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Having sex has two primary purposes: pleasure and reproduction. Some would add intimacy and expression of love. There are also secondary purposes, such as providing employment, or to obtain physical protection.

What does matter to us in addition to our experiences? First, we want to do certain things, it is only because we want to do the actions that we want the experiences of doing them or thinking that we've done them . . . A second reason for not plugging in is that we want to be a certain way, to be a certain sort of person. Someone floating in a tank is an indeterminate blob . . . Is he courageous, kind, intelligent, witty, loving? It's not merely that it's difficult to tell; there's no way he is . . .

Thirdly, plugging into an experience machine limits us to a man-made world, to a world no deeper or more important than that which people can construct. There is no actual contact with any deeper reality, though the experience of it can be simulated.¹

Nozick makes two claims. The first, that we should not connect to such a machine, I will address later. His second claim is that we would not connect. This has not been borne out by history. We have enthusiastically embraced various "experience machines". Television and other electronic fantasy worlds have replaced the real world of games and play for many children. Sometime next century, "sensual machines" will deliver a complete visual-auditory-tactile environment.² "Virtual sex" may well become more pleasurable, more available, less risky, and cheaper than what some people find to be a rather ordinary, painful or disappointing physical alternative compared with the glamorous "reality" offered to them by the advertising and other industries.

By 2099, Nozick's Experience Machine may be a reality. Moore's Law states computational power is roughly doubling every 18 months. Bill Gates has claimed that in 20 years a US$10 000 computer will have the same power as the human brain.² If artificial intelligence replaces or supplants human intelligence, and human minds "upload" into machines³ or are replaced by them, "sex" between artificial minds may become a reality. The intimacy and love aspects of sex would presumably be as important to artificial persons as they are to us, and sex between artificial persons could mimic or improve all aspects of physical sex.

The use of AR may expand considerably in the near future for two reasons: the introduction of preimplantation genetic diagnosis (PGD) and the identification of new genetic information. When the Human Genome Project is complete, the potential of PGD will be enormous. Couples may be able to select embryos less likely to develop heart disease, cancer, dementia, and so on.

As genes for more complex characteristics like intelligence,⁵ personality and behaviour are identified, there will be pressure to select certain desired traits. PGD is now used for sex selection,⁶ and may in the future play a greater role in family planning.

The next step might be to remove any genetic predisposition to disease. Still more controversially, we may modify non-medical characteristics (eg, creating darker-skinned children to protect against UV radiation as the ozone layer disappears).

We may soon see the use of AR beyond treating infertility or preventing genetic disease. Postmenopausal women have produced children using AR with donor eggs, and men have "donated" sperm after death and fathered children.^7,8 A 32-year-old investment banker recently had embryos frozen in England to allow her the option of having a child after she had established her career.⁹ Freezing eggs is more experimental and not readily available. However, the technology is rapidly advancing and births have been reported.^10-13 Although freezing embryos is a well developed technique, is readily available, and has good success rates, it requires sperm -- freezing eggs does not. Freezing eggs and embryos has a number of attractions (Box 1).

Reproduction may change more radically. Cloning in non-human animals is already a reality.¹⁴ In some States same-sex couples and single people can use AR to reproduce with donor gametes; in future, parthenogenesis (the production of an individual from an egg) and induced meiosis (causing a somatic cell to change to a sex cell) may enable them to have a child with genetic material from only themselves.

Nozick claimed that we should not connect to the Experience Machine. In part, his claims were based on the limits of artificiality and the man-made world. But it remains an open question what "pleasure machines" and artificial intelligence would be able to do, and what we would be able to do with them. Non-carbon-based life may be better, more productive and part of a "deeper reality".

• The most valid concern about any new technology is its safety, as the National Bioethics Advisory Commission concluded in its inquiry into cloning.¹⁵ Harm to others is also an important concern. For example, sex selection is alleged to have harmful effects on children of the opposite sex in the family and for the status of women in society.

• Another concern is that the use of technology to select children will place great expectations on the child. In the cloning debate, this is called the "living in the shadow" objection. It is argued that parents, in choosing a child with defined characteristics, may fail to love that child "unconditionally" and use (or commodify) it for their own ends.

• There are also worries that the use of these technologies will change the structure of families. For example, the offspring produced by cloning will have only one immediate genetic parent, and in AR, offspring may not know their genetic parents, and half- or full-siblings may not know of their relationship. Victoria and South Australia now require that details of gamete donors be kept and released to offspring.

• Concerns have been raised by UNESCO that cloning is an "affront to human dignity".¹⁶ However, there are over 5000 clones living in Australia today who have happy, normal existences. Indeed, one in every 300 births produces new clones (as identical twins).

• "Slippery slope" arguments claim that the expanded use of AR is the thin end of the wedge, the beginning of a return to Nazi eugenics and euthanasia.^17,18

All these objections have been critically addressed in the ethics literature.^9,19-20 There are two major arguments for allowing access to these new technologies. The first is respect for "procreative autonomy", the liberty of couples to decide when and how to have children, and indeed which children to have, according to what they judge is best.¹⁰ Parents know best their own circumstances and ultimately it is parents who must live with and make sacrifices for their children.

The second argument is that there can be good reasons in individual circumstances to choose certain characteristics in the children we bear. Consider the Ayala case (Box 2). In similar cases, AR has been used to produce children to serve as bone marrow donors.²⁴ There was only a one-in-four chance that the child the Ayalas conceived would be compatible with Anissa. Use of AR (cloning Anissa or PGD and HLA typing of embryos) could have made it certain that the child would be compatible with Anissa.

While Marissa's parents "used her" to save the life of Anissa, they also appear capable of loving her as a person in her own right. And her sister's life was saved. Should Marissa regret the fact that her parents decided to have her to provide bone marrow for her sister? She could, if her life has been so bad that she wishes she had never been brought into existence, but her life is not that bad. This raises a general point about reproductive technologies: if the intervention determines which unique sperm and egg unite, that particular child would not have existed without the technological intervention. Even if the child is disadvantaged psychologically, it is only wrong to employ the technology from the child's perspective if its life is so bad that it is not worth living.

This would have at least one bad effect. The rich will enjoy the highest pleasures and select or create the babies they judge to be best. While some people are better off and no-one is worse off, this is potentially divisive and inegalitarian. There may be serious conflict between efficiency and equality.

There may also not be a conflict. If genetic and reproductive technology is used to prevent genetic disease or correct genetic inequality, this may promote both equality and efficiency. Some have argued that genetic enhancement of those disadvantaged by the genetic lottery is required by justice.²⁵

What if there is an irresolvable tension between equality and efficiency? There are several alternatives. One is to ban the use of technology in these ways and so to ensure that nobody has access to it. If the divisiveness that differential access to these technologies causes is great enough to threaten social stability, this may be the best option.

Another option is to ensure that everyone has some access to AR, or a right to a "fair go". Consider a parallel: football. Everyone can go to the football. Some have better seats, some meet the players, some get to go to the Grand Final, some even have individual boxes, but everyone can go and watch and barrack and feel a part of the footy culture. When there is talk of building a new football stadium, no-one ever says (at least not publicly) that the resources would be better used to reduce hospital waiting lists or on improving health in other ways. Our challenge may be to find some way in which all the community can enjoy, to some level, the perceived benefits of technological advance, whether these be new forms of pleasure or different modes of reproduction, even if the benefits are not the prevention or treatment of disease. Even if we do not use community resources from the health budget to fund access to these new technologies (because they represent "personal preferences" and not "medical needs"), perhaps we can access other budgets -- sport and leisure for example -- to fund more equitable access. At any rate, what all of us have a legitimate claim to is a tolerably good life in a broad sense, and not the longest life, or even the healthiest possible life.

1. Nozick R. Anarchy, state and utopia. New York: Basic Books, 1974; 43-44.
2. Kurzweil R. The age of spiritual machines. Sydney: Allen and Unwin, 1999; 146-149.
3. Broderick D. The spike. Melbourne: Reed Books, 1997.
4. Hurst T, Shafir E, Lancaster P. Assisted conception Australia and New Zealand 1997. Sydney: Australian Institute of Health and Welfare National Perinatal Statistics Unit, 1999; 1.
5. Newson A, Williamson R. Should we undertake genetic research into intelligence? Bioethics 1999; 13: 327-342.
6. Savulescu J. Sex selection: the case for.Med J Aust 1999; 171: 373-375.
7. Harris J. Rights and reproductive choice. In: Harris J, Holm S, editors. The future of reproduction. Oxford: Clarendon Press, 1998.
8. Robertson JA. Children of choice: freedom and the new reproductive technologies. Princeton: Princeton University Press, 1994.
9. Brennan Z. Woman to freeze embryo for the sake of her career. The Sunday Times (London) 1998; 16 August.
10. Porcu E, Fabbri R, Seracchioli R, et al. Birth of a healthy female after intracytoplasmic sperm injection of cryopreserved human oocytes. Fertil Steril 1997; 68: 724-726.
11. Gook DA, Edgar DH. Cryopreservation of the human female gamete -- current and future issues. Hum Reprod. In press, 1999.
12. Kolata G. Researchers report breakthrough using frozen eggs to create pregnancy. New York Times 1997; 17 October: 1.
13. Tucker MJ, Wright G, Morton PC, Massey JB. Birth after cryopreservation of immature oocytes with subsequent in vitro maturation. Fertil Steril 1998; 70: 578-579.
14. Wilmut I, Schnieke AE, McWhir J, et al. Viable offspring derived from fetal and adult mammalian cells. Nature 1997; 385: 810-813.
15. National Bioethics Advisory Commission. Cloning human beings. Maryland: National Bioethics Advisory Commission, 1997.
16. UNESCO. Declaration on the Human Genome and human rights, adopted on 11 November 1997 (13), Article 11. UNESCO, 1997.
17. Lamb D. Down the slippery slope: arguing in applied ethics. New York: Croom Helm, 1988.
18. Burgess JA. The great slippery slope argument. J Med Ethics 1993; 19: 169-174.
19. Harris J. Goodbye Dolly? The ethics of human cloning. J Med Ethics 1997; 23: 353-360.
20. Tooley M. The moral status of the cloning of humans. In: Humber JM, Almeder RF, editors. Human cloning. New Jersey: Humana Press, 1998; 65-101.
21. Harris J, Holm S, editors. The future of reproduction. Oxford: Clarendon Press, 1998.
22. Rachels J. When philosophers shoot from the hip. Bioethics 1991; 5: 66-71.
23. Hastings Center Report 1994; May/June: 2.
24. Lamperd R. Race for life. Sun Herald (Melbourne) 1998; 2 July: 1.
25. Holtug N. Does justice require genetic enhancements? J Med Ethics 199; 25: 137-143.

Reprints will not be available from the authors.
Correspondence: Associate Professor J Savulescu, Murdoch Institute, Royal Children's Hospital and Centre for the Study of Health and Society, University of Melbourne, Parkville, VIC 3052.
savulesjATcryptic.rch.unimelb.edu.au

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