Abstract
It is common practice to regard participants in assisted and collaborative reproduction (gamete donors, embryologists, fertility doctors, etc.) as simply providing a desired biological product or medical service. These agents are not procreators in the ordinary sense, nor do they stand in any kind of meaningful parental relation to the resulting offspring. This paper challenges the common view by defending a principle of procreative responsibility and then demonstrating that this standard applies as much to those who provide reproductive assistance in the form of medical services or gametes, as it does to coital reproducers or intending parents. Drawing on vocabulary from the common law tradition, I suggest that it may be helpful to refer to the various participants in assisted and collaborative reproduction (ACR) as accessories to procreation. Referring to the participants in ACR as accessories to procreation highlights the fact that these agents are not just providing medical services or products. They are participating in a supply chain designed to bring about new persons. I conclude by arguing that regulative standards in the fertility industry should be structured such that they permit, facilitate, and encourage agents to satisfy the requirements of procreative responsibility.
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Notes
The term assisted reproduction refers to the use of medical intervention to achieve pregnancy, whereas collaborative reproduction refers to assisted reproduction that involves third party participation, that is, agents who are neither medical professionals providing services, nor agents intending to become parents. Examples of third party participants include gamete donors and surrogates. The distinction between assisted and collaborative reproduction is not significant for the purposes of this paper, and thus I opt to use the abbreviation ACR to refer to both.
While I realize that “gamete donor” is something of a misleading euphemism given that most donors receive financial compensation, I will nonetheless follow common practice and employ this phrase.
I offer more precise definitions for the terms ‘accessory to procreation’ and ‘principal procreator’ in section 3.
Following others, I understand a life to be “worth living” provided that it does not contain so much suffering and frustration that nonexistence would be rationally preferable to such a life. See Feinberg 1992.
I thank Sandra Shapshay for bringing this ambiguity to my attention.
Those who are capable of procreating but who lack the cognitive capacities requisite for full moral agency are an exception.
A concern for the transmission of recessive genetic disease is also frequently cited as the justification for prohibiting sibling and first cousin marriages.
This third case is significantly different from the ones considered above. Measures taken to ensure healthy fetal development during pregnancy benefit a particular subject. The subject (fetus/child) is made better or worse off depending on the gestating woman’s actions. However, in endeavoring to avoid creating children with a particular genetic disease we are not seeking to benefit any particular subject. This is the non-identity problem, so named by Derek Parfit (1984). According to the non-identity problem, if it is wrong to reproduce a child with Huntington’s disease, it cannot be wrong in virtue of the child’s interests, for the disease can only be avoided by preventing the birth of the child, and this is certainly worse for the child, assuming life with Huntington’s disease is still a life worth living. I address this problem below.
This is not intended to be a complete account. The interests of future persons may be morally salient for other reasons, as when we talk about obligations to future generations.
It should be noted that future person is not identical with existing fetus. Thus, the moral standing of the future person should not be confused with whatever moral standing the fetus may or may not have. According to the view I defend here, if an agent has a decisive intention to terminate her pregnancy, then we have no reason to anticipate a future person and thus no reason to be concerned with a future person’s interests and no duty of gestational care, though, of course, a fetus still exists. I do not intend to address whether or not a fetus has any moral standing and what this entails. For a similar account which does address the moral status of the fetus see Harman 1999.
I am grateful to an anonymous referee for pointing out the need for this distinction.
http://www.cdc.gov/pednss/what_is/pnss_health_indicators.htm#Smoking/Drinking Indicators; accessed on May 27, 2011.
A modest number would be two embryos in most cases, possibly more if the patient is older than 35.
One might object to this analysis by arguing that a unique embryo corresponds to a particular future person in the same way a fetus does; thus, in the case of IVF, we can consider the interests of particular future persons prior to pregnancy. I think this analysis assumes more similarity between fetuses and embryos than is warranted. A developing fetus corresponds to a particular future person whose interests are morally salient when there is no reason to believe the fetus will not eventually become a person. A fetus that meets this description is on course to become a person. An in vitro embryo is not on a similar trajectory to become a person. It has the potential to become a person, but it is more like a gamete than a fetus in this respect.
Whether this moral work is viewed as a blessing or a burden depends on the subjective perspective of the individual; in either case, it is still work.
I understand the burden to be undue in virtue of the fact that it is substantial, foreseeable, and avoidable.
Teenage pregnancy is often employed as an example of the non-identity problem. However, with this example there is a danger of conflating (a) being born to a teenage mother and (b) being raised by a teenage mother and/or father. Mothers younger than 15 years old are at a much higher risk of delivering a very low birth weight baby. This risk can be avoided only by avoiding or terminating pregnancy. Thus, very-young teenage pregnancies may be non-identity cases. However, insofar as the harms associated with being raised by teenage parents can be avoided by being raised by a different set of parents, cases of older-teenage pregnancy will not be non-identity cases.
The harm to the interests of the teenage parent is, I believe, another reason to object to teenage pregnancy, however, this reason is less relevant to the matter at hand.
It is worth noting that while non-identity cases are the most challenging, they are also the least common.
http://www.mayoclinic.com/health/huntingtons-disease/DS00401; accessed on January 12, 2011.
The relevant harms and benefits are just those typically associated with human existence (pleasures, pains, joys, disappointments, satisfactions, frustrations, etc.).
If we understand parental responsibility as responsibility for the welfare of a particular child or children, then Steinbock and McClamrock’s principle is poorly named. For the principle is applicable prior to conception, and thus prior to becoming a parent and inheriting responsibility for a particular child. Given that this principle concerns when one ought to refrain from procreating, I think it is appropriate to classify it as a principle of procreative responsibility, despite the label the authors attach to it.
I suspect that Purdy, as well as Steinbock and McClamrock, employ the language of parenthood in order to appeal to parental responsibility as the ground for the moral obligation to refrain from procreating in some cases. If the account I have given above is convincing, then I have shown that we need not appeal to parental roles or responsibility in order to ground procreative responsibility.
Steinbock and McClamrock’s examples include a teenager who wants to have a baby, Parfit’s example of a woman who conceives prior to receiving medical treatment for a temporary illness, persons with Huntington’s disease who reproduce despite the risk of passing on the disease, and HIV infected women who reproduce. Given no indication to think otherwise, I am assuming that these are all cases of unassisted coital reproduction. At the end of their article, however, Steinbock and McClamrock introduce the example of a 59 year-old British woman who gave birth to twins in 1993 after having receiving IVF treatment in Rome. The embryos implanted in the British woman were created using her husband’s sperm and eggs donated by a younger woman. The authors defend the mother’s choice to pursue procreation at age 59, maintaining it is consistent with the principle they propose.
For instance, a fertile agent who engages in sexual intercourse and becomes pregnant may not have had any intention to reproduce or to rear the child if the pregnancy is carried to term. Thus it cannot be the intention that defines a prospective parent. (This is consistent with the authors’ claim that “The principle of parental responsibility is aimed only at those individuals who are capable of controlling their fertility, and of making the conscious decision whether to have children” (Steinbock and McClamrock 1994).) One might be inclined to identify the causal role in creating a child as the feature which is common to both cases. This, however, would not exclude fertility doctors who perform IVF from the category of prospective parent.
The phrase is a common one. Steinbock and McClamrock contend that “the principle of parental responsibility says only that it is wrong to bring children into the world when there is a good reason to think that their lives will be terrible” (1994). “Having a child,” a phrase which features prominently in Rivera-López’s No-Harm Thesis, is another ambiguous act description.
It may also apply to those who assist in birthing – midwives, obstetric physicians and nurses, etc.
Emphasis mine.
Callahan 1992 is a notable exception to this rule.
As I understand it, an agent has a procreative end when she deliberately seeks to create a child who will be his or hers in either the genetic/biological sense or in the sense of being legally his or hers to rear. Obviously, these two senses of his/hers are not mutually exclusive.
Let us stipulate, for the sake of argument, that the probability is the same in both cases.
There are most likely others who indirectly assist Mary as well – gamete brokers, drug manufacturers, etc. For the sake of simplicity I will focus on these four parties.
I understand heterosexual intercourse to be a causal chain designed to culminate in the birth of a child when no reasonable measures are taken to prevent pregnancy. ACR, on the other hand, represent supply chains designed to culminate in the birth of a child. I understand action X to be part of a supply chain designed to culminate in the birth of a child insofar as X is an essential step in a multi-step process devised by agents with the explicit intention of bringing about the birth of a child and which yields this outcome regularly. Donating one’s eggs to a fertility clinic would count as participating in a supply chain designed to culminate in the birth of a child. Taking a patient’s blood-pressure would not.
Parallel with the legal case where there must be at least one principal for a crime to have taken place, there must be at least one principal procreator in every case of procreation, though there may be more than one.
According to the CDC’s 2008 ART Success Rates Report, 436 US fertility clinics sent data to the CDC in compliance with the Fertility Clinic Success Rate and Certification Act of 1992.
Given the sensitive nature of such screening, as well as the potential for biases regarding race, class, and sexual orientation, this responsibility should fall to someone appropriately trained for this kind of work, rather than a fertility specialist. What I am recommending is that fertility clinics include such persons on their staff. I thank Sandra Shapshay for bringing these concerns to my attention.
These restrictions may strike some as unfair given that no attempt is currently made to enforce the standard of procreative responsibility on coital reproduction. While the restrictions I propose may make it more difficult for some couples to become parents via ACR, I do not believe the charge of unfairness is warranted. Regulating coital reproduction would require far more extreme and controversial measures (e.g. forced contraception) and could not be justified by a concern to facilitate responsible third party participation. The primary intent of the regulations I propose is to enable professionals and non-professionals to provide reproductive assistance with confidence that they are acting in a responsible manner. This concern for accessories to procreation is absent in coital reproduction.
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Acknowledgements
The author wishes to thank Sandra Shapshay, Richard B. Miller, Mark Wilson, Robert Crouch, Rory Weeks, and two anonymous referees for their helpful comments, as well as the Office of the Vice President for Research at the University of Georgia for a faculty research grant that supported the writing of this paper.
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Fahmy, M.S. On Procreative Responsibility in Assisted and Collaborative Reproduction. Ethic Theory Moral Prac 16, 55–70 (2013). https://doi.org/10.1007/s10677-011-9330-7
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DOI: https://doi.org/10.1007/s10677-011-9330-7