Would you have allowed Bill Gates to be born?

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Gates was born on Oct. 28, 1955. When he arrived in the world the science of human genetics was truly in its infancy. Newborn babies were only tested for a few rare genetic conditions. Fifty years later, the field of human genetics is thriving. Tests have been established for detecting Tay-Sachs disease, Huntington’s disease, some forms of breast cancer and Alzheimer’s disease, and hundreds of other fatal or disabling conditions.

The drive for more genetic tests continues unabated. Undoubtedly the genes for autism and Asperger’s will soon be found. When they are, my question — would you have stopped Bill Gates from existing? — will take on a very real meaning.

Fewer geniuses?
There are many in the autism and Asperger’s community, like the newly formed Aspies for Freedom, who worry that the minute a genetic test appears, it will spell the end for a lot of future geniuses, like Gates. Maybe there will be fewer Thomas Jeffersons or Lewis Carrolls — remarkable thinkers who also fit the profile for Asperger’s.

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As genetic testing moves into the world of mental health, we are going to face some very tough questions. Will medicine suggest that any and every variation from absolute normalcy is pathological? How can we draw lines between disabling diseases such as severe autism and more mild differences such as Asperger’s, which may give society some of its greatest achievers? Will parents have complete say over the kind of children they want to bear? And what sorts of messages will doctors and genetic counselors convey when talking about risks, probabilities and choices that involve not life and death but personality and sociability, genius and geekiness?

All I can tell you is that neither medicine nor the general public are at all ready to deal with the emerging genetic knowledge about autism, Asperger’s or other aspects of mental health. But the future of our society may well hinge on how we answer these questions.

Arthur Caplan is director of the Center for Bioethics at the University of Pennsylvania.

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