, if not explicitly stated by
himself, is at least implied in his writings, and is explicitly stated by
2
one of his disciples. It must be mentioned, however, that Chu-hsi
(朱熹) ascribes the very opposite doctrine to Lao-tzŭ, who, he says,
regarded existence and non-existence as two, whereas Chou-tzŭ (周
3
子) regarded them as one. In the Tao-tê Ching the originator of the
universe is referred to under the names Non-Existence, Existence,
Nature (Tao) and various other designations—all which, however,
represent one idea in various manifestations. It is in all cases Nature
(Tao) which is meant, and we are now prepared to examine the part
which Lao-tzŭ assigns to this Tao in the production and regulation of
the physical world.
Tao, as spoken of by Lao-tzŭ, may be considered as a potential
or as an actual existence, and under this latter head it may be
contemplated in itself and as an operating agent in the universe.
Regarded as a potential existence it may, when compared with
actual existence, be pronounced non-existence. It is from this point
of view imperceptible to man, and can be spoken of only negatively;
and so such terms as non-existence (無), the unlimited or infinite (無
極 ), the non-exerting ( 無 爲 ), the matterless ( 無 物 ), are the
4
expressions used with reference to Tao thus considered.
Accordingly Lao-tzŭ, when speaking of it as a potential existence, as
the logical antecedent of all perceptible existence—seems to regard
it as equivalent to the primeval Nothing or Chaos. So too the Yuan-
miao-nei-pʽien ( 元 妙 内 篇 ) says that the great Tao which arose in
5
non-exertion is the ancestor of all things. From this state, however,
it passes into the condition of actual existence, a transition which is
6
expressed under the metaphor of generation. To this doctrine, that
existence is generated from non-existence, Chu-hsi objects; but his
objection arises chiefly, I think, from supposing that Lao-tzŭ
regarded them as two distinct things, whereas his doctrine on this
subject is exactly like that of Chou-tzŭ, with which Chu-hsi seems to
7
agree. We are not to suppose that Nature is ever simply and
entirely potential to the utter exclusion of actuality, or vice versa: on
the contrary, these two existences or conditions are represented as
8
alternately generating each the other. Thus the potential (or
nominal non-existence) may be supposed to be in time later than
the actual, though the latter must always be logically regarded as
consequent on the former. In itself, again, Tao, regarded as an actual
existence is, as has been seen, calm, void, eternal, unchanging and
bare of all qualities. Regarded as an agent operating throughout the
universe, on the other hand, Tao may be spoken of as great,
changing, far-extending, and finally returning (to the state of
9
potentiality). A late author gives a curious illustration of the above
notions of Lao-tzŭ, taken from the well-known habits of the
Ateuchus with reference to the propagation of its species, but this
author proceeds on the supposition that non-existence and existence
are different. We have now to combine these two conceptions of
Tao, as a potential and as an actual existence. Though void,
shapeless, and immaterial, it yet contains the potentiality of all
10
substance and shape, and from itself it produces the universe,
diffusing itself over or permeating all space. It is said to have
11
generated the world, and is frequently spoken of as the mother of
12
this latter —“the dark primeval mother, teeming with dreamy
beings.” All things that exist submit to Tao as their chief, but it
13
displays no lordship over them. In the spring time it quickens the
dead world, clothes it as with a garment, and nourishes it, yet the
world knows not its foster-mother. A distinction, however, is made—
the nameless is said to be the origin of heaven and earth, while the
named is the mother of the myriad objects which inhabit the earth.
Though there is nothing done in the universe which is not done by
Nature, though all things depend on it for their existence, yet in no
14
case is Nature seen acting. It is in its own deep self a unit—the
smallest possible quantity—yet it prevails over the wide expanse of
15
the universe, operating unspent but unseen.
We now come to the generations of the heavens and the earth,
16
and their history is thus given by Lao-tzŭ. Tao generated One, One
generated Two, Two generated Three, and Three generated the
material world. That is, according to the explanation given by some,
Nature (Tao) generated the Yin-chʽi (陰氣), the passive and inferior
element in the composition of things; this in its turn produced the
Yang-chʽi ( 陽 氣 ), the active and superior element; which again
produced Ho (和), that is, that harmonious agreement of the passive
and active elements which brought about the production of all
17
things. Another explanation is that Tao considered as Non-
existence produced the Great Extreme (Tʽai-chi 太 極 ), which
produced the passive and active elements; then Harmony united
18
these two and generated the universe. Of this section of the Tao-
tê Ching Rémusat observes—“En effet, Lao-tseu explique, d’une
manière qui est entièrement conforme à la doctrine Platonicienne,
comment les deux principes, celui du ciel et celui de la terre, ou l’air
grossier et l’ether, sont liés entre eux par un Souffle qui les unit et
qui produit l’harmonie. Il est impossible d’exprimer plus clairemeut
les idées de Timée de Locres, dont les termes semblent la traduction
19
du passage Chinois.” The doctrines, however, on the formation of
the world put into the mouth of Timæus, and the ideas of Lao-tzŭ on
this subject, seem to me to have very little in common. The Greek
philosopher makes a personal deity the artificer of the universe,
fashioning the world out of the bright and solid elements, fire and
earth, which he unites by means of air and water, thus forming a
friendship and harmony indissoluble by any except the author. The
harmony of Lao-tzŭ, on the other hand is, if we understand him
aright, only the unconflicting alternation of the two cosmical
elements, and there is no divine Demiurg in his system. There is,
however, a statement in the Timæus which resembles Lao-tzŭ’s
statement on this subject, and to which we will refer hereafter.
First in order after Tao is Tʽien ( 天 ), or the material heaven
above us. This is represented as pure and clear in consequence of
having obtained the One—that is, in consequence of having
20
participated in the great “over-soul” or Universal Nature. Were
heaven to lose its purity and clearness it would be in danger of
destruction. Of the heavenly bodies and their revolutions, Lao-tzŭ
does not make mention, nor have we any means of ascertaining
what were his ideas respecting them. Nearly all that he says about
Tʽien or heaven is metaphorical, with apparent reference to an agent
endowed with consciousness (according to our ways of thinking).
Thus he speaks of it as enduring for a long period because it does
not exist for itself; as being free from partiality towards any of the
creatures in the world; as being next in dignity above a king and
21
below Tao, and as taking this last for its rule of conduct.
The space between heaven and earth is represented as like a
22
bottomless bag or tube, though this is perhaps merely a
23
metaphorical expression. The earth itself is at rest, this being the
specific nature which it has as the result of its participation in Tao.
The heavens are always revolving over the earth, producing the
varieties of the seasons, vivifying, nourishing, and killing all things;
but it remains stationary in calm repose. Were it to lose the
informing nature which makes it so, the earth would probably be set
in motion. Its place is next in order after heaven which it takes as its
model. It is impartial, spontaneous, unostentatious, and exists long
because it does not exist for itself. Neither in heaven nor on earth
can anything violent endure for a lengthened period. The whirlwind
24
and heavy rains may come, but they do not last even for a day.
Next to heaven and earth are the “myriad things” that is, the
animate and inanimate objects which surround us; and here again it
must be borne in mind that Lao-tzŭ’s allusions to these matters are
only incidental and by way of illustration generally. As has been
seen, all things spring from and participate in Nature, which is, as it
were, their mother. This Nature (Tao) is, as we have seen,
imperceptible in itself, and when considered merely as a potentiality;
but it bodies itself forth and takes a local habitation and a name in
all the objects which exist in the universe, and thus it becomes
palpable to human observation—not in its essence but only in its
workings. Now this manifestation of Nature constitutes for each
object or class of objects in the world its Tê (德)—that is, what it has
received or obtained from Tao, according to some commentators. Tê
is usually translated by virtue, but this word very inadequately
represents the meaning of the word in this connection. Sometimes it
seems to be almost synonymous with Tao, and has functions
assigned to it which at other times are represented as pertaining to
this latter. If, however, we regard Tao as the great or universal
Nature, we may consider Tê as the particular Nature with which
creatures are endowed out of the former. It is also the conscious
excellence which man and all other creatures obtain when
spontaneity is lost. Thus Lao-tzŭ regards all things as equally with
man under the care of Nature, which produces and nourishes all
alike. Heaven and earth, he says, have no partialities—they regard
the “myriad things” as the straw-made dogs which were formed for
the sacrifices and prayers for rain, and cast aside when the rites
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were finished. In another passage of the Tao-tê Ching it is said
that Tao generates all things, Tê nourishes all things, Matter (Wu 物)
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bodies them forth, and Order (勢) gives them perfection.
Lao-tzŭ, in accordance with popular Chinese ideas, speaks of five
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colours, five sounds, and five tastes; and he attributes to these a
baneful influence on man, whom he teaches to overcome and nullify
them as much as possible. All things in the world, moreover, are
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arranged in a system of dualism. Motion is always followed by rest,
and this again by motion. Long and short, high and low, mutually