[4.3.] Responses of the Three Normative Theories.

 

 

[4.3.1.] Utilitarianism.

 

Utilitarianism focuses on what sorts of benefit or harm come to the child who is conceived by way of the new technology, as well as to others who might be affected. So it will always ask: what are the consequences of conceiving a child by way of a given method?

 

·         With regard to AID (artificial insemination by donor), Pence refers to bioethicists (James & Callahan) who maintain that “it is harmful to intentionally create a child who will lack a connection to his male ancestor.” (111, emphasis added) These ethicists are concerned with psychological harm that will come to the child as a result of being born into a home where his or her biological father is absent. The same might be said about children both to parents in their 50s or beyond, since it is more likely that those parents will die when their children are relatively young.

 

·         Pence points out that IVF babies are twice as likely to have birth defects, although such defects are still rare. The probability of birth defects also rises in the case of multiple conceptions, including those that are brought about on purpose with fertility drugs or by IVF.

• This includes the octuplets born this Monday, January 26, outside Los Angeles. As is common with multiple-births, the octuplets all weigh much less than normal (the heaviest weighs only four pounds). Although doctors have released no information about how the children were conceived, the odds against eight simultaneous conceptions occurring naturally are extraordinarily high. There are, in fact, no documented cases of octuplets being naturally conceived.[1] Almost certainly the mother took a drug to cause super-ovulation

 

Such utilitarian objections raise the question: can you harm someone by conceiving him or her? That is, can an action that brings someone into existence count as harming that person, given that he or she would not have existed otherwise? [We will return to this issue shortly.]

 

 

[4.3.2.] Kant’s Deontology.

 

Kant focuses on universalizable actions (the first version of the Categorical Imperative) and on treating people as ends rather than means only and respecting their autonomy (the second version of the CI).

 

·         With regard to any of these techniques, Kant might say that prohibiting women from using these new technologies counts as an attack on autonomy and on “the idea that a woman is self-governing.” (118)

 

·         But on the other hand, with regard to the research that led to successful IVF, Pence notes: “Before the first successful IVF birth, at least a hundred embryos created by IVF either failed to implant or miscarried as fetuses.” (111) This does not seem like a utilitarian objection, since it does not make a claim about the happiness of the embryos that are destroyed, or about their well-being. At the time these embryos “die,” they are not conscious or capable of consciousness. They simply fail to implant in the uterine lining or are otherwise miscarried relatively early in pregnancy. The best way to understand this criticism may be as a Kantian objection, one that views the embryos as persons and says that such techniques disrespect them.

 

·         Pence’s example of an immoral motive: a woman conceives a child simply in order to get someone to marry her. The woman who becomes pregnant for this reason is treating both her child and the man she wishes to marry as means to her ends.

 

 

[4.3.3.] Virtue Ethics.

 

Virtue ethics focuses on the personality traits of the parents as those traits are exemplified in their motives. Even if no harm comes to the child, the child might still be wronged by having been created for immoral reasons. This approach, as well as Kant’s, assumes that a person can be wronged, even if he or she is not harmed.

 

·         If someone decides to create a child through reproductive cloning because he is conceited or narcissistic and believes his genotype ought to be replicated because he himself is a superior human being, then his actions flow from vices rather than virtues, and to that degree he is a bad person.

 

 

[4.4.] Three Types of Harm.

 

The utilitarian response to new reproductive technologies raises the question: can someone be harmed simply by having been created?

 

·         On the one hand, some lives seem worse than never being born at all. “[I]t seems wrong to say that any kind of life is better than no life.” (114) There may be lives which are so terrible that bringing someone into existence who can only have that sort of life counts as harming her, e.g., knowingly carrying to term a child with Tay-Sachs disease, a fatal genetic disorder that has devastating effects on a child’s nervous system and invariably results in death by the age of four.[2]

 

·         On the other hand, the fact that a new reproductive technology bears this kind of risk does not imply that we should never use it:  “Even if a few [children created by IVF and IAD] had birth defects, the normal existence of another hundred thousand wanted children compensates for this harm.” (114)

 

As a case around which to center the discussion of harm, Pence suggests that of parents who want to have a deaf child. They use IVF and Pre-Implantation Genetic Diagnosis (PGD) (conducting genetic tests on pre-implantation embryos created in the laboratory, to help determine what characteristics, and especially what diseases, if any, the eventual child will have) to identify which of the embryos has congenital deafness, and choose to implant that embryo specifically because it has that characteristic.[3]

 

In order to clarify the issue of whether you can harm someone by creating him or her, Pence distinguishes three types of harm (115). Note that these are not mutually exclusive—it is possible for one person to be harmed in more than one of these ways.

 

1. baseline harm: “requires an adverse change in someone’s condition.” A being who is the subject of baseline harm must exist before the harm occurs. So in this sense of the word “harm,” “someone who doesn’t yet exist cannot be harmed, because he has no baseline from which change can occur.”

·         You cause this sort of harm when, for example, you assault an adult, or a child who already exists. The person exists before the harmful action, and because of the action that person is worse off than she would have been otherwise.

·         No form of conception, be it natural or by way of some new technology, can ever count as this sort of harm. Since conception is, by definition, the bringing into existence of a new being, there can never be a baseline against which to judge conception as harmful, so no conception counts as baseline harm.

·         Since no type of conception can result in baseline harm, creating embryos through IVF and then using PGD to select one that will be deaf is not a form of baseline harm. The deaf-child has not been baseline-harmed.

 

2. abnormal harm: Like baseline harm, this sort of harm changes a situation from what normally would have been into something worse. But unlike baseline harm, it does not require that the being that is harmed exist before the harm is caused. In this sense, someone can be harmed “by being brought into existence with some defect that could have been avoided by taking reasonable precautions. Here, the event or omission that causes the defect is the cause of harm.”

·         For example, a mother who drinks and smokes excessively while she is attempting to get pregnant may conceive a child who has birth defects.

·         If a medical professional involved in the gestation and delivery of the child makes a mistake resulting in an injury to the fetus/child, then he has caused this sort of harm. The legal term for this sort of harm is “wrongful birth.”

·         Pence believes that the choice of a deaf embryo over a hearing embryo constitutes abnormal harm:

 

Preventing abnormal harm underlies the belief that parents should do everything possible to have healthy, unimpaired babies; that anything less than the maximal effort is blameworthy; and that it is wrong for a woman to take risks with a future person’s intelligence or health. In this sense, deaf parents harm their children when they only implant embryos genetically disposed to be deaf. (115)

 

But this seems wrong. Selecting an IVF-embryo based on PGD for deafness does not result in that particular fetus being different. No matter what the parents or doctors do, that embryo still has the gene(s) that cause(s) deafness. So creating that embryo, implanting it, and carrying it to term does not count as abnormal harm.

 

3. total harm: This occurs when someone is caused to have “a life of total pain and injury, such that no hope exists of relief,” e.g., being conceived in such a way as to be totally blind, deaf, and paralyzed.

·         The legal term for this sort of harm is “wrongful life.” “Courts have almost always rejected wrongful life suits because courts have rejected the implication that killing a baby can benefit it.” (116)

·         Pretty clearly, being born deaf but otherwise healthy is not a form of total harm.

 

 

**Some instances of total harm are also instances of abnormal harm, but others are not. Here is an example of total harm that is not abnormal harm:

·         Suppose that any child created through SCNT (cloning) has a very high risk of birth defects. [We don’t yet know whether this is true, since attempts to clone non-human primates has to gone very far yet.]

·         Now, a child created through cloning can only exist as a clone. There is no way that such a child who is conceived through cloning could be conceived through other methods.[4]

·         If in a given instance the cloning process results in a child whose life is terrible (due to genetic, physical or psychological disabilities), then she is the victim of total harm.

·         But she is not the victim of abnormal harm, since her situation was not changed from what it normally would have been into something worse. For any given clone, there is no such thing as “what the situation would normally have been”—there is just the one and only sort of situation in which she does in fact exist: the one in which she is a clone.

 

 

[4.5.] Harming vs. Wronging.

 

If the foregoing is correct, then choosing to implant a deaf embryo rather than a hearing embryo does not count as harm. It is neither baseline harm, nor abnormal harm, nor total harm.

 

But that does not settle the question whether it is morally permissible to choose a deaf embryo over a hearing one. Choosing the deaf embryo might still be wrong (immoral), only for some other reason. For example:

·         Assume (and this is a very contentious assumption—it may well be false) that, in general, people with hearing have happier lives than people who are deaf

·         If this is the case, then, in choosing the deaf embryo, the parents may be acting so as to bring about less happiness in the world than they could otherwise bring about.

·         In other words, in the scenario in which they choose the deaf embryo, there is in the long-run less happiness in the world than there would have been had they chosen the hearing embryo.

·         So a utilitarian would say that the parents have done something wrong in choosing the deaf embryo, even though they have not harmed the deaf child or otherwise done anything wrong to the deaf child that they created.

 

This choice is analogous to one described by philosopher Derek Parfit[5] in his book Reasons and Persons (1984):

·         Suppose that there is a 14-year-old girl who wants to be a mother.

·         If she has a child now, at age 14, she will not be able to give that child a very good start in life.

·         On the other hand, if she waits several years, she will be able to give her child a much better start.

·         Parfit’s view is that it would be morally worse for her to conceive now, even though it would not be worse for the child that she would bear in that case. The child she would bear as a 14-year-old would not be harmed or wronged; he or she would have no legitimate complaint against the mother.[6]

 

 

Stopping point for Friday January 30. We have fallen a bit behind, and so next time we will discuss some of what you read for today. Still, for next time, finish reading Pence ch.5 (126-36).