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Abstract 摘要

Genetic medicine has made so many unthinkable things possible these days that someday we might be able to determine the features of anyone's genetic profile. Once this is feasible, then the distribution of genetic profiles is no longer a matter of natural lottery. It is then to be decided by social institutions and to be assessed in term of social justice. This paper is concerned with the questions as to whether society then should provide genetic medical resources for parents so that the impact on opportunity of genetic inequalities could be neutralized or minimized, and whether society should bring about genetic equality. I answer both questions negatively from the perspective of a conception of justice, which I have been developing. I call this conception reasonable contractarianism, which holds that society owes to each member a duty to choose an institutional scheme that he or she (if properly motivated) could not reasonably reject. I argued that the brute luck view of equal opportunity, which might give positive answers to the questions I pose, is implausible. In my view, society is obligated to make sure that no one could complain that given his genetic profile, he would rather prefer not being born at all to living. To discharge this obligation, I argue, society should provide gene-based medical resources to help parents give birth to genetically healthy babies. Such provision is necessary for society to do what it owes to its members. I also argue that choosing an institutional scheme that respects the autonomy of family allows unequal distribution of resources, amounts to choosing a scheme that is unfair to those who are genetically inferior. Society should compensate for them. In the end, I suggest that in order not to fail to provide sufficient compensation, society might have to reduce the inequality of opportunity induced by the autonomy of family via genetic measures, despite that this is not what society owes to those who would come to exist with genetically inferior profiles.

基因醫學的進步,有朝一日將使得一個人在出生時的基因組合,不再只是純然的運氣,而是社會體制可以影響和決定的。會這一天來臨時,社會正義是否要求社會提供給父母親必要的基因醫療資源,以避免讓下一代因為基因差異而在機會上不平等?是否要求社會應該提供所有成員必要的基因醫療服務,以確保人與人之間在基因組合上平等?本文從合理契約論的角度來分析對這兩個問題,提出負面的答案。合理契約論的正義觀結合了亞里斯多德與羅爾斯對於正義之概念的分析,主張:社會有欠於每個成員去選擇一個他不能合理拒絕的體制。在這個架構下,本文把基因差異所衍生出來的機會不平等,置於分配正義的脈絡來考察。本文分析了泛公平式的機會平等原則、中立化基因差異原則、基因平等原則,並且指出這些原則的困難。本文認為,為了避免社會成員因為基因缺陷而有生不如死的抗議,社會有義務要做到讓所有的人帶有一定程度的基因品質。但由於基因工程可能會改變人的同一性,本文論證,在合理契約論的架構下,社會並沒有義務去提供必要的基因醫療資源來中立化基因差異,更沒有義務去落實基因平等。但本文也論證,在允許資源不平等、尊重家庭自主性的體制裡,公平式的機會平等要求社會必須補償基因組合較差者。而為了避免補償不足,社會也許應該提供基因醫療資源,縮小人與人之間因為基因差異而衍生的機會不平等,雖然這並不是社會有欠於基因組合較差者的義務。

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